Association between physical education classes and physical activity among 187,386 adolescents aged 13–17 years from 50 lowand middle-income countries

Zhan, Xuzhi; Clark, Cain C.T; Bao, Ran; Duncan, Micheal; Hong, Jin-Tao; Chen, Si-Tong

doi:10.1016/j.jped.2020.11.009

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ORIGINAL ARTICLE • J. Pediatr. (Rio J.) 97 (05) • Sep-Oct 2021 • https://doi.org/10.1016/j.jped.2020.11.009 copy

Association between physical education classes and physical activity among 187,386 adolescents aged 13–17 years from 50 lowand middle-income countries

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

This study aimed to examine the association between physical education classes and PA among adolescents from 50 lowand middle-income countries (LMICs).

Methods:

A self-reported questionnaire from the Global School-based Student Survey (GSHS) was used to collect information on participation frequency of physical education classes and being physically active over the last week, as well as other control variables (e.g., sex, age, country, sedentary behavior). Multivariable logistic regression and a pooled meta-analysis were performed to explore the association and compared country-wise differences.

Results:

Included adolescents aged from 13 to 17 years (n = 187,386, %boys = 51.7; mean age = 14.6 years), the prevalence of sufficient PA (meeting the PA guidelines) was 14.9%. The prevalence of 5 days or more to engage in physical education classes was 16.5%. Compared with adolescents who had 0 days for physical education classes, higher participation frequency was more likely related to sufficient PA (OR: 1 day = 1.34, 2 days = 1.66, 3 days = 1.67, 4 days = 1.79, 5 days or more = 2.46), these findings were also observed in both sexes. A moderate inconsistency on the association across the included countries was found (I²2 Janssen I, LeBlanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010;7:40. = 53%, p < 0.01), although the pooled OR was 1.50 (95% CI: 1.36–1.65).

Conclusions:

Participating in more physical education classes may be an effective approach to increase physical activity levels among adolescents in LMICs. However, promoting physical activity levels among adolescents in LMICs through physical education classes should consider more country-specific factors.

KEYWORDS
Physical activity epidemiology; Physical education; GSHS; Adolescents; Lowand middle-income countries

Country	Sample size	Year	0 days	1 day	2 days	3 days	4 days	5 days or more	Physical activity^a a Denotes meeting the physical activity guidelines the results in this Table were weighted by complex samples.
Total	187,386	/	21.1%	36.1%	18.7%	4.7%	2.9%	16.5%	14.9%
Afghanistan	1809	2014	31.1%	19.4%	11.5%	10.7%	9.6%	17.7%	9.2%
Algeria	3687	2011	15.7%	55.1%	6.0%	4.0%	3.0%	16.3%	15.8%
Antigua & Barbuda	1066	2009	28.3%	40.3%	5.7%	2.6%	2.2%	20.9%	22.8%
Argentina	24,932	2012	7.9%	15.9%	50.9%	2.8%	2.4%	20.1%	16.6%
Bangladesh	2603	2014	10.5%	10.0%	30.1%	15.6%	6.2%	27.6%	42.3%
Belize	1482	2011	28.2%	42.6%	9.1%	4.1%	2.7%	13.3%	20.7%
Benin	1511	2016	13.1%	66.4%	8.6%	2.4%	1.2%	8.3%	29.3%
Bolivia	3161	2012	12.1%	51.2%	5.2%	2.1%	1.9%	27.6%	14.2%
Cambodia	2761	2013	35.3%	36.9%	17.0%	3.7%	1.4%	5.7%	6.8%
Costa Rica	2544	2009	20.3%	43.6%	2.3%	1.8%	2.1%	29.9%	18.3%
Dominican Republic	1203	2016	22.1%	24.3%	20.8%	4.3%	3.8%	24.6%	13.3%
Egypt	1959	2011	35.0%	25.9%	22.3%	3.0%	0.9%	13.0%	12.6%
El Salvador	1736	2013	12.9%	34.7%	14.0%	1.6%	1.9%	34.9%	13.1%
Fiji	2789	2016	19.0%	48.9%	10.7%	5.8%	4.3%	11.3%	20.7%
Ghana	2115	2012	27.4%	29.1%	14.5%	7.8%	4.8%	16.3%	12.1%
Guatemala	3565	2015	10.3%	41.2%	12.4%	2.7%	4.6%	28.7%	10.7%
Guyana	2207	2010	49.9%	22.4%	8.9%	4.8%	2.5%	11.3%	15.6%
Honduras	1399	2012	9.5%	38.1%	22.9%	2.0%	2.0%	25.5%	15.9%
Indonesia	8553	2015	11.3%	66.2%	10.2%	2.7%	0.8%	8.9%	12.9%
Iraq	1720	2012	35.2%	21.3%	13.7%	4.0%	2.6%	23.3%	15.2%
Jamaica	1475	2017	40.0%	35.7%	5.6%	3.4%	1.6%	13.8%	22.9%
Kiribati	1453	2011	21.5%	30.7%	13.7%	6.5%	3.1%	24.6%	17.9%
Lao People’s Democratic Republic	3552	2015	32.8%	54.3%	2.4%	0.9%	0.9%	8.7%	16.6%
Lebanon	4148	2017	41.1%	27.6%	9.5%	2.9%	1.9%	16.9%	12.8%
Liberia	998	2017	30.8%	27.4%	12.9%	4.0%	4.1%	20.8%	10.4%
Malaysia	24,684	2012	11.1%	42.3%	20.6%	3.3%	2.2%	20.5%	14.2%
Mauritania	1721	2010	41.8%	19.4%	8.9%	3.8%	4.4%	21.7%	12.5%
Mauritius	2770	2017	16.7%	49.2%	6.0%	3.9%	3.3%	20.8%	18.9%
Mongolia	4395	2013	4.6%	25.6%	63.5%	2.5%	0.4%	3.5%	24.8%
Morocco	4507	2016	18.9%	12.9%	33.3%	4.4%	2.9%	27.7%	10.6%
Mozambique	1167	2015	8.4%	33.6%	36.0%	7.0%	5.5%	9.5%	13.1%
Myanmar	2387	2016	31.6%	33.1%	17.4%	5.5%	2.4%	9.9%	10.2%
Namibia	3092	2013	24.0%	39.2%	7.5%	3.1%	3.1%	23.1%	13.7%
Nepal	5360	2015	32.7%	13.4%	9.6%	7.6%	5.7%	30.9%	15.5%
Pakistan	9796	2009	59.5%	12.2%	14.3%	4.2%	1.9%	7.9%	11.3%
Paraguay	2611	2017	14.7%	59.3%	6.2%	2.7%	1.6%	15.4%	17.1%
Peru	2783	2010	7.7%	86.0%	4.0%	0.6%	0.1%	1.5%	15.2%
Philippines	7574	2015	13.5%	29.8%	9.9%	5.6%	7.4%	33.7%	7.6%
Samoa	1817	2011	37.5%	23.1%	11.5%	8.1%	5.1%	14.6%	12.1%
Solomon Islands	1154	2011	27.5%	24.9%	8.1%	5.0%	6.0%	28.5%	16.9%
Sri Lanka	3075	2016	30.6%	13.4%	14.6%	10.4%	6.6%	24.4%	15.1%
Sudan	1947	2012	53.2%	24.4%	7.1%	4.2%	1.7%	9.3%	7.9%
Suriname	1697	2016	18.4%	42.3%	5.6%	3.7%	1.7%	28.3%	19.3%
Syrian Arab Republic	2486	2010	20.6%	48.6%	5.7%	2.2%	1.8%	21.1%	11.0%
Tanzania	2743	2014	35.3%	16.8%	10.6%	6.8%	5.7%	24.8%	19.8%
Thailand	4809	2015	14.1%	66.2%	9.5%	3.1%	1.1%	6.1%	11.6%
Timor-Leste	2591	2015	15.9%	45.5%	12.4%	3.7%	2.8%	19.7%	9.7%
Tonga	2279	2017	53.3%	15.4%	8.7%	4.7%	3.4%	14.4%	18.0%
Tuvalu	636	2013	44.0%	10.6%	8.5%	4.1%	4.7%	28.0%	11.0%
Vietnam	2976	2013	3.5%	43.5%	48.6%	1.1%	0.5%	2.8%	13.1%
Yemen	1901	2014	53.7%	13.7%	6.5%	2.9%	3.0%	20.2%	11.5%

Physical education classes	Overall^a a Denote controlling for sex, age, food insecurity, sedentary behavior and country.			Boy^b b Denotes controlling for age, food insecurity, sedentary behavior and country.			Girl^b b Denotes controlling for age, food insecurity, sedentary behavior and country.
Physical education classes	OR	95% CI		OR	95% CI		OR	95% CI
0 days	Ref			Ref			Ref
1 day	1.34	1.16	1.55	1.44	1.18	1.75	1.20	1.01	1.42
2 days	1.66	1.35	2.05	1.74	1.29	2.35	1.53	1.23	1.90
3 days	1.67	1.38	2.02	1.78	1.38	2.30	1.52	1.18	1.94
4 days	1.79	1.38	2.31	2.07	1.48	2.89	1.38	1.02	1.93
5 or more days	2.46	2.14	2.83	2.65	2.17	3.22	2.20	1.84	2.64

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[1] * Corresponding author. E-mail: sitongchen@szu.edu.cn (S. Chen).