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Steps per day and health-related quality of life in schoolchildren: the mediator role of cardiorespiratory fitness

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Abstract

To analyse the relationship between steps per day and health-related quality of life (HRQoL) and cardiorespiratory fitness (CRF) and to examine whether the relationship between steps per day and HRQoL is mediated by CRF in schoolchildren. This was a cross-sectional study including 501 schoolchildren (aged 9–12 years, 47% girls), from Cuenca, Spain. Steps per day were measured using the Xiaomi Mi Band 3 Smart Bracelet, HRQoL was estimated by the KIDSCREEN-27 questionnaire, and CRF was assessed using the 20-m shuttle run test. Analysis of covariance and multivariate analysis of covariance models showed that children with a higher mean number of steps per day (> 9000 steps/day) had better HRQoL (global score, and physical and psychological well-being) and higher CRF levels than their peers with a lower number of steps per day (p < 0.05); however, these differences were no longer significant when controlling for sex, age, mother’s education level, and CRF (p > 0.05). Linear regression models estimated that each 1000-step increment was associated with better CRF (β = 0.350; 95% CI, 0.192 to 0.508). In addition, the relationship between steps per day and HRQoL was mediated by CRF (p < 0.05).

    Conclusion: Steps per day are a good metric to estimate daily physical activity because of its positive relationship with CRF. Moreover, those children taking more than 9000 steps per day are associated with higher levels of physical and psychological well-being. Finally, a substantial part of the improvement in HRQoL achieved through the increase in physical activity (steps per day) is mediated by CRF.

What is Known:

• Physical activity is known to have a positive impact on health-related quality of life in children. Steps per day are commonly used as a measure of physical activity.

• Cardiorespiratory fitness is a recognized indicator of overall health in youth.

What is New:

• Increments of steps per day were associated with better CRF, with a nonlinear association after approximately 9000 steps/day.

• Schoolchildren with > 9000 steps/ day showed better HRQoL.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on request.

Abbreviations

WHO:

World Health Organization

HRQoL:

Health-related quality of life

PA:

Physical activity

CRF:

Cardiorespiratory fitness

MVPA:

Moderate to vigorous physical activity

LOESS:

Locally weighted scatterplot smoothing

ANCOVA:

Analysis of covariance

MANCOVA:

Multivariate analysis of covariance

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Funding

This work was supported by the Ministry of Economy and Competitiveness-Carlos III Health Institute and FEDER funds (PI19/01126) and Health Outcomes-Oriented Cooperative Research Networks (RD21/0016/0025) co-funded with European Union – NextGenerationEU funds. ERG (2022-UNIVERS-11373), MLLT (2022-PROD-20657) and SNAA (2020-PREDUCLM-16704) are supported by a grant from the University of Castilla-La Mancha. IMG is supported by a grant from the Science, Innovation and Universities (FPU21/06866).

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Authors and Affiliations

  1. Health and Social Research Center, Universidad de Castilla-La Mancha, 16071, Cuenca, Spain

    Eva Rodríguez-Gutiérrez, Ana Torres-Costoso, Irene Martínez-García, Sergio Núñez de Arenas-Arroyo, Maribel Lucerón-Lucas-Torres, Irene Sequí-Domínguez, Celia Álvarez-Bueno & Vicente Martínez-Vizcaíno

  2. Research Network On Chronicity, Primary Care and Health Promotion (RICAPPS), Cuenca, Spain

    Eva Rodríguez-Gutiérrez, Sergio Núñez de Arenas-Arroyo & Irene Sequí-Domínguez

  3. Facultad de Fisioterapia y Enfermería, Universidad de Castilla-La Mancha, Avda. Carlos III s/n 45071, Toledo, Spain

    Ana Torres-Costoso

  4. Department of Health Sciences, Institute for Sustainability & Food Chain Innovation (ISFOOD), Public University of Navarre, 31006, Pamplona, Spain

    María Medrano-Echeverría

  5. IdiSNA, Navarra Institute for Health Research, 31006, Pamplona, Spain

    María Medrano-Echeverría

  6. Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain

    María Medrano-Echeverría

  7. Facultad de Enfermería de Albacete, Universidad de Castilla-La Mancha - Campus de Albacete, Albacete, Spain

    Irene Sequí-Domínguez

  8. Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay

    Celia Álvarez-Bueno

  9. Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, 3460000, Talca, Chile

    Vicente Martínez-Vizcaíno

Authors
  1. Eva Rodríguez-Gutiérrez
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  2. Ana Torres-Costoso
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  9. Vicente Martínez-Vizcaíno
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Contributions

Eva Rodríguez Gutiérrez and Ana Torres Costoso participated in the design of the study and contributed to data collection and data reduction/analysis. Irene Martínez García, Maribel Lucerón Lucas-Torres and Sergio Núñez de Arenas Arroyo participated in the design of the study and contributed to data collection. Vicente Martínez Vizcaíno, Celia Álvarez Bueno, Irene Sequí Domínguez and María Medrano Echeverría contributed to data reduction/analysis and interpretation of results. The first draft of the manuscript was written by Eva Rodríguez Gutiérrez and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ana Torres-Costoso.

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Rodríguez-Gutiérrez, E., Torres-Costoso, A., Martínez-García, I. et al. Steps per day and health-related quality of life in schoolchildren: the mediator role of cardiorespiratory fitness. Eur J Pediatr 183, 739–748 (2024). https://doi.org/10.1007/s00431-023-05333-1

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