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MRC Epidemiology Unit, Institute of Metabolic Science and UKCRC Centre for Diet and Activity Research (CEDAR), Addenbrooke's Hospital, Cambridge, United Kingdom
MRC Epidemiology Unit, Institute of Metabolic Science and UKCRC Centre for Diet and Activity Research (CEDAR), Addenbrooke's Hospital, Cambridge, United Kingdom
MRC Epidemiology Unit, Institute of Metabolic Science and UKCRC Centre for Diet and Activity Research (CEDAR), Addenbrooke's Hospital, Cambridge, United Kingdom
Address correspondence to: Simon J. Griffin, DM, MRC Epidemiology Unit, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
MRC Epidemiology Unit, Institute of Metabolic Science and UKCRC Centre for Diet and Activity Research (CEDAR), Addenbrooke's Hospital, Cambridge, United Kingdom
Data are available on correlates of physical activity in children and adolescents, less is known about the determinants of change. This review aims to systematically review the published evidence regarding determinants of change in physical activity in children and adolescents.
Evidence acquisition
Prospective quantitative studies investigating change in physical activity in children and adolescents aged 4–18 years were identified from seven databases (to November 2010): PubMed, SCOPUS, PsycINFO, Ovid MEDLINE, SPORTDdiscus, Embase, and Web of Knowledge. Study inclusion, quality assessment, and data extraction were independently validated by two researchers. Semi-quantitative results were stratified by age (4–9 years, 10–13 years, and 14–18 years).
Evidence synthesis
Of the 46 studies that were included, 31 used self-reported physical activity; average methodologic quality was 3.2 (SD=1.2), scored 0–5. Of 62 potential determinants identified, 30 were studied more than three times and 14 reported consistent findings (66% of the reported associations were in the same direction). For children aged 4–9 years, girls reported larger declines than boys. Among those aged 10–13 years, higher levels of previous physical activity and self-efficacy resulted in smaller declines. Among adolescents (aged 14–18 years), higher perceived behavioral control, support for physical activity, and self-efficacy were associated with smaller declines in physical activity.
Conclusions
Few of the variables studied were consistently associated with changes in physical activity, although some were similar to those identified in cross-sectional studies. The heterogeneity in study samples, exposure and outcome variables, and the reliance on self-reported physical activity limit conclusions and highlight the need for further research to inform development and targeting of interventions.
Context
Higher levels of physical activity in childhood are associated with favorable metabolic and cardiovascular disease risk profiles,
Features of the metabolic syndrome are associated with objectively measured physical activity and fitness in Danish children: the European Youth Heart Study (EYHS).
Physical activity and its link with mental, social and moral health in young people.
in: Biddle S.J. Sallis J.F. Cavill N. Young and active? Young people and health enhancing physical activity—evidence and implications Health Education Authority,
London1998
U.S. Secretary of Health and Human Services and U.S. Secretary of Education Promoting better health for young people through physical activity and sport.
To date, a broad range of factors has been investigated, including demographic, biological, environmental, social, and psychological. Several in-depth reviews focusing on correlates of physical activity in youth have also been published.
Gender, age, SES, and parental and peer influences were among the most-researched correlates. However, previously identified correlates mostly relate to cross-sectional differences in levels of physical activity. Findings are therefore limited to hypothesis generation concerning potential causal factors and mediators.
Toward a better understanding of the influences on physical activity: the role of determinants, correlates, causal variables, mediators, moderators, and confounders.
Understanding of factors associated with physical activity would be significantly enhanced by examination of these previously identified correlates, and other factors, in longitudinal studies. Identifying determinants—potential causal factors
Toward a better understanding of the influences on physical activity: the role of determinants, correlates, causal variables, mediators, moderators, and confounders.
—and mediators of change in child and adolescent physical activity should strengthen the evidence base to inform the development and targeting of effective interventions.
”Is there nothing more practical than a good theory?” Why innovations and advances in health behavior change will arise if interventions are used to test and refine theory.
U.S. Secretary of Health and Human Services and U.S. Secretary of Education Promoting better health for young people through physical activity and sport.
research may increasingly focus on change in physical activity behavior and its determinants. However, comparatively few studies have investigated determinants of change in physical activity, and no review has so far attempted to synthesize this evidence. Following the ecologic model of physical activity behavior,
in: Glanz K. Lewis F.M. Rimer B.K. Health behavior and health education: theory, research, and practice. 2nd ed. Jossey-Bass,
San Francisco2004: 403-424
a systematic review was conducted of studies investigating potential determinants of change in physical activity in children and adolescents. The aim of the review is to collate the current evidence base, highlight research trends and limitations in physical activity determinants research, and synthesize the existing evidence.
Evidence Acquisition
Search Methods/Identification of Studies
Computer searches for reports of studies investigating determinants of change in physical activity in children and adolescents were conducted using seven electronic databases (PubMed, PsycINFO, SCOPUS, Embase, Ovid MEDLINE, Web of Knowledge, and SPORTDiscus) including all electronically archived literature within the databases up until November 2010. The search strategy was based on the study population, physical activity behavior and its longitudinal patterns, study design, and the investigation of determinants of change in physical activity.
Inclusion/Exclusion Criteria
This review was restricted to studies published in English. To be included, a study had to be a prospective study quantifying change in physical activity in children or adolescents, and assessing at least one potential determinant of change. All studies were required to include a measure of physical activity at baseline and at follow-up. In addition, participants had to be within the range of 4–18 years within their measurement periods. Intervention studies were included only if a cohort analysis assessing associations between potential determinants and change in physical activity was reported.
All types of overall physical activity domains were included, except for studies focusing on a single specific behavior, such as active transport. As heterogeneity in change in the different domains of physical activity was anticipated, an a priori decision not to stratify by domain of physical activity was made. This review considers both determinants and longitudinal correlated changes in potential determinants and physical activity. Bauman et al.
Toward a better understanding of the influences on physical activity: the role of determinants, correlates, causal variables, mediators, moderators, and confounders.
define a determinant as a preceding, causal predictor of change in physical activity. Results for determinants and associations between changes in physical activity and changes in the determinants were grouped together.
All studies identified through the database searches were extracted into an Endnote database. The titles, abstracts, and full texts of these papers were then screened for the inclusion criteria. The initial search and scanning was conducted by one reviewer and a 15% random sample was double checked at each title, abstract, and full-paper review stage, respectively. Should there have been a difference in opinions of more than one fifth of the doubly checked sample, further checks would have been completed. In four cases of differences in opinion, a consensus was reached by discussion or after consultation with a mediator. Reference lists of all papers included in the final sample were scanned for any additional relevant papers.
Data Extraction
Data extraction for all included studies was undertaken using standardized forms by one reviewer, and independently validated by a review of two random 15% samples of the included papers. Any discrepancies were resolved by discussion. The extracted data included first author, publication year, title, journal, country, study population, study setting, baseline descriptive data, physical activity measurement, analysis method, length of follow-up, number of follow-up measurements and results. Where possible, results from adjusted multivariate models were extracted instead of single variable model results. In line with previously published systematic reviews, potential determinants were categorized as biological and demographic, sociocultural, psychological, or physical environment variables following previous research.
Semiquantitative results were stratified into three groups according to the mean age of the study samples: 4–9 years, an age group covering the transitional period between ages 10–13 years and 14–18 years.
The a priori decision to stratify according to age was based on two main factors. First, correlates of physical activity have previously been shown to differ for children and adolescents
; thus, determinants of change may also differ according to age. Second, research has also suggested an impact of major life transitions on behavior change throughout the life course.
One of these transitions may be from primary to secondary school, occurring approximately between ages 10 and 13 years. Publications that did not report a mean age for the sample population were categorized into age groups according to the middle value of the reported age range.
Assessment of Methodologic Quality
A scale assessing methodologic quality was constructed (shown in Appendix A, available online at www.ajpm-online.net) and modified from previously reported checklists.
The scale was focused on internal and external validity and all studies were assessed against the scale by one reviewer and independently validated by two random 15% samples of the included studies. The five-item scale is shown in Appendix A (available online at www.ajpmonline.org). Items were marked “positive,” “negative,” or “not sufficiently described.” A total score was calculated by adding all positive scores for each assessed study. The scoring system placed an emphasis on positive scores. Negative and not sufficiently described items were treated equally in that no points were scored for either.
Strength of Evidence
Results supported by objective measures of physical activity and studies with higher methodologic quality were highlighted. The smallest individual subsample was considered as the unit of analysis.
For instance, if results were stratified by boys and girls, two samples marked “m” for boys and “f” for girls were reviewed.
Because of the expected heterogeneity in a number of key aspects of the included studies—such as the constructs used to measure the exposure variables, type of physical activity measure used, length of follow-up, setting, and study population—an a priori decision not to meta-analyze the data was made. Instead, a classification system similar to previous systematic reviews
was used. Significant associations (p<0.05) were noted as (++) or (– –), according to the direction of the association, whereas statistical findings below a threshold p-value <0.1 were reported as (+) and (–) for a positive or negative direction of association, respectively. Significant associations (p<0.05) without a stated direction of association were followed up by correspondence with the author; in case of no reply, the most likely direction of association was reported with reference to existing research. No association and inconclusive evidence were denoted by a (0) and (?), respectively. For a conclusion to be drawn, a determinant had to be reported by at least three study samples, and at least two thirds of the reported associations were required to be in the same direction.
A positive, negative, or null association was reported as ++, – –, or 00 respectively. If it was not possible to reach a conclusion, an indeterminate association was reported as ??.
Evidence Synthesis
Of 14,487 studies identified through all database searches, 163 papers were read in full and 46 papers were included (Figure 1). Potential papers were most commonly excluded because they did not address determinants of change in physical activity, examined cross-sectional data, or the sample population age did not match the review inclusion criteria (Table 1 and Appendix B [available online at www.ajpmonline.org] show descriptive summaries of all included studies
La prediction de la pratique sportive actuelle a partir du sexe, de la pratique passee et des attitudes chez des enfants: une analyse longitudinale.
Sociol Sport J.1986; 3 ([Prediction of present participation from children's gender, past participation, and attitudes: a longitudinal analysis]): 101-111
Predicting change in physical activity, dietary restraint, and physique anxiety in adolescent girls: examining covariance in physical self-perceptions.
Why are early maturing girls less active? Links between pubertal development, psychological well-being, and physical activity among girls at ages 11 and 13.
A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls.
Predicting change in physical activity, dietary restraint, and physique anxiety in adolescent girls: examining covariance in physical self-perceptions.
Why are early maturing girls less active? Links between pubertal development, psychological well-being, and physical activity among girls at ages 11 and 13.
A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls.
La prediction de la pratique sportive actuelle a partir du sexe, de la pratique passee et des attitudes chez des enfants: une analyse longitudinale.
Sociol Sport J.1986; 3 ([Prediction of present participation from children's gender, past participation, and attitudes: a longitudinal analysis]): 101-111
Predicting change in physical activity, dietary restraint, and physique anxiety in adolescent girls: examining covariance in physical self-perceptions.
Why are early maturing girls less active? Links between pubertal development, psychological well-being, and physical activity among girls at ages 11 and 13.
A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls.
Table 1Child and adolescent studies categorized by the baseline age of the included sample, publication year of the study, and analysis method employed
La prediction de la pratique sportive actuelle a partir du sexe, de la pratique passee et des attitudes chez des enfants: une analyse longitudinale.
Sociol Sport J.1986; 3 ([Prediction of present participation from children's gender, past participation, and attitudes: a longitudinal analysis]): 101-111
Why are early maturing girls less active? Links between pubertal development, psychological well-being, and physical activity among girls at ages 11 and 13.
A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls.
Predicting change in physical activity, dietary restraint, and physique anxiety in adolescent girls: examining covariance in physical self-perceptions.
La prediction de la pratique sportive actuelle a partir du sexe, de la pratique passee et des attitudes chez des enfants: une analyse longitudinale.
Sociol Sport J.1986; 3 ([Prediction of present participation from children's gender, past participation, and attitudes: a longitudinal analysis]): 101-111
Predicting change in physical activity, dietary restraint, and physique anxiety in adolescent girls: examining covariance in physical self-perceptions.
Why are early maturing girls less active? Links between pubertal development, psychological well-being, and physical activity among girls at ages 11 and 13.
A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls.
La prediction de la pratique sportive actuelle a partir du sexe, de la pratique passee et des attitudes chez des enfants: une analyse longitudinale.
Sociol Sport J.1986; 3 ([Prediction of present participation from children's gender, past participation, and attitudes: a longitudinal analysis]): 101-111
Why are early maturing girls less active? Links between pubertal development, psychological well-being, and physical activity among girls at ages 11 and 13.
Predicting change in physical activity, dietary restraint, and physique anxiety in adolescent girls: examining covariance in physical self-perceptions.
A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls.
La prediction de la pratique sportive actuelle a partir du sexe, de la pratique passee et des attitudes chez des enfants: une analyse longitudinale.
Sociol Sport J.1986; 3 ([Prediction of present participation from children's gender, past participation, and attitudes: a longitudinal analysis]): 101-111
Predicting change in physical activity, dietary restraint, and physique anxiety in adolescent girls: examining covariance in physical self-perceptions.
A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls.
Why are early maturing girls less active? Links between pubertal development, psychological well-being, and physical activity among girls at ages 11 and 13.
La prediction de la pratique sportive actuelle a partir du sexe, de la pratique passee et des attitudes chez des enfants: une analyse longitudinale.
Sociol Sport J.1986; 3 ([Prediction of present participation from children's gender, past participation, and attitudes: a longitudinal analysis]): 101-111
Predicting change in physical activity, dietary restraint, and physique anxiety in adolescent girls: examining covariance in physical self-perceptions.
Why are early maturing girls less active? Links between pubertal development, psychological well-being, and physical activity among girls at ages 11 and 13.
A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls.
Predicting change in physical activity, dietary restraint, and physique anxiety in adolescent girls: examining covariance in physical self-perceptions.
A longitudinal examination of the influence of maturation on physical self-perceptions and the relationship with physical activity in early adolescent girls.