Piya-amornphan et al. BMC Pediatrics(2020) 20:118
https://doi.org/10.1186/s12887-020-2017-2

RESEARCH ARTICLE

Open AccessPhysical activity and creativity of children
and youths
Nitita Piya-amornphan* , Anoma Santiworakul, Salila Cetthakrikul and Phatcharawadee Srirug

Abstract
Background: Childhood is an important period for developing maturity in thinking. Accumulating evidence shows theassociation between physical activity and cognitive function. Although both the intelligence quotient and emotional
quotient have been reported to be associated with physical activity, there is a limited amount of published research
regarding the association between physical activity and cognitive function in children and youths. With respect tocreativity, an important skill for the twenty-first century, little evidence on the creative quotient promotion in childhood
is available. The present study, therefore, is designed to explore the correlation between physical activity and creativity.
Methods: The participants included 1447 students with different age groups in 34 schools from Southern Thailand.
Age groups were categorized according to Thailand’s 2016 Report Card on Physical Activity for Children and Youth,
where 521 students were aged 6–9 years, 487 students were aged 10–13 years, and 439 students were aged 14–17
years. Creativity was measured through the use of the Test for Creative Thinking-Drawing Production (TCT-DP). Active
play, time with family and peers, and sedentary behavior were monitored by the Thailand Physical Activity Children
Survey-the Student Questionnaire (TPACS-SQ).
Results: The correlation between the TCT-DP score representing creativity and active play was noticed in adolescents(r = 0.148, p = 0.001), but not found in participants aged 6–13 years. Active play was associated with time with family
and peers in all age groups (r = 0.485, p < 0.001).
Conclusions: The present data supports the idea that optimal physical activity is required during childhood fordeveloping thinking process. Promotion of active play with family and peers may facilitate creativity skills.
Keywords: Childhood cognitive function, Creativity, Intelligence, Physical activity

BackgroundPhysical activity is known to affect health outcomesthroughout one’s life [1, 2]. The optimal level of physicalactivity can improve health status and reduce the incidence of chronic diseases (e.g. cardiovascular disease, diabetes, cancer, and depression) [2, 3]. The World HealthOrganization recommends that adults should perform
aerobic physical activity for at least 150 min at moderateintensity or 75 min at vigorous intensity throughout theweek, whereas children and youths should accumulate at* Correspondence: nitita.do@wu.ac.th
Department of Physical Therapy, School of Allied Health Sciences, Walailak
University, Nakhon Si Thammarat 80160, Thailand

least 60 min of moderate to vigorous intensity physical activity daily [3]. In children and youths, the nine common
indicators related to physical activity have been identified
by the global matrix of grades. The indicators include thefollowing five behaviors: 1) overall physical activity, 2) organized sport participation, 3) active play, 4) active transportation, and 5) sedentary behavior; and the following
four key influences: 1) family and peers, 2) school, 3) community and built environment, and 4) government strategies and investments [4]. Literature showed that active
play, sedentary behavior, and time with family and peers
have been frequently studied. Physical activity has beenmarkedly achieved through active play, active play was reported to increase physical activity and prevent childhood© The Author(s). 2020 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License,
which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give
appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate ifchanges were made. The images or other third party material in this article are included in the article's Creative Commonslicence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commonslicence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to thedata made available in this article, unless otherwise stated in a credit line to the data.

Piya-amornphan et al. BMC Pediatrics(2020) 20:118

obesity [5, 6]. Family and peers provide the social support
for promoting physical activity, it includes situations andconditions in which parents/peers facilitate physical activity for their children/friends [7]. Family and peers have astrong impact on physical activity during childhood. Thereis evidence showing that parenting practices are associatedwith how children prefer to play [7, 8], peer relationships
enhance an engagement in team sports and other physicaland leisure activities as well [9, 10]. Sedentary behavior
has been classified as behavior that falls under the screentime guidelines [11]. In contrast to indicators potentiating
physical activity (i.e. active play and time with family andpeers), sedentary behavior is a global health risk leading toan increased rate of premature death, especially from noncommunicable diseases [11]. Although active play, timewith family and peers, and sedentary behavior have significantly affected physical activity in children and youths, theassociation among these indicators are still elusive.
Whether they interact with each other should be clarified.
Besides health improvement and disease prevention, physical activity among young people is important for growth anddevelopment [11, 12]. Regarding cognitive function, brain
function and academic achievement have been reported to be
associated with physical activity [13–15]. The association between physical activity, healthiness, and the intelligence quotients of 135 high school students in Jeddah in the Kingdomof Saudi Arabia was reported, and the findings indicated thatthe intelligence quotient was positively associated with physical activity and health status [16]. In addition, there is evidence that demonstrates a positive link between theemotional quotient and physical activity in 599 Taiwanese college students [17]. Higher emotional quotient was also associated with longer duration of exercise (weekly hours) in 64
participants with a mean aged of 19.88 years [18]. Taken together, these cross-sectional studies revealed that an increasein physical activity was associated with both higher intelligencequotient and emotional quotient in childhood.
Critical thinking, communication, collaboration, and creativity have been classified as the most prominent twentyfirst century competencies identified on the basis of making
a measurable contribution to educational accomplishments,
relationships, employment, and health and well-being outcomes [19]. Creativity has been defined as the ability to produce novel and appropriate work. Novel work means originalor unexpected, while appropriate work implies useful oradaptive [20, 21]. Creativity is important for social development because that lead to driving innovation and responding
to unforeseen problems [19]. Cognitive abilities attributed toprefrontal cortex function are required for creativity. In
humans, the prefrontal cortex does not completely mature
until the early 20s [20, 21]. Childhood, thus, is a valuable
time for development of creative skills. Information showing
how to promote creativity development according to cognitive milestones is required. The objectives of the present

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study therefore aimed at exploring the correlation between
physical activity and creativity in children and youths. Indicators of physical activity including active play, time with family
and peers, sedentary behavior, and their relevant associations
were also areas of focus in this study.

Methods
Stratified sampling

The sample size in Thailand’s 2016 Report Card on Physical
Activity for Children and Youth was calculated based on thenumber of students across the country, and a multistage
stratified cluster sampling was adopted to recruit students
into the study. Thailand geographically is divided into 9 regions with 77 provinces and 878 districts. All provinces
within each region were stratified according to their population size. Each province was then randomly recruited; thecity districts were purposively selected and other districts
were randomly chosen. Schools were finally randomly enlisted, herein the response rate was approximately 84.3% of
those invited. Students within each school were then classified by gender and age, and they were proportionally recruited according to the size of the school. Participants weredivided into three age groups, which included 6–9, 10–13,
and 14–17 years of age [11]. These age groups were mainlyclassified by the age structure and education in Thailand.
The classification reflected the differences in physical andcognitive development milestones among each age group.
All healthy students were included in the study. Skeletal orother diseases affecting physical activity had not been reported in each student. Height, weight, and body mass index
were screened in all students before data collection. In thepresent study, data was collected from 1447 students in 34
schools from Southern Thailand. These students completed
responses to both the physical activity questionnaire andcreativity test. There were a negligible number of students
declining the participation.
Physical activity survey

The data set of physical activity in the present study isthe same set reported in Thailand’s 2016 Report Cardon Physical Activity for Children and Youth. Physicalactivity of students was assessed by using the Thailand
Physical Activity Children Survey-the Student Questionnaire (TPACS-SQ). TPACS-SQ was developed for eachage group in order to accommodate the differences instudent capability and maturity classified by the age
structure and education in Thailand. All healthy students were asked the number of days that they retained
activity/behavior as recommended per day over the past
7 days, and a list of activities such as play, sports, recreation, and leisure activity was provided to students inall age groups as an example. For students aged 6 to 9
years, face-to-face interviews were conducted within aclass by using image cards. In the other two older age

Piya-amornphan et al. BMC Pediatrics(2020) 20:118

groups, the students completed the survey in a classfacilitated by three research team members and aclass teacher. Test-retest reliability of the items measuring physical activity was reported in the study ofAmornsriwatanakul et al. in 2016 [11].
Creativity assessment

Creativity was determined in the present study throughthe use of the Test for Creative Thinking-Drawing Production (TCT-DP) carried out following the protocol of
Urban reported in 2004 [22, 23]. The reliability and validity of TCT-DP has been provided in many studies [22,23], and it has been previously reported that experiencein drawing is unrelated to the TCT-DP score [23]. When
finishing a physical activity survey, the same set of research team members informed the students how to do
the test. Participants were asked to complete a drawing
with six flawed elements placed on a creativity test sheet©
Jellen and Urban (1989) (Fig. 1) [24], all students performed this test autonomously and by themselves. An assessment of the TCT-DP consisted of fourteen criteria
which include the following: 1) continuations, 2) completions, 3) new elements, 4) connections made with a line,5) connections that contribute to a theme, 6) boundary
breaking that is fragment-dependent, 7) boundary breaking that is fragment-independent, 8) perspective, 9) humor

Fig. 1 A form of TCT-DP, Urban and Jellen (1989)

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and affectivity, 10) unconventionality with, manipulationof the test material, 11) unconventionality with, abstractelements, 12) unconventionality in the use of symbols, 13)
unconventionality with, unconventional usage of the given
fragments, and 14) speed [23]. These creativity scores
were independently assessed by three research team members in which the final TCT-DP result was the sum of thepoints obtained in all tested criteria. All creativity results
were double-checked by the lead author.
Statistical analysis

Data of the physical activity survey were carried out by using
CSPro V6.1 (U.S. Census Bureau). In the present study, allanalyses were conducted through using SPSS V21. KruskalWallis test was used to determine the difference of physicalactivity indicators and creativity among age groups. Correlation analyses was then performed with the Spearman’s
correlation. Association between physical activity indicators,
including active play, time with family and peers, and sedentary behavior, and creativity was primarily monitored. Correlation among these physical activity indicators was also
ascertained. The statistical significance level was p-value ≤0.05.
The Spearman correlation coefficient generally indicated weak,moderate, or strong association between variables. Regression
analysis was also performed to determine the impact ofphysical activity indicator on creativity score.

Piya-amornphan et al. BMC Pediatrics(2020) 20:118

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Results
Participant characteristics

All healthy students were included in the present study
in which health status was screened through their healthreport obtained from a class teacher. No health problem
was reported for all students. Skeletal or other diseases
affecting physical activity had not been informed in each
student, impairment of motor and cognitive functions
was also not noticed. Height, weight, and body massindex of all participants were in normal range. The datafrom 1447 students were categorized into three agegroups, which included 6–9 years, 10–13 years, and 14–
17 years based on the age structure and education in
Thailand (Supplementary Table 1). The number of students in each group ranged from 439 to 521. There wereno markedly differences in gender proportion among
any of the groups (Supplementary Table 1).
Physical activity pattern and the creativity score

With respect to the TPACS-SQ and guideline for physical activity in children and youths, any day with at least 60 min of
active play was recorded, and it was found that children andyouths spent between 3 and 4 days per week on average inrecommended active play. In addition to active play, spending
over 2 h per day with family and peers was determined; the results of the survey indicated that participants did this around2 days per week on average. When measuring sedentary behavior, the findings indicated that participants engaged in sedentary behavior that was not more than 2 h per day for about
3 to 4 days per week on average. Duration patterns of physicalactivity indicators in each age group were similar. They spent
the most amount of time in sedentary behavior followed by
active play followed by the least amount of time being spent
with family and peers (Table 1). Adolescents were the mostsedentary (Table 1). The total TCT-DP scores which indicatedcreativity ability in the present study ranged between 9 and 69
points, and the TCT-DP score increased in accordance withthe age group (Table 1).
Correlation between physical activity indicators andcreativity

In children aged 6–9 years and 10–13 years, the TCTDP score was not associated with all three indicators ofphysical activity (Table 2). The correlation between creativity and active play was present in participants aged
14–17 years (Fig. 2). Impact of active play on creativity
was analyzed by using regression analysis. It was
showed that TCT-DP was not depended on active play
(Supplementary Table 2).
Association among the physical activity indicators ofchildren and youths

Association among three physical activity indicators, including active play, time with family and peers, and sedentary behavior was observed in 1447 participants, aged 6–
17 years. All indicators were associated with each other,
the highest level of association was an association between
active play and time with family and peers (Table 3).

Discussion
Physical activity indicators reported in the present study
partly conduced a grading of the physical activity indicators showed in Thailand’2016 Report Card [11]. It was
found that children and youths had an active play gradeof “F”, indicating that only 0–20% of them met the defined benchmark. At the same time, sedentary behaviorof children and youths received a grade of “D–”, meaning that 21–25% of them met the optimal level. A better
grade was given to the time spent with family and peers,in which 66–75% of children and youth met the guideline, resulting in a grade of “B” [11]. Taken together,
Thai children and youths lowly participated in physicalactivity and active play, their sedentary behaviors arehigh. These results also reflect an increasing in physicalinactivity and sedentary behavior among children andyouths [11, 25]. Since physical inactivity and sedentary
behavior have contributed to the global burden of various morbidities and premature mortality [26]. This incident in children and youths thus should be strongly
concerned. In the present study, active play was foundto be associated with time spent with family and peers
in all age groups. It supports the idea that the family andpeers is an important factor for enhancing physical activity in children and youths [7–10]. A strategy for increasing active play and time spent with family and peers
combined with a lessening in sedentary behavior may

Table 1 Baseline of physical activity and creativity
6–9 yearsn = 521

10–13 years
n = 487

14–17 years
n = 439

p–value

Active play at least 60 min (day/week)

3 (0–7)

3 (0–7)

3 (0–7)0.173

Family and peers at least 2 h (day/week)

2 (0–7)

2 (0–7)

2 (0–7)0.172

Sedentary behavior not more than 2 h (day/week)

3 (0–7)

3 (0–7)

2 (0–7)0.039*

20 (10–46)

21 (9–43)

24 (11–69)< 0.001***

Parameters
Physical activity indicator

TCT-DP

Data expressed as median (min–max), * p-value ≤ 0.05; *** p-value ≤ 0.001

Piya-amornphan et al. BMC Pediatrics(2020) 20:118

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Table 2 Physical activity indicators and creativity
Physical activity indicator

TCT–DP
6–9 yearsn = 521

10–13 years
n = 487

14–17 years
n = 439

Correlation coefficient (r)

0.010

0.014

0.148***

p–value

0.408

0.379

0.001

Correlation coefficient (r)

0.056

0.020

0.040

p–value

0.099

0.327

0.204

Correlation coefficient (r)−0.0340.056−0.050p–value

0.217

0.108

0.150

Active play

Family and peers

Sedentary behavior*** p-value ≤ 0.001

fight against the problems of an increasing physicalinactivity and sedentary behavior and support healthpromotion in children and youths.
The mean and range of the TCT-DP score of children
and youths in the present study were in line with the previous studies [27–30], it also indicated that there was alimited number of students with high-creativity abilities.
An increasing in the TCT-DP according to age group canbe explained by the fact that the brain region involved ingenerating creative ideas does not mature until humans
pass their 20th birthday [20, 21]. Differences in creative
thought were discovered between different age groups,

Fig. 2 Correlation between active play and creativity

using functional magnetic resonance imaging while participants carried out divergent thinking tasks [31]. It wasdemonstrated that default and executive networks weremore functionally coupled for creative process in older
than younger adults [31]. Although age has been found toaffect creativity, there is a creativity difference among agematched individuals [32]. This fact supports the idea thata high creativity ability may associate with other factors affecting cognitive function. The present study thus aimed
at exploring the correlation between physical activity indicators and creativity in children and youths. Creativity wasdetermined through using TCT-DP which has been considered a reliable test [23]. However, Jankowska et al. [30].
reported that TCT-DP might also require a specific profile
of gaze distribution or self-regulation strategies because
the more time participants spent looking at the manypieces in the test sheet, the higher their scores were. The
dwell time for a single fragment, in contrast, wasnegatively related to the TCT-DP score [30].
As mentioned previously, the optimal level of physical activity has been reported to improve cognitive function [1–3].
In childhood, physical activity is associated with theintelligence and emotional quotients [16–18]. Latorre Románet al. in 2017 [33], reported the association between physicalfitness and creativity in elementary school children (n = 308,
age from 8 to 12 years). The participants completed a fitness
test battery and the Prueba de Imaginación Creativa para
Niños (PIC-N; Creative Imagination Test for Children). It
was observed that physical fitness was positively correlatedPiya-amornphan et al. BMC Pediatrics(2020) 20:118

Page 6 of 7

Table 3 Correlation among the children and youth’s physical activity indicators
Physical activity indicator

Active play

Family and peers

Sedentary behavior

1.000

0.485***

0.081**< 0.001

0.002

1.000

0.088***

Active play
Correlation coefficient (r)p–value
Family and peers
Correlation coefficient (r)0.485***

p–value< 0.001

0.001

Sedentary behavior
Correlation coefficient (r)0.081**

0.088***

p–value

0.002

0.001

1.000

n = 1447, ** p-value ≤ 0.01; *** p-value ≤ 0.001

with creativity, and boys had better physical fitness andhigher creativity skill [33]. In the present study, the differencein creativity were not observed between genders. The association between creativity and physical activity indicators was
specifically monitored according to age groups divided by
the age structure and education in Thailand. The result thus
reflects that association in each age group in which their cognitive and physical functions are different. In addition, thisstudy pointed to the physical activity indicators, including active play, time with family and peers, and sedentary behavior
which has been frequently reported to affect physical activity
and physical fitness in children and youth [5–10]. The results showed that creativity was associated with active playin adolescents; however, the association was not found inparticipants aged 6–14 years. All results of physical activity
indicators were collected by using a self-report instrument, recall ability has been reported as a weakness of theself-report instrument [11]. Recalling the types andamount of time spent in physical activity might be difficult
for children, especially in the youngest age group [11].
Since active play has been reported as the directly indicator of physical activity in children and youths [5, 6]. The
present study thus supports the finding that physical activity is essential for cognitive development in children andyouths [13–15]. Increased physical activity, especially inactive play may be a strategy for facilitating creativity.
Nevertheless, the present results also implied that there
are many factors related to creativity. To enhance creativity ability in this generation, more information is needed
to clarify other factors associated with creativity.
Limitations and future plan

Health status reported in the present study was observed
only through health report obtained from a class teacher,but more demographic and health condition information
should be considered for future studies as well. As physical activity is important for cognitive function and related with intelligence quotient, emotional quotient, andcreativity skills in childhood. Future longitudinal study

thus plan to investigate the difference of these variables
in adolescents with low and high physical activity. An
objective measurement of behaviors and a screening tool
for assessing the time spent with family and peers should
be consider included.

Conclusions
Physical activity is important to good health, especially inchildhood, which is the golden period for physical andmental development. Physical activity has been reported
to enhance both the intelligence quotient and emotional
quotient. The present study supports the positive correlation between physical activity and creativity ability; indeed, the active play indicator was dominant.
Supplementary information
Supplementary information accompanies this paper at https://doi.org/10.
1186/s12887-020-2017-2.
Additional file 1 Supplementary Table 1. Characteristics ofparticipants. Supplementary Table 2. Impact of active play on
creativity.
Additional file 2. Raw data.
Abbreviations
TCT-DP: Test for Creative Thinking-Drawing Production; TPACS-SQ: Thailand
Physical Activity Children Survey-the Student Questionnaire
Acknowledgements
The data of physical activity in the present study were obtained from the
Physical Activity Research Centre (PARC). The PARC committee was officially
set up and authorized by the Thai Health Promotion Foundation(ThaiHealth). This research was also partially supported by the new strategic
research (P2P) project, Walailak University. The authors would like to thankProf. Dr. Narattaphol Charoenphandhu, M.D., Ph.D., Assoc. Prof. Apichai
Wattanapisit, M.D., Assoc. Prof. Dr. Jitbanjong Tangpong, Ph.D., and Assoc.
Prof. Dr. Manas Kotepui, Ph.D. for their kind support. We are also grateful to
Mr. David C. Chang for English manuscript editing.
Authors’ contributions
N.P., A.S., S.C. and P.S. have performed research; N.P. has designed theresearch; N.P., A.S., S.C. and P.S.have analyzed data. N.P.wrote the paper andat the same time the corresponding author. The author(s) read andapproved the final manuscript.

Piya-amornphan et al. BMC Pediatrics(2020) 20:118

Funding
Research grant came from the Institute of Research and Innovation, Walailak
University (WU59401 to Nitita Piya-amornphan). This funding source had norole in the design of the study and did not have any role in collection, analysis, and interpretation of data or in writing the manuscript.
Availability of data and materials
Not applicable in regard to the raw data of physical activity because thedata was entered in a specific program (CSPro V6.1) and it is authorized by
the Physical Activity Research Centre (PARC). The data represented in thepresent study, including active play, time spent with family and peers,
sedentary behavior, and creativity scores are provided in an additional
supporting file.
Ethics approval and consent to participate
The study protocol in the present study received ethical approval from the
Ethical Clearance Committee on Human Rights related to research involving
human subjects, Walailak University. The protocol number was 15/036.
Written informed consent for participation was obtained from all participants
and guardians of participants aged less than 16 years old, in which theyreceived the information sheet through an active school consent procedure.
Children were provided an opportunity to decline participation in the survey.
The study protocol of Thailand’s 2016 Report Card on Physical Activity forChildren and Youth also received ethical approval from the University ofWestern Australia and the Institution for the Development of Human
Research Protections in Thailand.
Consent for publication
Not applicable.
Competing interests
None.
Received: 23 May 2019 Accepted: 2 March 2020

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