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

Designing stepped wedge trials to evaluate physical activity interventions in schools: methodological considerations

BACKGROUND

In a stepped wedge design, schools are randomised to a sequence of measurements, with each sequence transitioning to intervention status at a different time. There are several advantages to such designs, including increased statistical power, logistical benefits and the ability to explore change over time. However, stepped wedge designs have not previously been used to evaluate school-based physical activity interventions in children. This paper aimed to explore the feasibility of this design, by identifying school constraints, balancing these with statistical considerations and exploring the power of this chosen design under different scenarios.

METHODS

We conducted three interlinked studies, with the results from one informing the next. Study 1 was a qualitative study to identify school constraints that inform the choice of stepped wedge configuration. Study 2 used simulation to choose a configuration that balanced these school constraints and statistical properties. Study 3 explored the statistical power for the chosen design for different school and pupil sample sizes, using an open cohort design (a mixture of new and repeated pupils).

RESULTS

School staff considered the proposed data collection feasible, and supported a maximum of 3-4 measurements per year and an implementation period of one school term. Study 2 therefore considered incomplete stepped wedge designs with five steps. Statistically, the best designs had a mix of control and intervention measurements in terms 2-4 and a spread of measurements across the whole study duration. Power depended on a combination of the overall recruitment rate and the retention rate. For 20 schools with an eligible class size of 30 pupils, we would be able to detect a 6 min difference in average weekday moderate-to-vigorous physical activity with 80% power, provided there were > 50% of pupils measured per school at each time. A similarly powered cluster randomised controlled trial would require 42 schools.

CONCLUSION

Stepped wedge trials are a viable design for evaluating school-based physical activity interventions. Incomplete designs, where not all schools are measured at each point, offer the flexibility to work around practical constraints.

"We just have to work with what we've got": a qualitative analysis of contextual challenges in facilities and resources for pupil physical activity in English primary schools

BACKGROUND

State primary schools present an opportunity to support children's physical activity equitably, however, many school-based physical activity interventions have been unsuccessful. Many interventions have focused on school built environments to increase or measure the physical infrastructure a school has. Yet literature suggests that broader social and institutional factors, such as school policies and staffing, are equally crucial for supporting pupil's physical activity. The aim of this study is to qualitatively explore and assess primary school staff perspectives on the role of school facilities and resources in supporting pupil physical activity and the factors that impact their use.

METHODS

We conducted 33 semi-structured interviews with state primary school staff in the Bristol area, Southwest England, between November 2023 and January 2024. Staff roles included headteacher/principal (n = 5), deputy headteacher/principal (n = 6), class teacher (n = 7), teaching assistant (n = 2), Physical Education (PE) subject lead (n = 8), dedicated PE teachers (n = 4), and Parent Teacher Association chair (n = 1). Staff were recruited from 19 purposively-sampled schools with a range of school sizes, locations, and sociodemographic characteristics. Reflexive thematic analysis was used.

RESULTS

Five themes were generated related to how school facilities and resources impact pupil physical activity: 1) Facilities and resources create potential for pupil physical activity, 2) A social context supportive of physical activity is needed to maximise this potential, 3) Logistical challenges undermine the potential of facilities and resources, 4) The potential of facilities and resources change throughout the school year, and 5) Facilities and resources are not always fit for purpose.

CONCLUSION

The presence of facilities or resources alone does not determine pupil physical activity at primary school. Factors such as the social context of the school, logistical and timetabling challenges, seasonality, and how fit for purpose facilities are for that school, are important factors in school staff and pupils' use and management of these facilities, and whether their potential is maximised or undermined. Future research and policy must broaden the focus from the presence of facilities and resources for physical activity, to include a focus on how these are maintained and engaged with in a school's specific context.

Applying intervention mapping to develop a program for promoting short physical activity breaks during class time in upper secondary schools: the MOVE12 protocol study

Introduction

Physical inactivity is a global health challenge, exacerbated by increased screen time and sedentary behaviors. Enhancing physical activity levels at schools offers a promising approach to promote lifelong healthy habits.

Methods

This protocol paper outlines the MOVE12 pilot study, a 12-week intervention study designed to increase physical activity among Norwegian upper secondary school students through 6-7-min daily MOVE-breaks integrated into lessons. Developed using the six-phase Intervention Mapping (IM) protocol, grounded in the social-ecological model and self-determination theory, the intervention focuses on fostering motivation and creating a supportive environment. Key steps include needs assessment, performance objectives, theoretical methods, and program structuring for sustainability.

Results

Linear mixed models, t-tests, and regression analyses will evaluate quantitative outcomes, while qualitative focus groups will explore engagement and behavior change.

Discussion

MOVE12 provides insights into scalable school-based interventions addressing physical inactivity, highlighting the potential of the IM framework to establish sustainable health promotion strategies.

Post-coronavirus disease 2019-associated symptoms among children and adolescents in the SARS-CoV-2 Omicron era

PURPOSE

Lack of a control group(s) and selection bias were the main criticisms of previous studies investigating the prevalence of post-coronavirus disease 2019 (COVID-19) syndrome (PCS). There are insufficient data regarding paediatric PCS, particularly in the SARS-CoV-2 Omicron era. As such, our study investigated PCS-associated symptoms in a representative control-matched cohort.

METHODS

This multicentre, cross-sectional, cohort study within the "Immunebridge" project of the German Network University Medicine (NUM) recruited children and adolescents (five to 17 years old) between July and October 2022. Children with polymerase chain reaction-confirmed SARS-CoV-2 infection in 2022 (COVID-19 group) were compared with those without history of SARS-CoV-2 infection and negative for SARS-CoV-2 antibodies. Queries included vaccinations, quality of life (QoL), and mental and physical symptoms potentially associated with PCS in the previous three months. An additional composite item, "physical performance", was created from the responses.

RESULTS

The number of children with ≥ 1 PCS symptom(s) was comparable between the COVID-19 (n = 114 [62.1%]) and control (n = 66 [64.9%]) groups. Concentration disorders were reported more frequently in the COVID-19 group (12.3% versus 1.5%; p = 0.012) and "physical performance" was significantly impaired (p = 0.016) regardless of age, sex, and SARS-CoV-2 vaccination. The frequencies of other symptoms were similar in both groups. The COVID-19 group rated their fitness as worse, with otherwise equal QoL ratings regarding general and mental health. Conclusion Children with and without previous infections did not differ in most PCS-associated symptoms. Exceptions included physical performance and cognitive problems, which appeared to be more impaired after Omicron infection than in controls.

WHAT IS KNOWN

• Mainly due to too few controlled studies, knowledge about the prevalence of individual symptoms in paediatric post-COVID-19 syndrome (PCS) for the Omicron era is poor.

WHAT IS NEW

• In a representative control-matched cohort most parent-reported PCS-associated symptoms and quality of life scores in children and adolescents with PCR-confirmed SARS-CoV-2 infection did not differ from those without infection. • Exceptions were physical performance and cognitive problems, which were apparently more severely impaired after SARS-CoV-2-Omicron infection than in the control subjects.

Neighborhood Social and Physical Environments and Sedentary Behaviors: Importance of Early Childhood in Shaping Health Behaviors

This study aims to investigate the persistence of sedentary behaviors from early childhood to adolescence and the longitudinal association between neighborhood social and physical environments and childhood sedentary behaviors. Using the Future of Families & Child Wellbeing Study (N = 2716), we conducted a cross-lagged path analysis to examine the longitudinal association between neighborhood social and physical environments (neighborhood socioeconomic status, observed physical disorder, and crime rates) and sedentary behaviors at subsequent measurement points, after controlling for demographic factors and family socioeconomic status. We observed the continuity of sedentary behaviors in early childhood, extending throughout adolescence. Neighborhood socioeconomic status was significantly associated with sedentary behaviors at subsequent measurement points from early childhood to adolescence. Observation-based physical disorder and crime rates were associated with engagement in greater sedentary behaviors in adolescence but not in early and middle childhood. We also observed a partial mediation effect of neighborhood physical disorder and crime rates in the association between neighborhood socioeconomic status and sedentary behaviors in adolescence. Our results demonstrated the importance of early childhood in shaping healthy behaviors and highlighted the contribution of unfavorable environments to sedentary behaviors. These findings call for the need to support disadvantaged neighborhoods, particularly by addressing safety concerns and physical disorder, for promoting physical activity and reducing sedentary behaviors among adolescents.

Assessing the impact of COVID-19 on the physical activity of 10-11-year-old children and their parents: Active-6 a mixed-methods study

Background

Physical activity is essential for long-term health, yet data from before the COVID-19 pandemic showed only 41% of 10- to 11-year-olds met the UK government's physical activity recommendations. Children's physical activity was limited during the national COVID-19 lockdowns. It is important to measure children's physical activity in the recovery period to assess the short- and medium-term impact of the lockdowns.

Objectives

To use mixed-methods to assess the impact of the COVID-19 pandemic on moderate-to-vigorous physical activity of year 6 children in the short-term (2021) and medium-term (2022) recovery periods by comparing these with data sampled from the same schools in 2017/18.

Methods

Quantitative and qualitative data were collected in two waves: wave 1 (May-December 2021), when lockdowns had finished but some COVID-19 mitigation policies were still in place, and wave 2 (January-July 2022), when most restrictions had been removed. These were compared with baseline data from similar year 6 children and parents/carers in the same schools collected between March 2017 and June 2018 (wave 0).

Results

In wave 1, average child accelerometer-measured weekday moderate-to-vigorous physical activity was 7-8 minutes lower than pre-pandemic while sedentary time was higher by almost 30 minutes. Child moderate-to-vigorous physical activity had recovered to pre-pandemic levels in wave 2, although sedentary time remained elevated. Across our studies, we found a new normal for child physical activity, characterised as more dependent on structured activities such as active clubs. Physical activity inequalities appear to be widening among girls and low socioeconomic position families, as they face unique barriers to participating in the new normal.

Limitations

Our sample includes more households with higher educational qualifications and predominantly female parents. Undertaking this research in schools while COVID-19 disruptions were ongoing created challenges to data collection which may have limited schools' and families' participation.

Conclusions

COVID-19 lockdowns negatively impacted child physical activity. It took almost a year of no restrictions for this to recover, and sedentary time remains high. Despite this recovery, 59% of children do not meet activity guidelines. There is a new normal to child physical activity that relies on structured activities, and some children and families may face challenges to taking part in the new normal. Strategies are needed to increase child physical activity for all.

Future work

Develop new ways to work in partnership with schools to design bespoke physical activity programmes that can be delivered at the school site. Develop new ways to help girls and children from lower-income households to be physically active. Find the most effective means of maximising existing school resources such as extended school provision (after-school clubs) and physical resources (equipment) to promote physical activity outside of curriculum time.

Funding

This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research as award number NIHR131847.

School-level variation in children's moderate to vigorous intensity physical activity before and after COVID-19: a multilevel model analysis

Background and objectives

Schools play a crucial role in facilitating physical activity among children, but the COVID-19 pandemic has affected both children's physical activity and the school environment. It is essential to understand between-school differences in children's physical activity post lockdown, to determine if and how the role of schools has changed.

Design and participants

Active-6 is a natural experiment comparing postlockdown accelerometer-estimated physical activity to a pre-COVID-19 comparator group. Accelerometer and individual data were collected on 1296 children aged 10-11 pre-COVID-19 (2017-8), with school characteristics collected from the 50 schools they attended. Post lockdown, we collected accelerometer, individual and school data from 393 children in 23 of the same schools and 436 children in 27 of the same schools in 2021 (Wave 1) and 2022 (Wave 2), respectively.

Methods

Sources of variation (between-school, between-pupil and within-pupil) in child weekday moderate to vigorous physical activity at each wave were modelled using linear mixed-effects models with school-level wave random coefficients. We extended the model to estimate the proportion of between-school variation explained by school policy, curriculum and physical environment factors and school-aggregated pupil characteristics. We also explored the extent to which postlockdown differences in moderate to vigorous physical activity were mediated by individual or school factors.

Results

Between-school variation comprised 13% of the total variation pre-COVID-19, 7% in Wave 1 and 13% in Wave 2. School factors associated with moderate to vigorous physical activity were the following: whether physical education was compromised due to space (often: 9 minutes lower moderate to vigorous physical activity; sometimes: 5.4 minutes lower); high after-school club attendance (7 minutes higher moderate to vigorous physical activity for each additional club attended on average in the school); cycle training policy (4 minutes higher moderate to vigorous physical activity); and higher prevalence of active travel (1 minute higher moderate to vigorous physical activity for each 10% point increase in prevalence). These factors explained 22% of the between-school variation pre-COVID-19, and 72% at Wave 2. The relative importance changed, with cycle training policy and active travel being the most important pre-COVID-19 and cycle training policy, active after-school clubs and compromised physical education space most important in Wave 2. No factors were found to mediate the postlockdown differences in moderate to vigorous physical activity, except compromised physical education space, which had a suppressor effect in Wave 2.

Limitations

Only 27 of the initial 50 schools participated post lockdown, limiting our ability to make comparisons across waves. Sample sizes were additionally affected by missing data for some variables.

Conclusions and future work

While schools continue to play an important role in facilitating children's physical activity, the factors that contribute to this have changed post-COVID-19, with cycle training, active after-school clubs and ensuring physical education is prioritised even when space is limited now explaining nearly three-quarters of the between-school variation in children's moderate to vigorous physical activity. School-level interventions that focus on these areas, and policies that support them, may offer the potential to increase children's physical activity.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131847.

Physical Activity and Sedentary Time Among U.S. Adolescents Before and During COVID-19: Findings From a Large Cohort Study

Introduction

Evidence suggests that adolescents engage in less physical activity during the summer break. Less is known regarding physical activity during the summer months of the COVID-19 pandemic.

Methods

Utilizing data from the Adolescent Brain Cognitive Development study, the authors examined daily activity measured by Fitbit Charge 2 devices before and after the onset of the COVID-19 pandemic during school and summer months. Linear models estimated activity during pre-COVID-19 school, pre-COVID-19 summer, COVID-19 school, and COVID-19 summer.

Results

Participants (N=7,179, aged 11.96 years, 51% female, 51% White) accumulated 8,671.0 (95% CI=8,544.7; 8,797.3) steps, 32.5 (95% CI=30.8, 32.3) minutes of moderate-to-vigorous physical activity, and 507.2 (95% CI=504.2, 510.2) minutes of sedentary time. During COVID-19 school, adolescents accumulated fewer daily steps and minutes of moderate-to-vigorous physical activity (-1,782.3 steps [95% CI= -2,052.7; -1,511.8] and -6.2 minutes [95% CI= -8.4, -4.0], respectively). Adolescents accumulated more minutes of daily sedentary time (29.6 minutes [95% CI=18.9, 40.3]) during COVID-19 school months than during the pre-COVID-19 school months. During pre-COVID-19 summer months, adolescents accumulated 1,255.1 (95% CI=745.3; 1,765.0) more daily steps than during COVID-19 months. Boys accumulated more daily steps and moderate-to-vigorous physical activity (2,011.5 steps [95% CI=1,271.9; 2,751.0] and 7.9 minutes [95% CI=1.4, 14.4], respectively) during the summer before COVID-19 than in summer during COVID-19. Both girls and boys accumulated more minutes of sedentary time during COVID-19 school months (47.4 [95% CI=27.5, 67.3] and 51.2 [95% CI=22.8, 79.7], respectively) than during COVID-19 summer months.

Conclusions

Societal restrictions during COVID-19 negatively impacted activity levels in the U.S., particularly during the summer months during COVID-19.

Data Analytics in Physical Activity Studies With Accelerometers: Scoping Review

BACKGROUND

Monitoring free-living physical activity (PA) through wearable devices enables the real-time assessment of activity features associated with health outcomes and provision of treatment recommendations and adjustments. The conclusions of studies on PA and health depend crucially on reliable statistical analyses of digital data. Data analytics, however, are challenging due to the various metrics adopted for measuring PA, different aims of studies, and complex temporal variations within variables. The application, interpretation, and appropriateness of these analytical tools have yet to be summarized.

OBJECTIVE

This research aimed to review studies that used analytical methods for analyzing PA monitored by accelerometers. Specifically, this review addressed three questions: (1) What metrics are used to describe an individual's free-living daily PA? (2) What are the current analytical tools for analyzing PA data, particularly under the aims of classification, association with health outcomes, and prediction of health events? and (3) What challenges exist in the analyses, and what recommendations for future research are suggested regarding the use of statistical methods in various research tasks?

METHODS

This scoping review was conducted following an existing framework to map research studies by exploring the information about PA. Three databases, PubMed, IEEE Xplore, and the ACM Digital Library, were searched in February 2024 to identify related publications. Eligible articles were classification, association, or prediction studies involving human PA monitored through wearable accelerometers.

RESULTS

After screening 1312 articles, 428 (32.62%) eligible studies were identified and categorized into at least 1 of the following 3 thematic categories: classification (75/428, 17.5%), association (342/428, 79.9%), and prediction (32/428, 7.5%). Most articles (414/428, 96.7%) derived PA variables from 3D acceleration, rather than 1D acceleration. All eligible articles (428/428, 100%) considered PA metrics represented in the time domain, while a small fraction (16/428, 3.7%) also considered PA metrics in the frequency domain. The number of studies evaluating the influence of PA on health conditions has increased greatly. Among the studies in our review, regression-type models were the most prevalent (373/428, 87.1%). The machine learning approach for classification research is also gaining popularity (32/75, 43%). In addition to summary statistics of PA, several recent studies used tools to incorporate PA trajectories and account for temporal patterns, including longitudinal data analysis with repeated PA measurements and functional data analysis with PA as a continuum for time-varying association (68/428, 15.9%).

CONCLUSIONS

Summary metrics can quickly provide descriptions of the strength, frequency, and duration of individuals' overall PA. When the distribution and profile of PA need to be evaluated or detected, considering PA metrics as longitudinal or functional data can provide detailed information and improve the understanding of the role PA plays in health. Depending on the research goal, appropriate analytical tools can ensure the reliability of the scientific findings.

Quality of life, capability well-being, financial strain and physical activity in the short- and medium-term COVID-19 post-lockdown phases in the UK: a repeated cross-sectional study

Background

The COVID-19 lockdowns had negative effects on children's and adults' mental and physical health. There is, however, a paucity of research that explores differences in health-related quality of life (HRQL) and well-being over time after the COVID-19 lockdowns had been lifted. Furlough during lockdowns, increases in unemployment, and the emerging cost-of-living crisis all put pressure on family finances, which could have a detrimental effect on HRQL and well-being. This study, part of the wider Active-6 study, explored how HRQL, capability well-being and family financial strain changed after the lockdowns, the relationship between these outcomes, and whether physical activity had any mediating effect on differences in HRQL and capability well-being.

Methods

Cross-sectional data were collected in May-December 2021 (Wave 1) and January-July 2022 (Wave 2). Children (aged 10-11) and their parent/carer were recruited from 23 to 27 schools in each wave, respectively, and completed validated questionnaires measuring HRQL (adults - EQ-5D-5L, children - CHU9D), capability well-being (adults - ICECAP-A) and family financial strain (adults - Family Economic Strain Scale, FESS). Children also completed questions on capability well-being. Weekday minutes of moderate-to-vigorous physical activity (MVPA) were measured using accelerometers. Mixed-effects regression models, adjusted for gender, age group (adults only), IMD and highest household education, were used to explore differences in HRQL and capability well-being between waves. In addition, the moderating effect of financial strain and the mediating effect of MVPA on HRQL and capability well-being were explored.

Results

Active-6 recruited 393 parent-child pairs in Wave 1 and 436 in Wave 2. There were no differences in HRQL (EQ-5D, CHU9D) and capability well-being (ICECAP-A) scores between waves, but financial strain was worse in Wave 2 compared to Wave 1 (FESS score difference 1.14 adjusted 95% CI 0.15 to 2.12). Increased financial strain was associated with lower (worse) EQ-5D-5L, CHU9D and ICECAP-A scores. There was no evidence of a mediating effect of MVPA.

Limitations and future work

Pre-COVID-19 data on HRQL were not collected, so analysis was limited to post-lockdown only. Participating parents were predominantly female and participation was lower among lower socio-economic groups, limiting our ability to explore inequalities. Intervention planning to increase physical activity and health and well-being during the COVID-19 recovery should consider the financial strain families are experiencing and the negative implications of financial strain on HRQL.

Conclusions

There were no differences in HRQL and capability well-being in children and adults after lockdowns lifted in 2021 and a year later in 2022. The results indicate increasing financial strain, which could reflect the UK's 'cost of living crisis'.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131847.

School-level intra-cluster correlation coefficients and autocorrelations for children's accelerometer-measured physical activity in England by age and gender

BACKGROUND

Randomised, cluster-based study designs in schools are commonly used to evaluate children's physical activity interventions. Sample size estimation relies on accurate estimation of the intra-cluster correlation coefficient (ICC), but published estimates, especially using accelerometry-measured physical activity, are few and vary depending on physical activity outcome and participant age. Less commonly-used cluster-based designs, such as stepped wedge designs, also need to account for correlations over time, e.g. cluster autocorrelation (CAC) and individual autocorrelation (IAC), but no estimates are currently available. This paper estimates the school-level ICC, CAC and IAC for England children's accelerometer-measured physical activity outcomes by age group and gender, to inform the design of future school-based cluster trials.

METHODS

Data were pooled from seven large English datasets of accelerometer-measured physical activity data between 2002-18 (> 13,500 pupils, 540 primary and secondary schools). Linear mixed effect models estimated ICCs for weekday and whole week for minutes spent in moderate-to-vigorous physical activity (MVPA) and being sedentary for different age groups, stratified by gender. The CAC (1,252 schools) and IAC (34,923 pupils) were estimated by length of follow-up from pooled longitudinal data.

RESULTS

School-level ICCs for weekday MVPA were higher in primary schools (from 0.07 (95% CI: 0.05, 0.10) to 0.08 (95% CI: 0.06, 0.11)) compared to secondary (from 0.04 (95% CI: 0.03, 0.07) to (95% CI: 0.04, 0.10)). Girls' ICCs were similar for primary and secondary schools, but boys' were lower in secondary. For all ages, combined the CAC was 0.60 (95% CI: 0.44-0.72), and the IAC was 0.46 (95% CI: 0.42-0.49), irrespective of follow-up time. Estimates were higher for MVPA vs sedentary time, and for weekdays vs the whole week.

CONCLUSIONS

Adequately powered studies are important to evidence effective physical activity strategies. Our estimates of the ICC, CAC and IAC may be used to plan future school-based physical activity evaluations and were fairly consistent across a range of ages and settings, suggesting that results may be applied to other high income countries with similar school physical activity provision. It is important to use estimates appropriate to the study design, and that match the intended study population as closely as possible.

Back to 'normal'? BMI, physical fitness and health-related quality of life of children from North East England before, during and after the COVID-19 lockdowns

We assessed whether changes in children's body mass index (BMI), physical fitness and health-related quality of life observed post-2020 United Kingdom COVID-19 lockdown remained 12 and 18 months later. Twenty-metre shuttle run test (20mSRT), handgrip strength, standing broad jump, sit-and-reach, height, body mass, and health-related quality of life (Kidscreen27 questionnaire) were measured in 90 children (8-9 years) during October 2019 ("T0"), November 2020 ("T1"), November 2021 ("T2") and June 2022 ("T3"). Mixed-effects models showed age- and sex-normalised BMI increased from T0 (mean: 0.71) to T1 (0.97), remaining elevated at T2 (0.95) and T3 (0.89). Decreases in 20mSRT performance were observed from T0 (22.0) to T1 (19.3), then increased at T2 (23.5) and T3 (28.3). Standing broad jump and handgrip strength increased over time. The proportion of children with overweight/obesity increased from T0 (32%) to T3 (48%). Health-related quality of life decreased for "Physical Wellbeing" yet increased for "Autonomy & Parents". Our findings highlight that lockdowns may have had lasting implications for children's health, and the urgent need to reduce overweight and obesity in North East England. Improving health and fitness behaviours to maximise long-term health outcomes and build resilience to future emergencies and disruptions to health behaviours is also paramount.

Exploring parents' physical activity motivation during the COVID-19 pandemic: a mixed-methods study from a self-determination theory perspective

Background and objectives

The COVID-19 lockdowns impacted physical activity for all, but especially parents, because they had to balance home, work and leisure activities. Motivation for exercise is consistently shown to be associated with physical activity levels. Self-determination theory provides a framework through which the motivation for exercise and its social-contextual antecedents can be explored. The purpose of this study is to explore the role of motivation in determining physical activity in parents and carers of English primary school children before, during and after the COVID-19 lockdowns.

Design, setting and participants

This study uses a mixed-methods design combining quantitative data and individual interviews. Participants were all parents/carers of children in year 6 (aged 10-11 years) at English primary schools in the United Kingdom.

Methods

Quantitative data were collected on three occasions: between March 2017 and May 2018 (Wave 0, N = 1296), between May and December 2021 (Wave 1, N = 393) and between January and July 2022 (wave 2, N = 436). Motivation for exercise was assessed using the Behavioural Regulations in Exercise Questionnaire-2 and moderate-to-vigorous physical activity was estimated via waist-worn accelerometers. Data were analysed via regression models. Interviews with a subsample of parents (N = 43) were conducted on two occasions: between September and December 2021 and between February and July 2022. Interviews covered the impact of the pandemic on children and parents' physical activity and changes over time. This study focuses on discussions around the parents' own physical activity behaviour and their motivation. The framework method was used for analysis.

Results

In separate linear regression models, intrinsic and identified regulation were associated with higher moderate-to-vigorous physical activity in waves 0 and 2. Amotivation was associated with lower moderate-to-vigorous physical activity in waves 0 and 2. In fully adjusted multivariable regression models, identified regulation was associated with a 4.9-minute increase in moderate-to-vigorous physical activity and introjected regulation was associated with a 2.3-minute decrease in moderate-to-vigorous physical activity at wave 0. Associations with moderate-to-vigorous physical activity were different in wave 2, with introjected regulation changing direction and a negative association with amotivation, although confidence intervals were wide due to smaller sample sizes. In the interviews, parents spoke of the effects that the COVID-19 lockdowns had on their motivation to be physically active in four theoretically driven themes: (1) motivation for physical activity, (2) perceived autonomy for physical activity, (3) perceived competence for physical activity and (4) perceived relatedness for physical activity.

Limitations

The smaller sample sizes for waves 1 and 2 may have limited the ability to identify associations between behavioural regulations and moderate-to-vigorous physical activity post pandemic. Across all waves, parents were predominantly active, females, white and from higher socioeconomic areas and therefore may not reflect broader experiences.

Conclusions and future work

Autonomous motivation, especially enjoyment and the importance for mental and physical well-being, was a key driver in keeping parents active during lockdowns and remains important for physical activity post lockdown, with introjected regulation potentially playing an increased role. Parents' interviews highlighted that while for some the lockdowns promoted autonomous motivation for exercise, others had enduring negative influences on their autonomy, competence and relatedness, which could be detrimental to their well-being. Strategies that focus on offering a range of novel activities for parents and that bring parent groups together may be effective.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131847.

Physical activity interventions in European primary schools: a scoping review to create a framework for the design of tailored interventions in European countries

Introduction

Schools provide a unique environment to facilitate physical activity for children. However, many school-based physical activity interventions have not been effective. We propose a new approach, which allows schools to tailor interventions to their specific context. This scoping review aimed to identify intervention components from previous school-based physical activity interventions to form the basis of a tailored approach in a European setting.

Methods

Joanna Briggs Institute guidelines for conducting scoping reviews were followed. European school-based intervention studies aimed at increasing physical activity in children aged 7-11 years published in English since 2015 were included. Databases searched were Ovid Medline, Embase, PsycINFO, Web of Science Social Sciences Citation Index, ERIC and British Education Index. Data was extracted on intervention components, context-related factors (geographical location, school size, child socioeconomic status and ethnicity), feasibility, acceptability and cost-effectiveness. A data-driven framework was developed to summarize the identified intervention components.

Results

79 articles were included, constituting 45 intervention studies. We identified 177 intervention components, which were synthesized into a framework of 60 intervention component types across 11 activity opportunities: six within the school day, three within the extended school day and two within the wider school environment. Interventions most frequently targeted physical education (21%), active and outdoor learning (16%), active breaks (15%), and school-level environmewnt (12%). Of the intervention components, 41% were delivered by school staff, 31% by the research team, and 24% by external organizations. Only 19% of intervention studies reported geographical location and only 10% reported school size. Participant ethnicity and socioeconomic information was reported by 15% and 25%, respectively. Intervention acceptability was reported in 51% of studies, feasibility in 49%, and cost effectiveness in 2%.

Discussion

This review offers a first step in developing a future framework to help schools to develop context-specific, tailored interventions. However, there was a lack of reporting of contextual factors within the included studies, making it difficult to understand the role of context. Future research should seek to measure and report contextual factors, and to better understand the important aspects of context within school-based physical activity.

The impact of the COVID-19 pandemic on the physical activity environment in English primary schools: a multi-perspective qualitative analysis

Background

The COVID-19 lockdowns and social distancing measures, including school closures, had a major impact on children's physical activity in England, with data showing an initial reduction in activity in the short-term post-lockdown phase of the pandemic followed by a recovery on average in the medium-term post-lockdown period. The school environment is an important context for child physical activity. The purpose of this study is to understand the changes that took place to school physical activity environments once schools reopened after lockdowns. This information will improve understanding of why changes to children's physical activity have occurred over the course of the pandemic and the implications for future promotion of physical activity in schools.

Methods

Interviews with parents (n = 43), school staff (n = 18) and focus groups with 10- to 11-year-old children (participant n = 92) were conducted at two time points: between September-December 2021 and February-July 2022. Interview and focus group guides covered the impact of the pandemic on child physical activity and changes to this over time. The framework method was used for analysis.

Results

Three themes and three subthemes were generated: (1) the return to school; (2) over-pressured staff and environment and (3) the uneven impact of the pandemic. Theme 3 consists of three subthemes: (a) retained pandemic policies, (b) impact on physical activity culture and (c) different children need different things.

Limitations and future work

Conducting this research in schools during ongoing COVID-19 disruptions was a challenge and may have limited school and participant participation, particularly school staff. The parent interview sample is predominantly female, active and of higher socioeconomic status, so the experiences of male, less active and lower socioeconomic parents are limited. This study suggests that the impact of COVID-19 on child physical activity is uneven, affecting some children more than others. Future work is therefore needed to explore the details of this potential diverging experience.

Conclusion

The COVID-19 pandemic, school closures and post-lockdown school policies have impacted upon primary school physical activity environments. The post-lockdown school environment is highly pressured, impacting the extent to which schools can support and encourage child physical activity. Future research is needed to further explore the impact of post-lockdown changes on physical activity environments in schools, particularly over the longer term, as schools continue to adapt post lockdowns. Strategies required to support school physical activity environments must be context specific and sensitive to these changes, pressures and needs.

Funding

This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131847.

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.

The status of active after-school clubs among primary school children in England (UK) after the COVD-19 lockdowns: implications for policy and practice

BACKGROUND

Children's physical activity in England is more dependent on active clubs after the COVID-19 pandemic. However, it is unclear how the COVID-19 pandemic and related cost-of-living crisis have impacted on active club participation, costs and provision. This mixed-methods natural experiment explored school-based and community-based active clubs after lockdowns, using a unique combination of data sources to highlight implications for policy and practice post-COVID-19.

METHODS

Cross-sectional questionnaire data on school and community active clubs were collected from 10-11-year-old children pre-COVID-19 in 2017-18 (N = 1,296; 50 schools), in 2021 (N = 393; 23 schools), and 2022 (N = 463; 27 schools). Club participation and attendance frequency were modelled using logistic and Poisson mixed effects models, adjusted for child age, gender and household education. In 2021 and 2022, parents reported expenditure on community-based clubs and schools provided data on school-based club provision, with data summarised descriptively. Qualitative data were collected in 2021 and 2022, with one-to-one interviews with school staff (N = 18) and parents (N = 43), and twelve child focus groups (N = 92), and analysed using the framework method.

RESULTS

School-based active club participation was higher in 2022 compared to pre-pandemic (50% /43%), while community-based club participation was lower (74%/80%). Children attended 0.3 fewer clubs per week. Those from lower education households were less likely to participate in both types of active clubs, and girls less likely to attend community clubs. In 2022, the median cost of community and school club sessions were £6.67 and £3.88 respectively, with 52% of school-based clubs free to parents. Schools offered an average of 3.4 active clubs per week for 10-11-year-olds in 2022, with 34% partly/wholly subsidised. Qualitative analysis highlighted the impact of the cost-of-living crisis and COVID-19 pandemic on family resources, encouraging a shift to more affordable and convenient school-based active clubs, which negatively impacted the community-based active club environment. However, many schools struggled to meet this increased demand.

CONCLUSIONS

Findings emphasise the importance for policymakers to support schools to meet increased demand for clubs and community clubs to increase affordable and convenient physical activity opportunities. Targeted support is needed to prevent socioeconomic and gender inequalities.

The Bidirectional Correlation between Fundamental Motor Skill and Moderate-to-Vigorous Physical Activities: A Systematic Review and Meta-Analysis

BACKGROUND

Physical activity in early life has positive health effects, but few children meet the physical activity recommendations. Fundamental motor skills (FMS) are related to physical activity and according to the theory, physical activity drives them in the early years and vice versa. However, no study has conducted a meta-analysis of the association between moderate-to-vigorous intensity physical activity (MVPA) and early FMS. This meta-analysis examined the bidirectional correlation between MVPA and domain-specific FMS in preschool children.

METHODS

We searched PubMed, Embase, and Cochrane Library databases for articles published up to August 2023. Cross-sectional and longitudinal studies were included if they targeted children (3-6 years old) as the study population. The association between objectively measured MVPA and FMS was evaluated.

RESULTS

We found 445 titles and abstracts. A total of ten studies (eleven datasets) and 2514 children met the inclusion criteria, including eight cross-sectional studies and three longitudinal studies. When using MVPA as the exposure, no associations were found with locomotor skills (β = 0.83, 95% CI: -0.08, 1.74, p = 0.07) and gross motor skills (β = 2.72, 95% CI: -0.28, 5.72, p = 0.08), but an association with object management skills was found (β = 0.18, 95% CI: 0.06, 0.30, p = 0.001). When MVPA was used as the outcome, no associations were observed between locomotor skills (β = 0.06, 95% CI: -0.35, 0.47, p = 0.79), but associations with object management skills (β = 0.15, 95% CI: 0.02, 0.27, p = 0.02) and gross motor skill were found (β = 0.56, 95% CI: 0.38, 0.75, p = 0.001). The sensitivity analysis showed that the results must be treated with caution.

CONCLUSION

We found that gross motor skill (exposure) was positively associated with MVPA (outcome) in preschoolers. Object management skills were positively associated with MVPA (exposure) and MVPA (outcome) in preschoolers. In contrast, MVPA as an exposure was not associated with locomotor skills and gross motor skills. The results may suggest that promoting FMS is important for preschool children's MVPA.

The new normal for children's physical activity and screen viewing: a multi-perspective qualitative analysis of behaviours a year after the COVID-19 lockdowns in the UK

BACKGROUND

The COVID-19 pandemic significantly impacted children's physical activity. Recent evidence indicated children's accelerometer-measured physical activity levels have, on average, returned to near pre-pandemic levels in 2022, though sedentary behaviour remains higher. However, insufficient physical activity levels among children continues to be a critical public health issue in the UK, with only 41% meeting physical activity guidelines. This study aimed to provide in-depth analysis of how the pandemic has shaped children's physical activity patterns beyond the short-term periods following lockdowns and identify the new challenges to engaging children in physical activity.

METHODS

One-to-one interviews with parents (n = 22), school staff (n = 9), and six focus groups with children aged 10-11 years (n = 45) were conducted between February and July 2022. Topics explored changes to children's physical activity and sedentary behaviour patterns, including screen-viewing, and factors influencing any changes. The framework method was used for analysis.

RESULTS

Five themes were generated. Theme 1 described residual lockdown habits, including increased screen-viewing within the home, while activities outside the home continued to feel less spontaneous. Theme 2 highlighted an interrupted development of social, emotional, and physical skills among children compared to what would be expected pre-pandemic. This coincided with Theme 3 which reflected increased mental health challenges among families, creating complex barriers to children's physical activity. A new normal for child physical activity was evoked and explored in Theme 4, with greater dependence on structured and organised activities. However, Theme 5 highlighted that girls and children with lower socio-economic position may be especially at risk of decreased physical activity.

CONCLUSIONS

There is a new normal for children's physical activity that is characterised by increased dependence on structured and organised physical activities, such as active clubs, and less on unstructured and spontaneous physical activities, such as physical play. While this may suit many children, girls and children from lower socio-economic households face barriers to participating in the new normal. It is important that affordable and equitable opportunities are provided to all children to prevent physical activity and health inequalities.