Extracurricular physical activities practiced by children: relationship with parents’ nutritional status and level of activity

Sedentarism is a global epidemic that engages 60 to 70% of the global population [1]. In Brazil, the 2014 Vigitel report showed that leisure physical activity (PA) frequency (at least 150 min moderate intensity per week) ranged from 30.4% (São Paulo) to 47.1% (Florianópolis) [2]. It is worth noting that, in Brazil, only 29% of adolescents achieve the World Health Organization (WHO) recommendation (≥ 60 daily minutes of moderate/vigorous intensity PA), a setting similar to other Latin American countries (10–20%) and in the world (20%).

A progressive PA decline occurs from childhood to adolescence. The multicenter International Children’s Accelerometry Database, which included data from Europe, North America, Australia and Brazil, showed a 4.2% yearly decrease in PA [3].

Physical inactivity is one of the most important risk factors for the development of chronic diseases, such as obesity, diabetes, and hypertension, and fight against such diseases is included in the public health policy agenda in several countries [4].

In Brazil, according to the 2008–2009 Household Budgets Survey (POF), an increased high prevalence of overweight and obesity was found among children aged 5–9 years, of 33.5% and 14.3%, respectively. Rates observed for adolescents were 20.5% and 4.9%, respectively [5].

It is known that children that are more active have a lower body mass index and a lower percentage of fat. In addition, obese children, compared with non-obese children, are less active and prefer low intensity activities as opposed to moderate and/or vigorous intensity activities [6].

The WHO recommends that children and adolescents aged 5–17 years should accumulate at least 60 min of moderate/vigorous intensity PA every day. Most of the activities should be aerobic. Vigorous intensity, including muscle and bone strengthening exercises should be incorporated at least 3 times per week [1].

Several factors contribute to the sedentary lifestyle in the pediatric age group: technology, insecurity and reduced space available for practicing PA in urban centers. Systematic review of Latin American literature in the field of physical activity interventions concluded that the promotion of physical activity in the school environment is highly recommended and effective [7].

In the USA, extracurricular PA programs in schools serve more than 10 million children annually and have shown to be effective in reducing the time spent in sedentary activities and in proposing at least 30 min of activities of moderate/vigorous intensity [8]. In Brazil, projects that make PA available at weekends and/or school counter-shifts are already a reality in several schools and are supported by current legislation and the proposal of the National Education Development Fund (FNDE) [9]. The National School Health Survey (PeNSE) included a representative sample of seniors (9th graders) from elementary school (2842 schools and 110,873 students) in 2012, and showed that extracurricular PA in schools was positively associated with increased level of leisure and total PA [10].

Given prior knowledge that children PA is effective in the prevention of obesity and other chronic diseases and contributes to improved strength, balance, flexibility, aerobic resistance, and speed, favoring healthy growth and even school performance, and the lack of studies evaluating the demand for school extracurricular physical activities justifies this study that aims to compare extracurricular physical activity among students with and without overweight and to relate it to the level of physical activity of their parents.

Males predominated 193 (51.5%) in the studied population, and the mean age was 8.7 ± 1.4 years (Table 1). Regarding nutritional status, the most observed disorders were overweight and obesity, affecting 98 (26.8%) and 79 (21.6%) children, respectively. Thinness and low height were found in less than 2% of students (Table 1). Boys had a higher share of severe obesity than girls (Fig. 1).

Table 1

Characterization of the studied population

Variable		Schools (n = 375)
Gender	Male	193 (51.5%)
	Female	182 (48.5%)
Age	Years	8.7 ± 1.4
Body mass index score Z	Malnutrition	2 (0.5%)
	Eutrophy	186 (50.9%)
	Overweight	98 (26.8%)
	Obesity	59 (16.2%)
	Severe obesity	20 (5.4%)
Height for age index score Z	Short stature	6 (1.6%)
	Normal stature	359 (98.3%)
Waist/height	Aumentada	123 (33.6%)
	Adequada	242 (66.3%)
Physical activity practice	Yes	86 (22.9%)
	No	289 (77.1%)
Physical activity type	Athletics	22 (25.6%)
	Capoeira	16 (18.6%)
	Circus	8 (9.3%)
	Dance	16 (18.6%)
	Fitness	21 (24.4%)
	Taekwondo	3 (3.5%)
Physical activity by parents	Very active	92 (27.5%)
	Active	122 (36.5%)
	Irregularly active A	34 (10.2%)
	Irregularly active B	59 (17.7%)
	Sedentary	27 (8.1%)

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There was no difference in gender and age between the two schools, and the options of activities that children could participate in were similar in both schools. Extracurricular physical activity was observed in 86 (22.9%) children. Among those who were engaged in some modality, the most popular were fitness 21 (24.4%), athletics 22 (25.6%), and dance 16 (18.6%) (Table 1).

In the present study, we observed that the children’s demand for PA in the extracurricular period was low and did not differ in relation to the nutritional status. A recent study with children from Florianópolis showed that the time spent with sedentary activities in the school period exceeded two-thirds of the total daily schedule [18]. Another study showed that Brazilian children spend 65% of the time in physical education classes, sitting or standing still, that is, without moving or developing vigorous activities [19].

Considering the results of the studies cited, we would infer that, along with other factors, educators provide little incentive to children for PA in the curricular period, which can reflect in the search for PA in schools’ counter-shifts. Other hypotheses may explain such a finding, such as the lack of parents’ appreciation of the importance of physical activity as child health promotion, children mobility constraints to go to school after regular hours, and lack of interest in the activities offered. An Australian study involving four schools listened to students in order to investigate how the school environment could be explored better as an incentive to engage in activities. Students suggested that improved physical spaces, such as installation of climbing walls, outdoor excursions, and the inclusion of music during activities could stimulate the practice [20].

There was no association between the demand for PA and the nutritional status of children in our study. A recent publication performed in 12 countries, including Brazil (n = 6,025 children aged 9–11 years), contrary to what we observed, showed an association between obesity and behaviors as a short time dedicated to activities of moderate/vigorous intensity, shorter sleep duration, and more time spent watching television [21].

In the study, we also verified that less than 10% of the parents were classified as sedentary and 36% as insufficiently active (sedentary+irregularly active). Using IPAQ’s short version, which included walking, interviewing 2001 people aged 14–77 years (953 males and 1048 females) from the State of São Paulo, Matsudo et al. 2002 [22] showed higher levels of sedentary lifestyle (21.2%) compared with what we observed. A study considering a Brazilian sample reported that individuals with higher level of schooling were physically more active in leisure compared with those with less schooling, who were more active at work [23]. Thus, one must consider the limitations regarding the tool used, namely IPAQ short version, which is unable to distinguish physical activity realms (leisure, occupational, housework, and travel).

We still did not find an association between the level of activity of parents and children’s search for physical activity. A study carried out with a sample of 1042 preschool children from Recife, Brazil, corroborating with our findings, found no association between the level of physical activity of parents and children [24]. A possible explanation for this lack of association may be the tool used to evaluate parents, considering that most of the studies in which this association was observed employed direct methods such as accelerometry to measure PA [25, 26].

In our study, we noted that boys practiced less physical activity compared with girls, even after adjustment for nutritional status. Studies in the literature show results discordant to ours. CESAs’ most sought-after activities, among which are fitness, athletics, and dance, may have favored this finding. A study conducted in Rio Grande do Sul evaluated the participation of adolescents in physical activities, according to gender and sports modality. Among male participants, the top-three modalities were soccer (82.5%), volleyball (18.2%), and bodybuilding (10.8%). Among female participants, volleyball (46.3%), dance (25.4%), and fitness (18.5%) prevailed. Around 8.5% of men and only 1.9% of women were engaged in martial sports, while 25.4% of women and only 3.8% of men were involved with dancing [27].

This is the first study evaluating the children’s demand for extracurricular physical activities in Educational Centers located in the outskirts of the Municipality of Santo André. Some limitations deserve consideration, such as the cross-sectional study design and the use of a questionnaire to assess the level of parental physical activity rather than the use of direct measures such as accelerometry.

Physical inactivity is a global concern, and alarming data in the pediatric age group require special attention and urgent proposals. Considering the importance of stimulating children’s physical activity and based on the results shown here highlighting the low demand for physical activity offered in schools, the need for stimulating measures by educators and relatives is all the more pressing. Future projects involving broad sensitization work by teams involved should be considered.