gms | German Medical Science

Background/research question: Emerging research suggests that physical activity among children and adolescents decreased during the COVID-19 pandemic. However, a differentiated overview of European youth is lacking. In particular, no systematic analysis has been conducted to date on the impact of heterogeneous pandemic restrictions and school closures within European countries, and with regard to potentially vulnerable groups [1], [2].

Methods: We searched seven databases and included studies for children and adolescents (≤19 years) of the WHO European Region that compared physical activity during the COVID-19 pandemic with a pre-pandemic baseline using validated measurement instruments. We used the Oxford Stringency Index as indicator of restriction stringency. Screening for eligibility, data extraction, assessment of the study risk of bias (using ROBINS-E instrument) and certainty grading of evidence (using the GRADE approach), were all done in duplicate. Data were pooled in random effects models. An a priori protocol was published, reporting was carried out in accordance with the PRISMA statement.

Trial registration: PROSPERO: CRD42023395871.

Results: Of 14,897 non-duplicate records, 26 publications (n=15,038 pre-pandemic, n=13,041 during pandemic) met full inclusion criteria. Comparison before and during the COVID-19 pandemic revealed a significant reduction in total physical activity (standardized mean difference [SMD], -0.57 [95%CI, -0.95; -0.20]) and moderate-to-vigorous physical activity (SMD, -0.43 [95% CI, -0.75; -0.10]), corresponding to a decrease of 12 minutes per day (a 20% reduction of the WHO recommendation). A decrease in sporting activity was also recorded. Subgroup analyses suggested that middle childhood (aged 8–12) and adolescents were particularly affected by the decline. The analyses outline a possible association between stricter school closures (partial or full closure) and more significant reductions in physical activity.

Conclusion: A sharp decline in all forms of physical activity was recorded among European children and adolescents during the COVID-19 pandemic. This decline was higher during periods of school closure and mainly affected younger schoolchildren and adolescents. These data are of key relevance for the derivation of evidence-based policy and specific health care services for children and adolescents. Immediate action by policy-makers and practitioners, as well as evidence-based public health strategies, are imperative in reversing this trend.

Competing interests: Prof Dr Martin Bujard (last five years): Research funding from the European Union and BMBF (German Federal Ministry of Education and Research). Travel grants and honoraria from universities, federal and state parliaments, federal and state ministries, Evangelical-Lutheran Church, Federal Agency for Civic Education. Consultant for BMFSFJ (German Federal Ministry for Family Affairs, Senior Citizens, Women and Youth). All grants and honoraria were declared to the law office of the German Federal Institute for Population Research (BiB).

No competing interests are declared by any of the other authors.