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Sports participation, psychosocial health and health-related quality of life
Moeijes, J.
2019
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Moeijes, J. (2019). Sports participation, psychosocial health and health-related quality of life: A cross-sectional and longitudinal study in Dutch primary school children.
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In the General introduction (Chapter 1), clear indications of a positive relationship between sports participation and health were presented. However, a number of research gaps were signalled.
Whereas most empirical studies in this field pertain to physical health, fewer studies are available on the relationship between sports participation and psychosocial health or health-related quality of life. Furthermore, the relationship of sports participation with psychosocial health or health-related quality of life has been investigated primarily in adults and adolescents. This relationship has been studied in children to a relatively limited extent. Finally, studies on the relationship between sports participation and psychosocial health or health-related quality of life mostly do not pay attention to several characteristics of sports participation simultaneously. These studies often focus on just one characteristic, for instance on frequency of sports participation or its individual versus team sports characteristic.
These research gaps stimulated the start of a large-scale research project based on the question on whether characteristics of sports participation are associated with psychosocial health and health-related quality of life in children.
From the population of Dutch primary schoolchildren in the fourth and fifth grade approximately 2,300 children have been studied and were involved in the cross-sectional analyses. About 500 children were also involved in the longitudinal analyses. Children’s sports participation, psychosocial health and health-related quality of life (HRQoL) have been examined by means of the Movement and Sports Monitor Questionnaire – Youth Aged 8–12 Years (MSMQ), the Strengths and Difficulties Questionnaire (SDQ) and the KIDSCREEN -52. Children filled in the questionnaires by themselves.
For a quick overview of the research findings described in Chapter 2 to 6, Table 1 displays the crosssectional and/or longitudinal associations that were found between several characteristics of sports participation on the one hand and the three aspects of psychosocial health (internalising problems, externalising problems and prosocial behavior) and the ten dimensions in the three domains of HRQoL (physical, psychological and social domain) on the other.
The general conclusion based on Table 1 is that for children, a number of characteristics of sports participation are associated with both (aspects of) psychosocial health and (dimensions of) HRQoL.
fewer internalising problems and better prosocial behaviour and only to a very limited extent associated with fewer externalising problems in children. The associations of membership of a sports club and frequency of sports participation with fewer internalising problems are for boys more prominent than for girls. For girls, the association of frequency of sports participation with better prosocial behaviour is more pronounced.
The intermediate constructs ‘sports self-concept’ and ‘self-esteem’ may help to clarify the associations of membership of a sports club and higher frequency of sports participation with fewer internalising problems. It is suggested that a more positive sports self-concept is beneficial for a child’s self-esteem (Bowker, 2006; Findlay & Coplan, 2008; Lee & Stone, 2012), which in turn might result in stronger resilience against internalizing problems (Bowker, Gadbois, & Cornock, 2003; Slutzky & Simpkins, 2009). However, we cannot rule out the possibility that higher frequency of par ticipation in sports activities is not a cause but a consequence of having a better self-concept and higher self-esteem or that the relationship may be bi-directional (Da Silva et al., 2012; Vella, Swann, Allen, Schweickle, & Magee, 2017).
The finding that frequency of sports participation (within the group of sports club members) was not associated with externalising problems might be explained by means of the intermediate concept of effortful control. This concept can be defined as the ‘ability to willfully or voluntarily inhibit, activate, or change (modulate) attention and behavior, as well as executive functioning tasks of planning, detecting errors, and integrating information relevant to selecting behavior’ (Eisenberg, Smith, & Spinrad, 2004, p. 263). Externalizing problems may be considered a consequence of a lack of effortful control (Eisenberg et al., 2001). A person’s effortful control is largely biologically rooted and relatively stable across time and contexts (Bates, Schermerhorn, & Petersen, 2012; Eisenberg et al., 2004), mainly evolving between the ages of 2 and 7 (Schermerhorn et al., 2013). The children in our sample, who were aged between 10 and 12 years, had probably already achieved such stability in their effortful control, such that this ability was little influenced by a higher frequency of sports participation. An explanation for the association observed between membership of a sports club and less externalising problems could be that non-athletes already have externalizing problems that prevent them from joining a sports club. Involvement in a sports club requires a child to obey the instructions of a supervisor or coach (Larson, 2000). Perhaps children with more externalizing problems are less willing to accept rules and authority, and, therefore, would be less likely to participate in a sports club.
to developing and sustaining adequate prosocial behaviour. A reverse explanation is, however, also possible. Children with poor prosocial behaviour may not become or stay a member of a sports club because they often have many behavioural problems (Denault & Déry, 2015). As indicated in the previous paragraph, many behavioural problems in combination with poor prosocial behaviour may cause that these children are not willing to stick to agreements and to behave according rules.
The finding that membership of a sports club and higher frequency of sports participation are more prominently associated with fewer internalising problems for boys than for girls is in line with previous studies. Ahn and Fedewa (2011) and Molinuevo, Bonillo, Pardo, Doval, and Torrubia (2010)also reported that boys had greater psycho-logical benefits from sports than girls. An ex planation may be that, in general, boys derive more self-esteem from success in sports activities than girls (Bowker, 2006; Daley, 2002). Bowker (2006)reported that satisfaction with physical competence (skills, fitness) influences a boy’s self-esteem, whereas satisfaction with physical appearance (body, weight) was of more significance for most girls. Furthermore, Chalabaev, Sarrazin, Fontayne, Boiché, and Clément-Guillotin (2013) and Plaza, Boiché, Brunel, and Ruchaud (2016)argued that boys and girls are susceptible to stereotype effects. Because sports participation is still largely considered to be a male activity in Western society, the impact of sports partici pation on one’s self-esteem varies by sex (Capranica et al., 2013; Deaner et al., 2012; Eagleman, 2015).
The more pronounced associations between higher frequency of sports participation and better prosocial behaviour for girls could be due to a difference between the sexes in how aggression and empathy are expressed during sports. Girls behave less aggressively than boys during sports activities because of both complex social and cultural expectations and the physical characteristics of boys and girls (Coulomb‐Cabagno & Rascle, 2006; Stanger, Kavussanu, & Ring, 2017). Stanger et al. (2017) found that men have more aggressive sports attitudes than women. Women have an attitude to sports which is characterized more by empathy, which tends to prevent them from acting aggressively towards others (Kavussanu, Stanger, & Boardley, 2013) and is, therefore, conducive to the development of prosocial behaviour.
A second conclusion is that with respect to HRQoL, membership of a sports club and higher frequency of sports participation are largely associated with a better HRQoL for the physical domain, to a slightly lesser extent with a better HRQoL for social domain, and to a limited extent with a better HRQoL in the psychological domain.
physical condition (Boyle, Jones, & Walters, 2010; Morales et al., 2013), which in turn results in higher physical well-being (Borras, Vidal, Ponseti, Cantallops, & Palou, 2011; Gu, Chang, & Solmon, 2016). Furthermore, the ‘feel-good’ effect of performing sports activities (Biddle, Mutrie, & Gorely 2015), which is expressed in, amongst others, a better subjective vitality refers to feeling alive and energetic after sports participation and occurs after at least moderate active sports participation (Reed & Buck, 2009).
With respect to the social domain, the association of membership of a sports club and higher frequency of sports participation with better HRQoL does suggest that organised sports activities provide possibilities for children to interact with friends and peers (Howie, Lukacs, Pastor, Reuben, & Mendola, 2010). These interactions facilitate positive social experiences (Holt, Tamminen, Tink, & Black, 2009; Pierce, Gould, & Camiré, 2017) and acquiring better social skills leading to a more favourable HRQoL (Breslin et al., 2012; Chen et al., 2014). Contrary to some investigators who reported negative effects of sports participation (Missiuna et al., 2014; Piek, Barrett, Allen, Jones, & Louise, 2005), our research findings are positive in the social domain. However, one could argue that children who have difficulties to engage in positive behaviours towards peers or stand at risk of being bullied might refrain from becoming a member of a sports club (Jankauskiene, Kardelis, Sukys, & Kardeliene, 2008).
Regarding the psychological domain, an explanation for the association of higher frequency of sports participation with better HRQoL might be that high sports-active children fulfil basic psychological needs for autonomy, competence and relatedness by spending several days per week at a sports club (Teixeira, Carraça, Markland, Silva, & Ryan, 2012). Furthermore, high or moderate sports-active children have the possibility to develop better motor skills, which in turn contributes to a positive sports self-perception (Babic et al., 2014; Balish, McLaren, Rainham, & Blanchard, 2014; Liu, Wu, & Ming, 2015; Robinson et al., 2015). Finally, the ‘feel-good’ effect of high or moderate active sports participation gives, besides benefits in the physical domain, also a pleasant mood and joy in the psychological domain (Reed & Buck, 2009).
Finally, a third more specific conclusion in the light of the research question is that contrary to membership of a sports club and frequency of sports particpation, the kind of sport(s) in which a child participates (i.e., indoor versus outdoor sports, individual versus teams sports, involvement in competition or not, and contact versus non-contact sports) seems to be of minor importance. In the present study, only a very limited number of associations with psychosocial health and HRQoL were found for the characteristics ‘performing indoor versus outdoor sports’ and ‘performing individual versus team sports’.
some studies in the field of outdoor exercise. Barton, Bragg, Wood, and Pretty (2016) observed that being active outdoors was associated with less depressive feelings in adults. An explanation for this might be that being outdoors has by itself a beneficial influence on someone’s brain (Mantler & Logan, 2015) and this, added with the effect of sports activity, could explain the positive influence of outdoor sports on mood, resulting in less depressive feelings (Barton et al., 2016). Another explanation may be that being active outdoor gives more opportunity to sunlight exposure (Sarris, O’Neil, Coulson, Schweitzer, & Berk, 2014), which might enhance vitamin D levels (Föcker et al., 2017). Although the results of studies in adults are inconsistent (Sarris et al., 2014), there are indications that low vitamin D levels are associated with depressed mood in children (Föcker et al., 2017).
The present study shows very limited associations between performing individual versus team sports with psychosocial health and HRQoL. An explanation might be that the distinction between individual and team sports is not that straightforward. Children participating in individual sports usually train together in groups just like children participating in team sports and, therefore, largely share the same group processes as team athletes (Donkers, Martin, & Evans, 2016). The positive effects of being a member of a group on psychosocial health or HRQoL (Vella, Magee, & Cliff, 2015) might occur not only in children performing team sports but also in children performing individual sports.
Additional analyses on the relationship between sports participation and HRQoL
In the analyses presented thus far, the relationship between a child’s sports participation and his or her HRQoL was analysed without taking the child’s psychosocial health into consideration. However, it is theoretically plausible that psychosocial health is a mediator and/or moderator in the relationship between sports participation and HRQoL (Otto et al., 2017; Ravens-Sieberer et al., 2008). This issue will be investigated below by some additional analyses that were conducted in order to shed more light on the interplay between our three key study outcomes.
METHODS
The mediation effect of psychosocial health was determined by calculating the percentage difference between the regression coefficient of the total effect and the regression coefficient of the direct effect (Rijnhart, Twisk, Chinapaw, de Boer, & Heymans, 2017). These additional analyses were controlled for gender, BMI, age, SES and household composition as covariates, as was the case with the analyses presented in Chapters 2 to 6.
The following procedure was applied. First, we investigated whether the total effect (path C) of sports participation in the relationship with HRQoL was significant. Subsequently, we determined the direct effect (path C’) of sports participation in the relationship with HRQoL by controlling for psychosocial health as a potential mediator. Finally, we assessed the percentage mediation by psychosocial health (1-(C’/C)). In addition to its mediator role, psychosocial health can also be a moderator. The moderating effect (also known as effect modification) of psychosocial health was analysed by adding the interaction term between sports participation and psychosocial health to the model to analyse the relationship between sports participation and HRQoL. When the interaction term is significant in this relationship, than significant moderation is demonstrated. The sign of the interaction term, positive or negative, reflects the stimulating or inhibiting effect of psychosocial health in the relationship between sports participation and HRQoL (Twisk, 2010).
The mediation and moderation analyses were restricted in four respects. First, the analyses whether psychosocial health is a mediator and/or moderator in the relationship between sports participation and HRQoL were based on cross-sectional data. The number of cases in the cross-sectional sample is much larger than the one in the longitudinal sample and thus offers better possibilities to establish possible associations with respect
Figure 1. Psychosocial health as a mediator in the relationship between sports participation and
HRQoLFigure 1. Psychosocial health as a mediator in the relationship between sports participation and HRQoL
Sports participation HRQoL
Sports participation HRQoL
PSH path C’ path C Total effect
Second, in the mediation analyses, we only paid attention to significant cross-sectional associations between characteristics of sports participation and dimensions of HRQoL. These are the cross-sectional associations presented in Chapter 5 of this thesis. Although the restriction to significant associations between sports participation and HRQoL was not necessary to establish possible mediation by psychosocial health (Rijnhart et al., 2017), it was done to limit the number of analyses.
Third, the mediation and moderation analyses focused on two characteristics of sports participation, namely membership of a sports club and frequency of sports participation since these two characteristics showed the largest number of associations with different dimensions of HRQoL (see Table 1 above).
Fourth, with respect to psychosocial health, only internalising problems and prosocial behaviour were taken into consideration in the mediation analyses. Because only a very small number of significant associations between sports participation and externalising problems were found (as has been noted in the first part of this chapter), externalising problems cannot be a mediator of any importance in the relationship between sports participation and HRQoL. However, it is not inconceivable that externalizing problems is a moderator in this relationship. Therefore, in contrast to the mediation analyses, the moderation analyses took all three aspects of psychosocial health into account and paid also attention to externalising problems.
RESULTS Mediation
Membership of a sports club
Table 2 and 3 show the results of the mediation analyses with respect to the associations between membership of a sports club and HRQoL. As announced above, these tables present only information about the HRQoL dimensions for which significant associations with membership of a sports club were found.
Figure 2. Psychosocial health as a moderator in the relationship between sports participation and
HRQoL
Figure 2. Psychosocial health as a moderator in the relationship between sports participation and HRQoL
Sports participation HRQoL
Table 3 shows the mediation effect of prosocial behaviour in the associations of membership of a sports club with HRQoL.
As has been shown in Tables 2 and 3, the association between membership of a sports club and the dimension in the physical domain of HRQoL is more strongly mediated by internalising problems (12%) than by prosocial behaviour (6%). The same is observed for the associations with respect to one out of three dimensions in the psychological domain (40% versus 18%) and five out of six dimensions in the social domain (14-47% versus 11-22%) of HRQoL.
Table 2. Percentage mediation of internalising problems in the cross-sectional associations between
mem-bership of a sports club and seven dimensions of HRQoL (n=1,876)
Membership sports cluba
Membership sports club controlled for
internalising problemsa %Mc
Total effect (path C) Direct effect (path C’)
Domain Dimension Bb CI Bb CI
Physical domain Physical well-being 4.24*** 3.02 - 5.47 3.75*** 2.58 - 4.92 12%
Psychological domain Self-perception 1.34* 0.15 - 2.53 0.81 -0.31 - 1.93 40%
Social domain Autonomy 1.78** 0.64 - 2.93 1.29* 0.21 - 2.38 28%
Parents and home life 1.43** 0.32 - 2.54 0.97 -0.08 - 2.01 32%
Financial resources 2.55*** 1.37 - 3.74 2.19*** 1.03 - 3.35 14%
Social support and peers 1.63** 0.44 - 2.81 1.17* 0.04 - 2.31 28%
Social acceptance (bullying) 1.66* 0.30 - 3.02 0.88 -0.34 - 2.12 47%
a Adjusted for sex, age, BMI, neighbourhood SES, household composition
b Unstandardized regression coefficient
c Percentage mediation
* p<0.05; ** p<0.01; *** p<0.001
Table 3. Percentage mediation of prosocial behaviour in the cross-sectional associations between
mem-bership of a sports club and seven dimensions of HRQoL (n=1,876)
Membership sports cluba
Membership sports club controlled for prosocial
behavioura %Mc
Total effect (path C) Direct effect (path C’)
Domain Dimension Bb CI Bb CI
Physical domain Physical well-being 4.24*** 3.02 - 5.47 3.98*** 2.77 - 5.18 6%
Psychological domain Self-perception 1.34* 0.15 - 2.53 1.10 -0.07 - 2.27 18%
Social domain Autonomy 1.78** 0.64 - 2.93 1.45** 0.33 - 2.56 19%
Parents and home life 1.43** 0.32 - 2.54 1.11* 0.04 - 2.18 22%
Financial resources 2.55*** 1.37 - 3.74 2.27*** 1.11 - 3.44 11%
Social support and peers 1.63** 0.44 - 2.81 1.28* 0.13 - 2.43 21%
Social acceptance (bullying) 1.66* 0.30 - 3.02 1.42* 0.07 - 2.77 14%
a Adjusted for sex, age, BMI, neighbourhood SES, household composition
b Unstandardized regression coefficient
c Percentage mediation
Frequency of sports participation
Tables 4 and 5 show the results of the mediation analyses regarding frequency of sports participation and HRQoL. The tables present only information about the HRQoL dimensions for which significant associations with frequency of sports participation were observed.
As can be seen from Table 4 and 5, the associations between frequency of sports participation and five out of ten dimensions of HRQoL were stronger mediated by internalising problems than by prosocial behaviour.
Moderation (effect modification)
The last additional analyses presented here focus on possible moderation by internalising problems, externalising problems and prosocial behaviour in the associations between membership of a sports club or frequency of sports participation and the ten HRQoL dimensions. For a brief and handy overview of the results, Table 6 presents only information about the HRQoL dimensions for which significant moderation was found.
As can be seen in Table 6, with respect to internalising problems, there was no significant moderation with the HRQoL dimensions.
Table 4. Percentage mediation of internalising problems in the cross-sectional associations between
fre-quency of sports participation and five dimensions of HRQoL (n=1,588)
Frequency of sports
participation in tertilesa
Frequency of sports participation in tertiles controlled for
internalising problemsa %Mc
Total effect (path C) Direct effect (path C’)
Domain Dimensions Bb CI Bb CI
Physical domain Physical
well-being high sports-activemoderate sports-active -1.02reference group-2.13 - 0.10 -1.05reference group-2.11 - 0.01
low sports-active -3.63*** -4.75 to -2.48 -2.98*** -4.07 to -1.90 18%
Psychological
domain Psychological well-being high sports-activemoderate sports-active -0.55reference group-1.62 - 0.51 -0.61reference group-1.60 - 0.36
low sports-active -1.46** -2.54 to -0.37 -0.62 -1.57 - 0.35 58%
Social domain Parents and
home life high sports-activemoderate sports-active -0.77reference group-1.77 - 0.24 -0.80reference group-1.74- 0.15
low sports-active -1.53** -2.55 to -0.50 -0.90 -1.87 – 0.06 41%
Financial
resources high sports-activemoderate sports-active -0.58reference group-1.61 - 0.46 -0.60reference group-1.61 – 0.41
low sports-active -1.18* -2.23 to -0.13 -0.76 -1.79 - 0.26 19%
School
environment high sports-activemoderate sports-active -0.47reference group-1.52 - 0.59 -0.50reference group-1.52 - 0.50
low sports-active -1.17* -2.25 to -0.09 -0.67 -1.72 - 0.37 43%
a Adjusted for sex, age, BMI, neighbourhood SES, household composition
b Unstandardized regression coefficient
c Percentage mediation
With regard to externalising problems, significant moderation was found in the associations between frequency of sports participation and the HRQoL dimensions ‘physical well-being’, ‘social acceptance (bullying)’ and ‘school environment’. On the one hand, children with more externalising problems seem to profit less from participating more frequently in sports activities with respect to the HRQoL domain ‘physical well-being’. One may argue that since these children often display hyperactive behaviour, sporting more frequently probably does not give them the extra ‘feel good’-effect that children with fewer externalizing problems get from exercising more often. On the other hand, children with more externalizing problems seem to benefit more from exercising with a higher frequency with respect to the dimensions ‘social acceptance (bullying)’ and ‘school environment’. A possible explanation for this could be that children with more externalising problem have less effortful control which prevents them from behaving adequately in relation to peers and at school (Denault & Déry, 2015). Due to their behavioural problems a substantial frequency of sports participation might be necessary to acquire social skills needed for resisting the bully and feeling at ease at school, resulting in higher satisfaction and joy with regard to these dimensions of their HRQoL.
Table 5. Percentage mediation of prosocial behaviour in the cross-sectional associations between
frequen-cy of sports participation and five dimensions of HRQoL (n=1,588)
Frequency of sports
participation in tertilesa
Frequency of sports
participationin tertiles
controlled for prosocial
behavioura %Mc
Total effect (path C) Direct effect (path C’)
Domain Dimension Bb CI Bb CI
Physical domain Physical well-being
high sports-active reference group reference group
moderate sports-active -1.02 -2.13 - 0.10 -1.01 -2.11 - 0.08
low sports-active -3.63*** -4.75 to -2.48 -3.50*** -4.61 to -2.39 4%
Psychological
domain Psychological well-being high sports-activemoderate sports-active -0.55reference group-1.62 - 0.51 -0.57reference group-1.59 - 0.46
low sports-active -1.46* -2.54 to -0.37 -1.35* -2.40 to -0.31 8%
Social domain Parents and
home life high sports-activemoderate sports-active -0.77reference group-1.77 - 0.24 -0.77reference group-1.74 - 0.21
low sports-active -1.53** -2.55 to -0.50 -1.43** -2.43 to -0.44 7%
Financial
resources high sports-activemoderate sports-active -0.58reference group-1.61 - 0.46 -0.58reference group-1.60 - 0.44
low sports-active -1.18* -2.23 to -0.13 -1.12* -2.15 to -0.08 5%
School
environment high sports-activemoderate sports-active -0.47reference group-1.52 - 0.59 -0.47reference group-1.49 - 0.54
low sports-active -1.17* -2.25 to -0.09 -1.08* -2.11 to -0.04 8%
a Adjusted for sex, age, BMI, neighbourhood SES, household composition
b Unstandardized regression coefficient
c Percentage mediation
With respect to prosocial behaviour, there was significant moderation in the association between frequency of sports participation and the HRQoL dimension ‘autonomy’. In children with better prosocial behaviour frequent sports participation and autonomy were more strongly associated than in children with less prosocial behaviour. This might be explained from the assumption that people, including children, can only feel free and autonomous when they behave friendly and nice towards peers. Good prosocial behaviour might be a condition for experiencing freedom and autonomy (cf. Caprara & Steca, 2005).
RELEVANCE FOR PRACTITIONERS
Based on the results of the present study, it seems that sports participation is beneficial for a child’s psychosocial health and HRQoL. In particular, being member of a sports club and performing sports activities with a moderate or high frequency are associated with both a better psychosocial health and a better HRQoL. This also applies, albeit to a small extent, to performing outdoor sports (contrary to indoor sports).
The relationship between a child’s sports participation and his or her HRQoL seems to be mediated substantially by psychosocial health, which means that this relationship occurs to a considerable degree through psychosocial health. Furthermore, the relationship between a child’s sports participation and his or her HRQoL seems to be moderated to a limited extent by the child’s psychosocial health, which means that this relationship is mostly independent of the extent to which a child had better or worse psychosocial health.
Table 6. Moderation by aspects of psychosocial health in the association between membership of a
sports club or frequency of sports participation and HRQoL Internalising
problems
Adjusteda
Externalising problems
Adjusteda Prosocial behaviourAdjusteda
HRQoL domain HRQoL
dimension Characteristic of sports participation B
b p CI Bb p CI Bb p CI
Physical domain Physical
well-being Frequency of sports participation NS -0.41 0.03 NS
Social
domain Autonomy Frequency of sports participation NS NS 0.93 0.01
Social acceptance (bullying) Frequency of sports participation NS 0.38 0.05 NS School
environment Frequency of sports participation NS 0.37 0.02 NS
a Adjusted for sex, age, BMI, neighbourhood SES, household composition
b regression coefficient for the interaction term
What are the practical implications of these findings and which recommendations can be made?
Practical implications
A first implication is that children should be encouraged to participate frequently in any kind of organized sports activities. Sports participation seems to be beneficial for a child’s psychosocial health and his or her HRQoL. Frequency of sports participation appears thereby to be much more relevant for a child’s psychosocial health and his or her HRQoL than the kind of sport(s) in which the child participates. Therefore, the choice for a sport that the child can and likes to do with a relatively high frequency is more important than the choice for a certain type of sport.
A second implication is that the promotion of sports participation aimed at fostering children’s HRQoL should not only be limited to children with poor psychosocial health. Sports participation seems to be beneficial for a child’s HRQoL, regardless the level of his or her psychosocial health. The associations observed between sports participation and HRQoL are moderated by a child’s psychosocial health only to a small extent.
A final implication is that a child’s HRQoL may be improved by sports activities that are conducive to the child’s psychosocial health. Most of the observed associations between sports participation and HRQoL are mediated by the child’s psychosocial health. This implies that sports activities that are profitable for a child’s psychosocial health may also be beneficial for his or her HRQoL.
Recommendations
How can children be stimulated to participate in any kind of organised sports activities on a regular base? Focusing on the context in which the children of the present study were investigated, i.e., primary schools, a number of recommendations can be made.
Second, primary schools could stimulate students to participate in the activities of a ‘sports mix organisation’ or ‘club extra’. Such organisations, which are found incidentally in the Netherlands, provide sports and play activities for children who are currently not able to participate in the activities of regular sports clubs due to motor and/or psychosocial problems. The sports mix activities are adapted to the level of these children, both in terms of their motor skills as well as in terms of their psychosocial development. During the sports mix course, which can have a varying duration for each child, children get the chance to develop further motorically and/or psychosocially until they are sufficiently equipped to participate in regular sports club activities. This way, children with motor and/or psychosocial problems may be empowered to make a switch to a regular sports club in the near future (De Meij, Chin A Paw, Kremers, Jurg, & van Mechelen, 2010; Van de Geer, 2005).
Third, because the proximity of a school to sport clubs does not seem to provide an advantage with regard to sports participation (Pot & Van Hilvoorde, 2013), primary schools should make greater use of the possibility to appoint an official who is partly employed by the primary school and partly working for one or more sports clubs in the immediate environment of the school. This linking pin construction, performed by a so-called ‘combination officer’, is quite common in the Netherlands and is conducive to the mutual coordination between physical education activities at school and the activities of the sports clubs, which may children stimulate to become member of a sports club (De Meester, Aelterman, Cardon, De Bourdeaudhuij, & Haerens, 2014; Vereniging Sport en Gemeenten, 2008).
Finally, elementary schools, ‘sports mix organisations’ and sports clubs could make use of the services of psychomotor therapists. These professionals can stimulate and guide children with behavioural problems in participating in sports activities. They are able to do so because of their expertise in both the field of psychosocial health and the field of human movement. This dual expertise makes them suited for helping children with mental and/or motor problems to take part in organised sports activities (NVPMT, 2009; Probst, Van Damme, & Vancampfort, 2017; Emck, Van Damme, & De Lange, in preparation).
FUTURE RESEARCH
Stavrakakis, De Jonge, Ormel, & Oldehinkel, 2012; Vella et al., 2017), intervention-based research can provide more insight into mechanisms and processes behind the observed associations between sports participation and psychosocial health/HRQoL.
Furthermore, future research might take more characteristics of sports participation into consideration. For example, the intensity of sports activities could be taken into account. The literature provides indications that the intensity of sports participation has a relationship with a person’s psychosocial health and HRQoL (Breslin et al., 2012; Brown et al., 2004; Wu et al., 2017). In the present study, the intensity of sports activities could not be properly measured, because we used self-report questionnaires. A more valid and reliable method is to have children wear an accelerometer during their sports activities.
REFERENCES
Ahn, S., & Fedewa, A. L. (2011). A meta-analysis of the relationship between children’s physical activity and mental health. Journal of Pediatric Psychology, 36(4), 385-397. https://doi.org/10.1093/jpepsy/jsq107 Babic, M. J., Morgan, P. J., Plotnikoff, R. C., Lonsdale, C., White, R. L., & Lubans, D. R. (2014). Physical
activity and physical self-concept in youth: Systematic review and meta-analysis. Sports Medicine, 44(11), 1589-1601. https://doi.org/10.1007/s40279-014-0229-z
Balish, S. M., McLaren, C., Rainham, D., & Blanchard, C. (2014). Correlates of youth sport attrition: A review and future directions. Psychology of Sport and Exercise, 15(4), 429-439. https://doi.org/10.1016/j. psychsport.2014.04.003
Barton, J., Bragg, R., Wood, C., & Pretty, J. (2016). Green exercise: Linking nature, health and well-being. New York: Routledge.
Bates, J. E., Schermerhorn, A. C., & Petersen, I. T. (2012). Temperament and parenting in developmental perspective. In M. Zentner & R. L. Shiner (Eds.), Handbook of temperament (pp. 425-441). New York, NY: The Guilford Press.
Biddle, S., Mutrie, N., & Gorely, T. (2015). Physical activity and psychological well-being: Does physical activity make us feel good? In S. Biddle, N. Mutrie, & T. Gorely (Eds.), Psychology of physical activity (3 ed., pp. 33-67). London/New York: Routlegde.
Borras, P. A., Vidal, J., Ponseti, X., Cantallops, J., & Palou, P. (2011). Predictors of quality of life in children.
Journal of Human Sport and Exercise, 6(4), 649-656. https://doi.org/10.4100/jhse.2011.64.08
Bowker, A. (2006). The relationship between sports participation and self-esteem during early adolescence.
Canadian Journal of Behavioural Science/Revue Canadienne des Sciences du Comportement, 38(3), 214-229.
https://doi.org/10.1037/cjbs2006009
Bowker, A., Gadbois, S., & Cornock, B. (2003). Sports participation and self-esteem: Variations as a function of gender and gender role orientation. Sex Roles, 49(1-2), 47-49. https://doi.org/10.1023/A:1023909619409 Boyle, S. E., Jones, G. L., & Walters, S. J. (2010). Physical activity, quality of life, weight status and diet in
adolescents. Quality of Life Research, 19(7), 943-954. https://doi.org/10.1023/A:1023909619409
Breslin, G., Gossrau-Breen, D., McCay, N., Gilmore, G., MacDonald, L., & Hanna, D. (2012). Physical activity, gender, weight status, and wellbeing in 9-to 11-year-old children: A cross-sectional survey. Journal
of Physical Activity and Health, 9(3), 394-401. https://doi.org/10.1123/jpah.9.3.394
Brown, D. W., Brown, D. R., Heath, G. W., Balluz, L., Giles, W. H., Ford, E. S., & Mokdad, A. H. (2004). Associations between physical activity dose and health-related quality of life. Medicine & Science in Sports
& Exercise, 36(5), 890-896. https://doi.org/10.1249/01.MSS.0000126778.77049.76
Capranica, L., Piacentini, M. F., Halson, S., Myburgh, K. H., Ogasawara, E., & Millard-Stafford, M. (2013). The gender gap in sport performance: Equity influences equality. International Journal of Sports Physiology
and Performance, 8(1), 99-103. https://doi.org/10.1123/ijspp.8.1.99
Caprara, G. V., & Steca, P. (2005). Self–efficacy beliefs as determinants of prosocial behavior conducive to life satisfaction across ages. Journal of Social and Clinical Psychology, 24(2), 191-217. https://doi.org/10.1521/ jscp.24.2.191.62271
Chalabaev, A., Sarrazin, P., Fontayne, P., Boiché, J., & Clément-Guillotin, C. (2013). The influence of sex stereotypes and gender roles on participation and performance in sport and exercise: Review and future directions. Psychology of Sport and Exercise, 14(2), 136-144. https://doi.org/10.1016/j.psychsport.2012.10.005 Chen, G., Ratcliffe, J., Olds, T., Magarey, A., Jones, M., & Leslie, E. (2014). BMI, health behaviors, and quality
of life in children and adolescents: A school-based study. Pediatrics, e868-e874. https://doi.org/10.1542/ peds.2013-0622
Chesham, R. A., Booth, J. N., Sweeney, E. L., Ryde, G. C., Gorely, T., Brooks, N. E., & Moran, C. N. (2018). The Daily Mile makes primary school children more active, less sedentary and improves their fitness and body composition: A quasi-experimental pilot study. BMC Medicine, 16(1), 64-76. https://doi.org/10.1186/ s12916-018-1049-z
Da Silva, M. A., Singh-Manoux, A., Brunner, E. J., Kaffashian, S., Shipley, M. J., Kivimäki, M., & Nabi, H. (2012). Bidirectional association between physical activity and symptoms of anxiety and depression: The Whitehall II study. European Journal of Epidemiology, 27(7), 537-546. https://doi.org/10.1007/ s10654-012-9692-8
Daley, A. J. (2002). Extra-curricular physical activities and physical self-perceptions in British 14-15-year-old male and female adolescents. European Physical Education Review, 8(1), 37-49. https://doi. org/10.1177/1356336X020081003
De Meester, A., Aelterman, N., Cardon, G., De Bourdeaudhuij, I., & Haerens, L. (2014). Extracurricular school-based sports as a motivating vehicle for sports participation in youth: A cross-sectional study. International
Journal of Behavioral Nutrition and Physical Activity, 11(1), 48. https://doi:10.1186/1479-5868-11-48
De Meij, J. S., Chin A Paw, M., Kremers, S. P., Jurg, M. E., & van Mechelen, W. (2010). Promoting physical activity in children: The stepwise development of the primary school-based JUMP-in intervention applying the RE-AIM evaluation framework. British Journal of Sports Medicine, 44(12), 879-887. https://doi. org/10.1136/bjsm.2008.053827
Deaner, R. O., Geary, D. C., Puts, D. A., Ham, S. A., Kruger, J., Fles, E., . . . Grandis, T. (2012). A sex difference in the predisposition for physical competition: Males play sports much more than females even
in the contemporary US. PLoS ONE, 7(11), e49168. https://doi.org/10.1371/journal.pone.0049168
Denault, A.-S., & Déry, M. (2015). Participation in organized activities and conduct problems in elementary school the mediating effect of social skills. Journal of Emotional and Behavioral Disorders, 23(3), 167-179. https://doi.org/10.1177/1063426614543950
Donaldson, S. J., & Ronan, K. R. (2006). The effects of sports participation on young adolescents’ emotional well-being. Adolescence, 41(162), 369-389.
Donkers, J. L., Martin, L. J., & Evans, M. B. (2016). Psychological collectivism in youth athletes on individual sport teams. International Journal of Sport and Exercise Psychology, 16(3), 285-299. https://doi.org/10.1080 /1612197X.2016.1218529
Downward, P., & Rasciute, S. (2011). Does sport make you happy? An analysis of the well-being derived from sports participation. International Review of Applied Economics, 25(3), 331-348. https://doi.org/10.1080/0 2692171.2010.511168
Eagleman, A. N. (2015). Constructing gender differences: Newspaper portrayals of male and female gymnasts at the 2012 Olympic Games. Sport in Society, 18(2), 234-247. https://doi.org/10.1080/17430437.2013.85 4509
Eisenberg, N., Cumberland, A., Spinrad, T. L., Fabes, R. A., Shepard, S. A., Reiser, M., . . . Guthrie, I. K. (2001). The relations of regulation and emotionality to children’s externalizing and internalizing problem behavior. Child Development, 72(4), 1112-1134. https://doi.org/10.1111/1467-8624.00337
Eisenberg, N., Smith, C. L., & Spinrad, T. L. (2004). Effortful control: Relations with emotion regulation, adjustment, and socialization in childhood. In K. Vohs & R. Baumeister (Eds.), Handbook of self-regulation:
Research, theory, and applications (pp. 263-283). New York, NY: The Guilford Press.
Emck, C., Van Damme, T., & De Lange, J. (In preparation). Psychomotor interventions for mental health: A body
and movement oriented approach; Children and adolescents. Amsterdam: Boom Uitgevers.
Findlay, L. C., & Coplan, R. J. (2008). Come out and play: Shyness in childhood and the benefits of organized sports participation. Canadian Journal of Behavioural Science/Revue Canadienne des Sciences du
Comportement, 40(3), 153-161. https://doi.org/10.1037/0008-400X.40.3.153
Föcker, M., Antel, J., Ring, S., Hahn, D., Kanal, Ö., Öztürk, D., . . . Libuda, L. (2017). Vitamin D and mental health in children and adolescents. European Child & Adolescent Psychiatry, 26(9), 1043-1066. https://doi. org/10.1007/s00787-017-0949-3
Gu, X., Chang, M., & Solmon, M. A. (2016). Physical activity, physical fitness, and health-related quality of life in school-aged children. Journal of Teaching in Physical Education, 35(2), 117-126. https://doi. org/10.1123/jtpe.2015-0110
Howie, L. D., Lukacs, S. L., Pastor, P. N., Reuben, C. A., & Mendola, P. (2010). Participation in activities outside of school hours in relation to problem behavior and social skills in middle childhood. Journal of
School Health, 80(3), 119-125. https://doi.org/10.1111/j.1746-1561.2009.00475.x
Jankauskiene, R., Kardelis, K., Sukys, S., & Kardeliene, L. (2008). Associations between school bullying and psychosocial factors. Social Behavior and Personality, 36(2), 145-162. https://doi.org/10.2224/ sbp.2008.36.2.145
Kavussanu, M., Stanger, N., & Boardley, I. D. (2013). The Prosocial and Antisocial Behaviour in Sport Scale: Further evidence for construct validity and reliability. Journal of Sports Sciences, 31(11), 1208-1221. https:// doi.org/10.1080/02640414.2013.775473
Larson, R. W. (2000). Toward a psychology of positive youth development. American Psychology, 55(1), 170-183. https://doi.org/10.1037//0003-066X.55.1.170
Lee, E. J., & Stone, S. I. (2012). Co-occurring internalizing and externalizing behavioral problems: The mediating effect of negative self-concept. Journal of Youth Adolescence, 41(6), 717-731. https://doi. org/10.1007/s10964-011-9700-4
Liu, M., Wu, L., & Ming, Q. (2015). How does physical activity intervention improve esteem and self-concept in children and adolescents? Evidence from a meta-analysis. PLoS ONE, 10(8), e0134804. https:// doi.org/10.1371/journal.pone.0134804
Mantler, A., & Logan, A. C. (2015). Natural environments and mental health. Advances in Integrative Medicine,
2(1), 5-12. https://doi.org/10.1016/j.aimed.2015.03.002
Missiuna, C., Cairney, J., Pollock, N., Campbell, W., Russell, D. J., Macdonald, K., . . . Cousins, M. (2014). Psychological distress in children with developmental coordination disorder and attention-deficit hyperactivity disorder. Research in Developmental Disabilities, 35(5), 1198-1207. https://doi.org/10.1016/j. ridd.2014.01.007
Molinuevo, B., Bonillo, A., Pardo, Y., Doval, E., & Torrubia, R. (2010). Participation in extracurricular activities and emotional and behavioral adjustment in middle childhood in Spanish boys and girls. Journal
of Community Psychology, 38(7), 842-857. https://doi.org/10.1002/jcop.20399
Morales, P. F., Sánchez-López, M., Moya-Martínez, P., García-Prieto, J. C., Martínez-Andrés, M., García, N. L., & Martínez-Vizcaíno, V. (2013). Health-related quality of life, obesity, and fitness in schoolchildren: The Cuenca study. Quality of Life Research, 22(7), 1515-1523. https://doi.org/10.1007/s11136-012-0282-8 NVPMT. (2009). Beroepsprofiel Psychomotorisch Therapeut [Psychomotor Therapist’s Professional Profile]. Utrecht:
Nederlandse Vereniging voor Psychomotorische Therapie.
Omorou, A. Y., Langlois, J., Lecomte, E., Briançon, S., & Vuillemin, A. (2016). Cumulative and bidirectional association of physical activity and sedentary behaviour with health-related quality of life in adolescents.
Quality of Life Research, 25(5), 1169-1178. https://doi.org/10.1007/s11136-015-1172-7
Otto, C., Haller, A.-C., Klasen, F., Hölling, H., Bullinger, M., Ravens-Sieberer, U., & group, B. s. (2017). Risk and protective factors of health-related quality of life in children and adolescents: Results of the longitudinal BELLA study. PLoS ONE, 12(12), e0190363. https://doi.org/10.1371/journal.pone.0190363 Penedo, F. J., & Dahn, J. R. (2005). Exercise and well-being: A review of mental and physical health
benefits associated with physical activity. Current Opinion in Psychiatry, 18(2), 189-193. https://doi. org/10.1097/00001504-200503000-00013
Pereira, S. M. P., Geoffroy, M.-C., & Power, C. (2014). Depressive symptoms and physical activity during 3 decades in adult life: Bidirectional associations in a prospective cohort study. JAMA Psychiatry, 71(12), 1373-1380. https://doi.org/10.1001/jamapsychiatry.2014.1240
Piek, J. P., Barrett, N. C., Allen, L., Jones, A., & Louise, M. (2005). The relationship between bullying and self-worth in children with movement coordination problems. British Journal of Educational Psychology, 75(3), 453-463. https://doi.org/10.1348/000709904X24573
Pierce, S., Gould, D., & Camiré, M. (2017). Definition and model of life skills transfer. International Review of
Sport and Exercise Psychology, 10(1), 186-211. https://doi.org/10.1080/1750984X.2016.1199727
Pot, N., & Van Hilvoorde, I. (2013). Participation in sporting clubs located on the schoolcampus. Is it different to playing sport at othersporting clubs? European Journal for Sport and Society, 10(4), 365-381. https://doi. org/10.1080/16138171.2013.11687928
Probst, M., Van Damme, T., & Vancampfort, D. (2017). Psychomotor therapy or physiotherapy in mental health for patients with psychiatric problems. In M. Probst & L. Skjaerven (Eds.), Physiotherapy in mental
health and psychiatry: A scientific and clinical based approach (pp. 69-73). London: Elsevier.
Ravens-Sieberer, U., Wille, N., Erhart, M., Bettge, S., Wittchen, H.-U., Rothenberger, A., . . . Bullinger, M. (2008). Prevalence of mental health problems among children and adolescents in Germany: Results of the BELLA study within the National Health Interview and Examination Survey. European Child & Adolescent
Psychiatry, 17(1), 22-33. https://doi.org/10.1007/s00787-008-1003-2
Reed, J., & Buck, S. (2009). The effect of regular aerobic exercise on positive-activated affect: A meta-analysis.
Psychology of Sport and Exercise, 10(6), 581-594. https://doi.org/10.1016/j.psychsport.2009.05.009
Rijnhart, J. J., Twisk, J. W., Chinapaw, M. J., de Boer, M. R., & Heymans, M. W. (2017). Comparison of methods for the analysis of relatively simple mediation models. Contemporary Clinical Trials Communications, 7, 130-135. https://doi.org/10.1016/j.conctc.2017.06.005
Robinson, L. E., Stodden, D. F., Barnett, L. M., Lopes, V. P., Logan, S. W., Rodrigues, L. P., & D’Hondt, E. (2015). Motor competence and its effect on positive developmental trajectories of health. Sports Medicine,
45(9), 1273-1284. https://doi.org/10.1007/s40279-015-0351-6
Ryde, G. C., Booth, J. N., Brooks, N. E., Chesham, R. A., Moran, C. N., & Gorely, T. (2018). The Daily Mile: What factors are associated with its implementation success? PLoS ONE, 13(10), e0204988. https://doi. org/10.1371/journal.pone.0204988
Sarris, J., O’Neil, A., Coulson, C. E., Schweitzer, I., & Berk, M. (2014). Lifestyle medicine for depression. BMC
Psychiatry, 14(1), 107. https://doi.org/10.1186/1471-244X-14-107
Schermerhorn, A. C., Bates, J. E., Goodnight, J. A., Lansford, J. E., Dodge, K. A., & Pettit, G. S. (2013). Temperament moderates associations between exposure to stress and children’s externalizing problems.
Child Development, 84(5), 1579-1593. https://doi.org/10.1111/cdev.12076
Slutzky, C. B., & Simpkins, S. D. (2009). The link between children’s sport participation and self-esteem: Exploring the mediating role of sport self-concept. Psychology of Sport and Exercise, 10(3), 381-389. https:// doi.org/10.1016/j.psychsport.2008.09.006
Snyder, A. R., Martinez, J. C., Bay, R. C., Parsons, J. T., Sauers, E. L., & Valovich McLeod, T. C. (2010). Health-related quality of life differs between adolescent athletes and adolescent nonathletes. Journal of
Sport Rehabilitation, 19(3), 237-248. https://doi.org/10.1123/jsr.19.3.237
Stanger, N., Kavussanu, M., & Ring, C. (2017). Gender moderates the relationship between empathy and aggressiveness in sport: The mediating role of anger. Journal of Applied Sport Psychology, 29(1), 44-58. https://doi.org/10.1080/10413200.2016.1196764
Stavrakakis, N., De Jonge, P., Ormel, J., & Oldehinkel, A. J. (2012). Bidirectional prospective associations between physical activity and depressive symptoms. The TRAILS Study. Journal of Adolescent Health,
50(5), 503-508. https://doi.org/10.1016/j.jadohealth.2011.09.004
Teixeira, P. J., Carraça, E. V., Markland, D., Silva, M. N., & Ryan, R. M. (2012). Exercise, physical activity, and self-determination theory: A systematic review. International Journal of Behavioral Nutrician and
Physical Activity, 9(1), 78. https://doi.org/10.1186/1479-5868-9-78
Twisk, J. W. (2010). Inleiding in de Toegepaste Biostatistiek [Introduction in Applied Biostatistics] (2nd ed.). Amsterdam: Reed Business.
Van de Geer, F. (2005). ‘School en sport speciaal’ pilot projecten (2001-2005): Een tussenrapportage
over de ‘school en sport speciaal’ pilotprojecten van NebasNsg [School and Special Sports: Pilot projects (2001-2005)]. Retrieved from Utrecht: https://www.kenniscentrumsport.nl/
publicatie?school-en-sport-speciaal-pilotprojecten-2001-2005&kb_id=3107&kb_q=Geer
Vella, S. A., Magee, C. A., & Cliff, D. P. (2015). Trajectories and predictors of health-related quality of life during childhood. Journal of Pediatrics, 167(2), 422-427. http://dx.doi.org/10.1016/j.jpeds.2015.04.079 Vella, S. A., Swann, C., Allen, M. S., Schweickle, M. J., & Magee, C. A. (2017). Bidirectional associations
between sport involvement and mental health in adolescence. Medicine & Science of Sports & Exercise,
Vereniging Sport en Gemeenten, V. U. o. S. a. M. (2008). Handboek combinatiefuncties. Oosterbeek: Vereniging Sport en Gemeenten (VSG) [Union of Sports and Municipalities].
Wu, X. Y., Han, L. H., Zhang, J. H., Luo, S., Hu, J. W., & Sun, K. (2017). The influence of physical activity, sedentary behavior on health-related quality of life among the general population of children and adolescents: A systematic review. PLoS ONE, 12(11), e0187668. https://doi.org/10.1371/journal. pone.0187668
