Keeping children healthy during and after COVID-19 pandemic: meeting youth physical activity needs

Comparing the Use and Effectiveness of In-Person and Remote Physical Education Delivery During the COVID-19 Pandemic

BACKGROUND

Physical Education is a key component to improve youth health, but there is limited information on Physical Education delivery in different formats.

PURPOSE

We compared PE formats (in-person versus remote) across evaluation aspects: weekly minutes; perceived effectiveness; and student-to-teacher ratio.

METHODS

We distributed questionnaires (2020-2021 school year) to school contacts who represented NFL Play 60 FitnessGram® Project (n=216) schools in multiple US cities. Questionnaires entailed learning format, weekly PE minutes, perceived effectiveness, and student-to-teacher ratio. We used linear mixed models to compare PE formats across evaluation variables.

RESULTS

Among 165 schools, 10% (n=17) offered in-person instruction, 31% (n=51) offered remote instruction, and 59% offered both (n=97). Results revealed higher in-person PE minutes (77.2±7.3) compared to remote minutes (67.1±14.6), but results were not significantly different (p=0.19). School contacts reported significantly more effective in-person PE (4.0) than remote PE (2.8, p<0.001). In-person PE also had significantly smaller reported student-to-teacher ratio (16.7) compared to remote PE (23.7, p<0.001).

DISCUSSION

Findings indicate PE was offered during the pandemic, but remote learning appeared less effective than in-person PE.

TRANSLATION to HEALTH EDUCATION PRACTICE

Efforts are needed to improve remote PE to reinforce high-quality PE in the future.

How Societal Forces of Change Are Transforming Youth Physical Activity Promotion in North America

BACKGROUND

Climate change, increasing recognition of institutionalized discrimination, and the COVID-19 pandemic are large-scale, societal events (ie, forces of change) that affect the timing, settings, and modes of youth physical activity. Despite the impact that forces of change have on youth physical activity and physical activity environments, few studies consider how they affect physical activity promotion.

METHODS

The authors use 2 established frameworks, the ecological model of physical activity and the youth physical activity timing, how, and setting framework, to highlight changes in physical activity patterns of youth in North America that have resulted from contemporary forces of change.

RESULTS

North American countries-Canada, Mexico, and the United States-have faced similar but contextually different challenges for promoting physical activity in response to climate change, increasing recognition of institutionalized discrimination, and the COVID-19 pandemic. Innovative applications of implementation science, digital health technologies, and community-based participatory research methodologies may be practical for increasing and sustaining youth physical activity in response to these forces of change.

CONCLUSIONS

Thoughtful synthesis of existing physical activity frameworks can help to guide the design and evaluation of new and existing physical activity initiatives. Researchers, practitioners, and policymakers are encouraged to carefully consider the intended and unintended consequences of actions designed to respond to forces of change.

The impact of SNAP-Ed interventions on California students' diet and physical activity during COVID-19

OBJECTIVE

School-based CalFresh Healthy Living (CFHL) (California's SNAP-Ed) interventions adapted to new learning environments necessitated by COVID-19. We examined the impact of these interventions on student diet and physical activity (PA) outcomes.

DESIGN

Quasi-experimental, two-group, pre-post.

SETTING

California public schools with ≥50 % of students Free and Reduced Price Meal-eligible (nintervention = 47; ncomparison = 17).

PARTICIPANTS

Fourth- and fifth-grade students who completed the online Eating and Activity Tool for Students at pre and post (nintervention = 1087; ncomparison = 846 students).

RESULTS

Intervention students reported a significantly greater increase in consumption frequency of total fruit (by 0·16 times/d; P = 0·032), driven primarily by a greater increase in 100 % fruit juice (by 0·11 times/d; P = 0·007). Intervention students reported a significantly greater increase in total vegetable consumption frequency (by 0·45 times/d; P < 0·001) than comparison students. Specifically, intervention students reported increased, whereas comparison students reported decreased, consumption frequencies for starchy vegetables (0·05 v. -0·10 times/d, P < 0·001), salad/green vegetables (0·01 v. -0·11 times/d, P = 0·005) and beans (0·04 v. -0·03 times/d, P = 0·025). Consumption frequency of other vegetables decreased in both groups (-0·01 v. -0·09 times/d) but decreased more among comparison students (P = 0·048). No differences in pre-post change in PA outcomes were detected.

CONCLUSIONS

Findings suggest that despite COVID-19-related challenges necessitating programme modifications, CFHL interventions played a role in protecting student consumption of fruit and vegetables during the 2020-2021 school year. Therefore, it appears that school-based CFHL interventions can be a viable means of safeguarding student nutrition at a time when access to nutritious food and PA opportunities are hindered.

ACTIVE YOU: Teacher Attributes and Attitudes Predicting Physical Activity Promotion

Background: Based on the Health Belief Model, this study examined preservice teacher attributes and attitudes toward providing physical activity opportunities for children in school. Methods: A quasi-experimental design was used to collect proof of concept and feasibility data for the ACTIVE YOU intervention as part of teacher education. Conclusions: Examination of a diverse sample of preservice teachers during their fieldwork revealed that those who engage in healthy behaviors and had positive attitudes toward physical activity in schools are more likely to take action and promote physical activity for their students.

Physical Education Teachers' Perceived Effectiveness in Association with Student Attendance, Teacher Adaptability, External Educational Supports, and Teaching Format During the COVID-19 Pandemic

Spring 2020 pandemic-control policies included an abrupt shift to remote teaching, which may have affected physical education (PE) teachers' perceived effectiveness. This study examined K-12 PE teachers' perceived effectiveness in association with student attendance, teacher adaptability, PE supports, teaching format (in-person, remote synchronous, remote asynchronous, etc.), and teacher- and school-level demographics at three time points (pre-pandemic 2019-early 2020, Spring 2020, 2020-2021 school year). An electronic survey was developed by an expert panel and distributed to U.S. public school PE teachers (convenience sampling via school health-related organizations). For analyses, teacher perceived effectiveness was dichotomized (very/extremely effective= "1"; not at all/slightly/moderately effective= "0"). Logistic regression models assessed associations between perceived effectiveness and independent variables (student attendance, teacher adaptability, PE supports, teaching format, and demographic variables) at each time point. Respondents (n=134; M age=46) were mostly female (62%), general PE teachers (82%, versus adapted), had a graduate degree (66%), had >11 years of teaching experience (63%), and from 26 states. Perception of being very/extremely effective was highest pre-pandemic 2019-early 2020 (93%), lowest in Spring 2020 (12%), and recovered somewhat in 2020-2021 (45%). During the 2020-2021 school year, teachers had greater odds of perceiving they were more effective if they reported having higher student attendance (OR 1.06 [CI:1.02-1.09], p>.001) and higher adaptability (OR 1.22 [CI: 1.09-1.37], p>.001), adjusting for gender, education level, years of experience, grade level taught, and Title I status. Professional development opportunities are needed for remote teaching of PE to enhance teachers' adaptability and perceived effectiveness during potential future school closures.

Changes in the body composition of boys aged 11-18 years due to COVID-19 measures in the Czech Republic

BACKGROUND

The lockdown measures related to coronavirus disease 2019 (COVID) impacted the health of adolescents by reducing physical activity (PA). The physical changes in response to decreases in PA can be measured with full body composition analysis. The aim of this study was to evaluate the effects of long-term PA restrictions on body fat (BF), fat-free mass (FFM) and skeletal muscle mass (SMM) in adolescents.

METHODS

A total of 1669 boys (before PA restriction (G1): 998; after PA restrictions ended (G2): 671; between the ages of 11 and 18 were included. The measured parameters were body mass (BM), visceral fat area (VFA), BF, FFM and SMM. The whole-body composition was evaluated using bioelectrical impedance analysis (BIA).

RESULTS

Compared to G1, G2 exhibited an increase in BF between 1.2 and 5.1%. This difference was significant in boys aged 13 to 18 years (p < 0.05). VFA increased between 5.3 and 20.5 cm²; this increase was significant in boys aged 13 to 18 years (p < 0.05). SMM decreased between 2.6 and 3.8%, and this decrease was significant in all age groups (p < 0.05). Changes in body composition were not accompanied by any significant changes in BM.

CONCLUSIONS

COVID-19 restrictions reduced PA, resulting in a significant decrease in SMM. This decrease may impact boys' ability to engage in sufficiently varied PA, which may lead to a further decline in PA and subsequent medical consequences in adulthood.

Youth physical activity and the COVID-19 pandemic: A systematic review

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Numerous studies examined youth physical activity (PA) during the COVID-19 pandemic.

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Overall decreases in youth PA were seen during the first 1.5 years of the pandemic.

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There were differences in PA by sub-populations (e.g., age, sex/gender)

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There were also differences in PA by location/type (e.g., outdoor, play)

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Programming and policy should focus on evolving PA promotion for youth.

The purpose of the systematic review was to identify, evaluate, and synthesize evidence from available published literature examining the impact of the coronavirus disease 2019 (COVID-19) pandemic on youth physical activity (PA). A systematic review of the literature was conducted for years 2020–2021. Published articles were searched in eight databases. Inclusion criteria included: availability of full-text, written in English language, and reported quantitative or qualitative results of original or secondary data on PA and COVID-19 related factors among youth (ages 5–17 years). A standard quality assessment tool assessed risk of bias and quality of included articles. The search retrieved 2,899 articles with 51 articles ultimately meeting inclusion criteria. The majority of articles (65 %) investigated change in PA from before to during the pandemic. Most evidence indicated an overall decrease in youth PA levels during the pandemic with differences observed among sub-populations (e.g., age, sex or gender), type, and location. Findings suggest pandemic-related closures hindered PA participation due to a high reliance on school- and sport-based PA. Programmatic strategies (e.g., activity breaks, active curriculum, free online activities/lessons) should include aligning intervention measures and geared towards evolving and ongoing PA promotion based on the latest findings.

Determining Trends and Factors Associated with Self-Reported Physical Activity among Adolescents in Rural North Carolina

It is important to better understand factors associated with physical activity (PA) levels in adolescents in rural areas. Cross-sectional data were used to obtain self-reported PA levels among adolescents in a school-based intervention in fall 2018. Demographic data, environmental variables, and cardiovascular fitness (PACER score) were also measured. Analyses included a two-sample t-test, ANOVA, a Chi-square test_, and a linear regression model. Participants included 3799 7th graders. Male (p < 0.0001), white (p < 0.0001), and healthy weight (p < 0.0001) participants reported more days of PA. The correlation between school physical education (PE) and PACER was modest (r = 0.27, p < 0.0001). Multiple linear regression model showed significant effects of school PE (p = 0.0011), gender (p < 0.0001), race (p < 0.0001), and weight category (p < 0.0001) on self-reported PA. The percentage of students reporting 60 min of PA for 5 (p < 0.0001) or 7 (p = 0.0307) days per week tended to be higher with increased days per week of school PE. Policy changes that increase PA and PE in middle schools may present opportunities to improve PA levels in adolescents, with emphasis on being inclusive and mindful of minority and female youth.

Impact of COVID-19 Pandemic on School-Aged Children's Physical Activity, Screen Time, and Sleep in Hong Kong: A Cross-Sectional Repeated Measures Study

Despite concerns about the negative effects of social distancing and prolonged school closures on children's lifestyle and physical activity (PA) during the COVID-19 pandemic, robust evidence is lacking on the impact of the pandemic-related school closures and social distancing on children's wellbeing and daily life. This study aimed to examine changes in the PA levels, sleep patterns, and screen time of school-aged children during the different phases of the COVID-19 outbreak in Hong Kong using a repeated cross-sectional design. School students (grades 1 to 12) were asked to report their daily electronic device usage and to fill in a sleep diary, recording their daily sleep onset and wake-up time. They were equipped with a PA monitor, Actigraph wGT3X-BT, to obtain objective data on their PA levels and sleep patterns. Students were recruited before the pandemic (September 2019-January 2020; n = 577), during school closures (March 2020-April 2020; n = 146), and after schools partially reopened (October 2020-July 2021; n = 227). Our results indicated lower PA levels, longer sleep duration, and longer screen time among participants recruited during school closures than those recruited before the COVID-19 outbreak. Primary school students were found to sleep on average for an extra hour during school closures. The later sleep onset and increased screen time documented during school closures persisted when schools partially reopened. Our findings illustrate the significant impact of social distancing policies during the COVID-19 pandemic on the sleep pattern, screen time, and PA level in school-aged children in Hong Kong. Professionals should urgently reinforce the importance of improving physically activity, good sleep hygiene, and regulated use of electronic devices for parents and school-aged children during this unprecedented time.

Online physically active academic lessons in COVID-19 times: A pilot study

Schools play an important role in promoting physical activity among students. This paper studies the perception of educators, students, and parents about the use of online physically active academic lessons during COVID-19 in the north of Chile. Starting the first week of November 2020, and for a period of five weeks, 323 students, alongside 11 educators, practiced a geometry-based dance routine online. The qualitative analysis results reveal a positive perception of the experience and an increase in physical activity without reducing the amount of time spent on academic activities. There were also improvements in learning, social relationships, and enjoyment.

Global Trends in the Research on Early Childhood Education during the COVID-19 Pandemic: A Bibliometric Analysis

During the COVID-19 pandemic, schools and preschools worldwide have been suspended, causing many challenges for students, parents, and teachers. Through home-schooling, preschool children struggle to accept new (online) learning modes. Teachers need to acquire digital skills quickly to deliver online teaching, while parents need to take on the role of a tutor at home to facilitate their children’s learning. This study aims to gauge the global trends in the research on early childhood education (ECE) during the COVID-19 pandemic, particularly considering the need for a swift response to the impact of the pandemic. We employed the bibliometric approach to studying ECE studies during the pandemic by identifying the countries of most-cited publications, most-cited categories of studies, and research methodologies used in the eligible studies (N = 507). Analysis reveals that technology integration in ECE has grown fast to timely facilitate online teaching and resolve varied challenges such as parental stress, a lack of resources, and the quality of education in this field. Based on the bibliometric approach, we highlighted research focusing on key themes such as online learning and teaching, physical activity, stress and mental health, and families in early childhood. This study offers a global perspective on ECE research during the pandemic and provides researchers, policymakers, and practitioners with future directions.

COVID-19 and health in children and adolescents in the US: A narrative systematic review

In the United States, the Coronavirus Disease 2019 (COVID-19) pandemic necessitated nationwide closures of kindergarten through twelfth grade (K-12) schools. Stay-at-home orders and social distancing mandates were also implemented to mitigate the spread of COVID-19. The purpose of this systematic review was to synthesize the existing literature on how COVID-19 impacted K-12 students' eating patterns, physical activity, and sleep in the United States. Utilizing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a literature search was conducted between October and December 2021. Inclusion criteria were studies focused on COVID-19 and eating patterns, physical activity, and sleep in students enrolled in K-12 schools since March 2020. International studies were excluded. Mixed findings were observed for eating patterns whereby the consumption of unhealthful savory and sweet items and healthful snacks (e.g., fruit and vegetables) increased. Reductions in physical activity and disrupted sleep routines were also observed. Heterogeneity in methodological procedures may limit the generalizability of these findings. In the United States, preliminary data suggest that select health-promoting behaviors were negatively impacted by the COVID-19 pandemic. Given that prolonged unhealthful eating patterns, physical inactivity, and poor sleep contribute to chronic disease risk, initiatives that increase health-promoting behaviors are warranted.

Using Implementation Mapping to develop and test an implementation strategy for active learning to promote physical activity in children: a feasibility study using a hybrid type 2 design

Background

Incorporating physical movement in the teaching of academic content (active learning) is a promising approach to improve children’s health and academic performance. Despite documented benefits, implementation of active learning remains challenging for schools. The aims of this study are to develop an implementation strategy to support the delivery of active learning in elementary schools and examine the impact of the developed implementation strategy on the implementation and effectiveness of active learning.

Methods

Aim 1 will use Implementation Mapping, which is a multi-step approach that guides the use of theory, stakeholder input, and existing literature to develop a scientifically based implementation strategy for active learning in elementary schools. Aim 2 will feature a feasibility study to examine the impact of the implementation strategy on both implementation and effectiveness outcomes, consistent with a Hybrid Type 2 design. Acceptability and implementation fidelity will be the primary implementation outcomes, and student physical activity levels will be the primary effectiveness outcome. We will recruit two elementary schools within our partner district, and one will be randomly assigned to receive usual support while the other will receive the newly developed implementation strategy. Participants from each school will complete baseline, 6-, and 12-month assessments. Bayesian statistical approaches will quantitatively examine preliminary effectiveness outcomes. We will also use an embedded mixed methods approach to triangulate findings.

Discussion

This study’s innovative overarching conceptual framework (centered on Implementation Mapping) will inform the development and testing of the implementation strategy. This study also uses methodological approaches optimal for feasibility studies, including mixed methods and Bayesian statistics. As a result, we will be able to gain a thorough understanding about the feasibility and preliminary effectiveness of the implementation strategy, which will inform subsequent research and practice for implementing active learning in schools.

Trial registration

ClinicalTrials.gov, NCT05048433, registered on September 8, 2021.

Educators' Psychosocial Burdens Due to the COVID-19 Pandemic and Predictive Factors: A Cross-Sectional Survey of the Relationship with Sense of Coherence and Social Capital

This study aims to identify the social and psychological burdens placed on educators during the third wave of the COVID-19 pandemic in Japan and to propose an optimal form of support. We investigated educators' perceptions of psychological and socioeconomic anxieties and burdens, sense of coherence, and social capital using a questionnaire survey of 1000 educators in January 2021. Multivariate regression analyses were conducted to analyze the associations between the variables. Results: Approximately 80% of the respondents considered COVID-19 a formidable, life-threatening illness. Our results revealed that the higher the social capital, the greater the fear of COVID-19, and the higher the sense of coherence, the lower this fear. Conclusions: The anxiety burden of implementing infection prevention was higher than the anxiety burden associated with distance learning. The predictive factors for educators' perceptions of burden included sense of coherence, gender, and age. Our findings suggest the importance of having the government and educational institutions provide multidimensional assistance that matches educators' individual characteristics.

COVID-19 Pandemic and Individuals With Intellectual Disability: Special Olympics as an Example of Organizational Responses and Challenges

The COVID-19 pandemic is a worldwide crisis. It has been, and is, an extreme challenge for our health care and prevention systems, and for society as a whole. Among many facets of life, physical activity and sport has been heavily impacted. The aim of this viewpoint article is to highlight the effect of the COVID-19 pandemic on individuals with an intellectual disability, with a particular focus on physical activity and Special Olympics. Specific objectives are (a) to share what the literature reveals about the impact of COVID-19 on the health and well-being of individuals with an intellectual disability, (b) to examine what is known about the impact of the pandemic on physical activity of individuals with an intellectual disability, (c) to describe Special Olympics program responses during the pandemic, and (d) to recommend areas for future research.

The impact of COVID-19 lockdown on sleep patterns, emotions, and behaviors of children and adolescents in Taiwan

BACKGROUND

The lockdown in May 2021 was the first and only lockdown implemented in Taiwan during the COVID-19 pandemic. The epidemic in Taiwan has been maintained under relatively better control and this study aimed to examine the impact of the lockdown on sleep and emotional and behavior disturbances in children and adolescents in Taiwan.

MATERIAL AND METHODS

Participants over 6 years old were recruited retrospectively from a cohort study, and their parents completed questionnaires including the Children's Sleep Habits Questionnaire (CSHQ), the Child Behavior Checklist (CBCL), the Swanson, Nolan and Pelham-IV Teacher and Parent Rating Scale (SNAP-IV), and the function assessment. A total of 217 children and adolescents whose parents completed questionnaires during both the lockdown period and the pre-lockdown period were included. We used paired t-test and independent t test; to analyze the differences between the lockdown and pre-lockdown periods and between different subgroups.

RESULTS

The mean age of all participants was 11.87 ± 3.97 years, with 69.6% male. The results of CSHQ indicated that our participants had significantly increased total sleep time (p = 0.000), more sleep onset delay (p = 0.011), fewer sleep duration problems (p = 0.029), less parasomnia (p = 0.018), fewer sleep breathing problems (p = 0.028), and less daytime sleepiness (p = 0.000) during the lockdown, especially males and children. We observed trends but no significant changes of all participants in CBCL and SNAP during the lockdown. The change of the inattention index reached a significant level between children and adolescents (p ² = 0.017). The results of the functional assessment showed more interferences in home living (p = 0.021) of all participants, especially males (p ¹ = 0.002).

CONCLUSIONS

The lockdown significantly impacted children and adolescents' sleep and functioning. We also observed trends of increased emotion, behavior and inattention problems, and significantly increased interference in home living. Male gender and younger age may be associated factors for sleep and functional disturbances of the lockdown.

Parents' Report of Canadian Elementary School Children's Physical Activity and Screen Time during the COVID-19 Pandemic: A Longitudinal Study

COVID-19 public health protocols have altered children’s daily routines, limiting their physical activity opportunities. The purpose of this study was to examine how the COVID-19 pandemic affected children’s (ages 10–12 years) physical activity and screen time, and to explore the impact of gender, socioeconomic status (SES), and public health constraints (i.e., facility use and social interaction) on the changes in children’s health behaviors. Online surveys were disseminated to parents at two time points: before COVID-19 (May 2019 to February 2020) and during COVID-19 (November to December 2020). Wilcoxon signed-rank tests were used to assess changes in physical activity and screen time, and for subgroup analyses. Parents (n = 95) reported declines in children’s physical activity (Z = −2.53, p = 0.01, d = 0.18), and increases in weekday (Z = −4.61, p < 0.01, d = 0.33) and weekend screen time (Z = −3.79, p < 0.01, d = 0.27). Significant changes in physical activity and screen time behaviors were identified between gender, SES, and facility use groups. All social interaction groups underwent significant changes in screen time. Overall, COVID-19 protocols have negatively influenced children’s physical activity and screen time. Due to the negative consequences of inactivity and excessive screen time, resources must be made available to support families during the pandemic.

Physical Activity of Children and Adolescents during the COVID-19 Pandemic-A Scoping Review

To counteract the COVIC-19 pandemic, many governments have introduced social distancing measures. While these restrictions helped contain the virus, it had adverse effects on individuals’ mental and physical health—especially children. The aim of the present study is to review the evidence on the effects of COVID-19 restrictions on children’s physical activity and their determinants. A scoping review was conducted in the databases PubMed, Web of Science, SportDiscus, and BISp-Surf. Inclusion criteria were empirical and peer-reviewed studies, youth samples, investigation of COVID-19 restrictions, and investigating changes and/or determinants of physical activity before and during the COVID-19 pandemic. Risk of bias was assessed using the checklist by Downs and Black. The search resulted in 1672 studies, of which 84 studies were included in the analysis. The results highlighted a decrease in physical activity during the pandemic, ranging between −10.8 min/day and −91 min/day. If an increase was detected, it related to unstructured and outdoor activities. The main determinants of children’s physical activity during the pandemic were age, gender, socioeconomic background, and the outdoor environment. The results imply that governments need to consider the negative effects that restrictive measures have on children’s physical activity and act to ensure high levels of physical activity.

The Impact of the COVID-19 Pandemic and Societal Infection Control Measures on Children and Adolescents' Mental Health: A Scoping Review

Background: The COVID-19 pandemic is primarily a crisis that affects people's physical health. However, it is well-known from previous epidemics and pandemics that there are other indirect negative impacts on mental health, among others. The purpose of this scoping review was to explore and summarise primary empirical research evidence on how the COVID-19 pandemic and societal infection control measures have impacted children and adolescents' mental health. Methods: A literature search was conducted in five scientific databases: PubMed, APA PsycINFO, Web of Science, CINHAL, and Social Science Premium Collection. The search string was designed using the Population (0-18 years), Exposure (COVID-19), Outcomes (mental health) framework. Mental health was defined broadly, covering mental well-being to mental disorders and psychiatric conditions. Results: Fifty-nine studies were included in the scoping review. Of these, 44 were cross-sectional and 15 were longitudinal studies. Most studies reported negative impact of the COVID-19 pandemic on child and adolescent mental health outcomes, yet the evidence was mixed. This was also the case for studies investigating societal control measures. Strong resilience, positive emotion regulation, physical activity, parental self-efficacy, family functioning and emotional regulation, and social support were reported as protective factors. On the contrary, emotional reactivity and experiential avoidance, exposure to excessive information, COVID-19 school concerns, presence of COVID-19 cases in the community, parental mental health problems, and high internet, social media and video game use were all identified as potentially harmful factors. Conclusions: Due to the methodological heterogeneity of the studies and geographical variation, it is challenging to draw definitive conclusions about the real impact of the COVID-19 pandemic on the mental health of children and adolescents. However, the existing body of research gives some insight to how parents, clinicians and policy makers can take action to mitigate the effects of COVID-19 and control measures. Interventions to promote physical activity and reduce screen time among children and adolescents are recommended, as well as parenting support programs.

Virtual Physical Education During COVID-19: Exploring Future Directions for Equitable Online Learning Tools

Introduction: School closures prompted by the COVID-19 pandemic reduced opportunities for US youth to be physically active and disproportionately impacted health disparities in this population. Physical education provides the largest intervention to support the physical activity of school-aged youth, but teachers' opinions about how to maintain quality programming during virtual learning periods remain unexplored. Applying a diversity, equity and inclusion framework, this study explored physical education teachers' perceived significance of different design features for an online teaching tool to promote physical activity equity during school closures. Methods: Previous literature and focus groups informed the development of a survey administered in summer/fall 2020. Survey participants (n = 60) were physical education teachers from 400 randomly selected US preschool-12th grade schools drawing from a national database. Participants rated the significance of four design features in relation to five key attributes of an online supplement to in-person physical education programs. One-way ANOVAs were used to assess differences in teachers' ratings by demographic characteristics. Results: Between-group differences were found in teacher ratings of design features related to the usability, accessibility, equitability, and formal assessment capabilities of an online physical education tool. Differences were based on teacher gender, school level, and geographic location. Conclusions: Future research to promote physical activity equity among preschool-12th grade youth should examine tailored virtual physical education learning tools that address what teachers perceive to be the most significant design features to support equitable physical education among diverse student groups.

Self-reported Mental and Physical Health Among Norwegian Adolescents Before and During the COVID-19 Pandemic

Importance

The COVID-19 pandemic and resulting conditions may negatively affect adolescents.

Objective

To examine aspects of self-reported mental and physical health among adolescents in Norway before and during the pandemic, including the role of pandemic-associated anxiety.

Design, Setting, and Participants

This cohort study examined a diverse nationwide sample of grade 11 students from the longitudinal MyLife study in Norway. The original study recruitment of all 8th, 9th, and 10th graders from the same middle schools facilitated identification of 2 sociodemographically comparable cohorts assessed in October to December 2018 and 2019, before the COVID-19 pandemic, and October to December 2020, during the pandemic. School entry and enrollment in Norway is determined by the birth year, and students usually start high school (11th grade) during the fall of the year of their 16th birthday. Data were analyzed from March to June 2021.

Exposures

The COVID-19 pandemic and associated conditions in Norway.

Main Outcomes and Measures

In grades 10 and 11, adolescents reported their depression symptoms using the Patient Health Questionnaire-9 (cutoff scores for moderate/severe depression, ≥15), number of close friends, physical health, and organized sports participation. Cohort differences were examined with a set of nested regression models, incrementally controlling for sociodemographic covariates and grade 10 outcomes.

Results

A sample of 2536 adolescents (1505 [59.4%] girls) was analyzed, including 1621 adolescents before the pandemic and 915 adolescents during the pandemic, of whom 158 adolescents (17.3%) reported high pandemic anxiety. The only significant difference in outcomes between the COVID-19 cohort and the pre-COVID-19 cohort were lower odds of organized sports participation (adjusted odds ratio [aOR], 0.69; 95% CI, 0.56-0.87). However, in subanalyses comparing adolescents with high anxiety during the COVID-19 pandemic with adolescents in the pre-COVID-19 cohort, adolescents with high pandemic anxiety were more likely to experience clinical-level depression symptoms (aOR, 2.17; 95% CI, 1.39-3.37) and poor physical health (aOR, 1.53; 95% CI, 1.01-2.31).

Conclusions and Relevance

In this cohort study of Norwegian adolescents, adolescents who started high school during the pandemic year had lower odds of organized sports participation in late 2020, but were otherwise comparable in terms of self-reported mental and physical health with their pre-COVID-19 counterparts. However, adolescents in the COVID-19 cohort experiencing high pandemic-related anxiety had significantly greater odds of poorer mental and physical health than adolescents in the pre-COVID-19 cohort. Strategies aiming to mitigate the impact of COVID-19 may benefit from identifying youth disproportionally affected by the pandemic conditions.

Sex-Stratified Trends in Meeting Physical Activity Guidelines, Participating in Sports, and Attending Physical Education Among US Adolescents, Youth Risk Behavior Survey 2009-2019

BACKGROUND

During the past decade, guidelines for youth aerobic and muscle-strengthening physical activity remained unchanged. Active People, Healthy NationSM highlighted school and youth strategies (eg, sports and physical education [PE]) to increase physical activity. Sex, grade, and race/ethnicity disparities exist. This study examines sex-specific trends and differences by grade and race/ethnicity for the prevalence of 5 youth physical activity behaviors from 2009 to 2019.

METHODS

The national Youth Risk Behavior Survey assesses adolescents (grades 9-12) meeting the aerobic, muscle-strengthening, and both guidelines (2011-2019) and sports participation and daily PE (2009-2019). Sex-stratified logistic regression assessed trends and 2009 or 2011-2019 differences by grade and racial/ethnic subgroups.

RESULTS

Decreases in meeting the aerobic, muscle-strengthening, and both guidelines were observed for nearly all male subgroups by grade and race/ethnicity, whereas female subgroups exhibited declines or no change to low prevalence. Sports and PE participation remained mostly constant; select subgroups showed decreases (ie, Hispanic males [sports]; Black males and ninth-grade females [PE]).

CONCLUSIONS

Past decade prevalence and patterns suggest that school-based and other strategies for all adolescents and tailored interventions for sex-specific subgroups may be needed to supplement sports and PE in promoting high school youth physical activity.

COVID-19 Pandemic and Reduced Physical Activity: Is There an Impact on Healthy and Asthmatic Children?

Physical activity (PA) has been seen to improve asthma symptoms, lung function, and quality of life, as well as to reduce airway inflammation and bronchial responsiveness. As a consequence of the COVID-19 pandemic, the minimal amount of PA recommended by the World Health Organization-i.e., about 60 min/day of moderate-to-high intensity-is difficult to achieve for many children, particularly those living in urban areas. Short-term changes in PA because of the COVID-19 pandemic may become habitual, increasing the risk of adverse asthma outcomes in children. Indeed, prolonged home confinement during the COVID-19 pandemic reduces PA levels and increases sedentary behaviors, possibly impairing immune system function and increasing susceptibility to inflammatory diseases. However, there is limited evidence regarding the effects of lockdown due to COVID-19 on PA and sedentary behaviors in asthmatic children. Given that children stay longer indoors, indoor air pollution represents a major issue to consider during home confinement. This narrative review aims to summarize the available evidence about the impact of decreased PA and increased sedentary behaviors on children with asthma during the COVID-19 pandemic. In addition, strategies for supporting PA in children with asthma during the COVID-19 pandemic are suggested, also looking at the issue of indoor air quality.