When children play, they feel better: organized activity participation and health in adolescents

Participation in OLTA was associated with enhanced physical and mental health among
all adolescents independently of the type of OLTA. The associations between particular
clusters of OLTA and less frequent occurrence of specific health complaints varied
by gender and age.

As expected, we found that being engaged in one or more OLTA, regardless of their
type, age or gender, was associated with higher life satisfaction and better self-rated
health. This is in line with the evidence that states that in general any level of
involvement is better than no involvement 29], 30]. However, the associations between particular clusters of OLTA and lower prevalence
of health complaints were observed to differ by gender and age. This indicates that
the actual type of activity matters, as previously pinpointed by Agans and Geldhof
31].

Unlike other studies 32], 33] we observed the strongest associations with healthy development indicators in adolescents
engaged solely in sports and not in those having different patterns of activity involvement,
i.e.’ all-rounders’ and ‘artists’ clusters. This contradicts the broadly recognized
premise that the more contexts children are involved in, the more developmental opportunities
they have 13], 34]–36]. Physical activity may be a significant element underlying this finding as it offers
undisputable benefits for physical and mental health 37]–39]. Those participating only in sports perhaps engage in physical activities more frequently
and intensely than those who are involved in different types of OLTA, thus, enhancing
their health-promoting effects. The link of other leisure pursuits and health in adolescents
appears to be weaker, which accords with the results of Zambon et al. 11].

Next, we found participation in individual and team sports to be associated with fewer
health complaints only in boys. Physical activity has been documented to reduce symptoms
of nervousness, irritability and sadness more in females than in males 40]. Therefore, we believe the weaker association between organized sports and health
complaints in adolescent girls might be attributable mostly to motivational and social
factors. First, compared with boys European girls do not consider competition/achievement
in physical activity to be as important 41], 42]. This is actually in conflict with primary goal of sports (to win) as a performance-
and success-centred setting. Second, boys consider conflict, which often arises in
a competitive environment, to be a more natural part of their sport friendship than
girls, who rather appreciate companionship, intimacy or pleasant play 43]. These discrepancies might lead to higher irritability or nervousness in girls, which
could explain the relatively stronger association with a lower frequency of these
health complaints in boys. Based on our results, it may be useful, especially in girls,
to treat individual and team sports as separate contexts of healthy youth development,
with each having specific advantages as has already been suggested by Hansen et al.
14].

Regarding the interaction effect of age, the most prominent differences in the associations
between participation in OLTA and the occurrence of health complaints were observed
in the artist cluster. The associations with less frequently feeling low, nervousness
and irritability were found in 11-year-old artists but not in those aged 15. In their
systematic review, Bungay Vella-Burrows 44] reported that interventions using creative activities were supportive of well-being
in youth without mentioning any age-specific data. Nevertheless, art performers have
in general been shown to be more prone to irritability, anxiety 45], neuroticism 46] and mood disorders 47]. Since we observed a noteworthy decline of participation in art activities with increasing
age, it is possible that only the “genuine” artists, who are more apt to suffer from
the above-mentioned symptoms, maintain their involvement. This could subsequently
result in the diminishing of the associations for the oldest age category.

Strengths and limitations

The present study has several strengths. The most important are its sample size and
the representativeness of the adolescent sample. Moreover, it uses the well-established
HBSC methodology that is being developed by expert groups on a continuous basis. To
the best of our knowledge it is also the first study in Europe using such a systematic
classification of OLTA and dealing with age and gender differences in more detail.

Our findings also need to be interpreted in light of some limitations. First, we did
not explore other dimensions of OLTA, such as frequency, duration, intensity and quality.
These have been shown to affect the developmental outcomes 8]; therefore the associations found in the present study might have been partly attributable
to some of these characteristics. Second, the cross-sectional design does not allow
us to draw any conclusions on causal relationships. It might be that being healthy
and satisfied is a prerequisite for entering an organized activity and not its consequence
48]. Third, all the analyses were based on self-reported data, which is more susceptible
to recall bias, though measures have in general been well-validated 22]. Fourth, we found sports participation to be strongly associated with health but
we could not adjust for physical activity. We could thus not determine to which degree
this association was due to physical activity in itself, or due to the organisational
aspect of sports participation.

Implications

In general, the results of our study support the contribution of OLTA to adolescents’
health. However, the gender- and age-related differences in particular patterns of
activities suggest that sports participation may reduce the prevalence of health complaints
primarily in boys. On the other hand, girls and younger adolescents seem to benefit
more from art activities.

Future research should concentrate on differences in relationship between particular
types of OLTA and relevant developmental indicators. It should be also focused on
unveiling the causal pathways between participation in organized-leisure time activities
and health.