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Background and objectives Schools play a crucial role in facilitating physical activity among children, but the COVID-19 pandemic has affected both children’s physical activity and the school environment. It is essential to understand between-school differences in children’s physical activity post lockdown, to determine if and how the role of schools has changed. Design and participants Active-6 is a natural experiment comparing postlockdown accelerometer-estimated physical activity to a pre-COVID-19 comparator group. Accelerometer and individual data were collected on 1296 children aged 10–11 pre-COVID-19 (2017–8), with school characteristics collected from the 50 schools they attended. Post lockdown, we collected accelerometer, individual and school data from 393 children in 23 of the same schools and 436 children in 27 of the same schools in 2021 (Wave 1) and 2022 (Wave 2), respectively. Methods Sources of variation (between-school, between-pupil and within-pupil) in child weekday moderate to vigorous physical activity at each wave were modelled using linear mixed-effects models with school-level wave random coefficients. We extended the model to estimate the proportion of between-school variation explained by school policy, curriculum and physical environment factors and school-aggregated pupil characteristics. We also explored the extent to which postlockdown differences in moderate to vigorous physical activity were mediated by individual or school factors. Results Between-school variation comprised 13% of the total variation pre-COVID-19, 7% in Wave 1 and 13% in Wave 2. School factors associated with moderate to vigorous physical activity were the following: whether physical education was compromised due to space (often: 9 minutes lower moderate to vigorous physical activity; sometimes: 5.4 minutes lower); high after-school club attendance (7 minutes higher moderate to vigorous physical activity for each additional club attended on average in the school); cycle training policy (4 minutes higher moderate to vigorous physical activity); and higher prevalence of active travel (1 minute higher moderate to vigorous physical activity for each 10% point increase in prevalence). These factors explained 22% of the between-school variation pre-COVID-19, and 72% at Wave 2. The relative importance changed, with cycle training policy and active travel being the most important pre-COVID-19 and cycle training policy, active after-school clubs and compromised physical education space most important in Wave 2. No factors were found to mediate the postlockdown differences in moderate to vigorous physical activity, except compromised physical education space, which had a suppressor effect in Wave 2. Limitations Only 27 of the initial 50 schools participated post lockdown, limiting our ability to make comparisons across waves. Sample sizes were additionally affected by missing data for some variables. Conclusions and future work While schools continue to play an important role in facilitating children’s physical activity, the factors that contribute to this have changed post-COVID-19, with cycle training, active after-school clubs and ensuring physical education is prioritised even when space is limited now explaining nearly three-quarters of the between-school variation in children’s moderate to vigorous physical activity. School-level interventions that focus on these areas, and policies that support them, may offer the potential to increase children’s physical activity. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131847. Plain language summary What was the question? Schools are important in helping children to be physically active. How active children are differs between schools. We wanted to know whether this has changed after the COVID-19 lockdowns. We also looked at features of the school, like equipment in the playground or being active in lessons, that might explain these differences. What did we do? We collected activity data from 10- to 11-year-olds from 50 schools around Bristol (United Kingdom) before and after the COVID-19 lockdowns. Children also told us about how they travelled to school and whether they went to after-school sports or exercise clubs. We asked schools about their policies and lessons. Finally, we collected data on the playground and surroundings. What did we find? In the first 6 months after lockdowns, schools had a much smaller role in children’s activity. But after a year, schools were once again an important influence on how active children were. We found that the school features that affected children’s activity had changed. Before the pandemic, the things that helped children most to be active were learning to ride a bike at school, and walking or cycling to school. After the pandemic, offering lots of after-school sports clubs was more important. Schools that struggled with physical education lessons because of a lack of space had fewer active pupils. What does this mean? Schools continue to play an important role in helping children be active. But this role has changed after the lockdowns. In the future, schools could help keep children active by offering plenty of after-school clubs and help children to learn to ride a bike. Also, it is important to make sure that physical education lessons are a priority, even when there is not much space.

Background The COVID-19 lockdowns had negative effects on children’s and adults’ mental and physical health. There is, however, a paucity of research that explores differences in health-related quality of life (HRQL) and well-being over time after the COVID-19 lockdowns had been lifted. Furlough during lockdowns, increases in unemployment, and the emerging cost-of-living crisis all put pressure on family finances, which could have a detrimental effect on HRQL and well-being. This study, part of the wider Active-6 study, explored how HRQL, capability well-being and family financial strain changed after the lockdowns, the relationship between these outcomes, and whether physical activity had any mediating effect on differences in HRQL and capability well-being. Methods Cross-sectional data were collected in May–December 2021 (Wave 1) and January–July 2022 (Wave 2). Children (aged 10–11) and their parent/carer were recruited from 23 to 27 schools in each wave, respectively, and completed validated questionnaires measuring HRQL (adults – EQ-5D-5L, children – CHU9D), capability well-being (adults – ICECAP-A) and family financial strain (adults – Family Economic Strain Scale, FESS). Children also completed questions on capability well-being. Weekday minutes of moderate-to-vigorous physical activity (MVPA) were measured using accelerometers. Mixed-effects regression models, adjusted for gender, age group (adults only), IMD and highest household education, were used to explore differences in HRQL and capability well-being between waves. In addition, the moderating effect of financial strain and the mediating effect of MVPA on HRQL and capability well-being were explored. Results Active-6 recruited 393 parent-child pairs in Wave 1 and 436 in Wave 2. There were no differences in HRQL (EQ-5D, CHU9D) and capability well-being (ICECAP-A) scores between waves, but financial strain was worse in Wave 2 compared to Wave 1 (FESS score difference 1.14 adjusted 95% CI 0.15 to 2.12). Increased financial strain was associated with lower (worse) EQ-5D-5L, CHU9D and ICECAP-A scores. There was no evidence of a mediating effect of MVPA. Limitations and future work Pre-COVID-19 data on HRQL were not collected, so analysis was limited to post-lockdown only. Participating parents were predominantly female and participation was lower among lower socio-economic groups, limiting our ability to explore inequalities. Intervention planning to increase physical activity and health and well-being during the COVID-19 recovery should consider the financial strain families are experiencing and the negative implications of financial strain on HRQL. Conclusions There were no differences in HRQL and capability well-being in children and adults after lockdowns lifted in 2021 and a year later in 2022. The results indicate increasing financial strain, which could reflect the UK’s ‘cost of living crisis’. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131847. Plain language summary Why did we do this study? We know that the COVID-19 pandemic negatively affected people’s mental and physical health. But we don’t know how quality of life, well-being and pressure on family finances changed for people after the lockdowns were lifted and society reopened. We also wanted to know if these changes were related to how physically active people were. What did we do? Children and a parent/carer answered questions about their quality of life, well-being and family budget pressures. Physical activity data were also collected using devices worn on their waists. We did this in 2021, when society started to reopen after lockdowns, and a year later in 2022 when all restrictions were gone. We explored differences in quality of life, well-being and pressure on family finances between 2021 and 2022. We then looked at whether any of these differences were because of changes in physical activity, and if financial strain was related to quality of life. What did we find? We did not find any differences in quality of life or well-being between 2021 and 2022. Financial strain increased slightly. As financial strain increased, quality of life and well-being decreased. This was worse for those experiencing most financial difficulties. Physical activity did not seem to explain differences in quality of life. What does this mean? If family finances are stretched, it might be difficult for families to pay for activities that will help their children be more active. We have also found that family financial difficulties are related to quality of life and well-being.

Background and objectives The COVID-19 lockdowns impacted physical activity for all, but especially parents, because they had to balance home, work and leisure activities. Motivation for exercise is consistently shown to be associated with physical activity levels. Self-determination theory provides a framework through which the motivation for exercise and its social-contextual antecedents can be explored. The purpose of this study is to explore the role of motivation in determining physical activity in parents and carers of English primary school children before, during and after the COVID-19 lockdowns. Design, setting and participants This study uses a mixed-methods design combining quantitative data and individual interviews. Participants were all parents/carers of children in year 6 (aged 10–11 years) at English primary schools in the United Kingdom. Methods Quantitative data were collected on three occasions: between March 2017 and May 2018 (Wave 0, N = 1296), between May and December 2021 (Wave 1, N = 393) and between January and July 2022 (wave 2, N = 436). Motivation for exercise was assessed using the Behavioural Regulations in Exercise Questionnaire-2 and moderate-to-vigorous physical activity was estimated via waist-worn accelerometers. Data were analysed via regression models. Interviews with a subsample of parents (N = 43) were conducted on two occasions: between September and December 2021 and between February and July 2022. Interviews covered the impact of the pandemic on children and parents’ physical activity and changes over time. This study focuses on discussions around the parents’ own physical activity behaviour and their motivation. The framework method was used for analysis. Results In separate linear regression models, intrinsic and identified regulation were associated with higher moderate-to-vigorous physical activity in waves 0 and 2. Amotivation was associated with lower moderate-to-vigorous physical activity in waves 0 and 2. In fully adjusted multivariable regression models, identified regulation was associated with a 4.9-minute increase in moderate-to-vigorous physical activity and introjected regulation was associated with a 2.3-minute decrease in moderate-to-vigorous physical activity at wave 0. Associations with moderate-to-vigorous physical activity were different in wave 2, with introjected regulation changing direction and a negative association with amotivation, although confidence intervals were wide due to smaller sample sizes. In the interviews, parents spoke of the effects that the COVID-19 lockdowns had on their motivation to be physically active in four theoretically driven themes: (1) motivation for physical activity, (2) perceived autonomy for physical activity, (3) perceived competence for physical activity and (4) perceived relatedness for physical activity. Limitations The smaller sample sizes for waves 1 and 2 may have limited the ability to identify associations between behavioural regulations and moderate-to-vigorous physical activity post pandemic. Across all waves, parents were predominantly active, females, white and from higher socioeconomic areas and therefore may not reflect broader experiences. Conclusions and future work Autonomous motivation, especially enjoyment and the importance for mental and physical well-being, was a key driver in keeping parents active during lockdowns and remains important for physical activity post lockdown, with introjected regulation potentially playing an increased role. Parents’ interviews highlighted that while for some the lockdowns promoted autonomous motivation for exercise, others had enduring negative influences on their autonomy, competence and relatedness, which could be detrimental to their well-being. Strategies that focus on offering a range of novel activities for parents and that bring parent groups together may be effective. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131847. Plain language summary What was the question? The COVID-19 pandemic affected parents’ ability to be active. Motivation is important for taking part in physical activity. We wanted to know how motivation for exercise had changed since before the pandemic and how it might still impact parents’ physical activity. What did we do? We asked groups of parents of children in year 6 (aged 10–11 years) to complete a questionnaire and wear a device that measures physical activity. One group did this before the pandemic and two groups did this after the lockdowns. We also spoke to parents two times after schools reopened. We asked about their physical activity, what they felt helped or stopped them being active and how this changed during the pandemic. What did we find? Motivation plays a part in how much physical activity parents do. Enjoying activities, being active because it is part of your identity and being active due to health make parents more active. Some parents felt they were more active in the first lockdown, as they had more time, freedom and a choice of new and exciting activities, while others felt the lockdowns led to them being less active. This was due to a loss of connection with other people and feeling less confident in their physical activity. What does this mean? This means that it is important that parents are well-supported in their physical activity post pandemic efforts to help parents be active should focus on creating opportunities for parents to try new activities opportunities for parents to be active together might lead to more physical activity, improved connections with others and better well-being.

Abstract Background Children’s physical activity in England is more dependent on active clubs after the COVID-19 pandemic. However, it is unclear how the COVID-19 pandemic and related cost-of-living crisis have impacted on active club participation, costs and provision. This mixed-methods natural experiment explored school-based and community-based active clubs after lockdowns, using a unique combination of data sources to highlight implications for policy and practice post-COVID-19. Methods Cross-sectional questionnaire data on school and community active clubs were collected from 10-11-year-old children pre-COVID-19 in 2017-18 (N = 1,296; 50 schools), in 2021 (N = 393; 23 schools), and 2022 (N = 463; 27 schools). Club participation and attendance frequency were modelled using logistic and Poisson mixed effects models, adjusted for child age, gender and household education. In 2021 and 2022, parents reported expenditure on community-based clubs and schools provided data on school-based club provision, with data summarised descriptively. Qualitative data were collected in 2021 and 2022, with one-to-one interviews with school staff (N = 18) and parents (N = 43), and twelve child focus groups (N = 92), and analysed using the framework method. Results School-based active club participation was higher in 2022 compared to pre-pandemic (50% /43%), while community-based club participation was lower (74%/80%). Children attended 0.3 fewer clubs per week. Those from lower education households were less likely to participate in both types of active clubs, and girls less likely to attend community clubs. In 2022, the median cost of community and school club sessions were £6.67 and £3.88 respectively, with 52% of school-based clubs free to parents. Schools offered an average of 3.4 active clubs per week for 10-11-year-olds in 2022, with 34% partly/wholly subsidised. Qualitative analysis highlighted the impact of the cost-of-living crisis and COVID-19 pandemic on family resources, encouraging a shift to more affordable and convenient school-based active clubs, which negatively impacted the community-based active club environment. However, many schools struggled to meet this increased demand. Conclusions Findings emphasise the importance for policymakers to support schools to meet increased demand for clubs and community clubs to increase affordable and convenient physical activity opportunities. Targeted support is needed to prevent socioeconomic and gender inequalities.

Abstract Background The COVID-19 pandemic significantly impacted children’s physical activity. Recent evidence indicated children’s accelerometer-measured physical activity levels have, on average, returned to near pre-pandemic levels in 2022, though sedentary behaviour remains higher. However, insufficient physical activity levels among children continues to be a critical public health issue in the UK, with only 41% meeting physical activity guidelines. This study aimed to provide in-depth analysis of how the pandemic has shaped children’s physical activity patterns beyond the short-term periods following lockdowns and identify the new challenges to engaging children in physical activity. Methods One-to-one interviews with parents (n = 22), school staff (n = 9), and six focus groups with children aged 10–11 years (n = 45) were conducted between February and July 2022. Topics explored changes to children’s physical activity and sedentary behaviour patterns, including screen-viewing, and factors influencing any changes. The framework method was used for analysis. Results Five themes were generated. Theme 1 described residual lockdown habits, including increased screen-viewing within the home, while activities outside the home continued to feel less spontaneous. Theme 2 highlighted an interrupted development of social, emotional, and physical skills among children compared to what would be expected pre-pandemic. This coincided with Theme 3 which reflected increased mental health challenges among families, creating complex barriers to children’s physical activity. A new normal for child physical activity was evoked and explored in Theme 4, with greater dependence on structured and organised activities. However, Theme 5 highlighted that girls and children with lower socio-economic position may be especially at risk of decreased physical activity. Conclusions There is a new normal for children’s physical activity that is characterised by increased dependence on structured and organised physical activities, such as active clubs, and less on unstructured and spontaneous physical activities, such as physical play. While this may suit many children, girls and children from lower socio-economic households face barriers to participating in the new normal. It is important that affordable and equitable opportunities are provided to all children to prevent physical activity and health inequalities.

Background The COVID-19 lockdowns and social distancing measures, including school closures, had a major impact on children’s physical activity in England, with data showing an initial reduction in activity in the short-term post-lockdown phase of the pandemic followed by a recovery on average in the medium-term post-lockdown period. The school environment is an important context for child physical activity. The purpose of this study is to understand the changes that took place to school physical activity environments once schools reopened after lockdowns. This information will improve understanding of why changes to children’s physical activity have occurred over the course of the pandemic and the implications for future promotion of physical activity in schools. Methods Interviews with parents (n = 43), school staff (n = 18) and focus groups with 10- to 11-year-old children (participant n = 92) were conducted at two time points: between September–December 2021 and February–July 2022. Interview and focus group guides covered the impact of the pandemic on child physical activity and changes to this over time. The framework method was used for analysis. Results Three themes and three subthemes were generated: (1) the return to school; (2) over-pressured staff and environment and (3) the uneven impact of the pandemic. Theme 3 consists of three subthemes: (a) retained pandemic policies, (b) impact on physical activity culture and (c) different children need different things. Limitations and future work Conducting this research in schools during ongoing COVID-19 disruptions was a challenge and may have limited school and participant participation, particularly school staff. The parent interview sample is predominantly female, active and of higher socioeconomic status, so the experiences of male, less active and lower socioeconomic parents are limited. This study suggests that the impact of COVID-19 on child physical activity is uneven, affecting some children more than others. Future work is therefore needed to explore the details of this potential diverging experience. Conclusion The COVID-19 pandemic, school closures and post-lockdown school policies have impacted upon primary school physical activity environments. The post-lockdown school environment is highly pressured, impacting the extent to which schools can support and encourage child physical activity. Future research is needed to further explore the impact of post-lockdown changes on physical activity environments in schools, particularly over the longer term, as schools continue to adapt post lockdowns. Strategies required to support school physical activity environments must be context specific and sensitive to these changes, pressures and needs. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131847. Plain language summary Why did we do this study? Schools are important spaces for children’s physical activity. Children can be active in physical education lessons, break times, after-school clubs and travelling to school. School closures and other COVID-19 restrictions affected children’s physical activity. We wanted to know how physical activity in primary schools might have changed since the pandemic. What did we do? We spoke to school staff, pupils and parents two times after schools reopened. We asked about children’s physical activity, and if or how this had changed over the course of the pandemic. We asked school staff about school policies around physical activity. What did we find? When children went back to school, schools needed a ‘recovery’ approach. Children’s academic, social and physical skills had been affected. For this time schools prioritised physical activity, but this was short-lived. Since then, schools have been highly pressured. They have had to ‘catch up’ on missed learning, staff are overloaded and some pupils are still affected by the lockdowns. Physical activity policies in schools have changed, but in many different ways. Some have kept social distancing policies; others feel their school culture has changed. Additionally, pupil ability and needs are more polarised. These factors have shaped, but are also shaped by, the high pressure in schools. What does this mean for children’s physical activity? Supporting changing child needs in highly pressured schools is hard for state primary schools. Changes to school physical activity policies need to be understood and evaluated. Strategies to ease pressure in schools are needed to support physical activity.

Abstract Background The COVID-19 pandemic has resulted in marked impacts on children’s physical activity, with large reductions in moderate-to-vigorous physical activity (MVPA) reported during lockdowns. Previous evidence showed children’s activity levels were lower and sedentary time higher immediately post-COVID lockdown, while there was little change in parental physical activity. We need to know if these patterns persist. Methods Active-6 is a natural experiment using repeated cross-sectional data conducted in two waves. Accelerometer data were collected on 393 children aged 10–11 and their parents from 23 schools in Wave 1 (June 2021-December 2021), and 436 children and parents from 27 schools in Wave 2 (January 2022-July 2022). These were compared to a pre-COVID-19 comparator group (March 2017-May 2018) of 1,296 children and parents in the same schools. Mean minutes of accelerometer-measured MVPA and sedentary time were derived for week- and weekend-days and compared across waves via linear multilevel models. We also analysed the date of data collection as a time series, to explore temporal patterns via generalised additive mixed models. Results There was no difference in children’s mean MVPA in Wave 2 (weekdays: -2.3 min; 95% CI: -5.9, 1.3 and weekends: 0.6 min; 95% CI: -3.5, 4.6) when compared to the pre-COVID-19 data. Sedentary time remained higher than pre-pandemic by 13.2 min (95% CI:5.3, 21.1) on weekdays. Differences compared to pre-COVID-19 changed over time, with children’s MVPA decreasing over winter, coinciding with COVID-19 outbreaks, and only returning to pre-pandemic levels towards May/June 2022. Parents’ sedentary time and weekday MVPA was similar to pre-COVID-19 levels, with MVPA higher than pre-pandemic by 7.7 min (95% CI: 1.4, 14.0) on weekends. Conclusion After an initial drop, children’s MVPA returned to pre-pandemic levels by July 2022, while sedentary time remained higher. Parents’ MVPA remained higher, especially at weekends. The recovery in physical activity is precarious and potentially susceptible to future COVID-19 outbreaks or changes in provision, and so robust measures to protect against future disruptions are needed. Furthermore, many children are still inactive, with only 41% meeting UK physical activity guidelines, and so there is still a need to increase children’s physical activity.

Abstract Background Restrictions during the COVID-19 pandemic have led to increased screen-viewing among children, especially during strict periods of lockdown. However, the extent to which screen-viewing patterns in UK school children have changed post lockdowns is unclear. The aim of this paper is to examine how screen-viewing changed in 10–11-year-old children over the 2020–21 COVID-19 pandemic, how this compares to before the pandemic, and the influences on screen-viewing behaviour. Methods This is a mixed methods study with 10–11-year-olds from 50 schools in the Greater Bristol area, UK. Cross-sectional questionnaire data on minutes of weekday and weekend television (TV) viewing and total leisure screen-viewing were collected pre-COVID-19 in 2017–18 (N = 1,296) and again post-lockdowns in 2021 (N = 393). Data were modelled using Poisson mixed models, adjusted for age, gender, household education and seasonality, with interactions by gender and household education. Qualitative data were drawn from six focus groups (47 children) and 21 one-to-one parent interviews that explored screen-viewing behaviour during the pandemic and analysed using the framework method. Results Total leisure screen-viewing was 11% (95% CI: 12%-18%) higher post-lockdown compared to pre-COVID-19 on weekdays, and 8% (95% CI: 6%-10%) on weekends, equating to around 12–15 min. TV-viewing (including streaming) was higher by 68% (95% CI: 63%-74%) on weekdays and 80% (95% CI: 75%-85%) on weekend days. Differences in both were higher for girls and children from households with lower educational attainment. Qualitative themes reflected an unavoidable increase in screen-based activities during lockdowns, the resulting habitualisation of screen-viewing post-lockdown, and the role of the parent in reducing post-2020/21 lockdown screen-viewing. Conclusions Although screen-viewing was higher post-lockdown compared to pre-COVID-19, the high increases reported during lockdowns were not, on average, sustained post-lockdown. This may be attributed to a combination of short-term fluctuations during periods of strict restrictions, parental support in regulating post-lockdown behaviour and age-related, rather than COVID-19-specific, increases in screen-viewing. However, socio-economic differences in our sample suggest that not all families were able to break the COVID-19-related adoption of screen-viewing, and that some groups may need additional support in managing a healthy balance of screen-viewing and other activities following the lockdowns.

Abstract Background Active-6 is exploring how the COVID-19 pandemic has impacted physical activity behaviour among Year 6 children (aged 10–11 years) and their parents in Southwest England. Initial findings from the Active-6 project have shown a 7–8 min decrease in moderate-to-vigorous physical activity and an increase in sedentary behaviour among children following the easing of restrictions in the UK in latter half of 2021. This finding suggests that the pandemic has had a persistent impact on child physical activity behaviour. This paper explored the possible mechanisms behind these changes. Methods Interviews with parents (n = 21), members of school staff (n = 9) and focus groups with children aged 10–11 years (n = 47) were conducted between August and December 2021 to discuss the impact of the pandemic on child physical activity behaviour. The framework method was used for analysis. Results Five themes spanning two key stages of the pandemic were described. Three themes related to the period of lockdowns and fluctuating restrictions (March 2020 – April 2021). These included: Theme 1) Lockdown: A short-lived adventure; Theme 2) Access to facilities during restrictions; and Theme 3) The importance of the parent. A further two themes were identified related to the period following the gradual easing of restrictions in April 2021. These included: Theme 4) An overwhelming return to normal; and Theme 5) Reopening fatigue. Conclusions The analysis suggested that feelings of novelty experienced during the initial stages of lockdown waned as restrictions were prolonged, creating an increasingly challenging period for parents and their children. However, during periods of restrictions, the importance of parental encouragement and access to appropriate facilities in the local and home environment helped facilitate physical activity. Following the easing of COVID-19 restrictions, emotional overwhelm and physical fatigue among children, stemming from a sedentary and socially isolated life in lockdown and other restrictions, were key contributors to the decreased moderate to vigorous physical activity and increased sedentary behaviour that was observed in a related quantitative study.

Abstract Background Restrictions due to the coronavirus disease 2019 (COVID-19) pandemic reduced physical activity provision for both children and their parents. Recent studies have reported decreases in physical activity levels during lockdown restrictions, but these were largely reliant on self-report methods, with data collected via unrepresentative self-report surveys. The post-pandemic impacts on children’s activity levels remain unknown. A key question is how active children become once lockdown restrictions are lifted. Methods Active-6 is a repeated cross-sectional natural experiment. Accelerometer data from 1296 children aged 10–11 and their parents were collected in 50 schools in the Greater Bristol area, UK in March 2017-May 2018 (pre-COVID-19 comparator group), and compared to 393 children aged 10–11 and parents in 23 of the same schools, collected in May-December 2021. Mean minutes of accelerometer-measured moderate-to-vigorous physical activity (MVPA) were derived for weekdays and weekend and compared pre- and post-lockdown via linear multilevel models. Results After adjusting for seasonality, accelerometer wear time and child/parent demographics, children’s mean weekday and weekend MVPA were 7.7 min (95% CI: 3.5 to 11.9) and 6.9 min (95% CI: 0.9 to 12.9) lower in 2021 than in 2018, respectively, while sedentary time was higher by 25.4 min (95% CI: 15.8 to 35.0) and 14.0 min (95% CI: 1.5 to 26.5). There was no evidence that differences varied by child gender or household education. There was no significant difference in parents’ MVPA or sedentary time, either on weekdays or weekends. Conclusions Children’s MVPA was lower by 7–8 min/day in 2021 once restrictions were lifted than before the pandemic for all groups, on both weekdays and weekends. Previous research has shown that there is an undesirable age-related decline in children’s physical activity. The 8-min difference reported here would be broadly comparable to the decline that would have previously been expected to occur over a three-year period. Parents’ physical activity was similar to pre-pandemic levels. Our results suggest that despite easing of restrictions, children’s activity levels have not returned to pre-pandemic levels. There is an urgent need to understand why these changes have occurred and how long they are maintained.

Abstract Background Physical activity is associated with improved physical and mental health among children, but many children do not meet the recommended hour per day of moderate-to-vigorous-intensity physical activity (MVPA). The aim of this paper is to investigate participation in active after-school clubs and active travel to and from school at age 11 and estimate the average daily minutes of MVPA associated with active club attendance and active travel. Methods Accelerometer data were collected on three weekdays for 1296 11-year-old children in a cross-sectional study. Children reported attendance at active after-school clubs and how they travelled to and from school for each day of the week. To account for repeat days within child and clustering within schools we used multilevel models with random effects at the school and child level, and fixed effects for all covariates. We calculated odds ratios for participation in active after-school clubs and active travel for gender, measures of socio-economic position and BMI category. We also explored the association between active club attendance, active travel and daily average MVPA. Results Boys and girls were equally likely to attend active after-school clubs. Boys were more likely to travel to school using active modes. Attendance at active after-school clubs and active travel home were not associated with each other. Attending an active after-school club was associated with an additional 7.6 min (95% CI: 5.0 to 10.3) average MVPA on that day among both boys and girls. Active travel was associated with an additional 4.7 min (95% CI: 2.9 to 6.5) average MVPA per journey for boys and 2.4 min (95% CI: 1.0 to 3.7) for girls. Conclusions Both active after-school clubs and active travel are associated with greater physical activity on the day that children participate in these, and we saw no evidence that those attending active clubs do so at the expense of active travel home afterwards. While the increased daily MVPA is small to moderate, active after-school clubs and active travel on multiple days of the week could make important contributions as part of complex interventions aimed at increasing population levels of physical activity in children.

Elevated blood pressure in children is a significant risk factor for the development of cardiovascular disease in adulthood. We examined how children's body mass index (BMI), physical activity and sedentary time at ages 9 and 11 are associated with blood pressure at age 11. Data were from 1283 children from Bristol, UK, who participated in the study aged 11 years, 797 of whom also participated in the study aged 9 years. Child height, weight and blood pressure were measured, and children wore accelerometers for five days, from which moderate-to-vigorous-intensity physical activity and sedentary minutes per day were derived. Multiple imputation of missing data and adjusted linear and logistic regression models were used to examine associations. Child BMI at 11 years was cross-sectionally associated with higher systolic and diastolic blood pressure (mean difference [95% confidence interval]: 0.91 [0.32 to 1.50] mm Hg and 1.08 [0.54 to 1.62] mm Hg, respectively, per standard deviation (SD) of BMI). BMI at age 9 was also positively associated with diastolic blood pressure at age 11 (1.16 mmHg per two years [0.49 to 1.84], per SD of BMI). For girls, sedentary time at age 9 years was associated with increased odds of having high systolic blood pressure at age 11 (odds ratio: 1.08 [1.01 to 1.16], per 10 minutes per day). There was no evidence of associations between sedentary time and blood pressure among boys. Similarly, there was little evidence that physical activity was associated with blood pressure in either cross-sectional or prospective analyses. Effective strategies are needed to prevent excess bodyweight among children in order to reduce cardiovascular disease risk.

Abstract Background Physical activity is associated with improved physical and mental health among children. However, physical activity declines and sedentary time increases with age, and large proportions of older children do not meet the recommended hour per day of moderate-to-vigorous-intensity physical activity (MVPA). The aim of this paper is to identify profiles of children based on the complex relationship between physical activity and sedentary time at ages 6 and 9 and explore how those profiles are associated with other covariates and how they change over time. Methods Valid accelerometer data were collected for 1132 children aged 6 and 1121 at age 9, with 565 children with data at both ages. We calculated the proportions of total wear time spent in sedentary, light and MVPA activity on both weekdays and weekends. Latent profile (class) analysis was applied separately to the two age groups to identify activity profiles. We then used latent transition analysis to explore transitions between profiles at the two time points. Results We identified five profiles of activity at age 6 and six profiles at age 9. Although profiles were not directly equivalent, five classes captured similar patterns at both ages and ranged from very active to inactive. At both ages, active profiles, where the majority achieved the recommended MVPA guidelines, were more likely to be active at weekends than on weekdays. There was substantial movement between classes, with strongest patterns of movement to classes with no change or a decrease in MVPA. Transition between classes was associated with sex, BMI z-score, screen-viewing and participation in out-of-school activities. Conclusions This paper is the first to apply latent profile analysis to the physical activity of UK children as they move through primary school. Profiles were identified at ages 6 and 9, reflecting different weekday and weekend patterns of physical activity and sedentary time. There was substantial movement between profiles between ages 6 and 9, mostly to no change or less active profiles. Weekend differences suggest that greater focus on how weekend activity contributes to an average of 60 min per day of MVPA across the week may be warranted.