Prevalence and Correlates of Meeting Physical Activity Guidelines Among Colombian Children and Adolescents

in Journal of Physical Activity and Health

Background: Global estimates have shown that a small proportion of children and adolescents are physically active. However, the evidence on physical activity (PA) among Colombian children and adolescents is limited. The objective of this study was to describe the prevalence and correlates of meeting PA guidelines among Colombian children and adolescents. Methods: Data were collected as part of the National Survey of Nutrition 2015. A national sample of 16,612 children and adolescents (3–17 y) was included. Prevalence estimates of meeting PA and active play guidelines were calculated, and Poisson regression models were conducted to identify correlates of PA. Results: Low proportion of Colombian children and adolescents met the PA guidelines. Low engagement in active play was observed among preschoolers. Correlates varied by age group. Female sex was a consistent negative correlate of meeting PA guidelines across all age groups. Conclusions: Urgent actions are needed to promote active play and PA among Colombian children and adolescents. The correlates identified in our study can help inform the development of actions to overcome the disparities and provide opportunities for children to achieve their full potential for healthy growth and development.

Regular physical activity (PA) is one of the most important behaviors for health promotion and disease prevention.1 Among preschoolers, PA is associated with improved motor and cognitive development, better psychosocial and metabolic health, and favorable fitness and bone health.2 Similarly, in school-aged children and adolescents, PA is favorably associated with adiposity, cardiometabolic risk factors, physical fitness, bone health, well-being, motor skills development, and psychological health.3 To obtain these benefits, the World Health Organization (WHO) recommends that children between 3 and 4 years of age should accumulate a daily minimum of 180 minutes in PAs of any intensity, of which at least 60 minutes should be moderate- to vigorous-intensity PA (MVPA).4 For children and adolescents between 5 and 17 years of age, the WHO recommends the accumulation of a minimum of 60 minutes of MVPA daily.5

Despite the multiple benefits of regular PA, the proportion of children and adolescents meeting the guidelines is small. According to the Global Matrix 3.0 of Report Card grades on PA, the proportion of children and adolescents meeting the guidelines is between 27% and 33%.6 A pooled analysis of data from 1.6 million students found that 81% of adolescents around the world do not achieve the recommended amount of PA.7 A study on Latin American and Caribbean children and adolescents reported that only 15% met the PA guidelines.8

Considering the important benefits of PA for health, and in response to the high prevalence of physical inactivity, the WHO launched the Global Action Plan on Physical Activity 2018–2030.9 This plan established a target of a 15% relative reduction in physical inactivity among adolescents and adults by 2030 and provides guidance on how to achieve this target.9 One of the main actions proposed is having reliable surveillance systems that provide quality data on multiple domains of PA and its sociocultural and environmental determinants, across all ages.9

In Colombia, PA and recreation are social rights, essential for the improvement of quality of life, and an indicator of social and human development.10 For this reason, multiple policies and strategies, like the WHO Global Action Plan, have been adopted to advance PA promotion, specifically for children and youth populations.11 Following the WHO suggested actions, improved surveillance of PA in Colombia is desirable. The evidence on PA of Colombian children and adolescents has been limited, and comes mainly from regional or local studies.12 The National Survey of Nutrition (ENSIN), in its most recent version (2015), provides nationally representative data on the PA of children and adolescents for the first time in the country’s history. ENSIN provides rich contextual data and provides a unique opportunity to understand PA levels and correlates in Colombia. Using ENSIN data, this paper aims to describe the prevalence of PA among Colombian children and adolescents (3–17 y) and to explore the factors associated with meeting PA guidelines within a socio-ecological framework.

Methods

Study Setting

Colombia is an upper middle-income country, located in the northwest of South America. Geographically, Colombia is grouped into 6 regions: Orinoquia-Amazonia, Atlantic, Central, Eastern, Pacific, and Capital District.13 With a Gini index of 50.4, Colombia is among the countries with the highest income inequalities in the world.14 Colombia is classified as a country with a high Human Development Index (0.761).15 However, the Human Development Index varies considerably across the country.16 According to the 2018 population census, Colombia has 45.5 million inhabitants, of which 34% are children and adolescents under 18 years of age.17

Study Design and Participants

This study analyzed cross-sectional data from the ENSIN 2015 survey,13 a national population survey, representative of urban and rural areas of Colombia, with a stratified, multistage probability cluster sampling design. The survey, administered by the Colombian Institute of Family Welfare, was conducted at the household level and comprised different components. All selected households were included in the demographic and anthropometric components. For the PA component, a probabilistic subsample was identified based on the required samples per region and age group. The subsample for this analysis included 4507 preschoolers (3–5 y), 5336 school-aged children (6–12 y), and 6769 adolescents (13–17 y).

Data Collection

Data were collected by trained nutritionists equipped with computer-assisted personal interview technology, specifically designed for the survey. For preschoolers (3–5 y) and school-aged children (6–12 y), a parent or the primary caregiver of the child responded to the interview. For adolescents (13–17 y), the responses were self-reported to the interviewer. Data were collected in the household setting, between December 2015 and November 2016, and released in June 2019.

Informed consent was obtained before conducting the survey. For children and adolescents <18 years of age, parents or legal guardians provided their consent, and children between 12 and 17 years also provided informed assent. Local ethics approval to conduct the survey was granted by the Profamilia Institutional Review Board on Research involving Human Subjects and the Colombian National Institutes of Health (reference number 2-2015; February 26, 2015). Approval for secondary data analyses was obtained from the University of Ottawa (Canada; file number H-06-19-3564).

Dependent Variables

The PA was self-reported or proxy reported in response to different questions according to age group. For preschool children, PA was assessed using the Questionnaire for the Measurement of PA and Sedentary Behaviors in preschool to fourth-grade children, which assesses PA out of school or day-care institutions among preschoolers to 10 year olds. This questionnaire has a moderate internal consistency for PA and high reproducibility mainly for walking to school and organized sports.18 For school-aged children and adolescents, PA was assessed with a question adapted from the US Youth Risk Behavior Surveillance System.19 Details on the questions, response options, and variables used in the analysis are provided in Table 1. For the analyses presented in this paper, dichotomous variables to indicate meeting/not meeting PA guidelines were created (Table 1). As sensitivity analyses, cutoffs of 5 and 6 days of MVPA were also examined for school-aged children and adolescents. Meeting muscle-strengthening recommendations for school-aged children and adolescents was explored descriptively.

Table 1

Description of the Dependent Variables and Covariates Included in the Analyses of Meeting PA Guidelines and its Factors Associated Among Colombian Children and Adolescents

VariableInstrumentQuestion and response optionsVariable processing and final variable used in the analysis
Meeting PA guidelines among preschoolersC-MAFYCS– During the last 7 days, did (name of the child) walk to go FROM home to school? How much time did he/she spend? (for each day)

– During the last 7 days, did (…) walk to go BACK FROM school to home? How much time did he/she spend? (for each day)

– Last week, did (…) practice any organized sport? How much time did he/she spend? (for each day)

– Last week, did (…) walk out of school? How much time did he/she spend? (for each day)

– Last week, out of school, did (…) play with a ball? How much time did he/she spend? (for each day)

– Last week, out of school, did (…) ride a bike, roller blades, skateboard, scooter? How much time did he/she spend? (for each day)

– Last week, out of school, did (…) play or swim in the pool, river, lake, lagoon, ocean or brook? How much time did he/she spend? (for each day)

– Last week, out of school, did (…) play at the park? How much time did he/she spend? (for each day)

– Last week, out of school, did (…) play with friends, neighbors or relatives? How much time did he/she spend? (for each day)
The total time in all activities per weekdays and weekend days was estimated in minutes, and an average of minutes of PA per day was calculated. A dichotomous variable to indicate if the preschooler met PA guidelines was created, using a cutoff of 180 min of PA per day including at least 60 min of energetic play for preschool children.
Meeting PA guidelines among school-aged childrenYRBSSDuring the last week (past 7 days), on how many days was (name of the child) physically active for at least 60 minutes per day? (Add up all the time […] spent in any kind of PA that increased his/her heart rate and made him/her breathe hard some of the time.)

Number of days _____
A dichotomous variable to indicate if the child met PA guidelines was created, using a cutoff of 7 d of MVPA.

Sensitivity analyses were conducted with cutoffs of 5 and 6 d of MVPA.
Meeting PA guidelines among adolescentsYRBSSDuring the last week (past 7 days), on how many days were you physically active for at least 60 minutes per day? (Add up all the time you spent in any kind of PA that increased your heart rate and made you breathe hard some of the time.)

Number of days _____
A dichotomous variable to indicate if the adolescent met PA guidelines was created, using a cutoff of 7 d of MVPA.

Sensitivity analyses were conducted with cutoffs of 5 and 6 d of MVPA.
Meeting muscle-strengthening recommendations among school-aged children and adolescentsYRBSSDuring the last week (past 7 days), how many days did (name of the child)/ you do exercises to strengthen or tone his/her/your muscles, such as squats, sit-ups, push-ups, weight lifting, cheerleading, monkey bars or mountain hiking?

Number of days _____
A dichotomous variable to indicate if the child or adolescent met muscle-strengthening recommendations was created, using a cutoff of 3 d/wk of muscular-strengthening activities.
Unstructured play among preschoolersC-MAFYCS– Last week, out of school, did (…) play with a ball? How much time did he/she spend? (for each day)

– Last week, out of school, did (…) ride a bike, roller blades, skateboard, scooter? How much time did he/she spend? (for each day)

– Last week, out of school, did (…) play or swim in the pool, river, lake, lagoon, ocean or brook? How much time did he/she spend? (for each day)

– Last week, out of school, did (…) play at the park? How much time did he/she spend? (for each day)

– Last week, out of school, did (…) play with friends, neighbors or relatives? How much time did he/she spend? (for each day)
The total time in play activities per weekdays and weekend days was estimated in minutes, and an average of minutes of play per day was calculated. A dichotomous variable to indicate the engagement in unstructured play was created, using a cutoff of 120 min/d.
Outdoor play among preschoolersC-MAFYCS– Last week, did (…) play outside the house? How much time did he/she spend? (for each day)The total time playing outdoors was obtained for weekdays and weekend days and the average of minutes of outdoor play per day was calculated. A dichotomous variable indicating the involvement in outdoor play was created, using a cutoff of 120 min/d.
SexHousehold Questionnaire of the ENSINParent or self-report: male or femaleDichotomous variable: male or female
AgeHousehold Questionnaire of ENSINHow old is (…)?/ How old are you?Continuous and categorical variables were included in the analyses: 3 and 4 vs 5 y old, 6–9 y old vs 10–12 y old, and 13–15 y old vs 16–17 y old.
EthnicityHousehold Questionnaire of ENSINAccording with your culture, town or physical characteristics, (…) is or recognize himself/herself as:

– Indigenous

– Gipsy/Rom

– Raizal of the archipelago

– Palenquero from San Basilio

– Black, mulatto, Afro-colombian, Afro-descendant

– None of the mentioned above.
Categories were grouped and a new categorical variable was created with the following categories:

Afro-Colombian vs Indigenous vs no ethnic identity reported.
WeightDirectly measured in kilograms using portable SECA 874 scales (Seca, Hamburg, Germany) after outer clothing and shoes were removedNot applicableUsed as a continuous variable for the estimation of the BMI.
HeightDirectly measured in centimeters with ShorrBoard stadiometers (Shorr Productions, Olney, MD) with the participants standing, with the head in the Frankfort plane, and 5 contact points of the body with the stadiometer: heels, calves, buttocks, shoulder blades, and head.Not applicableUsed as a continuous variable for the estimation of the BMI.
BMICalculated based on the direct measures of weight and heightNot applicableThe continuous variable was categorized using the WHO growth standards and reference tables. For children under 5 y of age BMI was categorized as no excess (BMI z score ≤ +2) vs overweight (BMI z score >+2 to ≤ +3) vs obesity (BMI z score >+3). For children and adolescents between 5 and 17 y of age BMI was categorized as no excess (BMI z score ≤ +1) vs overweight (BMI z score >+1 to ≤ +2) vs obesity (BMI z score >+2).
Wealth indexHousehold Questionnaire of ENSINWealth index was calculated based on asset ownership, availability of public utilities and the materials used for housing construction using a principal component analysis approach.Wealth index was categorized into quartiles for the analyses.
AreaHousehold Questionnaire of ENSINParent or self-report of the area where the household is located: municipal center vs. population centre vs. scattered rural.Area categories were grouped into 2 categories: urban (municipal centers) and rural (population centers and scattered rural).
TV availability in the child’s bedroomNIK surveyDoes (…) have a TV in his/her room?/Do you have a TV in your room? Yes vs. NoDichotomous variable: Yes or No
Video games availability in the child’s bedroomNIK surveyDoes (…) have video games systems (Playstation, Xbox, cellphone, smartphone, iPod, iPad or other tablets, etc.)?/Do you have videogames systems (Playstation, Xbox, cellphone, smartphone, iPod, iPad or other tablets, etc.)? Yes vs. NoDichotomous variable: Yes or No
Maternal adherence to PA guidelinesIPAQTransport and leisure time domains of the IPAQ questionnaire on its long version.Total minutes of PA on each domain were calculated and a dichotomous variable to indicate adherence to PA guidelines was created, using a cutoff of 150 min of moderate to vigorous activity per week.
PE frequency among adolescentsAdapted from YRBSSIn the last week you were in school (last 7 days), on how many days did you go to physical education (PE) classes? Number of days _____The continuous variable was categorized into 3 categories: No class in the last week vs 1 day vs 2 or more days
Parks availabilityAdapted from NIK surveyAre there any parks, green spaces, recreation facilities or sports facilities in your neighborhood, where (…)/you can play? Yes vs. NoDichotomous variable: Yes or No
Safety perception of parksAdapted from NIK surveyIs it safe for (…)/you to play at the park in your neighborhood? Yes vs. NoDichotomous variable: Yes or No
Counseling on PA by health providersDesigned for ENSINDuring the last 12 months, did any doctor or health professional recommend (…)/ you to start or continue exercising, doing any PA or playing sports? Yes vs. NoDichotomous variable: Yes or No
Geographic regionHousehold Questionnaire of ENSINParent or self-report of the department where the household is located.The reported departments were categorized into the following regions according to their geographical location: Orinoquia-Amazonia vs Atlantic vs Central vs Eastern vs Pacific vs Capital District
Participation in organized activities and programs among school-aged childrenDesigned for ENSINDuring the LAST WEEK (past 7 days), did (…) do any of these activities? Read all the response options and check all that apply

□ Sports teams (soccer, basketball, volleyball, etc.)?

□ Organized groups (dance, martial arts, etc.)?

□ Attend Ciclovía (when streets are closed to motorized vehicles, usually Sundays and holidays, for recreational and exercise purposes)?

□ None of these
Dichotomous variables were created for each response category to ascertain the participation in organized activities and programs:

– Sports clubs (Yes vs No)

– Organized groups (Yes vs No)

– Ciclovías (Yes vs No)

Participation in organized activities and programs among adolescentsDesigned for ENSINIn the last month, did you participate in any of the following PA programs: a) Ciclovías? (when streets are closed to motorized vehicles, usually Sundays and holidays, for recreational and exercise purposes); b) PA classes? (e.g. aerobics classes, rumba, stretching, yoga, etc.); c) PA programs at school?; d) Sports clubs?;  e) Organized groups? (dance, martial arts, etc.)Dichotomous variables were created for each response category to ascertain the participation in organized activities and programs:

– Ciclovías (Yes vs No)

– PA classes (Yes vs No)

– PA programs at school (Yes vs No)

– Sports clubs (Yes vs No)

– Organized groups (Yes vs No)
Frequency of participation in programs and organized activities among adolescentsDesigned for ENSINHow often have you had participated in this/these program(s)?

If the adolescent has participated in more than one program, sum the total participation

□ Once per month

□ Twice per month

□ Three times per month

□ Four times per month or more
A categorical variable with the 4 response options was used for the analyses.

Abbreviations: BMI: body mass index; C-MAFYCS, Questionnaire for the Measurement of Physical Activity and Sedentary Behaviors in preschool to fourth-grade children; ENSIN, the National Survey of Nutrition in Colombia; IPAQ, International Questionnaire of Physical Activity; MVPA, moderate- to vigorous-intensity PA; NIK, Neighborhood Impact on Kids survey; PA, physical activity; PE, physical education; WHO, World Health Organization; YRBSS, US Youth Risk Behavior Surveillance System.

Considering the importance of active play for the health and development of younger children, active play involvement was explored among preschoolers. Two variables to assess active play were created, based on the benchmarks proposed by the Active Healthy Kids Global Alliance,6 engagement in unstructured active play and involvement in outdoor play (Table 1).

Covariates

The covariates for this analysis were selected among the available variables in the database and taking into account the socio-ecological framework of PA20; therefore, these variables belong to different levels of influence. For the individual level, sociodemographic (age and ethnicity) and biologic variables (sex and body mass index [BMI]) were included. Sociodemographic variables were measured in the Household Questionnaire of ENSIN.13 Ethnicity was assessed with a self-determination question described in Table 1. Ethnicity was reported by the household main respondent. Despite being one of the main social conditions considered in the survey, ENSIN was not designed to be representative by ethnicity. Weight and height were measured objectively (Table 1). BMI was calculated based on the direct measures of weight and height and categorized using the WHO growth standards and reference tables (Table 1).21,22

For the household level, wealth index, area, the availability of TV in the child’s bedroom and video games devices at home, and maternal adherence to PA guidelines were included. Availability of devices was assessed with questions adapted from the Neighborhood Impact on Kids survey,23 and maternal PA was assessed with the International PA Questionnaire.24 For the school level, the number of days with physical education classes was assessed, only for adolescents. At the community level, the availability and perceived safety of parks was assessed with questions adapted from the Neighborhood Impact on Kids survey,23 and counseling on PA by health providers was assessed with a specific question designed for ENSIN (Table 1). For the natural environment level, the geographic region where children and adolescents lived was included. For the policy level, participation in organized sports, organized activity groups, Ciclovías (Open Street programs in Colombia),25 and PA programs was assessed among adolescents (Table 1).

Statistical Analysis

Descriptive statistics of the sample and overall and stratified population-weighted prevalence estimates for PA and active play were calculated. Group differences were determined with chi-square tests. To estimate the factors associated with PA, prevalence ratios (PRs) were determined using Poisson regression models with robust variance. Bivariate models were conducted with each of the selected covariates. Multivariable models included the variables that showed at least marginally significant associations (P < .10) in the bivariate models and were adjusted for age and sex. The variables with P values <.05 were considered correlates of PA indicators. Given that all the variables were obtained at the household level, a multilevel modeling approach was not used. The analyses were conducted using STATA (version 14.0; StataCorp, College Station, TX) with the survey (SVY) module for complex samples to take into account the characteristics of the study design, sample weights, and missing data. This module accounts for the clustering of the data.

Results

Characteristics of the sample are presented in Tables 2 and 3. Respondents with missing data on the main variables of interest were excluded. Approximately 48% of the samples for the 3 age groups were females. The mean age was 4.0 years (SD = 0.8), 8.9 years (SD = 2.0), and 14.9 years (SD = 1.4) for preschoolers, children, and adolescents, respectively. Over 80% of the sample did not recognize themselves as Afro-Colombian or Indigenous, so were categorized as other. Statistically significant differences were observed between males and females. Among preschoolers, males had a higher prevalence of overweight and obesity than females. For school-aged children, higher participation in sport clubs was observed among males, while females had a higher participation in organized activities. Among adolescents, females had a higher prevalence of overweight and obesity. Male adolescents reported a higher availability of parks in their neighborhood and higher safety perceptions than females. A higher proportion of females reported receiving PA counseling by health professionals, and there were differences by sex in the participation in programs (Table 3).

Table 2

Sociodemographic Characteristics of 4507 Preschool Children From Colombia—ENSIN 2015

Preschool children
Total sampleMalesFemales
Sociodemographic variablesna%SEn%SEn%SEP value
Sex
 Female219748.51.21NANA
 Male231051.61.21NANA
Age, y
 3–4300270.21.03151770.51.46148569.81.35.736
 5150529.81.0379329.51.4671230.21.35
Ethnicity
 Afro-Colombian4419.10.782228.20.8121910.01.11.170
 Indigenous4814.70.632464.50.702354.90.71
 Other354786.20.84182187.30.94172685.11.17
BMI categorization
 No excessb386089.00.76193686.61.22192491.50.82.002
 Overweight3758.40.6921810.11.141576.60.72
 Obesity1302.60.33823.30.51481.90.40
Wealth quartiles
 First237441.11.31119840.31.58117642.01.89.650
 Second108626.31.1857527.61.5051124.91.56
 Third71320.31.2236519.61.3434821.02.04
 Fourth33412.41.0117212.51.3516212.21.35
Area
 Urban320872.41.20163171.81.47157772.91.71.593
 Rural129327.61.2067528.21.4761827.11.71
TV available at the child’s bedroom
 Yes173442.31.1590644.31.5882840.11.55.057
 No276757.71.15140055.71.58136759.91.55
Video games devices availability
 Yes55414.00.8429513.71.1225914.21.32.788
 No394786.00.84201186.31.12193685.81.32
Maternal PAc
 Meeting WHO guidelines37841.22.6118838.63.6119044.33.74.288
 Not meeting WHO guidelines48958.82.6125361.43.6123655.73.74
Parks availability in the neighborhood
 Yes237655.41.37127356.91.70110353.81.94.187
 No212544.61.37103343.11.70109246.31.94
Safety perceptiond
 Is safe to play in the park179375.71.5797777.31.9781674.02.22.233
 Is not safe to play in the park58324.31.5729622.71.9728726.02.22
Counseling on PA
 Yes64114.70.8032915.01.1031214.31.10.621
 No386085.30.80197785.01.10188385.71.10
Geographic region
 Atlantic93524.41.0349125.01.2644423.81.44.814
 Eastern79917.01.2440116.21.4139817.81.61
 Orinoquia-Amazonia7753.90.273953.80.533804.00.47
 Capital District31814.01.3016114.21.4515713.72.14
 Central97024.20.9349824.91.3447223.51.35
 Pacific71016.50.7036415.80.9434617.21.17

Abbreviations: BMI, body mass index; NA, not applicable; PA, physical activity; WHO, World Health Organization.

aThe total sample size for preschoolers was 4507 children. However, the following variables had missing values: ethnicity = 38; BMI = 142; area, TV availability, video games availability, parks availability, and counseling on PA = 6. bNo excess category groups children with thinness, risk of thinness and normal BMI. cThe variable maternal PA is available only for the dyads of children and mothers selected for the PA component of the survey; therefore, the sample sizes are smaller. dSafety perception was assessed only among those who reported having a park in their neighborhood.

Table 3

Sociodemoraphic Characteristics of 12,105 Children and Adolescents From Colombia—ENSIN 2015

School-aged childrenAdolescents
Total sampleMalesFemalesTotal sampleMalesFemales
Sociodemographic variablesna%SEn%SEn%SEP valuenb%SEn%SEn%SEP value
Sex
 Female255848.11.12NANANA333048.20.93NANANA
 Male277851.91.12NANA343951.80.93NANA
Ethnicity
 Afro-Colombian4529.80.932339.61.0921910.11.06.8425759.10.913349.41.132418.70.96.176
 Indigenous6715.90.783335.71.233386.11.066534.40.782623.90.783915.00.89
 Other416884.31.11219284.81.48197683.81.39548786.50.80281486.70.99267386.31.00
BMI categorization
 No excessc389574.11.16201972.91.60187675.41.51.528523581.90.75280685.10.96242978.61.11<.001
 Overweight88317.90.8445018.51.2843317.21.2195813.80.6534211.30.8861616.40.96
 Obesity3748.00.762198.61.031557.41.103004.30.401293.70.451715.00.63
Wealth quartiles
 First286839.21.56147939.02.06138939.41.78.620341437.91.29173038.51.63168437.31.49.767
 Second129025.61.1970925.81.4958125.31.64157223.30.9680523.51.1976723.01.21
 Third76319.71.0338218.71.3538120.71.44112321.30.9257021.11.3655321.51.24
 Fourth41515.61.1620816.41.5820714.71.3566017.51.0933416.91.3632618.21.41
Area
 Urban401673.71.35208774.01.77192973.41.57.782492273.91.27240673.51.49251674.41.44.535
 Rural131726.31.3569026.01.7762725.61.57184226.11.27102926.51.4981325.61.44
TV available at the child’s bedroom
 Yes180739.61.3292139.01.7988640.31.76.601241141.41.06124141.61.46117041.31.42.883
 No352560.41.32185561.01.79167059.71.76435258.61.06219358.51.46215958.71.42
Video games devices availability
 Yes145233.71.2878235.21.8567032.01.70.208390162.11.03197061.61.37193162.71.30.507
 No388166.31.28199564.81.85188668.01.70286337.91.03146538.41.37139837.31.30
Maternal PAd
 Meeting WHO guidelines51248.92.1525851.13.3025446.83.35.40836650.32.7818549.13.2018151.54.19.630
 Not meeting WHO guidelines59051.12.1529549.03.3029553.23.3548649.72.7824050.93.2024648.54.19
PE classese
 No class in the last weekNANANANA80318.60.8836417.21.2643920.11.22.007
 One dayNANANA273761.11.24144264.81.70129557.31.67
 Two or more daysNANANA105420.31.1449318.01.3756122.61.68
Parks availability in the neighborhood
 Yes312161.41.54165062.61.89147160.11.90.263428567.11.12226169.41.28202464.51.43.002
 No221238.61.54112737.41.89108539.91.90247932.91.12117430.61.28130535.51.43
Safety perceptionf
 Is safe to play in the park237172.11.58127172.72.12110071.42.14.652319572.61.21178377.41.59141267.21.79<.001
 Is not safe to play in the park75027.91.5837927.32.1237128.62.14109027.41.2147822.61.5961232.81.79
Counseling on PA
 Yes89018.60.9646618.31.2742419.01.38.687116618.80.7651116.00.9465521.81.18<.001
 No444381.40.96231181.71.27213281.01.38559881.20.76292484.00.94267478.31.18
Geographic region
 Atlantic78623.51.5441823.42.0536823.61.66.740137024.01.0380824.71.3356223.21.23.815
 Eastern80917.91.8840917.12.0540018.71.90118118.01.5361917.61.5456218.41.77
 Orinoquia-Amazonia15603.30.248023.20.327583.40.2512493.00.194413.00.308083.00.25
 Capital District36814.51.4019314.21.8517514.91.6041013.21.1822913.61.6118112.71.28
 Central119524.41.2363125.41.6956423.21.30167824.60.8884924.21.1582925.11.20
 Pacific61816.50.9332516.71.1929316.21.2188117.30.8149317.00.9838817.71.13
Participation in organized activities and programsg
 Cicloviash
  Yes832.00.45511.90.41322.00.84.92547715.81.1729221.01.8318510.11.13<.001
  No525098.00.45272698.10.41252498.00.84303884.31.17144779.01.83159189.91.13
 Community PA programs (eg, aerobics)
  YesNANANANA80820.41.2030016.41.3550823.91.77.001
  NoNANANA287379.61.20138483.61.35148976.11.77
 PA programs at school
  YesNANANANA192147.81.29101650.21.7090545.41.87.054
  NoNANANA204552.21.2995149.81.70109454.61.87
 Sport clubs
  Yes223741.71.18147754.31.7576028.11.50<.001112528.51.1978038.51.7434516.71.28<.001
  No309658.31.18130045.71.75179672.01.50270971.61.19126661.51.74144383.31.28
 Organized groups (dance, martial arts, etc)
  Yes4848.30.691715.40.7331311.41.13<.00172819.71.1725815.71.4847023.11.70.002
  No484991.70.69260694.60.73224388.61.13281080.31.17133284.31.48147876.91.70
 Frequency of participation in programs and organized activitiesi
  Once per monthNANANANA73822.41.2834820.61.6839024.61.85.242
  Twice per monthNANANA44914.30.9521713.81.3723214.91.33
  Three times per monthNANANA2988.90.791648.80.981349.01.17
  Four times per month or moreNANANA166554.41.5693556.82.1973051.52.19

Abbreviations: BMI, body mass index; NA, not applicable; PA, physical activity; PE, physical education; WHO, World Health Organization.

aThe total sample size for school-aged children was 5336 children. However, the following variables had missing values: ethnicity = 45; BMI = 184; TV availability = 4; and area, video games availability, parks availability, counseling on PA and participation in Ciclovias, sport clubs, and organized groups = 3. bThe total sample size for adolescents was 6769. However, the following variables had missing values: ethnicity = 54, BMI = 276, TV availability = 6; and area, video games availability, parks availability, counseling on PA = 5. cNo excess category groups children with thinness, risk of thinness, and normal BMI. dThe variable maternal PA is available only for the dyads of children and mothers selected for the PA component of the survey, therefore the sample sizes are smaller. eThe frequency of PE classes was assessed only among school-attending adolescents, for this reason the sample size is smaller. fSafety perception was assessed only among those who reported having a park in their neighborhood. gParticipation in organized activities and programs was assessed only among school-aged children and adolescents who reported knowing those programs. hCiclovias are defined as a program that closes the streets to motorized vehicles, usually Sundays and holidays, for recreational and exercise purposes. iThe frequency of participation in programs was assessed only among those adolescents who reported participating in at least one of the programs and activities listed.

PA Prevalence

Preschool Children

Table 4 presents the results of PA and play among preschoolers according to the socio-ecological framework selected variables. The overall prevalence of meeting PA guidelines among preschoolers was 24.4% with a higher prevalence among males (Figure 1). Regarding unstructured play, 31.3% of preschoolers were involved in more than 2 hours per day, with higher participation among males. Approximately 10.9% of preschoolers played outdoors for more than 2 hours per day.

Figure 1
Figure 1

—Prevalence estimates of meeting PA guidelines among Colombian children by sex ENSIN 2015. Data are shown as mean values (in percentage) and 95% CIs. Vigorous activities correspond to activities that strengthen muscle and bone. ENSIN indicates the National Survey of Nutrition in Colombia; CI, confidence interval; MVPA, moderate- to vigorous-intensity PA; PA, physical activity.

Citation: Journal of Physical Activity and Health 18, 4; 10.1123/jpah.2020-0568

Table 4

Prevalence of Meeting PA Guidelines and Play Engagement Among Preschool Children From Colombia

Preschool children
Meeting 180 min of any intensity PA + 60 min of energetic playMore than 2 h of unstructured play per dayMore than 2 h of outdoors play per day
Sociodemographic and PA relevant variablesP (%)CISEPP (%)CISEPP (%)CISEP
Total24.4(22.2–26.7)1.12531.5(29.3–33.8)1.12610.9(9.5–12.6)0.7785
Sex
 Female19.9(17.3–22.8)1.388<.00126.6(23.9–29.5)1.400<.00110.4(8.4–12.8)1.088.448
 Male28.6(25.5–31.9)1.58736.1(32.9–39.4)1.62411.5(9.6–13.6)1.010
Age, y
 3–424.8(22.1–27.8)1.415.49231.9(29.1–34.8)1.422.51911.5(9.7–13.6)0.983.156
 523.3(19.9–27.0)1.77430.4(27.1–34.1)1.7539.6(7.9–11.7)0.953
Ethnicity
 Afro-Colombian31.3(25.3–38.0)3.184.05844.2(37.5–51.2)3.459<.00121.5(16.1–28.2)3.015<.001
 Indigenous20.6(13.6–30.0)4.10225.1(18.2–33.5)3.86016.0(10.2–24.3)3.504
 Other23.9(21.5–26.5)1.24830.5(28.1–33.1)1.2509.5(8.0–11.3)0.820
BMI categorization
 No excessa24.7(22.3–27.2)1.210.97531.5(29.2–34.0)1.207.59811.4(9.8–13.3)0.869.133
 Overweight25.2(18.9–32.7)3.46235.2(27.8–43.5)3.9749.6(6.5–14.0)1.837
 Obesity25.8(15.8–39.1)5.86730.5(20.1–43.3)5.8705.0(2.0–12.1)2.281
Wealth quartiles
 First (poorest)23.4(20.5–26.5)1.509.07029.6(26.7–32.8)1.545.34616.6(14.1–19.5)1.342<.001
 Second25.2(20.9–30.1)2.30133.7(29.2–38.5)2.3237.4(5.1–10.4)1.304
 Third20.9(16.9–25.5)2.14530.1(25.7–35.0)2.3475.1(3.4–7.6)1.018
 Fourth (wealthiest)31.8(23.9–40.9)4.28735.0(27.4–43.5)4.0499.2(5.0–16.3)2.740
Area
 Urban25.2(22.6–28.1)1.361.21733.1(30.4–36.0)1.391.0218.6(7.1–10.5)0.848<.001
 Rural22.2(18.5–26.4)1.96927.2(23.4–31.3)1.96717.0(14.0–20.4)1.595
TV available at the child’s bedroom
 Yes22.5(19.4–25.9)1.611.11630.3(27.1–33.8)1.684.3607.9(6.3–9.8)0.872<.001
 No25.8(23.0–28.8)1.43532.4(29.5–35.4)1.46613.2(11.1–15.6)1.122
Video games devices availability
 Yes27.7(21.4–35.1)3.439.28438.8(31.2–44.9)3.451.0489.3(5.7–14.7)2.196.443
 No23.9(21.5–26.3)1.20330.5(28.1–33.0)1.22211.2(9.7–13.0)0.827
Maternal PA
 Meeting WHO guidelines25.2(17.5–34.9)4.302.83630.2(22.2–39.5)4.288.8698.3(5.4–12.5)1.714.285
 Not meeting WHO guidelines24.1(18.0–31.5)3.33331.1(24.5–38.5)3.45211.5(7.1–18.2)2.667
Parks availability in the neighborhood
 Yes26.7(23.6–29.9)1.566.02034.2(31.1–37.4)1.583.0099.1(7.3–11.3)0.993.006
 No21.6(18.8–24.7)1.48728.2(25.1–31.4)1.57213.3(11.1–15.8)1.163
Safety perceptionb
 Is safe to play in the park28.0(24.8–31.5)1.666.20136.2(32.8–39.6)1.689.0588.4(6.4–10.9)1.110.252
 Is not safe to play in the park22.5(15.9–30.8)3.71828.0(21.3–36.0)3.67911.0(7.5–16.0)2.107
Counseling on PA
 Yes23.3(18.0–29.5)2.898.68035.4(29.7–41.6)2.988.1617.9(5.2–11.6)1.569.074
 No24.6(22.2–27.2)1.24030.8(28.4–33.4)1.24911.5(9.9–13.3)0.860
Geographic region
 Atlantic26.4(22.6–30.5)1.977.48934.4(30.3–38.8)2.125.29614.5(11.4–18.4)1.739.018
 Eastern25.3(20.2–31.1)2.73829.7(25.0–35.0)2.5069.1(5.8–13.9)1.978
 Orinoquia-Amazonia15.7(9.5–25.0)3.85520.8(13.8–30.2)4.0809.9(6.4–15.2)2.158
 Capital District26.4(19.0–35.5)4.16729.5(21.9–38.5)4.1685.1(2.2–11.5)2.123
 Central22.8(19.1–27.0)1.9832.7(28.5–37.1)2.15010.4(8.1–13.2)1.267
 Pacific23.2(18.3–29.0)2.6731.3(26.5–36.7)2.55913.5(10.1–17.8)1.905

Abbreviations: BMI, body mass index; CI, confidence interval; PA, physical activity; WHO, World Health Organization.

aNo excess category groups children with thinness, risk of thinness, and normal BMI. bSafety perception was assessed only among those who reported having a park in their neighborhood.

School-Aged Children

Overall, 31.1% of school-aged children met the PA guidelines, with a higher prevalence among males (35.8%; Figure 1) and several differences by sociodemographic and PA relevant variables (Table 5). When the vigorous activities and muscle-strengthening recommendations were considered, the prevalence estimate decreased to 3.1%, and sex differences remained (Figure 1). The sensitivity analyses showed that when 5- and 6-day cutoffs were used, the prevalence increased to 36.9% and 32.5%, respectively.

Table 5

Prevalence of Meeting PA Guidelines Among Colombian School-Aged Children and Adolescents

School-aged childrenAdolescents
Meeting 60 min of MVPA dailyMeeting 60 min of MVPA daily + 3 d of vigorous activitiesMeeting 60 min of MVPA dailyMeeting 60 min of MVPA daily + 3 d of vigorous activities
Sociodemographic and PA relevant variablesP (%)CISEPP (%)CISEPP (%)CISEPP (%)CISEP
Total31.1(28.4–34.0)1.3983.1(2.5–3.8)0.34313.4(12.0–15.0)0.7534.8(4.0–5.7)0.434
Sex
 Female26.0(22.9–29.4)1.621<.0012.4(1.7–3.3)0.401.0507.6(6.1–9.6)0.871<.0012.1(1.5–2.8)0.334<.001
 Male35.8(32.1–39.7)1.9113.7(2.8–5.0)0.54118.8(16.7–21.0)1.0847.3(5.9–9.0)0.750
Ethnicity
 Afro-Colombian45.2(37.6–53.0)3.893<.0015.3(2.9–9.3)1.538.06217.1(12.0–23.8)2.944.2315.8(3.7–9.1)1.316.228
 Indigenous47.6(35.2–60.4)6.4142.2(1.0–4.9)0.89712.9(8.5–19.0)2.5902.6(1.4–4.9)0.841
 Other28.3(25.5–31.2)1.4142.8(2.2–3.6)0.33513.1(11.7–14.6)0.7444.8(3.9–5.8)0.484
BMI categorization
 No excessa33.3(30.4–36.3)1.477.0013.0(2.3–3.9)0.402.64114.4(12.7–16.3)0.904.0035.0(4.1–6.2)0.512.337
 Overweight27.0(22.3–32.4)2.5183.1(2.0–4.8)0.6788.4(6.3–11.1)1.1923.8(2.3–6.0)0.887
 Obesity18.6(12.5–26.7)3.5342.1(1.0–4.4)0.75912.7(8.1–19.4)2.7816.8(3.4–13.1)2.286
Wealth quartiles
 First (poorest)38.5(34.2–43.0)2.215<.0013.2(2.3–4.5)0.551.94015.4(12.9–18.4)1.375.0193.7(2.8–4.8)0.507.241
 Second26.5(22.3–31.1)2.1942.8(1.8–4.3)0.59915.3(12.6–18.4)1.4725.9(3.9–8.7)1.181
 Third24.8(20.5–29.8)2.3273.0(1.9–4.5)0.64310.4(8.2–13.1)1.2375.5(3.9–7.8)0.977
 Fourth (wealthiest)28.1(22.0–35.1)3.2973.3(1.7–6.6)1.14810.2(6.9–14.8)1.9404.8(2.9–7.8)1.166
Area
 Urban29.4(26.4–32.6)1.549.0282.9(2.2–3.8)0.394.39113.1(11.5–14.8)0.818.3725.5(4.5–6.7)0.550.005
 Rural35.9(30.8–41.4)2.6613.6(2.4–5.4)0.73414.4(11.8–17.6)1.4492.9(1.9–4.3)0.574
TV available at the child’s bedroom
 Yes24.5(21.5–27.7)1.552<.0012.5(1.7–3.7)0.500.17312.2(10.3–14.4)1.030.1555.1(3.9–6.7)0.708.529
 No35.5(31.8–39.3)1.8593.5(2.7–4.5)0.45214.3(12.3–16.4)1.0214.5(3.5–5.8)0.563
Video games devices availability
 Yes25.9(22.1–30.0)1.961.0032.8(1.8–4.3)0.593.59512.7(11.0–14.5)0.873.1755.8(4.7–7.2)0.636.001
 No33.8(30.4–37.3)1.7093.2(1.5–4.2)0.42014.6(12.3–17.2)1.2333.1(2.3–4.1)0.447
Maternal PA
 Meeting WHO guidelines24.8(18.9–31.7)3.169.9214.3(2.1–8.5)1.492.46816.2(9.1–27.1)4.415.7735.3(2.4–11.3)2.030.612
 Not meeting WHO guidelines24.3(18.9–30.7)2.9353.1(1.8–5.3)0.82614.5(8.7–23.1)3.5217.4(2.7–18.3)3.511
PE classesb
 No class in the last weekNANA12.6(9.5–16.4)1.707.9525.6(3.3–9.4)1.455.849
 One dayNANA13.2(11.1–15.6)1.1314.9(3.6–6.6)0.727
 Two or more daysNANA12.9(10.2–16.2)1.4885.2(3.6–7.6)0.976
Parks availability in the neighborhood
 Yes28.5(25.6–31.7)1.516.0063.3(2.5–4.4)0.466.31514.2(12.5–16.1)0.887.0795.7(4.7–7.1)0.603<.001
 No35.2(31.0–39.6)2.1432.7(1.9–3.8)0.46911.8(9.8–14.2)1.1162.8(2.0–3.9)0.452
Safety perceptionc
 Is safe to play in the park30.3(27.2–33.6)1.605.0463.7(2.7–5.0)0.567.18014.9(13.0–17.1)1.031.2006.2(5.0–7.6)0.661.369
 Is not safe to play in the park24.0(19.0–29.9)2.7242.4(1.3–4.3)0.72512.2(9.1–16.1)1.7324.6(2.5–8.4)1.394
Counseling on PA
 Yes25.2(20.8–30.1)2.317.0094.3(2.8–6.7)0.942.08714.0(10.6–18.3)1.918.7346.1(4.3–8.6)1.062.118
 No32.5(29.5–35.6)1.5472.8(2.1–3.6)0.36313.3(11.7–15.0)0.8074.5(3.6–5.5)0.468
Geographic region
 Atlantic42.2(36.0–48.5)3.138<.0012.7(1.8–4.0)0.538.45014.6(12.1–17.5)1.363.6784.5(3.2–6.2)0.724.758
 Eastern24.1(19.9–28.9)2.2442.9(1.8–4.8)0.73212.8(9.9–16.4)1.6215.2(3.7–7.3)0.900
 Orinoquia-Amazonia40.7(34.9–46.7)2.9605.4(3.9–7.5)0.89415.6(11.9–20.3)2.1097.8(5.0–12.1)1.752
 Capital District19.4(14.0–26.2)3.0573.7(1.9–7.1)1.22113.7(9.3–19.7)2.5934.8(2.2–10.1)1.841
 Central28.4(23.7–33.5)2.4452.4(1.5–3.7)0.52411.6(9.5–14.2)1.1714.2(3.0–5.9)0.723
 Pacific35.4(27.7–43.9)4.0713.8(2.0–6.9)1.15814.4(10.2–19.8)2.3835.0(3.1–7.8)1.143
Participation in organized activities and programs
 Cicloviasd
  Yes29.4(15.1–49.2)8.771.8431.3(0.3–5.2)0.911.20717.7(12.7–24.1)2.829.07011.2(6.7–18.1)2.777.004
  No31.1(28.4–34.0)1.4103.1(2.5–3.9)0.34912.6(10.7–14.8)1.0174.9(3.9–6.1)0.559
 Community PA programs (eg, aerobics)
  YesNANA10.0(7.4–13.3)1.440.0285.1(3.4–7.6)1.030.643
  NoNANA14.3(12.2–16.7)1.1155.7(4.4–7.4)0.742
 PA programs at school
  YesNANA15.8(13.5–18.6)1.271.0056.5(4.9–8.5)0.886.023
  NoNANA11.3(9.4–13.5)1.0224.1(3.1–5.5)0.595
 Sport clubs
  Yes32.1(28.5–36.0)1.878.4044.8(3.5–6.4)0.707<.00120.0(16.6–23.9)1.825.00211.1(8.5–14.5)1.513<.001
  No30.4(27.3–33.7)1.6031.9(1.4–2.6)0.29813.1(10.9–15.7)1.1924.6(3.4–6.3)0.728
 Organized groups
  Yes22.3(16.8–29.0)3.051.0061.9(1.0–3.7)0.643.15813.8(10.3–18.2)1.969.7326.5(4.0–10.5)1.566.332
  No31.9(29.1–34.8)1.4383.2(2.5–4.0)0.37013.0(11.0–15.2)1.0455.0(3.9–6.4)0.615
 Frequency of participation in programs and organized activities
  Once per monthNANA13.4(8.9–19.6)2.643.0247.1(3.4–14.2)2.545.107
  Twice per monthNANA11.4(7.9–16.2)2.0393.8(2.0–7.3)1.245
  Three times per monthNANA10.3(6.7–15.7)2.2073.7(1.8–7.4)1.303
  Four times per month or moreNANA18.5(15.8–21.5)1.4219.1(7.1–11.5)1.072

Abbreviations: BMI, body mass index; CI, confidence interval; MVPA; moderate- to vigorous-intensity PA; NA, not applicable; PA, physical activity; PE, physical education; WHO, World Health Organization.

aNo excess category groups children with thinness, risk of thinness, and normal BMI. bThe frequency of PE classes was assessed only among school-attending adolescents. cSafety perception was assessed only among those who reported having a park in their neighborhood. dCiclovias are defined as a program that closes the streets to motorized vehicles, usually Sundays and holidays, for recreational and exercise purposes.

Adolescents

Among adolescents, 13.4% met the PA guidelines with higher levels among males (18.8%; Figure 1). Other significant differences were observed between groups (Table 5). When vigorous activities and muscle-strengthening recommendations were considered, the prevalence estimate decreased to 4.8% and a significant difference between males and females remained (Figure 1). The sensitivity analysis showed that when 5- and 6-day cutoffs were used, the prevalence increased to 20.5% and 15.7%, respectively.

Correlates of PA Indicators

Meeting PA Guidelines Among Preschoolers

According to the bivariate analyses, female sex, lower socioeconomic status, and TV availability in the bedroom were negatively associated with meeting PA guidelines. Afro-Colombian ethnicity and park availability were positively associated with meeting the PA guidelines. Multivariable analyses showed preschool females were less likely to meet the PA guidelines compared with males (PR = 0.70, P < .001), as well as preschoolers in the third wealth quartile compared with the wealthiest (PR = 0.66, P = .016). Afro-Colombian preschoolers were more likely to meet the PA guidelines compared with those that did not report ethnic identity (PR = 1.36, P = .011), and preschoolers who had parks in their neighborhood were more likely to be active than those who did not have any (PR = 1.23, P = .026) (Figure 2A).

Figure 2
Figure 2

—PRs and 95% CIs of correlates of PA indicators among Colombian preschool children. (A) Correlates of meeting PA guidelines. Meeting guidelines is defined as engaging in at least 180 minutes of PA per day including at least 60 minutes of energetic play. (B) Correlates of more than 2 hours of unstructured play per day. (C) Correlates of more than 2 hours of outdoors play per day. CI indicates confidence interval; PA, physical activity; PRs, prevalence ratios.

Citation: Journal of Physical Activity and Health 18, 4; 10.1123/jpah.2020-0568

Unstructured Play Among Preschoolers

According to the bivariate models, female sex, living in rural areas, lower socioeconomic status, and living in the Orinoquia-Amazonia region were negatively associated with achieving 2 hours of unstructured play per day. Afro-Colombian ethnicity, video games devices availability, and having a park in the neighborhood were positively associated with unstructured play. According to the multivariable analysis, preschool females were less likely to engage in unstructured play compared with males (PR = 0.74, P < .001), Afro-Colombian preschoolers were more likely to participate in unstructured play than those that did not report ethnic identity (PR = 1.54, P < .001), and preschoolers who had parks in their neighborhood were more likely to spend more than 2 hours of unstructured play per day than their counterparts (PR = 1.22, P = .009) (Figure 2B).

Outdoor Play Among Preschoolers

The bivariate models showed negative associations for outdoor play with female sex, obesity, and TV availability in the bedroom. Positive associations were observed with Afro-Colombian and indigenous ethnicity, lower socioeconomic status, living in a rural area, parks availability, safety perception, not receiving counseling in PA, and living in the Atlantic and Pacific regions. According to the multivariable analysis, Afro-Colombian preschoolers were more likely to engage in 2 daily hours of outdoor play compared with preschoolers who did not report ethnic identity (PR = 1.86, P = .001; Figure 2C).

Meeting PA Guidelines Among School-Aged Children

The bivariate models showed negative associations with female sex, overweightness and obesity, TV availability in the child’s bedroom, parks availability, and involvement in organized activities. Positive associations were found with younger age; Afro-Colombian and indigenous ethnicity; lower socioeconomic status; video games devices availability; parks availability; safety perception; and living in the Atlantic, Orinoquia-Amazonia, Central or Pacific region. According to the multivariable analysis, females were less likely to meet the PA guidelines than males (PR = 0.74, P < .001), and children with obesity were less likely to meet the guidelines than their counterparts (PR = 0.60, P = .007). Likewise, children who had a TV in their bedroom were less likely to be active than those who did not (PR = 0.83, P = .014). In contrast, younger children (6–9 y old) were more likely to meet the PA guidelines than their older counterparts (PR = 1.67, P < .001), Afro-Colombian children were more likely to be active than those who did not report an ethnic identity (PR = 1.42, P = .001), and children from the Atlantic (PR = 1.75, P = .003) and Amazonia-Orinoquia region (PR = 1.87, P = .001) had an increased likelihood of being active than those from the Capital District (Figure 3).

Figure 3
Figure 3

—PRs and 95% CIs of correlates of meeting PA guidelines among Colombian school-aged children. Meeting guidelines was defined as engaging in at least 60 minutes of MVPA per day 7 days per week. CI indicates confidence interval; MVPA, moderate- to vigorous-intensity PA; PA, physical activity; PRs, prevalence ratios.

Citation: Journal of Physical Activity and Health 18, 4; 10.1123/jpah.2020-0568

Meeting PA Guidelines Among Adolescents

According to the bivariate models, negative associations were observed for female sex, overweightness, TV and video games devices availability, and participation in community programs. Positive associations were found for the first and second wealth quartiles, parks availability, and participation in Ciclovías, school programs, and sports clubs, as well as the participation in programs 4 times per month or more. Given that the program-related variables were available only for a subsample, 2 multivariable models were conducted. In the first multivariable model, all the variables associated in the bivariate models were included except the program-related ones. The first model showed that females were less likely to meet PA guidelines than males (PR = 0.42, P < .001), and adolescents who were overweight were less likely to be active than their counterparts (PR = 0.67, P = .011). Also, adolescents who reported having a park in their neighborhood were more likely to meet the PA guidelines, compared with those who did not have a park (PR = 1.27, P = .020: Figure 4A). The second multivariable model included the same variables as the first one, plus all the program variables that were significant in the bivariate models. This model showed that females were less likely to be active than males (PR = 0.52, P = .010), while adolescents in the 2 lowest quartiles of the wealth index were more likely to meet the guidelines than their counterparts in the wealthiest quartile (PR = 3.66, P = .001 and PR = 3.37, P = .004 for the first and second quartiles, respectively). The adolescents who participated in programs 4 or more times per month were more likely to meet PA guidelines than those who participated only once per month (PR = 2.15, P = .014; Figure 4B).

Figure 4
Figure 4

—PRs and 95% CIs of correlates of meeting PA guidelines among Colombian adolescents. Meeting guidelines was defined as engaging in at least 60 minutes of MVPA per day 7 days per week. (A) First multivariable model and (B) second multivariable model including program participation variables. CI indicates confidence interval; MVPA, moderate- to vigorous-intensity PA; PA, physical activity; PRs, prevalence ratios.

Citation: Journal of Physical Activity and Health 18, 4; 10.1123/jpah.2020-0568

Discussion

Our results show that the prevalence of meeting PA guidelines among Colombian children and adolescents is low and decreases across age groups. The differences by sex were consistent across all age groups indicating that females are less active than males, and steep decreases in the prevalence of meeting PA guidelines were observed when the recommendation for vigorous and strengthening activities were taken into account. Several variables from the individual, household, community, and environmental levels were identified as correlates of PA indicators and are discussed below.

Among preschoolers, the low estimates are concerning considering the importance of PA and play from early ages for the development of cognitive, social, physical, and emotional skills.2629 Also, it is important to highlight that sex differences of approximately 9 percentage points were observed in PA and unstructured play, indicating a clear inequity for females, as these are likely to be socially shaped differences, and therefore, unfair and avoidable. In the context of the scarce evidence on preschool adherence to the current PA guidelines, our results are notably lower than results from Canada, Australia, and Finland, where 61.8% to 94.3% preschoolers met PA guidelines.3033 However, it should be noted that those estimates were based on accelerometry measures, while ours were based on information reported by parents, who tend to under-report PA, especially for young children.34 Estimates based on proxy-reported PA in Canadian preschoolers have shown an adherence to PA guidelines of 38%, still higher than our findings.35 No comparable evidence was found from Latin American countries, probably because evidence in early years children using the recently released guidelines is just emerging.

Our results for school-aged children and adolescents are similar to the global and regional estimates.68 A third of school-aged children and only 13% of adolescents met the global recommendations on PA for health.5 This means that the large majority of Colombian children and adolescents are not enjoying the health benefits associated to the practice of regular PA, and this situation is worse among females. The results of the sensitivity analyses showed similar patterns and cause for concern when the cutoff points were 5 and 6 days per week. This could be indicative of the limitation of the question used to assess PA, which inquires about frequency of PA instead of duration. The differences that we observed in the prevalence of meeting PA guidelines across age groups do not follow the patterns reported previously suggesting that the decline in MVPA happened around the age of school entry or around 7 years of age.36,37 This could be related to 2 factors. First, a methodological reason, as preschool PA was assessed with a different questionnaire than school-aged and adolescents’ PA. And second, preschool and school-aged variables were reported by a proxy, while adolescents’ PA was self-reported. However, the steep decline observed specifically among adolescents is consistent with previous literature that has reported PA declines in the transition to adolescence.38,39

Correlates at the Individual Level

Our results showed that female sex, age, Afro-Colombian ethnicity, and BMI were associated with PA indicators among Colombian children and adolescents. However, the direction of the associations varied, and the correlates varied according to the age group. Female sex was a consistent negative correlate for all age groups and indicators, except for outdoor play. Sex is the most consistent correlate in the literature for all age groups,40,41 and our results are indicative of the need to create policies and programs with a differential approach that provide opportunities for girls to be active since early years. Age was identified as a correlate only for school-aged children, indicating that younger children were more likely to be active. This is also consistent with the literature,40 and suggests the need to consider the age of the target population for PA programs, and to design strategies that maintain or even increase children’s participation in active behaviors as they get older. The positive association of Afro-Colombian ethnicity with PA and unstructured play among preschool and school-aged children could be indicative of cultural differences that influence the activities in which young children spend their time. For example, traditional games- or dance-related activities belonging to the Afro-Colombian culture can contribute to explain the observed difference. Also, the higher involvement in PA can be related to poverty conditions prevalent among Afro-Colombian populations. Unfortunately, there is a lack of research on PA with an ethnic-minority focus in Colombia that would help to better understand this association. Regarding BMI, our findings show that school-aged children with obesity and adolescents with overweightness were less likely to be active. This association needs to be considered in the design of PA strategies in the context of the increase in overweightness and obesity that Colombia is experiencing.

Correlates at the Household Level

Socioeconomic status and the availability of TV in the child’s bedroom were significant correlates of PA at the household level. Among preschoolers, children in the lower wealth quartiles were less likely to be active than the wealthiest. This association was opposite for adolescents. In contrast with our findings, previous literature reported no association between socioeconomic status and PA in young children4143 and positive associations for adolescents in the wealthiest groups.40 We hypothesize that our findings for preschool children can be related to greater opportunities for being active out of school or in day-care centers for the wealthiest families. These findings should be considered in order to improve the actions within the Early Childhood Public Policy to promote the adequate development of the most vulnerable populations. For adolescents, our results can be related to the necessity of involving other domains of PA, such as transport or occupational activities, which are more prevalent among lower socioeconomic levels, as well as a higher involvement in sedentary activities among the wealthiest groups. These results highlight the need to reach the wealthiest adolescents with activities that encourage them to be more active, as well as to continue promoting PA among lower socioeconomic groups. The negative association between TV availability in the bedroom and PA among school-aged children is consistent with evidence from the United States and Brazil44,45 and suggests the need to advise parents to avoid having TVs in children’s bedrooms.

Correlates at the Community Level

The availability of parks in the neighborhood was a positive correlate of PA and unstructured play among preschool children and adolescents. Despite the inconsistent evidence in this field,46 our results support positive associations previously reported47 and suggest that parks represent a viable approach for promoting daily PA. It is interesting to observe the lack of association with PA counseling across age groups. This suggests that the scarce counseling efforts are not related to a greater proportion of children or adolescents meeting PA guidelines and needs to be improved. This is especially relevant considering that among those who received PA counseling, there are greater proportions of individuals who are less likely to meet PA recommendations, such as females, children, and adolescents with overweightness or obesity, and children and adolescents in the highest wealth quartile.

Correlates at the Environmental and Policy Level

At the environmental level, living in the Orinoquia-Amazonia and Atlantic regions were positive correlates of meeting PA guidelines among school-aged children. In these regions, meeting PA guidelines was approximately 10 percentage points higher than the national estimates. These regions are composed mostly of departments (administrative units) with middle Human Development Index, which are lower than the national estimate. As it has been observed in other contexts, those social development conditions can be related to a higher involvement in active behaviors, probably by necessity.48 In these contexts, the high prevalence of meeting PA guidelines needs to be preserved, providing safe and enjoyable opportunities for being active. At the policy level, frequent attendance (4 times per month or more) in PA programs was a positive correlate of PA among adolescents. This result is very relevant for the policy agenda of the country. Colombia has implemented PA programs such as Ciclovías,25 community PA programs (eg, the National Program of Healthy Life Habits),49 organized sports programs (eg, Supérate),50 and PA programs at schools, but the evaluation of their impact among children and adolescents has been limited.25 Despite the lack of evaluation, the positive association of the frequent participation in programs supports the maintenance and promotion of regular PA programs for Colombian young people.

Policy Implications

The ENSIN data are the most comprehensive nationally representative data on PA for Colombia and the best available evidence that could serve as baseline data to assess the 15% relative reduction in physical inactivity established by the WHO.9 Based on our findings, we highlight the following messages that can help to strengthen public policies on PA, childhood development, and education, among others: (1) public policies in Colombia should recognize and promote play and specifically outdoor play as a key component of healthy child development; (2) inequities by sex and socioeconomic level in PA need to be addressed beginning with the early years through policies with differential approaches that allow the targeting of the most vulnerable populations; (3) programs to promote PA should include strategies to involve children with overweightness or obesity, empowering them to participate and avoiding segregation or marginalization; (4) urban planning policies should take into account the importance of safe parks availability and community programs in public spaces (eg, streets, parks) for PA and health, and (5) PA programs should be offered on a sustained and regular basis to have a better impact on children’s and adolescents’ compliance with PA guidelines.

Strengths and Limitations

The main strength of this study is the use of a nationally representative sample for a wide age range of children, which ensures the generalizability of our results to the Colombian population of children and youth. Also, the use of standardized measurement instruments reduces the risk of bias. Key limitations include the cross-sectional nature of the survey that does not allow causal inferences from our findings. Second, the use of self- and proxy-report variables to ascertain meeting PA guidelines could be affected by social desirability bias or by underestimations or overestimations because of a recall bias. Third, some of the questionnaires used in ENSIN were adapted from studies in other settings but their validity for Colombian context has not been evaluated.

Conclusions

The majority of Colombian children and adolescents are insufficiently active. Urgent actions are needed to maintain and hopefully increase the involvement in active play and PA. These actions can be guided by the correlates identified in our study, to overcome disparities and provide opportunities for children to achieve their full potential for healthy growth and development.

Acknowledgments

S.A.G. was supported by the Government of Ontario and the University of Ottawa through the Ontario Trillium Scholarship for doctoral studies. The ENSIN was funded by the Colombian Institute of Family Welfare, the Ministry of Health and Social Protection, the National Institute of Health, and the National Planning Department. The funding institutions had no role in the design of the study or the collection, analysis, and interpretation of data, or in writing the manuscript.

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González, Chaput, and Tremblay are with the Healthy Active Living and Obesity Research Group, Children’s Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada. González is also with the School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada. Sarmiento is with the School of Medicine, Universidad de los Andes, Bogotá, Colombia. Katzmarzyk is with the Pennington Biomedical Research Center, Baton Rouge, LA, USA. Camargo-Lemos is with the Physical Therapy School, Universidad Industrial de Santander, Bucaramanga, Colombia.

González (sgonzalez@cheo.on.ca) is corresponding author.
  • View in gallery

    —Prevalence estimates of meeting PA guidelines among Colombian children by sex ENSIN 2015. Data are shown as mean values (in percentage) and 95% CIs. Vigorous activities correspond to activities that strengthen muscle and bone. ENSIN indicates the National Survey of Nutrition in Colombia; CI, confidence interval; MVPA, moderate- to vigorous-intensity PA; PA, physical activity.

  • View in gallery

    —PRs and 95% CIs of correlates of PA indicators among Colombian preschool children. (A) Correlates of meeting PA guidelines. Meeting guidelines is defined as engaging in at least 180 minutes of PA per day including at least 60 minutes of energetic play. (B) Correlates of more than 2 hours of unstructured play per day. (C) Correlates of more than 2 hours of outdoors play per day. CI indicates confidence interval; PA, physical activity; PRs, prevalence ratios.

  • View in gallery

    —PRs and 95% CIs of correlates of meeting PA guidelines among Colombian school-aged children. Meeting guidelines was defined as engaging in at least 60 minutes of MVPA per day 7 days per week. CI indicates confidence interval; MVPA, moderate- to vigorous-intensity PA; PA, physical activity; PRs, prevalence ratios.

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    —PRs and 95% CIs of correlates of meeting PA guidelines among Colombian adolescents. Meeting guidelines was defined as engaging in at least 60 minutes of MVPA per day 7 days per week. (A) First multivariable model and (B) second multivariable model including program participation variables. CI indicates confidence interval; MVPA, moderate- to vigorous-intensity PA; PA, physical activity; PRs, prevalence ratios.

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