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Abstract
Despite consensus that physical fitness (PF) plays an important role in promoting mental health and academic achievement, little is known regarding the mechanisms by which this effect works. Blair, Cheng, and Holder (2001) proposed a conceptual model to identify the behavioral mechanism of health outcomes, in which both health-related PF and skill-related PF were identified as the direct determinants of health outcomes. Guided by Blair and colleagues’ model, the primary purpose of this study was to examine the association between health-related PF, skill-related PF, depression and academic achievement among adolescents. The second purpose was to investigate whether depression would mediate the association between physical fitness and academic achievement among this population. A total of 144 adolescents (M age = 14.55, SD = 0.62) were recruited from two middle schools. Health-related PF was significantly associated with depression, and skill-related PF was related to academic achievement. Mediation analysis supports the statistically significant indirect effect of depression on the relation between health-related PF and academic achievement. The findings suggest that individuals who are physically fit and show positive mental functioning may have better academic achievement during adolescence.
The increasing prevalence of childhood obesity is one of the major public concerns in both developed and the developing countries (Ortega, Ruiz, Castillo, & Sjöström, 2008; Shan, Xi, Cheng, Hou, Wang, & Mi, 2010). Research indicates that being overweight and obesity are associated with lower physical exercise capability and reduced levels of physical fitness (PF; Ortega et al., 2008; US Department of Health and Human Services, 2008). Low levels of physical fitness in adolescence tend to track into adulthood (Malina, 1996; M Minck, Ruiter, Van Mechelen, Kemper, & Twisk, 2000), and are associated with unfavorable chronic disease risk factor profiles in adulthood (Ruiz et al., 2009; US Department of Health and Human Services, 2008). Hence, maintaining appropriate levels of physical fitness during adolescence is important for both short- and long-term health of youth.
School physical education (PE) provides a unique avenue for youth to develop appropriate levels of physical fitness through various physical activity opportunities and practices (Sallis, McKenzie, Beets, Beighle, Erwin, & Lee, 2012). However, 20% or more of children fail to meet recommended fitness standards in one or more areas, and PE remains a marginalized program in many school districts, which in the US may be a negative consequence of the No Child Left Behind Act of 2001 (Institute of Medicine, 2013; Rice & Howell, 2000). In order to advocate the value and importance of PE, an increasing body of research has attempted to investigate the association between physical fitness and academic achievement in youth (Bass, Brown, Laurson, & Coleman, 2013; Castelli, Hillman, Buck, & Erwin, 2007; Chomitz et al., 2009; Kantomaa et al., 2013; Torrijos-Niño et al., 2014; Welk et al., 2010). These findings suggest that higher academic performance may be related to school physical fitness attainment, especially health-related PF components.
Physical fitness including health-related PF and skill-related PF is considered one of the most important health markers, as well as a predictor of morbidity and mortality for cardiovascular disease and for all-cause mortality in youth and adults (Blair et al., 2001; Kvaavik, Klepp, Tell, Meyer, & Batty, 2009; Ortega et al., 2008; Zagout et al., 2016). Health-related PF can be thought of as an integrated measure of physical capacity including cardiorespiratory endurance, muscular strength and endurance, flexibility and body composition. Skill-related PF has six components, sometimes defined as motor function in the literature, including agility, balance, coordination, speed, power, and reaction time (American College of Sport Medicine, 2010; Corbin, Pangrazi, & Franks, 2000; Cooper Institute, 2010).
Blair and colleagues (2001) proposed a conceptual model to identify the behavioral mechanism of health outcomes, in which both health-related PF and skill-related PF (motor function was used in their model) were identified as the direct determinants to health outcomes. However, physical fitness, especially skill-related PF was not adequately assessed in most studies, suggesting the effects of all components of physical fitness (health- and skill-related PF) on mental health need more investigation (Blair, Cheng, & Holder, 2001), as well as their combined effects on academic performance among adolescents. Research indicated that physical fitness is an important determinant of academic success because physical fitness has positive effects on cognitive function and performance in attention tasks, or by its effects on mental health including depression, stress, and quality of life (Gu, Chang, & Solmon, 2016; Lubans et al., 2016). Theoretically, it is reasonable to assume the association between physical fitness and academic attainment may be influenced by mental health status (Lubans et al., 2016). Approximately 20% of school-aged children have a diagnosable mental health problem (i.e., depression) and those individuals are more likely to be classified as overweight or obese (Ahn & Fedewa, 2011).
Depression has become the most prevalent mental health problem during adolescence in the developing world, and depression may predict more severe adult illness (Guo, Yang, Cao, Li, & Siegrist, 2014; Sumer, Giannotta, Settanni, & Ciairano, 2009). Cross-sectional studies have shown that depression is negatively correlated with academic achievement in children, such that children with higher levels of depression tend to be less successful in academic performance (Grimm 2007; Owens, Stevenson, Hadwin, & Norgate, 2012; Preiss & Franova, 2006). Conversely, failure to achieve academic goals or outcomes may also add stress to the students and cause or worsen depression. Despite consensus that physical fitness plays an important role in promoting mental health and improving problems such as depression (Ahn & Fedewa, 2011) and academic achievement (Donnely et al., 2016), little is known regarding the mechanisms by which this effect works.
Given the public health burden of mental health problems among adolescents in both developed and developing countries (Ahn & Fedewa, 2011; Guo et al., 2014), research focusing on the mechanisms of physical fitness relations to depression symptoms are needed from international perspective in order to understand academic attainment among adolescent population. Enhancing adolescents’ health and academic performance is a global research agenda (Donnelly et al., 2016; Shaw, Gomes, Polotskaia, & Jankowska, 2015), therefore, school psychology, administrative, and teaching personnel should increase their awareness of the positive effect of fitness in order to frame the appropriate learning environment (e.g., PE curriculum, fitness development). Although health-related PF has drawn sufficient attentions in developed counties such as North America and Europe (Welk et al., 2010; Zagout et al., 2016), skill-related PF has been the major focus for physical activity and fitness professionals in developing counties such as China (Bianco et al., 2015). This line of research, therefore, may provide meaningful insights and practical implications for research and school psychologists to oversee the international gradient of adolescent health and academic achievement.
A group of scholars recently conducted a systemic review (Donnelly et al., 2016) to investigate the relation between physical activity, fitness, cognitive function, and academic achievement among children. Donnelly and colleagues (2016) found that 24 of 73 articles were focused on the relation between fitness and academics, and most of them only focused on the health-related PF components (65% used FITNESSGRAM®). They also argued that efforts to promote health-related PF will not detract students from learning but may actually enhance their school performance. For example, Welk and colleagues (2010) investigated the effects of health-related PF and academic performance among adolescents in Texas, and a positive but small effect was reported.
Haapala and colleagues (2013) provided the primary evidence to support the weak but positive association between skill-related PF components (e.g., balance), and academic achievement among primary school children. Kantomaa and colleagues (2013), however, found skill-related PF (motor function) but not cardiorespiratory fitness had an indirect effect on academic achievement through physical activity. The developing literature suggests that physical fitness may have an impact on academic performance through direct and indirect physical and psychological mechanisms (Kantomaa et al., 2013). To date, very few studies have been focused on this research direction, especially related to the relation between skill-related PF and academic achievement among youth.
Given the fact that very few studies have considered the differential effects of physical fitness for adolescents when they investigate the relationship between mental health and academic performance, the present study aimed to provide new insights into these relationships by including both health- and skill-related PF and an indicator of mental health (e.g., depression). The primary purpose of this study was to examine the association between health-related PF, skill-related PF, depression and academic performance (mathematics, science and language) among Chinese adolescents. The second purpose was to investigate whether depression would mediate the association between physical fitness (health- and skill-related PF) and academic achievement among this population.
Methods
Participants
A total of 144 (96 boys, 48 girls) middle school students were recruited from two public schools in China. The participants consisted of seventh and eighth graders ranging from 13- to 17-years-old (Mage = 14.55, SD = 0.62). Approval to conduct the study was received from the University Institutional Review Board, and permission to collect data was granted by the school district, the school principal, and the PE teachers prior to the start of the study. Children and their parents agreed to participate via the informed consent and assent process.
Measures
Health-related physical fitness
Health-related PF was represented by cardiorespiratory fitness, muscular fitness, and body composition in this study. The FITNESSGRAM® test battery (Cooper Institute, 2007) was used in this study and tests were conducted by well-trained research assistants. Specifically, cardiovascular fitness was assessed by means of the Progressive Aerobic Cardiovascular Endurance Run (PACER) and the PACER score was the total number of successful ‘laps the students completed. The maximal oxygen consumption (VO2 max, ml/kg/min) was calculated based on age, gender, Body Mass Index, and the PACER scores according to a validated regression equation (Mahar, Guerieri, Hanna, & Kemble, 2011). Muscular fitness was measured by two tests, curl-ups and push-ups in this study. All test scores were transformed to standardized scores, and the sum of standardized scores represented the health-related PF index in the data analyses (Gu et al., 2016). FITNESSGRAM manual (Cooper Institute, 2007) indicates the tests are reliable and valid representations of each component of health-related PF.
Skill-related physical fitness
Components of skill-related PF have a relationship with enhanced performance in sports and motor skills (Corbin, Pangrazi, & Franks, 2000). In this study, a 50-meter dash was used to assess students’ running speed. Students’ power, the ability to exert muscle force quickly, was measured by using the standing long jump. Both test are reliable and valid tests of skill-related PF (Corbin, Pangrazi, & Franks, 2000).
Depression
The Center for Epidemiological Studies-Depression Scale (CES-DC; Faulstich, Carey, Ruggiero, Enyart, & Gresham, 1986) includes 20 items that measure depressive symptoms. The Chinese version of the CES-DC was validated in a previous study and also applied to the adolescent population (Li, Cheung, Chung, & Ho, 2010). Participants respond to each item using a four-point Likert-type scale that ranges from 0 = not at all to 3 = a lot. Total score was the sum of the items and range from 0 (no symptoms) to 60 (high level of symptoms). It has been reported that the CES-DC was a reliable and valid measure of depression for children and adolescents aged 12- to 18-years-old (Fendrich, Warner, & Weissman, 1990). Cronbach’s alpha coefficient in the current study was 0.85.
Academic achievement
Academic achievement is defined as a child's success and performance in school subject areas and can be measured by specific tests, such as mathematics, science, and language literacy (Donnelly et al., 2016). Academic achievement was assessed through standardized written tests designed for different grade levels in China. The test raw scores were used in this study ranging from 0–100 in each subject area. These standardized test scores represent students’ learning and understanding in school subject areas such as mathematics, science, and language literacy (i.e., ≥ 90.0 = excellent; ≥ 80.0 = good; ≥ 60.0 = acceptable; < 60 = poor). Data were obtained from school records at the end of the academic year. The sum raw scores of three subjects were used to represent academic achievement index according to the widely-accepted evaluation and grading system in China. There are no age or grade-specific standards on those standardized tests.
Procedures
The study was approved by the University Institutional Review Board. Before collecting data, parents, school principals and physical educators were informed by letter about the purpose of the study. Written parental consent and adolescents’ assent were obtained prior to data collection. Research assistants in this study were well-trained kinesiology graduate students who went through the FITNESSGRAM® protocol training and field practices in various research projects. For this study, investigators and research assistants also participated in two-day intensive training sessions to insure reliable and valid data collection procedures. Health-related PF (FITNESSGRAM®; Cooper Institute, 2007) and skill-related PF (50 meter dash and standing long jump) were measured at the middle of the semester. After the fitness testing, the following day students spent 10–15 minutes in the classroom completing the assessment of depression using the Center for Epidemiological Studies-Depression Scale (CES-DC; Faulstich et al., 1986). These measures were appropriate for the middle school students. All the academic achievement scores including mathematics, science, and language literacy were provided by the school district.
Data analyses
Descriptive statistical analysis was conducted for the study variables including health-related PF, skill-related PF, depression, and academic achievement (Mean ± SD). Pearson correlations were conducted to examine the relations among health-related PF, skill-related PF, depression, and academic achievement. Missing data were replaced using mean substitution (less than 2% missing data). If more than 50% of the items were missing in one questionnaire, the participant was excluded from the data analysis.
Subsequently, structural equitation modeling (SEM; AMOS 20.0) was used to test the mediation effect of mental health (mediator: depression) on the relations between physical fitness (independent variables: health-related and skill-related PF) and academic achievement (dependent variables: mathematics, science, and language literacy). Gender was controlled in the SEM model considering its significant effect on depression (Janssen & LeBlanc, 2010; Rosenfield & Mouzon, 2013). Goodness-of-fit statistics (Hu & Bentler, 1999) to test the model fit included: χ2 goodness-of-fit test (χ2GoF), normed fit index (NFI), Tucker-Lewis Index (TLI), incremental fit index (IFI), comparative fit index (CFI), and root mean squared error of approximation (RMSEA). The Bootstrapping test was used to test the statistical significance of the indirect effect (mediation effect) by calculating the 95% confidence intervals (1000 bootstrap samples; Preacher & Hayes, 2008). An alpha level of .05 was used for all statistical analyses.
Results
The descriptive results of the study are shown in Table 1. The correlation coefficients among health-related PF, skill-related PF, depression, and academic achievement are presented in Table 2. Depression was significantly negatively correlated with all three academic subjects including mathematics, science, and language literacy (r = −0.32; r = −0.31; r = −0.21, respectively, p < 0.05). It was found that health-related PF was significantly related with depression (r = −0.21; p < 0.05), and skill-related PF was associated with academic performance (r = 0.26; p < 0.01).
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Table 1. Descriptive characteristics for the study sample.
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Table 2. Correlations among the study variables.
We used overall health-related and skill-related PF as measured variables (exogenous), an observed variable of depression (endogenous), and mathematics, science, and language literacy, as indicators of the latent academic achievement (endogenous) (Figure 1). Based on the recommendation from previous research (Eveland-Sayers et al., 2009), gender as a confounder was controlled in the SEM model. The goodness-of-fit indices suggested a well-fitting model (χ2/df = 11.75/9, p = 0.228; NFI = 0.965; IFI = 0.992; CFI = 0.991; RMSEA = 0.046; 90% CI [0.000, 0.111]). Specifically, a full mediation model was supported because the direct effect of health-related PF on depression was reduced and became non-significant in the model (standardized regression weights from −0.21 to −0.05; Figure 1; Mackinnon, Fairchild, & Fritz, 2007).
The statistically significant indirect effect (mediation) of the health-related PF on academic achievement through depression was supported according to the bootstrapping analysis (95% bootstrap CI [0.51, 3.99]; Preacher & Hayes, 2008). That is, the relation between health-related PF and academic achievement was fully mediated by depression regardless of gender. On the other hand, skill-related PF was not significantly related to depression in the model, and its direct effect on academic achievement remained weak but significant (β = 0.19, p < 0.05). Thus, the indirect effect (mediation) of skill-related PF on academic achievement through depression was not supported in this study.
Discussion
Enhancing adolescents’ health and academic performance is a global research agenda (Donnelly et al., 2016; Shaw, Gomes, Polotskaia, & Jankowska, 2015). The primary goal of this study was to obtain scientific evidence to enhance our understanding of the effect of both health-related and skill-related physical fitness on adolescents’ mental health and academic performance. To our knowledge, the study was one of the first attempts to explore the effects of both health-related and skill-related PF on adolescents’ mental health and academic achievement. Examining the mechanism among those variables may help to identify and tailor interventions or resources essential to academic success in schools. The broad scope of potential advantages arising from overall physical fitness including health-related and skill-related components, highlighted in this study, require a rethinking of current recommendations for school PE and health/wellness programs. Internationally, the finding generated from this study may provide other developed or developing countries a reminder or insight of the different effects of health-related PF and skill-related PF, especially on adolescents’ academic achievement.
In the school setting, limited studies have investigated the influence of skill-related PF components on depression and most of them focused on health-related PF components (cardiorespiratory fitness and BMI; Janssen, & LeBlanc, 2010). In the correlational analysis, we found only health-related PF but not skill-related PF was significantly related to students’ depression, which is consistent with previous studies (Greenleaf et al., 2010; Janssen & LeBlanc, 2010; Ortega et al., 2008). These findings highlight the important role of health-related PF on adolescents’ mental health problems such as depression. School-based interventions aimed at preventing mental impairment in the adolescent population might be more successful when specific health-related PF components are targeted such as cardiorespiratory fitness and muscular fitness. For instance, school recess is a scheduled break from academics which could provide opportunity for adolescents’ socialization and peers interaction. School psychologists may work with physical fitness specialists (e.g., physical education teachers) to design fitness-based intervention programs or consultant sessions during recess. Consequently, these efforts can help alleviate the clash between health education (physical and mental) and the overall academic agenda, and provide support for policies that encourage health literacy in school environments across various population. (Paakkari & Paakkari, 2012).
It is surprising that we did not find the significant association between health-related PF and academic performance in this adolescent population, which is inconsistent with previous studies focused on elementary children (Castelli et al., 2007; Lorenz, Stylianou, Moore, & Kulinna, 2016). An early study with a large number of participants (N = 7961; Dwyer et al., 2001), however, reported the same results as our study. Specifically, Dwyer and colleagues (2001) found that there was no relationship between health-related PF component (i.e., cardiorespiratory fitness measured by a laboratory bicycle-based PWC170) and academic performance. It should be noted that the mechanism towards the functional relationship between physical fitness and academic achievement is not clear in the literature and the statistically significant association reported in the literature was small to moderate (β = 0.10–0.42; Santana et al., 2016). In addition, the results of the mediation analysis in the present study may also provide insight on this inconsistent finding. Including both health-related PF and skill-related PF in the structural model to understand their potential prediction to both depression and academic performance was the unique contribution of this study.
The mediation path model demonstrated that health-related PF had a direct effect on depression, which in turn had an indirect effect on academic performance. That is, increased health-related PF has the potential to improve mental function, both of which could influence academic achievement. We did not find the direct effect from skill-related PF to depression, but a significant direct association was found with academic achievement. These findings are consistent with current literature that skill-related PF components such as muscular force/power had positive relations with academic performance (see reviews, Keeley & Fox, 2009; Santana et al., 2016). Blair and colleagues (2001)’s conceptual model indicated that the components of physical fitness with documented potential for improving health are cardiorespiratory fitness, muscular strength and endurance, and motor ability, each of which may have different effects on the brain. Our results provided unique evidence that skill-related PF may be beneficial for academic achievement among adolescents. This notion was also supported in another systematic review by Fogelholm (2010), which indicated that health-related PF (i.e., BMI and cardiorespiratory fitness) was a more protective factor than other behavioral variables such as PA and motor ability towards health outcomes, which was also tested through our mediation model.
Our study confirmed not only the effects of physical fitness on academic performance but also provide the insights of why sometimes the correlation may be small or not reach significance due to the possible confounders/mediators such as depression found in this study regardless of gender (we controlled gender in the model). We did not control BMI in the model because the initial analysis indicated it was not related to the academic performance and depression. The evidence was small but significant which provides the insight that it would be important to enhance not only health-related PF but also skill-related PF such as speed and power measured in this study.
School health providers and PE programs may need to enhance those skill-related PF components to elicit improvements in academic attainment among this population. School psychologists, for example, may encourage adolescents to participate in more fitness-based exercises in and out of school settings, and provide relative coping skills to minimize the depression symptoms. The development of coping skills promoted in fitness-based activities such as yoga and martial arts may provide the positive effects on mental health, consequently on academic attainment (Lunas et al., 2016). Although the bootstrapping method provided statistically significant for our results, the relatively small sample size has been acknowledged as one of the limitations in this study. The data are cross-sectional, thus, the interpreting of the results cannot assume the causal relationship among study variables. Future research (e.g., randomized control trial, longitudinal study) could be conducted to determine the directional pathway from physical fitness and depression to students’ academic achievement.
Conclusion
The health benefits of physical fitness in youth are documented (Gu, Chang, & Solmon, 2016; Janssen & LeBlanc, 2010; Ruiz & Ortega, 2009). However, the literature focused on the effect of all aspects of physical fitness (both health-related PF and skill-related PF) on depression is scarce. The interventions aimed at alleviating depression symptoms in adolescents should focus on health-related PF components (cardiorespiratory and muscular fitness) which is consistent with previous research evidence. Policy makers would benefit from more definitive data on the causal relationship between physical fitness and mental health, thus further research is required in this emerging field. As a whole society, efforts toward adolescents’ health promotion and academic improvement should be a global research action. Nonetheless, our study brings new information to the field and shows the combined effects of both health-related PF and depression on academic achievement of the adolescents. Our results suggest that developing healthy individuals who are physically fit and show positive mental functioning may benefit academic achievement during adolescence.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
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Author biographies
Man Xiang, MS is an Associate Professor and Dean in the College of Public Education at Zhejiang Institute of Mechanical and Electrical Engineering. She has expertise in physical education pedagogy and school-based physical activity programming. She also has expertise in statistics with SEM model. She has numerous years of work with statistics and as a research consultant for various large grants in China. As a research and administrator, she has led her research team to received 11 sources of external funding and has acted as principal investigator on eight of the 11 occasions.
Xiangli Gu, PhD is an Assistant Professor in the Department of Kinesiology, Health Promotion, and Recreation at University of North Texas. Her research agenda focuses on 1) achievement motivation in physical activity and health promotion, 2) the behavioral mechanism of childhood obesity including physical activity, physical fitness, and motor skills assessment among youth, and 3) how those behavioral variables may affect school-aged students’ academic performance and health outcomes. Her research foci are aligned with objectives of the SHAPE America and Healthy People 2020, and can help address the health disparity issue among school-aged children. As one SHAPE America Research Fellow, she has been an author for 26 data based journal articles and book chapters and more than 40 published scholarly conference presentations at professional meetings. She was also recognized as one selected research fellow for the Physical Activity and Public Health Postgraduate Course hosted by the CDC and the University of South Carolina in 2016. https://www.coe.unt.edu/facultystaff-department/xiangli-gu
Allen Jackson, PhD has been a member of the UNT faculty since 1978. He served as a Department Chair at the Department of Kinesiology, Health Promotion, and Recreation at University of North Texas from 2010 to 2016. His principal professional interests are in measurement, research methods, and physical activity and health. He has authored over 100 publications including textbooks and research articles. His research and professional activities have been supported by over 1.5 million dollars in external funding. He is a fellow in the American College of Sports Medicine and the National Academy of Kinesiology and a member of the Science Board for the President's Council for Physical Fitness Sports & Nutrition. https://www.coe.unt.edu/facultystaff-department/allen-jackson
Tao Zhang, PhD is an Associate Professor in the Department of Kinesiology, Health Promotion, and Recreation at University of North Texas. He has made more than 80 research presentations at international and national conferences, published around 40 peer reviewed research articles, (co-)authored more than 60 peer reviewed research abstracts, conference papers and book chapters, and completed 12 funded research projects in the US and China. His research focuses on supportive school physical activity environments, achievement motivation, and youth physical activity and health promotion from social, psychological and behavioral perspectives. He was inducted as a Research Fellow in the Society of Health and Physical Educators (SHAPE America) in 2012, and earned the Mabel Lee Award from SHAPE America in 2013. He has been an active reviewer for 14 scholarly journals in Kinesiology and Education. He serves as the Editorial Board Members for the Journal of Teaching in Physical Education, Journal of Teaching, Research, and Media in Kinesiology, Journal of American College Health, and Women in Sport and Physical Activity Journal. https://www.coe.unt.edu/facultystaff-department/tao-zhang
Xiaozan Wang, PhD is a Professor and Dean of School of Physical Education & Health Care at the East China Normal University. Her research interests focus on three major areas: 1) physical education curriculum & instruction, 2) physical education teacher education, and 3) adolescent physical education learning behavior and health promotion. She has authored over 100 publications including textbooks and research articles. Her research and professional activities have been supported by over 40 national and federal external funding. http://faculty.ecnu.edu.cn/s/1348/t/15418/main.jspy
Qiang Guo, PhD is a Lecturer in the College of Physical Education at Ningbo University. His professional interests are in health promotion emphasizing physical activity epidemiology, physical fitness and obesity prevention. As a new researcher from China, he also focuses on the cooperative and comparative study in this field from an international perspective. He has published ten research papers in peer-reviewed journals and made more than 20 scholarly conference presentations in the US, Europe and China. He is also a member of the International Society for Physical Activity and Health (ISPAH), the Society of Health and Physical Educators (SHAPE America), and American College of Sports Medicine (ACSM). He has been invited to translate The Bangkok Declaration on Physical Activity for Global Health and Sustainable development into Chinese in 2017. http://www.ispah.org/resources