Health Reports
Are adolescents who do physical activity with their parents more active and mentally healthier?

Abstract

Background

Adolescents who engage in physical activity experience positive mental health outcomes. However, the increasing prevalence of physical inactivity combined with high screen time use among adolescents is a growing concern. Parents play an important role in shaping adolescents’ physical activity and screen time levels through active participation and involvement.

Data and methods

This nationally representative cross-sectional study used self-reported data from the 2019 Canadian Health Survey on Children and Youth. The frequency of family physical activity included five categories from “never” to “daily.” Outcome measures included achieving the physical activity (60 minutes or more of moderate-to-vigorous physical activity per day) and recreational screen time (two hours or less per day) recommendations, as well as mental health indicators. Logistic regression analyses examined the associations between family physical activity frequency and adolescents’ physical activity, screen time, and mental health, with adjustments for relevant covariates.  

Results

In adjusted models, across all outcomes, results showed that a higher frequency of family physical activity was associated with better outcomes in a dose–response relationship when compared with never engaging in family physical activity. The strongest associations for daily frequency of family physical activity (compared with never engaging in it) were with high life satisfaction (odd ratio [OR]: 4.25, 95% confidence interval [CI]: 3.16 to 5.72) and with high perceived mental health (OR: 3.60, 95% CI: 2.62 to 4.96). Subgroup analyses stratified by gender were generally consistent with the main results.

Interpretation

A higher frequency of family physical activity was associated with a greater likelihood of adhering to the physical activity and recreational screen time recommendations and better mental health in Canadian adolescents. Family physical activity may be an important way to promote adolescents’ physical activity and positively influence their mental health.

Keywords

family physical activity, adolescents, youth, screen time, anxiety, depression, life satisfaction, stress, public health

Authors

Anaelle Cohen and Mark S. Tremblay are with Carleton University. Mark S. Tremblay is also with the Children’s Hospital of Eastern Ontario Research Institute (CHEO RI) and the University of Ottawa. Justin J. Lang and Stephanie A. Prince are with the Public Health Agency of Canada and the University of Ottawa. Justin J. Lang is also with CHEO RI and the University of South Australia. Rachel C. Colley is with Statistics Canada. Jean-Philippe Chaput is with the University of Ottawa and CHEO RI. 

 

What is already known on this subject?

• Adolescents who engage in 60 minutes or more of moderate-to-vigorous physical activity (MVPA) and limit their recreational screen time to two hours or less per day experience better mental and physical health outcomes.
• However, the increasing prevalence of physical inactivity combined with high screen time use among adolescents is a significant concern, contributing to negative mental health outcomes.
• Parents who serve as role models and offer support contribute to adolescents’ MVPA levels.

What does this study add?

• Adolescents who participate in family physical activity have a higher prevalence of meeting the recommended 60 minutes or more of MVPA per day and two hours or less of recreational screen time per day.
• Adolescents who engage in physical activities with their parents more frequently have higher perceived mental health, lower anxiety and depressive symptoms, higher life satisfaction, and lower life stress.

Introduction

Adolescence is a critical period for the development of physical and mental health.^Note 1 Fostering positive mental health during this period is essential for promoting overall health and well-being, which has positive implications across the lifespan.^Note 1 Approximately 14% of adolescents aged 10 to 19 years worldwide exhibit mental health issues, accounting for 13% of the worldwide burden of disease for this age group.^Note 2 Mental health concerns among adolescents include emotional disorders such as anxiety and symptoms of depression. From 2011 to 2018, the prevalence of diagnosed mood disorders (including depression) among Canadian youth rose from 4.3% to 7.8%, while anxiety disorders increased from 6.0% to 12.9%.^Note 3 These conditions can adversely influence adolescents’ academic performance, lead to social isolation and loneliness, and in severe cases, depression may result in suicide.^Note 2 

Physical activity has been linked to many positive effects on the mental health of adolescents.^Note 4, ^Note 5 For example, adolescents who engage in higher levels of physical activity experience reduced levels of depression.^Note 5 Despite the positive relationship between physical activity and mental health, the prevalence of physical inactivity among adolescents is a concern. The World Health Organization recommends that children and adolescents aged 5 to 17 years engage in at least 60 minutes of moderate-to-vigorous physical activity (MVPA) per day on average.^Note 6 However, research by Guthold et al.^Note 7 revealed that 81% of adolescents worldwide are insufficiently active. In Canada, 35.6% of youth aged 12 to 17 years meet the MVPA recommendation.^Note 8

Alongside low physical activity levels, recreational screen time among adolescents has also been increasing, raising particular public health concerns.^Note 9, ^Note 10 The Canadian 24-hour Movement Guidelines recommend adolescents limit their recreational screen time to a daily maximum of two hours.^Note 11 Meeting this recommendation has also been associated with better mental health in adolescents.^Note 12, ^Note 13 In 2018 to 2019, 30.9% of youth in Canada met the recreational screen time recommendation.8 Research conducted by Maras et al.^Note 14 showed that adolescents participating in screen-based sedentary behaviours, such as playing video games and computer use, are more likely to exhibit symptoms of depression, and higher anxiety symptoms were associated with video gaming.^Note 14 Thus, the high level of physical inactivity coupled with screen-based sedentary behaviours are important contributing factors to consider when evaluating depressive and anxiety symptoms experienced by adolescents.

Families play an important role in influencing their children’s attitudes, beliefs, and behaviours regarding physical activity and sedentary behaviour, and may influence their adolescents’ physical activity patterns^Note 15, ^Note 16, ^Note 17,^Note 18 and sedentary behaviours.^Note 19 In addition to parent–child physical activity co-participation,^Note 15 parents serve as role models, provide motivation, and offer support (e.g., financial, transportation) for healthy behaviours. A systematic review of cross-sectional studies discovered that parental modelling and support contributed to adolescents’ levels of MVPA.^Note 15 Furthermore, a positive association was observed between the reported physical activity of mothers and the physical activity levels of adolescents.^Note 15 Similarly, children and adolescents have been shown to engage in higher levels of screen-based sedentary behaviours when their parents do so as well.^Note 20, ^Note 21

While existing studies have provided evidence of parental influence and modelling on children’s physical activity and screen time,^Note 19, ^Note 21, ^Note 22 research exploring parents’ active involvement in adolescents’ physical activity—specifically when they participate together, rather than just serving as role models or providing support—is limited. Furthermore, studies regarding the association between family physical activity and the mental health of adolescents are lacking. A better understanding of the role of family physical activity during adolescence can help inform the development of interventions aimed at improving adolescents’ physical activity, screen time levels, and mental health. Therefore, this study examined the associations between family physical activity and adolescents’ adherence to the MVPA and recreational screen time recommendations and their mental health using a large and nationally representative sample. It was hypothesized that a higher frequency of family physical activity would be associated with greater adherence to the MVPA and recreational screen time recommendations and better mental health-related outcomes among Canadian adolescents.

Data and methods

Study design and participants

This cross-sectional study was based on data from Statistics Canada’s 2019 Canadian Health Survey on Children and Youth (CHSCY). Data were collected from February 11 to August 2, 2019. Detailed information about the survey methodology is available elsewhere.^Note 23 The target population for the 2019 CHSCY was children and adolescents aged 1 to 17 years residing in the 10 provinces and the three territories of Canada. The Canada Child Benefit was used to create the survey sampling frame. Excluded from the survey’s coverage were children and adolescents living on First Nation reserves and other Indigenous settlements, children and adolescents living in foster homes, and the institutionalized population. Of the children and adolescents aged 1 to 17 years in Canada, approximately 98% in the provinces and 96% in the territories were included in the survey frame. The present study focuses on adolescents aged 12 to 17 years because the question about family physical activity was only asked to this age group. Adolescents completed survey questions directly through an online electronic questionnaire or via telephone interviews for follow-up on non-responses. For the mental health questions, only anxiety and depressive symptoms were assessed by the person most knowledgeable (typically one of the parents); all other questions were self-reported by the adolescents. The response rate was 41.3% for adolescents, yielding a sample of 11,077 participants. For the present analysis, respondents lacking information on family physical activity (n=46), dependent variables (n=2,062), or covariate data (n=756) were excluded, resulting in a final sample size of 8,213 participants. The descriptive characteristics of included and excluded participants are provided in Appendix Table A1. Statistics Canada secured the necessary approvals to conduct the CHSCY. Informed consent was obtained from participants before they joined the study. 

Independent variable: Family physical activity

To assess family physical activity, adolescents were asked the following question: “How often do you do physical activities with your parents like playing sports or going for a walk or a hike?” The response options included “daily,” “weekly,” “monthly,” “a few times a year,” and “never.” All five categories were used for the analysis.

Dependent variables

Sixty minutes or more of moderate-to-vigorous physical activity per day

Adolescents were asked to report the amount of physical activity they engaged in each day over the past seven days where they sweated at least a little or breathed harder. On the days they participated in physical activity, they had to indicate the duration to the nearest 15 minutes, with response options ranging from “no time” to “seven hours or more.” Total MVPA time over the last seven days was determined, and daily average MVPA (minutes per day) was calculated. The prevalence of adolescents who obtained an average 60 minutes or more of MVPA per day was calculated.^Note 6, ^Note 11 

Two hours or less of recreational screen time per day

Participants were asked to report the time they spent in their free time over the past seven days using an electronic device, such as a mobile device, computer, tablet, video game console, or television, while sitting or lying down. Response options included “no time,” “less than 3 hours,” “3 hours to less than 7 hours,” “7 hours to less than 14 hours,” “14 hours to less than 21 hours,” and “21 hours or more.” Although not directly aligned, adherence to the recommendation (two hours or less of recreational screen time per day) was identified as those reporting “7 hours to less than 14 hours” per week or less.^Note 11    

Indicators of mental health

Based on availability in the CHSCY, measures of positive mental health and mental ill-health (reflective of adaptive or maladaptive functioning) were included. These included youth-reported mental health, life satisfaction, and life stress. Parent-reported anxiety and depressive symptoms were also included. Perceived mental health is a valid and widely used indicator in population health surveys and has consistently been associated with multi-item measures of mental health, self-rated health, and health-related problems.^Note 24 Perceived symptoms of anxiety and depression are widely used in national surveys, and the Washington Group / UNICEF Child Functioning Module has been shown to be valid for this population.^Note 25, ^Note 26, ^Note 27 Perceived life satisfaction is routinely used as an indicator of well-being at the individual level, with many studies supporting its validity.^Note 28, ^Note 29, ^Note 30 Finally, perceived life stress is another important factor affecting mental health, and single-item assessments have demonstrated comparability to more extensive questionnaires in capturing perceived general life stress.^Note 31

Perceived mental healthwas assessed using the following question: “In general, how is your mental health?” Response options were “excellent,” “very good,” “good,” “fair,” and “poor.” Responses of “excellent” and “very good” were coded as having high perceived mental health, in accordance with the Positive Mental Health Surveillance Indicator Framework (PMHSIF).^Note 32, ^Note 33

Anxiety and depressive symptomswere assessed by the person most knowledgeable, using questions from the Washington Group / UNICEF Child Functioning Module.^Note 34 Anxiety symptoms were assessed with the question, “How often does this child seem very anxious, nervous or worried?” Depressive symptoms were assessed with the question, “How often does this child seem very sad or depressed?” Response options for both questions included “daily,” “weekly,” “monthly,” “a few times a year,” and “never.” Responses of “a few times a year” and “never” were coded as having low anxiety or depressive symptoms.^Note 34

Life satisfactionwas assessed with the question: “Using a scale of 0 to 10, where 0 means ‘very dissatisfied’ and 10 means ‘very satisfied,’ how do you feel about your life as a whole right now?” Life satisfaction was dichotomized as “very satisfied” (score of 9 or more) and “less than very satisfied” (score of less than 9), based on the PMHSIF.^Note 32

Perceived life stresswas assessed with the question: “Thinking about the amount of stress in your life, how would you describe most of your days?” Response options included “not at all stressful,” “not very stressful,” “a bit stressful,” “quite a bit stressful,” and “extremely stressful.” Responses of “not at all stressful,” “not very stressful,” and “a bit stressful” were coded as having a low level of life stress, in line with a 2017 study.^Note 35

Covariates

Age (years), gender (boy or girl), highest parental education (categorized as less than high school; high school with no postsecondary; and postsecondary certificate, diploma, or university degree), population groups (14 options from a list), sleep duration (hours per night) and body mass index (z-score) were used as covariates in the analyses based on their availability in the dataset and their known associations in the literature with the outcome measures.^Note 1, ^Note 2, ^Note 3

Statistical analysis

Descriptive characteristics of the included sample are presented as mean values or proportions (with 95% confidence intervals [CIs]). Dependent variables were compared across family physical activity groups and by gender using chi-square tests. Logistic regression analyses were conducted to examine associations between the frequency of family physical activity and outcome measures, with adjustment for covariates. Adjusted odds ratios (aORs) and 95% CIs are reported. Statistics Canada-derived sample weights were applied to adjust for the survey’s complex sampling design and potential non-response bias to ensure that the findings remain representative of the Canadian adolescent population. To estimate the 95% CIs, bootstrap weights were utilized. All statistical analyses were conducted using SAS Enterprise Guide 7.1 (SAS Institute, Cary, North Carolina). A p-value of less than 0.05 was used as the threshold for statistical significance.   

Results

Table 1 shows the descriptive characteristics of the sample. The majority of households had at least a postsecondary level of education (86.1%) and participants were generally from a White population group (66.5%). Among respondents, 11.4% met the MVPA recommendation (an average of 60 minutes or more per day) and 56.3% met the recreational screen time recommendation (two hours or less per day). The majority of adolescents reported high perceived mental health (66.6%), low anxiety symptoms (69.3%), low depressive symptoms (84.7%), and low life stress (79.4%). High life satisfaction was reported by just under half (45.4%) of Canadian adolescents. Boys were more likely than girls to engage in an average of 60 minutes or more of MVPA per day (13.1% versus. 9.5%), report high perceived mental health (73.9% versus 59.0%), high life satisfaction (48.4% versus 42.3%), and low anxiety (75.5% versus 62.7%) and depressive symptoms (88.8% versus 80.3%). In contrast, girls were more likely than boys to meet the recreational screen time recommendation (60.3% versus 52.5%).



Table 2 shows the proportion of Canadian adolescents with an average of 60 minutes or more of MVPA per day and an average of two hours or less of recreational screen time per day, high perceived mental health, low anxiety or depressive symptoms, high life satisfaction, and low life stress across the frequencies of family physical activity. In the full sample (boys and girls combined), engaging in daily family physical activity was associated with the highest prevalence of adolescents meeting the MVPA (22.5%) and recreational screen time (72.7%) recommendations. It was also associated with the highest prevalence of high perceived mental health (81.0%), low anxiety symptoms (73.2%), low depressive symptoms (88.9%), high life satisfaction (67.3%), and low life stress (85.8%). Significant differences were noted between boys and girls for all outcome measures.



Table 3 shows results of the logistic regression analyses for the associations between family physical activity frequency and the outcomes in the full sample (boys and girls combined). In the adjusted models, results showed that engaging in daily family physical activity was most strongly associated with desirable physical activity, recreational screen time, and mental health outcomes among Canadian adolescents. For example, the strongest associations for daily frequency of family physical activity (compared with never engaging in it) were with high life satisfaction (aOR: 4.25, 95% CI: 3.16 to 5.72) and with high perceived mental health (aOR: 3.60, 95% CI: 2.62 to 4.96). Associations tended to show a dose–response relationship, whereby a daily frequency of family physical activity was the category most strongly associated with better outcome measures. Subgroup analyses stratified by gender were generally consistent with the main results (see Appendix tables A2 and A3). A key difference between boys and girls was observed in anxiety and depressive symptoms. More frequent family physical activity was linked to lower levels of anxiety and depressive symptoms in girls, while this association was not found in boys. Additionally, the study found that a higher proportion of boys met the MVPA recommendation when participating in family physical activity; however, this association was not observed in girls. Also, further adjustment for meeting physical activity and recreational screen time recommendations in the mental health models slightly attenuated the estimates, but the results were consistent with the main analyses (see Appendix Table A4).



Discussion

This study investigated the association between the frequency of engaging in physical activities as a family and Canadian adolescents’ adherence to the physical activity (60 minutes or more of MVPA per day on average) and screen time (two hours or less per day) recommendations and their mental health. Despite an extensive review of the existing literature on the association between parental modelling and support and adolescents’ physical activity levels,^Note 15, ^Note 16, ^Note 17, ^Note 36 there is a clear gap in examining the association between family physical activity participation and adolescents’ physical activity levels, screen time levels, and mental health. The findings revealed that more frequent family participation in physical activity was associated with a higher prevalence of adolescents engaging in 60 minutes or more of MVPA per day and two hours or less of recreational screen time per day. Adolescents who engaged in more family physical activity also showed a higher prevalence of high perceived mental health and life satisfaction, and lower symptoms of anxiety, depression, and life stress. A dose–response relationship was observed between family physical activity frequency and the outcomes, with more favourable outcomes associated with a higher frequency.

The association between family physical activity and higher prevalence of adolescents meeting the recommended MVPA levels aligns with previous research that demonstrates a positive association between parents’ involvement in physical activities and children and adolescent MVPA levels.^Note 37 This association may be observed because participating in physical activities with parents enhances self-efficacy in overcoming challenges and results in more enjoyment for the parents and the adolescents.^Note 37 By actively participating in physical activities with their children, parents help motivate their children to engage in physical activities and provide a direct form of parental modelling.^Note 38 A higher frequency of family physical activity may also reduce recreational screen time in adolescents by providing structured, engaging alternatives to sedentary activities like watching TV or playing video games. Families that prioritize and engage in physical activities together foster a more active lifestyle and reduce the time available for screens.^Note 41 This positive influence can also shape healthier habits and routines that discourage excessive screen use. Additionally, parental engagement may positively affect adolescents’ mental health by strengthening the parent–adolescent relationship.

The present study’s findings are consistent with other research examining the association between parental modelling and support and children’s physical activity levels.^Note 39 Fuemmeler et al.^Note 40 found an association between parents’ and children’s MVPA levels: children with active parents demonstrated higher MVPA levels than those with less active parents. Systematic reviews provide further evidence that parental support, including encouragement, participation in activities, and providing transportation, is positively associated with higher levels of adolescent physical activity.^Note 41 Moreover, Canadian research using the 2007 to 2013 Canadian Health Measures Survey (CHMS) found that for every additional 20 minutes of physical activity by a parent, an additional 5 minutes of physical activity was observed in their child.^Note 21 Additional research using the CHMS also found an association between parents’ physical fitness and the level of physical activity and fitness of their children.^Note 42 

The results of the study also show a higher proportion of boys meeting the MVPA recommendation when engaging in family physical activity, compared with girls. Adolescent girls may exhibit lower levels of physical activity compared with boys because of gender norms that may affect their participation in physical activity.^Note 43 Boys and girls also may spend their time differently. While girls may allocate more time to socializing, boys may tend to spend their time participating in various sports.^Note 43 In addition to differences in preferences, research has suggested that parental support may affect boys and girls differently. For example, Telford et al.^Note 44 found that boys were more active than girls when they received greater parental support. Family physical activity may be associated with higher activity levels in boys than girls because of traditional gender norms and socialization, which often encourage boys to engage in sports and physical play more than girls, who may face different societal expectations or opportunities. In contrast, findings from Laird et al.^Note 45 show that support and encouragement from families serve as factors in motivating girls to engage in physical activities. As well, parental modelling, through active participation and demonstrating positive attitudes toward physical activity, plays an important role in encouraging girls to participate in physical activity by shaping their behaviour and attitudes.^Note 45

The Consensus Statement on the Role of the Family in the Physical Activity, Sedentary, and Sleep Behaviours of Children and Youth includes a conceptual model that helps explain the observed association between family physical activity and adolescents’ MVPA and screen-time levels.^Note 41 The conceptual model demonstrates that youth’s physical activity and sedentary screen time behaviours are interconnected with and influenced by family dynamics. Various factors, such as parental practices (e.g., support, modelling, and active engagement), beliefs, and styles, have a direct influence on youth’s adoption of healthy behaviours.^Note 41 These factors are shaped by family members (including parents and siblings), family structures (e.g., one-parent-family households, couple family households), and family functioning (e.g., cohesion and warmth).^Note 41 External factors that influence the family dynamic and youth’s healthy behaviours include elements of the community environment (e.g., the availability of green spaces), social influences (e.g., interactions with peers), and media and policies (e.g., child-directed advertising).^Note 41

In the present study, findings also indicated an association between a higher frequency of family physical activity and lower anxiety and depression symptoms in adolescents. This also aligns with previous studies that found that physically active adolescents report fewer depression and anxiety symptoms^Note 46, ^Note 47 and better overall well-being.^Note 47 Stratified analyses showed that the findings were especially true for girls, but not for boys. Higher levels of family physical activity may be more associated with lower anxiety and depressive symptoms in adolescent girls because girls often place greater importance on social bonding and emotional support, which can be strengthened through family activities. Additionally, physical activity may help girls regulate stress and mood more effectively, given gender differences in emotional processing and coping strategies.

Parental engagement in adolescents’ physical activity plays a significant role in supporting their mental health. Parents who actively participate or encourage physical activity can foster stronger emotional bonds and provide adolescents with a sense of support and security.^Note 41 This involvement can reduce feelings of isolation, boost self-esteem, and create a positive environment for emotional regulation.^Note 41 Moreover, shared physical activities may enhance communication between parents and adolescents, further strengthening the relationship and improving mental well-being.^Note 41 Through these mechanisms, parental engagement can help protect adolescents from anxiety, depression, and other mental health challenges. Future studies should also examine gender differences in parental engagement in physical activity and whether it affects mental health outcomes differently.

Strengths and limitations

The strengths of this study include the use of a large, nationally representative sample and the inclusion of psychometrically valid mental health questions. To the authors’ knowledge, this is the first study to directly examine the association between family physical activity and adolescents’ levels of physical activity and screen time. Previous research did not directly explore whether parents and adolescents participated in physical activity together; instead, it made assumptions about their joint participation. However, given the cross-sectional nature of the study design, causal and directional inferences cannot be made. Parents with good mental health are more likely to be physically active and encourage their adolescents to engage in physical activity. Because parental mental health is also linked to children’s mental health, this study is potentially limited by not controlling for that potential confounding factor. MVPA was collected through self-report, which may have been influenced by recall and social desirability biases. Anxiety and depressive symptoms were assessed by the person most knowledgeable, and sometimes there is a discrepancy between parent and adolescent responses. Also, 18.6% of adolescents in the sample were excluded because of missing data for the outcome measures. However, the effect on the generalizability of the results is likely minimal given the similarities between included and excluded participants across the study variables (Appendix Table A1). Specific family characteristics and the types of physical activities adolescents and families engaged in also remain unknown. Future studies should incorporate a more comprehensive assessment that considers family income and wealth and family structure (e.g., presence of siblings, one-parent family versus couple family, presence of grandparents); the types (e.g., structured versus unstructured), duration, and context of physical activities; and device-measured MVPA. Furthermore, future studies should consider other types of parental support (e.g., role modelling, verbal support) in the statistical models, as they are likely to be correlated with parental co-participation in physical activity. Finally, in addition to family physical activity, future studies should examine family screen time and whether it affects outcome measures.

Conclusion

Findings from this study suggest a significant positive association between a higher frequency of adolescent physical activity with their parents and higher physical activity levels, lower recreational screen time, and improved mental health outcomes. A dose–response relationship was observed, whereby higher frequency of family physical activity was associated with more favourable mental health outcomes. These findings provide support for the importance of promoting family physical activity during adolescence. Future research should explore longitudinal associations with device-based measures and employ intervention designs, such as family-based programs, to demonstrate cause-and-effect associations between family physical activity and adolescent mental health.