Longitudinal changes in objectively-measured physical activity and sedentary time among school-age children in Central Texas, US during the COVID-19 pandemic

Physical activity and sleep changes among children during the COVID-19 pandemic

Daily routines, including in-person school and extracurricular activities, are important for maintaining healthy physical activity and sleep habits in children. The COVID-19 pandemic significantly disrupted daily routines as in-person school and activities closed to prevent spread of SARS-CoV-2. We aimed to examine and assess differences in objectively measured physical activity levels and sleep patterns from wearable sensors in children with obesity before, during, and after a period of school and extracurricular activity closures associated with the COVID-19 pandemic. We compared average step count and sleep patterns (using the Mann-Whitney U Test) before and during the pandemic-associated school closures by using data from activity tracker wristbands (Garmin VivoFit 3). Data were collected from 94 children (aged 5-17) with obesity, who were enrolled in a randomized controlled trial testing a community-based lifestyle intervention for a duration of 12-months. During the period that in-person school and extracurricular activities were closed due to the COVID-19 pandemic, children with obesity experienced objectively-measured decreases in physical activity, and sleep duration. From March 15, 2020 to March 31, 2021, corresponding with local school closures, average daily step count decreased by 1655 steps. Sleep onset and wake time were delayed by about an hour and 45 min, respectively, while sleep duration decreased by over 12 min as compared with the pre-closure period. Step counts increased with the resumption of in-person activities. These findings provide objective evidence for parents, clinicians, and public health professionals on the importance of in-person daily activities and routines on health behaviors, particularly for children with pre-existing obesity. Trial Registration: Clinical trial registration: NCT03339440.

Accelerometer-measured 24-hour movement behaviours over 7 days in Malaysian children and adolescents: A cross-sectional study

BACKGROUND

Quantifying movement behaviours over 24-hours enables the combined effects of and inter-relations between sleep, sedentary time and physical activity (PA) to be understood. This is the first study describing 24-hour movement behaviours in school-aged children and adolescents in South-East Asia. Further aims were to investigate between-participant differences in movement behaviours by demographic characteristics and timing of data collection during Ramadan and COVID-19 restrictions.

METHODS

Data came from the South-East Asia Community Observatory health surveillance cohort, 2021-2022. Children aged 7-18 years within selected households in Segamat, Malaysia wore an Axivity AX6 accelerometer on their wrist for 24 hours/day over 7 days, completed the PAQ-C questionnaire, and demographic information was obtained. Accelerometer data was processed using GGIR to determine time spent asleep, inactive, in light-intensity PA (LPA) and moderate-to-vigorous PA (MVPA). Differences in accelerometer-measured PA by demographic characteristics (sex, age, ethnicity, socioeconomic group) were explored using univariate linear regression. Differences between data collected during vs outside Ramadan or during vs after COVID-19 restrictions, were investigated through univariate and multiple linear regressions, adjusted for age, sex and ethnicity.

RESULTS

The 491 participants providing accelerometer data spent 8.2 (95% confidence interval (CI) = 7.9-8.4) hours/day asleep, 12.4 (95% CI = 12.2-12.7) hours/day inactive, 2.8 (95% CI = 2.7-2.9) hours/day in LPA, and 33.0 (95% CI = 31.0-35.1) minutes/day in MVPA. Greater PA and less time inactive were observed in boys vs girls, children vs adolescents, Indian and Chinese vs Malay children and higher income vs lower income households. Data collection during Ramadan or during COVID-19 restrictions were not associated with MVPA engagement after adjustment for demographic characteristics.

CONCLUSIONS

Demographic characteristics remained the strongest correlates of accelerometer-measured 24-hour movement behaviours in Malaysian children and adolescents. Future studies should seek to understand why predominantly girls, adolescents and children from Malay ethnicities have particularly low movement behaviours within Malaysia.

Effects of non-pharmacological interventions on youth with internet addiction: a systematic review and meta-analysis of randomized controlled trials

Objective

To assess the overall effectiveness of non-pharmacological interventions on internet addiction (IA) in youth.

Method

Randomized controlled trials (RCTs) published from their inception to April 1, 2023 were searched in Cochrane, Embase, Medline, Web of Science, China National Knowledge Infrastructure, China Science and Technology Journal Database, Chinese BioMedical Literature Database, and WanFang Data. Two reviewers independently extracted data and evaluated bias using the Cochrane Risk of Bias tool.

Results

Sixty-six studies performed from 2007 to 2023, with a total of 4,385 participants, were identified. The NPIs included group counseling, cognitive behavioral therapy, sports intervention, combined interventions, eHealth, educational intervention, positive psychology intervention, sand play intervention, and electrotherapy. The results revealed that NPIs significantly reduced IA levels (standardized mean difference, SMD: -2.01, 95% confidence interval, CI: -2.29 to -1.73, I2 = 93.0%), anxiety levels (SMD: -1.07, 95%CI: -1.41 to -0.73, I2 = 72.4%), depression levels (SMD: -1.11, 95%CI: -1.52 to -0.7, I2 = 84.3%), and SCL-90 (SMD: -0.75, 95%CI: -0.97 to -0.54, I2 = 27.7%). Subgroup analysis stratified by intervention measure showed that cognitive behavioral therapy, group counseling, sports intervention, combined intervention, educational intervention, positive psychology intervention, sandplay intervention, and mobile health were all effective in relieving symptoms of IA except electrotherapy.

Conclusion

NPIs appear to be effective in the treatment of IA in youth, which would act as an alternative treatment of IA. Further studies with larger sample sizes and robust designs are needed.

Regional differences of physical fitness and overweight and obesity prevalence among college students before and after COVID-19 pandemic since the "double first-class" initiative in China

Introduction

Physical fitness has been widely recognized as a powerful marker of health in children and adolescents, and it negatively affected by the COVID-19 pandemic. The construction of world-class universities and first-class disciplines, known as the "Double First-Class" Initiative (DFC), is a major commitment made by the Chinese government to adapt to changes in the educational environment, both domestically and internationally, in order to promote the development and practice of international higher education. The aim of the study was to look deep into the regional differences of physical fitness and overweight and obesity prevalence among college students before and after the COVID-19 pandemic since the DFC.

Methods

The original physical fitness parameters of students from 10 DFC universities and colleges in Central South China were downloaded from the official website of Chinese National Student Physical Fitness Database (CNSPFD) and then divided into 3 groups based on the pandemic periods: pre-pandemic (2019), the first year after pandemic outbreak (2020), and the second year after pandemic outbreak (2021). All the data were stored in Excel 2010, analyzed by SPSS 17.0, and plotted with ArcGIS 10.4.

Results

The total "fail" percentage (from 9.19% in 2019 to 12.94% in 2021) and the prevalence of overweight and obesity in boys (from 22.53 to 29.25% in 2021) exhibited a continuous increase year by year, and among all the physical fitness indicators the score of strength in boys and endurance quality in all individuals were the lowest in overweight and obesity groups. Students with 'fail' rate developed from northern and northeastern province to southern areas from 2019 to 2021. For grade 2019th, overweight and obesity students who also failed the test had covered nationwide and the most affected areas including northeast, east, as well as central north in senior year. The distribution of overall fitness assessments in Hubei province was in accordance with the national data, and the overall scoring growths in both class of 2021st and 2022nd were measured with a negative increase (p < 0.01).

Conclusion

The government and related functional departments should take into consideration the student regional sources, especially in western and northeast regions of China, and school polices and physical education (PE) teachers should pay more attention to put training efforts on endurance for all adolescents and strength for boys and the group of overweight and obesity who also failed in the standard test, when designing specific interventions to promote physical health and counteract the negative effects of COVID-19 pandemic in college students.

Comparison of children's physical activity profiles before and after COVID-19 lockdowns: A latent profile analysis

Physical activity is important for children's health, but moderate to vigorous physical activity (MVPA) declines with age. COVID-19 lockdowns resulted in reduced MVPA and increased sedentary time among children. Characterising children's activity patterns may help identify groups who are most likely to be inactive post-lockdown. Data were combined from a pre-COVID-19 cohort study on children aged 5-6 years (Year1: n = 1299), 8-9 years (Year4: n = 1223) and 10-11 years (Year6: n = 1296) and cross-sectional post-lockdown data from a natural experiment on 10-11-year-olds in 2021 (Year6-W1: n = 393) and 2022 (Year6-W2: n = 436). The proportions of time spent in MVPA, light physical activity (LPA) and sedentary time on weekdays and weekends were derived from accelerometer data. Latent class analysis was used to identify activity profiles pre and post-lockdown, and estimate pre-COVID-19 transitions between Year4 and Year6. We identified six pre-COVID-19 activity profiles in Year6, including a new profile characterised by very low MVPA and high sedentary time (19% of children). There was substantial movement between profiles at Year4 and Year6, with 45% moving to a profile with lower MVPA. Likelihood ratio tests suggested differences in Year6 activity profiles pre and post-lockdown, with a new post-lockdown profile emerging characterised by higher LPA. The percentage of children in the least active profiles (where under 20% meet UK physical activity guidelines), rose post-lockdown, from 34% pre-COVID-19 to 50% in 2021 and 40% in 2022. We also saw gender and socioeconomic gaps widen, and increased separation between high and low physical activity levels. Children's physical activity has changed post-COVID-19, in terms of who is being active and how. The impact varies by activity profile, which is influenced by gender and socio-economic position. A greater understanding of these differences and targeting of low active groups is needed to increase both individual and population levels of physical activity.

Conceptualisation and Measurement of Social Cohesion within the Sport and Physical Activity Context: A Scoping Review

Sport, physical activity and social cohesion are increasingly linked within the academic literature. Indeed, studies recognise both the importance of social cohesion for promoting physical activity and the potential of sport to support social cohesion. Up until now, however, the ways in which social cohesion has been defined and measured in the context of sport and physical activity have not been the subject of much academic attention. Through a scoping review of studies measuring social cohesion in the sport and physical activity context, we aim to uncover how social cohesion is defined and measured, thus allowing us to better grasp how the concept is understood and operationalised in this field. As such, full-text inclusion occurred when studies quantitatively measured social cohesion through a questionnaire/survey instrument in connection with sport or physical activity participation or within programmes using sport to foster social cohesion. A total of 40 papers were included in the review, showing broad support for the argument that social cohesion is positively related to sport or physical activity participation. However, the retained texts engage on only a surface level with the concept of social cohesion, with around half not defining the term and the associated measurement tools using only a fraction of the dimensions typically associated with social cohesion. To conclude, we propose future directions to enhance conceptual engagement with and measurement of social cohesion.

Assessing physical activity promotion in different settings and how its associated with public participation during COVID-19 epidemic: evidence from national policy evaluation

BACKGROUND

Various interventions, programs and policies have been implemented to improve physical activity (PA) levels worldwide. However, countries continue to face barriers and challenges in achieving their targets. To date, there is a lack of study on the evaluation of physical activity (PA) promotion and how it's associated with public participation.

METHODS

This study assessed PA promotion in eight different settings in terms of policy availability, policy implementation, and public participation in PA programs. Policy availability was assessed by reviewing 384 policy and strategy documents, rules, regulations, legislation, and guidelines on PA. We scored the documents by using the Comprehensive Analysis of Policy on Physical Activity (CAPPA) framework. Data to assess policy implementation and public participation were taken from the Thailand Report Card Survey 2021 (TRC2021), and the Thailand Surveillance on Physical Activity (SPA) 2021. Both surveys comprised over 5,000 nationally-representative samples from on-screen, face-to-face interviews, and an online self-administered survey. We scored the policy implementation and public participation based on respondents' response towards policy implementation and participation indicators. A grading scheme was applied to indicate how successful an investment has been made.

RESULTS

Public education and mass media received the highest average score in policy availability, implementation and public participation in PA program (67.9%, grade B), followed by active urban design (66.1%, grade B-) and active transport (63.7%, grade B-). Workplace, whole-of-school, and community-wide initiatives were the investments with the lowest scores, implying low availability, limited implementation, and less accessibility to public. Females were less likely to participate in active transport, active urban design, sports/recreation for all, workplace activity, and community-wide initiatives. Age and educational attainment were consistent predictors of utilization in all investments.

CONCLUSIONS

With varying degrees of policy availability and accessibility, public participation in PA investments is likely to be constrained by biological and socioeconomic inequality. Future investments should aim at providing generalized or tailored interventions to ensure equal access and participation for all segments of the population.

Short and medium-term effects of the COVID-19 lockdowns on child and parent accelerometer-measured physical activity and sedentary time: a natural experiment

BACKGROUND

The COVID-19 pandemic has resulted in marked impacts on children's physical activity, with large reductions in moderate-to-vigorous physical activity (MVPA) reported during lockdowns. Previous evidence showed children's activity levels were lower and sedentary time higher immediately post-COVID lockdown, while there was little change in parental physical activity. We need to know if these patterns persist.

METHODS

Active-6 is a natural experiment using repeated cross-sectional data conducted in two waves. Accelerometer data were collected on 393 children aged 10-11 and their parents from 23 schools in Wave 1 (June 2021-December 2021), and 436 children and parents from 27 schools in Wave 2 (January 2022-July 2022). These were compared to a pre-COVID-19 comparator group (March 2017-May 2018) of 1,296 children and parents in the same schools. Mean minutes of accelerometer-measured MVPA and sedentary time were derived for week- and weekend-days and compared across waves via linear multilevel models. We also analysed the date of data collection as a time series, to explore temporal patterns via generalised additive mixed models.

RESULTS

There was no difference in children's mean MVPA in Wave 2 (weekdays: -2.3 min; 95% CI: -5.9, 1.3 and weekends: 0.6 min; 95% CI: -3.5, 4.6) when compared to the pre-COVID-19 data. Sedentary time remained higher than pre-pandemic by 13.2 min (95% CI:5.3, 21.1) on weekdays. Differences compared to pre-COVID-19 changed over time, with children's MVPA decreasing over winter, coinciding with COVID-19 outbreaks, and only returning to pre-pandemic levels towards May/June 2022. Parents' sedentary time and weekday MVPA was similar to pre-COVID-19 levels, with MVPA higher than pre-pandemic by 7.7 min (95% CI: 1.4, 14.0) on weekends.

CONCLUSION

After an initial drop, children's MVPA returned to pre-pandemic levels by July 2022, while sedentary time remained higher. Parents' MVPA remained higher, especially at weekends. The recovery in physical activity is precarious and potentially susceptible to future COVID-19 outbreaks or changes in provision, and so robust measures to protect against future disruptions are needed. Furthermore, many children are still inactive, with only 41% meeting UK physical activity guidelines, and so there is still a need to increase children's physical activity.

Metabolic control during the first two years of the COVID-19 pandemic in pediatric patients with type 1 diabetes: results from the German DPV initiative

AIM

To assess effects of the SARS-CoV2 pandemic on metabolic control in youth with type 1 diabetes (T1D) in Germany in a population-based analysis.

METHODS

Data from 33,372 pediatric T1D patients from the Diabetes Prospective Follow-up (DPV) registry, with face-to-face visits or telemedicine contacts in the years 2019-2021, were available. Datasets from eight time periods between March 15, 2020, and December 31, 2021, according to SARS-CoV2 incidence waves, were compared to those from five control time periods. Parameters of metabolic control were assessed with adjustment for sex, age, diabetes duration, and repeated measurements. Laboratory-measured HbA1c values and those estimated from CGM were aggregated into a combined glucose indicator (CGI).

RESULTS

There was no clinically relevant difference in metabolic control between pandemic and control time periods with adjusted CGI values ranging from 7.61% [7.60-7.63] (mean [95% confidence interval (CI)]) in the third quarter of 2019 to 7.83% [7.82-7.85] in the time period from January 1 to March 15 2020, in the other control periods, and during the pandemic, CGI values lay between these values. BMI-SDS rose during the pandemic from 0.29 [0.28-0.30] (mean [95% CI]) in the third quarter of 2019 to 0.40 [0.39-0.41] during the fourth wave. Adjusted insulin dose rose during the pandemic. Event rates for hypoglycemic coma and diabetic ketoacidosis remained unchanged.

CONCLUSIONS

We found no clinically relevant change of glycemic control or incidence of acute diabetes complications during the pandemic. The observed BMI increase may represent an important health risk for youth with T1D.

Recovery shape of physical activity after COVID-19 pandemic

BACKGROUND

Since the shutdowns associated with the coronavirus disease 2019 pandemic, there has been limited discourse on physical activity (PA) recovery (i.e., the ability of individuals to resume PA at pre-pandemic levels), including recovery rate, speed of recovery, which individuals are able to return quickly, who is left behind, and what are the causes of those differences. This study aimed to estimate the level and shape of PA recovery rate in Thailand.

METHODS

This study employed 2 rounds (2020 and 2021) of Thailand's Surveillance on Physical Activity dataset for the analysis. Each round included over 6600 samples from individuals aged 18 years or older. PA was assessed subjectively. Recovery rate was calculated from the relative difference in the cumulative minutes of MVPA from 2 different periods.

RESULTS

The Thai population experienced a medium level of recession of PA (-26.1%) and a moderate level of recovery of PA (37.44%). PA recovery in the Thai population resembled an imperfect V shape, reflecting a sharp decline followed by an immediate upturn; still, recovered PA remained lower than pre-pandemic levels. The quickest recovery was found among older adults, whereas students, young adults, residents of Bangkok, the unemployed, and those who had a negative attitude toward PA experienced the highest recession of PA and were among the slowest to recover.

CONCLUSION

The level of recovery of PA among Thai adults is largely determined by the preventive behaviors demonstrated by groups within the population who have a higher awareness of their health. The effect of the mandatory coronavirus disease 2019 containment measures on PA was temporary. However, the slower recovery rate of PA among some individuals was caused by a combination of restrictive measures and socioeconomic inequality, which required more time and effort to overcome.

A multi-perspective qualitative exploration of the reasons for changes in the physical activity among 10-11-year-old children following the easing of the COVID-19 lockdown in the UK in 2021

Background

Active-6 is exploring how the COVID-19 pandemic has impacted physical activity behaviour among Year 6 children (aged 10–11 years) and their parents in Southwest England. Initial findings from the Active-6 project have shown a 7–8 min decrease in moderate-to-vigorous physical activity and an increase in sedentary behaviour among children following the easing of restrictions in the UK in latter half of 2021. This finding suggests that the pandemic has had a persistent impact on child physical activity behaviour. This paper explored the possible mechanisms behind these changes.

Methods

Interviews with parents (n = 21), members of school staff (n = 9) and focus groups with children aged 10–11 years (n = 47) were conducted between August and December 2021 to discuss the impact of the pandemic on child physical activity behaviour. The framework method was used for analysis.

Results

Five themes spanning two key stages of the pandemic were described. Three themes related to the period of lockdowns and fluctuating restrictions (March 2020 – April 2021). These included: Theme 1) Lockdown: A short-lived adventure; Theme 2) Access to facilities during restrictions; and Theme 3) The importance of the parent. A further two themes were identified related to the period following the gradual easing of restrictions in April 2021. These included: Theme 4) An overwhelming return to normal; and Theme 5) Reopening fatigue.

Conclusions

The analysis suggested that feelings of novelty experienced during the initial stages of lockdown waned as restrictions were prolonged, creating an increasingly challenging period for parents and their children. However, during periods of restrictions, the importance of parental encouragement and access to appropriate facilities in the local and home environment helped facilitate physical activity. Following the easing of COVID-19 restrictions, emotional overwhelm and physical fatigue among children, stemming from a sedentary and socially isolated life in lockdown and other restrictions, were key contributors to the decreased moderate to vigorous physical activity and increased sedentary behaviour that was observed in a related quantitative study.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01356-3.

Cross-Sectional Associations between Playing Sports or Electronic Games in Leisure Time and Life Satisfaction in 12-Year-Old Children from the European Union

Leisure time activities in childhood may have a crucial role in the development of subjective well-being. Nevertheless, more research is needed with cross-national samples concerning the differential effects of lifestyles on life satisfaction. The aim of this cross-sectional study was to analyze the associations between the frequency of playing sports/exercise or playing electronic games on life satisfaction in a sample of 12-year-old children from nine countries from the European Union. The data used in this publication come from the third wave of the Children’s Worlds project, an international survey of children’s lives and well-being whose administration started in 2017. The sample was composed of 10,626 children (50.9% boys) from Estonia, Belgium, Croatia, Hungary, Italy, Malta, Poland, Romania, and Spain. They completed the Student Life Satisfaction Scale and answered two questions to assess the frequency of playing sport or exercise, and the frequency of playing electronic games. The results indicated notable scores in life satisfaction in all participating countries. The results showed some differences between boys and girls, and among the countries, in the frequency of sport practice and electronic games in the leisure time, as well as in the overall level of life satisfaction. The results also underlined that sport practice had a greater positive effect on life satisfaction than the use of electronic games. Thus, this study highlights the need to design programs to promote sport practice in leisure time for 12-year-old children in Europe, in order to protect their subjective well-being.

Change in physical fitness due to the COVID-19 pandemic lockdown in French adolescents: a comparison between two independent large samples from Diagnoform battery

Numerous studies reported a significant decline in physical activity level in adolescents as a result of the COVID-19 lockdown. Physical fitness is recognized as a powerful marker of health in youth. The aim of this study was to evaluate the impact of the COVID-19 pandemic lockdown on health-related physical fitness in French adolescents. Two cross-sectional studies were performed comparing two different groups of French adolescents, before (sample 1) and after the first lockdown (sample 2). A total of 1231 adolescents (aged to 16.5 ± 1.5 years) participated in the two cross-sectional studies. Complete data for physical fitness and anthropometrics data were obtained. Adolescents from sample 2 showed lower physical fitness levels compared to adolescents from sample 1. Regarding physical fitness for boys and girls, physical fitness levels were significantly lower in both sex between adolescents from the sample 1 and adolescents from the sample 2, except for cardiorespiratory fitness and flexibility for boys and girls, respectively. The physical fitness global score was also significantly lower between adolescents from the sample 1 and 2 for boys (-9.8%, p < 0.01) and girls (-16.2%; p < 0.01), respectively. Overall, the higher difference was found for performance in the speed body displacement test (-30%). A difference of 12.8% and 25% was observed for boys and girls, respectively.   Conclusion: COVID-19 pandemic lockdown had a negative impact on physical fitness in French youth. This study highlights the need to develop, in a near future, prevention programmes in order to improve the physical fitness in youth. What is Known: • COVID-19 pandemic deeply impacted lifestyle habits. A worrying decrease of physical activity, associated to a dramatic increase of time spent in sedentary behaviors was found in many coutries. What is New: • Our study bring first data on the health-related physical fitness consequences due to lockdown in French adolescents. Our study demonstrate the negative impact of COVID-19 pandemic lockdown on health-related physical fitness in French adolescents.