Adolescents with Higher Cognitive and Affective Domains of Physical Literacy Possess Better Physical Fitness: The Importance of Developing the Concept of Physical Literacy in High Schools

Relationship between perceived physical literacy and obesity-related outcomes in adolescents: the EHDLA study

Purpose

The aim of the present study was to examine the relationship between perceived physical literacy and obesity-related outcomes among adolescents from Spain.

Methods

This is a secondary cross-sectional analysis including a total sample of 845 Spanish adolescents (55.3% girls) aged 12-17 years from the Valle de Ricote (Region of Murcia) from the Eating Healthy and Daily Life Activities (EHDLA) project. Physical literacy was evaluated using the Spanish Perceived Physical Literacy Instrument for adolescents (S-PPLI). Body mass index was computed by taking the participants' body weight in kilograms and dividing it by the square of their height in meters, and body mass index (z score) and overweight/obesity and obesity were computed by the World Health Organization age- and sex-specific thresholds. Waist circumference was measured using a constant tension tape. Moreover, the waist-to-height ratio was calculated, and therefore, abdominal obesity was determined. Skinfold measurements were taken at the triceps and medial calf using calibrated steel calipers.

Results

In general, the overall trend was downward (i.e., the higher the PPLI score the lower the obesity-related indicators), with the approximate significance of smooth terms being statistically significant for all models examined (p < 0.001). Adolescents with lower perceived physical literacy (PPL) showed the highest estimated marginal means of body mass index, body mass index z score, waist circumference, waist-to-height ratio, and skinfold (triceps and calf) and predictive probabilities of having excess weight, obesity, and abdominal obesity, while their counterparts with high PPL had the lowest. In addition, significant differences were observed for all the obesity-related indications between adolescents with low PPL and those with medium PPL (p-adjusted < 0.05 for all indicators), as well as with those with high PPL (p-adjusted < 0.05 for all indicators). Moreover, these significant differences were also shown for most indicators between adolescents with medium PPL and those with high PPL (except for obesity).

Conclusion

Physical literacy could play a crucial role in maintaining more desirable obesity-related outcomes in adolescents. Adolescents with high perceived physical literacy showed lower obesity-related indicators (i.e., body mass index, body mass index z score, waist circumference, waist-to-height ratio, skinfolds), as well as a lower probability of having excess weight, obesity, and abdominal obesity.

Evaluation of Physical Literacy in 9- to 11-Year-Old Children: Reliability and Validity of Two Measurement Tools in Three Southeastern European Countries

The awareness of the importance of physical literacy (PL) is globally increasing; however, knowledge of the applicability of PL measurement tools in southeastern Europe is limited. The aim of this study was to evaluate the reliability and validity of translated versions of the CAPL-2 and PLAYself questionnaires in 9- to 11-year-old elementary school children from Croatia, Bosnia and Herzegovina, and Montenegro. The participants were 303 children (141 girls; all 9 to 11 years of age) from Croatia (n = 71), Bosnia and Herzegovina (n = 162), and Montenegro (n = 70), enrolled in regular elementary school. The participants were tested throughout a test-retest procedure using two PL evaluation tools, i.e., the Canadian Assessment of Physical Literacy (shorter version, CAPL-2) and the Physical Literacy Assessment of Youth (PLAYself) questionnaires. With an intraclass correlation (ICC) of 0.70-0.80 for specific questionnaire subscales and 0.84 for the total score, PLAYself was found to be reliable. With Kappa values of 0.11-0.23 and a percentage of absolute agreement of less than 62%, CAPL-2 appeared to be less reliable. Factors related to sport participation were significantly positively associated with the PLAYself score, indicating its proper validity. In conclusion, we suggest the usage of the PLAYself questionnaire in further studies examining PL in children of a similar age in the region. Future studies in other age groups and languages are also warranted.

Cross-Sectional Association between Perceived Physical Literacy and Mediterranean Dietary Patterns in Adolescents: The EHDLA Study

PURPOSE

The objective of the current study was to analyze the relationship between perceived physical literacy (PPL) and adherence to the Mediterranean Diet (MedDiet) and its specific components in a sample of Spanish adolescents.

METHODS

In this cross-sectional study, we examined a sample of 845 adolescents (58.1% boys) aged 12-17 years from the Valle de Ricote (Region of Murcia, Spain). PPL was assessed by the Spanish Perceived Physical Literacy Instrument for adolescents (S-PPLI). To assess adherence to the MedDiet, the Mediterranean Diet Quality Index in children and adolescents (KIDMED) was applied.

RESULTS

In unadjusted analyses, adolescents with medium or high PPL were more likely to have optimal adherence to the MedDiet (medium PPL: OR = 1.69, 95% CI 1.20-2.40, p-adjusted = 0.003; high PPL: OR = 2.90, 95% CI 2.03-4.17, p-adjusted < 0.001). These findings remained significant after adjusting for sex, age, socioeconomic status, body mass index, energy intake, overall sleep duration, physical activity, and sedentary behavior (medium PPL: OR = 1.51, 95% CI 1.05-2.19, p-adjusted = 0.003; high PPL: OR = 2.27, 95% CI 1.53-3.39, p-adjusted < 0.001).

CONCLUSIONS

PPL could play a relevant role in the adoption of healthy eating habits among adolescents. Adolescents with low or medium PPL were less likely to report optimal adherence to the MedDiet. Adolescents with high PPL seem to consume more fruits, vegetables, fish, pulses, nuts, and dairies (for breakfast). Conversely, these adolescents tend to skip breakfast less, as well as to consume less commercially baked goods or pastries at this meal.

Effectiveness of Physical-Literacy-Based Online Education on Indices of Physical Fitness in High-School Adolescents: Intervention Study during the COVID-19 Pandemic Period

There is a global consensus that physical literacy (PL) is an important determinant of physical fitness (PF), but studies have rarely examined the effects of PL-based interventions on PF. The aim of this research was to evaluate the effectiveness of specific online video-based PL intervention on PF indices in high-school students from Croatia. Participants were 423 high-school adolescents (295 girls, 128 boys; 14-to-18 years of age), divided into an intervention group (n = 230) and a control group (n = 193). The intervention lasted 12 weeks. Educational video materials were disseminated to the intervention group by the closed social network during the pandemic period. Variables included height, mass, BMI, cardiorespiratory fitness (CRF), and power, strength, and flexibility indices. Pre- to post-testing design was applied, with two-way analysis of variance for repeated measurement (Time × Group). Applied intervention induced positive effects in CRF (the intervention group improved their capacities, while no changes occurred in the control group) and BMI (the intervention group retained their BMI levels at the pre-testing level, while BMI of the control group slightly increased over the course of the study), with better effectiveness in girls than in boys. No effects were evidenced for other variables. The positive effects of applied educational intervention on BMI and CRF are encouraging knowing that both indices are related to health status.

Validity, Reliability, and Feasibility of Physical Literacy Assessments Designed for School Children: A Systematic Review

BACKGROUND

While the burgeoning researcher and practitioner interest in physical literacy has stimulated new assessment approaches, the optimal tool for assessment among school-aged children remains unclear.

OBJECTIVE

The purpose of this review was to: (i) identify assessment instruments designed to measure physical literacy in school-aged children; (ii) map instruments to a holistic construct of physical literacy (as specified by the Australian Physical Literacy Framework); (iii) document the validity and reliability for these instruments; and (iv) assess the feasibility of these instruments for use in school environments.

DESIGN

This systematic review (registered with PROSPERO on 21 August, 2022) was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement.

DATA SOURCES

Reviews of physical literacy assessments in the past 5 years (2017 +) were initially used to identify relevant assessments. Following that, a search (20 July, 2022) in six databases (CINAHL, ERIC, GlobalHealth, MEDLINE, PsycINFO, SPORTDiscus) was conducted for assessments that were missed/or published since publication of the reviews. Each step of screening involved evaluation from two authors, with any issues resolved through discussion with a third author. Nine instruments were identified from eight reviews. The database search identified 375 potential papers of which 67 full text papers were screened, resulting in 39 papers relevant to a physical literacy assessment.

INCLUSION AND EXCLUSION CRITERIA

Instruments were classified against the Australian Physical Literacy Framework and needed to have assessed at least three of the Australian Physical Literacy Framework domains (i.e., psychological, social, cognitive, and/or physical).

ANALYSES

Instruments were assessed for five aspects of validity (test content, response processes, internal structure, relations with other variables, and the consequences of testing). Feasibility in schools was documented according to time, space, equipment, training, and qualifications.

RESULTS

Assessments with more validity/reliability evidence, according to age, were as follows: for children, the Physical Literacy in Children Questionnaire (PL-C Quest) and Passport for Life (PFL). For older children and adolescents, the Canadian Assessment for Physical Literacy (CAPL version 2). For adolescents, the Adolescent Physical Literacy Questionnaire (APLQ) and Portuguese Physical Literacy Assessment Questionnaire (PPLA-Q). Survey-based instruments were appraised to be the most feasible to administer in schools.

CONCLUSIONS

This review identified optimal physical literacy assessments for children and adolescents based on current validity and reliability data. Instrument validity for specific populations was a clear gap, particularly for children with disability. While survey-based instruments were deemed the most feasible for use in schools, a comprehensive assessment may arguably require objective measures for elements in the physical domain. If a physical literacy assessment in schools is to be performed by teachers, this may require linking physical literacy to the curriculum and developing teachers' skills to develop and assess children's physical literacy.

Physical Literacy for Communities (PL4C): physical literacy, physical activity and associations with wellbeing

BACKGROUND

Physical literacy (PL) is considered an important determinant of children's physical activity through which health benefits may be derived. The purpose of this study is to describe a sample of Canadian children's baseline levels of PL and movement behaviors, and explore whether the associations between PL and their mental wellbeing, if any, are mediated by moderate-to-vigorous physical activity (MVPA).

METHODS

All grade two children in 14 elementary schools in the West Vancouver School District, Canada were invited to participate in a two-year longitudinal project. PL was assessed through PLAYfun and PLAYself tools. Physical activity was measured by wrist-worn accelerometers (GT3X + BT) for seven days. Children's mental well-being was assessed using the Strengths and Difficulties Questionnaire (SDQ). A score of total difficulties was aggregated for internalizing and externalizing problems.

RESULTS

A total of 355 children aged 7-9 (183 boys, 166 girls, 6 non-binary) participated with 258 children providing valid accelerometer data. Children exhibited an average of 111.1 min of MVPA per day, with 97.3% meeting the physical activity guidelines. Approximately 43% (108/250) of participants were meeting the Canadian 24-h movement guidelines. Children were at an 'emerging' level of overall physical competence (45.8 ± 5.6) and reported a mean score of 68.9 (SD = 12.3) for self-perceived PL, with no significant differences between boys and girls. PL was significantly associated with MVPA (r = .27) and all SDQ variables (rs = -.26-.13) except for externalizing problems. Mediation analyses showed PL was negatively associated with internalizing problems and total difficulties when the association with MVPA was considered. However, the mediating role of MVPA was found only between PL and internalizing problems, β = -.06, 95%CI [-.12, -.01].

CONCLUSIONS

Although most of our sample was physically active and showed higher adherence to 24-H movement guidelines than comparable population data, the motor competence and self-perceived PL of our sample were similar to those of previous studies. PL has an independent association with children's internalizing problems and total difficulties. Ongoing assessment will investigate the relationships between PL and children's mental health from a longitudinal perspective.

Synthesising physical literacy research for 'blank spots': A Systematic review of reviews

The holistic concept of physical literacy (PL) has gained considerable attention worldwide and integrates different determinants (e.g., physical, affective, and cognitive) of physical activity. The purpose of this systematic review (PROSPERO registration: CRD42022312764) was to broadly synthesise PL research and determine "blank spots". We performed standardized searches for PL reviews in 23 databases. Inclusion criteria were English language, any review with a systematized search, publication by June 2023 and PL relevance in an article's main body. The content and insights of the identified reviews were assigned to six literature-driven "problem fields": (i) theory/concept, (ii) measurement/levels/trends, (iii) determinants, (iv) outcomes, (v) interventions, and (vi) policy. We employed nine items for assessing the methodological quality of the reviews (including six items from AMSTAR-2). The screening resulted in an inclusion of 41 PL reviews of different methodology. Existing reviews most frequently analysed aspects of measurement (n = 20) as well as theory/definition (n = 19), followed by interventions (n = 17). In contrast, determinants (n = 6), outcomes (n = 5) and policy aspects (n = 4) were discussed less often. Accordingly, the major "blank spots" are: empirical studies on determinants and outcomes; PL levels and trends; pivotal moderators of interventions; and policy aspects. We recommend the scientific community to address these to move the field forward.

The Effectiveness of a Physical Literacy-Based Intervention for Increasing Physical Activity Levels and Improving Health Indicators in Overweight and Obese Adolescents (CAPACITES 64)

Recently, the concept of Physical Literacy (PL) has emerged as a key concept for promoting active behavior and improving health indicators in adolescents. Overweight and obese adolescents have a low level of Physical Activity (PA), low cardiorespiratory capacity, and high Body Fat percentage (%BF). However, the development of PL in the interest of health improvement has never been studied in overweight and obese adolescents. The objective of this study was to evaluate the impact of an intervention developing PL in overweight and obese adolescents in order to increase their (PA) and improve their health. The study was a prospective, single-arm, non-randomized interventional study. The intervention brings together different actions in PA and dietary education in different adolescent living environments. The study took place over a 9-month period with two data collection times (0; +9 months) and measured Body Mass Index (BMI) and BMI z score, %BF and Skeletal Muscle Mass (%SMM), Moderate-to-Vigorous intensity Physical Activity (MVPA) by accelerometry, CRF, as well as PL by the CAPL-2 tool. Thirteen adolescents (age 11.7 (±1.09) years old) improved their PL scores (+8.3 (±9.3) pts; p ≤ 0.01). BMI z score (-0.3 (±0.3), p ≤ 0.01), their %BF (-3.8 (±4.9); p ≤ 0.01), their CRF (+1.5 (±1.7) mL·min·kg^-1; p ≤ 0.01), and their MVPA (+4.6 (±13.7) min/day; p = 0.36). Initiating multidimensional interventions to develop PL in overweight and obese adolescents may be a promising prospect to enable an increase in their MVPA and improve their long-term health. Longer-term randomized controlled interventional studies are needed to confirm these findings.

Specificity of the Associations between Indices of Cardiovascular Health with Health Literacy and Physical Literacy; A Cross-Sectional Study in Older Adolescents

Background and Objectives: Cardiovascular health status (CVHS) is an important determinant of health, while it is theorized that health literacy (HL) and physical literacy (PL) could be directly related to CVHS. The aim of this study was to evaluate gender-specific associations between PL and HL and indices of CVHS in adolescence. Materials and Methods: The participants were 247 adolescents (177 females) from Split-Dalmatia county in Croatia who were tested on HL, PL, and CVHS (physical activity level (PAL) and lipid profile). The lipid profile included total cholesterol, triglycerides, high-density lipoproteins, non-high-density lipoprotein-cholesterol, and low-density lipoproteins. Gender-stratified multivariate cluster analysis (K-means clustering) was used to group participants into three homogenous groups on the basis of their HL and PL, while differences between clusters in CVHS were evidenced by analysis of the variance and consecutive post-hoc tests. Results: The lipid profile was better in girls with higher HL scores. Additionally, clusters consisting of participants with a better PL were characterized by higher PAL. We have found no evidence that HL is associated with PAL, while PL was not associated with the lipid profile. Conclusions: HL was specifically associated with direct indicators of health status (lipid profile) in girls, while PL was associated with PAL as a particular behavioral health indicator in both genders. The study highlights the necessity of including education of HL and PL in schools.

Are Health Literacy and Physical Literacy Independent Concepts? A Gender-Stratified Analysis in Medical School Students from Croatia

Health literacy (HL) and physical literacy (PL) are concepts responsible for achieving and maintaining positive health behaviors. This study aimed to investigate gender-specific associations: (i) between PL and HL; and (ii) among HL, PL, and body composition. We observed 253 students attending health-area high schools from southern Croatia (181 girls; 16.9 ± 1.4 years). HL was assessed by the European Health Literacy Survey Questionnaire, PL by the PLAYself questionnaire, and body composition by bioimpedance analysis. The t-test was used to assess the differences between genders, and Pearson’s correlation coefficients were calculated to establish the associations between variables. The results showed a similar level of HL (t-test = 0.2; p = 0.83) and PL (t-test = 0.01; p = 0.99) in boys and girls. Significant but small correlations were identified between HL and PL only in the girls (<10% of common variance). The body composition indices were significantly correlated with PL only in the boys (15−20% of common variance). Our research highlights the necessity of the independent evaluation of HL and PL in adolescence. Further studies evaluating other indices of health status in relation to PL and HL are warranted.