In reply to the comment of Kersting et al [...

Burchartz, Alexander

Eichsteller, Ana

Hanssen-Doose, Anke

Kolb, Simon

Niessner, Claudia

Nigg, Carina

Oriwol, Doris

Schmidt, Steffen C. E.

Woll, Alexander

Worth, Annette

Wunsch, Kathrin

Children

English

PubMed

KITopen

childrenReplyReply to Kersting et al. Comment on “Wunsch et al. The Impactof COVID-19 on the Interrelation of Physical Activity, ScreenTime and Health-Related Quality of Life in Children andAdolescents in Germany: Results of the Motorik-Modul Study.Children 2021, 8, 98”Kathrin Wunsch 1,* , Carina Nigg 1 , Claudia Niessner 1 , Steffen C. E. Schmidt 1 , Doris Oriwol 1,2 ,Anke Hanssen-Doose 2 , Alexander Burchartz 1 , Ana Eichsteller 1, Simon Kolb 1 , Annette Worth 2and Alexander Woll 1Citation: Wunsch, K.; Nigg, C.;Niessner, C.; Schmidt, S.C.E.; Oriwol,D.; Hanssen-Doose, A.; Burchartz, A.;Eichsteller, A.; Kolb, S.; Worth, A.;et al. Reply to Kersting et al.Comment on “Wunsch et al. TheImpact of COVID-19 on theInterrelation of Physical Activity,Screen Time and Health-RelatedQuality of Life in Children andAdolescents in Germany: Results ofthe Motorik-Modul Study. Children2021, 8, 98”. Children 2021, 8, 533.https://doi.org/10.3390/children8070533Academic Editor: Zoe KnowlesReceived: 19 May 2021Accepted: 16 June 2021Published: 23 June 2021Publisher’s Note: MDPI stays neutralwith regard to jurisdictional claims inpublished maps and institutional affil-iations.Copyright: © 2021 by the authors.Licensee MDPI, Basel, Switzerland.This article is an open access articledistributed under the terms andconditions of the Creative CommonsAttribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).1 Institute of Sports and Sports Science, Karlsruhe Institute of Technology, 76131 Karlsruhe, Germany;carina.nigg@partner.kit.edu (C.N.); claudia.niessner@kit.edu (C.N.); Steffen.schmidt@kit.edu (S.C.E.S.);doris.oriwol@partner.kit.edu (D.O.); alexander.burchartz@kit.edu (A.B.); ana.eichsteller@kit.edu (A.E.);simon.kolb@kit.edu (S.K.); alexander.woll@kit.edu (A.W.)2 Institute of Movement and Sport, University of Education Karlsruhe, 76133 Karlsruhe, Germany;anke.hanssen-doose@ph-karlsruhe.de (A.H.-D.); annette.worth@ph-karlsruhe.de (A.W.)* Correspondence: Kathrin.wunsch@kit.edu; Tel.: +49-721-608-45-431In reply to the comment of Kersting et al. [1], there is a need to mention that there aremultiple health behaviors, which may relate to health-related quality of life. Nudelmanand Shiloh attempted to cluster these behaviors and created a taxonomy consisting of66 health behaviors [2]. In a network analytic approach, they screened all those behaviorsfor interrelatedness and centrality [3] and found eating behavior to be one of the mostcentral ones. This, in turn, may substantiate the assumption determined by the authorsof the respective comment that dietary behavior may be as important in the prediction ofHRQoL as physical activity and screen time. A recent review and meta-analysis of Wu andcolleagues [4] support this assumption, as the authors found that dietary behavior wasindeed associated with health-related quality of life in children and adolescents.However, next to nutrition, Nudelman and Shiloh [2] identified three other relevantdomains of health behaviors: general well-being, risk avoidance, and health maintenance.Our current examination focused on the latter domain, which includes physical (in-)activity and exercise. Considering those four domains, we agree that nutrition mightbe an important factor when investigating relationships between health behaviors andhealth-related quality of life. For a comprehensive investigation, we would like to add thathealth behaviors of the remaining two categories, risk avoidance (e.g., substance use) andgeneral well-being including stress (e.g., stress, relationships), should also be added.Furthermore, we recommend that the directionality of the associations still needsto be investigated. Contrary to our hypothesis, we did not find physical activity to be asignificant predictor of health-related quality of life during the COVID-19 pandemic. Con-sidering the nutrition domain, there is only a limited number of studies that investigatedlongitudinal associations between dietary behaviors and health-related quality of life inchildren and adolescents [4], warranting future research to investigate if a positive longitu-dinal relationship exists across the developmental period of childhood and adolescence.In the context of the COVID-19 pandemic, only a few cross-sectional investigations exist,examining changes in nutrition behavior in the pediatric population [5], while we are notaware of any studies that investigated associations between nutrition and health-relatedquality of life.In conclusion, we would recommend investigating associations between health behav-iors and health-related quality of life beyond physical activity and screen time, includingChildren 2021, 8, 533. https://doi.org/10.3390/children8070533 https://www.mdpi.com/journal/childrenChildren 2021, 8, 533 2 of 2nutrition and dietary behaviors, in addition to health behaviors concerning general well-being and risk avoidance.Author Contributions: Writing—original draft preparation, K.W.; writing—review and editing, K.W.,C.N. (Carina Nigg), C.N. (Claudia Niessner), S.C.E.S., D.O., A.H.-D., A.B., A.E., S.K., A.W. (AnnetteWorth), A.W. (Alexander Woll); funding acquisition, A.W. (Annette Worth), A.W. (Alexander Woll).All authors have read and agreed to the published version of the manuscript.Funding: This work was supported by the Federal Ministry of Education and Research [01ER1503]within the research program ‘long-term studies’ in public health research. It has been developedwithin the Motorik-Modul Longitudinal Study (MoMo) (2009–2021): Physical fitness and physicalactivity as determinants of health development in children and adolescents. The funding sourceplayed no role in study design, data collection, analysis, and interpretation, but agreed to thesubmission of this manuscript.Institutional Review Board Statement: The study was conducted according to the guidelines ofthe Declaration of Helsinki, and approved by the Ethics Committee of the Karlsruhe Instituteof Technology.Informed Consent Statement: Informed consent was obtained from all subjects involved in the study.Data Availability Statement: Not appplicable.Conflicts of Interest: The authors declare no conflict of interest.References1. Kersting, M.; Kalhoff, H.; Lücke, T. Comment on Wunsch et al. The Impact of COVID-19 on the Interrelation of Physical Activity,Screen Time and Health-Related Quality of Life in Children and Adolescents in Germany: Results of the Motorik-Modul Study.Children 2021, 8, 98. Children 2021, 8, 520. [CrossRef]2. Nudelman, G.; Shiloh, S. Mapping health behaviors: Constructing and validating a common-sense taxonomy of health behaviors.Soc. Sci. Med. 2015, 146, 1–10. [CrossRef] [PubMed]3. Nudelman, G.; Kalish, Y.; Shiloh, S. The centrality of health behaviours: A network analytic approach. Br. J. Health Psychol. 2018,24, 215–236. [CrossRef] [PubMed]4. Wu, X.Y.; Zhuang, L.H.; Li, W.; Guo, H.W.; Zhang, J.H.; Zhao, Y.K.; Hu, J.W.; Gao, Q.Q.; Luo, S.; Ohinmaa, A.; et al. The influenceof diet quality and dietary behavior on health-related quality of life in the general population of children and adolescents: Asystematic review and meta-analysis. Qual. Life Res. 2019, 28, 1989–2015. [CrossRef] [PubMed]5. Zemrani, B.; Gehri, M.; Masserey, E.; Knob, C.; Pellaton, R. A hidden side of the COVID-19 pandemic in children: The doubleburden of undernutrition and overnutrition. Int. J. Equity Health 2021, 20, 44. [CrossRef] [PubMed]

Reply to Kersting et al. Comment on “Wunsch et al. The Impact of COVID-19 on the Interrelation of Physical Activity, Screen Time and Health-Related Quality of Life in Children and Adolescents in Germany: Results of the Motorik-Modul Study. Children 2021, 8, 98”

Kathrin Wunsch

Carina Nigg

Claudia Niessner

Steffen C. E. Schmidt

Doris Oriwol

Anke Hanssen-Doose

Alexander Burchartz

Ana Eichsteller

Simon Kolb

Annette Worth

Alexander Woll

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Reply to Kersting et al. Comment on “Wunsch et al. The Impact of COVID-19 on the Interrelation of Physical Activity, Screen Time and Health-Related Quality of Life in Children and Adolescents in Germany: Results of the Motorik-Modul Study. <i>Children</i> 2021, <i>8</i>, 98”

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Reply to Kersting et al. Comment on “Wunsch et al. The Impact of COVID-19 on the Interrelation of Physical Activity, Screen Time and Health-Related Quality of Life in Children and Adolescents in Germany: Results of the Motorik-Modul Study. Children 2021, 8, 98”

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