Impact of the COVID-19 Pandemic on Sedentary Time and Behaviour in Children and Adults: A Systematic Review and Meta-Analysis

The effects of COVID-19 on the Physical Activity and Recreational Screen Time among Chinese children and adolescents

Background

The lack of Physical Activity (PA) and prolonged Recreational Screen Time (RST) among children and adolescents has been exacerbated during the COVID-19 pandemic, causing this issue to escalate into a crucial public health concern. This study aims to investigate the trends in PA and RST among Chinese children and adolescents from 2019 to 2022, thereby analyzing the short-term and long-term effects of the pandemic on PA and RST among Chinese children and adolescents.

Methods

A nationally representative sample of Chinese primary, middle, and high school students was surveyed annually between September and December from 2019 to 2022 using a consistent set of questionnaires. Trends in PA and RST across different school levels, genders, areas (urban/rural), and regions (north/south) were analyzed using Segmented Linear Regression.

Results

From 2019 to 2022, the PA and RST of children and adolescents displayed an inverted U-shaped trend, initially increasing and subsequently declining. Specifically, from 2019 to 2021, the PA of children and adolescents significantly increased but dramatically declined from 2021 to 2022. This trend in PA is more pronounced among primary, male, urban, and northern children and adolescent. The RST of children and adolescents increased from 2019 to 2020 but significantly decreased from 2020 to 2022. This trend in RST is more pronounced among primary, urban, and southern children and adolescent.

Conclusions

This research unveils the effects of the pandemic on PA and RST in children and adolescents, suggesting short-term beneficial and long-term adverse effects on PA and short-term adverse and long-term beneficial effects on RST. These findings provide a foundation for formulating policies related to children and adolescents' PA and RST during the pandemic.

Factors impacting physical activity among post-treatment pediatric cancer survivors with overweight and obesity

BACKGROUND

Pediatric cancer survivors (PCS) with overweight and obesity are at risk for various secondary chronic diseases. Although previous research has found physical activity (PA) as beneficial after treatment, the PA levels are low among PCS, highlighting the need for lifestyle interventions targeting PA.

METHODS

A secondary analysis of preliminary baseline data from a multi-site trial, NOURISH-T + , a healthy lifestyle intervention for PCS with overweight and obesity, and their caregivers, was conducted to assess factors related to PCS PA (i.e., moderate to vigorous intensity PA, MVPA). Kendall's Tau-b was used to assess correlations between PCS MVPA, health and treatment-related factors, and caregivers' sedentary behavior and MVPA. Wilcoxon Signed Ranks Test was used to assess the differences between PCS and caregiver sedentary behavior and MVPA. A multiple linear regression analysis was performed to determine predictors of PCS MVPA.

RESULTS

Seventy-three PCS-caregiver dyads were included in this analysis (N = 146). Many of the PCS were female, diagnosed with Acute Lymphoblastic Leukemia, stage 1, with a mean body mass index (BMI) percentile of 94.4 ± 4.7. Caregivers were female and parents to the PCS. Significant correlations were found between PCS MVPA, time since treatment, PCS weight change since COVID, caregiver sedentary behavior and MVPA. Significant differences were observed between PCS and caregiver sedentary behavior and MVPA. Household income, radiation treatment, and caregiver MVPA were significant predictors of PCS MVPA.   Conclusions: Demographics, cancer treatment type, and caregiver role modeling are important factors to consider when developing future lifestyle interventions for PCS. (NCT04656496, registered 12-07-2020).

WHAT IS KNOWN

• Parents/caregivers are presumed to be a potential influence on their children's physical activity What is new: • Parents/caregivers' moderate-to-vigorous physical activity is the strongest predictor of their children's (pediatric cancer survivors') physical activity.

A single-blinded, randomized, parallel intervention to evaluate genetics and omics-based personalized nutrition in general population via an e-commerce tool: The PREVENTOMICS e-commerce study

BACKGROUND

Personalized nutrition (PN) has been proposed as a strategy to increase the effectiveness of dietary recommendations and ultimately improve health status.

OBJECTIVES

We aimed to assess whether including omics-based PN in an e-commerce tool improves dietary behavior and metabolic profile in general population.

METHODS

A 21-wk parallel, single-blinded, randomized intervention involved 193 adults assigned to a control group following Mediterranean diet recommendations (n = 57, completers = 36), PN (n = 70, completers = 45), or personalized plan (PP, n = 68, completers = 53) integrating a behavioral change program with PN recommendations. The intervention used metabolomics, proteomics, and genetic data to assist participants in creating personalized shopping lists in a simulated e-commerce retailer portal. The primary outcome was the Mediterranean diet adherence screener (MEDAS) score; secondary outcomes included biometric and metabolic markers and dietary habits.

RESULTS

Volunteers were categorized with a scoring system based on biomarkers of lipid, carbohydrate metabolism, inflammation, oxidative stress, and microbiota, and dietary recommendations delivered accordingly in the PN and PP groups. The intervention significantly increased MEDAS scores in all volunteers (control-3 points; 95% confidence interval [CI]: 2.2, 3.8; PN-2.7 points; 95% CI: 2.0, 3.3; and PP-2.8 points; 95% CI: 2.1, 3.4; q < 0.001). No significant differences were observed in dietary habits or health parameters between PN and control groups after adjustment for multiple comparisons. Nevertheless, personalized recommendations significantly (false discovery rate < 0.05) and selectively enhanced the scores calculated with biomarkers of carbohydrate metabolism (β: -0.37; 95% CI: -0.56, -0.18), oxidative stress (β: -0.37; 95% CI: -0.60, -0.15), microbiota (β: -0.38; 95% CI: -0.63, -0.15), and inflammation (β: -0.78; 95% CI: -1.24, -0.31) compared with control diet.

CONCLUSIONS

Integration of personalized strategies within an e-commerce-like tool did not enhance adherence to Mediterranean diet or improved health markers compared with general recommendations. The metabotyping approach showed promising results and more research is guaranteed to further promote its application in PN. This trial was registered at clinicaltrials.gov as NCT04641559 (https://clinicaltrials.gov/study/NCT04641559?cond=NCT04641559&rank=1).

Psychological Factors Associated with General Quality of Life in the Context of COVID-19 Pandemic: A Cross-Sectional Study on a Multicultural Sample of Romanian Medical Students

The COVID-19 pandemic had a significant impact on the general quality of life (GQOL) of a large number of individuals, including those in the academic environment. This study investigated GQOL in a sample of 613 Romanian medicine students (81.57% were female; mean age = 21.40 ± 1.749 years) in relation to their Big Five personality characteristics, Perceived Stress and Fear of COVID-19. The study was conducted between June 2020 and March 2022. These variables were investigated with the Big Five Inventory-2: Extra-Short Form, the Fear of COVID-19 Scale (FCV-19S), the Perceived Stress Scale-10 and the Satisfaction with Life Scale (SWLS). Statistical analysis included hierarchical linear regression and t-tests. The results indicated a significant direct relationship between GQOL and the personality traits of Conscientiousness, Extraversion and Agreeableness. However, a significant inverse relationship was observed between GQOL and Perceived Stress and Neuroticism. Fear of COVID-19 was significantly higher in women, while no other socio-demographic variables were associated with GQOL. A total of 61.7% of the studied population returned to their original residency during the pandemic years. These results could be important for better understanding the vulnerability to significant epidemiological events in academic populations and for planning adequate preventive or interventional measures.

A Retrospective Analysis of the Effects of Cardiac Rehabilitation on Health Markers and Performance Outcomes among Diabetic and Non-Diabetic Patients with Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention

BACKGROUND

The aim of this study was to investigate the effects of cardiac rehabilitation on health markers and performance outcomes among diabetic and nondiabetic patients with coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI).

METHODS

One hundred and ninety-seven patients with PCI and CABG, who attended phase 2 cardiac rehabilitation, were included in the study. Patient data were separated by cardiac diagnosis, (PCI and CABG), diabetes category (diabetic and nondiabetic), number of sessions attended (12-24 or 25-36), and time (pre- to post-test). The Duke Activity Score Index and Patient Health Questionnaire-9 questionnaires and measurements for total cholesterol, high-density lipoprotein, low-density lipoprotein, triglycerides, and, if diabetic, A1c and fasting blood glucose, were taken at baseline and upon completion of the program.

RESULTS

High-density lipoprotein (p < 0.001), diastolic blood pressure (p = 0.004), Duke Activity Score Index questionnaire (p < 0.001), Patient Health Questionnaire-9 (p < 0.001), and A1c (p = 0.003) significantly improved from pre- to post-testing. Total cholesterol (p < 0.001) and low-density lipoprotein (p < 0.001) for the 25-36 nondiabetic PCI group significantly decreased. Triglycerides decreased for all 12-24 session groups (p = 0.015). Fasting blood glucose significantly decreased (p = 0.037) for the 12-24 PCI group with diabetes. No significant interactions were found for systolic blood pressure and body weight.

CONCLUSION

Cardiac rehabilitation resulted in significant improvements in the lipid panel, diastolic blood pressure, and questionnaire results, regardless of the number of sessions attended. However, no significant benefits for systolic blood pressure were observed.

Impact of the COVID-19 lockdown on the oral health behaviour of young children

AIM

Children up to the age of 10 are dependant primarily on their caregivers for oral care; COVID-19 lockdowns may have disrupted this care. We therefore assessed whether the COVID-19 lockdown affected routine parental oral care for their children.

METHODS

A short online survey regarding oral health behaviour and changes in the home setting during the COVID-19 lockdown was emailed to parents (n = 782, response 15%) participating in an existing study 'Healthy Teeth All Aboard (HTAA)'.

RESULTS

During the lockdown, 29% of parents reported that they skipped their children's toothbrushing more often than before the lockdown, and 49% of the children were allowed to consume sugary snacks or drinks more often. These behaviours were not significantly associated with socio-economic status, country of birth of the mother, work situation of the parents, school attendance patterns or HTAA participation status.

CONCLUSION

The COVID-19 lockdown affected the daily oral hygiene routines of children, potentially increasing caries risk.

CLINICAL RELEVANCE

Dental professionals should be aware of the potential impacts on oral health in children in the circumstance of a new lockdown. Parents should be made aware of the oral health consequences of a lockdown.

National Trends in the Prevalence of Screen Time and Its Association With Biopsychosocial Risk Factors Among Korean Adolescents, 2008-2021

PURPOSE

Prior studies suggested an increase in screen time among adolescents during the COVID-19 pandemic; however, due to limited sample size and a short-term observation period, these associations are inconclusive and inconsistent. Thus, we aimed to compare screen time during the pandemic and the long-term trend through a Korean large-scale and long-term study of one million adolescents.

METHODS

Data from 2008 to 2021 on 913,191 Korean adolescents aged 12-18 years were obtained via a nationwide, large-scale, and serial study. We investigated the change of screen time use over time and the change in trend before and during the pandemic (2008-2019 vs. 2020-2021) by using weighted linear regression model with estimates of β-coefficients and 95% confidence intervals (CIs). Moreover, we analyzed the differences in vulnerability of biopsychosocial factor before and during the pandemic.

RESULTS

A total of 913,191 adolescents were included in this analysis. During the pandemic, the overall screen time of Korean adolescents significantly increased compared to the expected based on the prepandemic period during the pre-COVID-19 period (weighted screen time before the pandemic [133.24 min/day; 95% CI, 132.08-134.40] vs. during the pandemic [303.66 min/day; 95% CI, 300.59-306.73]; βdiff 0.331; 95% CI, 0.311-0.351). Comparing before and during the pandemic, potential risk factors associated with screen exposure included female sex, sadness, suicidal thoughts, alcohol consumption, low educational level of parents, low level of vigorous physical activity, middle school students, and low household income.

DISCUSSION

Through large-scale nationwide study, this study described the 14-year trend of screen time among Korean adolescents. In the era of COVID-19, the prevalence of screen exposure has been increasing more rapidly than before at the population level. Also, the pandemic amplified the differences in screen time across grade, sex, sadness, suicidal thoughts, smoking, alcohol consumption, education level of parents, physical activity, and household income groups.

Changes in physical activity and sedentary behavior during the first COVID-19 pandemic- restrictions in Germany: a nationwide survey : Running head: physical activity during the COVID-19 restrictions

BACKGROUND

The COVID-19 pandemic restrictions posed challenges to maintaining healthy lifestyles and physical well-being. During the first mobility restrictions from March to mid-July 2020, the German population was advised to stay home, except for work, exercise, and essential shopping. Our objective was to comprehensively assess the impact of these restrictions on changes in physical activity and sedentary behavior to identify the most affected groups.

METHODS

Between April 30, 2020, and May 12, 2020, we distributed a COVID-19-specific questionnaire to participants of the German National Cohort (NAKO). This questionnaire gathered information about participants' physical activity and sedentary behavior currently compared to the time before the restrictions. We integrated this new data with existing information on anxiety, depressive symptoms, and physical activity. The analyses focused on sociodemographic factors, social relationships, physical health, and working conditions.

RESULTS

Out of 152,421 respondents, a significant proportion reported altered physical activity and sedentary behavioral patterns due to COVID-19 restrictions. Over a third of the participants initially meeting the WHO's physical activity recommendation could no longer meet the guidelines during the restrictions. Participants reported substantial declines in sports activities (mean change (M) = -0.38; 95% CI: -.390; -.378; range from -2 to + 2) and reduced active transportation (M = -0.12; 95% CI: -.126; -.117). However, they also increased recreational physical activities (M = 0.12; 95% CI: .117; .126) while engaging in more sedentary behavior (M = 0.24; 95% CI: .240; .247) compared to pre-restriction levels. Multivariable linear and log-binomial regression models indicated that younger adults were more affected by the restrictions than older adults. The shift to remote work, self-rated health, and depressive symptoms were the factors most strongly associated with changes in all physical activity domains, including sedentary behavior, and the likelihood to continue following the physical activity guidelines.

CONCLUSIONS

Mobility patterns shifted towards inactivity or low-intensity activities during the nationwide restrictions in the spring of 2020, potentially leading to considerable and lasting health risks.

An investigation into exercise prescription post-COVID-19 pandemic amongst Non-Consultant Hospital Doctors in an acute hospital setting

BACKGROUND

Being sedentary is an independent risk factor for severe COVID-19 infection, suggesting the important role physical activity (PA) has as a modifiable risk factor for COVID-19 outcome.

AIMS

The aim of this study was to evaluate NCHD's exercise prescribing practices and establish how these related to their knowledge, attitudes, and demographics and if their practices had changed since the COVID-19 pandemic began.

METHODS

An online survey was emailed to NCHDs working in city centre teaching hospitals in southern Ireland. Using a combination of forced choice items and five-point Likert scales, questions examined NCHD's knowledge, attitudes, and practices of exercise prescription.

RESULTS

For education, 30% of participants were able to correctly answer both WHO PA guidelines. 10% agreed that they knew where to refer patients for specialist exercise programs. For attitudes, 100% of participants in this study agreed that PA played a role in the prevention of disease. For practices, 36% of participants did not prescribe exercise at all. No participant strongly agreed with being confident in prescribing exercises. 90% did not increase their exercise prescribing practices since the introduction of pandemic restrictions.

CONCLUSIONS

Despite an overall positive attitude towards PA in this study, findings suggest exercise prescribing was not carried out regularly amongst the majority of participants. There was a lack of confidence and knowledge regarding exercise prescribing amongst NCHDs. The majority of NCHDs have not changed their exercise prescribing practices since the COVID-19 pandemic began. Findings suggest there is an urgent need for educational tools and supports to assist doctors with exercise prescribing.

Evaluating the impact of work from home policies on Google search Trends related to ankle surgery during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic caused notable shifts in healthcare behavior, influenced by remote work policies. This study examines the impact of Work from Home (WFH) policies on public interest in ankle-related orthopaedic surgeries, utilizing Google search trends. Understanding these trends is crucial for healthcare providers, enabling them to adapt services and communication to evolving patient needs during challenging times.

OBJECTIVE

To comprehend variations in search volume and trends for ankle-related queries due to WFH policies during the COVID-19 pandemic.

METHODS

Ankle-related terms accessible to laypersons were analyzed using Google Trends data from March 2018 to March 2022 in the United States. Data were divided into pre-pandemic (March 2018-March 2020) and post-pandemic (March 2020-March 2022) periods. Weekly search interest data for 20 terms were analyzed using a Mann-Whitney U test. The study aimed to identify significant changes in search interest, providing insights into public information-seeking behavior concerning ankle surgeries.

RESULTS

Among the 20 terms analyzed, 11 exhibited significant changes. Ankle arthritis and ankle bursitis showed increased interest, suggesting heightened concern during the pandemic. Conversely, post-pandemic interest decreased for terms 9 terms, including ankle pain and ankle tendonitis, indicating reduced worry. Moderate declines were noted for ankle gout, Achilles tendonitis, and heel bursitis, reflecting shifting patient priorities. Some terms, including ankle fracture and ankle arthroplasty, showed stable information-seeking behavior despite the pandemic.

CONCLUSIONS

The study underscores the nuanced impact of WFH policies on public interest in ankle-related orthopaedic surgeries. Varied search trends highlight changing patient concerns. Healthcare providers can use these insights to tailor services effectively, meeting evolving patient needs and enhancing communication strategies.

Improvements in stress among Latinas participating in a randomized controlled trial of technology-supported physical activity interventions

High levels of stress and inactivity likely contribute to chronic disease disparities among Latinas in the U.S. and call for intervention. To inform such efforts, the current study examined the relationships among changes (over time) in physical activity, stress, and related cardiometabolic biomarkers among sedentary (mostly) first generation Latinas. Data are taken from a randomized controlled trial (N = 199 Latinas) of two home-based physical activity interventions (Original vs. theory- and technology- Enhanced versions). Physical activity and perceived stress were assessed at baseline and 6 and 12 months. Blood draws occurred at baseline and 6 months in a random subsample (N = 153). The participants were underactive (<60/min week of moderate-to-vigorous physical activity) Mexican American (89%) women with moderate perceived stress scores (M = 21.49, SD = 8.55, range = 0-40) and excess weight (M BMI = 30.6) at baseline. Overall, participants reported decreases in stress after 6 months enroled in the physical activity programs. The odds of a reduction in perceived stress were 11% higher among Enhanced versus Original Intervention participants (OR = 1.11, 95% CI: 1.05-2.27). Those who met physical activity guidelines were significantly more likely to report reductions in perceived stress over 6 months (OR = 1.92, 95% CI: 1.08-4.16). Furthermore, those who reported reductions in perceived stress over 6 months reported significantly more moderate-to-vigorous physical activity at 12 months (+69 min/week, SE = 27.98, p = 0.01) compared to those who did not. Greater reductions in perceived stress over 6 months were associated with greater improvements in cardiometabolic biomarkers (HbA1c, triglycerides, p's < 0.05). These results support a bidirectional relationship between improvements in stress and physical activity among Latinas. Future implications include using physical activity to address stress management and health disparities in this community.

Isolating unique variance in mental health outcomes attributable to personality variables and childhood emotional abuse

Introduction

University students are at high risk for anxiety and depression. Our main objective was to tease apart variance in symptom severity that was uniquely attributable to four associated variables that are frequently confounded: exposure to childhood emotional abuse, alexithymia, sensory processing sensitivity (SPS), and anxiety sensitivity (AS).

Methods

University students (N = 410) completed an online survey designed to measure our four key study variables along with several other potentially relevant variables including sex, physical activity levels, and perceived COVID-19 impacts.

Results

Over half of the participants reported moderate to extremely severe symptoms of anxiety and depression. Females reported stronger signs of SPS and AS and were more likely than males to have increased their moderate/vigorous exercise since the pandemic began. After controlling for the other variables, the best predictors of perceived COVID-19 impacts were SPS, childhood emotional abuse, and current levels of physical activity. Whereas all three personality variables and childhood emotional abuse emerged as significant predictors of both depression and anxiety, neither COVID-19 impacts nor physical activity levels accounted for unique variance in either model. Unexpectedly, male sex emerged as an additional risk factor for depression, raising the possibility that males experience unique stressors and societal pressures that increase their risk of depression.

Discussion

These findings help to clarify the links between childhood emotional abuse, personality traits implicated in emotional awareness and self-regulation, and mental health. They may have important implications for the development and implementation of individualized treatments for common mental disorders.

IoT-Based Solution for Detecting and Monitoring Upper Crossed Syndrome

A sedentary lifestyle has caused adults to spend more than 6 h seated, which has led to inactivity and spinal issues. This context underscores the growing sedentary behavior, exemplified by extended sitting hours among adults and university students. Such inactivity triggers various health problems and spinal disorders, notably Upper Crossed Syndrome (UCS) and its association with thoracic kyphosis, which can cause severe spinal curvature and related complications. Traditional detection involves clinical assessments and corrective exercises; however, this work proposes a multi-layered system for a back brace to detect, monitor, and potentially prevent the main signs of UCS. Building and using a framework that detects and monitors signs of UCS has facilitated patient-doctor interaction, automated the detection process for improved patient-physician coordination, and helped improve patients' spines over time. The smart wearable brace includes inertial measurement unit (IMU) sensors targeting hunched-back postures. The IMU sensors capture postural readings, which are then used for classification. Multiple classifiers were used where the long short-term memory (LSTM) model had the highest accuracy of 99.3%. Using the classifier helped detect and monitor UCS over time. Integrating the wearable device with a mobile interface enables real-time data visualization and immediate feedback for users to correct and mitigate UCS-related issues.

The Relationship between Self-Reported Sitting Time and Vitamin D Levels in Middle-Aged and Elderly Taiwanese Population: A Community-Based Cross-Sectional Study

(1) Background: Many studies have revealed a relationship between serum 25-hydroxy vitamin D and physical activity. This study aimed to investigate the relationship between self-reported sitting time and serum 25-hydroxy vitamin D levels in middle-aged and elderly adults in Taiwan. (2) Methods: A total of 396 people were enrolled in our study during a community health examination in Taiwan in 2019. We grouped participants from low to high according to their tertile of serum 25-hydroxy vitamin D levels, using the following categories: deficiency, insufficiency, and sufficiency. Parameters including self-reported sitting time were analyzed between each group. Pearson correlation coefficients were calculated to explore the relationships of serum 25-hydroxy vitamin D levels with age-adjusted risk factors. A scatter plot demonstrated the relationship between serum 25-hydroxy vitamin D levels and self-reported sitting time. The association between serum 25-hydroxy vitamin D levels and self-reported sitting time was assessed by multivariate linear regression with adjustment for age, sex, waist circumference, low-density lipoprotein, triglycerides, and smoking and drinking status. (3) Results: We analyzed the data from 396 participants. A total of 41.4% of participants were male, and the average age of all participants was 64.91 (±8.80) years. The participants in the high serum 25-hydroxy vitamin D group were more likely to have shorter self-reported sitting time. Serum 25-hydroxy vitamin D was negatively correlated (Pearson's r) with self-reported sitting time, even after adjustment for age. According to the results of multivariate linear regression, vitamin D levels showed a negative association with self-reported sitting time (β = -0.131, p = 0.006) after adjustment for age, sex, waist circumference, low-density lipoprotein, triglycerides, and smoking and drinking status. (4) Conclusions: According to our research, self-reported sitting time was inversely correlated with serum 25-hydroxy vitamin D in middle-aged and elderly people in Taiwan. Meanwhile, longer self-reported sitting time can be an independent risk factor for lower serum 25-hydroxy vitamin D levels.

Physical fitness among children with diverse weight status during and after the COVID-19 pandemic: a population-wide, cohort study based on the Slovenian physical fitness surveillance system (SLOfit)

Background

COVID-19 public health crisis has exerted immediate negative impacts on children's physical fitness, but the longer-term effects are not clear, and the impact on children with excess weight is yet unknown. We examined changes in multiple components of physical fitness in response to COVID-19 imposed restrictions, but also a year after the restrictions were terminated, and compared these trends in groups of boys and girls with normal weight, overweight, or obesity before the pandemic.

Methods

Information was gathered through Slovenia's national fitness surveillance system, and included 41,330 children (19,890 girls), aged 5-17, who had their fitness levels measured yearly from 2019 to 2022. Multilevel linear mixed models, fitted separately for boys and girls, were used to model the individual-level trends over time in centile score for each fitness test across 3 weight groups.

Findings

Overall fitness levels decreased markedly across all weight categories between 2019 and 2020, with the largest decreases in Total Fitness Index observed in children with normal weight and overweight (-8.4 and -7.7 centiles for boys and -8.3 and -8.8 for girls, respectively, p < 0.001). While there was some recovery in the overall fitness level between 2020 and 2022, it remained much lower in 2022 compared to 2019 across most groups, apart from boys with obesity. Fitness components that had the largest impact on general fitness trends were cardiorespiratory fitness, lower body power, body core, and upper body strength.

Interpretation

A severe decline in fitness that has not come close to returning to pre-pandemic levels in most population groups of youth begs for urgent population-wide initiatives that will provide additional opportunities for physical activity to youth. Among vulnerable groups, girls with overweight and obesity deserve a special focus of these policies.

Funding

Horizon 2020 (Grant no. 774548), Slovenian National Research Agency (Grant no. P5-0142), Croatian Science Foundation (Grant no. DOK-2020-01-3728).

Exercise breaks prevent attenuation in cerebrovascular function following an acute bout of uninterrupted sitting in healthy children

The purpose of this study was to examine the effect of an acute bout of prolonged sitting with and without exercise breaks on cerebrovascular function in 7- to 13-year-old children. Forty-two children and adolescents were recruited to a crossover trial, with 15 girls (mean age 10.1 ± 2.5 years) and 16 boys (mean age 10.5 ± 1.3 years) completing the two trial conditions: SIT, uninterrupted sitting for 3 h and CYCLE, 3 h of sitting interrupted hourly with a 10-min moderate intensity exercise break. Cerebrovascular function was measured Pre and Post SIT and CYCLE from blood flow (Q ̇ ${\dot{Q}}$ ), diameter, and shear rate of the internal carotid artery (ICA) at rest and in response to CO2 . Blood velocity in the middle (MCA) and posterior (PCA) cerebral arteries was assessed at rest, during a neurovascular coupling task (NVC) and in response to CO2 . We demonstrate that SIT but not CYCLE reduced ICA cerebrovascular reactivity to CO2 (%Δ ICAQ ̇ ${\dot{Q}}$ /Δ end-tidal CO2 : SIT: Pre 5.0 ± 2.4%/mmHg to Post 3.3 ± 2.8%/mmHg vs. CYCLE: Pre 4.4 ± 2.3%/mmHg to Post 5.3 ± 3.4%/mmHg, P = 0.05) and slowed the MCA blood velocity onset response time to hypercapnia (SIT: Pre 57.2 ± 32.6 s to Post 76.6 ± 55.2 s, vs. CYCLE: Pre 64.1 ± 40.4 s to Post 52.3 ± 28.8 s, P = 0.05). There were no changes in NVC. Importantly, breaking up prolonged sitting with hourly exercise breaks prevented the reductions in cerebrovascular reactivity to CO2 and the slowed intracranial blood velocity onset response time to hypercapnia apparent with uninterrupted sitting in children. NEW FINDINGS: What is the central question of this study? What are the effects of interrupting prolonged sitting on cerebrovascular function in children? What is the main finding and its importance? Prolonged sitting results in declines in cerebrovascular reactivity, a valuable index of cerebrovascular health. Breaking up prolonged sitting with hourly 10 min exercise breaks prevented these changes. These initial findings suggest excessive sedentary behaviour does impact cerebrovascular function in childhood, but taking exercise breaks prevents declines.

Cardiovascular health worsening in patients with autoimmune rheumatological diseases during the COVID-19 pandemic

Rheumatic autoimmune diseases are associated with a myriad of comorbidities. Of particular importance due to their morbimortality are cardiovascular diseases. COVID-19 greatly impacted the world population in many different areas. Patients with rheumatic diseases had to face changes in their healthcare, in addition to unemployment, a decrease in physical activity, social isolation, and lack of access to certain medications. This review summarizes the impact of COVID-19 pandemic on cardiovascular risk factors, comorbidities, and unhealthy behaviors in patients with rheumatic inflammatory autoimmune diseases, particularly focused on rheumatoid arthritis and systemic lupus erythematosus. Searches were carried out in MEDLINE/PubMed and Scopus from August to December 2022. Four reviewers screened the title and abstract of retrieved records. Potentially eligible reports were then reviewed in full text. Differences were reconciled by either consensus or discussion with an external reviewer. During the COVID-19 pandemic, patients with rheumatic diseases showed an increase in the prevalence of mental health disorders (43.2-57.7%), reduced physical activity (56.8%), and a worsening in eating behaviors. Alcohol intake increased (18.2%), especially in early phases of the pandemic. Smoking prevalence decreased (28.2%). Dyslipidemia and hypertension showed no changes. The pandemic and lockdown affected rheumatic patients not only in disease-related characteristics but in the prevalence of their cardiovascular comorbidities and risk factors. Lifestyle changes, such as healthy eating, physical activity, and optimal management of their rheumatic diseases and comorbidities, are essential to manage the long-lasting consequences of the COVID-19 outbreak. Key Points • During the COVID-19 pandemic, anxiety, depression, sedentarism, obesity, and a worsening in eating behaviors increased. •Patients with rheumatic diseases and comorbidities have worse clinical outcomes and a higher cardiovascular disease burden than those without them. •Comparative studies are necessary to precisely elucidate the pandemic's impact on the prevalence of cardiovascular disease, risk factors, and comorbidities in patients with rheumatoid arthritis and systemic lupus erythematosus.

Sedentary behavior and neck pain in adults: A systematic review and meta-analysis

Sedentary lifestyle is an imperative risk for musculoskeletal pain. We sought to investigate the association between different types of sedentary behaviors (SBs) and neck pain (NP) among adults. A systematic search was conducted in PubMed, Web of Science, Embase, Scopus, and Google Scholar up to the end of April 2023. The odds ratio (95% CI) was considered as the desired effect size for the association between SBs and the NP. Among 1881 records found by primary search, 46, and 27 reports were included in the qualitative and quantitative analysis respectively. All included studies qualified as good or fair. Our results indicated that SB is a risk factor for NP among adults (OR = 1.5, [1.29, 1.76]). Computer and mobile phone use were also found to be considerable risk factors for NP (OR = 1.3, [1.12, 1.53], and OR = 2.11, [1.32, 3.42] respectively). However, sitting time showed an insignificant association with NP (OR = 1.33, [0.86, 2.07]). Subgroup analysis revealed that SBs are a significant risk factor for NP among university students (OR = 1.58, [1.27, 1.97]), but the association among office workers was marginally insignificant (OR = 1.36, [0.98, 1.89]). According to the meta-regression results, the male gender was found to increase the risk of NP. Meanwhile, Egger's test revealed the presence of publication bias (p-value <0.0001). A sedentary lifestyle as well as computer and mobile phone use is associated with a considerable risk of NP among adults, especially university students. Further, longitudinal studies are needed to better clarify the causality relationships.

A Repeated Cross-Sectional Pilot Study of Physical Activity, Levels of Depression and Anxiety during the COVID-19 Pandemic in Young Greek Adults

Regular physical activity (PA) and, more specifically, exercise, is associated with lower levels of stress, depression, and anxiety. The aim of this repeated cross-sectional pilot study was to investigate the impact of participating in PA on the mental health of young adults in Greece during the COVID-19 pandemic. The study was carried out during two quarantine periods: Survey I on 5 May 2020, and Survey II on 30 April 2021. The Hamilton Anxiety (HAM-A) and Beck Depression Inventory-II (BDI-II) scales and the level of PA were used to assess a sample of individuals aged between 18 and 26 years old. In 2020 and 2021, a total of 268 (33.9% males) and 380 (37.1% females) subjects participated in the studies, respectively. According to the findings, the vast majority of the participants in both samples reported that they are physically active (p = 0.86), while they consider exercise as a significant health factor (p = 0.10). Moreover, anxiety levels statistically significant increased (p = 0.001), while depression levels remained relatively stable with a slight increase of approximately (p > 0.05). Additionally, in both surveys, individuals who engaged in a PA program exhibited reduced levels of depression and anxiety (p = 0.001). Also, gender appears to influence anxiety and depression levels, while a lack of exercise exacerbates these measures in both genders when compared to physically active individuals. Concludingly, it is crucial for public health strategies to include interventions that promote safe PA in the event of future lockdowns or similar emergencies.

The long-term boomerang effect of COVID-19 on admissions for non-COVID diseases: the ECIEN-2022 study

Since COVID-19 pandemic started, many changes have been seen in the cycling patterns of pediatric pathologies. On year 2020, we described the initial effects of COVID-19, with a significant decrease in emergency visits and admissions, but 2 years later the situation seems to be reversed. Our study bridges a literature gap by exploring the lasting effects of COVID-19 on pediatric non-COVID admissions, particularly the resurgence of respiratory illnesses. ECIEN-2022 is a single-center, retrospective, observational-study conducted 3 years after the pandemic onset, to describe the long-term effects of COVID-19 in pediatric admissions for non-COVID diseases. Admissions during year 2022 were compared with the Pre-Pandemic Period (PPP: 2015-2019). Pediatric Emergency Department (P-ED) visits, hospital, and Intensive Care Unit (P-ICU) admissions were compared across pre- and post-pandemic periods. Monthly distribution and year-waves are presented. P-ED monthly visits (mean and Standard deviation (SD) raised from 3521 (533) in the PPP to 3775 (996) in 2022 (p < 0.001). Monthly hospital admissions in the 3rd quarter of the Pre-Pandemic Period were 111.7/month (SD:29), dropped to 88.5(SD:6.5) in 2020 and raised to 149(SD:38.8) in 2022 (p = 0.036). An increase in respiratory illnesses was observed in 2022 compared to PPP; Bronchiolitis increased 38%, bronchitis 56%, and admissions for Respiratory Syncytial Virus 67%.  Conclusion: COVID-19 pandemic has had a significant impact on the use and nature of pediatric health services. The initial decrease has been followed by a boomerang effect with an increase of cases, mainly due to an increase in respiratory infections when pandemic control measures and social restrictions have been lifted. It is essential to maintain an active surveillance and monitorization of these patterns to ensure appropriate healthcare access and utilization. What is Known: • COVID-19 pandemic initially led to a significant decrease in emergency visits and admissions for non-COVID diseases. What is New: • ECIEN-2022 study investigated the long-term effects of COVID-19 on pediatric admissions for non-COVID diseases, detecting a "boomerang effect" with an increase in pediatric admissions for non-COVID diseases in year 2022. • Pediatric Emergency Department visits and hospital admissions for non-COVID diseases, especially those due to respiratory infections, increased significantly in 2022 when compared to the Pre-Pandemic Period.

The impact of the COVID-19 pandemic on inequalities in lifestyle behaviours and mental health and wellbeing of elementary school children in northern Canada

Objectives

The COVID-19 pandemic has negatively affected children's lifestyle behaviours and mental health and wellbeing, and concerns have been raised that COVID-19 has also increased health inequalities. No study to date has quantified the impact of COVID-19 on health inequalities among children. We compared pre-pandemic vs. post-lockdown inequalities in lifestyle behaviours and mental health and wellbeing among children living in rural and remote northern communities.

Methods

We surveyed 473 grade 4-6 students (9-12 years of age) from 11 schools in rural and remote communities in northern Canada in 2018 (pre-pandemic), and 443 grade 4-6 students from the same schools in 2020 (post-lockdown). The surveys included questions on sedentary behaviours, physical activity, dietary intake, and mental health and wellbeing. We measured inequality in these behaviors using the Gini coefficient, a unitless measure ranging from 0 to 1 with a higher value indicating greater inequality. We used temporal changes (2020 vs. 2018) in Gini coefficients to assess the impact of COVID-19 on inequalities in lifestyle behaviours and mental health and wellbeing separately among girls and boys.

Results

Inequalities in all examined lifestyle behaviours increased between 2018 and 2020. Inequalities in watching TV, playing video games, and using a cell phone increased among girls, while inequalities in playing video games, using computers and tablets, and consumption of sugar, salt, saturated fat and total fat increased among boys. Changes in inequalities in mental health and wellbeing were small and not statistically significant.

Conclusion

The findings suggest that the COVID-19 pandemic has exacerbated inequalities in lifestyle behaviours among children living in rural and remote northern communities. If not addressed, these differences may translate into exacerbated inequalities in future health. The findings further suggest that school health programs can help mitigate the negative impact of the pandemic on lifestyle behaviours and mental health and wellbeing.

The Physiological and Molecular Links Between Physical Activity and Brain Health: A Review

There is currently an epidemic of sedentary behavior throughout the world, leading to negative impacts on physical health and contributing to both mortality and burden of disease. The consequences of this also impact the brain, where increased levels of cognitive decline are observed in individuals who are more sedentary. This review explores the physiological and molecular responses to our sedentary propensity, its contribution to several medical conditions and cognitive deficits, and the benefits of moderate levels of physical activity and exercise. Also presented is the recommended level of activity for overall physical health improvement.

Eighteen-Month Changes in Physical Activity, Body Weight, Quadriceps Strength, and Gait Biomechanics during the COVID-19 Pandemic

PURPOSE

This study assessed the effects of the COVID-19 pandemic restrictions/lockdowns on physical activity levels, body mass, quadriceps strength, and gait biomechanics over 18 months.

METHODS

Ten healthy men were assessed at baseline (~14 wk before first lockdown) and 17.9 ± 0.3 months later (<1 wk after second lockdown). At both times, physical activity levels, body mass, and quadriceps strength were acquired using the International Physical Activity Questionnaire, a force plate, and a dynamometer, respectively. Gait data were also acquired using a motion capture system and force plates during self-paced walking, from which spatiotemporal parameters, knee angles, and external moments were computed. Baseline and follow-up measurements were compared using two-tailed paired t -tests ( α = 0.05).

RESULTS

At follow-up, participants spent less time doing vigorous physical activity (∆ = -76 ± 157 min·wk -1 , P = 0.048), exhibited a tendency toward increased sedentary time (∆ = +120 ± 162 min·d -1 , P = 0.056), weighed more (∆ = +2.5 ± 2.8 kg, P = 0.021), and showed a trend toward reduced quadriceps strength (∆ = -0.29 ± 0.45 (N·m)·kg -1 , P = 0.071) compared with baseline. At follow-up, participants walked slower (∆ = -0.09 ± 0.07 m·s -1 , P = 0.005), had greater knee flexion angles at heel strike (∆ = +2.2° ± 1.8°, P = 0.004) and during late stance (∆ = +2.2° ± 1.8°, P = 0.004), had reduced knee extension moments (∆ = -0.09 ± 0.09 (N·m)·kg -1 , P = 0.012) and knee internal rotation moments (∆ = -0.02 ± 0.02 (N·m)·kg -1 , P = 0.012) during late stance.

CONCLUSIONS

Healthy men exhibited reduced physical activity levels, increased body weight, a tendency toward reduced quadriceps strength, and altered gait biomechanics over the initial 18 months of the COVID-19 pandemic-alterations that could have far-reaching health consequences.

Determinants of recreational screen time behavior following the COVID-19 pandemic among Canadian adults

The objectives of our study were to examine recreational screen time behavior before and 2 years following the COVID-19 pandemic lockdown, and explore whether components of the capability-opportunity-motivation-behavior (COM-B) model would predict changes in this recreational screen time behavior profile over the 2-year period. This cross-sectional, retrospective study was conducted in March 2022. Canadian adults (n = 977) completed an online survey that collected demographic information, current screen time behavior, screen time behavior prior to the pandemic, and beliefs about capability, opportunities, and motivation for limiting screen time based on the COM-B model. We found that post-pandemic recreational screen time (3.91 ± 2.85 h/day) was significantly higher than pre-pandemic levels (3.47 ± 2.50 h/day, p < 0.01). Three recreational screen time behavior profiles were identified based on the Canadian 24-Hour Movement Guidelines: (1) always met screen time guidelines (≤3 h/day) (47.8%; n = 454); (2) increased screen time (10.1%; n = 96); and (3) never met screen time guidelines (42%; n = 399). The overall discriminant function was found to be significant among the groups (Wilks' λ = 0.90; canonical r = 0.31, χ2 = (14) = 95.81, p < 0.001). The group that always met screen time guidelines had the highest levels of automatic motivation, reflective motivation, social opportunity, and psychological capabilities to limit screen time compared to other screen time profile groups. In conclusion, recreational screen time remains elevated post-pandemic. Addressing motivation (automatic and reflective), psychological capabilities, and social opportunities may be critical for future interventions aiming to limit recreational screen time.

Daily step counts before, during, and after COVID-19 pandemic: a smartphone-tracking study of university students in Egypt and Saudi Arabia

BACKGROUND

COVID-19 pandemic has drastically changed people's lifestyles and daily routines around the world. This study aimed to investigate changes in daily step counts - as an indicator of physical activity - before, during, and after the pandemic among university students in Egypt and Saudi Arabia and to identify regional and gender factors that may have influenced physical activity during these periods.

METHODS

A total of 1273 university students from Egypt (Assiut University and Zagazig University) and Saudi Arabia (Taif University, King Faisal University, and Imam AbdulRahman Bin Faisal University) provided valid data on their daily step counts recorded by a smartphone application (iPhone Health App) from January 2019 to December 2021. The data was divided and averaged based on three periods: the pre-pandemic year (January to December 2019), the first pandemic year (January to December 2020), and the second pandemic year (January to December 2021).

RESULTS

The results showed a significant decrease in daily steps from pre-pandemic to the first pandemic year, followed by an increase in the second pandemic year. However, daily step counts did not fully recover to pre-pandemic levels in male Egyptian and marginally in male Saudi participants. In both nationalities, female participants did not show a significant difference in daily steps between the pre-pandemic and second-pandemic years. Female Egyptian participants had significantly lower daily step counts than male Egyptian participants, and a gender difference in daily steps was also observed in Saudi female participants in the pre-pandemic and the second pandemic year but not during the first pandemic year.

CONCLUSION

These findings outline the need for strategies in Egypt and Saudi Arabia to promote physical activity and reduce sedentary behavior, especially among young women, to mitigate the negative consequences of COVID-19 and meet physical activity guidelines.

Effect of the COVID-19 pandemic on emergency department attendances for pediatric injuries in Mozambique's central hospitals: an interrupted time series and a comparison within the restriction periods between 2019 and 2020

Objectives

Hospital-based studies indicate that restriction measures imposed during the COVID-19 pandemic have affected the number and characteristics of pediatric injuries. However, few studies have been conducted in resource-poor countries. This study aimed to determine whether injury-related emergency department (ED) attendances in Mozambique were affected during the restriction periods in 2020 and how the pattern of injury changed.

Methods

Mozambique faced two restriction periods in 2020. An interrupted time series was applied to weekly data of pediatric injuries from the ED records of four central hospitals in Mozambique in 2019 and 2020. Weekly numbers of injuries were modeled using a Poisson regression model to estimate the effect of COVID-19 restrictions on trends over calendar time. Then, for each restriction period, differences in injury mechanisms, severity, need for surgery, and intensive care unit (ICU) attendances were compared between 2019 and 2020.

Results

During the 76 weeks preceding the restrictions, there was a stable trend in ED attendances. The weekly number dropped by 48.7% after implementation of the first restrictions. By the end of 2020, the weekly numbers were back to the levels observed before the restrictions. Road traffic injuries (RTIs) and falls dropped during the first restriction period and RTIs and burns during the second. There was an increase of 80% in ICU attendances in all periods of 2020 at three hospitals during the first and second restriction periods.

Conclusion

The COVID-19 restrictions yielded a reduction in the weekly number of pediatric injuries seen at Mozambique's central hospitals, above all RTIs and falls. The drop reflects reductions in visits most importantly for RTIs, falls, and burns, but was accompanied by an increase in the proportion of ICU cases. This effect was not maintained when the restrictions were relaxed. Whether this reflects reduced exposure to injury or hesitancy to seek care remains to be determined.

Level of evidence

Level III, retrospective study with up to two negative criteria.

[Physical activity in the regional health plans in Spain: a review of proposals]

OBJECTIVE

To identify if the regional government health plans in Spain include specific objectives and measures related to physical activity.

METHOD

Institutional websites were scanned to identify the most recent health plan of each regional government. The information included in the health plans on objectives and measures and the population groups targeted by these measures was extracted. The search was completed on 24 January 2022.

RESULTS

Sixteen health plans were identified of which six are in force in 2022; 15 of these have incorporated specific objectives and measures on physical activity. Most of the actions are focus on general population, children-adolescents and elderly population. The plans of Cantabria, the Comunitat Valenciana and País Vasco cover physical activity more widely, proposing measures for seven of the eight identified population groups.

CONCLUSIONS

Most of the health plans include measures related to physical activity and target two or more population groups. The objectives, specific measures and population groups were highly heterogeneous. This study could serve to prompt regional governments to review their health plans, update them and improve them in terms of physical activity. It seems advisable that the different health plans should have a homogeneous framework of proposals related to the promotion of physical activity.

Exchanging screen for non-screen sitting time or physical activity might attenuate depression and anxiety: A cross-sectional isotemporal analysis during early pandemics in South America

OBJECTIVES

To examine the theoretical substitutions of screen exposure, non-screen sitting time, moderate and vigorous physical activity with depressive and anxiety symptoms in South American adults during the COVID-19 pandemic.

DESIGN

A cross-sectional study during the first months of the COVID-19 pandemic with data from 1981 adults from Chile, Argentina, and Brazil.

METHODS

Depressive and anxiety symptoms were assessed using the Beck Depression and Anxiety Inventories. Participants also reported physical activity, sitting time, screen exposure, sociodemographic, and tobacco use data. Isotemporal substitution models were created using multivariable linear regression methods.

RESULTS

Vigorous physical activity, moderate physical activity, and screen exposure were independently associated with depression and anxiety symptoms. In adjusted isotemporal substitution models, replacing 10 min/day of either screen exposure or non-screen sitting time with any intensity of physical activity was associated with lower levels of depressive symptoms. Improvements in anxiety symptoms were found when reallocating either screen exposure or non-screen sitting time to moderate physical activity. Furthermore, replacing 10 min/day of screen exposure with non-screen sitting time was beneficially associated with anxiety (B = -0.033; 95 % CI = -0.059, -0.006) and depression (B = -0.026; 95 % CI = -0.050, -0.002).

CONCLUSIONS

Replacement of screen exposure with any intensity of physical activity or non-screen sitting time could improve mental health symptoms. Strategies aiming to reduce depressive and anxiety symptoms highlight physical activity promotion. However, future interventions should explore specific sedentary behaviors as some will relate positively while others negatively.

Physical Inactivity, Sedentary Behavior and Quality of Life in the Chilean Population: ENCAVI Results, 2015-2016

Regular physical activity (PA) is indicated to be one of the main healthy habits that allow populations to achieve a good quality of life (QoL); however, levels of physical inactivity (PI) and sedentary behavior (SB) have risen worldwide, with negative health effects. The aim of this study is to analyze PI and SB levels, as well as their association with QoL in the Chilean population. A secondary analysis was performed based on the database from the 2015-2016 National Quality of Life Survey (ENCAVI) in Chile, using the modules for sociodemographic characteristics, health, and PA. Contingency tables and logistic regressions were conducted to determine the association between PI (low-intensity PA, LIPA; low-moderate PA, LMPA), SB (P75), and QoL adjusted for sociodemographic variables. Approximately 84%, 83%, and 47% of the participants presented LIPA, LMPA, and moderate-high SB, respectively. Participants that presented high PI and SB had lower QoL scores than those who were more active (p < 0.05). We observe that, in people with PI (LIPA), there is a higher risk of a low QoL regarding mental and physical components (OR 1.941; OR 1.189, p < 0.001) among females (OR 1.473; OR 1.513, p < 0.001) and those of a low educational level (OR 2.170; OR 1.410 p < 0.001). People with PI (LMPA) increased their risk for a low QoL in regard to mental and physical components (OR 1.750; OR 1.458, p < 0.001) among females (OR 1.528; OR 1.507, p < 0.001) and those of a low educational level (OR 2.195; OR 1.402 p < 0.001). We observe that people with SB (P75) increased their risk of a low QoL concerning physical and mental components (OR 1.475; OR 1.257, p < 0.001) for those of the female gender (OR 1.615; OR 1.563, p < 0.001) and a low educational level (OR 2.248; OR 1.423 p < 0.001). High levels of PI in both intensities and SB impact QoL in the Chilean population. It is crucial to generate public policies for more PA, especially for females and those of lower educational levels.

Economic burden of excessive sedentary behaviour in Canada

OBJECTIVE

To estimate health care and health-related productivity costs associated with excessive sedentary behaviour (> 8 h/day and > 9 h/day) in Canadian adults.

METHODS

Three pieces of information were used to estimate costs: (1) the pooled relative risk estimates of adverse health outcomes consistently shown to be associated with excessive sedentary behaviour, gathered from meta-analyses of prospective cohort studies; (2) the prevalence of excessive sedentary behaviour in Canadian men and women, obtained using waist-worn accelerometry in a nationally representative sample of adults (Canadian Health Measures Survey 2018-2019); and (3) the direct (health care) and indirect (lost productivity due to premature mortality) costs of the adverse health outcomes, selected using the Economic Burden of Illness in Canada 2010 data. The 2010 costs were then adjusted to 2021 costs to account for inflation, population growth, and higher average earnings. A Monte Carlo simulation was conducted to account for uncertainty in the model.

RESULTS

The total costs of excessive sedentary behaviour in Canada were $2.2 billion (8 h/day cut-point) and $1.8 billion (9 h/day cut-point) in 2021, representing 1.6% and 1.3% of the overall burden of illness costs, respectively. The two most expensive chronic diseases attributable to excessive sedentary behaviour were cardiovascular disease and type 2 diabetes. A 10% decrease in excessive sedentary behaviour (from 87.7% to 77.7%) would save an estimated $219 million per year in costs.

CONCLUSION

Excessive sedentary behaviour significantly contributes to the economic burden of illness in Canada. There is a need for evidence-based and cost-effective strategies that reduce excessive sedentary behaviour in the population.

COVID-19 Containment Measures-a Step Back for Walking Mobility? A 2-Year, 60-Country Analysis of the Apple Mobility Data

BACKGROUND

COVID-19 containment measures curb viral spread but may hamper walking mobility. As a low daily step count is associated with increased noncommunicable diseases and mortality, assessing the relationship between pandemic responses and walking mobility can help trade-off public health measures. We investigated the association between containment stringency and walking mobility across 60 countries in the period between January 21, 2020 and January 21, 2022 and modeled how this could impact mortality hazard.

METHODS

Walking mobility was measured through the Apple Mobility Trends, containment measures stringency index through the Oxford COVID-19 response tracker (which considers local policies on closures, healthcare, and economy), and meteorological data by National Oceanic and Atmospheric Administration weather stations. Walking mobility was regressed over stringency in a mixed-effect model with weather variables as covariates. The impact of stringency on all-cause mortality due to reduced mobility was modeled based on regression results, prepandemic walking mobility, and the association between step count and all-cause mortality hazard.

RESULTS

Across the 60 countries, the average stringency was 55 (9) (mean [SD]) out of 100. Stringency was negatively associated with walking mobility; a log-linear model fitted data better than a linear one, with a regression coefficient for stringency on ln (walking mobility) (95% confidence interval) of  -1.201 × 10-2 (-1.221 × 10-2 to -1.183 × 10-2). Increasing stringency, thus decreasing walking mobility, nonlinearly incremented the modeled all-cause mortality hazard by up to ∼40%.

CONCLUSIONS

In this study, walking mobility was negatively associated with containment measures stringency; the relationship between stringency, mobility, and the subsequent impact on health outcomes may be nonlinear. These findings can help in balancing pandemic containment policies.

Valuing preventable deaths from major non-communicable diseases and all causes associated with sedentary behavior in Argentina

OBJECTIVE

This study estimated the population attributable fractions, preventable deaths, and indirect economic costs from major non-communicable diseases (NCDs) and all causes associated with excessive sitting time in Argentina in 2019.

METHODS

Population attributable fractions were used to calculate preventable deaths from NCDs and all causes associated with prolonged sitting time (≥6 h/d). Then, the human capital approach was used to quantify the present value of lifetime earnings, which was subsequently used to calculate indirect costs due to lost productivity. A Monte Carlo simulation was performed in three counterfactual scenarios to evaluate the sensitivity of the results.

RESULTS

In Argentinian men and women, respectively, approximately 11.3% (381) [10% (290)] of deaths from colon cancer, 4.4% (250) from breast cancer (women only), 4.6% (588) [4.4% (402)] from coronary heart disease, 30.5% (1390) [27% (1047)] from diabetes, and 14.9% (24,686) [13.7% (21,418)] from all causes could have been avoided annually by eliminating excessive sitting time. The indirect economic costs of excessive sitting time reached 0.025% (0.019%-0.032%) and 0.37% (0.25-0.58%) of gross domestic product (GDP) for major NCDs and all causes, respectively. High levels of heterogeneity were found at the regional level.

CONCLUSION

Prolonged sitting time generates substantial societal costs. Public policies aimed at reducing excessive sedentary behavior in the overall population, especially in the most affected regions, would represent considerable savings for society as a whole. Such initiatives should address the complex and multifactorial causes of sedentary behavior, the clear gender and age differences in this behavior, and the factors underlying these differences.

Understanding factors affecting implementation success and sustainability of a comprehensive prevention program for cardiovascular disease in primary health care: a qualitative process evaluation study combining RE-AIM and CFIR

AIM

Our aim was to evaluate the implementation process of a comprehensive cardiovascular disease prevention program in general practice, to enhance understanding of influencing factors to implementation success and sustainability, and to learn how to overcome barriers.

BACKGROUND

Cardiovascular disease and its risk factors are the world's leading cause of mortality, yet can be prevented by addressing unhealthy lifestyle behavior. Nevertheless, the transition toward a prevention-oriented primary health care remains limited. A better understanding of factors facilitating or hindering implementation success and sustainability of prevention programs, and how barriers may be addressed, is needed. This work is part of Horizon 2020 project 'SPICES', which aims to implement validated preventive interventions in vulnerable populations.

METHODS

We conducted a qualitative process evaluation with participatory action research approach of implementation in five general practices. Data were collected through 38 semi-structured individual and small group interviews with seven physicians, 11 nurses, one manager and one nursing assistant, conducted before, during, and after the implementation period. We applied adaptive framework analysis guided by RE-AIM Qualitative Evaluation for Systematic Translation (RE-AIM QuEST) and Consolidated Framework for Implementation Research (CFIR).

FINDINGS

Multiple facilitators and barriers affected reach of vulnerable target populations: adoption by primary health care providers, implementation and fidelity and intention to maintain the program into routine practice. In addition, our study revealed concrete actions, linked to implementation strategies, that can be undertaken to address identified barriers. Prioritization of prevention in general practice vision, ownership, and shared responsibility of all team members, compatibility with existing work processes and systems, expanding nurse's roles and upskilling competence profiles, supportive financial and regulatory frameworks, and a strong community - health care link are crucial to increase implementation success and long-term maintenance of prevention programs. COVID-19 was a major barrier to the implementation. RE-AIM QuEST, CFIR, and participatory strategies are useful to guide implementation of prevention programs in primary health care.

Sleep Disturbances and Mental Well-Being of Preschool Children during the COVID-19 Pandemic in Mexico

COVID-19 pandemic confinement caused changes in families and children's routines worldwide. Studies conducted at the beginning of the pandemic have examined the harmful effects of these changes on mental health, including sleep disturbances. As sleep is essential for optimal childhood development, this study was designed to determine preschool-aged (3-6 years old) children's sleep parameters and mental well-being during the COVID-19 pandemic in Mexico. Using a cross-sectional design, a survey was applied to parents of preschool children, inquiring about their children's confinement status, routine changes, and electronics use. The parents responded to the Children's Sleep Habits Questionnaire and the Strengths and Difficulties Questionnaire to assess children's sleep and mental well-being. To provide objective sleep data, the children wore wrist actigraphy for seven days. Fifty-one participants completed the assessment. The children's mean age was 5.2 years, and the prevalence of sleep disturbances was 68.6%. The use of electronic tablets in the bedroom near bedtime and symptoms of mental health deterioration (i.e., emotional distress and behavioral difficulties) were associated with sleep disturbances and their severity. The COVID-19 pandemic's confinement-related routine changes greatly impacted preschool children's sleep and well-being. We recommend establishing age-tailored interventions to manage children at higher risk.

COVID-19 induced changes in physical activity patterns, screen time and sleep among Swedish adolescents - a cohort study

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic had a huge impact on daily life, even in countries such as Sweden where the restrictions were relatively mild. This paper assesses the effects of the COVID-19 pandemic restrictions on physical activity (PA) patterns, screen time, and sleep among Swedish adolescents. The exposures explored include gender, parental education, anthropometrics, and cardiovascular fitness (CVF).

METHODS

Cohort data were collected from September 26th to December 6th, 2019, and from April 12th to June 9th, 2021. Participants were 13-14 years-old (7th graders) at baseline with 585 participating at both baseline and follow-up. At both baseline and follow-up PA and sedentary time were measured with accelerometers, and sleep and screen time with questionnaires. The exposure variables (gender, parental education, anthropometrics and CVF) were collected at baseline. Multilevel linear regression analyses were performed.

RESULTS

Moderate-to-vigorous-physical activity (MVPA) remained unchanged while light physical activity (LiPA) decreased and sedentary time increased. Sleep duration decreased and screen time increased. Girls, adolescents with overweight/obesity (BMI and percent body fat), and those with lower CVF at baseline had less favourable changes in PA patterns, sleep and screen time.

CONCLUSIONS

Although no significant (α = 0.05) changes were seen in MVPA, both LiPA and sedentary time as well as sleep and screen time changed in unfavourable ways. More intense activities are often organised and seem to have withstood the pandemic, while less intense activities decreased. Some groups were more vulnerable and will need directed intervention in the post-pandemic period as well as when future pandemics hit.

Infection Control in Dental Practice during the COVID-19 Pandemic: What Is Changed?

The COVID-19 pandemic has profoundly changed our lives. Since the SARS-CoV-2 was discovered, many studies have been done on the transmission mode, its replication within humans, and its survival even in the outside environment and on inanimate surfaces. Undoubtedly, health care workers have faced the greatest risks because of their close contact with potentially infected patients. Of these, dental health care professionals are certainly among the most vulnerable categories, precisely because infection occurs with the airborne virus. The treatment of patients within the dental office has changed profoundly, respecting all preventive measures towards the patient and the practitioners themselves. The aim of this paper is to understand whether the protocols changed for the prevention of SARS-CoV-2 infection among dentists remained even after the most acute phase of the pandemic. In particular, this study analyzed habits, protocols, preventive measures, and any costs incurred in the COVID-19 era for the prevention of SARS-CoV-2 infection among dental workers and patients.

Changes of Oral and Physical Functions in Older Japanese Who Participated in Keyboard Harmonica and Exercise Classes during COVID-19-Related Movement Restrictions

Many older people have restricted activities or movements because of the coronavirus disease 2019 (COVID-19) pandemic, which causes concerns about secondary health problems. This study aimed to investigate how frailty-prevention activities implemented by local governments have changed the health of community-dwelling older people during the COVID-19 pandemic. In this observational study, the participants were 23 older Japanese people who took part in keyboard harmonica or exercise classes in 2021. Oral function examination and physical function tests were conducted at baseline and after 10 months of follow-up. In each class, the participants met 15 times and worked on assignments at home. The results showed that oral diadochokinesis/pa/, which represents lip dexterity, improved during 10 months (from 6.6 to 6.8 times/s, p < 0.046); however, grip strength (p < 0.005) and total skeletal muscle mass (p < 0.017) decreased in the keyboard harmonica group. In the exercise group, a statistically significant difference was found only in grip strength, which decreased (p < 0.003). The oral and physical functions of older people who participated in frailty-prevention activities implemented by local governments characteristically changed. Moreover, activity restrictions during the COVID-19 pandemic may have caused decreased grip strength.

A Comparative Study of Inhibition Function between High-Intensity Interval Training and Moderate-Intensity Continuous Training in Healthy People: A Systematic Review with Meta-Analysis

Meta-analysis was used to compare the effects of two interventions, high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT), on inhibition in executive function in healthy people, providing some theoretical basis for exercise practice and health interventions. We searched the PubMed, Science Direct, Web Of science, Cochrane, and CNKI databases for relevant articles on the inhibition function effects of HIIT and MICT in healthy populations for the period of library construction to 15 September 2022. The basic information of the screened literature was organized and summarized using Excel. Statistical analysis of the correct rate and response time indicators of the inhibition function in the HIIT and MICT groups was performed using Review Manager 5.3 analysis software. A total of 285 subjects from 8 studies were included in this study, the number of HIIT subjects was 142, the number of MICT subjects was 143, including teenagers, young adults, and the elderly. Eight studies included response time, and four included correct rate and response time. The standardized mean difference (SMD) for correct rate inhibition function in the HIIT and MICT groups was 0.14, 95% CI (-0.18, 0.47), SMD at response time was 0.03, 95% CI (-0.20, 0.27). In addition, no significant differences were found between the two exercise modalities in either the intervention period or the population receiving the intervention. Both HIIT and MICT could improve inhibition function in healthy people, but there was no significant difference in the improvement effect between them. It is hoped that this study can provide some references for people's choice of health intervention methods and clinical practice.

Emotional and behavioral changes in French children during the COVID-19 pandemic: a retrospective study

COVID-19 outbreak caused severe disruptions in daily life, partly due to limitations implemented to prevent the spreading. In France, it included school closures during a national lockdown, then a reopening of schools, with access depending on viral status of students and teachers. Those changes had an impact on children's mental health. We conducted an online cross-sectional study using a parental self-administered survey in December 2021 to explore the emotional and behavioral changes (EBC) during this 5th wave (W5) and retrospectively since the first one (W1) in their children and their multidimensionality with principal factor analysis (PCA) and stability analysis. Out of 4552 parent responders, 62.4% (n = 2839) noticed negative EBC during W1 and 54.1% (n = 2462) during W5 of the pandemic. Only 10.0% of the responders noticed negative EBC at W1 but not during the W5. In younger children (3-6 years old) with significant EBC, PCA revealed three main dimensions at W1 and W5: restlessness, depression and anxiety. In older children (7-13 years old), PCA showed partially similar dimensions: depression-suicidality, anxiety and withdrawal. Almost all correlations between dimensions at W1 and W5 were significantly positive. Every EBC was stable across waves, except for one. Recall bias concerning the EBC during W1 and lack of data concerning parental mental health should be taken into account. Our stability analysis found a strong correlation between dimensions at W1 and W5. Our results highlighted the impact of the COVID-19 outbreak on children's mental health and the predictive aspect of its early deterioration.

Children's excessive digital media use, mental health problems and the protective role of parenting during COVID-19

COVID-19's outbreak in March 2020 and the social distancing measures that followed it changed the lives of children worldwide. Studies assessing the pandemic's implications for children have reported an alarming increase in the use of digital media (DM) and warned of its adverse impacts on children's functioning and development. The current study aimed to assess the relationship between excessive and problematic DM use and emotional, behavioral, and academic functioning among Israeli adolescents during COVID-19 and to identify adolescents at elevated risk of developing problematic DM use. Three hundred forty-seven Israeli parent-child dyads (M age = 11.81, SD = 1.41) separately completed measures assessing children's DM use (time and addiction), functioning (academic, social, emotional, and behavioral), behavioral dysregulation, and the parents' parenting practices. The results showed that DM addiction, but not DM use, was related to children's emotional, behavioral, and academic difficulties. Moreover, the results indicated that negative parenting and behavioral dysregulation increased the risk of DM addiction, which in turn increased emotional, behavioral, and academic difficulties. The results underscored parents' role in preventing problematic DM use and highlighted the need to treat DM use and problematic DM use as distinct constructs.

Obesity and weight change during the COVID-19 pandemic in children and adults: A systematic review and meta-analysis

Many obesity risk factors have increased during the COVID-19 pandemic, including physical inactivity, poor diet, stress, and poverty. The aim of this systematic review was to evaluate the impact of the COVID-19 pandemic, as well as associated lockdowns or restrictions, on weight change in children and adults. We searched five databases from January 2020 to November 2021. We included only longitudinal studies with measures from before and during the pandemic that evaluated the change in weight, body mass index (BMI) (or BMI z-scores for children), waist circumference, or the prevalence of obesity. Random effects meta-analyses were conducted to obtain pooled estimates of the mean difference in outcomes. Subgroups were evaluated for age groups and diabetes or obesity at baseline. The risk of bias was assessed using a modified version of the Newcastle-Ottawa Scale, and the certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. A total of 74 studies were included (3,213,776 total participants): 31 studies of children, 41 studies of adults, and 2 studies of children and adults. In children, the pooled mean difference was 1.65 kg (95% confidence interval [CI]: 0.40, 2.90; 9 studies) for weight and 0.13 (95% CI 0.10, 0.17; 20 studies) for BMI z-scores, and the prevalence of obesity increased by 2% (95% CI 1%, 3%; 12 studies). In adults, the pooled mean difference was 0.93 kg (95% CI 0.54, 1.33; 27 studies) for weight and 0.38 kg/m² (95% CI 0.21, 0.55; 25 studies) for BMI, and the prevalence of obesity increased by 1% (95% CI 0%, 3%; 11 studies). In children and adults, the pooled mean difference for waist circumference was 1.03 cm (95% CI -0.08, 2.15; 4 studies). There was considerable heterogeneity observed for all outcomes in both children and adults, and the certainty of evidence assessed using GRADE was very low for all outcomes. During the first year of the COVID-19 pandemic, small but potentially clinically significant increases in weight gain, BMI, and increased prevalence of obesity in both children and adults were observed. Increases were greater in children, and targeted prevention interventions may be warranted.

The Association between Change in Lifestyle Behaviors and Mental Health Indicators in Immunosuppressed Individuals during the COVID-19 Pandemic

Little is known on how changes in lifestyle behaviors affect mental health among immunosuppressed individuals who observed stricter physical and social distancing measures due to higher risk of complications during the COVID-19 pandemic. This study examines the association between changes in moderate-to-vigorous physical activity (MVPA), sedentary time (ST) and sleep duration following COVID-19 outbreak on mental health indicators of immunosuppressed individuals and their relatives. Participants (n = 132) completed an online questionnaire between May and August 2020. Linear regressions were conducted to assess the associations between an increase or decrease in lifestyle behaviors and mental health indicators. Individuals with decreased MVPA and increased ST experienced higher distress, anxiety and depressive symptoms. Those who reported an increase or decrease in sleep had higher levels of stress, distress and depressive symptoms. Decreases in sleep was associated with higher anxiety symptoms. Lifestyle behaviors in the context of a stressful life event such as the COVID-19 pandemic may impact mental health indicators of immunosuppressed individuals and their relatives.

The impact of the COVID-19 pandemic on cardiovascular health behaviors and risk factors: A new troubling normal that may be here to stay

In March 2020, the Coronavirus disease 2019 (COVID-19) outbreak was officially declared a global pandemic, leading to closure of public facilities, enforced social distancing and stay-at-home mandates to limit exposures and reduce transmission rates. While the severity of this "lockdown" period varied by country, the disruptions of the pandemic on multiple facets of life (e.g., daily activities, education, the workplace) as well as the social, economic, and healthcare systems impacts were unprecedented. These disruptions and impacts are having a profound negative effect on multiple facets of behavioral health and psychosocial wellbeing that are inextricably linked to cardiometabolic health and associated with adverse outcomes of COVID-19. For example, adoption of various cardiometabolic risk behavior behaviors observed during the pandemic contributed to irretractable trends in weight gain and poor mental health, raising concerns on the possible long-term consequences of the pandemic on cardiometabolic disease risk, and vulnerabilities to future viral pandemics. The purpose of this review is to summarize the direct and indirect effects of the pandemic on cardiometabolic health risk behaviors, particularly related to poor diet quality, physical inactivity and sedentary behaviors, smoking, sleep patterns and mental health. Additional insights into how the pandemic has amplified cardiovascular risk behaviors, particularly in our most vulnerable populations, and the potential implications for the future if these modifiable risk behaviors do not become better controlled, are described.

Sedentary time of university students before and during the COVID-19 pandemic: Risk groups and pre-pandemic predictors using cross-sectional and longitudinal data

Background

The present study aimed to (1) assess and compare sedentary time (ST) of university students before and during the COVID-19 pandemic, (2) examine risk groups with regard to ST and the "extent of change" in ST (from before to during the pandemic) in association with sociodemographic (gender, age), study-related (degree aspired to, field of study, semester), and pre-pandemic physical health-related [pre-pandemic physical activity (PA) and ST levels, pre-pandemic BMI class] variables, and (3) investigate whether the change in ST was predicted by these variables.

Methods

Two online surveys were conducted among students at the University of Mainz, Germany-the first in 2019 (before the pandemic) and the second in 2020 (during the pandemic). Participants of both surveys were included in a longitudinal sample. With the longitudinal sample's data, paired t-tests, single factor, and mixed analyses of variances were used to examine group differences in ST and the "extent of change" in ST. A linear regression analysis was computed to investigate the influence of the abovementioned sociodemographic, study-related, and pre-pandemic physical health-related variables on the change in ST.

Results

Of the N = 4,351 (pre-pandemic) and N = 3,066 (in-pandemic) participants of the online surveys, N = 443 entered the longitudinal sample. ST increased by 1.4 h/day to critical levels (≥8 h/day) in all subgroups analyzed-even among students who were highly physically active before the pandemic. Students with a low pre-pandemic ST had the largest increase in ST. Pre-pandemic PA level negatively predicted the change in ST.

Conclusion

Even during a global pandemic lockdown, individuals who were previously more physically active and had less ST showed more health-promoting behavior in terms of ST. Therefore, it can be stated that efforts to promote PA and reduce ST are always valuable. Since ST increased and was worryingly high in all subgroups analyzed, all university students should be targeted by multidimensional approaches to tackle ST and promote their health.

Validation of the illustrated questionnaire on eating and sedentary behaviors (QUICAS) for seven to ten-year-old children

The Illustrated Questionnaire on Eating and Sedentary Behaviors (QUICAS) was developed and validated for schoolchildren seven to ten years old. It used previous day recall and was illustrated with ten eating behaviors (referring to the act of eating without distractions, with company, on a regular basis, the type of food eaten, and participation in tasks involved in meal preparation) and five sedentary behaviors (related to the use of television, computer, tablet, cell phone, and video game). The instrument was validated in four stages: (1) Its content was developed based on literature review and expert evaluation; (2) Items were validated by comparing the responses of children and their parents, through a questionnaire on Google Forms. At this stage, a convenience sample was adopted, consisting of 145 parent-child dyads. High sensitivity (average of 90.7%); high specificity (mean of 87.9%); low number of false positives (mean of 12.1%); low number of false negatives (mean of 9.3%); almost perfect agreement between the child's and the parent's reports (k = 0.81); and low disagreement (≤22%) were found. In addition, the child's gender and age did not significantly influence the child's report. (3) The illustrations were validated in a focus group with 18 children, who satisfactorily described all the eating and sedentary behaviors of the illustrations. (4) In the pretest of the questionnaire on Google Forms, with the participation of 15 children, the majority (86.7%) judged the questionnaire as excellent or good. Therefore, the QUICAS is valid to assess eating and sedentary behaviors in schoolchildren seven to ten years old.

The 2022 India Report Card on physical activity for children and adolescents

Background

With strong evidence of physical inactivity's link to chronic disease and economic burden - particularly with childhood active living behaviors tracking into adulthood - it is imperative to promote physical activity among children and adolescents in India.

Objectives

To evaluate active living patterns among Indian children and adolescents.

Methods

The India Report Card (IRC) team, which consists of experts in India and Canada, systematically collected and appraised evidence on 11 indicators of active living, including 5 behavioral (Overall Physical Activity, Organized Sport Participation, Active Play, Active Transportation, Sedentary Behavior), 2 individual-level (Physical Fitness, Yoga) and 4 sources of influence (Family and Peers, School, Community and Built Environment, Government). Peer-reviewed articles were appraised based on national representativeness, sample size, and data quality. Grey literature was appraised based on comprehensiveness, validity of the sources, and representativeness. All indicators were assessed against parameters provided by the Active Healthy Kids Global Alliance.

Results

Active Transportation and Government Strategies were ranked highest with a B- and C+ grade, respectively. Overall Physical Activity and Schools were assigned a C grade, while Sedentary Behavior and Community and Built Environment were given D grades. Yoga was the lowest ranking indicator with a D- grade. Organized Sport Participation, Active Play, Family and Peers, and Physical Fitness were all graded incomplete.

Conclusions

Active Transportation, Government Strategies, and Overall Physical Activity have improved since the 2018 IRC, a positive trend that needs to be translated to other indicators. However, Sedentary Behavior has consistently worsened, with grades C, C-, and D-, in 2016, 2018, and 2022, respectively. Evidence generated by the 2022 IRC suggests opportunities for improvement not only in India, but also the 56 other countries taking part in Global Matrix 4.0.