Active Kids, Healthy Bodies. Physical Activity Promotion in Schools. An investigation of leisure-time sports, healthcare-seeking behaviour, and physical activity tracking in children

Charlotte Raadkjær Lykkegaard*

*Corresponding author for this work

Research output: ThesisPh.D. thesis

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Abstract

This thesis is based on a Danish school-based intervention study known as the Childhood Health Activity and Motor Performance School Study – Denmark (The CHAMPS-study DK), as well as the development of a mobile-friendly measurement tool to track physical activity in children. The CHAMPS-study DK was designed to promote physical activity and musculoskeletal health in children.

Physical activity is linked to numerous health benefits, yet many children are not meeting the WHO´s guidelines for daily physically activity, potentially leading to various health problems. To address this issue, several school-based interventions have been developed and implemented with the goal of promoting physical activity among children. The CHAMPS-study DK was one such intervention. It involved four control schools that maintained the mandatory two physical education classes per week and six sports schools that implemented an additional four physical education classes per week (4 times 45 minutes) based on an age-related training concept designed by Team Danmark. Data on weekly organised sports participation and experienced musculoskeletal complaints were obtained using SMS-tracking. Parents of children with musculoskeletal complaints, regardless of school type, were contacted by the research team clinicians by telephone to ensure appropriate treatment and supervision. If deemed necessary, the child was offered an examination. 

Previous findings from the CHAMPS-study DK indicate that the introduction of additional physical education classes in the sports schools led to increased physical activity levels among sports school children during school hours but did not result in an overall increase in their daily physical activity levels. Hower, there has not been an exploration of how children´s physical activities were distributed across school, transportation, household, and leisure time, including their participation in organised leisure-time sports. Additionally, an investigation of their healthcare-seeking behaviour before, during and after the CHAMPS-study period has not been conducted. 

This thesis addresses parts of this research gap through two studies (Paper I and II). Firstly, we explored CHAMPS-children´s trajectories of sports participation over five years and how their physical abilities at a young age were associated with their long-term involvement in sports. Secondly, we investigated whether participating in the CHAMPS-study DK was associated with changes in visits to physiotherapists, chiropractors, and general practitioners, and whether this association was sustained over time. In the third study, unrelated to CHAMPS, we developed and piloted a Danish mobile application version of the Oxford Physical Activity Questionnaire (OPAQ) for children, aiming to measure daily physical activity in all domains, including school, transportation, household, and  leisure time.

We identified five distinct subgroups each displaying different rates of increase and decrease in organised leisure-time sports participation, peaking around age 14 in the three most active groups followed by a decrease across all three groups. All genders were equally represented across all five subgroups, however, the distribution of children from the two school types did vary. We found a higher proportion of control school children in the most active sports participation trajectory subgroups, and conversely, a higher proportion of sports school children in the less active subgroups. After controlling for sex and school type, we found that children aged 5 to 10 years old who demonstrated a high motor performance score at the beginning of the study were more likely to be allocated to one of the two most sports-active trajectory subgroups than children with a low score. Furthermore, we found that children who participated in the CHAMPS-study DK modified their healthcare-seeking behaviour during the period after the CHAMPS-study compared to children who did not participate in the CHAMPS-study DK and maintained these changes for at least five years after the study had ended. Finally, we found that the Danish online version of the Oxford Physical Activity Questionnaire was a straightforward and quick tool for children to complete, but it tended to underestimate moderate to vigorous physical activities by approximately 30 minutes per day compared to ActiGraph-GX3 accelerometer.

In conclusion, school-based interventions, such as the CHAMPS-study DK, effectively increased physical activity levels during school hours, but did not result in an overall increase in total daily physical activity. In our study, we found that one explanatory factor for this lack of increase could be attributed to lower engagement in organised leisure-time sports among children from the intervention schools. Our study revealed that children aged 5 to 10 years old with a high baseline motor performance score participated more in organised leisure-time sports than their peers with a low motor performance score. Additionally, we observed a tendency for organised leisure-time sports participation to decline around age 13-14. This implies the potential benefits of age-differentiated interventions to promote physical activity, such as implementing motor performance programs for younger children, and encouraging active transportation to school and introducing physical activity throughout the school day for middle and secondary students.

Furthermore, within the CHAMPS-study, children with musculoskeletal complaints showed a change in healthcare-seeking preferences. Utilisation of physiotherapy and chiropractic services increased, while general practitioner services declined, persisting for at least five years post-CHAMPS. This suggests that research studies involving systematic interactions with participants experiencing musculoskeletal complaints may influence subsequent healthcare-seeking behaviour. Future research should address the influence of health literacy, health education, and healthcare provider recommendations on the participant’s healthcare decisions during such research studies. 

To effectively increase the proportion of children meeting the WHO´s guidelines for daily activity, it is crucial to gain a deeper understanding of the factors that either facilitate or hinder their engagement in physical activities, as well as the types and patterns of activities they typically prefer. In this regard, a mobile application version such as the Danish online version of Oxford Physical activity questionnaire may serve as a useful tool for tracking physical activity where objective measures are not feasible. However, it is important to note that a thorough validation process is necessary before recommending our version of OPAQ for use in future research. 

Finally, to achieve the World Health Organization´s (WHO) Global action plan on physical activity 2018-2030, future investment, funding, and political and leadership support at national, regional, and local levels are vital, and this thesis emphasizes the need for continued research and intervention.
Original languageEnglish
Awarding Institution
  • University of Southern Denmark
Supervisors/Advisors
  • Søndergaard, Jens, Principal supervisor
  • Holden, Sinéad, Co-supervisor, External person
  • Wehberg, Sonja, Co-supervisor
  • Wedderkopp, Niels, Supervisor
  • Waldorff, Frans Boch, Supervisor
Date of defence16. Apr 2024
Publisher
DOIs
Publication statusPublished - 30. Jan 2024

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