The purposes of this study were to show representative prevalence rates for complying with the PA guideline of 60
minutes of moderate-to-vigorous PA every day in children and adolescents in Germany and to evaluate socio-demographic correlates of compliance with the PA guideline. The results of this study showed that only 15.3% of children and adolescents aged between 4 and 17
years meet the current PA guideline of 60
minutes of moderate-to-vigorous PA every day. These estimates are comparable to results of the HBSC-Study for Germany [12
]. The results of both studies emphasise the importance of interventions aimed at enhancing the level of PA in children and adolescents in Germany. The gender differences in compliance with PA guidelines in this study are in agreement with earlier reports for other countries including European countries [12
] and the United States [13
]. Both in children and adolescents, boys show higher compliance rate than girls. These differences are especially large in preschool children (4–5
years) where 35.4% of boys and 28.4% of girls meet the PA guideline. For schoolchildren and adolescents, the difference between both gender groups decreases.
A progressive decrease in the prevalence of compliance with the PA guideline with age was observed. Similar age-related decreases have been reported in several international studies with subjective [12
] and objective [29
] measures of PA. For girls, there is a continuous decrease during childhood and adolescence. In childhood, the chance to meet the PA guideline decreased by 17% every year and during adolescence 19%. Therefore, PA interventions should be employed for girls of all ages. For boys, there was a significant decrease in the prevalence of meeting the PA guideline only during childhood but not during adolescence. Especially, strong decrease in the compliance rate was observed during the transition from childhood to adolescence and hence this stage of life seems to be a particularly critical period for the maintenance of PA levels [30
]. In the German school system, most children change from primary school to secondary school around 10
years of age, requiring a reorganisation of everyday activities and friendships. Hence, PA programs need a special focus on this age period.
Interestingly, socioeconomic status influenced compliance with the PA guideline only in girls but not in boys. Contrary to our expectations, girls with low socioeconomic status were more likely to comply with the PA guideline than girls with high socioeconomic status. These differences intensify in adolescence. These results contradict the findings of a previous review [19
] that in 58% of the reviewed studies children and adolescents from families with higher socioeconomic status tended to be more physically active than those from families with lower socioeconomic status. We speculate that this discrepancy in results between studies is related to the German school system in which adolescents with higher socioeconomic status more frequently attend a "Gymnasium" (an academic secondary school in the tripartite German secondary school system) and usually spend more time at school especially in the afternoons. Long schooldays, afternoon school and homework presumably pose an organisational challenge for meeting the PA guideline. However, it is unclear why this effect occurs only in girls but not in boys.
Migration background was a predictor of compliance with the PA guideline only for girls but not for boys. Interestingly, coming from a family with migration background had a negative effect on PA compliance in children but a positive effect on PA compliance in adolescents. For girls with migration background, the likelihood of meeting the PA guideline decreased slightly with increasing age. However, for girls without migration background, the compliance with the PA guideline decreased drastically around the transition from childhood to adolescence. Similarly to the socioeconomic effect, we speculate that the German school system may be responsible for these developments. Adolescents without migration background are more likely to attend the "Gymnasium" that is associated with more time spent at school and on homework. However, it remains unclear why the effect of migration background on PA compliance only affects girls but not boys. Further studies are needed to test this assumption and to better understand these gender specific differences.
In contrast to the effects of socioeconomic status and migration background, the effect of residential area significantly influenced compliance with the PA guideline only in boys. We hypothesize that boys who live in rural areas are more likely to use a bicycle and walk longer distances to get to school and to meet with friends. While in cites and medium-sized towns, the public transportation grid is well developed, rural areas suffer from a lack of public transportation. Hence, adolescent boys in rural areas may be forced to be physically active as a means of transportation. One strategy to bring the level of PA up to 60
minutes of moderate-to-vigorous PA per day could be to increase use of active transport by improving the infrastructure (e. g. building safe and convenient bicycle and walking paths) and promoting active transport in schools and communities. Two types of interventions were found to be effective in promoting PA: community-scale and street-scale urban design, as well as land use policies and practices [31
]. Urban planners, policy makers and local communities should be involved in such interventions [32
]. These endeavours should be implemented especially in such regions (e. g. rural areas) where active transport is safe for children and adolescents. Girls should be encouraged to use this kind of transportation in particular [33
This work examined the socio-demographic predictors of compliance with the PA guideline. However, one important issue is to question the appropriateness of the PA guidelines. PA guidelines were developed to quantify the amount of PA which is needed to support the normal growth and maturation, health, and fitness of children and adolescents. After reviewing 850 articles on the relationship between PA and health in children and adolescents, Strong et al. [3
] conclude that “school-age youth should participate daily in 60
minutes or more of moderate to vigorous physical activity”. Several international [6
] organisations have adopted this PA recommendation for children and adolescents. However, these strictly formulated PA recommendations raise the question whether the daily regularity of 60
minutes of moderate to vigorous PA is the most important aspect for health benefits or the accumulation of moderate to vigorous PA within one week. Convincing empirical evidence for the daily regularity of PA has not been yet shown. Because this issue has a serious impact on formulating future PA guidelines further research in this field is required. Especially, longitudinal studies are needed to evaluate the merit of PA recommendations.
The major strength of this study is that the subjective measure of compliance with the PA guideline used in this study is a well established instrument [16
]. In addition, this study reports national level representative data for children and adolescents in Germany for the full age spectrum between 4 and 17
years. However, the results of this study should be interpreted with caution because of some limitations. First, this study has a cross-sectional design, and hence the results of the study do not allow causal inferences of predictors. Second, the results were based on self-report data which has been shown to overestimate the prevalence rates of PA compliance compared to those assessed using objective measures [34
]. In fact, compliance rates measured with objective measures may be even lower than those reported in this study. Third, this study did not provide information on the school obligations and transportation grid that would allow for a better understanding of the effects of socio-demographic variables.