ArticlePDF AvailableLiterature Review

Parental Social Support and the Physical Activity-Related Behaviors of Youth: A Review

October 2010
Health Education & Behavior 37(5):621-44

DOI:10.1177/1090198110363884

Source
PubMed

Authors:

Michael W Beets

University of South Carolina

Brandon L. Alderman

Rutgers, The State University of New Jersey

Social support from parents serves as one of the primary influences of youth physical activity-related behaviors. A systematic review was conducted on the relationship of parental social support to the physical activity-related behaviors of youth. Four categories of social support were identified, falling under two distinct mechanisms-tangible and intangible. Tangible social support is divided into two categories: instrumental-purchasing equipment/payment of fees and transportation-and conditional-doing activity with and watching/supervision. Intangible social support is divided into the two categories of motivational- encouragement and praise-and informational-discussing benefits of. The majority of studies demonstrated positive associations among selected measures of parental tangible and intangible social support and youth activity. Overall, parental social support demonstrated positive effects. Many studies, however, combine social support categories and/or respondents into composite measures, making it difficult to disentangle the specific effects of parents and the type of support provided.

(continued)

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Studies Reporting Parental Social Support Relationships Related to Measured Physical Activity Levels of Youth

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Social Support Definition Based on Review of Literature

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The online version of this article can be found at:

DOI: 10.1177/1090198110363884

2010 37: 621 originally published online 20 August 2010Health Educ Behav

Michael W. Beets, Bradley J. Cardinal and Brandon L. Alderman

Review

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Michael W. Beets, University of South Carolina, Columbia. Bradley J. Cardinal, Oregon State University,

Corvallis. Brandon L. Alderman, Rutgers University, New Brunswick.

Address correspondence to Michael W. Beets, University of South Carolina, Department of Exercise

Science, Public Health Research Center, 131, 921 Assembly Street, Columbia, SC 29208; phone: (803) 777-

3003; e-mail: beets@mailbox.sc.edu.

Health Education & Behavior, Vol. 37(5): 621-644 (October 2010)

DOI: 10.1177/1090198110363884

Parental Social Support and the Physical

Activity–Related Behaviors of Youth: A Review

Michael W. Beets, MPH, PhD

Bradley J. Cardinal, PhD

Brandon L. Alderman, PhD

Social support from parents serves as one of the primary influences of youth physical activity–related

behaviors. A systematic review was conducted on the relationship of parental social support to the physical

activity–related behaviors of youth. Four categories of social support were identified, falling under two dis-

tinct mechanisms—tangible and intangible. Tangible social support is divided into two categories:

instrumental—purchasing equipment/payment of fees and transportation—and conditional—doing activity

with and watching/supervision. Intangible social support is divided into the two categories of motivational—

encouragement and praise—and informational—discussing benefits of. The majority of studies demonstrated

positive associations among selected measures of parental tangible and intangible social support and youth

activity. Overall, parental social support demonstrated positive effects. Many studies, however, combine

social support categories and/or respondents into composite measures, making it difficult to disentangle the

specific effects of parents and the type of support provided.

Keywords: family; adolescents; childhood; health behavior; social support

Nationally, the percentage of children and adolescents who meet the recommenda-

tion (U.S. Department of Health and Human Services [USDHHS], 2008) of 60 minutes

of daily physical activity is unacceptably low. Recent estimates indicate approximately

42% of from 6- to 11-year-olds and only 8% of from 12- to 17-year-olds meet daily

recommendations (Troiano et al., 2008). Parents (e.g., parents or other adult caretakers

in the home) are considered to be one of the primary influences on the activity-related

behavioral patterns (e.g., sports, outdoor play, exercise) of youth (i.e., children and

adolescents; Brustad, 1993; Kohl & Hobbs, 1998; Lindsay, Sussner, Kim, & Gortmaker,

2006; Sallis, Prochaska, & Taylor, 2000). They serve as models, reinforcers, and advo-

cates of both health enhancing and health compromising behaviors and, as such, they

have the potential for altering the ever increasing sedentary nature of the lifestyles

exhibited by today’s youth (USDHHS, 2001). Such emphasis is predicated on the fact

that the majority of youth spend roughly 18 years of their life in close proximity to their

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622 Health Education & Behavior (October 2010)

parents (Goldscheider, Thornton, & Young-DeMarco, 1993). During the course of this

time, parents exert considerable influence over the health-related behaviors of their

children (Perry, Crockett, & Pirie, 1987; Schor & American Academy of Pediatrics

Task Force on the Family, 2003) and are one of the immediate and primary sources of

health information and education (Hopper, Gruber, Munoz, & Herb, 1992). These inter-

actions have also demonstrated lasting effects on subsequent adult activity-related

behavioral patterns (A. M. Thompson, Humbert, & Mirwald, 2003). In addition, parents

serve a “gate keeper” role to physical activity (Welk, Wood, & Morss, 2003), control-

ling access to community activity and sport programs (Atsalakis & Sleap, 1996;

Boufous, Finch, & Bauman, 2004) and access to outdoor environments (Klesges, Eck,

Hanson, Haddock, & Klesges, 1990) where activity can take place. Therefore, espe-

cially during childhood (from 5 to12 years old) when behaviors are under less volitional

control, parents are one of the primary providers of inhibitory and promotive opportuni-

ties whereby children can be active.

Parents influence their children’s activity behaviors through a variety of means

(Taylor, Baranowski, & Sallis, 1994). This includes parents’ own activity levels, either

through modeling or familial aggregation of activity patterns (Moore et al., 1991;

Raudsepp & Viira, 2000; Sallis, Patterson, Buono, Atkins, & Nader, 1988); parental

attitudes, beliefs, and values toward activity (Dempsey, Kimiecik, & Horn, 1993; Eccles

& Harold, 1991; Kimiecik, Horn, & Shurin, 1996); genetic lineage (Pérusse, Tremblay,

Leblanc, & Bouchard, 1989); and social support for activity (Sallis, Alcaraz, McKenzie,

& Hovell, 1999a; Sallis et al., 1992; Trost et al., 2003a). Of these, the presence of social

support, which consists of indirect verbal and nonverbal support and direct tangible

assistance positively impacts children’s and adolescents’ activity levels (Sallis et al.,

2000). However, although evidence corroborating the role of parental social support and

activity has accumulated, inconsistencies among findings exist as to what types (i.e.,

tangible, intangible), providers (i.e., mother or father), and characteristics of the recipi-

ents (e.g., gender, age, weight status) are related to increased activity levels. Complicating

matters further is the lack of distinction among similar, yet conceptually unique, con-

structs of social interactions (e.g., social norms, modeling). If practitioners are to suc-

cessfully plan, implement, and evaluate family-based social support interventions,

questions pertaining to who should be involved, what those involved should provide,

when it should be provided, and to whom it should be provided need clear delineation.

The purpose of this article is to address these questions by conducting a systematic

review of literature on the provision of social support by parents and its relation to youth

(<18 years old) physical activity levels in an attempt to address these identified needs.

METHOD OF LITERATURE REVIEW

An extensive review of published literature in the English language from 1970 to

August 2008 was conducted using the following key terms in various combinations:

“physical activity,” “sports,” “children,” “adolescent,” “youth,” “parent,” and “social

support.” Additional key terms were used for the dimensional aspects of support:

“transportation,” “encouragement,” “prompts,” “financial,” and “praise.” The follow-

ing databases were used: EBSCOhost, Academic Search Premier, Alt HealthWatch,

CINAHL, MEDLINE, Health Source: Nursing/Academic Edition, Health Source:

Consumer Edition, Middle Search Plus, Psychology and Behavioral Sciences Collection,

Primary Search, PsycINFO, PubMed, and SPORTDiscus. Furthermore, given the lack

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Beets et al. / Parental Social Support and Physical Activity 623

of consistency in terminology (addressed later in this article), additional terms—“social

norms,” “social influence,” and “social provisions”—were included. Additional studies

were identified through book chapters, review articles, and reference lists of previously

published work. In the context of the current review, physical activity is used to define

any bodily movement that results in energy expenditure. This definition allows for the

inclusion of both organized (e.g., sports) and nonorganized (e.g., free play) physical

activities. Information from each article was extracted using standardized forms devel-

oped specifically for this study. Information regarding sample characteristics (age of

youth, parent reference—mother, father, female adult, male adult), physical activity

measures, social support definitions and dimensions (see below), direction of the effect

(positive, negative or no association), and whether the article was quantitative or

qualitative was compiled by the authors. Because family and parent terms were used to

refer to similar referents—male/female adult, dad/mom—articles that used one or the

other were included in the review. Based on the heterogeneity of the research included

in the review, a quantitative analysis (i.e., meta-analysis) was deemed inappropriate.

Rather, a narrative approach was employed, allowing for the inclusion of both quantita-

tive as well as qualitative research.

Inclusion–Exclusion Criteria

This review article focuses on the influence of parent-provided social support for

physical activity of typically developing children and adolescents (<18 years old) in the

community, home, and school settings. Articles were excluded that focused on youth

with various complications associated with physical and mental disabilities or with

special health care needs and those with unhealthy weight gains located within a clini-

cal or residential treatment facility. Readers interested in family involvement in such

populations are referred to an overview article by McLean, Griffin, Toney, and

Hardeman (2003). Studies must have also measured one of the characteristics of social

support (defined below) by either parent assessment or as perceived by the child/ado-

lescent (i.e., self-report) along with physical activity and/or sport involvement of the

child/adolescent. Qualitative studies regarding physical activity behaviors and parental

influences were also included.

Literature examining familial aggregation (Aarino, Winter, Kujala, & Kaprio, 1997;

Freedson & Evenson, 1991; Gilmer, Harrell, Miles, & Hepworth, 2003; Moore et al.,

1991; Pérusse, LeBlanc, & Bouchard, 1988; Sallis et al., 1988) of activity patterns

focusing on modeling as a form of influence by specifying the level of activity of par-

ents and their children, without reference to the proportion of the reported activity

performed together (e.g., mother–child, father–child), were excluded. Although illus-

trative of the similarity of activity levels that exist within a family, such studies do not

meet the requirement for describing social supportive behaviors as specified for this

review. Additionally, intervention studies attempting to increase social support were not

included, given the experimental manipulation of social support in relation to physical

activity. Readers interested in findings from intervention studies are directed to the

article by O’Connor, Jago, and Baranowski (2009).

Terminology—Social Support

Operationalizations of social support are ubiquitous, and depending on the nature of

the behavior in question, the variables being measured, and the guiding hypotheses

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624 Health Education & Behavior (October 2010)

proposed, vary considerably across studies. Social support is conceptually different

from social norms, modeling, social influence, and social networks (Barrera, 1986;

Courneya, Plotnikoff, Hotz, & Birkett, 2004; Heaney & Israel, 2002; Israel & Rounds,

1987), yet it has been used interchangeably with these constructs both within and across

studies (e.g., Davison & Schmalz, 2006) and reviews (Pugliese & Tinsley, 2007). This

lack of conceptual precision adds to the vagueness of the social support mechanisms

being examined and, subsequently, the interpretation of results in this area of research

and the possibility of invalid operationalizations (Thoits, 1982). This has been

addressed in previous reviews (Barrera, 1986; McNeill, Kreuter, & Subramanian, 2006;

O’Reilly, 1988; Thoits, 1982; Wallston, Alagna, DeVellis, & DeVellis, 1983) and is

viewed as a persistent limiting factor when attempting to synthesize the body of litera-

ture on this topic.

Therefore, the following multidimensional definition is proposed and was used as a

guiding framework for this review. Social support represents the functional character-

istics associated with the interactions between a parent and his or her children in the

context of intentionally participating in, prompting, discussing, and/or providing

activity-related opportunities. Social support is, therefore, a multidimensional umbrella

term used to describe various ways in which significant referents, in this case parents,

knowingly influence the activity behaviors of their children and may include some, but

not necessarily all, functional dimensions of support. Furthermore, social supportive

behaviors may consist of both tangible behaviors, such as providing transportation to

places where the child can be active, and intangible behaviors, such as encouraging

one’s child to be physically active.

LITERATURE FINDINGS

A total of 1,322 references matched the keyword criteria. References were subjected

to further scrutiny for relevance. This resulted in a total of 80 articles meeting the

review criteria. Social support was examined as a composite measure or index score

(e.g., principal component factor analysis), as single item indicators, or was discussed

through focus groups in qualitative papers. Of these, 66 (82.5%) reported the relation-

ship between social support and measured physical activity (e.g., self-report, acceler-

ometer, pedometer). Within this group, 29 studies (44%) used a composite measure

(combining social support dimensions). The remaining 14 studies (17.5%) either

reported differences in social support among gender or ethnic groups or described

social support qualitatively. The results of the search are presented in Table 1 and a

listing of the corresponding studies in Table 2.

The four primary functional dimensions of support consistent within the literature

identified by the review include: instrumental—provision of tangible aid and services;

conditional—direct involvement of the parent in the activity or being physically pres-

ent, yet not directly participating when the activity occurs; motivational—provision of

verbal and nonverbal prompts to engage in the behavior of interest and validation and

affirmation of involvement in or performance of physical activity; and informational—

provision of advice, suggestions, and information to address the behavior of interest.

Collectively, social support is described as exhibiting, at minimum, one of these dimen-

sions, which can be grouped into two broad categories: tangible and intangible sup-

portive behaviors (see Table 3).

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625

Table 1. Number of Null and Positive Findings for Studies (N = 66) Investigating the Relationship Between Parental Social Support Types and Measured

Physical Activity of Children and Adolescents

Boys Girls Boys and Girls Total

Dimension

Type

% +c

Studies

(n)d

Total

Studies (%)e

Instrumental Transportation 3 2 40 3 4 57 1 4 80 7 10 59 11 17

Payment of fees and/or

equipment 1 1 50 1 1 50 0 0 — 2 2 50 4 6

Conditional Performed activity with 1 6 86 3 6 67 3 5 63 7 17 71 18 27

Watching/Supervision 1 0 0 1 0 0 2 3 60 4 3 43 6 9

Motivational Encourage 2 8 80 4 12 75 5 9 64 11 29 73 31 47

Praise — — — — — — 1 3 75 1 3 75 4 6

Informational Discuss importance/health

benefits 0 0 — 0 0 — 1 0 0 1 0 0 1 2

Composite 5 5 50 6 13 68 4 8 67 15 26 63 29 44

a. 0 = null findings.

b. + = positive findings.

c. Percentage of studies reporting a positive association between social support and physical activity (i.e., social support related to increased or greater amounts

of physical activity).

d. Number of unique studies reporting a positive association between social support and physical activity (i.e., social support related to increased or greater amounts

of physical activity).

e. Percentage of studies reporting outcomes for each social support type and composite out of 66 (total number of studies linking parental social support to

physical activity). Note: the total percentage does not add up to 100% because of studies reporting, separately, on one or more social support types.

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626

Table 2. Studies Reporting Parental Social Support Relationships Related to Measured Physical Activity Levels of Youth

Boys Girls Boys and Girls

Dimension Type 0a+b0a+b0a+b

Instrumental Transportation Hovell et al.

(1996)

Morgan et al.

(2003)

Sallis et al.

(1992)

Hoefer et al.

(2001)

Sallis et al. (1999a)

Adkins et al.

(2004)

Brown (1985)

Hovell et al.

(1996)

Hoefer et al. (2001)

Morgan et al. (2003)

Sallis et al. (1999a)

Sallis et al. (1992)

Duncan et al.

(2005)

Beets et al. (2006)

Heitzler et al. (2006)

Morgan et al. (2003)

Prochaska et al.

(2002)

Payment of fees and/

or equipment

Stucky-Ropp

DiLorenzo

(1993)

Sallis et al. (1999a) Sallis et al.

(1999a)

Stucky-Ropp &

DiLorenzo (1993)

Conditional Performed activity

with

Morgan et al.

(2003)

Beets et al. (2007)

Hovell et al. (1996)

Ornelas et al. (2007)

Sallis et al. (1992)

Sallis et al. (1999a)

Wilson & Dollman

(2007)

Adkins et al.

(2004)

Morgan et al.

(2003)

Sallis et al. (1992)

Hovell et al. (1996)

Ornelas et al. (2007)

Sharma et al. (2008)

Springer et al. (2006)

Sallis et al. (1999a)

Wilson & Dollman

(2009)

Beets et al.

(2006)

Duncan et al.

(2005)

Klesges et al.,

(1990)

Beets & Foley (2008)

Prochaska et al.

(2002)

Heitzler et al. (2006)

Nelson et al. (2005)

Welk et al. (2003)

Watching/

Supervision

Beets et al.

(2007)

Beets et al. (2007) Beets et al.

(2006)

Brown (1985)

Duncan et al. (2005)

Heitzler et al. (2006)

Prochaska et al.

(2002)

Motivational Encourage Beets et al.

(2007)

Sallis et al.

(1992)

Anderssen & Wold

(1992)

Bauer et al. (2008)

Brustad (1996)

Elder et al. (1998)

McGuire et al.

(2002)

Adkins et al.

(2004)

Beets et al. (2007)

Sallis et al. (1992)

Sallis et al.

(1999a)

Anderssen & Wold

(1992)

Bauer et al. (2008)

Brown (1985)

Brustad (1996)

Butcher (1985)

Elder et al. (1998)

Beets et al.

(2006)

Duncan et al.

(2005)

Klesges et al.

(1990)

Allender et al. (2006)

Biddle & Goudas

(1996)

Brustad (1993)

Cardon et al. (2005)

De Bourdeaudhuij

et al. (2005)

(continued)

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627

Table 2. (continued)

Boys Girls Boys and Girls

Dimension Type 0a+b0a+b0a+b

O’Loughlin et al.

(1999)

Sallis et al. (1999a)

Wilson & Dollman

(2007)

King et al. (2008)

McGuire et al. (2002)

O’Loughlin et al. (1999)

Sharma et al. (2008)

Springer et al. (2006)

Wilson & Dollman (2009)

Prochaska

et al. (2002)

Timperio et al.

(2008)

Fredricks & Eccles

(2005)

Hohepa et al. (2007)

Klesges et al. (1986)

Sabiston & Crocker

(2008)

Praise Timperio et al.

(2008)

Arredondo et al.

(2006)

Beets et al. (2006)

Prochaska et al.

(2002)

Informational Discuss

importance/

health

benefits

Duncan et al.

(2005)

Composite Frenn et al.

(2005)

DiLorenzo

et al. (1998)

Higgins et al.

(2003)

Wu et al.

(2003)

Zakarian

et al. (1994)

Davison (2004)

Greendorfer &

Lewko (1978)

Lewko & Ewing

(1980)

Sallis et al. (1999b)

Sallis et al. (2002)

Adkins et al.

(2004)

Bungum &

Vincent

(1997)

DiLorenzo et al.

(1998)

Higgins et al.

(2003)

Wu et al. (2003)

Davison et al. (2003)

Davison (2004)

Dowda et al. (2007)

Frenn et al. (2005)

Greendorfer &Lewko (1978)

Ievers-Landis et al. (2003)

Kuo et al. (2007)

Lewko (1978)

Lewko & Ewing (1980)

Neumark-Sztainer et al. (2003)

Sallis et al., (1999b)

Sallis et al. (2002)

Saunders et al. (2004)

Zakarian et al. (1994)

Hamilton &

White (2008)

Timperio et al.

(2008)

Trost et al.

(2003b)

Wu et al.

(2002)

Davison & Schmalz

(2006)

Frenn et al. (2005)

Garcia et al. (1995)

Heitzler et al.

(2006)

Ommundsen et al.

(2006)

Strauss et al. (2001)

Trost et al. (2003a)

Welk et al. (2003)

a. 0 = null findings.

b. + = positive findings.

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628 Health Education & Behavior (October 2010)

Table 3. Social Support Definition Based on Review of Literature

Category

Dimension

Definition

Parental

Behaviors

Example Items

Tangible Instrumental Provision of

tangible aid and/

or services

Transportation “[Referent] provided

transportation for

physical activity”

Payment of

fees

“[Referent] provided

money for

participation”

Enrolment in

physical

activity/

sports

“How active are you in

enrolling your daughter/

son in sports?”

Purchase

equipment

“Buy sports clothing/

equipment for their

child”

Conditional Directly involved or

within proximity

of the activity

with the child

Perform

activity with

“Offered to do physical

activities with me”

“Actively participate in

physical activity with

the child”

“[Referent] did physical

activity with you”

“Family use of physical

activity as recreation”

Watching “How often do you go to

your daughter’s/son’s

sporting events with

her/him?”

Intangible Motivational Provision of verbal/

nonverbal

prompts to

engage in the

behavior of

interest,

validation and

affirmation of

involvement or

performance from

participating in

the behavior

Encouragement “Encourage their child to

go outside”

“How frequently their

[referent] encourages

them to be physically

active”

Praise “Praised their child for

participation in physical

activity”

Informational Provision of advice,

suggestions, and

information to

address the

behavior of

interest

Discuss

importance

of physical

active/

participation

in sports

Discuss how to

be active

“[Referent] told you

physical activity was

good for your health”

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Beets et al. / Parental Social Support and Physical Activity 629

Support Types—Tangible

Tangible support, considered one of the most effective means of support for physical

activity (Sallis et al., 1992; Trost et al., 2003a), comprises overt behaviors performed

by parents that directly facilitate the involvement in activity. This support includes

tangible aid given by parents such as providing transportation to places where the child

can engage in a variety of activity-related behaviors, such as sports, team practices, play

with friends, or play at local community parks/recreation facilities (Davison, Cutting,

& Birch, 2003). This type of support may also include direct involvement of the parents

in the activity with the child, such as playing together, using family time to be active

(V. J. Thompson et al., 2003; Welk et al., 2003), or parents serving as spectators or

supervisors as the activity occurs (Beets, Vogel, Chapman, Pitetti, & Cardinal, 2007;

Duncan, Duncan, & Strycker, 2005). Less commonly measured is the purchasing of

equipment and payment of fees that afford opportunities to be active or facilitate activ-

ity involvement (Davison et al., 2003; Sallis et al., 1999a). Each of these is discussed

in the following sections.

Instrumental—Transportation. One of the major barriers for children to participate

in activity-related behaviors is the ability to access places (e.g., parks/playgrounds,

sport practices/meets) where the child can be active (Davison & Lawson, 2006; O’Dea,

2003). Of the studies reviewed, 11 (17%) reported findings linking transportation social

support to youth activity levels. Cross-sectional analyses indicate parental provision of

transportation is a key component to youth accessing these places and is linked to

greater levels of activity (Beets, Vogel, Forlaw, Pitetti, & Cardinal, 2006; Heitzler,

Martin, Duke, & Huhman, 2006; Hoefer, McKenzie, Sallis, Marshall, & Conway, 2001;

Sallis et al., 1992; Sallis et al., 1999a). These associations are rather robust, with trans-

portation appearing as a predictor of activity levels from both self-report and objective

physical activity measures (Sallis et al., 1992). This relation has also been found in

longitudinal studies. During a 20-month period, transportation proved to be the only

supportive behavior provided by parents predictive of change in activity for both boys

and girls (Sallis et al., 1999a). Apart from activity levels, transportation is related to

levels of adiposity in girls, with leaner girls (based on skinfolds and BMI) receiving

more parental transportation to places where they can be active than their heavier coun-

terparts (Hovell, Kolody, & Sallis, 1996). Transportation is also linked to increased

cardiovascular fitness (i.e., mile run/walk time; Sallis et al., 1992).

Although limited in the ability to draw substantive conclusions regarding variations

in supportive behaviors among various ethnic groups, a study of Native American chil-

dren indicated that 80% of the children reported their parents take them to places where

they can be active, suggesting a high degree of involvement of the parents in this com-

munity (J. L. Thompson et al., 2001). Conversely, Hispanic youth receive considerably

less transportation to places to be active than their ethnic counterparts (Hoefer et al.,

2001). Thus, preliminary differences have been identified, yet whether these are tied to

cultural influences regarding parenting practices, socioeconomic status, or parental

perceptions of safety (Sallis, McKenzie, Elder, Broyles, & Nader, 1997) requires fur-

ther investigation.

Children report transportation as one of the common forms of social support they

receive from their parents. In addition, children have also expressed the desire to

receive greater amounts of this form of social support (Wright, Wilson, Griffin, &

Evans, 2008). This is perhaps because of the inability of children to self-transport to

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630 Health Education & Behavior (October 2010)

places where they can participate in activities, thereby necessitating parental involve-

ment. Activities such as sports, community organized programs, and access to play-

grounds and parks are likely to require parental transportation, especially if the distance

from their home is considerable or environmental barriers such as street design and

heavy traffic volume limits access by means of walking or biking (Hoefer et al., 2001).

As few residents are located within walking or biking distance of parks/playgrounds,

greater reliance on parents to assist in accessing neighborhood and city public spaces

(e.g., parks) may be required. Importantly, the provision of transportation does not

require parents to be active themselves. Inactive parents, therefore, can have active

children simply by facilitating their ability to access places where they can be active

(Trost et al., 2003a).

Instrumental—Payment of Fees/Purchasing Equipment. Only four studies (6%)

assessed the association of parental payment of fees and purchase of equipment to

activity-related behaviors. Though limited in number, these studies do indicate that

mothers and fathers purchase more equipment for boys than girls for sport-related

activity (Fredricks & Eccles, 2005), and payment of fees has been associated with

higher activity levels of boys during a 20-month period (Sallis et al., 1999a). The

long-term beneficial consequences of reducing financial barriers to activity during

childhood are the development of positive activity-related memories, which may

contribute to greater levels of adult activity participation, especially for women (A.

M. Thompson et al., 2003). The provision of money may be a fruitful means by which

adolescent boys and girls (from 10 to 14 years old) can be more physically active

(Wright et al., 2008).

Both cost and lack of equipment have been found to be unrelated to perceived behav-

ioral control for involvement in vigorous activity (Craig, Goldberg, & Dietz, 1996),

suggesting youth can participate in high intensity activities without encountering finan-

cial barriers. This finding may also signify the need to differentiate the different domains

of activity—free play versus sports—whereby the latter is more likely to have costs and

equipment barriers associated with involvement. High costs associated with involve-

ment are rated as the number one reason for nonparticipation in school–community

sport and nonsport activities (Hultsman, 1993). Financial hardships also vary by the

type of sport in which one participates (Baxter-Jones & Maffulli, 2003) and reduce the

opportunity to engage in more formal school- and community-related activities.

Sport-related activities, both school and community sponsored, are one of the pri-

mary settings where children and adolescents receive numerous health benefits, includ-

ing increased physical activity (Beets & Pitetti, 2005; Katzmarzyk & Malina, 1998;

Wilde, Corbin, & Le Masurier, 2004). Given that more than 6.9 million youth partici-

pate in sports (National Federation of State High School Associations, 2004), it seems

reasonable to expect that financial barriers to the participation in sports would reduce

overall activity levels.

Conditional—Perform Activity Together. A total of 18 studies (27%) reported asso-

ciations between parents performing activity with and the physical activity levels of

children and/or adolescents. The direct involvement of mothers and fathers in activities

with their children is related to increased levels of physical activity (Adkins, Sherwood,

Story, & Davis, 2004; Beets et al., 2007; Heitzler et al., 2006; Hovell et al., 1996;

Loucaides & Chedzoy, 2005; Morgan et al., 2003; Ornelas, Perreira, & Ayala, 2007;

Prochaska, Rodgers, & Sallis, 2002; Sallis et al., 1992; Sallis et al., 1999a; Sallis,

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Beets et al. / Parental Social Support and Physical Activity 631

Prochaska, Taylor, Hill, & Geraci, 1999b; Sharma, Hoelscher, Kelder, Day, &

Hergenroeder, 2008; Springer, Kelder, & Hoelscher, 2006; Welk et al., 2003; Wilson &

Dollman, 2007; 2009), meeting recommended physical activity levels (Nelson, Gordon-

Larsen, Adair, & Popkin, 2005), and reduced sedentary behaviors (Springer et al.,

2006). Having a parent physically active with his or her child is also related to more

free-time physical activity (Heitzler et al., 2006). However, as children move into ado-

lescence, the influence of parents on activity levels may be supplanted with peer activ-

ity involvement, suggesting this form of support may be influential during childhood,

with younger children more likely to report someone in the family being active with

them (Lown & Braunschweig, 2008). Direct parental involvement, therefore, may be

more important during the early developmental years (5 to 12 years), the time that

coincides with the formulation of many health-related behaviors (Institute of Medicine,

2004; A. M. Thompson et al., 2003). Preliminary results suggest that positive parental

involvement during childhood contributes to adult activity behaviors (A. M. Thompson

et al., 2003); however, additional longitudinal studies are necessary to confirm this

observation.

Of the two parental figures, fathers are thought to overtly use their own activity

behaviors to intentionally influence the activity levels of children (Davison et al.,

2003). This overt behavior is supported in analyses of father–child interactions, with

father–child activity characterized by more physical play-type activities (e.g., rough

and tumble play; MacDonald & Parke, 1986; Paquette, 2004). However, these interac-

tions may be limited to specific time frames and living arrangements (single- vs. two-

parent households; Wright et al., 2008). The traditional role fathers play in the family,

that of primary breadwinner (Christiansen & Palkovitz, 2001; Hewlett, 2003), may

restrict their influence on activity to weekends in contrast to weekdays. Compared to

mothers, fathers engage in greater amounts of direct involvement with their child in

activities during the weekend versus weekdays (Yeung, Sandberg, Davis-Kean, &

Hofferth, 2001). Recent findings indicate that for boys, fathers’ direct involvement dur-

ing the weekend is associated with greater overall activity levels (Beets et al., 2007).

Fathers, therefore, appear to exert considerable influence on their children’s activity

levels, yet they may be limited in the time they have to interact with their child based

on the traditional role they fulfill within the family (Yeung et al., 2001). Conversely,

studies indicate that mother’s “playing with you” is related to adolescent girls’ activity,

particularly among girls from Vietnamese backgrounds (Wilson & Dollman, 2009).

Given these associations, it would appear that increasing parental involvement is a

viable means by which to increase physical activity.

The amount of time mothers and fathers spend playing with their child may be dif-

ferent based on gender, with some studies indicating that parents report more playtime

with boys (Fredricks & Eccles, 2005). Time spent active with their child may also be

associated with the weight status of the child, with nonoverweight boys and girls report-

ing more male (i.e., father) activity involvement than their overweight peers (Zabinski,

Saelens, Stein, Hayden-Wade, & Wilfley, 2003). Hence, children at risk of being over-

weight may require direct parental involvement to engage in sufficient amounts of

activity. One study indicated that children at risk of becoming overweight—based on

parental weight status—were substantially more active when parents were involved in

the activity than when they participated in activity alone (Klesges et al., 1990). Thus,

parental involvement may be useful in increasing the activity levels of overweight

children, which is a needed area of investigation (McLean et al., 2003).

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632 Health Education & Behavior (October 2010)

Conditional—Watching/Supervision. Six studies (9%) reported findings linking

parental watching/supervision to their children’s physical activity. Although their

directly participating in activity with children leads to increased activity levels, parents

do not necessarily have to be active to be influential. Parents who are present, but not

directly participating in the activity, have children who exhibit higher activity levels

(Duncan et al., 2005; Heitzler et al., 2006; Prochaska et al., 2002). This association may

be because of sports involvement, where the presence of spectators is an integral part

of the milieu. It seems reasonable, therefore, to expect children who are involved in

sports to have higher levels of parental watching. Girls indicate their mothers’ involve-

ment is more likely to be as a spectator of their sport involvement (V. J. Thompson

et al., 2003), suggesting the importance of mothers’ presence. Moreover, boys indicate

they would like to have a parent present at a meet/practice to provide support for their

involvement (Wright et al., 2008). Youth from more socioeconomically advantaged

backgrounds report greater amounts of parental watching (Duncan et al., 2005), which

in turn, is related to higher levels of activity. This association may be a result of youth

from a higher socioeconomic status being able to participate in sports (e.g., fewer finan-

cial barriers—see discussion above) and/or that parents of high income levels have

more flexible schedules or discretionary time, which facilitates their ability to view

their child’s sport participation.

It appears watching is linked to activity, but it may be so as an outcome of, rather

than a precursor to, activity. For instance, the presence of parents may serve as a non-

verbal form of parental approval of the child’s involvement, potentially increasing the

likelihood of continuation. However, the presence of parents watching practices and

meets may not be as important for those children already highly involved in competi-

tive sports (Brown, 1985). Thus, watching may serve as an important supportive behav-

ior during the initial development and acquisition of the activity behavior. The presence

of a parent may also be construed as watching for the purpose of safety or supervision.

Without the presence of a parent/guardian, safety concerns may prohibit younger chil-

dren from accessing outdoor places to play (Beets & Foley, 2008; Sallis et al., 1997).

This may be even greater for girls, with parents more likely to allow boys of the same

age to play outdoors and unsupervised in comparison to girls (Soori & Bhopal, 2002).

Future research examining the relationship between parental watching and activity

levels among children and adolescents should help to clarify the role of watching on

youth activity behaviors.

Support Type—Intangible

Intangible support consists of verbal encouragement to participate in sports or

physical activities and praise for involvement and effort. Such support is believed to

enhance motivation for continuing involvement (Prochaska et al., 2002), provide feed-

back on current performance, and contribute to greater levels of perceived competence,

which have been shown to lead to higher levels of activity (Brustad, 1993). Another less

studied intangible supportive behavior is the provision of information on how to per-

form and why (e.g., health benefits) one should be active (Duncan et al., 2005; V. J.

Thompson et al., 2003). These are discussed, separately, below.

Informational—Importance of Activity and How to Be Active. Examination of the

role of informational support has received the least attention in the social support litera-

ture (one study, 2%) and is one of the support mechanisms for which little information

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Beets et al. / Parental Social Support and Physical Activity 633

has been gathered. Unfortunately, when information support is measured in studies

(e.g., Bungum & Vincent, 1997; Dowda, Dishman, Pfeiffer, & Pate, 2007; Sallis, Taylor,

Dowda, Freedson, & Pate, 2002), it has been used in conjunction with additional sup-

port items (e.g., encouragement, transportation) to create a summated scale or factor

score, thereby limiting the ability to determine the unique influence information has on

activity levels. Nevertheless, several important observations can be made. A qualitative

study (V. J. Thompson et al., 2003) indicated that African American girls received infor-

mation from their parents on the importance of maintaining a healthy weight and the

benefits to overall health from physical activity. However, this informational support

was not linked directly to activity levels, and therefore it provides information only on

its presence and not on its impact on activity levels. Older children receive more infor-

mational support than younger children (Duncan et al., 2005), which may partly arise

from the ability of older children to comprehend the more abstract processes (e.g.,

physiological changes) that occur with sustained activity involvement. Currently, no

specific recommendations can be made regarding the influence of informational support

on youth activity levels. This area deserves greater attention in future studies.

Motivational—Encouragement. Encouragement is the most extensively studied

intangible supportive behavior (31 studies, 47%). Encouragement is conceptualized as

motivational prompts or suggestions provided by parents to foster the involvement of

their child in activity. Encouragement serves as a precursor to activity involvement,

with activity occurring after its provision. Encouragement may also occur while the

activity is taking place, thereby serving as a reinforcer of the behavior. Encouragement

is positively related to the intensity of activity (Bauer, Nelson, Boutelle, & Neumark-

Sztainer, 2008; Biddle & Goudas, 1996; De Bourdeaudhuij et al., 2005; King,

Tergerson, & Wilson, 2008; Klesges, Malott, Boschee, & Weber, 1986; Springer et al.,

2006); amount of activity (Anderssen & Wold, 1992; Cardon et al., 2005; Elder et al.,

1998; McGuire et al., 2002; O’Loughlin, Paradis, Kishchuk, Barnett, & Renaud, 1999;

Strauss, Rodzilsky, Burack, & Colin, 2001); after school activity and sports (Allender,

Cowburn, & Foster, 2006; Hohepa, Scragg, Schofield, Kolt, & Schaaf, 2007); girls’

attraction to sports and games (Brustad, 1996); intentions to be active (Biddle &

Goudas, 1996); bone mineral density, daily physical activity, and days per week spent

doing jumping activities (Sharma et al., 2008); boys’ short-term change (20 months) in

physical activity (Sallis et al., 1999a); perceived competence (Brustad, 1993); per-

ceived benefits from physical activity (King et al., 2008); sport participation (Brown,

1985; Butcher, 1985; Fredricks & Eccles, 2005); and subsequent adult activity levels

(A. M. Thompson et al., 2003). Given the consistent findings in the literature, encour-

agement stands as one of the more influential forms of intangible supportive behaviors.

According to interviews, youth would like to receive more encouragement from

their parents (O’Dea, 2003; Ries, Voorhees, Gittelsohn, Roche, & Astone, 2008; Wright

et al., 2008). These findings signify that while encouragement may be present, the

amount perceived is insufficient to fully influence activity levels, or the means through

which parents are encouraging is not fully adequate. This may be especially true for

girls, as boys appear to receive more encouragement to be active from their parents than

do girls (Brustad, 1993; Fredricks & Eccles, 2005; Sallis et al., 1992; J. L. Thompson

et al., 2001; Timperio et al., 2008). Parents concerned about their child’s weight attempt

to provide more encouragement to their children to participate in activity (V. J.

Thompson et al., 2003), and this increase in encouragement may account for the lack

of differences between overweight and nonoverweight youth (Zabinski et al., 2003).

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634 Health Education & Behavior (October 2010)

However, one study indicated nonoverweight children perceived greater amounts of

parental encouragement than overweight children (De Bourdeaudhuij et al., 2005).

Interviews at adulthood reflecting back on their childhood parental support indicate

that those who were classified as inactive or moderately active during childhood and

adolescence reported receiving lower amounts of encouragement to be active (A. M.

Thompson et al., 2003). This lower amount of encouragement was suggested to be the

reason for their lack of activity during both childhood and adulthood. Studies indicate

that the provision of encouragement is mediated through psychosocial attributes such

as feelings of greater physical self-competence and liking of and attraction to activity

and sports (Biddle & Goudas, 1996; Brustad, 1993; 1996), which are suggested to lead

to greater rates of participation.

Importantly, if the provision of motivation, suggestions, or prompts for activity leads

to increased activity levels, then designing programs that develop the “encouragement

skills” of parents may prove fruitful. Parents could be taught about the what, when, and

how of providing verbal prompts for their children. Another method may be to increase

parental enjoyment of activity, given that parents who enjoy activity more provide

greater amounts of encouragement to their child (Brustad, 1993).

Motivational—Praise. Four studies (6%) reported findings linking praise to physical

activity. Praise is a motivational response provided by parents that serves to validate the

child’s performance and/or effort in the activity. Unlike encouragement, praise is

reserved until after an activity has been performed. Thus, the presence of praise neces-

sitates prior activity involvement of some form. Like informational support (see above),

praise has usually been included within a summated scale or composite score of sup-

portive behaviors, making it impossible to determine its unique influence on activity

levels (e.g., Garcia, Pender, Antonakos, & Ronis, 1998; Trost et al., 2003a). In the few

studies that have separated out the effects of praise from other support types, it does

appear to be related to increased activity levels. For instance, in a rural sample of

fourth- through eighth-grade students, praise was found to be one of the primary influ-

encers of activity (Beets et al., 2006). Additional support for praise was found in a

sample of California youth (Prochaska et al., 2002). However, given the insufficient

amount of studies examining these relationships, care must be taken in establishing a

connection. Nevertheless, the studies conducted to date indicate this may be a poten-

tially important correlate to activity involvement and certainly one that deserves greater

research attention.

Support Types—Composite Measures

As previously noted, 29 studies (44%) have examined supportive behaviors as a

summated scale or composite score. Although this alleviates some of the methodologi-

cal issues surrounding single-item indicators and it may minimize respondent burden,

such an approach assumes the overall level of support is more important than the provi-

sion of a specific supportive behavior. Unique associations have been observed among

the specific support types and activity, indicating these should be considered distinct

behaviors, each resulting in its own effect on physical activity. The use of summated

scales also masks some of the relationships that appear to be important for facilitating

activity, and it therefore limits our understanding in developing interventions.

Furthermore, although summative scales of social support do allow for the provision

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Beets et al. / Parental Social Support and Physical Activity 635

of generic recommendations for parents, they lack the necessary specificity on which

supportive behaviors need to be provided to increase physical activity. Moreover, single

items (e.g., encouragement) used with summated responses from more than one respon-

dent (e.g., mother and father; Hohepa et al., 2007), or in reference to “a family member”

or “member of your household” (e.g., Grieser et al., 2008; Hamilton & White, 2008;

Zakarian, Hovell, Hofstetter, Sallis, & Keating, 1994), or included with other referents,

such as peers and teachers (e.g., Biddle & Goudas, 1996; Frenn et al., 2005; Lown &

Braunschweig, 2008; Neumark-Sztainer, Story, Hannan, Tharp, & Rex, 2003), pre-

cludes the understanding of the unique role each parent takes in promoting physical

activity.

Overall levels of family support appear to be related to increased activity, with

parental social support attenuating the decline of physical activity of adolescent girls

from eighth to twelfth grade (Dowda et al., 2007). However, the amount of variance for

activity explained is generally small (e.g., Anderssen & Wold, 1992; Frenn et al., 2005;

Kuo, Voorhees, Haythornthwaite, & Young, 2007; Sallis et al., 1999b; Stucky-Ropp &

DiLorenzo, 1993). Nevertheless, the majority of findings indicate more active youth

perceive more family support (e.g., Davison, 2004; Davison et al., 2003; Davison &

Schmalz, 2006; Lewko & Ewing, 1980; Saunders, Molt, Dowda, Dishman, & Pate,

2004; Trost et al., 2003a; Ward et al., 2006; Welk et al., 2003).

The effect of parental social support on activity has been shown to be mediated

through several psychosocial variables. Parental support is mediated through a child’s

self-efficacy and self-esteem (Ornelas et al., 2007; Trost et al., 2003a; Wu, Pender, &

Yang, 2002), perceptions of competence and subjective values toward physical activity

(Sharma et al., 2008), and preadolescent girls’ weight bearing exercise knowledge

(Ievers-Landis et al., 2003); it also influences their perceived competence and attraction

to and liking of activities (Brustad, 1993; 1996), all of which are processes that are

likely to increase their involvement in and satisfaction of physical activity. Supportive

behaviors are also predictive of subsequent activity levels during adulthood (A. M.

Thompson et al., 2003), further substantiating their importance in maintaining involve-

ment in activity.

Many of the studies indicate the primary respondent is the mother (e.g., Adkins

et al., 2004; Beets & Foley, 2008; Brustad, 1993; Stucky-Ropp & DiLorenzo, 1993).

Hence, most of the information regarding parental support is derived from mothers.

Mothers are more likely to provide support in the form of enrolling their children in

sports/activities and attending their sporting events (i.e., logistic support), whereas

fathers use their own activity behaviors more overtly to influence their children’s activ-

ity (i.e., explicit support; Davison et al., 2003). Fathers are also instrumental in facilitat-

ing sport involvement for boys and girls (Greendorfer & Lewko, 1978). Because of

these differences, analyses using a composite of mothers and fathers may actually sup-

press the unique influence of each parent (De Bourdeaudhuij et al., 2005; Greendorfer

& Lewko, 1978). Thus, when examining parental support, it is necessary to separate the

differential influences of mothers and fathers.

Boys report receiving more parental support than do girls (Trost et al., 2003a; Welk

et al., 2003), which would coincide with the greater amounts of reported activity for

boys (USDHHS, 1996). Gender differences have also been found in studies examining

supporting behaviors singularly (Anderssen & Wold, 1992; Brustad, 1993; Fredricks &

Eccles, 2005); however, this observation is not always consistent. Several studies sug-

gest that boys report less support for activity (Higgins, Gaul, Gibbons, & Van Gyn,

2003; Wu, Pender, & Noureddine, 2003). When grouped by activity levels, low active

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636 Health Education & Behavior (October 2010)

boys and girls report similar amounts of support (Lewko & Ewing, 1980), with one

study observing no differences at all (Garcia et al., 1995).

Whether parents provide differential support to their child based on weight status or

ethnic background is currently unclear. Several studies indicate that overweight and

nonoverweight youth perceive similar amounts of overall support (Trost, Sirad, Dowda,

Pfeiffer, & Pate, 2003b; Ward et al., 2006) and encouragement, praise, transportation,

and participating in activity with their parents (Beets et al., 2006), although several

studies suggest some disparity in support provision, with overweight youth reporting

less support (De Bourdeaudhuij et al., 2005; Zabinski et al., 2003) and lower amounts

of parental watching (Beets et al., 2006).

Several studies indicate differences in family social support among various ethnic

groups with some reporting White non-Hispanics having higher amounts (Grieser et al.,

2008; Wilson & Dollman, 2007; 2009), whereas others report African American and

rural girls perceive more than their White non-Hispanic peers (Felton et al., 2002).

What is unclear is whether these differences exist because of actual cultural variations

in parent–child interactions or parenting styles (Arredondo et al., 2006). Finally, in

terms of religion, the only study to date examining parental social support in relation to

levels of religiosity found higher levels of perceived support for adolescents from less

religious families (Kahan, 2005), suggesting religion may play a role in determining

parental supportive behaviors.

Methodological Issues

Apart from the inconsistencies as to what social support specifically entails, several

methodological concerns have been raised regarding the measurement of physical

activity and questionnaire specification of activity when examining social support.

Physical activity is a complex behavior and no one method of assessing it is considered

ideal. This uncertainty in measurement is especially true when measuring the activity

levels of children (Welk, Corbin, & Dale, 2000). The variations in whether or not social

support is related to youth activity levels is suggested to be a function of the activity

measure employed (Prochaska et al., 2002). In studies using both objective and self-

report activity, analyses show that objective monitoring (e.g., accelerometers, observa-

tion) either reveals no relationship with social support (Adkins et al., 2004; Klesges

et al., 1990; Morgan et al., 2003; Prochaska et al., 2002; Sallis et al., 2002) or the rela-

tionship is considerably weaker in comparison to self-reported activity (Prochaska

et al., 2002). Great care, therefore, must be taken when examining the relationships

between social support and physical activity. To date, relatively few studies have used

multiple methods, and thus considerable work is still required in this area.

Additional concerns in this body of research relate to the wording and assessment of

physical activity in the available questionnaires. Typically, social support question-

naires use a generic reference to physical activity by including sports and physical

activity together. These domains of activity are conceptually unique (Caspersen,

Powell, & Christensen, 1985) and are likely to require different types of support to

facilitate participation (Heitzler et al., 2006). Consequently, supportive behaviors nec-

essary for enhancing participation in certain types of activities are relatively unex-

plored.

Only a single article reported information related to social interactions as a negative

construct (DiLorenzo, Stucky-Ropp, Vander Wal, & Gotham, 1998). The two items

asked about the family criticizing exercise and complaining about time spent in exercise.

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Beets et al. / Parental Social Support and Physical Activity 637

The negative family support was inversely related to boys’ physical activity solely. Apart

from this, no other attempts have been made to develop measures for negative parental

social supportive behaviors for children’s physical activity. In qualitative analyses, chil-

dren, adolescents, and adults perceive some aspects of social support to hinder their

participation in physical activities (A. M. Thompson et al., 2003; Wright et al., 2008).

Investigations of social support among older adults (Chogahara, 1999) and individuals

with traumatic brain injuries (Driver, 2007) indicate distinct positive and negative

domains of perceived social support. Such findings bring into question whether similar

polarities may be present with parental provisions of social support. However, attention

needs to be paid as to whether the negative aspects of parental social support are unique

constructs (e.g., inhibiting behaviors) or simply the flip side of the coin of items already

developed (e.g., child unable to participate because activities are too expensive). If

polarities do exist, studies can help us understand how these behaviors can be modified

to prevent physical inactivity.

IMPLICATIONS FOR PRACTICE

Despite wide ranges in the type of support examined, sample characteristics, mea-

sures of physical activity, and analytical approaches, current evidence indicates that

parental supportive behaviors are an important facilitator of the physical activity–

related behaviors of youth. The following recommendations are offered as a guiding

framework for frontline practitioners working with families. Initially, an inventory of

the social supportive behaviors parents and/or guardians currently provide should be

assessed. This will direct attention toward areas where parents and/or guardians should

place additional effort for the promotion of physical activity. Thus, the supportive

behaviors identified in the review can serve as a listing of potential behaviors parents

and/or guardians can use to facilitate physical activity of their children. Importantly,

because mothers and fathers influence their child’s physical activity levels differently,

practitioners should use different approaches when providing male and female parents

and/or guardians ideas about how they might be physically active with or promote the

physical activity of their child.

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Objectives This study examined the sociodemographic factors associated with muscle-strengthening exercise (MSE) participation in a sample of Chinese school-aged children. Methods A cross-sectional survey was conducted in March 2021, comprising 67,281 students from public schools in Shenzhen through a multistage sampling method. The survey collected data on MSE participation, sociodemographics, family and educational information, and other aspects. A three-level mixed multilevel effect model was performed to analyze the associations between the selected sociodemographic characteristics and MSE participation. Results were presented using odd ratios (OR) with 95% confidence intervals (CI). Results 38.6% of participants met the MSE guidelines. In models of adherence to MSE guidelines and MSE days, boys were more likely to participate in MSE (OR = 1.31, 95%CI: 1.27–1.36, p < 0.001) than girls. Compared to primary school students, junior middle school students (OR = 1.60, 95%CI: 1.47–1.74, p < 0.001) were more likely to participate in MSE, whereas high school students (OR = 0.61, 95%CI: 0.51–0.73, p < 0.001) participated less frequently. Socioeconomic status (both OR = 1.07, 95%CI: 1.01–1.13, p < 0.001) was positively associated with MSE participation. Participants who perceived their weight as “about the right weight” or “slightly overweight” were most likely to participate in MSE. Weight satisfaction was negatively associated with guideline adherence, with those “very dissatisfied” with their weight being more likely to adhere. Positive associations between sports club participation and sports equipment satisfaction with MSE participation were also found. Other factors, such as ethnicity and parental education level, showed no significant association. Conclusion MSE participation is correlated by sociodemographic, behavioral, and self-perception factors, particularly sex, age, socioeconomic status, sports club involvement, and weight perception. Interventions to enhance MSE participation should target the important identified factors. Future studies should consider using longitudinal designs to strengthen understanding of MSE, further aiding in developing relevant and effective interventions.

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Mar 2025
J ADV NURS

Aim This study explored the perceptions of weight, shape and physical activity of Palestinian refugee adolescent girls and their mothers living in Baqa'a camp, Jordan. Design A descriptive qualitative design. Methods A purposive sampling approach was employed to recruit 12 Palestinians (six adolescent girls and their mothers) from a Palestinian refugee camp between March 2019 and mid‐January 2020. Results The socioecological model framed the analysis process and revealed four main themes. At the individual level: ‘The Perfect Body’ explained how mothers and daughters conceptualised ideal body weight and shape and factors that influenced this perception. At the relationship level: ‘it's tough love I give, it's tough love I accept’ explored the tumultuous mother–daughter relationship and impact on weight, shape and physical activity. At the community level: ‘The camp community is insular and the setting, spartan’ highlighted how people within the community and the environment itself impacted on healthy behaviours, and at the society level: ‘The influence of where you are and who you are’ explored how the broader levels of society and the culture determined attitudes and perpetuated body weight and shape ideals among women. Conclusion Greater effort involves collaboration among nurses, educators, community leaders, parents, media professionals and researchers to deliver positive health messaging on weight, shape and the importance of physical activity, with further investment in resources and infrastructure to support behaviour change. Implications for the Profession and/or Patient Care Findings assist nurses in addressing sociocultural issues regarding body image among women and girls in refugee camps and in advocating for policies and practices that reduce health disparities. Impacts The findings provide nurses, educators and community leaders' insight in designing interventions that incorporate family dynamics and parenting styles to promote healthy body image, weight management and physical activity among adolescents and their mothers. Schools, with the support of school nurses, can implement programmes that promote open communication and positive modelling of body image, leading to healthier self‐esteem and attitudes among adolescents. Reporting Method We have adhered to relevant EQUATOR guidelines using the COREQ reporting framework for qualitative research. Patient or Public Contribution No patient or public contribution.

I simply have to accompany my parents to sell, nothing else!: a multi-method exploration of barriers and facilitators of extracurricular physical activity among Mexican schoolchildren

Article

Full-text available

Mar 2025
INT J BEHAV NUTR PHY

Background The time spent physically active outside of school (e.g., extracurricular physical activity) is an important contributor to children’s total daily physical activity for health and well-being. Little is known about the opportunities available to children to engage in extracurricular physical activity from low- to middle-income countries. This study aims to answer the question: What are the main perceived barriers and facilitators of extracurricular physical activity among school-age children in Mexico? Methods A multi-method cross-sectional study was performed. Six focus groups with children (aged 9–12 years), six focus groups with parents, 10 one-on-one interviews with parents, 12 interviews with teachers, and six interviews with head teachers were conducted across Campeche, Morelos, and Mexico State, Mexico. A questionnaire was applied to explore children’s physical activity frequency and preferences for time inside and outside of school. Qualitative data analyses were performed with inductive thematic analysis supported with NVivo software. Quantitative data were analysed with descriptive statistics using IBM SPSS 26. Results Three main themes summarise the study’s findings: (1) how children spend their time outside of school, (2) the places that children access, and (3) the social environment for physical activity outside of the school. The data suggest that children in Mexico dedicate their spare time to screen, work, do housework, or perform unstructured physical activity mostly at home instead of playing sports or actively outdoors. Family support, enjoyment of physical activity, access to programs and facilities, time, living in a housing complex with open common areas, and mild weather were important facilitators identified. 69.4% of children engage in extracurricular physical activity, none of which was provided by schools. More children commute by walking than riding a bike to and from school. Children living inland spent three times more time at home compared to those in seafront areas. Conclusions Children rely on their families to partake in extracurricular structured physical activity. Policies targeting children’s health and well-being should include school-based extracurricular physical activity programs.

Associations between 24-h movement behaviors and health-related quality of life(HRQoL) in preschool children: a cross-sectional study

Article

Full-text available

Feb 2025
QUAL LIFE RES

Purpose To investigate the association between preschool children's 24-h movement behaviors and health-related quality of life (HRQoL), exploring the impact of time reallocation among these behaviors and examining gender differences. Methods This study analysed HRQoL and 24-h movement behaviors of 349 preschool children in three kindergartens in Beijing, China, selected through convenience sampling using a cross-sectional study design. A t-test and multivariate analysis of variance methods were used to investigate gender differences. The study examined the relationship between 24-h movement behaviors and HRQoL using component data analysis and component isochronic substitution model methods, with an investigation into gender differences in the overall association. Results The study found a negative correlation between sedentary behavior (SB) and overall HRQoL score (γ = − 11.92, p < 0.05) in the entire sample, particularly affecting physical health score (γ = − 14.39, p < 0.01). Among boys, SB was negatively correlated with the HRQoL total score (γ = − 15.83, p < 0.05), while sleep was positively correlated with psychosocial health scores (γ = 17.814, p = 0.01). However, there was no significant association found between 24-h movement behaviors and HRQoL in girls. When using the component isochronic substitution model, reallocating 30 min from sedentary behavior to sleep increased the total HRQoL score of preschool children by 0.865 points (95% CI 0.071, 1.658). In contrast, reallocating 30 min from sleep to sedentary behavior resulted in a decrease of 0.850 points (95% CI − 1.638, − 0.062) in the total HRQoL score. Conclusions To improve preschool children's HRQoL, it is recommended to reduce their sedentary behavior time and increase their sleep time. Public health policymakers should consider this when developing 24-h movement behavior guidelines for preschoolers.

Associations of Parental Perceived Health with Child Movement Behaviors within Two-Parent Households

Article

Full-text available

Feb 2025

This study aimed to examine how perceived parental mental and physical health status was associated with child physical activity, screen time, and sleep. Participants were 6- to 17-year-old minors (N = 20,156; 47.9% female) from the 2022 US National Survey of Children’s Health. Dependent variables were children’s physical activity frequency, screen time, and sleep. Independent variables were parents’ physical and mental health status. Using the Actor-Partner Interdependence Model, two adjusted path models were constructed. One for parent mental health associating with parental physical health, another for parent physical health associating with parental mental health–both further associating with child movement behaviors. Path models also examined the covariance within parental dyads. Approximately 20.1% of children adhered to physical activity recommendations, 61.2% to screentime recommendations, and 66.4% to sleep recommendations. Parental physical health status mediated the association of parents' mental health status on child movement behaviors, and vice-versa. Mediated associations represented 20.1% to 50.5% of the total associations. Dyadic correlations were moderate (r = 0.52 – 0.60). Most of the dyadic correlations and covariance were explained by actor-driven effects, suggesting that the mediated parental association with child behaviors may be due to health perceptions related to the individual parent and not the other parent.

The Influence of Perceived Autonomy Support on Physical Activity Among High School Students: The Mediating Roles of Basic Psychological Needs

Article

Apr 2025

Parental and peer support has been documented as an important factor in physical activities among high school students. Likewise, coach support has an important impact on physical activity among high school students. Meanwhile, many studies show that basic psychological needs have an essential effect on perceived autonomy and physical activity. As such, this study, using self-determination theory, aimed to explore the mediating role of basic psychological needs on physical activity among high school students in China. The Sport Climate Questionnaire, Psychological Need Satisfaction in Exercise Scale—Physical Activity, and the three-item Physical Activity Rating Scale-3 were employed to gauge responses from 736 high school students (15–18 years old). A structural equation model was employed to test the mediating effect. The researchers found a significant positive effect of perceived coach support on basic psychological need satisfaction. Basic psychological need satisfaction was also found to be a significant predictor of physical activity. Surprisingly, the results showed that perceived coach support negatively influences physical activity. As such, an indirect mediating effect is established. Basic psychological needs had an indirect mediating effect and could reduce the negative effect of coach support on physical activity engagement.

Leveraging agent-based modeling and a randomized intervention to advance childhood physical activity: A study protocol

Article

Full-text available

Apr 2025
PLOS ONE

This study (1R01HD107002-01A1) protocol describes the planned creation and use of an agent-based model (ABM) of early childhood physical activity (PA). Successful early childhood PA interventions can potentially play an important role in both increasing overall population health as well as closing health disparities across subpopulations. At present, effective strategies for doing so are currently unknown. In large part, this is because PA determinants operate across levels dynamically, interact with one another, and can differ substantially across children. A complex systems approach—specifically, ABM—can be used to provide important insights about effect pathways driving child PA. Design of the proposed ABM will be based on high-quality extant research on childhood physical activity while allowing for the testing of hypotheses that extend beyond this body of literature. Its primary source of input data will be participants in GROW (NCT01316653), a completed cohort-based randomized controlled trial (RCT) that includes extensive longitudinal PA data collected from accelerometer observations of children from ages 3–9. We will iteratively test and improve upon an etiologic ABM of childhood PA, ensuring that it can satisfactorily reproduce micro- and macro-level influences and trends comparable to those seen in GROW. The tested ABM will then be used to extrapolate beyond the context of the GROW RCT, experimentally identifying potentially efficacious intervention strategies to improve childhood physical activity through program implementation or changes in policies and practices. We will use expert input to identify promising intervention approaches. We will use the model to systematically experiment with a wide array of different hypothetical combinations of intervention specifications and combinations. At the end of the model experimentation step, we expect to generate insights of broad applicability to the field of PA science regarding what might work, and for whom, in promoting PA and reducing disparities in these behaviors.

Staying active in sports during the transition from school to work: The role of social support in young adulthood

Article

Apr 2025
Int Rev Sociol Sport

The transition from school to work is typically unfavourable for the sports participation of young adults. However, receiving social support might help young adults maintain their involvement in sports during this transition. To test this proposition, we investigated whether social support from partners, family, friends and coworkers had a mitigating effect on the decline in sports frequency. Using quasi-longitudinal data on 1040 young adults from the TRansition Into Active Living survey, we find with fixed-effects panel regression models that the transition from full-time education to employment indeed negatively impacted weekly sports frequency. This decline is mitigated by frequent experiences of social support for sports. Social support from friends and coworkers seemed especially important in alleviating the drop in sports frequency. Policy implications and avenues for future research are discussed.

Motor Proficiency and Factors Influencing Motor Proficiency Throughout lifespan: A Narrative Review

Article

Apr 2025

Motor proficiency plays a crucial role in physical and cognitive development, affecting various domains of an individual's life including academic performance, social interactions, and overall well-being. This narrative review synthesizes the existing literature to explore the intrinsic and extrinsic factors that affect motor proficiency. The key determinants identified include biological factors such as age, gender, and neurological health; psychological elements such as motivation and confidence; environmental influences including socioeconomic status and physical environment; and the role of physical activity, physical fitness, and physical education. The interplay of these factors reveals the complexity of motor proficiency development, emphasizing the need for holistic interventions and further research to address the gaps in understanding. Key words: Motor proficiency, factor influencing, biological, environmental, physical development

Identity, Rurality, and Gender: A Phenomenological Exploration of Rural Nova Scotian Girls’ Physical Activity Experiences

Article

Apr 2025

Background/Objectives: Adolescent girls’ physical activity levels are well below the minimum recommended levels for health and wellbeing. Rural-dwelling adolescents may also experience decreased physical activity levels than their urban counterparts, placing rural adolescent girls at a greater disadvantage. The reasons for these low levels are multifactorial, including, but not limited to, age, geographical locations, and gendered stereotypes surrounding activities. Qualitative investigations into adolescent girls’ physical activity can provide deeper understandings on the key barriers and supports that specific populations experience and have been limited in the current literature. This study explores the physical activity experiences of adolescent girls living in rural Nova Scotia to provide deeper understandings of the needs of this population to inform physical activity policy and programming. Methods: Heideggerian hermeneutic phenomenology and feminist post-structuralism were used in a bricolage fashion to analyze six semi-structured interviews from adolescent girls between 11–13 years old living in rural eastern Nova Scotia. Results: Three major themes were identified from the interviews: (1) what physical activity looks like depends on your definition; (2) “What do you do when the boys take over the gym?”; and (3) “It’s really nice to have space…but there’s a lot less options out here”. The themes were not independent, but rather all were linked by the threads of gendered sociocultural expectations and hegemonic femininity. Conclusions: Distinct physical activity identities were exposed within the stories, shaped by parental and peer supports, personal ideals, sociocultural gender roles, and individual sense of agency surrounding physical activity engagement. Rural adolescent girls need both increased social and parental support to better navigate barriers of location and gender stereotypes that may be limiting their physical activity.

Correlates of Physical Activity in a National Sample of Girls and Boys in Grades 4 Through 12

Article

Full-text available

Jul 1999

Psychological, biological, social, and physical environmental variables were examined for their association with physical activity of young people. A national sample of 1,504 parents and children in Grades 4–12 were interviewed by telephone. Twenty-two potential determinants were assessed along with an 11-item child physical activity index (α = .76). Hierarchical multiple regressions were conducted separately for 6 age–sex subgroups. Percentage of variance explained ranged from 18% for boys in Grades 4–6 to 59% for girls in Grades 10–12. Three variables had strong and consistent associations with the child physical activity index that generalized across subgroups: use of afternoon time for sports and physical activity, enjoyment of physical education, and family support for physical activity. These 3 variables should be targeted for change to promote physical activity in all groups of young people.

Who Will Go Out and Play? Parental and Psychological Influences on Children’s Attraction to Physical Activity

Article

Full-text available

Aug 1993

Robert Brustad

Identifying social and psychological influences affecting children’s attitudes about physical activity is an important step in understanding individual differences in children’s activity involvement. This study examined the influence of parental socialization and children’s psychological characteristics upon attraction to physical activity. Fourth-grade children (N=81) completed questionnaires assessing perceived physical competence and attraction to physical activity. Parents also completed questionnaires assessing their physical activity orientations and level of encouragement of their child’s physical activity. A proposed model linking four sets of social and psychological variables was tested through path analysis. The results generally supported the hypothesized model and suggested that parental physical activity orientations, parental encouragement levels, children’s gender, and children’s perceived physical competence are important influences upon children’s attraction to physical activity.

Development of Physical Activity Behaviors Among Children and Adolescents

Article

Mar 1998

Physical activity is a key component of energy balance and is promoted in children and adolescents as a lifelong positive health behavior. Understanding the potential behavioral determinants necessitates understanding influences from three fundamental areas: 1) physiologic and developmental factors, 2) environmental factors, and 3) psychological, social, and demographic factors. The literature to date has generally investigated potential predictors of physical activity in children and adolescents in each of these three general areas, although existing data rely largely on cross-sectional studies in which it is difficult to distinguish a determinant from a correlate. In all likelihood, aspects of each of these three areas interact in a multidimensional way to influence physical activity in youth. This article reviews evidence of potential determinants of physical activity in children and adolescents and provides recommendations for future work.

Promoting physical activity among taiwanese and american adolescents

Article

Mar 2002

The purpose of this paper is to present a comparative analysis of the determinants of physical activity among adolescents in Taiwan and in the United States. Pender's Health Promotion Model (HPM) served as the theoretical framework for both studies (Pender, 1996). The major determinants of health behavior in the HPM are perceived benefits, perceived barriers, self-efficacy, activity-related affect, interpersonal influences, situational influences, commitment to a plan of action, and immediate competing demands. In Taiwan, 969 middle school students (55% males; 45% females) from Taipei provided data for the study. In the United States, the sample was collected from 286 late elementary and middle school students (48% males; 52% females). Results showed the gender differences in activity levels were apparent in the youths from both countries. In both Taiwanese and American youths, boys were more active than girls. Cross-cultural differences in the importance of barriers to physical activity emerged. Among Taiwanese adolescents, barriers did not emerge as a significant direct predictor of physical activity as they did among US adolescents. Perceived efficacy directly predicted physical activity among Taiwanese youths while it indirectly predicted physical activity and appeared to be mediated by beliefs regarding exercise benefits and barriers among American youths. In addition, the paths of effect for interpersonal influences were different when Taiwanese and US youths were compared. The findings from this paper have important and culturally-relevant information that can inform future physical activity intervention studies with diverse adolescents.

GENETIC AND ENVIRONMENTAL INFLUENCES ON LEVEL OF HABITUAL PHYSICAL ACTIVITY AND EXERCISE PARTICIPATION

Article

May 1989
AM J EPIDEMIOL

In order to quantify genetic and environmental determinants of physical activity level, 1,610 subjects from 375 families who lived in the greater Québec city area completed a three-day activity record in 1978–1981. Level of habitual physical activity, which includes all the usual activities of life, and exercise participation, which includes activities requiring at least five times the resting oxygen consumption and more, were derived from this record. Familial correlations were computed in several pairs of biologic relatives and relatives by adoption after adjustment for the effects of age, sex, physical fitness, body mass index, and socioeconomic status, and analyzed with a model of path analysis that allows the separation of the transmissible effect between generations (t²) into genetic (h²) and cultural (b²) components of inheritance. The transmission was found to be statistically significant, but was accounted for by genetic factors for level of habitual physical activity (t² = h² = 29%), and by cultural factors for exercise participation (t² = b² = 12%). Although non-transmissible environmental factors remain the major determinants of these two physical activity indicators in this population, the results suggest that children can acquire from their parents certain customs regarding exercise behavior and that the propensity toward being spontaneously active could be partly influenced by the genotype.

Factors Influencing the Process of Withdrawal by Female Adolescents from the Role of Competitive Age Group Swimmer

Article

Jun 1985

Barbara A. Brown

The high attrition rates observed among young athletes, particularly adolescents, have been attributed to and studied primarily as outcomes of negative aspects of the organization and administration of competitive youth sport. The present study extends this research by examining withdrawal from competitive sport roles in the broader context of the role constellation and lifestyle of adolescent girls. A conceptual framework was developed to examine the process of withdrawal from the role of competitive age group swimmer. It was hypothesized that withdrawal is influenced by six categories of factors: (a) the salience of gender-role stereotypes; (b) the diversity and salience of the opportunity set; (c) the degree of social support from significant others for the sport role; (d) the extent to which the athlete role is perceived as central to personal identity; (e) the extent to which positive and negative outcomes are associated with sport involvement; and (f) the degree of commitment to the athlete role. Survey data were collected from 211 former swimmers and 193 currently involved age group swimmers in Ontario, Canada. It was concluded that a combination of factors from a variety of sources interact to influence the role transition.

Why do kids eat healthful foods?. Perceived benefits of and barriers to healthful eating and physical activity amont children and adolescents

Article

Jan 2003
J AM DIET ASSOC

J. O'Dea

Free-Living Pedometer Step Counts of High School Students

Article

Feb 2004

The purpose of this study was to examine the pedometer-measured physical activity levels of high school students (Grades 9-12). Comparisons were made between sexes, among grades, among groups based on level of participation in sport and physical education, and among groups based on levels of self-reported physical activity (based on questions from the National Youth Risk Behavior Surveillance System). Participants wore sealed pedometers for 4 consecutive school days. Results indicated no differences among days of monitoring but did show significant differences in mean steps per day between sexes, among grades, and among activity levels. Males took more steps per day than did females, and 10th graders took more steps than did 12th graders. Teens involved in sport and physical education took more steps than did those not involved. Teens who reported meeting both moderate and vigorous activity recommendations were most active, followed by teens meeting recommendations for moderate activity.

Registration of Children in a Physical Activity Program: An Application of the Theory of Planned Behavior

Article

May 1996

Community physical activity programs are a means by which children may be provided with appropriate physical activity, although it is not yet known how children register in these programs. In this research, registration of young children in community physical activity programs was assumed to be a product of decisions made by their parents. The purpose of the research was to explore the usefulness of the theory of planned behavior in predicting registration of children in a community physical activity program from decisions made by their parents. A simple random sample of 400 first-grade elementary school children resident in Heraklion, Crete, was selected. Their parents completed a questionnaire corresponding to the framework of the theory of planned behavior. It was concluded that the theory of planned behavior is valid in predicting the defined behavior.

Parental Influence on Children’s Moderate to Vigorous Physical Activity Participation: An Expectancy-Value Approach

Article

May 1993

This investigation examined parental influence on children’s moderate to vigorous physical activity (MVPA) participation via an expectancy-value model that included parents’ behavior, parents’ beliefs about their children’s MVPA, and children’s beliefs about their MVPA. The influence of parents on their children’s MVPA was investigated via questionnaires tapping the belief systems of fourth- and fifth-grade children (n=71) and their parents (n=69). Self-reported MVPA was assessed for parents and children. Correlational analyses demonstrated a number of significant relationships between parents’ belief systems and children’s MVPA behavior and children’s belief systems and their physical activity participation. Based on hierarchical regression analyses, there was no evidence of a positive relationship between parents’ physical activity behavior (role modeling) and children’s physical activity behavior. Parents’ perceptions of their children’s MVPA competence was the only parent belief system variable relate...

Parental Social Support and the Physical Activity-Related Behaviors of Youth: A Review

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