Physical activity and physical fitness among children and adolescents after the onset of the COVID-19 pandemic in the WHO European Region: a systematic review protocol

Abstract

IntroductionThe implementation of COVID-19 pandemic-related restrictions resulted in limitations for physical activity (PA) opportunities, which may have initiated a longer-term behavioural change. The protocol describes the methodology for a planned systematic review that aims to summarise changes in PA and physical fitness (PF) in children and adolescents in the WHO European Region after the onset of the COVID-19 pandemic.Methods and analysisThe protocol adheres to the ‘Preferred Reporting Items for Systematic Review and Meta-Analysis for Protocols’ (PRISMA-P) statement. Using a peer-reviewed search strategy according to the evidence-based checklist ‘Peer Review of Electronic Search Strategies’ (PRESS), we will perform a systematic literature search in seven databases. Inclusion criteria are all primary studies that gathered data on children and adolescents ≤19 years living in the WHO European Region and made a comparison to pre-pandemic data. Primary outcomes are PA and PF. We will assess the risk of bias with the ‘Risk of Bias Instrument for Non-Randomized Studies of Exposures’ (ROBINS-E). The ‘Grading of Recommendations Assessment, Development and Evaluation’ (GRADE) approach will be used for the evaluation of the certainty of evidence. Also, subgroup analyses will be performed (eg, for gender, age, stringency of pandemic restrictions).Ethics and disseminationEthical approval is not required, as primary data will not be collected in this study. The results will be presented in a peer-reviewed publication and at congresses relevant to the research field.PROSPERO registration numberCRD42023395871.

Level and correlates of physical activity among children and adolescents with juvenile idiopathic arthritis compared to controls: results from a German nationwide prospective observational cohort study

“…Although we cannot rule out that other clinical factors are responsible for physical inactivity in some patients, this finding highlights the importance of applying behavior change techniques to adolescents. As studies indicate that measures to contain the COVID-19 pandemic have had negative impacts on PA among European children and adolescents [ 38 ], this becomes all the more important. However, negative effects of pandemic-related restrictions were not reflected in the level of self-reported PA in our patients, at least until 2022.…”

How the COVID-19 pandemic and related school closures reduce physical activity among children and adolescents in the WHO European Region: a systematic review and meta-analysis

“…The systematic review and meta-analysis is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) [ 17 ] statement (Additional file [AF 1 ]: Table S1) and adheres to the Cochrane Handbook for Systematic Reviews [ 18 ]. It was registered on the International Prospective Register of Systematic Reviews (PROSPERO; CRD42023395871) [ 19 ] and an a priori protocol was published [ 20 ]. Deviations from the protocol are reported in AF 1 : Table S2.…”

“…We designed the search strategy by using validated or recommended search filters and conducted a peer-review process considering the evidence-based Peer Review of Electronic Search Strategies (PRESS) checklist [ 22 ] (see protocol [ 20 ] for further details). The search strategy for every database is presented in the Supplement (AF 1 : Table S4).…”

“…For the School Closure Index, we specified two cut-off points: no or few alterations compared with a pre-COVID-19 situation (index < 2) and partial or full school closure (index ≥ 2) [ 28 ]. More details on these indices are contained in the protocol [ 20 ].…”

“…All studies were independently assessed by two reviewers (HLW, SH), using the ‘Risk of Bias (RoB) in Non-randomized Studies - of Exposure’ (ROBINS-E) instrument. This tool comprises seven assessment criteria, with the RoB judgements expressed as ‘low RoB’, ‘some concerns RoB’, ‘high RoB’ or ‘very high RoB’ [ 57 ]; more details are provided in the protocol [ 20 ]. The studies were subsequently grouped into ‘some concerns RoB’ and ‘high RoB’ (including the categories ‘high RoB’ and ‘very high RoB’); no study received the rating ‘low RoB’.…”