Associations Between Changes in 24-Hour Movement Behaviors in Children and Adolescents During the COVID-19 Pandemic: A Systematic Review and Mediation-Based Meta-Analysis

Adherence to 24-Hour Movement Guidelines before and during COVID-19 in children: A review

This study aims to describe and compare adherence to the 24-Hour Movement Guidelines (recommendations for physical activity, screen time, and sleep duration) among children before and during COVID-19 pandemic . The literature search was conducted on Web of Science, PubMed, MEDLINE, and SPORTDiscus for quantitative studies on 24-hour movement behaviors, published in English. The studies were categorized by collection date into before the pandemic (June 16th, 2016 - March 10, 2020) and during the pandemic (March 11th, 2020 - May 5, 2023), with all studies included. A random-effects model was employed to synthesize the adherence rates, and subgroup analyses were conducted based on age, sex, region, and Human development index (HDI) groups. Before the pandemic, 12.1% (95% CI:10.3%-13.9%) of overall children met the three recommendations. During the pandemic, 8.6% (95% CI: 6.4%-11.4%) of overall children met the three recommendations. The adherence to the three recommendations during the pandemic was 3.5% lower (p<0.05) than before the pandemic, with significant regional differences (p<0.05). Most children fail to meet the guidelines in any period. The adherence to the three 24-Hour Movement Guidelines during the pandemic was lower than before, with varying degrees of low adherence across different groups.

Home-Delivered Pediatric Weight Management for Low-Income Families: A Randomized Controlled Trial

BACKGROUND AND OBJECTIVES

Children from lower-income households lose less weight in family-based weight management interventions, likely due to barriers to treatment attendance and adherence. The CHECK randomized controlled trial tested whether delivering pediatric weight management interventions in the home improves weight loss outcomes relative to clinic-delivered intervention.

METHODS

Enrolled families included 269 children (137 boys) who were aged 6 to 12 years, had overweight/obesity, and lived in lower-income English- or Spanish-speaking households in Chicago, Illinois (2017-2022). All families received a 12-month pediatric weight management intervention with 18 planned in-person sessions and 12 planned telephone contacts. The sole difference between arms was the location (home vs clinic) of in-person intervention sessions. Intention-to-treat analyses compared treatment arms on 12-month change in BMI z-score (zBMI), intervention session attendance and contact time, and secondary clinical outcomes.

RESULTS

Twelve-month zBMI change did not differ (P = .58) between the home-delivered (n = 133; -0.031, SD = 0.26) and clinic-delivered arms (n = 136; -0.002, SD = 0.30). Across both arms, session attendance and total contact time predicted larger decreases in zBMI. Both variables were higher in the home-delivered arm (median = 11 sessions, 500 minutes) than the clinic-delivered arm (median = 6.5 sessions, 315.5 minutes; P values < .001). Post hoc analyses indicated that home-delivered (vs clinic-delivered) intervention led to 0.03 (SE = 0.008, P = .0004) greater zBMI reductions across time points prior to the COVID-19 pandemic, but not after.

CONCLUSIONS

Home delivery did not improve overall 12-month weight loss outcomes. Home-delivered intervention did increase session attendance and contact time and may have had beneficial weight loss effects prior to the COVID-19 pandemic.

Long-term follow-up of the impact of brief sleep and lifestyle interventions in infancy on BMI z-score at 11 years of age: The POI randomized controlled trial

OBJECTIVE

To determine whether BMI differences observed at 5 years of age, from early intervention in infancy, remained apparent at 11 years.

METHODS

Participants (n = 734) from the original randomized controlled trial (n = 802) underwent measures of body mass index (BMI), body composition (DXA), sleep and physical activity (24-h accelerometry, questionnaire), diet (repeated 24-h recalls), screen time (daily diaries), wellbeing (CHU-9D, WHO-5), and family functioning (McMaster FAD) around their 11th birthday. Following multiple imputation, regression models explored the effects of two interventions ('Sleep' vs. 'Food, Activity and Breastfeeding' [FAB]) using a 2 × 2 factorial design.

RESULTS

Five hundred twelve children (48% female, mean [SD] age 11.1 [0.1] years) returned for the 11-year assessment (63% of original sample). Significant differences in BMI z-score (mean difference; 95% CI: -0.16; -0.41, 0.08) or the risk of overweight (including obesity) (odds ratio; 95% CI: 0.85; 0.56, 1.29) were no longer observed between children who had received the sleep intervention compared with those who had not. By contrast, children who had received the FAB intervention had greater BMI z-scores (0.24; 0.01, 0.47) and a higher risk of obesity (1.56; 1.03, 2.36) than children not enrolled in FAB. No significant differences were observed in any lifestyle variables nor wellbeing measures across all groups.

CONCLUSIONS

Sustained reductions in BMI and obesity risk from an early sleep intervention were not apparent 9 years later, whereas a more traditional lifestyle intervention resulted in increased rates of obesity, not explained by any differences in lifestyle behaviours measured.

CLINICAL TRIAL REGISTRY

ClinicalTrials.gov number NCT00892983, https://clinicaltrials.gov/study/NCT00892983.

Mapping Evidence on Integrated 24-Hour Movement Behaviors in Children and Adolescents: A Scoping Review of Reviews

BACKGROUND

There has been a substantial increase in research on the new 24-hour movement paradigm, emphasizing the importance of considering the "whole day" and investigating integrated movement behaviors (physical activity, sedentary behavior, and sleep). This scoping review aims to map the evidence from reviews that have summarized information on integrated 24-hour movement behaviors in children and adolescents.

METHODS

Eight databases were searched in May 2023, with an update in October 2024. The review followed the PRISMA-ScR framework and the guidelines of the Joanna Briggs Institute Reviewer's Manual.

RESULTS

National 24-hour movement guidelines for children and adolescents exist in only a few countries (Australia, Canada, New Zealand, and South Africa). There is a lack of valid and reliable measurement tools for assessing 24-hour movement. Globally, children and adolescents, with and without disabilities, show low adherence to these guidelines. Reallocating time to moderate-to-vigorous physical activity was beneficial, while other reallocations had mixed results to health. COVID-19 reduced physical activity and increased screen time and sleep. Healthy movement behaviors are positively associated with better health outcomes in children and adolescents. There is a possible relationship between adherence to 24-hour movement behaviors and cognitive function, pollution measures, and eHealth interventions. Inconsistencies were identified in the terms used.

CONCLUSIONS

High-quality research is needed to develop measurement tools that assess the long-term health impact of 24-hour movement and to create solutions for improving adherence, mainly in countries lacking specific guidelines.

Impact of the COVID-19 Pandemic on Psychosocial Distress in Adolescents with Obesity Compared to Those with Type 1 Diabetes: Results from the KICK-COVID Study in Germany

INTRODUCTION

The aim of this study was to investigate the impact of the COVID-19 pandemic on psychosocial well-being in adolescents with obesity compared to those with type 1 diabetes.

METHODS

As part of the German KICK-COVID Study, adolescents aged 12-21 with overweight or obesity from the German/Austrian Adiposity Follow-up Registry (APV) completed well-being, anxiety, and depression questionnaires (WHO-5, GAD-7, PHQ-9) during routine visits amidst the COVID-19 pandemic. By multivariable linear regression models, adjusted for age, gender, and immigration background, the association between psychosocial distress, anthropometrics, and cardiometabolic risk factors was analyzed. Data were compared to those of youth with type 1 diabetes from the German/Austrian Diabetes Follow-up Registry (DPV) and normative values from the general population. Additionally, a mediation analysis examined the impact of loneliness on mental health through media consumption.

RESULTS

From June 2021 to September 2023, 235 adolescents from 6 German and 1 Austrian pediatric obesity centers were enrolled. Results were compared to 235 age- and gender-matched participants from the DPV registry (54.04% males; mean age 15.21 ± 1.66 years) and normative values. Youth with type 1 diabetes were more anxious about their health risk, but distress factors were more pronounced in the APV group (p < 0.001). Girls from the APV group showed higher mental distress than boys across all applied questionnaires, but not for age, BMI-SDS, and migration background as predictors. Perception of loneliness correlated with poorer mental health outcomes, but it was not associated to media consumption. Comparisons with normative values revealed significantly higher depression and anxiety scores (p < 0.001) and lower well-being scores in the APV group (p < 0.01).

CONCLUSIONS

Youth with obesity and diabetes experienced significant psychosocial distress during the COVID-19 pandemic. Disease-specific differences were observed on the level of single items: Adolescents with type 1 diabetes expressed heightened concern about their health risks, while those with obesity reported lower self-esteem, increased suicidal thoughts, and fluctuating appetite. Female gender appeared to pose an additional risk factor. Media consumption was notably higher in the APV cohort. Healthcare providers should be vigilant regarding psychological comorbidities in youth with chronic conditions, particularly during periods of heightened stress.

Exploring Physical Activity Among Mexican American Immigrants in New York City Before and During the COVID-19 Pandemic: A Two-Wave Panel, Mixed-Method Analysis

The COVID-19 pandemic was associated with decreases in moderate-to-vigorous physical activity and increases in sedentary time for children and adults, and there is some evidence that Latino populations were particularly affected. This article leverages a two-wave panel, mixed-method social network dataset collected before and during the pandemic with Mexican American immigrants living in New York City to examine social networks and other factors associated with physical activity and explore participants' perceptions about how the pandemic affected their physical activity. Participants (n = 49) completed in-person, egocentric social network interviews between January and June 2019 and virtual follow-up egocentric social network interviews between May and November 2021. Qualitative data collection with a subsample (n = 25) occurred between October and December 2022. Social network quantitative analyses found that age and female sex were negatively associated with participants' baseline physical activity level, but the proportion of alters (important persons identified by the participant) with whom the participant did physical activity at baseline was positively associated. Baseline physical activity level was inversely related to the change in physical activity, and the change in the proportion of alters who were close to the participant was negatively associated with physical activity change at follow-up. Qualitative results supported the quantitative findings, providing rich narratives regarding the importance of social support for physical activity during the pandemic. Social networks among Mexican American immigrants in New York City provided motivation and support for physical activity but became harder to sustain during a pandemic. The findings can inform strategies to create environments that are conducive to physical activity while also protecting public health.

Toward a whole-of-virtual school framework for promoting student physical activity: a scoping review protocol

BACKGROUND

The advent of full-time virtual schooling presents unique challenges and opportunities for the promotion of physical activity (PA) among children and adolescents. Despite the recognized benefits of PA as an essential component for combating non-communicable diseases and ensuring holistic development, there is a notable gap in understanding how to effectively integrate PA within the digital learning environments of full-time virtual schools. Current efforts to promote student PA are targeted for implementation exclusively in contexts characterized by physical school campuses that are bound to their surrounding local communities. This is problematic given the digital, widely distributed, and contextually unmoored nature of virtual schooling. Our aim in this scoping review is to advance research on whole-of-school physical activity promotion within full-time virtual schools by examining the published literature on whole-of-school PA promotion within full-time virtual schools. Specifically, this review will map the literature, consolidate knowledge claims and practical implications, and identify evidence gaps that merit further investigation.

METHODS/DESIGN

This review will be conducted using evidence-informed scoping review methodology and reporting guidelines. Articles will be included if they are peer-reviewed English-language research, commentary, practical, or grey literature and relate to the participation, support, design, development, and/or provision of remote online PA interventions delivered through primary/elementary and/or secondary/middle school/high schools. Searches will be conducted in PsycInfo, ERIC, SportDiscus, and Web of Science. Additional hand-searching, reference scans, and grey literature searches will also be performed. Two trained research assistants will independently complete study screening and selection and data charting with guidance from a senior author. Charted data will be displayed in table form, and depending on the results, data will also be synthesized through qualitative content analysis using the Active Schools guiding framework as an analytical and interpretive lens.

DISCUSSION

This scoping review will serve as a guidepost for the application and advancement of research on whole-of-school PA promotion through full-time virtual schools. The results will address the increased importance of equitable online learning and PA promotion due to the expanding virtual education landscape, with implications for public health and education policy.

SYSTEMATIC REVIEW REGISTRATION

Open Science Framework:  https://osf.io/f6wau/ .

Secular trends in the prevalence of meeting 24-hour movement guidelines among U.S. adolescents: evidence from NHANES 2007-2016

Background

The 24-Hour Movement Guidelines (24-HMG) recommend a balanced combination of physical activity (PA), sedentary behavior (SB) and sleep (SLP) for optimal health. However, there is limited understanding of how well U.S. adolescents adhere to these guidelines. This study aims to analyze the prevalence trends of meeting the 24-HMG among a nationally representative sample of U.S. general adolescents.

Methods

The study included 2,273 adolescents (55.3% boys) aged 16-19 who participated in the National Health and Nutrition Examination Surveys (NHANES) from 2007 to 2016. The researchers categorized the adolescents based on whether they met various PA, SB, and SLP recommendations, as well as different combinations of these recommendations, separately for boys and girls. The prevalence rate, weighted by survey data, was calculated along with a 95% confidence interval (CI) to assess the changes in meeting the 24-HMG among U.S. adolescents across different survey years and sociodemographic subgroups.

Results

In the 2015-2016 cycle, approximately 6.3% of adolescents did not meet any of the three recommendations, while only 19.2% of adolescents achieved all three guidelines. Compliance with PA and SB recommendations among adolescents has decreased over time, from 72.5% (65.9% to 79.2%) to 64.2% (57.4% to 70.9%) for PA, and from 59.0% (49.6% to 68.4%) to 46.6% (37.8% to 55.5%) for SB, respectively, from 2007-2008 cycle to 2015-2016 cycle. Boys exhibited more favorable patterns in meeting different sets of recommendations compared to girls (p-value <0.001). This includes meeting both PA and SB guidelines (15.5% for boys and 11.1% for girls) and meeting both PA and SLP guidelines (19.5% for boys and 15.7% for girls). The level of parental education was found to have effect on meeting all three guidelines (Ptrend < 0.05).

Conclusion

We analyzed ten consecutive years of representative NHANES data to evaluate the prevalence meeting 24-HMG and found that the proportion of adolescents aged 16-19 in the U.S. who adhered to all three movement guidelines simultaneously has consistently remained low throughout each survey cycle. Notably, there has been a significant decline in the proportion of adolescents meeting the SB guideline.