sus ainabili y
A icle
Li e Sa is ac ion, Physical Ac i i y and Quali y o Li e
Associa ed wi h he Heal h o School-Age Adolescen s
JoséD. U chaga 1, Raquel M. Gue a a 2,* , An onio S. Cabaco 3and JoséE. Mo al-Ga cía2
1Facul y o Communica ion, Pon i ical Uni e si y o Salamanca, C/Compañía,5, 37002 Salamanca, Spain;
[email p o ec ed]
2Facul y o Educa ion, Pon i ical Uni e si y o Salamanca, C/Compañía,5, 37002 Salamanca, Spain;
[email p o ec ed]
3Facul y o Psychology, Pon i ical Uni e si y o Salamanca, C/Compañía,5, 37002 Salamanca, Spain;
[email p o ec ed]
*Co espondence: [email p o ec ed]
Recei ed: 1 Sep embe 2020; Accep ed: 11 No embe 2020; Published: 14 No embe 2020


Abs ac :
The main pu pose o his s udy is o unde s and he Quali y o Li e Associa ed wi h Heal h
(QLAH) o a sample o school-age adolescen s, and he exis ing associa ions be ween he la e and
o he a iables, such as amily li e sa is ac ion, pe sonal li e sa is ac ion (LS), iendships sa is ac ion,
physical ac i i y wi h amily, iends and pe sonal physical ac i i y. The sample consis ed o 1226 Spanish
school-age adolescen s (50.9% boys and 40.1% gi ls) wi h ages be ween 12 and 16 yea s old. Se e al scales
ha we e ex ac ed om he in e na ional Heal h Beha iou in School-aged Child en (HBSC) 2016
s udy, sponso ed by he Wo ld Heal h O ganiza ion (WHO), we e used as wo king ins umen s in his
piece o esea ch. SPSS (24.0) was he so wa e package used o pe o m he analyses o desc ip i e
s a is ics, co ela ion and mul iple eg ession, whe eas AMOS (24.0) was used o s uc u al equa ions.
The esul s e eal a s ong associa ion be ween he physical ac i i y (PA) s uden s unde ake (pe sonal,
wi h hei amilies and iends) and li e sa is ac ion, amily li e sa is ac ion and sa is ac ion wi h he
ela ionships wi h iends. Addi ionally, bo h cons uc s (physical ac i i y and sa is ac ion, unde s ood
as an indica o o good heal h) can p edic he esponden s’ Quali y o Li e Associa ed wi h Heal h.
The a iables (QLAH, LS and PA) a e in e ela ed, hus esul ing in majo p ac ical implica ions.
Keywo ds: adolescence; li e sa is ac ion; heal hy habi s; amily; pee ela ionships; school
1. In oduc ion
Adolescence is a pa icula ly ele an s age in he de elopmen o indi iduals, as i is du ing his
ime ha iden i y is o med, he indi idual’s socialisa ion p ocess e ol es, wi h many o he habi s ha
will accompany hem h oughou hei adul age also being acqui ed a his s age. In ecen decades,
nume ous esea ch s udies ha e ocused on his s age as a majo de elopmen s age [
1
–
5
] and ha e
highligh ed i as a key ime o he adop ion o heal hy li es yles, poin ing ou i s impo ance o
building posi i e amily and social ela ionships ha ensu e he wellbeing o he indi idual [
6
–
11
].
Addi ionally, his is a key s age in he sense ha i is he ime when he li es yle o indi iduals begins
o o m, po en ially a ec ing hei heal h du ing adul hood [12,13].
Heal h is b oadly unde s ood—in eg a ing he physical, men al and social dimensions o he
adolescen — o depend on di e se ac o s, such as he en i onmen , human biology o he heal h
sys em [
1
–
5
] de e mining hei u u e physical, men al and social wellbeing [
14
]. Compa a i e s udies
unde aken in a ious coun ies main ain his iew [
15
] and allow o he design o p e en a i e policies,
which ake in o accoun he ole o con ex ual (coun y) o pe sonal (age o gende ) a iables [16].
Sus ainabili y 2020,12, 9486; doi:10.3390/su12229486 www.mdpi.com/jou nal/sus ainabili y
Sus ainabili y 2020,12, 9486 2 o 13
One o he g ea es bene i s o he adop ion and consolida ion o heal hy habi s as a mechanism
o imp o e people’s heal h is he p ac ice o physical ac i i y (PA), which has a posi i e impac
on he physical, physiological, psychological and social sphe es o li e [
17
,
18
]. Regula p ac ice o
PA posi i ely con ibu es o he imp o emen o he physical condi ion (bo h he ca dio espi a o y
unc ions and muscle s eng h). Vigo ous exe cise, o example, has been associa ed wi h a heal hy
le el o ca dio espi a o y i ness [
19
]. Resea ch indica es ha PA is bene icial in educing he isk o
ca dio ascula and me abolic disease, educing body a , imp o ing bone heal h and educing he
symp oms o dep ession [
18
,
19
]. I also posi i ely a ec s men al heal h, as egula p ac ice o PA
inc eases sel -es eem, c ea ing posi i i y in he indi idual who exe cises, whe eas a seden a y li es yle
causes dep essi e moods and heal h issues [20].
The consolida ion o heal hy habi s, such as he habi ual p ac ice o PA is essen ial a all s ages o
li e as i b ings people nume ous bene i s in he p e en ion o disease, he adop ion o o he heal hy
habi s and as a ac o p o ec ing agains beha iou s ha pose a isk o heal h [
21
,
22
]. A ecen esea ch
s udy [
23
] disco e ed ha he p ac ice o PA has associa ions wi h o he pa ame e s, such as he
educ ion o oxic subs ance consump ion o he imp o emen o nu i ion [24].
In Spain, he da a ex ac ed om he Heal h Beha iou in School-aged Child en (HBSC) 2016 [
25
]
s udy e eal ha 48.4% o adolescen s akes PA acco ding o he ecommenda ions o he Wo ld Heal h
O ganiza ion (WHO) [
26
]. Addi ionally, he same s udy shows ha boys end o p ac ice mo e PA han
gi ls and ha hei p ac ice dec eases wi h age in bo h cases [
25
]. Despi e he posi i e e ec s o an
ac i e li e and he impo ance o p ac ising PA in childhood and adolescence being known o e e yone,
only a mino i y o young people comply wi h he daily ecommenda ions o p ac icing mode a e o
igo ous PA o 60 min [27–35].
School is no ed as being a undamen al en i y in he p omo ion o physical/spo s ac i i ies [
36
]
and i is conside ed as a majo pilla in he es ablishmen o heal hy li e habi s in adolescence [
37
,
38
].
I is impo an o ake in o accoun he a io be ween physical educa ion lessons and ou -o -school
ec ea ional ac i i ies [
39
,
40
] and he need o inc ease he p ac ice o physical/spo s ac i i ies ou side
school du ing his pe iod o ime, as he amoun o PA aken in school does no seem o be su icien [
41
].
The amily can play a complemen a y ole o ha o school, as he simul aneous wo k in bo h
en i onmen s makes i easie o p omo e ac i e and heal hy li e habi s and o c ea e a good mo i a ional
g ound om he ea ly s ages o li e ha p o ides bene i s o adolescen s [
42
,
43
]. The in luence ha
hose close o he adolescen can ha e is an impo an ac o in inc easing hei mo i a ion and hei
in e es owa ds physically ac i e ac i i ies [
43
]. In line wi h his, ecen esea ch e eals ha he
p ac ice o PA wi hin he amily p omo es PA in adolescence [
44
–
51
]. The p ac ice o PA by iends
also seems o impac on he pe sonal p ac ice o PA [50–53].
In e ms o men al heal h, li e a u e shows ha he li e sa is ac ion (LS) adolescen s epo o ha e is
closely linked o hei wellbeing, wi h his being a subjec i e indica o [
54
] a ising om he compa ison
be ween hei pe sonal ci cums ances and wha hey belie e o be an adequa e li e s anda d [
55
],
which also has majo implica ions in he psychological, social and educa ional unc ioning o hese
indi iduals [56–60].
Nume ous esea ch s udies p o e ha adolescen s’ sa is ac ion wi h li e is especially ela ed o
he expe iences he indi iduals ha e wi h hei amilies [
8
,
61
], which is he main sou ce o suppo
p o iding wellbeing o he indi iduals, oge he wi h hei iends [
62
–
65
]. O he au ho s [
10
], con i m
a high le el o amily ha mony as being c ucial o he de elopmen o an adolescen . Aspec s such
as school sa is ac ion, heal h, money and wo k a e also ela ed o he le el o li e sa is ac ion in
adolescen s, whe e hei ela ionships wi h iends a e an impo an ac o o hei psychological
de elopmen [66,67].
Addi ionally, se e al pape s ake bo h aspec s in o accoun , i.e., PA and LS, and s a e ha he e
is a close associa ion be ween hem. These s udies ha e ound ha people whose li e habi s include
PA ha e a be e pe cep ion o hei heal h and LS le els [
68
–
71
]. Since he 80s, he assessmen o
Quali y o Li e Associa ed wi h Heal h (QLAH) has acqui ed ce ain impo ance in esea ch as a
Sus ainabili y 2020,12, 9486 3 o 13
measu emen o heal h, being unde s ood as a alid cons uc o he assessmen o adolescen s’
heal h [
72
]. This mul idimensional cons uc includes he subjec i e assessmen o social, physical and
cogni i e unc ioning, mobili y, pe sonal ca e and emo ional wellbeing [
73
]. In he same way, physical
condi ion associa ed wi h heal h (PFH) is deemed o be one o he ac o s de e mining Quali y o Li e
Associa ed wi h Heal h (QLAH) [74,75].
Ano he impo an ac o o ake in o accoun is he measu ing ins umen s employed in his
esea ch, as a a ie y o scales ha e been used o assess he cons uc “quali y o li e in adolescen s”.
In he las i y yea s, he mos commonly used ins umen o da a aken om o e hal a million
adolescen s in e iewed in Ame ica and Eu ope, was PedsQl [
76
], in si ua ions associa ed wi h
pa hologies, whe eas KIDSCREEN [
77
] was used o heal hy adolescen s. The e a e also ques ionnai es
on he quali y o li e o adolescen s [
78
], which a e speci ic o s udies associa ed wi h hei ca e s o o
help assess he e iciency o s uden p og ams such as CHQ [79].
Al hough quali y o li e, heal h and p ac ice o PA ha e been analysed in p e ious s udies, he e a e
no enough s udies dealing wi h he connec ion be ween all hese a iables in school-age adolescen s.
The e is a need o analyse he ela ionships be ween he physical, men al and social heal h o adolescen s
in o de o ind ou he deg ee o which he ac o s unde s udy in hese h ee dimensions can p edic he
heal h s a us o he adolescen (acco ding o hei Quali y o Li e Associa ed wi h Heal h). This esea ch
in ends o unde s and he Quali y o Li e Associa ed wi h Heal h (QLAH) and he ela ionship exis ing
be ween his and o he a iables, such as amily li e sa is ac ion, li e sa is ac ion, sa is ac ion wi h he
ela ionships wi h iends, amily physical ac i i ies, iends’ physical ac i i ies and pe sonal physical
ac i i y. The inno a i e aspec ha he in es iga ion con ibu es is he s udy o he a o emen ioned
concep s as a whole, agains he o he mo e agmen ed o bila e al iews con ibu ed by p e ious
esea ch s udies.
2. Ma e ials and Me hods
2.1. Design and Pa icipan s
The sample was aken in he ci y o Salamanca, in Spain. A desc ip i e c oss-sec ional s udy was
designed wi h he pa icipa ion o 16 schools selec ed by conglome a e s a i ied andom mul is age
sampling, which p o ided a ep esen a ion o he 4 a eas o social ac ion o he ci y and he ypes o
schools (s a e o semi-s a e).
The o al sample consis ed o 1226 Spanish school-aged adolescen s (50.9% boys and 49.1% gi ls),
en olled in he 2017/2018 school yea and dis ibu ed in o 2 academic le els: 1s yea o Obliga o y
Seconda y Educa ion wi h 602 pa icipan s (331 boys and 271 gi ls; age: 12.9
±
0.57 yea s old) and
4 h yea o Obliga o y Seconda y Educa ion wi h 624 pa icipan s (281 boys and 343 gi ls; age:
16.09 ±0.73 yea s old). The sample had a ma gin e o o 2% (p=q=0.5; con idence le el =95%).
2.2. Ins umen s
A sociodemog aphic ques ionnai e and a ious speci ic scales, which we e alida ed o he s udy
o he a ious cons uc s, we e used. All o hem a e also p esen in he HBSC s udy [
25
]. The ollowing
a e he ins umen s employed:
(a)
Sociodemog aphic ques ionnai e in o de o de e mine sex (male and emale) and age in yea s.
(b)
In o de o measu e he le el o pe sonal li e sa is ac ion (PLS), Can il’s scale [
80
] was used,
consis ing o only one-i em ques ion: “Gene ally speaking, wha do you eel you li e is like a
p esen ?”. A scale o 0 o 10 was used o he answe op ions, whe e 0 means “The wo s li e
possible” and 10 means “The bes li e possible”.
(c)
Family li e sa is ac ion (FLS) was measu ed by adap ing he Can il [
80
] scale and i consis ed
o only one-i em ques ion: “Gene ally speaking, how sa is ied a e you wi h you amily
ela ionships?”. A scale o 0 o 10 was used o he answe op ions, whe e 0 means “My amily
does no ge on a all” and 10 means “My amily ge s on eally well”.
Sus ainabili y 2020,12, 9486 4 o 13
(d)
Sa is ac ion wi h he ela ionships wi h iends (SF) was measu ed using he ollowing ques ion:
“I you we e o a e he ela ionship you ha e wi h you iends in gene al, wha sco e would you
gi e i ?” A scale o 0 o 10 was used o he answe op ions, whe e 0 means “I ha e he wo s
ela ionship possible wi h my iends” and 10 means “I ha e he bes ela ionship possible wi h
my iends”.
(e)
PA was assessed by means o h ee speci ic i ems ex ac ed om he HBSC (2014) s udy
ques ionnai e [
81
]: wo ques ions ela ing o amily, one ela ed wi h pe sonal physical ac i i y
and one wi h he spo s ac i i ies unde aken by iends: Family: “How equen ly do you and
you amily usually do one o he ollowing hings oge he ? Go ou o walks oge he (FPA-W);
P ac ice spo s oge he ” (FPA-S). Bo h ques ions had 5 answe op ions: e e y day (5), mos
days (4), app oxima ely once a week (3), less o en han once a week (2), ne e (1). Pe sonal
physical ac i i y (PPA): “In he las 7 days, how many days we e you physically ac i e o a o al
o a leas 60 min pe day? The answe op ions o e ed we e om 0 o 7 days. Spo s physical
ac i i y unde aken by iends (PAF-S): “Mos people wi hin my g oups o iends p ac ice some
spo s ac i i y wi h o he people”. Fou po en ial answe op ions we e p o ided (ne e , a ely,
occasionally, o en).
( )
The QLAH was assessed using he Kidsc een-10 [
77
] package, which is a ool ha can alloca e a
global index o emo ional wellbeing h ough 10 i ems which comp ise physical, psychological
and social aspec s. The s uden s we e equi ed o answe whe he “in he las week” hey el
well and i , ull o ene gy, sad, lonely, whe he hey had enough ime o hemsel es, managed o
do he hings hey wan ed o do in hei leisu e ime, we e ea ed ai ly by hei pa en s, had a
good ime wi h hei iends, hings wen well in school o high school, and whe he hey we e
able o concen a e o pay a en ion. The sco e o each o he i ems wen om 1 o 5 (ne e , a ely,
occasionally, almos always and always).
2.3. P ocedu e
This esea ch s udy was de eloped in compliance wi h he e hical code o he Decla a ion o
Helsinki, e ised in 2013, applicable o hese ypes o esea ch s udies, bu also adap ed o he Da a
P o ec ion Ac (O ganic Law 15/1999) and unde he p emises o he Spanish cu en ly e ec i e laws
on esea ch wi h human subjec s (Royal Dec ee 561/1993). The s udy p o ocol was app o ed by he
E hics Commi ee o Resea ch wi h Human Subjec s o he Pon i ical Uni e si y o Salamanca.
Be o e he da a we e collec ed, he school cen es we e app oached in o de o ob ain p io
pe mission o he esponden s o pa icipa e in he s udy. Pa en al consen was also sough so ha
hey could be pa o he esea ch by explaining o he adolescen s ha he da a would be p ocessed
anonymously and olun a ily. Pa icipan s did no ob ain compensa ion o hei con ibu ions.
In o de o p e en he esponden s’ answe s om being biased, a coding sys em was used o gua an ee
anonymi y and con iden iali y o he esponden s a all imes. Ques ionnai es we e comple ed wi hin
he no mal school hou s a he ime alloca ed o pe sonal u o ing suppo , by ained in e iewe s unde
he supe ision o he main esea che . The s uden s answe ed he ques ionnai e in app oxima ely
en minu es.
The p ocedu e (Figu e 1) complied wi h he h ee basic equi emen s o he In e na ional
Coo dina ing Cen e o he HBSC s udy: he s uden s answe ed he ques ionnai e by hemsel es;
anonymi y o he answe s was assu ed and gua an eed and he ques ionnai es we e adminis e ed
wi hin he school cen e.
The inclusion c i e ia we e: olun a y s uden pa icipa ion and p o ision o pa en al o legal
cus odian au ho isa ion. The exclusion c i e ia o his piece o esea ch we e: he p o ision o
inapp op ia e o incomple e answe s o any o he i ems in he ques ionnai es, ailu e o p o ide
pa en al o legal cus odian au ho isa ion, e idence o a pa hology ha could p e en he child om
egula ly p ac icing PA du ing he ime o he s udy o in he 6 p e ious mon hs.
Sus ainabili y 2020,12, 9486 5 o 13
Sus ainabili y 2020, 12, x FOR PEER REVIEW 5 o 14
Da a analysis was pe o med using he SPSS 24.0. and AMOS 24.0 so wa e packages. Desc ip i e
s a is ics we e used in o de o unde s and he dis ibu ion; he Pea son co ela ion index was employed
o he s udy o he bi a ia e ela ionships; and mul iple eg ession was used o he p edic ion o
a iables QLAH, pe sonal li e sa is ac ion (PLS) and pe sonal physical ac i i y (PPA). The AMOS
24.0 so wa e package allowed o he s udy o he s uc u al equa ion modelling adjus men s using
he Maximum Likelihood me hod.
Figu e 1. Cha on he s ep-by-s ep p ocedu e o he su ey.
3. Resul s
Ini ially, he p edic ed co ela ions we e p esen ed in he i e esea ch-speci ic objec i es and,
subsequen ly, he esul o a model o s uc u al equa ions.
3.1. Co ela ion Analysis
The co ela ions ob ained amongs he a iables being he objec o he s udy (Table 1) p o e o
all be signi ican (p < 0.01), and o ollow he p edic ed pa e n.
Table 1. Summa y o he in e -co ela ions and desc ip o s o sco es in QLAH, FLS, PLS, FS, FPA-W,
FPA-S, PPA and PAF-S.
QLAH FLS PLS FS FPA-S FPA-W PPA PAF-S
FLS 0.496 ***
PLS 0.585 *** 0.528 ***
FS 0.322 *** 0.227 *** 0.329 ***
FPA-S 0.267 *** 0.287 *** 0.257 *** 0.165 ***
FPA-W 0.314 *** 0.361 *** 0.295 *** 0.086 ** 0.456 ***
PPA 0.299 *** 0.136 *** 0.169 *** 0.182 *** 0.229 *** 0.090 **
PAF-S 0.209 *** 0.167 *** 0.108 *** 0.089 ** 0.160 *** 0.104 *** 0.211 ***
M 37.9 8.30 7.79 8.83 2.10 2.62 4.38 2.60
SD 6.07 1.89 1.65 1.28 1.197 1.14 1.96 0.592
Skewness −0.48 −1.49 −0.92 −1.87 0.82 0.20 −0.22 −1.19
Ku osis 0.21 2.67 1.29 5.70 −0.37 −0.69 −0.89 0.41
No e: QLAH: Quali y o Li e Associa ed wi h Heal h; FLS: Family Li e Sa is ac ion; PLS: Pe sonal Li e
Sa is ac ion; FS: F iendships Sa is ac ion; FPA-S: Family Physical Ac i i y: Spo s; FPA-W: Family Physical
Figu e 1. Cha on he s ep-by-s ep p ocedu e o he su ey.
2.4. Da a Analysis
Da a analysis was pe o med using he SPSS 24.0. and AMOS 24.0 so wa e packages. Desc ip i e
s a is ics we e used in o de o unde s and he dis ibu ion; he Pea son co ela ion index was employed
o he s udy o he bi a ia e ela ionships; and mul iple eg ession was used o he p edic ion o
a iables QLAH, pe sonal li e sa is ac ion (PLS) and pe sonal physical ac i i y (PPA). The AMOS 24.0
so wa e package allowed o he s udy o he s uc u al equa ion modelling adjus men s using he
Maximum Likelihood me hod.
3. Resul s
Ini ially, he p edic ed co ela ions we e p esen ed in he i e esea ch-speci ic objec i es and,
subsequen ly, he esul o a model o s uc u al equa ions.
3.1. Co ela ion Analysis
The co ela ions ob ained amongs he a iables being he objec o he s udy (Table 1) p o e o all
be signi ican (p<0.01), and o ollow he p edic ed pa e n.
In he i s place, posi i e co ela ions ha e been iden i ied be ween he PA p ac iced wi h he
amily, he PA p ac iced by he adolescen and he PA p ac iced by hei iends. The e a e e y
signi ican co ela ions (p<0.001) be ween he pe sonal physical ac i i y (PPA) unde aken and bo h
he spo s/physical ac i i y p ac iced wi h he amily (FPA-S) (0.229) and he spo s/physical ac i i y
p ac iced by iends (PAF-S) (0.211).
In line wi h expec a ions, in second place he e we e posi i e co ela ions be ween pe sonal li e
sa is ac ion and amily li e sa is ac ion (0.528) as well as iendships sa is ac ion (0.329). The e is also a
posi i e co ela ion be ween amily li e sa is ac ion (FLS) and iendships sa is ac ion (FS) (0.227).
Family li e sa is ac ion (FLS) is posi i ely co ela ed wi h he p ac ice o amily physical ac i i y,
whe he i is a spo s ac i i y (FPA-S) (0.287) o walks (FPA-W) (0.361).
In ou h place, QLAH is con i med o be co ela ed wi h he a ious ypes o PA ( amily, pe sonal
and iends’ ac i i ies), as well as LS (wi h he amily, wi h onesel and wi h iends). The closes
co ela ions be ween QLAH and he le el o sa is ac ion a e ob ained wi h pe sonal li e sa is ac ion
(PLS) (0.585) and amily li e sa is ac ion (FLS) (0.496). The closes co ela ions be ween QLAH and
PA a e ob ained wi h amily spo s/physical ac i i y (FPA-S) (0.314) and pe sonal physical ac i i y
(PPA) (0.299).

Sus ainabili y 2020,12, 9486 6 o 13
Table 1.
Summa y o he in e -co ela ions and desc ip o s o sco es in QLAH, FLS, PLS, FS, FPA-W,
FPA-S, PPA and PAF-S.
QLAH FLS PLS FS FPA-S FPA-W PPA PAF-S
FLS 0.496 ***
PLS 0.585 *** 0.528 ***
FS 0.322 *** 0.227 *** 0.329 ***
FPA-S 0.267 *** 0.287 *** 0.257 *** 0.165 ***
FPA-W 0.314 *** 0.361 *** 0.295 *** 0.086 ** 0.456 ***
PPA 0.299 *** 0.136 *** 0.169 *** 0.182 *** 0.229 *** 0.090 **
PAF-S 0.209 *** 0.167 *** 0.108 *** 0.089 ** 0.160 *** 0.104 *** 0.211 ***
M 37.9 8.30 7.79 8.83 2.10 2.62 4.38 2.60
SD 6.07 1.89 1.65 1.28 1.197 1.14 1.96 0.592
Skewness −0.48 −1.49 −0.92 −1.87 0.82 0.20 −0.22 −1.19
Ku osis 0.21 2.67 1.29 5.70 −0.37 −0.69 −0.89 0.41
No e: QLAH: Quali y o Li e Associa ed wi h Heal h; FLS: Family Li e Sa is ac ion; PLS: Pe sonal Li e Sa is ac ion;
FS: F iendships Sa is ac ion; FPA-S: Family Physical Ac i i y: Spo s; FPA-W: Family Physical Ac i i y: Walks; PPA:
Pe sonal Physical Ac i i y (las week, 60 min./day); PAF-S: Spo s/Physical Ac i i y P ac iced by F iends); M: mean;
SD: s anda d de ia ion. ** p<0.01; *** p<0.001.
Mul iple eg ession. The ele an mul iple eg ession analysis was pe o med ia he “s ep by
s ep” p ocedu e o he p edic ion o he QLAH, PLS and PPA a iables, wi h a 0.05 p obabili y en y
c i e ion and 0.10 p obabili y emo al c i e ion. The esul s (Table 2) e eal ha QLAH is he mos
p edic able a iable (R
2
=0.451), wi h he sa is ac ion pa ame e s unde conside a ion being e y
ele an ( amily, iendships and pe sonal li e sa is ac ion), as well as a ious aspec s o physical
ac i i y (pe sonal, iends and amily walks). PLS is he second mos p edic able a iable (R
2
=0.436)
and o his p edic ion QLAH, FLS, FS and FPA-W a e ele an . And las ly, he p edic ion o PPA is
e y low (R
2
=0.142), which includes QLAH, he h ee PA a iables (FPA-S, FPA-W and PAF) and FS.
Table 2. Mul iple eg ession models o QLAH, PLS and PPA: las s ep.
Dependen
Va iable
Coe icien s Co ela ions Collinea i y
S ep Model BdSEdBe p Ze o-O de Pa ial Tole anceVIF
QLAH a6
(Cons an )
11.47 1.080 10.61
<0.001
PLS 1.40 0.096 0.379 14.51
<0.001
0.585 0.384 0.659 1.52
FLS 0.648 0.084 0.201 7.73
<0.001
0.496 0.216 0.663 1.51
PPA 0.504 0.069 0.163 7.34
<0.001
0.299 0.206 0.917 1.09
FS 0.508 0.108 0.107 4.71
<0.001
0.322 0.134 0.871 1.15
FPA-W 0.518 0.122 0.097 4.23
<0.001
0.314 0.120 0.851 1.18
PAF-S 0.831 0.225 0.081 3.70
<0.001
0.209 0.105 0.934 1.07
Model Summa y: R=0.672; R2=0.451; adj R2=0.449; SEE g=4.50
ANOVA: F=167.7.; p<0.001
PLS b4
(Cons an )
0.012 0.292 0.04 0.968
QLAH 0.103 0.007 0.380 14.65
<0.001
0.585 0.387 0.687 1.46
FLS 0.251 0.022 0.287 11.20
<0.001
0.528 0.305 0.701 1.43
FS 0.175 0.029 0.136 5.97
<0.001
0.329 0.168 0.889 1.13
FPA-W 0.088 0.034 0.061 2.60 0.010 0.295 0.074 0.844 1.18
Model Summa y: R=0.661; R2=0.436; adj R2=0.435; SEE g=1.24
ANOVA: F=236.6.; p<0.001
Sus ainabili y 2020,12, 9486 7 o 13
Table 2. Con .
Dependen
Va iable
Coe icien s Co ela ions Collinea i y
S ep Model BdSEdBe p Ze o-O de Pa ial Tole anceVIF
PPA c5
(Cons an )
−
0.812
0.455 −1.79 0.074
QLAH 0.073 0.010 0.225 7.51
<0.001
0.299 0.210 0.783 1.28
FPA-S 0.279 0.050 0.171 5.62
<0.001
0.229 0.159 0.759 1.32
PAF-S 0.457 0.090 0.138 5.07
<0.001
0.211 0.144 0.944 1.06
FS 0.117 0.043 0.076 2.70 0.007 0.182 0.077 0.886 1.13
FPA-W −
0.137
0.053 −
0.079
−2.60 0.010 0.090 −
0.074
0.750 1.33
Model Summa y: R=0.377; R2=0.142; adj R2=0.139; SEE g=1.82
ANOVA: F=40.56.; p<0.001
a. Excluded a iable: FPA-S; b. Excluded a iables: FPA-S, PAF-S and PPA; c. Excluded a iables: FLS and PLS;
d. Uns anda dized; e. S anda dized; . VIF =Va iance in la ion ac o ; g. SEE =S anda d e o o es ima e.
3.2. S uc u al Equa ion Model
Based on he abo e esul s, a model o associa ion amongs he a iables was sough , aking QLAH
as a dependen a iable and o include in he model bo h sa is ac ion a iables and physical ac i i y
a iables. P io o he Pa hAnalysis, mul i a ia e no mali y was checked [
82
] which can be admi ed
o la ge samples i he a iables ake asymme y alues below 3 and ku osis alues o 10 (Table 2).
The wo king me hodology consis ed o adding a iables and hei associa ions o he pu poses
o p edic ing QLAH, in a way ha a heo e ically in e p e able model could be ob ained and he
adjus men indexes could be accep able.
The model ob ained (Figu e 2) e ealed an RMSEA (Roo Mean Squa e E o o App oxima ion)
o 0.06 (CI 90% =0.019, 0.113) wi h a PClose o 0.282, which indica es an adequa e model adjus men .
The inc emen al adjus men indexes e eal op imal adjus men (NFI, no mal i index =0.996;
FRI, lexibili y- igidi y index =0.959; IFI, inc emen al i index =0.997; TLI, Tucke Lewis index =0.966;
CFI, Ben le compa a i e i index =0.997) [82,83].
Sus ainabili y 2020, 12, x FOR PEER REVIEW 8 o 14
3.2. S uc u al Equa ion Model
Based on he abo e esul s, a model o associa ion amongs he a iables was sough , aking QLAH
as a dependen a iable and o include in he model bo h sa is ac ion a iables and physical ac i i y
a iables. P io o he Pa hAnalysis, mul i a ia e no mali y was checked [82] which can be admi ed
o la ge samples i he a iables ake asymme y alues below 3 and ku osis alues o 10 (Table 2).
The wo king me hodology consis ed o adding a iables and hei associa ions o he pu poses o
p edic ing QLAH, in a way ha a heo e ically in e p e able model could be ob ained and he
adjus men indexes could be accep able.
The model ob ained (Figu e 2) e ealed an RMSEA (Roo Mean Squa e E o o App oxima ion)
o 0.06 (CI 90% = 0.019, 0.113) wi h a PClose o 0.282, which indica es an adequa e model adjus men .
The inc emen al adjus men indexes e eal op imal adjus men (NFI, no mal i index = 0.996; FRI,
lexibili y- igidi y index = 0.959; IFI, inc emen al i index = 0.997; TLI, Tucke Lewis index = 0.966;
CFI, Ben le compa a i e i index = 0.997) [82,83].
The model explains 38.4% o he a iance o QLAH. Va iables PLS (0.519) and PPA (0.191) a e
he ones con ibu ing mos o explain QLAH di ec ly, ollowed by FS (.104). Addi ionally, he indi ec
e ec o PLS (0.034) on QLAH h ough FS should be aken in o accoun .
Figu e 2. S uc u al equa ion modelling o he p edic ion o QLAH based on FLS, PLS, FS and PPA.
Es ima es o he s anda dised maximum likelihood pa ame e s. All he coe icien s a e signi ican o
p < 0.001.
The model es ablishes ha he e a e co ela ions be ween PPA and he a ious LS dimensions
unde assessmen (pe sonal, amily and iends), as well as be ween PLS and FLS and FS and he las
wo wi h QLAH.
4. Discussion
The esul s o his esea ch s udy a e in line wi h o he Spanish esea ch on physical ac i i y, wi h
pe sonal physical ac i i y being associa ed wi h amily physical ac i i y [44,45]. Thus, adolescen s who
s a e hey walk in he company o hei pa en s and ha hey p ac ice physical ac i i y wi h hem on
a egula basis e eal be e le els o physical ac i i y and, in u n, acco ding o he da a ob ained,
be e amily li e sa is ac ion. I is he e o e essen ial o he amily o suppo child en in he p ac ice o
PA and e en o hem o p ac ice i oge he [46–48], since such suppo can be de e mining in he
consolida ion o heal hy habi s, e en in adul hood [49]. Va ious esea ch s udies ha e con i med ha
adolescence is a key s age o he consolida ion o li es yle and p ac ice o PA on a egula basis [11,18].
Figu e 2.
S uc u al equa ion modelling o he p edic ion o QLAH based on FLS, PLS, FS and PPA.
Es ima es o he s anda dised maximum likelihood pa ame e s. All he coe icien s a e signi ican o
p<0.001.
The model explains 38.4% o he a iance o QLAH. Va iables PLS (0.519) and PPA (0.191) a e he
ones con ibu ing mos o explain QLAH di ec ly, ollowed by FS (.104). Addi ionally, he indi ec
e ec o PLS (0.034) on QLAH h ough FS should be aken in o accoun .
Sus ainabili y 2020,12, 9486 8 o 13
The model es ablishes ha he e a e co ela ions be ween PPA and he a ious LS dimensions
unde assessmen (pe sonal, amily and iends), as well as be ween PLS and FLS and FS and he las
wo wi h QLAH.
4. Discussion
The esul s o his esea ch s udy a e in line wi h o he Spanish esea ch on physical ac i i y,
wi h pe sonal physical ac i i y being associa ed wi h amily physical ac i i y [
44
,
45
]. Thus, adolescen s
who s a e hey walk in he company o hei pa en s and ha hey p ac ice physical ac i i y wi h hem
on a egula basis e eal be e le els o physical ac i i y and, in u n, acco ding o he da a ob ained,
be e amily li e sa is ac ion. I is he e o e essen ial o he amily o suppo child en in he p ac ice
o PA and e en o hem o p ac ice i oge he [
46
–
48
], since such suppo can be de e mining in he
consolida ion o heal hy habi s, e en in adul hood [
49
]. Va ious esea ch s udies ha e con i med ha
adolescence is a key s age o he consolida ion o li es yle and p ac ice o PA on a egula basis [
11
,
18
].
The esul s a e also in line wi h o he s udies which p o e an associa ion be ween he pe sonal
physical ac i i y and he ac ha iends p ac ice physical ac i i y oo [
62
–
66
]. In ac , he iendships
social en i onmen has an impac on he p ac ice o PA; hus, adolescen s who a e iendly wi h
physically ac i e indi iduals a e mo e likely o mo e away om seden a y habi s and o emain mo e
physically ac i e [
51
]. This in luence o iends on he p omo ion o heal hy li es yles can exis om
childhood o la e adolescence [63].
On he o he hand, he LS o he adolescen s being in e iewed was closely associa ed wi h hei
amily li e sa is ac ion and hei iendships sa is ac ion [
8
,
10
,
61
]. A close bond wi h hei amilies and
posi i e social ela ionships undoub edly ha e an impac on he heal h o adolescen s; and he e o e
i is p o en as essen ial o p omo e measu es o gua an ee such heal hy ela ionships, as hey help
imp o e LS, PA and QLAH a his s age o de elopmen . In his sense, li e sa is ac ion is also ein o ced
when adolescen s sha e hei p oblems o conce ns wi h hei pa en s and iends [
63
]. The e o e,
subjec i e wellbeing is posi i ely associa ed wi h he in e ac ions be ween amily membe s and iends,
o example, when hey sha e daily li e ac i i ies [64].
Adolescen s who enjoy a be e QLAH e eal g ea e pe cei ed suppo in he adop ion o heal hy
habi s, such as he p ac ice o PA, by hei pa en s and iends [
65
]. The abo e-men ioned empi ic
e idence has an impac on he imp o emen o he physical condi ion and on he p e en ion o
ca dio ascula disease [
11
], con ibu ing o imp o ed psychosocial heal h s a us [
67
], socialisa ion and
e en academic pe o mance [58–60].
In oday’s socie y, and mo e pa icula ly du ing a heal h pandemic (COVID-19), i is especially
ele an o p omo e he wellbeing o people o all ages, ensu ing hey enjoy a heal hy li es yle and
en i onmen as he means o sus ainable de elopmen . The ac o s de e mining and in luencing he
heal h o people a e nume ous and hese ha e an impac on hei de elopmen . Amongs hem, physical
condi ion plays a pa icula ly ele an ole [
24
,
74
]. Fo example, p omo ing he egula p ac ice o
physical exe cise is essen ial o help adop an ac i e and heal hy li es yle a ce ain s ages o li e [
31
].
In his sense, child en and adolescen s a e ecommended o p ac ice mode a e o igo ous physical
ac i i y o o e 60 min e e y day [
32
] in o de o ensu e ein o ced wellbeing om an ea ly s age o
li e [
33
,
34
], as his habi can be ex ended o adul hood [
24
]. In spi e o his, he p ac ice o physical
ac i i y emains below he ecommended le els [
35
]. In ligh o his, i becomes necessa y o c ea e an
en i onmen ha p omo es heal hy li es yles, whe e he s uc u e and design o he ci ies allow o he
sus ainable de elopmen [
16
] o hei inhabi an s, as well as o he educa ional ins i u ions and he
local communi ies o make an e o o p omo e he adop ion o habi s ha con ibu e o good physical,
men al and social heal h.
A limi a ion o his piece o esea ch is ha wi h he pu pose o compa ing i s indings agains he
HBSC in e na ional s udy, his s udy used single-i em ins umen s (such as he Can il Scale) in o de
o measu e he le el o pe sonal li e sa is ac ion (PLS), amily li e sa is ac ion (FLS) and sa is ac ion
Sus ainabili y 2020,12, 9486 9 o 13
wi h he ela ionships wi h iends (SF). We belie e o u he esea ch wo k i is impo an o use
ins umen s wi h mo e i ems.
5. Conclusions
This s udy e eals ha LS in he adolescen and PA a e di ec ly connec ed wi h posi i e ela ionships
wi h hei amilies and iends, as well as he physical ac i i y he amily and iends p ac ice. QLAH
can be p edic ed o a g ea ex en om he sa is ac ion o he adolescen (wi h li e, wi h hei amily li e
and wi h hei iendships) and om hei p ac ice o PA (as well as ha o he amily and iends).
The e o e, he s udy e eals he e is an in e ela ionship be ween LS, QLAH and PA, which a e he
h ee dimensions o an in eg al concep o heal h.
Howe e , he esul s o his s udy ha e limi a ions, including he use o a c oss-sec ional design,
as well as he c i ical conside a ions ha hese ypes o s udies ecei e, as hey ollow sel - epo ing
me hods and he e o e do no conside subjec i e ac o s [
84
]. On he o he hand, one s eng h ha
mus be highligh ed is he sample olume and ype, as well as he inclusion o a iables ela ing o
amily and iends.
F om an applied poin o iew, he e idence o an exis ing associa ion amongs LS, QLAH and he
p ac ice o PA o adolescen s’ heal h and hei heal hy habi s implies ha i is impo an o p omo e
posi i e ela ionships in he amily and wi h iends [
58
,
65
,
67
]. I is he e o e essen ial o de elop
s a egies o p omo e heal hy li es yles, in ol ing a ious sec o s, such as he educa ional, social,
amily and he media sec o s. This is a s a egy ha p e en s he issues iden i ied in la e s ages o
de elopmen such as, o example, in uni e si y s uden s, whe e he ime spen using social media has
been ound o ha e, amongs o he e ec s, a educ ion in he p ac ice o physical ac i i y and a poo e
quali y o li e [
75
]. The e o e, he s udy o g oups o popula ions pe o med by li e s ages, in spi e o
being c oss-sec ional, as is he case wi h his s udy, p o ides he possibili y o es ablishing p ospec i e
iews ha can be he g ounds o disease p e en ion and heal h-p omo ion p og ams.
Au ho Con ibu ions:
Concep ualisa ion, R.M.G., A.S.C. and J.E.M.-G.; me hodology J.D.U. and J.E.M.-G.;
o mal analysis, J.D.U.; in es iga ion, R.M.G.; da a cu a ion, J.D.U.; w i ing—o iginal d a p epa a ion, J.D.U.,
R.M.G., A.S.C. and J.E.M.-G.; w i ing— e iew and edi ing, R.M.G. and J.E.M.-G.; isualisa ion, J.D.U. and A.S.C.;
supe ision, J.D.U. and R.M.G.; p ojec adminis a ion, R.M.G.; unding acquisi ion, J.D.U., R.M.G., A.S.C. and
J.E.M.-G. All au ho s ha e ead and ag eed o he published e sion o he manusc ip .
Funding: This esea ch ecei ed no ex e nal unding.
Con lic s o In e es : The au ho s decla e no con lic o in e es .
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