Adverse Childhood Experiences and Quality of Life: A Mediating Role of Physical Activity

Abstract

Purpose

Examine whether barriers to physical activity (PA) and PA level serve as serial mediators to the relationship between adverse childhood experiences (ACEs) and perceived quality of physical health. Design: Cross-sectional. Setting: A public university in Southeast United States.

Subjects

Seventy-five participants (18- 49 years). Measures: Self-report measures related to ACEs, barriers to PA, amount of PA, and perceived quality of physical health.

Analysis

Serial mediation analysis. Barriers to PA was a first-order mediator, and PA level was a second-order mediator between ACEs and perceived quality of physical health.

Results

Barriers to PA and PA levels serially mediated the relationship between ACEs and perceived quality of physical health (c = −1.01, SE = .251, P = .0002, 95% CI [−1.50, −.499]). The direct effect of ACEs on perceived quality of physical health was nonsignificant when mediators were controlled (c’ = −.383, SE = .252, P = .133, 95% CI [−.886, .120]). Higher ACE scores were associated with more barriers to PA, lower PA levels, and in turn, lower perceived quality of physical health.

Conclusion

The current study highlights specific pathways that contribute to the relationship between ACEs and perceived quality of physical health. Albeit limited by the sample size, preliminary data support prioritization of interventions that reduce barriers to PA when trying to increase PA in populations that are prone to early adversity.

Keywords

Physical activity health ACEs

Purpose

Adverse Childhood Experiences (ACEs) are associated with heightened risk for health disparities and substance use in adulthood.¹ ACEs have the potential to have enduring effects on individual life trajectories.² One protective factor between ACEs and later physical health is physical activity (PA).³ Higher PA has been associated with outcomes including lower risk of health disparities⁴ and higher quality of life.⁵ Identifying and targeting the potential links between ACEs and adult PA and perceived quality of physical health may reduce one potential cause of health disparities throughout the life course. Thus, this study examined the most prevalent PA barriers and whether barriers to PA and PA level serve as serial mediators to the relationship between ACEs and perceived quality of physical health within a single sample and research study.

Methods

Design

A cross-sectional design. Individuals completed five questionnaires, in a research lab, related to their demographics, barriers to PA, PA levels, ACEs, and perceived quality of physical health via RedCAP. Participants were eligible for one of ten $25 dollar gift cards and/or SONA credit for their participation.

Sample

Seventy-five participants between 18 and 49 years of age (M = 21.81; SD = 4.75) who were undergraduate or graduate students currently attending a public university in Southeast United States. Participants were recruited using SONA subject pool, psychology courses, and listservs. The study protocol was approved by an Institutional Review Board (c1221.10e).

Measures

A variety of information related to participants were collected. Examples include race/ethnicity, age, and gender. The CDC Barriers to Being Active self-report questionnaire, (α = .91)⁶ the International Physical Activity Questionnaire-Short Form (IPAQ-SF), K = 1.00.⁷ Philadelphia ACES Questionnaire (α = .85),⁸ and the WHO Quality of Life-BREF (WHOQOL-BREF) (physical health domain, α = .70)⁹ were administered in the lab via an electronic survey.

Analysis

Frequencies for demographic characteristics were calculated (Table 1). All analyses were conducted using the Statistical Package for Social Sciences (SPSS), Version 26. Correlations were utilized to examine associations between, and independence of, ACE score, reported barriers to PA, self-reported PA, and perceived quality of physical health. Serial mediation analysis was conducted using Model 6 from the PROCESS macro for SPSS, Version 2.16.¹⁰ Barriers to PA was examined as a first-order mediator, self-reported physical activity as a second-order mediator, in the relation between ACEs, and perceived quality of physical health.

Table 1.

Demographic Characteristics of the Sample.

	M (SD)/Frequency (%)
Age	21.81 (4.75)
Gender (female)	53 (69.7)
Race (white)	54 (72.0)
Undergraduate	62 (82.7)

Results

The most prevalent barriers to PA were lack of energy (57.3%), lack of willpower (57.3%) and lack of time (56%). ACE scores were positively correlated with barriers to PA (r = .348, P = .01), and PA levels (r = .226, P = .05), and negatively correlated with perceived quality of physical health (r = −.385, P < .01).

A significant total effect was observed in the model (c = −1.01, SE = .251, P = .0002, 95% CI [−1.50, −.499]), Figure 1. The direct effect of ACEs on perceived quality of physical health was nonsignificant when mediators were controlled (c’ = −.383, SE = .252, P = .133, 95% CI [−.886, .120]). Additionally, several indirect effects were observed in this model. First, the total indirect effect of ACEs on perceived quality of physical health (ab = −.617, SE = .189, 95% CI [−1.04, −.299]) was significant. Second, higher ACE scores were associated with more barriers to physical activity and, subsequently, lower perceived quality of physical health (a₁b₁ = −.343, SE = .157, 95% CI [−.694, −.088]). Third, higher ACE scores were associated with higher physical activity levels, which related to lower perceived quality of physical health (a₂b₂ = −.374, SE = .185, 95% CI [−.783, −.073]). Finally, higher ACE scores were associated with more barriers to physical activity, lower physical activity levels, which successively related to lower perceived quality of physical health (a₁d₂₁b₂ = .099, SE = .060, 95% CI [.013, .246]).

Figure 1.

Serial mediation.

Discussion

Summary

The relationship between ACEs and physical health was serially mediated through barriers to PA and PA levels. Higher ACE scores were associated with more barriers to PA, lower PA levels, which was subsequently associated with lower perceived quality of physical health. Moreover, a specific indirect effect was observed through barriers to PA indicating that higher ACE scores were associated with more barriers to PA, which was then associated with lower perceived quality of physical health.

However, the specific indirect effect through PA level indicated that higher ACE scores were associated with higher PA levels, which was associated with lower perceived quality of physical health. This indirect effect is the opposite of what one would predict given the previous literature on ACEs, PA, and physical health. Past research suggest that higher ACE scores are associated with lower PA levels,¹¹ and higher PA is associated with better physical health.¹² Thus, data are inconsistent with the large body of literature suggesting PA can be seen as a potential resilience factor that can maintain/enhance physical health.

Limitations

The study has limited generalizability because the sample size is relatively small and consisted of predominantly White, female college students from one geographic location. The use of in-person, self-report methodology for the questionnaires may have biased participants to pick the more socially desirable answer.¹² Moreover, people tend to overestimate PA levels when using self-report measures.¹³ Future research should include subjective and objective measures of PA (e.g., actigraphy, accelerometer) and examine the impact of other protective factors (i.e., relationship with caregivers, problem solving skills, self-regulation) that serve as a pathway in the interrelations among ACES, PA, and perceived quality of physical health.

Significance

Higher ACE scores were associated with more barriers to physical activity lower perceived quality of physical health in adulthood. This indicates that ACEs have the potential to have enduring effects on individual life trajectories and health.² PA is a well-known approach to combat health disparities and improve physical and mental health outcomes.^5,11 Future research should use objective methods to explore the relationship between childhood adversity and adulthood perception of physical health. Additionally, there is a need for researchers to use innovative approaches to encourage and sustain physical activity in adulthood.

So What?

What Is Already Known on This Topic?

ACEs are associated with heightened risk for health disparities and substance use,¹ and individuals with higher ACEs scores are likely have lower physical activity levels .¹⁴ Higher levels of PA have been associated with lower risk of health disparities⁴ and higher quality of life.⁵

What Does This Article Add?

Preliminary evidence that barriers to PA and PA levels are important in understanding the relationship between ACEs and physical health. Specifically, higher ACE scores were associated with more barriers to PA, which was associated with lower physical health.

What Are the Implications for Health Promotion Practice or Research?

It reiterates the importance of implementing PA in daily life to enhance or maintain overall quality of physical health. Interventions reducing barriers to PA should be prioritized when trying to increase PA in populations prone to early adversity.

Footnotes

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.

ORCID iD

Loni J. Parrish

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