Introduction

Childhood obesity has become a global health problem with alarming prevalence figures. Accor ding to WHO data, in 2016 more than 41 million children under five years of age were overweight or obese worldwide¹, estimating that if the trend conti nues, in 2022 there will be more obese children than underweight².

Chile is no exception to this alarming epidemic. According to data from the National Board of School Aid and Scholarships (JUNAEB), between 2007 and 2013 child obesity increased from 21.8% to 25.3% in schoolchildren between the ages of six and seven. This increase since 2013 has decreased to 24.6% in 2016 and to 23.9% in 2017, however, the increase in overweight children increased from 26.0% in 2012 to 26.4% in 2017³.

Among the main risk factors associated with its development and other chronic non-communicable diseases (CNCDs) is the excessive calorie intake along with sedentarism and physical inactivity¹.

In addition, the sedentarism, defined as any wa king behavior characterized by energy expenditure ≤ 1.5 METs (metabolic-energy-equivalents), such as watching television or sitting^4,5, begins at a young age, either because of the lack of restriction given by parents to their children in relation to time spent watching television, using the computer, cell phone, or other tech nological devices that increase the time schoolchildren spend sitting^6,7,8. This attitude also affects maximum oxygen consumption (VO_2max), which is considered a very important predictor of cardiovascular mortality and affects both men and women of different ages⁹. If we add to this the lack of physical activity (PA), along with an unhealthy diet, it is not surprising that the school population in Chile currently leads Latin Ame rican obesity levels¹⁰.

The family is considered a key element to support, motivate and teach healthy lifestyles since parents are transmitters of behaviors and role models for their children^11,12,13,14. In this context, activities such as daily PA practice should be a behavior that parents trans mit and share with their children. However, Chilean parents only perform 13.8 minutes per day of PA¹⁵. Although the Government of Chile has implemented several healthy living programs with the participation of the family^16,17,18, it is not known what support parents offer their children to perform PA. Therefore, the ob jective of this study was to determine the influence of economic support, motivational and accompaniment of parents to their children to perform physical activity and its relationship with the nutritional status and cardiorespiratory capacity of first-grade schoolchildren in a school in the Talcahuano commune.

Subjects And Method

Statistical analysis

Data are presented as mean and standard deviation for continuous variables and as a percentage for categorical variables. Normal distributions of continuous variables were assessed using the Anderson-Darling test. Differences for continuous variables between wo men and men were determined by t-test for independent samples. Differences for categorical variables were determined with the Chi-square test. Differences in anthropometric and PA variables according to paren tal support (economic and motivational support) were determined by t-test analysis for independent samples. Statistically significant differences were determined as p-value < 0.05. All statistical analyses were conducted in STATA SE version 14.0 software.

Results

(Table 1) shows the general characteristics of the stu died population. Overall, the cohort of 70 schoolchil dren had an average age of 6.6 ± 0.6 years and 53% were women. The mean body weight and BMI were 25.2 ± 5.2 kg and 17.9 ± 2.9 kg/m², respectively. There were no significant anthropometric differences bet ween sexes.

Table 1 Cohort socio-demographics, anthropometrics and lifestyle characteristics by sex. 

Regarding nutritional status, the prevalence of overweight was 19.3% higher in girls than boys (40.5% vs 21.2%). However, the prevalence of obesity was 10.4% higher in boys than girls (21.2% vs 10.8%) (Ta ble 1).

In relation to the different levels of PA, and as shown in (Table 1), there were only significant differences for moderate intensity PA (p < 0.006), with girls spending more time in moderate PA than boys (16.4 vs. 12.5 min). Regarding cardiorespiratory fitness (VO- ₂max), boys had a slightly lower fitness than girls (36.3 vs 39.8 ml/kg/min, respectively); however, the diffe rence was not statistically significant (p > 0.05).

(Table 2) shows the financial support of parents for their children to perform PA. There were no significant differences for anthropometric, obesity, fitness and PA variables between children who receive economic support and those who do not.

Table 2 Anthropometric, physical activity and fitness levels by financial support of parents for their children to perform PA. 

(Table 3) shows the results of parent’s motivational support for their children to perform PA. Neither the motivation and/or accompanying the children to per form AF during the week was associated to differences in anthropometric variables. However, those school children who were accompanied by their parents on weekends to the sports location had a higher level of moderate PA during physical education classes (15.5 ± 8.2 min/class) compared to those who were not ac companied (10.6 ± 8.3 min/class).

Table 3 Anthropometric, physical activity and fitness levels by support of parents for their children to perform PA. 

Finally, (Figure 1) shows the type of PA the parents perform (moderate or vigorous) during the week. (Fi gure 1a) shows that 58% declared that they did not per form PA any day, highlighting that 90% of them did not comply with the international PA recommenda tions of 150 minutes minimum of moderate PA and/ or 75 minutes of vigorous PA per week³⁰. In relation to whether the parents practice PA with their children (Figure 1b), a greater participation is observed during the weekend compared to the other days of the week, with 75% and 38% participation, respectively.

Figure 1 Parents physical activity levels during weekdays figure 1a and family physical activity participation figure 1b. Data is presented as %. The Parental Influence on Physical Activity Scale^20,21 questionnaire was used to collect these data. Figure 1a shows parents frequency of doing PA during week days. Figure 1b shows whether parents do PA with their children during week and weekend days. 

Discussion

Parents play a fundamental role in the acquisition and formation of habits in their children³¹. However, in this study, it was demonstrated that the economic and motivational support of parents for the child to practice PA was not associated with differences in nu tritional status or the intensity with which they per form PA during physical education class. On the other hand, when analyzing the levels of intensity with which schoolchildren participate in the physical education class, it was identified that, of the total time spent in the physical education class, 76.9% of them performed low-intensity PA (≤ 1.5 METs), 19.5% of the time was spent in moderate activity and 3.6% in vigorous acti vity. These results could be explained by the model of PA shared by parents and children and, in addition, by the parents’ own sedentary behavior, which could be a model to be followed by schoolchildren. The results suggest that future studies should measure the PA in tensity of parents and children over a longer period of time In order to elucidate how parents PA behaviours influence or match their children lifestyle behaviours.

In relation to the shared practice of PA between parents and children during the weekend and over weekdays, the study showed that 43.5% did not. This reality was also evidenced in the study carried out by Gamito and Feu in 292 Spanish adolescents³², in whom it was identified that 48.5% never practiced PA in family. However, Varela et al., in a study of 91 Colom bian preschool parents (one to five years old), showed that 62% of them accompanied their children to per form PA, and the age of the children could influence the parents’ accompaniment to perform some type of PA³³. In our study, 56.5% of parents accompanied their children when they practiced PA, a lower figure than the study in preschools and higher than the study of Gamito and Feu in adolescents.

Although this study did not investigate the cha racteristics of PA performed by parents and children, a study conducted by Cabrera et al., in the same geo graphical and sociocultural context with parents of 1st grade schoolchildren³⁴, reported that 27% of PA sha red by parents and children during the week consists of walking out to a convenience store. The games they play with their children, in a park or square in the sec tor during the week, was 12% weekly and 16% during the weekends. It was also identified that 20 and 22% of parents watch television with their children during the week and weekend, respectively. In this context, García et al.³⁵ identified that the behavior of Spanish parents, in relation to watching television, is significant in the behavior of their children (p = 0.06 in the case of parents and children and p < 0.05 for mothers and children).

On the other hand, and in relation to the economic support provided by parents, several studies indicate that the economic factor could affect the performance of PA in schoolchildren^36,37. This was demonstrated by Almorox and Urbanos who identified that, in indivi duals between 0 and 14 years of age, there was signifi cant inequality related to income in relation to physical inactivity during leisure time among Spanish children who favor the more affluent³⁶. This reality was also identified in Argentina by Tuñon and Laíño³⁷, who ob served in a sample of 3,402 schoolchildren and adoles cents that those with economically vulnerable families had lower levels of PA compared to schoolchildren be longing to a middle socioeconomic stratum.

Considering the obesogenic environment, which encourages excessive consumption of unhealthy food and sedentary attitudes explained by Santos Muñoz³⁸, it seems logical to think that the behaviors presented by parents will increase over time influenced by the environment in which they live. Therefore, if parents are to support children in practicing PA, future acti ve lifestyle programs should consider strategies to en courage family participation in shared PA practices. Some examples could be walks, bike rides, excursions, dances where parents and children participate, ideally starting from the first cycle of life³⁹. Considering that obese schoolchildren want their parents to accompany them to play or ride bicycles⁴⁰, it is essential to create programs that incorporate the family as a fundamental pillar in the acquisition of PA habits. These activities could be developed in the environment of the edu cational establishment through the management and incorporation of public policies and specialized profes sionals who execute them.

Among the strengths of this study is the inclusion of a representative sample of schoolchildren in the commune. Another strength was the measurement of variables of interest using standardized techniques, including the objective measurement of PA levels using accelerometers. The evaluation and approval by the Scientific Ethical Committee of the Talcahuano Health Service, which depends on the Ministry of Health, is also considered a strength. However, there are limi tations in the study design that have to be considered when interpreting the results. One of them includes the measurement of PA only during physical educa tion class. Although some differences were observed, we cannot rule out that those students who belong to families that practice or favor PA could perform more PA than those families that do not favor PA; however, to answer this question, future studies will have to incorporate the measurement of PA levels for at least seven days to determine the levels of total PA in this population. Another limitation is the use of question naires for reporting behaviors associated with PA prac tice which may be influenced by parents’ perceptions or also called social desirability bias, which may not always accurately reflect what is happening in reality.

This study concludes that the economic and mo tivational support of parents for the child to practice PA was not associated with differences in the nutritio nal status or the intensity with which they perform PA during physical education class, it was identified that the highest percentage (76.9%) of PA practiced during physical education class has low intensity (≤1.5 METs). Future studies should further investigate the associa tion between parental support, nutritional status of children and performance during education class. Mo reover, the association between parental support and PA outside of a school environment warrants further investigation.

Ethical responsibilities

Human Beings and animals protection: Disclosure the authors state that the procedures were followed according to the Declaration of Helsinki and the World Medical Association regarding human experimenta tion developed for the medical community.

Data confidentiality: The authors state that they have followed the protocols of their Center and Local regulations on the publication of patient data.

Rights to privacy and informed consent: The authors have obtained the informed consent of the patients and/or subjects referred to in the article. This docu ment is in the possession of the correspondence author.

Financial Disclosure: Authors state that no economic support has been asso ciated with the present study.

Conflicts of Interest: Authors declare no conflict of interest regarding the present study.

Aknowledgments: This Study was supported by the University of Concep cion. Universidad de Concepción por el financiamiento otorgado para realizar esta investigación. We would like to thank all participants and school who took part in the study. The research was designed, conducted, analysed and interpreted entirely by the authors.