Abstract
BACKGROUND: There is evidence of a negative association between excessive screen time and health-related quality of life (HRQoL), and a positive association between higher levels of physical activity (PA) and HRQoL. However, research focusing on early childhood, a crucial period of development, and the formation and reinforcement of habits for long-term health outcomes remains scarce. This study examined the relationship between screen time and PA with HRQoL, after controlling for relevant confounders such as socioeconomic status (SES) and weight status in Spanish preschoolers. METHODS: A cross-sectional analysis was conducted using baseline data from the MOVI-HIIT study, which included 494 children aged 4-5 years from 9 schools in Ciudad Real, Spain. HRQoL was assessed using KINDL-R questionnaires completed by both children and parents. Screen time and PA were estimated through parental questionnaires and categorized according to international guidelines. Body mass index (BMI) and SES were included as covariates. Partial correlations and covariance analyses were performed. RESULTS: Among the participants, 68.6% adhered to the recommendation of ≤ 1 h/day of screen time, while 87.2% met the PA guideline of ≥ 180 min/day. Children exceeding screen time recommendations reported lower overall HRQoL, particularly among girls, even after adjusting for BMI, SES, and PA. Conversely, children meeting PA guidelines exhibited higher parent-reported overall HRQoL scores. CONCLUSIONS: Meeting recommendations of ≤ 1 h/day of screen time and ≥ 180 min/day of PA is associated with better HRQoL scores in 4- to 5-year-olds, with gender-specific differences. Interventions should promote healthy habits from early childhood, incorporating a gender perspective and emphasizing equitable physical activities and digital content monitoring.