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.

The effects of warm weather on children's outdoor heat stress and physical activity in a preschool yard in Gothenburg, Sweden.

Hot weather conditions can have negative impacts on the thermal comfort and physical activity of vulnerable groups such as children. The aim of this study is to analyze the effects of warm weather on 5-year-old children's thermal comfort and physical activity in a preschool yard in Gothenburg, Sweden. In situ measurements were conducted for 1-1.5 h in the early afternoon on 8 days in May, June, and August of 2022. The thermal comfort and physical activity was estimated with GPS-tracks, heart rate monitors, and step counts and compared to observed weather conditions. Results show that physical activity decreases under warmer weather conditions, depicted by a decrease in distance moved, step counts, and highest registered pulse. Moreover, on warm days, the children avoid sunlit areas. For 50% or more of the time spent in sunlit areas, the children are exposed to cautious levels of heat. In shaded areas, on the other hand, the children are less exposed, with five out of 8 days having 50% or more of the time at neutral levels. The study demonstrates the importance of access to shaded areas in preschool yards where children can continue their active play while simultaneously maintaining a safe thermal status.

Physical literacy in Europe: The current state of implementation in research, practice, and policy.

Background/objective: The holistic concept of physical literacy (PL) embraces different person-centered qualities (physical, cognitive, affective/psychological) necessary to lead physically active lifestyles. PL has recently gained increasing attention globally and Europe is no exception. However, scientific endeavors summarizing the current state of PL in Europe are lacking. Therefore, the goal of this study was to comprehensively assess and compare the implementation of PL in research, policy, and practice across the continent. Methods: We assembled a panel of experts representing 25 European countries. Employing a complementary mixed-methods design, the experts first prepared reviews about the current state of PL in their countries (categories: research, practice/policy). The reviews underwent comparative document analysis, ensuring a transnational four-eyes principle. For re-validation purposes, the representatives completed a quantitative survey with questions reflecting the inductive themes from the document analysis. Results: The document analysis resulted in ten disjunct themes (related to "concept", "research", "practice/policy", "future/prospect") and yielded a heterogenous PL situation in Europe. The implementation state was strongly linked to conceptual discussions (e.g., existence of competing approaches), linguistic issues (e.g., translations), and country-specific traditions. Despite growing scholarly attention, PL hesitantly permeates practice and policy in most countries. Nevertheless, the experts largely anticipate increasing popularity of PL for the future. Conclusion: Despite the heterogeneous situation across Europe, the analysis has uncovered similarities among the countries, such as the presence of established yet not identical concepts. Research should intensify academic activities (conceptual-linguistic elaborations, empirical work) before PL may gain further access into practical and political spheres in the long term.

Leisure-time organised physical activity and dietary intake among Swedish adolescents.

This study aimed to investigate associations between participation in leisure-time organised physical activity (LTOPA) and dietary intake in a large representative sample of Swedish adolescents participating in the national dietary survey Riksmaten Adolescents 2016-2017. A sample of 2807 participants aged 11-12, 14-15 and 17-18 years were included. Information about LTOPA and dietary intake were collected through questionnaires and two 24-hour recalls on the web (RiksmatenFlex). For dietary intake, overall healthy eating index, intake of fruit, vegetables, candy, sugar-sweetened beverages, and the proportion of added sugar to total energy intake were analysed. Significance-testing for associations was performed with analysis of covariance. LTOPA was associated with lower sugar-sweetened beverages intake among adolescent boys (p < 0.001, ηp2 = 0.012) and girls (p = 0.007, ηp2 = 0.005), higher fruit intake among boys (p = 0.043, ηp2 = 0.003), and lower vegetable intake among girls (p < 0.001, ηp2 = 0.009). However, LTOPA was unrelated to the overall healthy eating index, candy intake, and the proportion of added sugar to total energy intake (p > 0.05). LTOPA was only associated with some healthy eating behaviours, and there is much room for improvement in the diets of Swedish adolescents.

Self-reported physical activity and sedentary behaviour amongst adolescents in Sweden vary depending on sex, age and parental education.

AIM: The aim of this study was to investigate self-reported physical activity and sedentary behaviour by sex, age and parental education in a large representative sample of Swedish adolescents. METHODS: This study is based on data from the national dietary survey Riksmaten Adolescents, which was conducted by the Swedish Food Agency in 2016-2017. In total, 3477 students from grade five (11-12 years), eight (14-15 years) and eleven (17-18 years) were included. A web questionnaire was used to collect information about physical activity and sedentary behaviour. RESULTS: In total, 53% reported active transport to and from school, 93% that they usually participate in the physical education, 76% reported a physically active leisure time, and 66% reported that they participated in organised physical activities. In addition, 12% and 6% reported two hours or less of screen time on weekdays and weekends, respectively. Participation in physical activity was generally lower amongst girls, older adolescents and for those from families with low-parental education. CONCLUSION: This study provide reference values for self-reported physical activities and sedentary behaviours amongst adolescents in Sweden. Strategies to increase physical activity and reduce screen time are needed, particularly amongst girls, older adolescents and amongst those with low-parental education.

Pupils' use of school outdoor play settings across seasons and its relation to sun exposure and physical activity.

BACKGROUND: Long outdoor stay may cause hazardous exposure to ultraviolet radiation (UVR) from the sun even at high latitudes as in Sweden (Spring to Autumn). On the other hand, long outdoor stay is a strong predictor of primary school children´s free mobility involving moderate to vigorous physical activity (MVPA). UV-protective outdoor environments enable long outdoor stay. We investigated the concurrent impact of different school outdoor play settings upon pupils´ sun exposure and levels of physical activity across different ages, genders, and seasons. METHOD: During 1 week each in September, March, and May, UVR exposure and MVPA were measured in pupils aged 7-11 years. Erythemally effective UVR exposure was measured by polysulphone film dosimeters and MVPA by accelerometers. Schoolyard play was recorded on maps, and used areas defined as four play settings (fixed play equipment, paved surfaces, sport fields, and green settings), categorized by season and gender. RESULTS: During the academic year, sport fields yielded the highest UVR exposures and generated most time in MVPA. In March, time outdoors and minutes in MVPA dropped and UVR exposures were suberythemal at all play settings. In May, green settings and fixed play equipment close to greenery promoted MVPA and protected from solar overexposure during long outdoor stays. CONCLUSION: More outdoor activities in early spring are recommended. In May, greenery attractive for play could protect against overexposure to UVR and stimulate both girls and boys to vigorous play.

A national survey showed low levels of physical activity in a representative sample of Swedish adolescents.

AIM: This study investigated objectively measured physical activity and sedentary time by sex, age and socioeconomic status in a large representative sample of Swedish adolescents. METHODS: In this cross-sectional national survey between 2016 and 2017, students aged 11-12, 14-15 and 17-18 years from 131 schools were invited to participate. Physical activity and sedentary time were measured objectively with accelerometers for seven consecutive days. Socioeconomic status (parental education) and country of birth were self-reported in a questionnaire. Weight and height were measured by trained staff. RESULTS: A total of 3477 adolescents participated in the study, and 2419 (73%) had at least 3 days of valid accelerometer data. The results showed that 43% of boys and 23% of girls reached the recommendation of 60 minutes of daily moderate-to-vigorous physical activity. Boys were more physically active than girls in all age groups. Girls with high socioeconomic status were more physically active than girls with low socioeconomic status (P < .001), and this difference was not found in boys. CONCLUSION: The majority of Swedish adolescents did not reach the physical activity recommendation, and boys were more active than girls. Effective strategies to increase physical activity, especially among girls with low socioeconomic status, are urgently needed.

Organised physical activity during leisure time is associated with more objectively measured physical activity among Swedish adolescents.

AIM: The aim of this study was to investigate associations between participation in organised physical activity (PA), such as sport and exercise during leisure time, and objectively measured PA and sedentary time in a large representative sample of Swedish adolescents. METHODS: This study was part of the school-based cross-sectional Swedish national dietary survey Riksmaten Adolescents 2016-17. Data from 3477 adolescents aged 11-12, 14-15 and 17-18 years were used in the analyses. Participation in organised PA and parental education were reported in questionnaires. PA and sedentary time were objectively measured through accelerometry during seven consecutive days. RESULTS: Adolescents who participated in organised PA had significantly higher total PA (14%, P < .001), more time spent on moderate-to-vigorous PA (MVPA) (8 minutes, P < .001) and had less sedentary time (15 minutes, P < .001). Those who participated in organised PA were more likely to reach recommended PA levels. Total PA and MVPA did not differ by parental education among those who participated in organised PA. CONCLUSION: Adolescents who participated in organised PA were more physically active, less sedentary and more likely to reach PA recommendations than those who did not.

School-based study showed a correlation between physical activity and smartphone and tablet use by students aged eight, 11 and 14.

AIM: This study investigated correlations between objectively measured physical activity (PA) and smartphone and tablet usage by sex and age in subjects aged eight, 11 and 14. METHODS: We recruited 549 children and adolescents (264 boys) from six schools in three middle-class communities in south-eastern Sweden. Steps per day were objectively measured using sealed pedometers and a brief daily questionnaire about smartphone and tablet usage. Correlations between mean steps per day and mean daily minutes of smartphone and tablet usage, and differences between low and high users, were investigated. RESULTS: There was a moderately inverse correlation between steps per day and smartphone and tablet usage in the total sample (r = -.329, P < .001), but it was lower in boys (r = -.340, P < .001) than girls (r = -.401, P < .001). When stratified further by both sex and age, this correlation was only found among 14-year-old girls (r = -.385, P < .001) and this group only, differences between low and high users (P = .005) were seen. CONCLUSION: There was a moderately inverse correlation between steps per day and smartphone and tablet usage. When stratified by both sex and age groups, this correlation was only observed in 14-year-old girls. The results may have implications for future PA interventions that target adolescent girls.

Comparisons of pedometer-determined weekday physical activity among Swedish school children and adolescents in 2000 and 2017 showed the highest reductions in adolescents.

AIM: This study compared differences in weekday physical activity among school children and adolescents in middle-class communities in south-eastern Sweden in 2000 and 2017. METHODS: Data were drawn from two independent cross-sectional cohorts of children and adolescents aged 8, 11 and 14. The same six schools, protocols, procedures and instruments were used in both years, with 332 subjects in 2000 and 562 in 2017. Mean steps per day (SPD) were measured with a Yamax SW-200 pedometer. RESULTS: The mean weekday SPD was similar among eight-year-old girls in both years, but 8% (p = 0.040) higher among eight-year-old boys in 2017. However, among 11-year-old children, the mean SPD were 12% lower among both girls (p = 0.033) and boys (p = 0.001). The SPD among 14-year-old adolescents were 24% (p = 0.012) and 30% (p < 0.001) lower among girls and boys, respectively. CONCLUSION: This school-based study from south-eastern Sweden showed that weekday physical activity differed between age groups in 2000 and 2017. The highest reductions were seen among older children and adolescents, particularly 14-year-old girls and boys. The only group that increased was eight-year-old boys, with no significant change in eight-year-old girls. A possible explanation might be the dramatically increased use of the Internet on phones and tablets.

Levels of physical activity during physical education lessons in Sweden.

AIM: The aim of this study was to measure the percentage of sedentary light and moderate-to-vigorous physical activity (%MVPA) provided by physical education (PE) lessons for Swedish second, fifth and eighth grade students, aged eight, 11 and 14. METHODS: We observed 39 PE lessons and divided them into seven lesson categories: ball play, ball games, dance, fitness, playing games, orienteering and gymnastics. Physical activity (PA) during PE was estimated using accelerometers and the height and weight of the children were measured. RESULTS: We studied 149 children: 63 in the second grade, 66 in the fifth grade and 19 in the eighth grade. On average, 25% of the PE lessons were spent in MVPA and the mean %MVPA varied with the lesson content, with fitness, orienteering and playing games being the most intense. The highest %MVPA was in the fitness category, providing 33% (8-62%) for girls and 37% (7-72%) for boys. With the exception of the second grade, no significant gender differences in %MVPA were seen. CONCLUSION: The content of Swedish PE lessons affected the %MVPA in all age groups. In some content, individuals reached two-thirds of their daily PA recommendations, highlighting the potential that PE contributes to public health goals.

"Couch-potatoeism" and childhood obesity: The inverse causality hypothesis.

The bulk of cross-sectional studies suggests that lower levels of physical activity are associated with childhood obesity. Although this has led to the general understanding that "couch-potatoes" are fat on account of their inactive lifestyles, cross-sectional studies do not imply causality. On the contrary, the contribution of physical activity to obesity during childhood is currently unclear, and lately, studies have suggested that "couch-potatoeism" could be the result of obesity rather than its cause. Coupled with evidence suggesting that interventions have had little effect on children's physical activity levels as well as on obesity, this inverse causality challenges the role of physical activity in childhood obesity prevention strategies.

Physical activity decreased by a quarter in the 11- to 12-year-old Swedish boys between 2000 and 2013 but was stable in girls: a smartphone effect?

AIM: This study explored physical activity, body mass index (BMI) and overweight and obesity from 2000 to 2013 using a convenience sample of second- and fifth-grade Swedish schoolchildren aged 8-9 years and 11-12 years, respectively. METHODS: We examined cross-sectional cohorts of 126 second-grade children in 2000, 84 in 2006 and 44 in 2013 and 105 fifth-grade children in 2000 and 38 in 2013. No fifth graders were available in 2006. Physical activity data were collected based on pedometer readings over four consecutive weekdays, and height and weight were measured. Identical instruments and procedures were used in all three years. RESULTS: There was an increase in physical activity in second-grade girls from 2000 to 2006 (p < 0.01), which then stabilised between 2006 and 2013, but second-grade boys and fifth-grade girls were stable throughout the study period. Fifth-grade boys decreased significantly (24%) from 16 670 to 12 704 steps per day (p < 0.01) from 2000 to 2013. Mean BMI scores remained stable over time. CONCLUSION: Time trends in physical activity differed between boys and girls. Second-grade boys and fifth-grade girls were stable throughout, whereas second-grade girls increased from 2000 to 2006 before stabilising. Fifth-grade boys showed a significant 24% reduction from 2000 to 2013. Changes in recess and leisure time habits, such as smartphone use, may have influenced the result.

Objectively measured sedentary behaviour and cardio-metabolic risk in youth: a review of evidence.

UNLABELLED: The aim of this paper was to review studies that examine the association between volume and pattern of objectively measured sedentary behaviour and markers of cardio-metabolic risk in youth. A search for relevant articles was conducted in PubMed and SportDiscus, and the following inclusion criteria were applied: (i) youth participants (age range 6-19); (ii) accelerometer-measured volume and/or pattern of sedentary behaviour and its association with ≥1 cardio-metabolic outcome; and (iii) published, in press or accepted in an English language peer-reviewed journal between January 2000 and October 2013. A total of 45 articles met the a priori criteria and, thus, were considered eligible for inclusion. Although youth accumulate approximately 6 to 8 h of daily sedentary behaviour, little evidence supports an association with individual and clustered cardio-metabolic risk when adjusted for moderate-to-vigorous physical activity (MVPA). CONCLUSION: We suggest that youth should be encouraged to engage in recommended levels of MVPA and reduce excessive time spent in screen-based sedentary behaviour. Future studies should examine the association between volume and pattern of objectively measured sedentary behaviour and cardio-metabolic risk independent of time spent in MVPA.

Awareness of current recommendations and guidelines regarding strength training for youth.

AIM: Physical conditioning of youth has always been a controversial topic as it raises ethical, physiological, and medical issues. Current recommendations and guidelines suggest that strength training is a relatively safe and worthwhile method in conditioning youth. This, however, requires well-informed coaches who follow age-appropriate strength training recommendations and guidelines, compiles well-designed strength training programs, and provides qualified supervision and instructions. The purpose of this study was to investigate coaches' awareness of current recommendations and guidelines regarding strength training for youth. METHOD: A total of 39 football (US: soccer) coaches (34 males and 5 females) training boys in age groups 8-12 years were included in this study. Data were collected using an attitude statement questionnaire, and the assertions were based upon current recommendations and guidelines. RESULTS: The results revealed significant differences among coaches in terms of knowledge of important aspects of strength training for youth. CONCLUSIONS: The results suggested that coaches in the present study were not aware of the latest recommendations and guidelines regarding strength training for youth.

Changes in Accelerometer-Measured Physical Activity and Sedentary Time Across Retirement Transition as a Predictor of Self-Rated Health.

BACKGROUND: Retirement transition has been shown to associate with changes in physical activity (PA) and self-rated health (SRH), but their interrelationship is less studied. The aim was to investigate changes in accelerometer-measured total PA, moderate to vigorous PA (MVPA), and sedentary time across retirement transition as a predictor of SRH. METHODS: Data from the Swedish Retirement Study and the Finnish Retirement and Aging study were harmonized and pooled. Data from 3 waves (about 12 mo apart) were included: 1 preretirement (wave 1) and 2 postretirement follow-ups (wave 2-3). A totally of 245 participants (27% men) were included. Thigh-worn accelerometers were used to collect data for PA variables (wave 1-2), and SRH was obtained from the questionnaire (wave 1-3). RESULTS: Between wave 1 and 2, total PA decreased with 11 (CI, -22 to -1) minutes per day, MVPA was stable (0 [CI, -3 to 3] min), and sedentary time decreased nonsignificantly with 9 (CI, -20 to 1) minutes. SRH changed between all 3 waves (all P < .001). At preretirement, 10 more minutes of MVPA was associated with greater odds of better SRH when adjusting for accelerometer wear-time, cohort, sex, age, and occupational status (odds ratio: 1.11 [95% CI, 1.02-1.22]). This association was no longer statistically significant when additionally adjusting for marital status, body mass index, and smoking. No significant associations were observed between changes in the PA variables during retirement transition and SRH at postretirement follow-ups. CONCLUSIONS: This study showed a cross-sectional association between MVPA and greater odds of reporting better SRH before retirement. No longitudinal associations were observed between changes in the PA variables from before to after retirement and later changes in SRH.

Towards a more sustainable future: simple recommendations to integrate planetary health into education.

This Personal View presents recommendations aimed at integrating planetary health into various stages of education, which are simple but effective, and designed with teachers in training and those who have not yet considered how to incorporate UNESCO's Education for Sustainable Development into their teaching practice. However, the constantly evolving nature of the Education for Sustainable Development programme must be recognised, and the importance of being able to adapt teaching methods to meet the changing needs of students as they progress through their educational journey should be highlighted. Therefore, this Personal View considers the cognitive, social, and ethical evolution of students and offers specific recommendations for preschool, primary, secondary, and university education levels. We recommend that educators should focus on teaching students to critically evaluate data on sustainability and to develop innovative solutions to environmental challenges. We also highlight the importance of incorporating practical projects, using active methods that promote skills related to caring for the planet, or the importance of situated learning that attends to the particularities of each context. In this way, students can develop skills and values that contribute to a more sustainable future. The recommendations made here aim to provide educators and researchers with simple but effective ways to integrate planetary health into education.

The COVID-19 pandemic: The importance of physical activity among faculty members.

The novel coronavirus (SARS-CoV-2) disease 2019 (COVID-19) pandemic has posed serious challenge to societies worldwide. To prevent person-to-person transmission of the coronavirus and avoid associated morbidity and mortality, several public health measures have been introduced by various health organizations and authorities, such as social distancing policies and quarantine. While necessary, these public health measures are likely to have implications for people's physical activity behaviors. This viewpoint is intended for faculty members and focus on the importance of physical activity for health. Suggestions on how to stay physically active during the COVID-19 pandemic are also provided.

Sustainable Development Competencies among More than 1100 Certified Physical Education and Health Teachers in Sweden.

School physical education and health (PEH) may not only be an important cornerstone to the holistic development of students but may also contribute to the sustainable development (SD) agenda. Although PEH may have unique characteristics that can contribute to the SD agenda, most research to date has been theoretical. The overall aim of this study was to explore the sustainable development competencies among physical education and health (PEH) teachers in Sweden. An online questionnaire was used to collect data about background and SD competencies. SD competencies was collected through the use of the Physical Education Scale for Sustainable Development in Future Teachers (PESD-FT). Of the 1153 participants, 31% reported being males, and 48% of the participants reported teaching PEH when completing the questionnaire. The median SD competencies score for all the participants was 105 (range: 18-144) out of 144. Virtually no differences were observed across the groups of participants. A stronger correlation was observed between SD competencies vs. long-time interests in health and health issues (rs = 0.343) than for long experience of participating in organized sports (rs = 0.173). In the total sample, 26% reported having taught about SD in PEH, such as using outdoor education, interdisciplinary projects, picking, and sorting waste, as well as paying attention to material issues. Among those who reported teaching PEH when completing the questionnaire, 70% perceived that they are in great need of professional development education in the area of SD. In conclusion, SD competencies were higher for the PESD-FT items that concerned the social dimension of SD compared to the economic and environmental dimensions. Relatively few teachers had taught about SD in PEH, and the majority perceive that they are in great need of professional development education in the area of SD. Future studies are required to understand more of what types of competencies practicing PEH teachers, and PEH teacher education programs, are lacking to fulfil the call for a contribution to the SD agenda.

A 20-Year Follow-Up Study of Objectively Measured Physical Activity.

BACKGROUND: The objectives of this study were to explore the effect of time, long-term tracking, and the proportion of objectively measured physical activity (PA) from early adolescence to the mid-thirties. METHODS: PA was measured as mean steps per day (SPD) with pedometers during 2000 (T1), 2003 (T2), 2005 (T3), 2010 (T4), 2016 (T5) and 2020 (T6). Data from 64 participants (n = 32 males) were analysed from their early adolescence (T1) to their mid-thirties (T6). RESULTS: SPD decreased in the total sample and among males and females (all, p < 0.001). Males took more mean SPD than females during T1 (p = 0.002), whereas females took more mean SPD during T2 (p = 0.009) and T6 (p = 0.008). Males' mean SPD tracked between T1 and T2 (p = 0.021), T2 and T3 (p = 0.030), T3 and T4 (p = 0.015) and T4 and T5 (p = 0.003). Females' mean SPD tracked between T3 and T4 (p = 0.024) and T5 and T6 (p < 0.001). In the total sample, more mean SPD were found on weekdays compared to weekend days at T3 (p = 0.017) and T5 (p < 0.001). CONCLUSIONS: SPD decreased between T1 and T6. Mean SPD tracked low-to-moderate in the short time span. From late adolescence to the mid-thirties, more mean SPD was observed during weekdays compared to weekend days.