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The Role of Physical Activity in the Relationship between Satisfaction with Life and Health-Related Quality of Life in School-Age Adolescents
The Role of Physical Activity in the Relationship between Satisfaction with Life and...
Villafaina, Santos;Tapia-Serrano, Miguel Ángel;Vaquero-Solís, Mikel;León-Llamas, Juan Luis;Sánchez-Miguel, Pedro Antonio
behavioral sciences Article The Role of Physical Activity in the Relationship between Satisfaction with Life and Health-Related Quality of Life in School-Age Adolescents 1 2 , 2 1 Santos Villafaina , Miguel Ángel Tapia-Serrano * , Mikel Vaquero-Solís , Juan Luis León-Llamas and Pedro Antonio Sánchez-Miguel Physical Activity and Quality of Life Research Group (AFYCAV), Faculty of Sport Sciences, University of Extremadura, Avd. de la Universidad S/N, 10003 Cáceres, Spain; email@example.com (S.V.); firstname.lastname@example.org (J.L.L.-L.) Department of Didactics of Music, Plastic and Body Expression, Teacher Training College, University of Extremadura, Avd. de la Universidad S/N, 10003 Cáceres, Spain; email@example.com (M.V.-S.); firstname.lastname@example.org (P.A.S.-M.) * Correspondence: email@example.com Abstract: (1) Background: Adolescence is a critical stage in the development of healthy habits. In this regard, physical activity has emerged as a useful tool to improve satisfaction with life and health-related quality of life in adolescents. Therefore, the aim of the present study was to examine the mediating role of physical activity in the relationship between satisfaction with life and health- related quality of life in adolescent boys and girls. Also, we aimed to investigate the differences between sexes in the HRQoL, physical activity level, and satisfaction with life. (2) Methods: A total of 297 adolescents, ranging in age from 11 to 12 years (11.46 1.63), participated in this cross- Citation: Villafaina, S.; sectional study. The Satisfaction with life scale, Physical activity Questionnaire for Adolescents Tapia-Serrano, M.Á.; Vaquero-Solís, and the KIDSCREEN-10 questionnaires were employed. (3) Results: The estimated indirect effect M.; León-Llamas, J.L.; showed that physical activity level was a mediator of the positive effect of satisfaction with life on Sánchez-Miguel, P.A. The Role of health-related quality of life ( = 0.105, 95% CI = 0.031; 0.202). However, the index of moderated Physical Activity in the Relationship mediation showed that sex is not a signiﬁcant moderator of the mediating role of physical activity between Satisfaction with Life and in the relationship between satisfaction with life and HRQoL ( = 0.033, 95% CI = 0.023, 0.136). Health-Related Quality of Life in Furthermore, signiﬁcant differences in satisfaction with life were found, with girls manifesting lower School-Age Adolescents. Behav. Sci. values (p-value = 0.026). (4) Conclusion: This study shows the importance of physical activity during 2021, 11, 121. https://doi.org/ adolescence and the association of this behavior with the health-related quality of life of adolescents. 10.3390/bs11090121 Keywords: health-related quality of life; exercise; adolescence Received: 30 July 2021 Accepted: 30 August 2021 Published: 3 September 2021 1. Introduction Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in Adulthood health-related behaviors are predicted by those which adolescence can published maps and institutional afﬁl- develop. Thus, adolescence is considered as a critical stage in the development of healthy iations. habits [1,2]. However, a decrease in the physical activity levels and an increase in sedentary activities can be observed during adolescence . This is relevant since these unhealthy habits can lead to an increase in being overweight and obesity, as well as that those adolescents with healthy lifestyles reported higher health related quality of life (HRQoL)  Copyright: © 2021 by the authors. (a multi-dimensional concept that includes domains related to physical, mental, emotional, Licensee MDPI, Basel, Switzerland. and social functioning). Furthermore, adolescence plays a relevant role in satisfaction with This article is an open access article life  and mental well-being . Nevertheless, differences can be observed among sex. In distributed under the terms and this regard, girls tend to be less active [7,8] than boys, as well as to report lower levels of conditions of the Creative Commons satisfaction with life . Attribution (CC BY) license (https:// The COVID-19 pandemic has caused children and adolescents to face massive changes creativecommons.org/licenses/by/ in their daily lives such as school closures, conﬁnement, or social distancing, which can 4.0/). Behav. Sci. 2021, 11, 121. https://doi.org/10.3390/bs11090121 https://www.mdpi.com/journal/behavsci Behav. Sci. 2021, 11, 121 2 of 12 burden them substantially [10,11]. This has increased the problem of sedentary lifestyles in children and adolescents, with 81% of students physically inactive before the pandemic , reducing active leisure activities while increasing screen recreational time [13,14]. This has burdened children and adolescent’s health substantially [10,11], reducing their HRQoL  and satisfaction with life . 1.1. Physical Activity and Health-Related Quality of Life Physical activity has emerged as a useful tool to maintain a healthy lifestyle . In this regard, several studies have pointed out the relationship between physical activity and HRQoL [18–22]. Thus, more than sixteen articles in the last year and a half have explored this relationship. In this regard, a previous study showed that physical activity levels can predict HRQoL in children as well as that physical activity is the main behavior in the prediction of the quality of life for a population of school adolescents . Further- more, improvements in cardiorespiratory ﬁtness may be useful to improve HRQoL [18,19]. Strengthening the relationship between level of physical activity and HRQoL, we can ﬁnd different articles exploring sedentary behaviors and their relation to HRQoL . In this regard, previous studies showed that adolescents who had longer exposure and lower physical activity levels reported lower HRQoL . Moreover, previous studies have been focused on the impact of physical activity volume and intensity on the improvements in HRQoL. Regarding physical activity vol- ume, previous studies found that the higher the physical activity level, the higher the HRQoL . Regarding physical activity intensity and improvement in HRQoL, a previous study showed that children who spent more time practicing moderate PA were associated with higher HRQoL scores . In the same vein, a study that explore the commitment of physical activity recommendations found that meeting combinations of screen time with moderate-to-vigorous physical activity were related to higher HRQoL . However, a previous study found that light intensity physical activity was associated with higher HRQoL in females whereas, in males, moderate and vigorous PA levels were associated with higher HRQoL values . Due to the relationship between physical activity and HRQoL in children and ado- lescents, a previous study has been focused on the inﬂuence of school-hours physical activity and quality of life . This study found a positive association between children’s school-hours physical activity and HRQoL . This result reinforces the usefulness of school-based physical activity programs to improve HRQoL. 1.2. Physical Activity and Satisfaction with Life Although multiple studies have shown a direct relationship between physical activity level and satisfaction with life [5,28,29], the relationship between physical activity and satisfaction with life has not been so widely studied. Higher levels of screen time and lower levels of physical activity were associated with lower satisfaction with life . Nevertheless, increasing physical activity is more crucial than emphasizing reducing screen time in improving the satisfaction with life of children and adolescents . Furthermore, Chmelík, et al.  showed that adolescents with higher satisfaction with life had higher physical activity levels as well as that those who spent more time engaged in physical activity showed higher satisfaction with life . Regarding physical activity intensity, three studies [32,33] showed that the strongest associations between satisfaction with life and physical activity were found in those adoles- cents who participated in vigorous physical activity. However, as previously found for the HRQoL , boys and girls differently responded to physical activity. In this regard, for boys, vigorous physical activity can be regarded as the predictor of better satisfaction with life, while, for girls, moderate-to-vigorous physical activity might be considered as a risk factor for lower life satisfaction . Behav. Sci. 2021, 11, 121 3 of 12 Due to the signiﬁcant association between physical activity enrolment and satisfaction with life, a previous study has encouraged public investments to promote adherence to physical activity in adolescents . 1.3. Satisfaction with Life and Health-Related Quality of Life Satisfaction with life and HRQoL are considered to be related to achieving a healthy lifestyle . Thus, the relationship between satisfaction with life and HRQoL has been shown in previous studies [37,38]. Satisfaction with life implies acceptance of one’s life circumstances in relation to the subjective judgment of their life situation in relation to one’s own expectations . Thus, satisfaction with life is considered by previous studies as a subjective and cognitive assessment of one’s quality of life [36,39]. Nevertheless, HRQol would indicate a general and constant state of well-being , which covers broad domains including psychological, spiritual, physical, economical, and social well- being . Regarding the physical domain of the HRQoL, a previous study found that, together with the psychological domain, they were signiﬁcant predictors of satisfaction with life . Furthermore, a previous study found a mediating and predictive role of subjective happiness in HRQoL . A previous study listed the factors affecting individuals’ life satisfaction in the mental, physical, and social spheres: feeling well physically, taking pleasure in life, consistency at the matter of reaching goals, social relationships, ﬁnding life meaningful, positive individual identity, and economical security . In this regard, physical activity can help to improve most of these factors. Furthermore, since HRQoL is a multi-dimensional concept that includes physical, mental, and social domains, improvements in satisfaction with life would result in changes in the HRQoL. Thus, physical activity might have a mediating role in the relationship between satisfaction with life and HRQoL. 1.4. Objectives and Novelty of the Study Taking into account the previous analyzed studies, there are several studies which investigate the relationship between physical activity level and HRQoL, and satisfaction with life. However, there is a lack of studies which investigate the mediating role of physical activity in the relationship between satisfaction with life and HRQoL in adolescent boys and girls. Therefore, the present study aimed: (1) to evaluate the mediating role of physical activity between satisfaction with life and HRQoL; (2) to investigate the moderating role of sex on the mediating role of physical activity in the relationship between satisfaction with life and HRQoL; (3) to investigate the differences between sex in the HRQoL, physical activity level, and satisfaction with life. This study, to the best of our knowledge, would be the ﬁrst which analyzed the mediating role of physical activity in the relationship between satisfaction with life and HRQoL in adolescents. Furthermore, it would be also the ﬁrst one which analyzed this relationship while taking into account the adolescents’ sex. 2. Materials and Methods 2.1. Participants Sample size calculation estimated a minimum of 278 participants to reach a mod- erate effect size. Finally, a total of 297 adolescents, ranging in age from 11 to 12 years (11.46 1.63), participated in this cross-sectional study. The PASS-21 software (NCSS, Kaysville, UT, USA) estimated that a sample size of 297 achieves 94% power to detect a mediation effect, taking into account the product of the regression coefﬁcients and the standard deviation of the mediator, and the independent and dependent variables. A researcher contacted 10 educational centres of Extremadura (Spain). The educational centres were asked to disseminate the information to the teachers of the centre. Never- theless, due to COVID-19 restrictions, six educational schools (primary or high schools) decided to participate. Another researcher administered and explained the questionnaires Behav. Sci. 2021, 11, 121 4 of 12 in the classrooms. All queries were solved by the researcher or the teacher, who was also present at the classroom. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Bioethics and Biosafety Committee of the University of Extremadura (89/2016). Parents or legal guardians signed written informed consent prior to participation in the study. 2.2. Measures Sociodemographic characteristics. Participants reported age, sex, and socioeconomic status (SES). Participant’s SES were obtained using a modiﬁed version of the Family Afﬂuence Scale-II (FAS II; ). Participants were asked if they have a room for themselves, if they have internet access at home, the number of personal computers at home, and the number of cars. Satisfaction with life. Satisfaction with life was measured using the satisfaction with life scale (SWLS) . This study employed the Spanish version of the SWLS . The internal consistency of this scale is 0.84 according to Cronbach’s Alpha. This scale has 5 items, with a 5-point Likert scale, ranging from 1 (totally disagree) to 5 (totally agree). The summary of the items is used to calculate the total SWLS score. Physical activity. Physical activity was assessed with the Physical Activity Question- naire for Adolescents (PAQ-A) , using the Spanish version . Internal consistency of the Spanish version showed a Cronbach’s Alpha = 0.65. This questionnaire evaluated the self-reported physical activity level. This is a self-administered, 7-day recall instrument, with 9 items scored on a 5-point scale. To calculate a physical activity score, the frequency of participation in a list of activities such as physical activity in Physical Education lessons, during the school break, at lunchtime, right after school, and evenings, as well as during the last weekend were asked. The mean of item 1 to 8 is used to calculate the ﬁnal PAQ-A activity summary score. Health-related Quality of life. HRQoL was measured with the Spanish version of the KIDSCREEN-10 questionnaire . Internal consistency of KIDSCREEN-10 total score showed a Cronbach’s Alpha = 0.82. This scale comprises a total of 10 items in a 5-point Likert scale ranging from 1 (never) to 5 (always). Responses were coded so that higher values indicated higher HRQoL. Responses were summed and Rasch person parameters were assigned to each possible sum score. The person parameters were transformed into values with a mean of 50 and a standard deviation (SD) of approximately 10 . 2.3. Statistical Analysis The SPSS statistical package (version 22.0; SPSS, Inc., Chicago, IL, USA) was used to conduct the analyses. Categorical variables are presented using frequencies and percent- ages, and continuous variables are presented using means and standard deviations. We applied covariance analysis adjusted by sex. Taking into account the results of Kolgomorov– Smirnov and Shapiro–Wilk tests, tests for independent samples or Mann–Whitney U were conducted to investigate differences between sex in HRQoL, satisfaction with life, and physical activity level. Effect sizes, Cohens’D or r, were calculated if p-value was obtained from a parametric or a non-parametric test respectively. In order to test the possible mediating role of physical activity between satisfaction with life and HRQoL, a simple mediation analysis was designed using the “model 4” of the PROCESS macro for SPSS provided by Hayes . In this model, satisfaction with life will be the independent variable (X variable), physical activity will be the mediating variable (M variable), and health-related quality of life will be the dependent variable (Y variable). We also included age as a covariate variable due to the possible impact of age on health-related quality of life . This analysis would allow us to estimate the indirect effect of physical activity level as a mediator between satisfaction with life and HRQoL. Furthermore, a moderated-mediation analysis was conducted using the “model 58” of the PROCESS macro for SPSS  to test the moderating impact of sex on satisfaction with Behav. Sci. 2021, 11, 121 5 of 12 life and physical activity relationship, and in the relationship between physical activity level and HRQoL. For this analysis, satisfaction with life was entered into the model as the independent variable (X variable), the physical activity level was entered into the model as the mediator (M variable), sex (dummy-coded; 0 = girls, 1 = boys) was included as the moderator (W variable), and HRQoL was speciﬁed as the outcome variable (Y variable). Age was also included as a covariate variable due to the possible impact of age on health- related quality of life  The PROCESS macro for SPSS (IBM, Chicago, IL, USA)  was used to perform the analyses. The mediation hypotheses were tested using the bias-corrected bootstrap method with 5000 samples to calculate conﬁdence intervals (95%). Signiﬁcance was considered when the conﬁdence interval did not cross zero. 3. Results Table 1 shows the descriptive characteristics of participants. They had a mean age of 11.46 (1.63) years old. Most of them had a room for themselves (83.2%) as well as internet access at home 97.9%. Adolescents had a mean HRQoL score of 48.08 (0.62), a physical activity level of 2.79 (0.62), and a satisfaction with life of 19.30 (3.98). Table 1. Descriptive characteristics of participants. Mean (SD) or Participants Girls Boys Number (%) Number of participants 297 152 145 Age (age) 11.46 (1.63) 11.57 (1.70) 11.32 (1.54) Sex [Male (Female)] 145 (152) - - Modiﬁed version of the Family Afﬂuence Scale-II Room for him/herself 247 (83.2%) 132 (86.8%) 115 (79.3%) Internet access at home (yes) 291 (97.9%) 148 (97.4%) 143 (98.6%) Number of personal computers at home None 12 (4%) 3 (2%) 9 (6.2%) One 87 (29.3%) 46 (30.3%) 41 (28.3%) Two or three 161 (54.3%) 83 (54.5%) 78 (53.8%) More than three 37 (12.4%) 20 (13.2%) 17 (11.7%) Number of cars None 1 (0.3%) 1 (0.7%) 0 (0%) One 58 (19.5%) 31 (20.4%) 27 (18.6%) Two or three 230 (77.5%) 116 (76.3%) 114 (78.6%) More than three 8 (2.7%) 4 (2.7%) 4 (2.8) HRQoL score 48.08 (0.62) 47.62 (7.84) 48.88 (7.66) Physical activity level 2.79 (0.62) 2.75 (0.62) 2.85 (0.62) Sport and activity list 1.64 (0.45) 1.62 (0.45) 1.66 (0.45) Physical activity during clasess 4.02 (0.92) 4.03 (0.88) 4.03 (0.96) At lunch 1.70 (1.13) 1.66 (1.12) 1.77 (1.15) After school 3.06 (1.26) 3.07 (1.24) 3.08 (1.29) Evenings 3.13 (1.17) 3.12 (1.08) 3.16 (1.25) Weekends 3.11 (1.10) 3.05 (1.11) 3.19 (1.09) Statements 2.65 (1.15) 2.49 (1.14) 2.82 (1.14) Weekly activity 3.06 (0.74) 3.02 (0.69) 3.13 (0.78) Satisfaction with life 19.30 (3.98) 18.73 (4.33) 19.95 (3.42) In most ways my life is close to my ideal 3.36 (1.10) 3.29 (1.10) 3.42 (1.11) The conditions of my life are excellent 3.98 (1.07) 3.78 (1.11) 4.21 (0.97) I am satisﬁed with my life 4.27 (1.06) 4.08 (1.19) 4.51 (0.80) So far I have gotten the important 3.97 (0.99) 3.90 (1.08) 4.06 (0.88) things I want in life If I could live my life over, I would 3.71 (1.37) 3.68 (1.38) 3.75 (1.35) change almost nothing Responses were summed and Rasch person parameters were assigned to each possible sum score. The person parameters were transformed into values with a mean of 50 and a standard deviation (SD) of approximately 10. The mean of item 1 to 8 is used to calculate the ﬁnal PAQ-A activity summary score. The summary of the items is used to calculate the total SWLS score. Path a = association between satisfaction with life and physical activity level; Path b = association be-tween physical activity level and HRQoL; Path c = direct effect of the satisfaction with life and HRQoL. Behav. Sci. 2021, 11, 121 6 of 12 Figure 1 shows the mediation model adjusted by age. Path a showed a signiﬁcant direct association between satisfaction with life and physical activity level ( = 0.030, 95% CI = 0.012; 0.047). Furthermore, age (the covariate included in the model) showed a signiﬁcant inﬂuence on physical activity ( = 0.063, 95% CI = 0.106; 0.019). Path b showed a signiﬁcant direct association between physical activity level and HRQoL in adolescents ( = 3.059, 95% CI = 1.900; 4.219). Moreover, age also showed a signiﬁcant inﬂuence on HRQoL ( = 0.674, 95% CI = 1.119; 0.230). The direct effect, path c, showed a signiﬁcant association between satisfaction with life and HRQoL ( = 0.976, 95% CI = 0.7930; 1.159). Furthermore, the estimated indirect effect showed that physical activity level is a mediator of the positive effect of satisfaction with life on HRQoL ( = 0.091, 95% CI = 0.028; 0.178). Figure 1. Simple mediation analysis of the effect of satisfaction with life on HRQoL mediated by physical activity level. This model was adjusted by age and the number of bootstrap samples was 5000. Path a = association between satisfaction with life and physical activity level; Path b = associa- tion between physical activity level and HRQoL; path c = direct effect of the satisfaction with life and HRQoL. Figure 2 show the moderated-mediated analysis. Sex did not moderate the interaction between satisfaction with life and physical activity level ( = 0.010, 95% CI = 0.046; 0.026) nor the relationship between physical activity and HRQoL ( = 0.074, 95% CI = 2.320; 2.172). The covariate, age, also showed signiﬁcant in physical activity ( = 0.063, 95% CI = 0.106; 0.019) and HRQoL ( = 0.680, 95% CI = 1.127; 0.234). The conditional indirect effect between satisfaction with life and HRQoL through physical activity was signiﬁcant for adolescent girls ( = 0.103, 95% CI = 0.028; 0.193), whereas it did not reach the signiﬁcance level for adolescents’ boys ( = 0.070, 95% CI = 0.023; 0.221). However, the conﬁdence interval for the index of moderated mediation did not show a signiﬁcant effect of sex as a moderator ( = 0.033, 95% CI = 0.023, 0.136). Thus, it cannot be said with 95% conﬁdence that the indirect effect depends on adolescents’ sex. Behav. Sci. 2021, 11, 121 7 of 12 Figure 2. Moderated-mediation analysis of the relation between satisfaction with life and HRQoL mediated by physical activity level and moderated by sex. This model was adjusted by age and the number of bootstrap samples was 5000. Path a = association between satisfaction with life and physical activity level; Path b = association between physical activity level and HRQoL; Path c = direct effect of the satisfaction with life and HRQoL. Table 2 shows the differences between girls and boys in the HRQoL, satisfaction with life, and physical activity level. Boys showed higher levels of satisfaction with life compared to girls (p < 0.05). However, no signiﬁcant differences were found for HRQoL and activity levels (p > 0.05) between girls and boys. Table 2. Differences between girls and boys in HRQoL, satisfaction with life, and physical activity level. Variables Girls Boys p-Value Effect Size HRQoL 47.62 (7.84) 48.88 (7.66) 0.100 0.190 Satisfaction with life 18.73 (4.33) 19.95 (3.42) 0.026 0.288 Physical activity level 2.75 (0.62) 2.85 (0.62) 0.185 0.155 Note: p-value obtained from t-test for independent sample; p-value obtained from Mann-Whitney U. Path a = as- sociation between satisfaction with life and physical activity level; Path b = association be-tween physical activity level and HRQoL. 4. Discussion This study aimed to investigate the mediating role of physical activity level on the relationship between satisfaction with life and HRQoL in adolescents. Furthermore, this study also investigated sex as a moderator of the mediating role of physical activity in the relationship between satisfaction with life and HRQoL. Also, this study aimed to investigate if there are differences between girls and boys in the HRQoL, satisfaction with life, and physical activity level. The main ﬁnding of the present study was that physical activity has a mediating role in the relationship between satisfaction with life and HRQoL. However, sex is not a signiﬁcant moderator of the mediating role of physical activity in the relationship between satisfaction with life and HRQoL. Moreover, this study also conﬁrms that adolescent girls have less satisfaction with life than adolescent boys. The ﬁrst objective of the study was to investigate the mediating role of physical activity in the relationship between satisfaction with life and HRQoL. Our results showed a signiﬁcant mediating role of physical activity in the relation between satisfaction with life and HRQoL. Moreover, results showed a direct relationship between physical activity and HRQoL. This relationship has been found in previous studies , where a higher level of Behav. Sci. 2021, 11, 121 8 of 12 physical activity was associated with an increased HRQoL . Furthermore, a previous study reported a dose–response association between moderate to vigorous physical activity and HRQoL, where an increase in physical activity was associated with additional HRQoL beneﬁts . This ﬁnding is supported by previous studies [4,56,57]. Also, this association has been corroborated by longitudinal and interventional studies in adolescents [57,58]. This showed the importance of physical activity on the maintenance and improvements of HRQoL. Interestingly, a previous study showed that body mass index has a relevant role in this association. Nevertheless, another study found that, irrespectively of their body mass index, less physically active children had lower HRQoL . This could indicate that active children and adolescents, just by practicing physical activity, report a better HRQoL. Taking into account that both HRQoL questionnaires, such as KIDSCREEN-10, ask about physical, social, and mental dimensions and the effect of physical activity on these dimensions [60,61], it is completely justiﬁed that this is signiﬁcant relationship. This is of special importance nowadays due to the negative impact of the COVID-19 pandemic on the HRQoL of children and adolescents. Thus, physical activity interventions are encouraged to ameliorate the negative impact of the pandemic on the HRQoL of adolescents. The second objective of this study was to explore the role of sex as a moderator. Results of the moderated-mediation analysis showed that age is not a moderator. However, the conditional indirect effect between satisfaction with life and HRQoL through physical activity was signiﬁcant for adolescent girls, whereas it did not reach the signiﬁcance level for adolescent boys. This result would be supported by a previous study which indicated that a higher level of physical activity longitudinally predicted a greater life satisfaction in adolescent girls after the one-year follow-up, but not in boys . This is relevant since a previous study showed that girls tend to be less active than boys, as well as to report a lower level of satisfaction with life . Regarding physical inactivity in adolescent girls, a previous study hypothesized that gender stereotypes could cause rejection of some physical activities since they are perceived as masculine . Therefore, future interventions should be focused on this aspect, promoting physical activity for girls due to the impact on satisfaction with life in adolescent girls. In our study, a signiﬁcant direct effect of satisfaction with life on HRQoL has been found in adolescents, independently of their sex. Moreover, we found that satisfaction with life had a positive effect on HRQoL. However, a previous study indicated that satisfaction with life and HRQoL are similar interdependent concepts, arguing that satisfaction with life is a global assessment of HRQoL . Furthermore, our study also showed a positive relationship between physical activity level and satisfaction with life. This is in line with previous studies where this relationship was also observed [65–67]. The third objective of this study was to investigate the differences among sexes in the HRQoL, satisfaction with life, and physical activity level. In this regard, adolescence is considered as a critical stage in the development of healthy habits with critical changes in their lifestyles [1,2]. In this regard, differences between girls and boys were found in satisfaction with life, with girls reporting lower levels. This is in line with previous studies where this difference was observed [9,68]. Studies also reported that males have higher levels of HRQoL  and physical activity [8,69]. Although the signiﬁcance level in this study was not reached, values were also higher in boys than in girls. This study has some limitations that should be acknowledged. First, the sample was recruited from a region of Spain, and therefore results cannot be extrapolated to another sociodemographic context. Furthermore, future research should include further samples in order to analyse the mediating role of physical activity in different subgroups of adolescents. 5. Conclusions Physical activity has a signiﬁcant mediating role on the relationship between satisfac- tion with life and HRQoL. According to the moderated-mediation analysis, sex did not show a signiﬁcant effect as a moderator in the mediating role of physical activity in the Behav. Sci. 2021, 11, 121 9 of 12 relationship between satisfaction with life and HRQoL. However, the conditional indirect effect between satisfaction with life and HRQoL through physical activity was signiﬁcant for adolescent girls, whereas it did not reach the signiﬁcance level for adolescent boys. Furthermore, adolescent girls showed a lower signiﬁcant level of satisfaction with life than adolescent boys. Therefore, future studies should be speciﬁcally focused on promoting physical activity interventions for girls in order to increase their satisfaction with life. Author Contributions: Conceptualization, S.V. and P.A.S.-M.; Data curation, S.V. and M.Á.T.-S.; Formal analysis, J.L.L.-L.; Investigation, S.V., M.Á.T.-S. and M.V.-S.; Methodology, S.V., M.Á.T.-S., M.V.-S., J.L.L.-L. and P.A.S.-M.; Project administration, P.A.S.-M.; Software, J.L.L.-L.; Supervision, M.V.-S. and P.A.S.-M.; Validation, M.Á.T.-S., J.L.L.-L. and P.A.S.-M.; Visualization, M.V.-S.; Writing— original draft, S.V.; Writing—review & editing, M.Á.T.-S., M.V.-S., J.L.L.-L. and P.A.S.-M. All authors have read and agreed to the published version of the manuscript. Funding: This research received no external funding. Institutional Review Board Statement: The study was conducted according to the guidelines of the Declaration of Helsinki and approved by the Institutional Review Board of University of Ex- tremadura (89/2016). Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. Data Availability Statement: Data will be available upon rationale request to the corresponding author. Acknowledgments: M.Á.T.-S. is supported by the Ministry of Economy and Infrastructures of Extremadura (PD18015). Conﬂicts of Interest: The authors declare no conﬂict of interest. References 1. Palomäki, S.; Hirvensalo, M.; Smith, K.; Raitakari, O.; Männistö, S.; Hutri-Kähönen, N.; Tammelin, T. Does organized sport participation during youth predict healthy habits in adulthood? A 28-year longitudinal study. Scand. J. Med. Sci. Sports 2018, 28, 1908–1915. [CrossRef] 2. Tammelin, R.; Yang, X.; Leskinen, E.; Kankaanpaa, A.; Hirvensalo, M.; Tammelin, T.; Raitakari, O.T. Tracking of physical activity from early childhood through youth into adulthood. Med. Sci. Sports Exerc. 2014, 46, 955–962. 3. Suchert, V.; Hanewinkel, R.; Isensee, B. Screen time, weight status and the self-concept of physical attractiveness in adolescents. J. Adolesc. 2016, 48, 11–17. [CrossRef] 4. Wu, X.Y.; Han, L.H.; Zhang, J.H.; Luo, S.; Hu, J.W.; Sun, K. The inﬂuence of physical activity, sedentary behavior on health-related quality of life among the general population of children and adolescents: A systematic review. PLoS ONE 2017, 12, e0187668. [CrossRef] 5. Vaquero Solís, M.; Sánchez-Miguel, P.A.; Tapia Serrano, M.Á.; Pulido, J.J.; Iglesias Gallego, D. Physical activity as a regulatory variable between adolescents’ motivational processes and satisfaction with life. Int. J. Environ. Res. Public Health 2019, 16, 2765. [CrossRef] [PubMed] 6. Poitras, V.J.; Gray, C.E.; Borghese, M.M.; Carson, V.; Chaput, J.-P.; Janssen, I.; Katzmarzyk, P.T.; Pate, R.R.; Connor Gorber, S.; Kho, M.E. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl. Physiol. Nutr. Metab. 2016, 41, S197–S239. [CrossRef] [PubMed] 7. Aladino, E. Estudio de Vigilancia del Crecimiento, Alimentación, Actividad Física, Desarrollo Infantil y Obesidad en España 2015; Agencia Española de Seguridad Alimentaria y Nutrición, Ministerio de Sanidad, Servicios Sociales e Igualdad: Madrid, Spain, 2013. 8. Corder, K.; Winpenny, E.; Love, R.; Brown, H.E.; White, M.; Van Sluijs, E. Change in physical activity from adolescence to early adulthood: A systematic review and meta-analysis of longitudinal cohort studies. Br. J. Sports Med. 2019, 53, 496–503. [CrossRef] [PubMed] 9. Goldbeck, L.; Schmitz, T.G.; Besier, T.; Herschbach, P.; Henrich, G. Life satisfaction decreases during adolescence. Qual. Life Res. 2007, 16, 969–979. [CrossRef] 10. Brief, U.P. The Impact of COVID-19 on Children; United Nations: New York, NY, USA, 2020. 11. Orben, A.; Tomova, L.; Blakemore, S.-J. The effects of social deprivation on adolescent development and mental health. Lancet Child Adolesc. Health 2020, 4, 634–640. [CrossRef] 12. Guthold, R.; Stevens, G.A.; Riley, L.M.; Bull, F.C. Global trends in insufﬁcient physical activity among adolescents: A pooled analysis of 298 population-based surveys with 1 6 million participants. Lancet Child Adolesc. Health 2020, 4, 23–35. [CrossRef] 13. López-Bueno, R.; López-Sánchez, G.F.; Casajús, J.A.; Calatayud, J.; Gil-Salmerón, A.; Grabovac, I.; Tully, M.A.; Smith, L. Health- related behaviors among school-aged children and adolescents during the Spanish COVID-19 conﬁnement. Front. Pediatr. 2020, 8, 573. [CrossRef] Behav. Sci. 2021, 11, 121 10 of 12 14. Xiang, M.; Zhang, Z.; Kuwahara, K. Impact of COVID-19 pandemic on children and adolescents’ lifestyle behavior larger than expected. Prog. Cardiovasc. Dis. 2020, 63, 531. [CrossRef] 15. Nobari, H.; Fashi, M.; Eskandari, A.; Villafaina, S.; Murillo-Garcia, Á.; Pérez-Gómez, J. Effect of COVID-19 on Health-Related Quality of Life in Adolescents and Children: A Systematic Review. Int. J. Environ. Res. Public Health 2021, 18, 4563. [CrossRef] [PubMed] 16. Von Soest, T.; Bakken, A.; Pedersen, W.; Sletten, M.A. Life satisfaction among adolescents before and during the COVID-19 pandemic. Tidsskr. Nor. Legeforen. 2020. [CrossRef] 17. Craven, R. The centrality of the self-concept construct for psychological wellbeing and unlocking human potential: Implicat. Educ. Child Psychol. 2008, 25, 104–118. 18. Saucedo-Araujo, R.G.; Huertas-Delgado, F.J.; Villa-González, E.; Ávila-García, M.; Gálvez-Fernández, P.; Tercedor, P. Is children’s health-related quality of life associated with physical ﬁtness and mode of commuting? PREVIENE Project. Perspect. Public Health 2021, 141, 102–110. [CrossRef] 19. Julian, V.; Thivel, D.; Miguet, M.; Pereira, B.; Lambert, C.; Costes, F.; Richard, R.; Duclos, M. Eccentric Cycling Training Improves Health-Related Quality of Life in Adolescents with Obesity. Obes. Facts 2020, 13, 548–559. [CrossRef] [PubMed] 20. Vaquero-Solís, M.; Tapia-Serrano, M.A.; Hortigüela-Alcalá, D.; Jacob-Sierra, M.; Sánchez-Miguel, P.A. Health Promotion through Movement Behaviors and Its Relationship with Quality of Life in Spanish High School Adolescents: A Predictive Study. Int. J. Environ. Res. Public Health 2021, 18, 7550. [CrossRef] 21. Wong, C.K.H.; Wong, R.S.; Cheung, J.P.Y.; Tung, K.T.S.; Yam, J.C.S.; Rich, M.; Fu, K.-W.; Cheung, P.W.H.; Luo, N.; Au, C.H. Impact of sleep duration, physical activity, and screen time on health-related quality of life in children and adolescents. Health Qual. Life Outcomes 2021, 19, 1–13. [CrossRef] 22. Qin, Z.; Wang, N.; Ware, R.S.; Sha, Y.; Xu, F. Lifestyle-related behaviors and health-related quality of life among children and adolescents in China. Health Qual. Life Outcomes 2021, 19, 1–9. [CrossRef] 23. Brudy, L.; Meyer, M.; Oberhoffer, R.; Ewert, P.; Müller, J. Move more–be happier? Physical Activity and Health-Related Quality of Life in Children with Congenital Heart Disease. Am. Heart J. 2021, 241, 68–73. [CrossRef] [PubMed] 24. Masini, A.; Gori, D.; Marini, S.; Lanari, M.; Scrimaglia, S.; Esposito, F.; Campa, F.; Grigoletto, A.; Ceciliani, A.; Toselli, S. The Determinants of Health-Related Quality of Life in a Sample of Primary School Children: A Cross-Sectional Analysis. Int. J. Environ. Res. Public Health 2021, 18, 3251. [CrossRef] 25. Khan, A.; Lee, E.-Y.; Tremblay, M.S. Meeting 24-h movement guidelines and associations with health related quality of life of Australian adolescents. J. Sci. Med. Sport 2021, 24, 468–473. [CrossRef] [PubMed] 26. Ávila-García, M.; Esojo-Rivas, M.; Villa-González, E.; Tercedor, P.; Huertas-Delgado, F.J. Relationship between Sedentary Time, Physical Activity, and Health-Related Quality of Life in Spanish Children. Int. J. Environ. Res. Public Health 2021, 18, 2702. [CrossRef] [PubMed] 27. Shoesmith, A.; Hall, A.; Hope, K.; Sutherland, R.; Hodder, R.K.; Trost, S.G.; Lecathelinais, C.; Lane, C.; McCarthy, N.; Nathan, N. Associations between in-school-hours physical activity and child health-related quality of life: A cross-sectional study in a sample of Australian primary school children. Prev. Med. Rep. 2020, 20, 101179. [CrossRef] [PubMed] 28. Esnaola, I.; Goñi, A.; Madariaga, J.M. El autoconcepto: Perspectivas de investigación. Rev. Psicodidact. 2008, 13, 69–96. 29. Fernández-Bustos, J.G.; Infantes-Paniagua, Á.; Cuevas, R.; Contreras, O.R. Effect of physical activity on self-concept: Theoretical model on the mediation of body image and physical self-concept in adolescents. Front. Psychol. 2019, 10, 1537. [CrossRef] [PubMed] 30. Khan, A.; Lee, E.-Y.; Rosenbaum, S.; Khan, S.R.; Tremblay, M.S. Dose-dependent and joint associations between screen time, physical activity, and mental wellbeing in adolescents: An international observational study. Lancet Child Adolesc. Health 2021, in press. [CrossRef] 31. Matin, N.; Kelishadi, R.; Heshmat, R.; Motamed-Gorji, N.; Djalalinia, S.; Motlagh, M.E.; Ardalan, G.; Areﬁrad, T.; Mohammadi, R.; Saﬁri, S. Joint association of screen time and physical activity on self-rated health and life satisfaction in children and adolescents: The CASPIAN-IV study. Int. Health 2017, 9, 58–68. [CrossRef] 32. Chmelík, F.; Frömel, K.; Grofﬁk, D.; Šafár, ˇ M.; Mitáš, J. Does Vigorous Physical Activity Contribute to Adolescent Life Satisfaction? Int. J. Environ. Res. Public Health 2021, 18, 2236. [CrossRef] [PubMed] 33. Hrafnkelsdottir, S.M.; Brychta, R.J.; Rognvaldsdottir, V.; Gestsdottir, S.; Chen, K.Y.; Johannsson, E.; Guðmundsdottir, S.L.; Arngrimsson, S.A. Less screen time and more frequent vigorous physical activity is associated with lower risk of reporting negative mental health symptoms among Icelandic adolescents. PLoS ONE 2018, 13, e0196286. [CrossRef] [PubMed] 34. Slapšinskaite, ˙ A.; Lukoševici ˇ ut ¯ e, ˙ J.; Šmigelskas, K. Interplay between adolescent physical activity and life satisfaction: Gender as potential effect modiﬁer. Int. J. Public Health 2020, 65, 1355–1363. [CrossRef] [PubMed] 35. Borraccino, A.; Lazzeri, G.; Kakaa, O.; Bad’ura, P.; Bottigliengo, D.; Dalmasso, P.; Lemma, P. The Contribution of Organised Leisure-Time Activities in Shaping Positive Community Health Practices among 13-and 15-Year-Old Adolescents: Results from the Health Behaviours in School-Aged Children Study in Italy. Int. J. Environ. Res. Public Health 2020, 17, 6637. [CrossRef] [PubMed] 36. Anand, M.; Arora, D. Burnout, life satisfaction and quality of life among executives of multinational companies. J. Indian Acad. Appl. Psychol. 2009, 35, 159–164. Behav. Sci. 2021, 11, 121 11 of 12 37. Cox, J.; Loughran, M.J.; Adams, E.M.; Navarro, R.L. Life satisfaction and health related quality of life among low-income medical patients: The mediating inﬂuence of self-esteem. Psychol. Health Med. 2012, 17, 652–658. [CrossRef] [PubMed] 38. Albert, I.; Trommsdorff, G. Are older adult German women satisﬁed with their lives? GeroPsych 2010, 23, 39–49. [CrossRef] 39. Paschali, A.; Tsitsas, G. Stress and life satisfaction among university students-a pilot study. Ann. Gen. Psychiatry 2010, 9, 1. [CrossRef] 40. Zullig, K.J.; Valois, R.F.; Drane, J.W. Adolescent distinctions between quality of life and self-rated health in quality of life research. Health Qual. Life Outcomes 2005, 3, 1–9. [CrossRef] 41. Wong, E.; Cronin, L.; Grifﬁth, L.; Irvine, E.J.; Guyatt, G.H. Problems of HRQL assessment: How much is too much? J. Clin. Epidemiol. 2001, 54, 1081–1085. [CrossRef] 42. Novianti, L.E.; Wungu, E.; Purba, F.D. Quality of life as a predictor of happiness and life satisfaction. J. Psikol. 2020, 47, 93–103. 43. Freire, T.; Ferreira, G. Health-related quality of life of adolescents: Relations with positive and negative psychological dimensions. Int. J. Adolesc. Youth 2018, 23, 11–24. [CrossRef] 44. Schmitter, C.; Zisselman, M.; Woldow, A. Life satisfaction ni centerarians residing in lont-term care. Ann. Long Term Care 1999, 7, 437–442. 45. Currie, C.; Molcho, M.; Boyce, W.; Holstein, B.; Torsheim, T.; Richter, M. Researching health inequalities in adolescents: The development of the Health Behaviour in School-Aged Children (HBSC) family afﬂuence scale. Soc. Sci. Med. 2008, 66, 1429–1436. [CrossRef] [PubMed] 46. Diener, E.; Suh, E.M.; Lucas, R.E.; Smith, H.L. Subjective well-being: Three decades of progress. Psychol. Bull. 1999, 125, 276. [CrossRef] 47. Atienza, F.L.; Pons, D.; Balaguer, I.; García-Merita, M. Propiedades psicométricas de la Escala de Satisfacción con la Vida en adolescentes. Psicothema 2000, 12, 314–319. 48. Kowalski, K.C.; Crocker, P.R.; Donen, R.M. The physical activity questionnaire for older children (PAQ-C) and adolescents (PAQ-A) manual. Coll. Kinesiol. Univ. Sask. 2004, 87, 1–38. 49. Martínez-Gómez, D.; Martínez-de-Haro, V.; Pozo, T.; Welk, G.J.; Villagra, A.; Calle, M.E.; Marcos, A.; Veiga, O.L. Fiabilidad y validez del cuestionario de actividad física PAQ-A en adolescentes españoles. Rev. Española Salud Pública 2009, 83, 427–439. [CrossRef] 50. Ravens-Sieberer, U.; Erhart, M.; Rajmil, L.; Herdman, M.; Auquier, P.; Bruil, J.; Power, M.; Duer, W.; Abel, T.; Czemy, L. Reliability, construct and criterion validity of the KIDSCREEN-10 score: A short measure for children and adolescents’ well-being and health-related quality of life. Qual. Life Res. 2010, 19, 1487–1500. [CrossRef] 51. Ravens-Sieberer, U. The Kidscreen Questionnaires: Quality of Life Questionnaires for Children and Adolescents; Handbook; Pabst Science Publishers: Lengerich, Germany, 2006. 52. Hayes, A.F. Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach; Guilford Publica- tions: New York, NY, USA, 2017. 53. Michel, G.; Bisegger, C.; Fuhr, D.C.; Abel, T. Age and gender differences in health-related quality of life of children and adolescents in Europe: A multilevel analysis. Qual. Life Res. Int. J. Qual. Life Asp. Treat. Care Rehabil. 2009, 18, 1147–1157. [CrossRef] 54. Vaquero-Solís, M.; Tapia-Serrano, M.A.; Hortigüela-Alcalá, D.; Sierra-Díaz, M.J.; Sánchez-Miguel, P.A. Physical Activity and Quality of Life in High School Students: Proposals for Improving the Self-Concept in Physical Education. Int. J. Environ. Res. Public Health 2021, 18, 7185. [CrossRef] [PubMed] 55. Galán, I.; Boix, R.; Medrano, M.J.; Ramos, P.; Rivera, F.; Pastor-Barriuso, R.; Moreno, C. Physical activity and self-reported health status among adolescents: A cross-sectional population-based study. BMJ Open 2013, 3, e002644. [CrossRef] 56. Haegele, J.A.; Famelia, R.; Lee, J. Health-related quality of life, physical activity, and sedentary behavior of adults with visual impairments. Disabil. Rehabil. 2017, 39, 2269–2276. [CrossRef] 57. Marker, A.M.; Steele, R.G.; Noser, A.E. Physical activity and health-related quality of life in children and adolescents: A systematic review and meta-analysis. Health Psychol. 2018, 37, 893. [CrossRef] 58. Rank, M.; Wilks, D.C.; Foley, L.; Jiang, Y.; Langhof, H.; Siegrist, M.; Halle, M. Health-related quality of life and physical activity in children and adolescents 2 years after an inpatient weight-loss program. J. Pediatr. 2014, 165, 732–737. [CrossRef] 59. Shoup, J.A.; Gattshall, M.; Dandamudi, P.; Estabrooks, P. Physical activity, quality of life, and weight status in overweight children. Qual. Life Res. 2008, 17, 407–412. [CrossRef] 60. Lubans, D.R.; Plotnikoff, R.C.; Lubans, N.J. A systematic review of the impact of physical activity programmes on social and emotional well-being in at-risk youth. Child Adolesc. Ment. Health 2012, 17, 2–13. [CrossRef] [PubMed] 61. Bell, S.L.; Audrey, S.; Gunnell, D.; Cooper, A.; Campbell, R. The relationship between physical activity, mental wellbeing and symptoms of mental health disorder in adolescents: A cohort study. Int. J. Behav. Nutr. Phys. Act. 2019, 16, 138. [CrossRef] 62. Gomez-Baya, D.; Mendoza, R.R.; Tomico, A. The prospective relationship of sport and physical activity with life satisfaction after a one-year follow-up: An examination of gender differences during mid-adolescence. Cuad. Psicol. Deporte 2018, 18, 169–186. 63. Corr, M.; McSharry, J.; Murtagh, E.M. Adolescent girls’ perceptions of physical activity: A systematic review of qualitative studies. Am. J. Health Promot. 2019, 33, 806–819. [CrossRef] [PubMed] 64. Shin, D.C.; Johnson, D.M. Avowed happiness as an overall assessment of the quality of life. Soc. Indic. Res. 1978, 5, 475–492. [CrossRef] Behav. Sci. 2021, 11, 121 12 of 12 65. Grao Cruces, A.; Nuviala Nuviala, A.; Fernández Martínez, A.; Pérez Turpin, J.A. Association of physical self-concept with physical activity, life satisfaction and Mediterranean diet in adolescents. Kinesiology 2014, 46, 3–11. 66. Mehdinezhad, V.; Golsanamlou, M. Inﬂuence of Physical Activity on Students’ Physical Self-Concept and Satisfaction with Life: Physical and Non-Physical Education Students’ Perspective. Turk. J. Sport Exerc. 2014, 16, 77–83. [CrossRef] 67. Sanmartín, M.G.; Miguel, J.M.T.; Navarro, P.C. Inﬂuencia del clima motivacional en educación física sobre las metas de logro y la satisfacción con la vida de los adolescentes. Retos Nuevas Tend. Educ. Física Deporte Recreación 2017, 31, 157–163. 68. Moksnes, U.K.; Espnes, G.A. Self-esteem and life satisfaction in adolescents—Gender and age as potential moderators. Qual. Life Res. 2013, 22, 2921–2928. [CrossRef] [PubMed] 69. Sousa-Sá, E.; Zhang, Z.; Pereira, J.R.; Wright, I.M.; Okely, A.D.; Santos, R. Systematic review on retinal microvasculature, physical activity, sedentary behaviour and adiposity in children and adolescents. Acta Paediatr. 2020, 109, 1956. [CrossRef]
Multidisciplinary Digital Publishing Institute
The Role of Physical Activity in the Relationship between Satisfaction with Life and Health-Related Quality of Life in School-Age Adolescents
Tapia-Serrano, Miguel Ángel
León-Llamas, Juan Luis
Sánchez-Miguel, Pedro Antonio
, Volume 11 (9) –
Sep 3, 2021
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