THE VAILDITY OF PROXY REPORT ON KINERGARTEN CHILDREN S PHYSICAL ACTIVITY IN HONG KONG AU YUNG CHING

1 THE VAILDITY OF PROXY REPORT ON KINERGARTEN CHILDREN S PHYSICAL ACTIVITY IN HONG KONG BY AU YUNG CHING 07005725 AN HONOURS PROJECT SUBMITTED IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF BACHELOR OF ARTS IN PHYSCIAL EDUCATION AND RECREATION MANAGEMENT (HONOURS) HONG KONG BAPTIST UNIVERSITY APRIL 2009

2 ACKNOWLEDGEMENTS I would like to express my greatest gratitude to my chief advisor and second advisor, Prof. Chow Bik Chu and Prof. Lena Fung for her professional and detailed advices on this study. Her kind guidance is valuable for me. In addition, I would also like to express my gratefulness to TWGHs Tin Wan Kindergarten, for helping me to encourage their children and their parents to be a subject and thanks for their arrangement of the tests. By the way, thank you for the subjects participation in this study. Lastly, I would like to express my appreciation to my colleagues Mr. Tang Wai Leung and Mr. Yip Chun Hing for their sincerely help and support during the project period. Au Yung Ching Department of Physical Education Hong Kong Baptist University Date: 24th April, 2009

3 ABSTRACT The objective of this paper is to assess the validity and the reliability of the Habitual Activity Estimation Scale (HAES) proxy-report on the physical activity levels of kindergarten children (grade of K3). A total of 24 children were randomly selected from the grade of K3 in a TWGHs Tin Wan kindergarten. Children s physical activity levels and patterns were assessed in one typical weekday and one typical weekend by using the HAES. Since it is difficult for children to recall the intensity and duration of physical activity by their cognitive limitation (Sirard and Pate, 2001), the HAES were completed by their parents. Daily steps walked by children on the typical weekday and weekend were recorded by the pedometer model of SW-700 and it was used to be an evaluation tool for assessing the validity of HAES proxy report. Independent-samples T-test, Paired-samples T-test, Spearman r and Pearson product-moment Test were used to analyze the data. The result indicated that there was no significant correlation between the HAES proxy report and the daily step counts of children on both weekday and weekend. The result also found that the step counts of children between weekday and weekend were not significantly difference. And boys and girls showed similar physical activity patterns on both weekday and weekend in this study. To conclude, the validity of HAES proxy report was low in this test.

4 TABLE OF CONTENTS CHAPTER Page 1. INTRODUCTION............ 6 Statement of the Problem..... 7 Hypotheses............ 8 Definition of Terms....... 9 Delimitations.......... 10 Limitations........... 11 Significant of the Study..... 12 2. REVIEW OF LITERATURE......... 15 The relationship between physical activity and chronic disease of children in Hong Kong...... 15 The physical activity patterns in preschoolers......... 17 Different measurement on children s physical activity... 19 Summary.............. 22 3. METHOD................ 24

5 Collection of Data........ 24 Data Analysis........... 25 4. ANALYSIS OF DATA.......... 28 Background Information....... 28 Results............ 32 Discussion.......... 38 5. SUMMARY AND CONCLUSIONS........ 47 Summary of Results........ 47 Conclusions............ 48 Recommendations for Further Studies. 50 REFERENCES............. 54 APPENDIX............. 57 A. Physical Activity Patterns Record of Children B. Sample of Habitual Activity Estimation Scale (HAES) Proxy Report C. Electronic Pedometers Model SW-700

6 Chapter 1 INTRODUCTION Chronic disease risk factors, including a sedentary lifestyle, may be present even in young children (Stirard & Pate, 2001). The researchers have indicated that there was an inverse relationship between physical activity and risk for developing several chronic diseases such as obesity, coronary heart disease (CHD), diabetes and colon cancer (Stirard & Pate, 2001). Early prevention programmes may be critical to reducing the rates of chronic disease (Stirard & Pate, 2001). Hay and Cairney (2006) pointed out that an understanding of the habitual physical activity levels of children with chronic disorders is an important consideration relevant to both treatment and clinical monitoring. Therefore, accurate assessment of physical activity in children is necessary to identify current levels of activity and to assess the effectiveness of intervention programmes designed to increase physical activity (Sirard & Pate, 2001). According to Hay and Cairney (2006), Habitual Activity Estimation Scale (HAES) is allows for an estimation of the duration and intensity of daily activity of children post infancy through adolescence. Thus, it is a feasible and useful tool for measuring the physical activity of children with chronic illness in clinical research (Hay and Cairney, 2006).

7 Physical activity has traditionally been measured with surveys and recall instruments, HAES has no exception. However, according to Sirard and Pate (2001), recall errors may be caused by children s cognitive limitation since it is difficult for children to recall the intensity and duration of physical activity. Therefore, 2-days proxy-reports (HAES were completed by proxy for preadolescent) would be one of the measurements to evaluate the current level of children s physical activity. Parents or teachers only need to recall the duration and intensity of children s physical activity within 2-days (Sirard & Pate, 2001). However, measurement techniques used for research and programme evaluation purpose must be valid, reliable, practical and nonreactive (Sirard & Pate, 2001). In order to assess the validity of 2-days proxy-report, pedometer data would be used to as a comparison on the activity between proxy-report and daily steps. Statement of problem The purpose of this study was to assess the validity of 2 days proxy-report of kindergarten children through comparing with the pedometer data.

8 Hypotheses The hypotheses of this study were as follow: 1. (a) There would be significant relationship between the child s overall activity level reported by parents and levels of physical fitness of the children on one typical weekday (b) There would be significant relationship between the child s overall activity level reported by parents and levels of physical fitness of the children on one typical weekend. 2. (a) There would be significant relationship between active relative hours of children which was estimated by their parents and the mean step count of the children on one typical weekday. (b) There would be significant relationship between active relative hours of children which was estimated by their parents and the mean step count of the children on one typical weekend. 3. (a) There would be significant relationship between the active activity time and the step count of children in weekday.

9 (b) There would be significant relationship between the active activity time and the step count of children in weekend. 4. (a) There would be no mean difference between the total steps walked by children between weekday and weekend. (b) There would be no mean difference between the total steps walked by boys between weekday and weekend. (c) There would be no mean difference between the total steps walked by girls between weekday and weekend. 5. (a) There would be no mean difference between boys and girls step counts in weekday. (b) There would be no mean difference between boys and girls step counts in weekend. Definition of terms The following terms were defined as: Physical activity It refers to the movement of human body that results in energy expenditure at different levels above the resting metabolic rate

10 (Anshel et al., 1991). Proxy-report It refers to the report that completed by children s parents or teachers used to assess activity of children too young to report their own behavior (Sallis, 1991). Pedometer Pedometers are matchbook-sized, battery-operated movement monitors that are attached to the waistband in the midline of the thigh on either side of the body and designed to measure the number of steps that a person takes during ambulatory activity such as walking or running (Berlin, Storti & Brach, 2006). Physical activity level In this study, the activity levels of children were measured by the proxy report of children s activity and pedometers readings. Delimitations The study would be implemented based on the following delimitations: 1. 24 children were randomly selected from the grade of K3

11 in TWGHs Tin Wan kindergarten. 2. Both 12 boys and 12 girls were selected. 3. Each child was required to wear a pedometer on his/her right waist during waking hours except bathing, swimming and sleeping consecutively for four days. Limitations There were many factors that could affect children s physical activity a day. So, the following limitations were considered when interpreting the results: 1. Since it is hard to collect data from all the kindergarten children in Hong Kong, so the proxy report result can only reflect the physical activity situation of specific kindergarten children. And it is possible that the study sample was not perfectly representative of the population of children who attended the grade K3 in Hong Kong. 2. The electronic pedometers model SW-700 could only measure steps by the displacement of vertical movement produced. Running and walking movements could not be distinguished. 3. Pedometer measurement might not be accurate due to possible

12 intentional shaking of the instrument done by subjects. 4. It was assumed that the teachers behaviors were the same as in different K3 classes in the kindergarten without the presence of observer. 5. Lesson topics of each class were not the same, so the teaching strategies may vary, which may affect the children s activity levels. 6. Weather conditions were not controllable to facilitating favorable constant environments for all children to do any physical activity. 7. Children s disciplines, which might indirectly affect their time to play, were not controllable. 8. Intensity of physical activity cannot be measured due to the limited function of pedometer. 9. Pedometer may become a motivation tool for children that may alter them to be active habitual physical activity pattern and level.

13 Significant of the study The main purpose of this study was to assess the validity and reliability of the 2 days proxy report of the kindergarten children. To understand why some children are more active than others and how to encourage them to be more active, there is a need to measure physical activity accurately and reliably. Valid methods of estimating physical activity in children are critical for understanding the dose-response relationship between physical and chronic diseases and associated risk factors. The 2 days proxy report can provide accurate knowledge of physical activity levels that allows researchers to develop physical activity intervention programmes and to assess their effectiveness (Sirard & Pate, 2001). Also, the measuring scale can be easily completed within 10 minutes which require only basic cognitive skills and the report can be easily recognized in terms of segments of time and distinct activity categories. Researchers propose the scale to be a clinically useful activity measurement tool (Hay & Cairney, 2006). In Hong Kong, children s living style are trained up by their parents; therefore, if parents do not know what the physical activity levels of their children are, it may lead to the children adopting an inactive living style. If the validity of the two days proxy report of the kindergarten children is high, parents

14 can know the physical activity status of their children more clearly, so that parents can change the habitual inactive living style of their children if they know their children are lack of physical activity by completing this proxy-report. Beside, this report can improve the relationship between children and parents. Since parents will recall their children s physical activity status on one typical weekday and one typical weekend, they need to observe their children at least two whole days, so it may make a chance that let parents know more about their children through observation. On the other hand, if the HAES proxy report was found that not reliable to use for clinical research, this study will investigate the problem and give explanation, so that to provide suggestions for further improvements of this study.

15 Chapter 2 REVIEW OF LITERATURE In this chapter, literature is reviewed for giving out a clearer picture of the relationship between two days parental proxy-report and pedometer. There are three sections in this chapter: (a) the relationship between physical activity and chronic disease of children in Hong Kong; (b) the physical activity patterns in preschoolers (c) different measurement on children s physical activity and (d) summary. The Relationship between Physical Activity and Chronic Disease of Children in Hong Kong Importance of Being Active at Preschool Stage This review was about the importance being active at preschool stage and the children s level of physical activity in Hong Kong. According to the study of Oliver, Schofield and Kolt (2007), regular participation in physical activity was the condition of being health of school-ages children. Obesity and inactivity may appear from childhood to adolescence and adulthood. Similarly, physical activity is a well documented and recognized component of a healthy lifestyle, and childhood experiences with physical activity have an important impact on lifelong behavior (Hands, Parkers & Larkin, 2006). Therefore,

16 there were many researches that focused on the importance of physical activity in preschool years (<5 years). Also, increased physical activity in preschoolers is associated with a reduced risk of being overweight or obese and reduced risk of having one or more risk factor for cardiovascular disease; also, increased physical activity can improve bone health and fundamental motor skill development (Oliver, Schofield & Kolt, 2007). Hong Kong Situation There was a study about Hong Kong children s physical activity situation. According to the study of Louie and Chan (2003), there was one in every five school children at age eleven being obese in Hong Kong. The writer indicated that the problem of obesity prevails in the Hong Kong context. Also, the number of obese children of age six to eighteen is estimated to be 140,000 and tends to increase with age (Louie & Chan, 2003). In addition, no study has yet looked into obesity in preschools, or was measured the physical activity level of preschool children, which is a factor that contributes to children s health and physical development. Why are Hong Kong children physically inactive? Louie and Chan (2003) suggested the following reasons explaining Hong Kong children being physically inactive is less time spent at outdoor,

17 little play space of children and over-concerned with children by teachers restraining their running speed and modes of play to avoid injuries. Therefore, help children being physically active, measuring their physical activity levels were very important to help children develop an active life style in Hong Kong. The physical activity patterns in preschoolers Many researches had investigated the physical activity patterns of preschoolers. The first characteristic was the gender difference of physical activity level. A study showed that young boys are more active than young girls (Oliver, Schofield1 and Kolt, 2007), and Louie and Chan (2003) also pointed out that boys were more physically active than girls both by the pedometer counts (F = 22.38, p < 0.01) and by CARS scores. The secondary characteristic was children were more active in weekends than weekdays. According to Hay and Cairney (2006), it showed that girls and boys had significantly more hours of activity in weekends than on weekdays due to the constraints of school. In addition, Hay and Cairney (2006) also indicated that children s activity patterns on Saturday and Sunday were significantly different from their patterns on weekday, the result showed that children were more active in weekends than weekdays since school days hold fewer

18 opportunities for activity because children are seated for a large portion of the day. And Chu (2007) found that weekday physical activity pattern characteristics was related to cardio respiratory fitness and dynamic exercise responses, whilst biomechanical efficiency was weakly related physical activity bouts. The third characteristic was the level of children s physical activity. A research showed that preschool-aged children participate in very little vigorous physical activity and exhibit high levels of sedentary behavior. And when children are active, movement is characterized by short bursts of activity, and velocity and movement types can vary considerably (Oliver, Schofield1 and Kolt, 2007). Unfortunately, the amount of sedentary behavior may be more important to assess than physical activity levels when investigating relationships between physical activity and health in preschool-aged children. For example, more than 2 3 hours daily of inactivity has been associated with increased overweight and obesity in cross-sectional and longitudinal studies of preschool-aged children (Oliver, Schofield1 and Kolt, 2007). Moreover, Chu (2007) find out that the majority of an average day for a Hong Kong Chinese child is spent sedentary, and the activity they engage in is of short duration and largely low-to-moderate intensity, also, occasional spurts of high intensity are experienced. The variation of these short-duration bouts

19 appeared to be important for fatness, cardiovascular and metabolic health. (Chu, 2007). Therefore, the physical activity patterns of children is one of the main factor to let children had a health life, so the validity of the measurement on children s physical activity levels were very important. Different Measurement on Children s Physical Activity There were many methods of measuring physical activity. Three types of physical activity measurement in children and adolescents were classified by Sirard and Pate (2001), which were primary measures, secondary measures and subjective measures. They pointed out that primary measure was a primary standard including direct observation, doubly labeled water (DLW) and indirect calorimetry for assessing the physical activity in children and adolescents. Secondary measures were considered the objective techniques, such as heart rate monitors, pedometers and accelerometers for the measurement of physical activity. Subjective measures were estimating physical activity levels in children by relying on responses from child, which included self-report questionnaires, proxy-report and diaries. A study indicated that where studies have used objective and subjective measures of physical activity, only the objective measurements have been reported, as this is likely to yield the most accurate information on physical activity (Oliver,

20 Schofield1 and Kolt, 2007). In the study, the writers explained that it is because objective measures can mitigate any potential inaccuracies resulting from self- or proxy-report bias and/ or bias resulting from researcher coding of physical activity (Oliver, Schofield1 and Kolt, 2007). Proxy-report Although there were many methods to measure physical activity, some researches pointed out that proxy report was the most suitable subjective measure to estimate the physical activity levels in children. According to Sallis (1991), age appears strongly related to the quality of physical activity recall data and children younger than age 10 cannot be expected to provide useful information on either recalls or diaries. Therefore, children younger than about age 10 were recommended to use direct observation, activity monitors, or other objective measures to estimate the physical activity levels. Also, Jozefiak, Larsson, Lars, Fritz Mattejat and Ravens-Sieberer (2008) concluded that the parents of school-children aged 8 16 years who evaluated the Quality of Life of their children significantly more positively than did the children themselves and no significant impact of parent and child gender in regard to agreement in ratings of child Quality of Life was found. Similarly, Varni, Limbers and Burwinkle (2007) indicated that

21 reliable and valid parent proxy-report instruments are essential primary outcome measures when children are unable to provide self-report when the child is too young, too cognitively impaired, too ill or fatigued to complete a Health-related quality of life (HRQOL) instrument, and parent proxy-report may be needed in such cases. In the study, they also proved the feasibility, reliability, and validity of parent proxy-report at the individual age subgroup for ages 2 16 years. Furthermore, according to Hay and Cairney (2006), the study examined the reliability of the scale with 2 day period, and the results led to the recommendation that the HAES be provided to measure 2 days, one a weekday, the other a weekend day. Also, john and Cairney (2006) concluded that the advantage of HAES completed by parents is it directly measures inactivity, which provides greater confidence in the descriptions of the habitual activity patterns of the children. Therefore, proxy-report with 2 day period was valid and feasible measure when estimating the physical activity levels of children. However, some studies have shown that proxy-report questionnaires are unlikely to be useful for determining actual physical activity levels of young children, and instead may be useful for identifying potential correlates of activity. It was because establishing validity is challenging due to the absence of a precise physical activity measure, or criterion, for young children (Oliver, Schofield,

22 & Kolt, 2007). Pedometry Pedometry is one of the methods that can measure all type of walking or running movement by using a pedometer which is attached to the waistband in the midline of the thigh on either side of the body. According to the study of Louie and Chan (2003), pedometers are a useful and user-friendly tool to evaluate preschool children s physical activity and the simple step count device can provide reliable data on the Hong Kong preschoolers physical activity levels. Besides, Hands, Parker and Larkin (2006) provided evidence that the pedometer is a better measure of physical activity in young children when engaged in a variety of free play activities as compared to the accelerometer. That meant pedometry is a valid and reliable method to measure the physical activity levels of children. Summary It is important to help children to establish an active physical activity lifestyle, so that the risk of developing several chronic diseases such as obesity, coronary heart disease (CHD), and diabetes and colon cancer can be reduced (Stirard & Pate, 2001). Therefore, the methods of measuring children s physical activity levels need to be valid and reliable. Many

23 researches have been recommended that both proxy-report and pedometry had high validity and reliability in estimating or measuring the children s physical activity levels. However, some studies showed that proxy-report questionnaires are unlikely to be useful for determining actual physical activity levels of young children (Oliver, Schofield, & Kolt, 2007). Studies also suggested that a combination of objective monitoring and direct observation may provide the best standard for the assessment of physical activity measurement tools (Oliver, Schofield, & Kolt, 2007). Thus, the aim of this study was to assess the correlation between proxy-report and pedometer data (step count per minute) of measuring children s physical activity levels in Hong Kong, so that the validity of proxy-report can be determined when it is need to estimate the physical activity levels of children. In addition, since the characteristics of children s physical activity is important information that explains their physical activity level, so the physical activity patterns of children would also be investigated in this study.

24 Chapter 3 METHODS Classes of K3 were randomly selected from TWGHs Tin Wan Kindergarten. Twenty four subjects were randomly selected in each class with twelve boys and twelve girls. Each subject was required to wear a pedometer on his/her right waist during waking hours except bathing, swimming and sleeping from Thursday to Sunday consecutively for four days in a typical week. Collection of data Proxy-report and electronic pedometers were used for the data collection in this study. All subjects parents completed the HAES in a week before collection of children s pedometry data. Parents were asked to choose a typical weekday and weekend to recall their children s physical activity levels and provide accurate time from waking up in the morning to before sleeping at night. In the HAES proxy-report, it divided the day into four time periods demarcated by wake-up, mealtimes (breakfast, lunch, supper) and bedtime (Hay & Cairney, 2006). In each time period, parents need to estimate and classify the percentage of children s physical activity levels into four different level, which were inactive (e.g. lying down), somewhat inactive (e.g. sitting), somewhat active (e.g. walking) and very active (e.g. running). Also, parents need to choose one physical activity

25 level from six different activity level which can perfectly describe their children s overall activity level in one typical weekday and weekend, which were very inactive, inactive, somewhat inactive, somewhat active, active and very active. Then, parents need to determine if there is any difference of the children s physical activity levels and life patterns in this typical weekday and weekend in the last six months. Finally, parents need to provide their working status, the daily average time contact with their children and the understanding levels of children s activity daily with their own perception. Pedometers SW-700 (Yamax, Jayan) were attached to the children s right waist and clipped firmly to the pants. They were requested to carry the pedometers during the whole day expect bathing and sleeping from Thursday to Sunday in a typical week. The readings of pedometers were recorded every night by parents just before children going to bed. Data Analysis The statistical data were analyzed by the Statistical Package for Social Science Version 11.0 (SPSS 11.0). All the descriptive data of mean, standard deviation and frequencies were computed.

26 The relationship between the child s overall activity level reported by parents and the actual levels of physical fitness of children on one typical weekday and weekend would be evaluated by the Spearman s correlation (r) test. All children s physical activity scores of HAES proxy-report would be calculated in terms of total mean scores, i.e. scaled from one to six, indicating their current activity as score 1 identified they were very inactive such as sleeping, score 2 identified they were inactive such as lying down or taking a nap, score 3 identified they were somewhat inactive such as sitting down, watching television or reading, score 4 identified they were somewhat active such as walking, shopping or doing simple housework, score 5 identified they were active such as walking with a fast speed, score 6 identified they were very active such as running, riding bicycle, swimming, or performing activity that required a lots of motion and sweating. Also, for the children s activity relative hours, two inactive categories and two active categories of parents estimation on children s physical activity levels in each different period were combined for analyses (Hay and Cairney, 2006). Then, the data would be converted into inactive (sedentary physical activity) relative hours and active (moderate to vigorous physical activity) relative hours of children s activity hours in both weekday and weekend. Therefore, the

27 correlation between the active relative hours of children which was estimated by their parents and the mean step count of the children on one typical weekday and weekend was evaluated by Pearson product-moment correlation (r). In addition, the relationship between the active activity (MVPA) time and total step walked by children in weekday and weekend would be computed by the Pearson product-moment correlation (r). Paired Sample t-test would be used to analyze the mean differences of all children s step count between weekday and weekend. The mean differences of boys and girls step count between weekday and weekend would also be analyzed by the Paired Sample t-test. Finally, the mean differences between boys and girls step count in weekday and weekend would be analyzed by the independent t-test.

28 CHAPTER 4 ANALYSIS OF DATA This chapter aimed to analyze the data collected to further investigate the relationship between children s physical activity level (step counts per minute) and the Habitual Activity Estimation Scale (HAES) proxy report. Also, children s daily physical activity patterns were taken into account for determining the correlation of proxy- report and the result of pedometer in assessing the preschoolers amount of daily physical activity. Background Information Sample Size There were totally 12 boys and 12 girls selected from four classes of the TWGHs Tin Wan Kindergarten. There were 9 boys and 5 girls from the morning classes, 2 boys and 2 girls from the afternoon classes and 1 boy and 5 girls from the whole day classes. Average Percentage Time of Parents Rating on Child s Overall Activity Level on One Typical Weekday and Weekend In this study, most parents think their children s overall level of activity were active (41.7%), some parents thinks that their children were somewhat active and somewhat inactive

29 (29.15%) on the typical weekday. Furthermore, most parents most parents think their children s overall level of activity were active (62.5%) and somewhat active (29.2%) on the typical weekend. Parent s Estimation on Their Children s Activity Level in Different Period of Time on One Typical Weekday and Weekend From the result, it was found that parents estimate their children spent most of their time on somewhat inactive activities after getting out of bed until starting breakfast (47.08%), after finishing breakfast until lunch (41.46%) and after finishing supper until bedtime (50.83%) and also very active activities after finishing lunch until starting supper (28.33%) on the typical weekday. (Refer to Figure 1) Also, parents estimate their children spent most of their time on somewhat inactive activities after getting out of bed until starting breakfast (49.08%), and after finishing supper until bedtime (44.38%), somewhat active activities after finishing breakfast until lunch (42.29%) and also very active activities after finishing lunch until starting supper (35.42%)on the typical weekend. (Refer to Figure 2)

30 Figure 1. Histogram of the percentage time of average parents rating their children s overall level of activity in one typical weekday Parent's estimation of their children's activity level in different period of time on one typical weekday % 60 50 40 30 20 10 0 bed to breakfast after breakfast until lunch after lunch until starting supper after supper until bedtime Time Inactve Somewhat inactive Somewhat active Very active Figure 2. The percentage time of average parents estimation on children spent in different level of activities in different period of time in one typical weekend. Parent's estimation of their children's activity level in different period of time on one typical weekend % 50 45 40 35 30 25 20 15 10 5 0 bed to breakfast after breakfast until lunch after lunch until starting supper after supper until bedtime Time Inactve Somewhat inactive Somewhat active Very active

31 Means Step Count of Children on the Typical Weekday and Weekend The means step count of children on weekday and weekend were shown in Table 1. It was found that the children s mean step count in weekend is more than weekday. Also, the mean step count of boys were more than girls in weekend but lesser than girls in weekday. Table 1. Means step count of children (per day and per minute) on weekday and weekend. (n = 24 children, 12 boys and 12 girls) Weekday Weekend n Mean Step count per day Mean Step count per min Mean Step count per day Mean Step count per min All 24 6973 9.22 8341 11.29 children Boys 12 6779 8.9 9791 12.9 Girls 12 7167 9.53 6890 9.64 Means of Children s Passive (Sedentary) and Active (Moderate to Vigorous) Activity Time on the Typical Weekday and Weekend The means of children s passive and active activity time on weekday and weekend were shown in Table 2. It was found that the means of children s passive and active activity time in weekend is more than weekday. Also, the mean of boys passive and active activity time were more than girls in both weekday and weekend.

32 Table 2. Means of children s passive and active activity time (in minutes) in weekday and weekend. (n= 24 children and 12 boys and 12 girls) Weekday Weekend n Mean of passive activity time (mins) Mean of active activity time (mins) Mean of passive activity time (mins) Mean of active activity time (mins) All 24 349.38 171.25 370 355 children Boys 12 427.5 235 488.75 381.25 Girls 12 271.25 107.5 251.25 328.75 Parents Working Status There were 9 out of 24 parents were fulltime worker and 1 was part time worker. 11 parents were householders and 3 parents were temporary waiting for work. The Understanding Levels of Daily Children s Activity Status with Parents Own Perception 13 out of 24 parents claimed that they were very clear with their children s daily activity status, 10 parents were considerably clear and 1 parent were not clear. Parents Description on the Difference of Children s Physical Activity Levels between the Typical Weekday and Weekend in Last Six Months 15 out of 24 parents reported that the typical weekday were very much like most weekdays in the last six months. Also, 15 out of 24 parents reported that the typical weekend were very

33 much like most weekends in the last six months Hypothesis 1 In order to check the relationship between the child s overall activity level reported by parents and the actual levels of physical fitness of children on one typical weekday and weekend, Spearman s (r) was used to investigate if there will be any correlation between the child s overall activity level reported by parents and the daily total steps of children on one typical weekday and weekend. Results were shown in Table 3 & 4. It was found that there was no significant correlation between these two factors on one typical weekday(r = -0.107, p > 0.05) and weekend (r = 0.003, p > 0.05). That meant child s overall activity level reported by parents in HAES and daily steps walked by children were not correlated on both weekday and weekend. Table. 3 Spearman r analysis of the child s overall activity level reported by parents and the daily total steps of children on one typical weekday (n=24) Mean step count of children (per day) Overall activity level reported by parents (1-6) (1=very inactive, 6 = very active) r p -0.127 0.553 Table. 4 Spearman r analysis of the child s overall activity level reported by parents and the daily total steps of children on one typical weekend (n=24) Mean step count of children (per day) Overall activity level reported by parents (1-6) (1=very inactive, 6 = very active) r p -0.003 0.989

34 Hypothesis 2 The relationship between the active (moderate to vigorous physical activity) relative hours of children estimated by their parents and the mean of daily step counts (per minute) of the children on one typical weekday and weekend were evaluated by the Pearson product-moment correlation (r) and the result were presented in Table 5 & 6. No significant correlation was found between these two factors (weekday: r = -0.387, p > 0.05, weekend: r = 0.076, p > 0.05). That means children s levels of physical fitness (mean of daily step counts per minute) was not correlated with the active relative hours (MVPA hours) of children which were estimated by their parents on both weekday and weekend. Table 5. Pearson s correlation coefficient of the child s active relative hours that were estimated by their parent and the levels of physical fitness (step counts per minute) of the children on one typical weekday. (n= 24) child s active relative hours that were estimated by their parent Mean step count of children (per minute) r -0.387 p 0.061 Table 6. Pearson s Correlation Coefficient of the child s active relative hours that were estimated by their parent and the levels of physical fitness (step count per minute) of the children on one typical weekend. (n= 24) Mean step count of children child s active relative hours that were estimated by their parent (per minute) r 0.076 p 0.723

35 Hypothesis 3 The relationship between the active activity (MVPA) time and the daily step counts of children (per minute) in weekday and weekend were computed by the Pearson product-moment correlation (r). No significant correlation between these two factors on both weekday and weekend (weekday: r = 0.232, p > 0.05, weekend: r = -0.072, p > 0.05). That meant the active activity (MVPA) time of children were not correlated with their daily step counts on weekday and weekend (Refer to Table 7&8). Table 7. The relationship between the active activity time (in minutes) and the step counts (per minute) of children in weekday (n = 24) Mean step count of children (per minute) r 0.232 child s time spent in active activity (minutes) p 0.275 Table 8. The relationship between the active activity time (in minutes) and the step counts (per minute) of children in weekend (n = 24) Mean step count of children (per minute) r -0.072 child s time spent in active activity (minutes) p 0.738 Hypothesis 4 (a) Pair sample t-test was used to compare the mean of daily step counts of children (per minute) between weekday and weekend. The means of daily step counts of children were showed in background information table 1 (check that). No significant mean

36 difference of the children s step counts (per minute) between weekday and weekend (p > 0.05) were found in this study. That meant there were no significant mean difference of the children s physical activity level between weekday and weekend (Refer to Table 9). Table 9. Pair sample t-test of the children s mean step count (per minute) between weekday and weekend. (n = 24 children) n t p Mean step count per min in weekday & mean step count per min in weekend 24-1.515 0.143 (b) Pair sample t-test was used to compare the mean of daily step counts of boys (per minute) between weekday and weekend. The means of daily step counts of boys were showed in background information table 1. From the result of Pair sample t-test, a significant mean difference of boys step counts (per minute) between weekday and weekend was found. (t = -2.421, p < 0.05). That meant boys were more active in weekend than in weekday since more mean step counts in weekend when compare with weekday. (Refer to Table 10)

37 Table 10. Paired sample T-test of the mean differences of boys mean step count (per minute) between weekday and weekend (n= 12 boys) n t p Boy s mean step count per min in weekday & boys mean step count per min in weekend 12-2.421 0.034 (c) Pair sample t-test was used to compare the mean of daily step counts of girls (per minute) between weekday and weekend. The daily means step counts of girls were shown in background information table 1. From the result of Pair sample t-test, no significant mean difference of girls step counts (per minute) between weekday and weekend was found. (p > 0.05). That meant there were no significant mean difference of girl s physical activity level between weekday and weekend (Refer to Table 11). Table 11. Paired sample T-test of the mean differences of girls mean step counts (per minute) between weekday and weekend (n= 12 girls) n t p Girls mean step count per min in weekday & girls mean step count per min in weekend 12-0.056 0.956

38 Hypothesis 5 (a) The mean difference between boys and girls daily step counts (per minute) in weekday was evaluated by Independent T-test. No significant mean difference between boys and girls step counts in weekday was found (p > 0.05) (Showed in table 12). Table 12. Independent T-test of the mean difference between boys and girls step counts (per minute) in weekday (n=12 boys and 12 girls) Gender n M SD Mean t p Difference Boys 12 8.9053 4.37688-0.62045-0.258 0.799 Girls 12 9.5258 7.09763 (b) The mean difference between boys and girls daily step counts (per minute) in weekend was evaluated by Independent T-test. No significant mean difference between boys and girls step counts in weekend was found (p > 0.05). (Showed in table 13) Table 13. Independent T-test of the mean difference between boys and girls step count (per minute) in weekday (n=12 boys and girls) Gender n M SD Mean t p Difference Boys 12 12.9410 5.71749 3.29801 1.336 0.195 Girls 12 9.6430 6.36256

39 Discussion Result description and explanation In this study, the HAES proxy-report were used to determine the physical activity level of aged 5 kindergarten children, which was estimated by parents observation of their children in one typical weekday and weekend, and the pedometer readings were used to collect the step counts of children in that typical weekday and weekend. In order to investigate the reliability and validity of the HAES proxy report, the parents estimation on their children s physical activity level, the active relative hours and the active (MVPA) activity time were used to compare the daily step counts of pedometer. However, the result showed that the relationship between the pedometer readings (daily mean step counts) and other three variables were not significantly correlated on both weekday and weekend. For example, in the HAES proxy report, most parents think that their children were physically active and the active relative hours of their children is high in weekday and weekend; however, the data of pedometer showed that the daily step counts of their children were very low when compared with other children. It illustrated that the HAES proxy-report could not really reflect the children s physical activity level. There were several reasons that can explain this phenomenon. Firstly, according to Hay and Cairney (2006), their study stated

40 out that In the trade-off between utility and accuracy, the HAES is weighted toward utility. It was because there is no means to convert the intensity or hours of the HAES into physiological units to determine energy expenditure (Hay and Cairney, 2006). As a result, the HAES, by definition, provide estimation only and therefore lacks precision, so that small or subtle changes in activity will be missed due to the impossible fine-grained comparisons (Hay and Cairney, 2006). Secondly, the HAES require some basic mathematical and language proficiency for completion that may make the scale challenging for a small segment of the population (Hay and Cairney, 2006). Thirdly, parents observation is not accurate on their children s physical activity patterns. Parents may not have enough time to observe their children since they need to go to work, they fill in the HAES with their rough estimation. Although most of parents think that they were considerably or very clear their children s physical activity level, there were still 10 out of 24 parents are fulltime and part time worker, so they may not have much time staying at home and observe their children s physical activity patterns. Furthermore, although a large part of the parents are householders (11 out of 24) who have so much time to staying with children, they, in fact, may not really observing their children in every minute. As a result, parents may not know the

41 physical activity level of children during school time on weekdays. Besides, there is a common perception among parents and teachers are that young children are much more active than indicated by the research data (Pate, McIver, Dowda, Brown, Addy, 2008). The study of O'Connor and Temple (2005) conclude that parents think their child is highly active while in preschool or day care. However in another research, it states that, children who attend preschools spend 30 hours per week at school, the research findings pointed out that 25 hours of the time is spent on sedentary activities and less than 1 hour is spent on Moderate to Vigorous Physical Activity (Pate, McIver, Dowda, Brown, Addy, 2008). This manifests that parents might think that they were very clear the physical activity level of their children but it is in fact not the truth. On the other hand, the accuracy of pedometer was one of the variables that may influence the result of this study. Although many researches indicated that pedometer was a valid and reliable measure of children s physical activity (Hands, Parker, Larkin, 2006), (Louie and Chan, 2003), the result of this study found out that there is no significant relationship between daily step counts and the physical activity level of children in HAES proxy report. It demonstrates that pedometer may not be a valid measure of children s (age 5) physical activity level. A relevant research concluded that pedometers are an inexpensive form of

42 body motion sensor, however, many fail to measure slow walking speeds or upper body movements, and most are unable to log data to determine changes in exercise intensity (Macfarlane, Lee, Ho, Chan, and Chan, 2006). Additionally, another research proved that by comparing pedometers with indirect calorimetry, the pedometer underestimated energy expenditure which suggested that pedometers provide accurate measurements for walking speeds from 3 4 mph but are less accurate at slower speeds. (Strycker, Duncan, Chaumeton, Duncan and Toobert,2007) Another research also indicated that pedometers are unable to measure intensity of activity or to accurately record some common activities in young children such as cycling or skateboarding. These may affect the validity of the information gathered with young children given the episodic and variable nature of their play (Strycker, Duncan, Chaumeton, Duncan and Toobert, 2007). From all these, we can conclude that parents observation of children s physical activity level may not exactly match with the pedometer readings. This is also one of the limitations of this study. Another reason to explain why there is no significant relationship between pedometer readings and children s physical activity level is that pedometers may appear to be a motivation tool for children in inducing them to be more active in habitual physical activity pattern and level. According to the study of

43 Jackson and Howton (2008), participants of the study reported that wearing the pedometer influenced activity participation overall. These subjective responses from the questionnaire supported the increases in the number of steps reported throughout the 12-week intervention period (Jackson and Howton, 2008). Moreover, in another research done by Clarke, et al (2007), the effectiveness of a pedometer program for increasing physical activity levels and reducing body weight in overweight and obese mothers of young children were tested. The result showed a positive relationship between the pedometer program with mothers motivational readiness to exercise, exercise self-efficacy, pedometer steps, and pedometer kilocalories (Clarke et al, 2007). Therefore, children may be more active than before due to the activator function of pedometer, leading to the inaccurate results found. Beside, although the mean step counts of weekend of children were higher than weekday, the result showed that there was no significant mean difference between the step counts of children on both weekday and weekend. That means the physical activity patterns of children was not significantly different on weekday and weekend. According to Sigmund, Croix, Mikla nkova, and Fromel (2007), it is proven that although preschoolers showed similarities in physical activity level between weekdays and weekends, the physical activity at weekends is higher than on

44 school days. The writer further explained that preschool children are physically active regardless of the type of day and daily regime may be attributed to the fact that preschool children cannot distinguish between school time and free time. Although the daily programme in kindergartens definitely provides more opportunities to perform physical activity, kindergarten also have long periods of physical inactive activities, including lying or sleeping for 60 min after lunch every day and time spent sitting during a morning snack break (10 20 min), lunch (15 30 min) and afternoon snack break (10 20 min) (Sigmund, Croix, Mikla nkova, and Fromel, 2007). Similarly, there were no significant mean difference between the physical activity level (mean step counts)of children on both weekday and weekend, the physical activity level (mean step counts) of weekend of children were higher than weekday(refer to table 1 in background information), it reflected that children may a little bit more active in weekend. The results of this study indicated that children s physical activity patterns were different on weekday and weekend (refer to table 2 in background information), children spent more time in active activity in weekend than weekday. It may due to that fact that children s weekday physical activity pattern characteristics was related to cardiorespiratory fitness and dynamic exercise responses, whilst biomechanical efficiency was weakly related physical

45 activity bouts, which depicted that children may be more active in weekend than in weekday(chu 2007). In addition, the study of Pate, McIver, Dowda, Brown, Addy (2008) manifested that space constraints, lack of equipment for physical activity, and lack of scheduled times for free play and outdoor play may be important factors of children s physical activity level.and it is shown that being outdoors is one of the most powerful correlates of physical activity in children. However, according to the study of Louie and Chan (2003), they explained Hong Kong children being physically inactive are spent less time outdoors, little playing space for children in school time and over-concerned with children by teachers restraining children s running speed and modes of play to avoid injuries on weekday. Studying in classrooms and spending less time outdoors is common in kindergartens in Hong Kong, in order to reduce the risk of children to get hurt. All in all, in this study, although the TWGHs Tin Wan kindergarten has free activity time for children but they just play in a small indoor area, making the children s physical activity level is still lower in weekday than weekend. Also, children need to follow the instructions by the teacher during school time, for instance, they cannot run in the classroom, they need to sit down and cannot leave their seat without teacher s permission. So, Hong Kong children may not be active

46 in weekday when compare with weekend. Furthermore, parents play an important role for children which can affect their physical activity level too. Research conducted by Pate, McIver, Dowda, Brown, Addy (2008) showed that parents thought that their children are highly active in preschool or day care, thus may be less likely to provide opportunities for or encourage physical activity behaviors in other settings, leading to the reduced levels of activity in the whole weekday. Although there is no significant mean difference between boys and girls step counts on both weekday and weekend, the mean step counts (per minute) of boys have 3.26 steps per minute more than girls in weekend and similar step counts in weekday. So, it can be concluded that boys were little bit more active than girls on weekend. According to Louie and Chan (2003), it found that boys spent more time involved in vigorous and very vigorous activity than girls. From the result of data, boys spent more time in moderate to vigorous physical activity than girls in both weekday and weekend (refer to table 2 in background information). They have also found that boys were more involved in rough-and-tumble play than girls (Louie and Chan, 2003), so it is not surprised that boys were more active than girls on both weekday and weekend.

48 CHAPTER 5 SUMMARY AND CONCLUSIONS The summary and conclusion of the study between the physical activity level of children and HAES proxy report and relevant results concluded in this study are listed below. Summary of Results This study attempted to investigate the relationship between the physical activity level of children and HAES proxy report. Besides, the relevant results, such as the physical activity patterns and the step counts of children on weekday and weekend days are taken into consideration when examining the relationship between them. Conclusions are made based on the results and shown as the followings: A total number of 24 children (12 boys and 12 girls), sampling from TWGHs Tin Wan Kindergarten, were observed and their activity levels were recorded in the study on one typical weekday and weekend. Children s physical activity patterns were also observed and recorded. Children were required to wear the pedometer during the whole day on that typical weekday and weekend. The present study shows that there is no relationship between the child s overall activity level reported by parents and levels of physical fitness of the children on one typical weekday

49 (p>0.05) and one typical weekend (p>0.05). Beside, the result shows that there is no relationship between active relative hours of children which was estimated by their parents and the mean step counts of the children on one typical weekday (p>0.05) and one typical weekend (p>0.05). Furthermore, the relationship between the time spent for active activity and the daily step counts of children was not correlated on one typical weekday (p>0.05) and one typical weekend (p>0.05). On the other hand, the study shows there is no significant mean difference of the total steps walked by children between weekday (p>0.05) and weekend (p>0.05). Finally, the result also shows that there is no significant gender difference on step counts in weekday (p>0.05) and weekend (p>0.05). Conclusions 1. The study shows that there is no relationship between the child s overall activity level reported by parents and levels of physical fitness of the children on one typical weekday and one typical weekend. 2. There is no relationship between active relative hours of children which was estimated by their parents and the mean

50 step counts of the children on one typical weekday and one typical weekend. 3. There is no relationship between the time spent for active activity and the daily step counts of children in one typical weekday and one typical weekend. The above conclusion proven that the HAES proxy report has no relationship with the pedometer readings, as it could not provide accurate children s physical activity level by parents, so the validity and reliability of HAES proxy report was low in this study. 4. (a) Although there is no significant mean difference of the total steps walked by children between weekday and weekend, the daily mean of step counts per minute on weekend was still more than the daily mean of step counts on weekday. (b) Although there is no significant mean difference of the total steps walked by boys between weekday and weekend, the boys daily mean of step counts per minute on weekend was still more than the daily mean of step counts on weekday. (c) Although there is no significant mean difference of the

51 total steps walked by girls between weekday and weekend, the girls daily mean of step counts per minute on weekend was still more than the daily mean of step counts on weekday. 5. Although there is no significant gender difference on step counts in weekday and weekend, boys were still more physically active than girls on weekday and weekend. Recommendations for Further Studies In this study, only 24 children of the kindergarten were observed. The relationship between parents estimation on children s physical activity levels and actual children s physical activity levels might not be accurately measured. In order to obtain a more significant and reliable result, a larger sample size is recommended. Due to the time limit, some factors which need a longer observation time were not examined in this study. For instance, such as free play space near the kindergarten, family health related background, as well as the lifestyles of parents were not be examined. However, these kinds of antecedent issues may affect the activity levels of children in both weekday and weekend.

52 Also, the testing period should be longer so that to increase the validity and reliability of HAES. Hay and Cairnay (2006) stated out that the correlations in activity categories after 8-week interval were substantially stronger between both weekdays and weekend days than those between weekdays and weekend days of the same week. Thus, there is a positive relationship with longer testing period and higher validity of HAES proxy report. Hay and Cairney (2006) supported that HAES is weighted toward utility than accuracy. Since there is no means to convert the intensity or hours of the HAES into physiological units to determine energy expenditure, only estimation can be provided only and therefore lacks precision (Hay and Cairney, 2006). To increase the accuracy when estimating children s physical activity level, HAES proxy report should be used in combination with physiological parameters (Corder,et al, 2008) that can estimated by parents easily, such as the heart rate or temperature after children participated inactive or moderate to vigorous physical activity. Of course, the scale of different level heart rate or temperature should be provided to parents. For example, average heart rate of children aged 5-7 years is 100 beats per minute, around 65 and 133 beats per minute indicating resting and exercising condition (Horizon Blue Cross

53 Blue Shield). In such cases, the energy expenditure can then be investigated, the validity and of HAES would then be higher. Furthermore, the test should be implemented with two or more measurement when testing the validity of HAES proxy report. A Study suggested that a combination of objective monitoring and direct observation may provide the best standard for the assessment of physical activity measurement tools (Oliver, Schofield, & Kolt, 2007). Based on this suggestion, it is better to use two or more objective monitoring in this test to assess the validity of HAES proxy report. To conclude, if available, a pre-and-post test set up with larger sample size is recommended to give a more accurate result. For the pre-test, mistake caused by mathematical and language proficiency for completion of parents is allowed, but the above problem should be eliminated in the post-test. Also, more factors should be taken into considerations, including free space for playing near the kindergarten, family health related background, and life style of parents, as these factors will affect the activity levels of children. Longer testing period of this test and collect the energy expenditure unit of children in HAES can also help to increase the validity of HAES proxy report. Finally, involve two or more measurement in this test can further ensure

the validity of HAES proxy report. 54

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56 Jackson, E. M., Howton, A. (2008). Increasing walking in college students using a pedometer intervention: Differences according to body mass index. Journal of American College Health, 57(2), 159-164. Louie, L., & Chan, L. (2003). The use of pedometry to evaluate the physical activity levels among preschool children in Hong Kong. Early Child Development and Care, 173(1), 97-107. Macfarlane, D.J., Lee, C. C. Y., Ho, E.Y. K., Chan, K. L., & Chan, D. (2006). Convergent validity of six methods to assess physical activity in daily life. Journal of Applied Physiology, 101, 1328-1334. O'Connor, J. P., & Temple, V. A. (2005). Constraints and facilitators for physical activity in family day care. Australia Journal Early Child, 30 (4), 1-9. Oliver, M., Schofield, G. M., & Kolt, G.S. (2007). Physical activity in preschoolers: Understanding prevalence and measurement issues. Sports Medicine, 37(12), 1045-1070. Pate, R. R., McIver, K., Dowda, M., Brown, W. H., Addy, C. (2008). Directly observed physical activity levels in preschool children. The Journal of School Health, 78 (8), 438-444. Sallis, J. F. (1991). Self-report measure of children s physical activity. Journal of School Health, 61(5), 215-219. Sirard, J.R., & Pate, R. R. (2001). Physical activity assessment in children and adolescents. Sports Medicine, 31(6), 439-454. Strycker, L. A., Duncan, S. C., Chaumeton, N. R., Duncan, T. E., & Toobert, D. J. (2007). Reliability of pedometer data in samples of youth and older women. International Journal of Behavioral Nutrition and Physical Activity, 4(4), 1-8. Sigmund, E., Croix, M. D. S., Miklankova, L., & Fromel, K. (2007). Physical activity patterns of kindergarten children in comparison to teenagers and young adults. European Journal of Public Health, 17 (6), 646 651.

57 Spurrier, N. J., Magarey, A. A., Golley, R., Curnow, F., & Sawyer, M. G. (2008). Relationships between the home environment and physical activity and dietary patterns of preschool children: a cross-sectional study. [Abstract]. International Journal of Behavioral Nutrition and Physical Activity, 5, 31. Abstract retrieved April 20, 2009, from ProQuest database. Varni, J. W., Limbers, C. A., & Burwinkle, T. M. (2007). Parent proxy-report of their children's health-related quality of life: an analysis of 13,878 parents' reliability and validity across age subgroups using the PedsQL 4.0 Generic Core Scales. Health and Quality of Life Outcomes, 5(2), 1-10.

58 Appendix A 身體活動紀錄表測試日 : 日期 : 3 月 19 日星期四起床時間 : am 戴上數步器時間 : am/pm 晚上睡前除下數步器時間 : pm 到達學校時間 : am/pm 午睡時間 ( 如有 ): am/pm ~ am/pm 離開學校時間 : am/pm 回到家的時間 : am/pm 數步器讀數 : 活動情況 ( 如有, 請填寫下表 ): 活動類別靜態活動 ( 如 : 如看電視, 上網或看書等等 ) 合共時間小時分鐘動態活動 ( 如 : 打球, 跳舞或到小時分鐘公園玩耍等等 ) 水上活動 ( 如 : 游泳等 ) 小時分鐘

59 Appendix B 東華三院田灣幼稚園編號 : 我的孩子生活中的兩天第一部份這份問卷將詢問有關你子女 ( 就讀 K3) 每天的活動程度請小心閱讀所有指示, 並真實地回答每個問題指示 ( 請細閱 ) 在過去的兩個星期內, 請回想一個有代表性的平日 ( 請選擇星期二星期三或星期四 ) 及一個有代表性的星期六的活動在每一個以下描述的時段內, 請估計你子女在進行不同活動程度所花費時間的百分比每一個時段內的時間百分比加起來必須是 100% 以下是不同活動程度的描述 : 不同活動程度的描述這些描述提供你不同活動程度的例子當你進行估計時, 請經常參考這些描述 a) 不活躍 - 躺下睡覺休息小睡 b) 稍微不活躍 - 坐著閱讀看電視玩電子遊戲機使用電腦進行其他以坐著為主的遊戲或活動 c) 稍微活躍 - 步行逛街做簡單家務 d) 十分活躍 - 跑蹦蹦跳跳踏單車溜冰游泳進行需要使用很多動作及令你呼吸急促或出汗的活動以下是一個完整時間百分比的例子 : 例子從完成晚飯至睡覺前的時段內, 請估計你的子女在不同活動程度中所花費的時間百分比 a) 不活躍 5 % ( 例如 : 小睡 ) b) 稍微不活躍 60 % ( 例如 : 看電視 ) c) 稍微活躍 25 % ( 例如 : 步行 ) d) 十分活躍 10 % ( 例如 : 踏單車 ) 總共 100 %

60 週日的活動在過去的兩個星期內, 請回想一個有代表性的平日 ( 請選擇星期二星期三或星期四 ), 並估計你子女在進行以下不同活動程度中所花費的時間百分比 1. 從起床至早餐前的時段內 : a) 不活躍 % b) 稍微不活躍 _ % c) 稍微活躍 _ % d) 十分活躍 _ % 總共 100 % 不活躍 2. 從完成早餐至午餐前的時段內 : a) 不活躍 % b) 稍微不活躍 _ % c) 稍微活躍 _ % d) 十分活躍 _ % 總共 100 % 稍微不活躍 3. 從完成午餐至晚餐前的時段內 : a) 不活躍 % b) 稍微不活躍 _ % c) 稍微活躍 _ % d) 十分活躍 _ % 總共 100 % 稍微活躍 4. 從完成晚飯至睡覺前的時段內 : a) 不活躍 % b) 稍微不活躍 _ % c) 稍微活躍 _ % d) 十分活躍 _ % 總共 100 % 十分活躍對於你正在描述的有代表性的平日中, 請盡量準確地提供以下問題的答案 5. 你的子女在早上何時起床? 早上 : 6. 你的子女何時開始進食早餐? 早上 : 7. 你的子女用多少時間去完成早餐? 分鐘 8. 你的子女何時開始進食午餐? 下午 : 9. 你的子女用多少時間去完成午餐? 分鐘

61 10. 你的子女何時開始進食晚餐? 晚上 : 11. 你的子女用多少時間去完成晚餐? 分鐘 12. 你的子女在晚上何時睡覺? 晚上 : 13. 對於這份問卷正詢問你有關有代表性的平日中, 請圈出你子女活動程度的整體水平 ( 只選一項 ): a) 十分不活躍 b) 不活躍 c) 稍微不活躍 d) 稍微活躍 e) 活躍 f) 十分活躍請完成以下句子, 並圈出你的答案 : 14. 我正在描述的平日 a) 和過去六個月內的大部份平日十分相似 b) 和過去六個月內的大部份平日有點相似 c) 和過去六個月內的大部份平日有點不同 d) 和過去六個月內的大部份平日十分不同 15. 在過去的六個月內, 我的子女 a) 較六個月前的平日不活躍得多 b) 較六個月前的平日稍微不活躍 c) 和六個月前的平日的活躍程度差不多 d) 較六個月前的平日稍微活躍 e) 較六個月前的平日活躍得多星期六的活動在過去的兩個星期內, 請回想一個有代表性的星期六, 並估計你子女在進行以下不同活動程度中所花費的時間百分比 1. 從起床至早餐前的時段內 : a) 不活躍 % b) 稍微不活躍 _ % c) 稍微活躍 _ % d) 十分活躍 _ % 總共 100 % 不活躍

62 2. 從完成早餐至午餐前的時段內 : a) 不活躍 % b) 稍微不活躍 _ % c) 稍微活躍 _ % d) 十分活躍 _ % 總共 100 % 稍微不活躍 3. 從完成午餐至晚餐前的時段內 : a) 不活躍 % b) 稍微不活躍 _ % c) 稍微活躍 _ % d) 十分活躍 _ % 總共 100 % 稍微活躍 4. 從完成晚飯至睡覺前的時段內 : a) 不活躍 % b) 稍微不活躍 _ % c) 稍微活躍 _ % d) 十分活躍 _ % 總共 100 % 十分活躍對於你正在描述的有代表性的星期六中, 請盡量準確地提供以下問題的答案 5. 你的子女在早上何時起床? 早上 : 6. 你的子女何時開始進食早餐? 早上 : 7. 你的子女用多少時間去完成早餐? 分鐘 8. 你的子女何時開始進食午餐? 下午 : 9. 你的子女用多少時間去完成午餐? 分鐘 10. 你的子女何時開始進食晚餐? 晚上 : 11. 你的子女用多少時間去完成晚餐? 分鐘 12. 你的子女在晚上何時睡覺? 晚上 : 13. 對於這份問卷正詢問你有關有代表性的星期六中, 請圈出你子女活動程度的整體水平 ( 只選一項 ): a) 十分不活躍 b) 不活躍 c) 稍微不活躍 d) 稍微活躍 e) 活躍 f) 十分活躍

63 請完成以下句子, 並圈出你的答案 : 14. 我正在描述的星期六 a) 和過去六個月內的大部份星期六十分相似 b) 和過去六個月內的大部份星期六有點相似 c) 和過去六個月內的大部份星期六有點不同 d) 和過去六個月內的大部份星期六十分不同 15. 在過去的六個月內, 我的子女 a) 較六個月前的星期六不活躍得多 b) 較六個月前的星期六稍微不活躍 c) 和六個月前的星期六的活躍程度差不多 d) 較六個月前的星期六稍微活躍 e) 較六個月前的星期六活躍得多第二部份個人資料子女姓名 : 子女性別 : 子女出生日期 : ( 月 / 年 ) 家長姓名 : 與子女關係 : 平均每天與子女相處時間 : 小時分鐘家長現時工作情況 : 全職工作兼職工作家庭主婦暫時待業退休其他 : 請選出對子女每天的活動狀況的清楚程度 : 十分清楚頗清楚不太清楚不清楚問卷已完結, 多謝你完成這份問卷!

Appendix C 64