Introduction
Methods
Study design
Setting
Participants
Variables
Physical activity, sedentary time and sleep
Validation of PA questions
Demographics and COVID-19 factors
COVID-19 restrictions
Country | Preschool, nursery, school closures | Workplace closures | Public transport closure | Restrictions on domestic travel | Stay at home requirements | Limit on private gatherings (how many people can get together) | Ability to go outside for exercise* | Playground, skate park closures** |
---|---|---|---|---|---|---|---|---|
Australia | Kept open for children of essential workers. | Required closing (or work from home) for some sectors or categories of workers | No measures | Internal movement restrictions in place | Require not leaving house with exceptions for daily exercise, grocery shopping, and ‘essential’ trips | Restrictions on gatherings of 10 people or less | Yes - for exercise | All closed |
Bangladesh | Required closing | Required closing (or work from home) for all-but-essential workplaces (eg grocery stores, doctors) | Required closing (or prohibit most citizens from using it) | Internal movement restrictions in place | Require not leaving house with exceptions for daily exercise, grocery shopping, and ‘essential’ trips | Restrictions on gatherings of 10 people or less | Not allowed | All closed |
China | Required closing | Required closing (or work from home) for all-but-essential workplaces (eg grocery stores, doctors) | Required closing (or prohibit most citizens from using it) | Internal movement restrictions in place | Require not leaving house with minimal exceptions (eg allowed to leave once a week, or only one person can leave at a time, etc) | Restrictions on gatherings of 10 people or less | Yes - but encouraged to reduce if possible | Partial playground and skate park closures |
Hong Kong | Required closing | Required closing (or work from home) for some sectors or categories of workers | No measures | No measures | Recommend not leaving house | There was no limit on how many people can congregate in private settings or at work, but not allowed to assemble in groups of more than 4 for public gatherings | Yes, but leisure venues for public gatherings were closed | All closed |
India | Required closing | Required closing (or work from home) for all-but-essential workplaces (eg grocery stores, doctors) | Required closing (only open for emergency services) | Internal movement not allowed except for emergency with prior permission of police | Require not leaving house with minimal exceptions (eg allowed to leave once a week, or only one person can leave at a time) | Restrictions on gatherings of 10 people or less | Not Allowed | All closed |
Indonesia | Required closing | Required closing (or work from home) for some sectors or categories of workers | Recommend closing (or significantly reduce volume /route/means of transport available) | Internal movement restrictions in place | Require not leaving house with exceptions for daily exercise, grocery shopping, and ‘essential’ trips | Restrictions on gatherings of 10 people or less | Yes - for exercise | All closed |
Malaysia | Required closing | Required closing (or work from home) for all-but-essential workplaces (eg grocery stores, doctors) | No measures | Internal movement restrictions in place | Recommend not leaving house | Restrictions on gatherings between 50 people | Not allowed | All closed |
Morocco | Stop teaching at all levels, public | Required closing (or work from home) for all-but-essential workplaces (eg grocery stores, doctors) | Required closing (or prohibit most citizens from using it) | limitation of travel between neighbourhood, regions and between cities | Leaving house not allowed with exceptions for health emergency, grocery shopping, and ‘essential’ trips | Prohibition of professional and private gatherings Professional meetings to be limited except nb. Limited and respecting the safety instructions | Not allowed | All closed |
Pakistan | Required closing | Required closing (or work from home) for all-but-essential workplaces (eg grocery stores, doctors) | Required closing (or prohibit most citizens from using it) | Internal movement restrictions in place | Require not leaving house with exceptions for daily exercise, grocery shopping, and ‘essential’ trips | Restrictions on gatherings of 10 people or less | Allowed only until 5 pm | All closed |
Spain | Required closing | Required closing (or work from home) for all-but-essential workplaces (eg grocery stores, doctors) | Recommend closing (or significantly reduce volume /route/means of transport available) | Internal movement restrictions in place | Require not leaving house with exceptions for grocery shopping and ‘essential’ trips | Restrictions on gatherings of 10 people or less | Not allowed | All closed |
Sri Lanka | Required closing | Required closing (or work from home) for all-but-essential workplaces (eg grocery stores, doctors) | Required closing (or prohibit most citizens from using it) | Internal movement restrictions in place | Require not leaving house with minimal exceptions (eg allowed to leave once a week, or only one person can leave at a time) | Restrictions on gatherings of 10 people or less | Not allowed | All closed |
Sweden | Preschool open. | Recommend closing (or recommend work from home) | No closure, however, fewer people per vehicle encouraged | Recommend not to travel between regions/cities (> 2 h from home) | No recommendation | Restrictions on gatherings between 50 people | Yes-allowed | All open |
United States | Kept open for children of essential workers. The majority of children stayed at home | Required closing (or work from home) for all-but-essential workplaces (eg grocery stores, doctors) | Recommend closing (or significantly reduce volume /route/means of transport available) | Internal movement restrictions in place | Require not leaving house with exceptions for daily exercise, grocery shopping, and ‘essential’ trips | Restrictions on gatherings of 10 people or less | Yes - “Take a walk, ride your bike, hike, jog and be in nature for exercise — just keep at least 6 feet between you and others.” | All closed |
Vietnam | Required closures | Required closing (or work from home) for all-but-essential workplaces (eg grocery stores, doctors) | Required closing (or prohibit most citizens from using it) | Internal movement restrictions in place | Require not leaving house with exceptions for daily exercise, grocery shopping, and ‘essential’ trips | Restrictions on gatherings of 2 people or less at public places outside workplace, schools, hospitals; 2 m distancing | Yes - but encouraged to reduce if possible | All closed |
Measurement
Bias
Study size
Statistical methods
Results
Participants
N | T1 | T2 | Mean change (95% CI)† | ||||
---|---|---|---|---|---|---|---|
Unadjusted | p-value | Adjusted§ | p-value | ||||
Time spent in movement behaviours (min/day) | |||||||
TPA | 852 | 200.7 (5.0) | 217.8 (4.8) | 16.5 (−40.0,72.9) | 0.540 | 25.1 (−31.7,81.9) | 0.361 |
MVPA | 847 | 60.6 (2.3) | 55.6 (2.4) | −5.7 (−25.0,13.6) | 0.528 | 5.6 (− 25.3,14.1) | 0.552 |
SST | 942 | 105.3 (3.6) | 162.0 (4.2) | 57.0 (43.0,71.0) | < 0.0001 | 54.9 (38.6,71.2) | < 0.0001 |
Total sleep duration - including nap (min) | 946 | 664.7 (2.9) | 641.2 (3.2) | −22.8 (−42.4,-3.2) | 0.026 | −9.2 (−28.9,10.6) | 0.341 |
Nap duration (min) | 287 | 111.5 (2.0) | 97.4 (2.9) | −16.6 (−31.6,-1.6) | 0.034 | − 18.5 (− 33.6,-3.4) | 0.020 |
Proportion of children meeting the recommendations of WHO Global guidelines (%) | |||||||
TPA | 852 | 53.1 (2.0) | 60.1 (1.7) | 1.45 (0.56,3.72) | 0.441 | 1.48 (0.56,3.87) | 0.426 |
MVPA | 847 | 50.8 (1.8) | 48.7 (1.9) | 0.82 (0.41,1.65) | 0.577 | 0.83 (0.39,1.76) | 0.633 |
SST | 942 | 48.0 (1.8) | 24.9 (1.7) | 0.28 (0.17,0.46) | < 0.0001 | 0.31 (0.18,0.55) | < 0.0001 |
Sleep | 946 | 84.2 (1.5) | 79.3 (1.6) | 0.67 (0.44,1.01) | 0.055 | 0.89 (0.57,1.41) | 0.628 |
All four recommendations | 842 | 13.6 (1.4) | 10.5 (1.2) | 0.77 (0.40,1.48) | 0.430 | 0.91 (0.44,1.88) | 0.791 |
Sleep characteristics | |||||||
Bedtime (24Hr:Min) | 947 | 21:20 (0:02) | 22:01 (0:03) | 0:40 (0:21,1:00) | < 0.001 | 0:34 (0:14,0:54) | 0.003 |
Wake-time (24Hr:Min) | 946 | 7:09 (0:02) | 8:09 (0:03) | 1:00 (0:37,1:23) | < 0.0005 | 0:59 (0:34,1:23) | < 0.0005 |
Poor sleep quality (%) | 924 | 5.4 (1.0) | 6.0 (0.9) | 0.50 (0.19,1.29) | 0.152 | 0.57 (0.21,1.54) | 0.267 |
Use screen devices 2 h before bed (%) | 922 | 72.5 (1.7) | 65.0 (2.0) | 0.66 (0.37,1.18) | 0.165 | 0.76 (0.42,1.41) | 0.388 |
Outdoor time | |||||||
Time spent outdoors on weekdays (min/day) | 934 | 180.7 (4.6) | 105.7 (3.7) | −75.7 (−141.6,-9.8) | 0.028 | −80.9 (−147.6,-14.1) | 0.021 |
Time spent outdoors on weekends (min/day) | 941 | 213.4 (5.0) | 115.6 (4.0) | − 98.3 (− 160.3,-36.4) | 0.004 | −104.7 (− 166.7,-42.6) | 0.003 |
COVID-19 factors | Changes in time spent in movement behaviours | |||||||
---|---|---|---|---|---|---|---|---|
TPA | MVPA | SST | Sleep duration | |||||
Model 1 | Model 2 | Model 1 | Model 2 | Model 1 | Model 2 | Model 1 | Model 2 | |
Level of restrictions | ||||||||
High (Ref) | – | – | – | – | – | – | – | – |
Low | 6.3 (− 185.1197.7) | 52.9 (− 160.0,265.8) | 27.7 (−25.2,80.7) | 36.9 (−31.4105.2) | −9.7 (−50.0,30.6) | −4.6 (−60.3,51.1) | − 14.6 (− 70.1,40.9) | −10.4 (− 98.1,77.4) |
Moderate | − 17.7 (− 193.1157.7) | 10.1 (− 137.0,157.2) | 4.4 (− 43.9,52.7) | 6.3 (− 40.8,53.3) | −18.0 (− 52.8,16.7) | − 22.5 (− 59.2,14.2) | −4.7 (− 52.4,43.0) | − 28.2 (− 83.6,27.2) |
Country income level | ||||||||
High-income (HIC) (Ref) | – | – | – | – | – | – | – | – |
Low/middle-income (LMIC) | 44.1 (− 96.0,184.2) | 78.1 (−96.7252.9) | 0.7 (− 41.9,43.4) | 22.6 (−33.2,78.5) | −11.5 (− 41.9,18.9) | − 10.9 (− 54.4,32.6) | 21.5 (− 17.7,60.6) | 21.8 (− 48.7,92.3) |
Go outside during COVID-19 | ||||||||
No (Ref) | – | – | – | – | – | – | – | – |
Yes | 7.1 (−22.6,36.9) | 9.3 (−20.9,39.4) | 5.5 (− 7.2,18.3) | 6.0 (− 7.2,19.2) | 2.0 (− 16.1,20.1) | 5.8 (− 12.9,24.5) | 4.1 (− 11.6,19.7) | 4.1 (− 11.6,19.7) |
Parent’s concern about child’s movement behaviour§ | ||||||||
No (Ref) | – | – | N/A | N/A | – | – | – | – |
Yes | −24.1 (− 48.2,0.06) | − 23.0 (− 47.4,1.4) | 15.7 (1.6,19.7) | 14.9 (0.2,29.6) | 4.7 (−8.2,17.7) | 4.3 (− 8.9,17.5) | ||
Parent’s perceived ability to support child to have healthy movement behaviours | ||||||||
No (Ref) | – | – | – | – | – | – | – | – |
Yes | −7.8 (−36.6,21.0) | −10.2 (− 39.0,18.5) | 8.6 (− 3.9,21.0) | 7.4 (−5.2,20.0) | −10.1 (− 27.1,6.9) | − 4.4 (− 21.8,13.1) | 5.6 (− 9.2,20.4) | 5.7 (− 9.1,20.4) |
Presence of outdoor space within house compound | ||||||||
No (Ref) | – | – | – | – | – | – | – | – |
Yes | 50.9 (16.5,85.4) | 54.7 (19.0,90.3) | 17.1 (2.5,31.8) | 16.7 (1.0,32.3) | −15.6 (− 33.9,2.8) | −16.9 (−37.6,3.8) | 1.6 (− 15.6,18.7) | 1.0 (− 17.0,19.0) |
Number of adults living within the same household | ||||||||
Two or less (Ref) | – | – | – | – | – | – | – | – |
More than two | 5.3 (−18.1,28.6) | 3.9 (−19.4,27.2) | −2.6 (−12.8,7.6) | −3.3 (−13.7,7.1) | 1.5 (−15.3,12.3) | −0.8 (− 15.2,13.6) | −6.3 (− 18.4,5.7) | −9.4 (− 21.7,2.9) |
Number of children living within the same household | ||||||||
Two or less (Ref) | – | – | – | – | – | – | – | – |
More than two | 22.5 (−6.6,51.6) | 25.2 (−4.1,54.4) | 2.5 (−10.1,15.1) | 3.2 (−9.7,16.1) | −2.5 (− 19.3,14.2) | 0.0 (−17.3,17.3) | −2.6 (− 17.2,12.0) | −2.6 (− 17.3,12.1) |
Parent’s perceived level of stress compared to before COVID-19 | ||||||||
Less/about the same (Ref) | – | – | – | – | – | – | – | – |
More stressed | −11.5 (−36.4,13.5) | −1.4 (−29.6,26.8) | −4.9 (− 15.7,5.9) | − 8.4 (− 21.0,4.1) | 15.0 (0.4,29.6) | 8.2 (− 8.8,25.3) | −1.7 (− 14.5,11.1) | 4.0 (− 10.5,18.5) |
Parent’s perceived level of exhaustion compared to before COVID-19 | ||||||||
Less/about the same (Ref) | – | – | – | – | – | – | – | – |
More exhausted | − 10.6 (−35.2,14.0) | −5.4 (− 33.2,22.3) | 3.8 (− 6.8,14.4) | 8.2 (− 4.0,20.4) | 13.3 (−1.2,27.8) | 6.1 (− 10.5,22.7) | −12.8 (− 25.4,-0.2) | −13.3 (− 27.4,0.7) |
Receiving any support from childcare centre | ||||||||
No (Ref) | – | – | – | – | – | – | – | – |
Yes | − 8.2 (− 51.5,35.1) | − 8.2 (− 53.7,37.4) | − 2.0 (− 20.0,16.0) | −0.1 (− 19.4,19.1) | − 22.6 (− 45.9,0.7) | − 21.7 (− 47.5,4.1) | 22.3 (1.2,43.4) | 29.8 (8.1,51.6) |
Using any resources to support/facilitate child’s movement behaviours at home | ||||||||
No (Ref) | – | – | – | – | – | – | – | – |
Yes | 2.7 (−23.2,28.5) | 7.2 (− 19.0,33.5) | 0.8 (− 10.3,11.9) | 0.3 (− 11.2,11.8) | 4.4 (− 11.0,19.9) | 3.2 (− 13.0,19.5) | 4.8 (− 8.9,18.6) | 5.0 (− 8.9,18.9) |
TPA guideline | MVPA guideline | SST guideline | Sleep guideline | All guidelines | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Model 1 | Model 2 | Model 1 | Model 2 | Model 1 | Model 2 | Model 1 | Model 2 | Model 1 | Model 2 | |
Level of restrictions | ||||||||||
High (Ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Low | 0.94 (0.11,7.83) | 4.29 (0.74,24.90) | 4.43 (1.77,11.12) | 3.59 (1.39,9.30) | 1.13 (0.52,2.44) | 1.91 (0.79,4.60) | 9.50 (2.60,34.71) | 6.71 (1.77,25.46) | 2.11 (0.98,4.54) | 4.33 (0.92,20.39) |
Moderate | 0.44 (0.06,3.01) | 0.50 (0.15,1.65) | 0.67 (0.30,1.47) | 0.89 (0.49,1.62) | 1.98 (1.08,3.62) | 2.71 (1.56,4.70) | 1.18 (0.48,2.89) | 0.76 (0.38,1.54) | 0.99 (0.47,2.07) | 1.14 (0.47,2.78) |
Country income level | ||||||||||
High-income (HIC) (Ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Low/middle-income (LMIC) | 3.87 (0.81,18.53) | 12.17 (3.03,49.00) | 0.67 (0.23,1.94) | 1.96 (1.02,3.77) | 1.98 (1.09,3.60) | 2.16 (1.19,3.94) | 0.44 (0.15,1.31) | 1.21 (0.55,2.65) | 1.30 (0.57,2.97) | 3.17 (0.86,11.75) |
Go outside during COVID-19 | ||||||||||
No (Ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Yes | 1.75 (1.10,2.78) | 1.70 (1.05,2.75) | 1.70 (1.06,2.71) | 1.52 (0.95,2.45) | 1.20 (0.76,1.89) | 1.19 (0.75,1.89) | 1.53 (0.93,2.51) | 1.51 (0.92,2.45) | 4.21 (1.46,12.18) | 3.30 (1.12,9.76) |
Parent’s concern about child’s movement behaviour§ | ||||||||||
No (Ref) | 1.00 | 1.00 | N/A | N/A | 1.00 | 1.00 | 1.00 | 1.00 | N/A | N/A |
Yes | 0.49 (0.34,0.72) | 0.50 (0.34,0.74) | 0.60 (0.42,0.86) | 0.68 (0.47,0.96) | 1.00 (0.65,1.56) | 0.97 (0.63,1.50) | ||||
Parent’s perceived ability to support child to have healthy movement behaviours | ||||||||||
No (Ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Yes | 1.25 (0.77,2.01) | 1.15 (0.71,1.86) | 2.19 (1.35,3.55) | 1.89 (1.17,3.06) | 1.15 (0.74,1.79) | 1.14 (0.73,1.79) | 0.99 (0.61,1.59) | 0.87 (0.54,1.41) | 1.56 (0.71,3.45) | 1.14 (0.51,2.51) |
Presence of outdoor space within house compound | ||||||||||
No (Ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Yes | 1.88 (1.07,3.30) | 2.41 (1.32,4.41) | 2.61 (1.55,4.40) | 2.61 (1.56,4.36) | 1.29 (0.81,2.06) | 1.14 (0.70,1.87) | 0.80 (0.46,1.38) | 0.65 (0.38,1.11) | 2.83 (1.43,5.60) | 1.82 (0.78,4.23) |
Number of adults living within the same household | ||||||||||
Two or less (Ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
More than two | 1.64 (1.12,2.42) | 1.55 (1.04,2.33) | 0.98 (0.68,1.39) | 0.97 (0.67,1.40) | 0.98 (0.70,1.37) | 0.96 (0.68,1.36) | 1.04 (0.70,1.53) | 1.12 (0.76,1.66) | 0.96 (0.54,1.70) | 1.06 (0.58,1.94) |
Number of children living within the same household | ||||||||||
Two or less (Ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
More than two | 1.21 (0.74,1.98) | 1.27 (0.76,2.13) | 1.01 (0.66,1.56) | 0.92 (0.59,1.45) | 0.99 (0.65,1.50) | 0.85 (0.56,1.31) | 0.99 (0.62,1.58) | 1.01 (0.63,1.61) | 1.42 (0.76,2.63) | 1.22 (0.64,2.33) |
Parent’s perceived level of stress compared to before COVID-19 | ||||||||||
Less/about the same (Ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
More stressed | 1.03 (0.69,1.53) | 1.41 (0.87,2.28) | 1.04 (0.71,1.52) | 0.98 (0.63,1.54) | 0.65 (0.45,0.93) | 0.90 (0.59,1.37) | 0.86 (0.56,1.33) | 1.06 (0.65,1.73) | 0.50 (0.26,0.93) | 0.56 (0.26,1.18) |
Parent’s perceived level of exhaustion compared to before COVID-19 | ||||||||||
Less/about the same (Ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
More exhausted | 0.73 (0.50,1.06) | 0.65 (0.41,1.02) | 1.18 (0.82,1.70) | 1.17 (0.75,1.83) | 0.63 (0.43,0.90) | 0.74 (0.49,1.13) | 0.62 (0.41,0.94) | 0.59 (0.37,0.95) | 0.71 (0.39,1.30) | 1.16 (0.57,2.33) |
Receiving any supports from childcare centre | ||||||||||
No (Ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Yes | 1.23 (0.63,2.39) | 1.33 (0.67,2.64) | 1.55 (0.85,2.85) | 1.64 (0.88,3.09) | 1.16 (0.66,2.05) | 1.18 (0.64,2.16) | 1.82 (0.96,3.46) | 1.64 (0.87,3.09) | 1.76 (0.66,4.70) | 1.47 (0.51,4.25) |
Using any resources to support/facilitate child’s movement behaviours at home | ||||||||||
No (Ref) | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 | 1.00 |
Yes | 1.12 (0.77,1.64) | 1.16 (0.78,1.72) | 1.39 (0.93,2.08) | 1.40 (0.93,2.12) | 0.89 (0.61,1.28) | 0.99 (0.68,1.43) | 1.11 (0.67,1.82) | 1.05 (0.65,1.71) | 0.98 (0.54,1.77) | 1.15 (0.63,2.09) |
Discussion
Key results summary
Generalisability
Limitations
Implications for future research, policy and practice
-
The strength of the associations between levels of government restrictions and all three movement behaviours highlights that priority must be given to keeping ECEC services open if it is feasible to do so in a COVID-safe manner. This will support children to accrue the recommended movement behaviours.
-
Being allowed outside during times of movement restrictions was independently associated with meeting all guidelines, emphasising the importance of i) allowing people to go outside each day, ii) parents providing opportunities for children to be outside, and iii) promoting active play for children when outside, with appropriate risk-mitigation strategies.
-
The findings highlight the importance of access to public green spaces, particularly in densely populated urban areas and for those without a garden/yard attached to their home. This has implications for land use policy, urban planning and housing design and development (e.g. rooftop gardens).
-
Having parents and children spending more time at home during times of movement restrictions, provides opportunities for parents to participate in physical activity together with their child. This could potentially result in improved mental health outcomes and increased PA for parents, coupled with increased PA and reduced SST for children [28, 29]. It would also encourage social interaction and enjoyment among children and their parents.
-
Developing resources that provide suggestions for ways to incorporate both indoor and outdoor physical activity, reduce SST and facilitate heathy levels of sleep, during times of movement restrictions could be particularly beneficial for both parents and children
-
Outdoor activities could include a nature walk or time spent at the playground, in the park/field playing tag, ball games or imaginative free play.
-
Indoor activities that do not require a lot of equipment and can keep children entertained for a considerable time include building a playhouse using blankets, boxes or towels, soft balls, playing hide and seek, or dancing to music.
-
Adapting equipment for small indoor spaces could include using a balloon instead of a ball, or using a skipping rope instead of running, or household items such as rolled up socks and a basket.
-
Co-viewing and interacting with children during SST and selecting educational content and active engagement over passive viewing is recommended [21].
-
Try to maintain regular bed and wake times. Be mindful that going to bed later (and waking up later), while still resulting in the same sleep duration may not be as beneficial as going to bed earlier (and waking up earlier). Keeping children active during the day, will also ensure they are tired and able to keep to regular sleep times.
-
-
Parental mental health needs to be considered when deciding what level of restrictions to impose to control the spread of COVID-19 and the consequences such restrictions may have on other aspects of health. In countries where levels of restrictions were low, parents’ stress and exhaustion were not as high, reaffirming that such restrictions impact parents, which may subsequently impact the child. Policymakers need to consider this in future pandemics or in subsequent waves of COVID-19 when making decisions about whether to close ECEC services or to adopt strict home quarantine orders.
-
The aggregated data across the 14 countries suggested that there was not a considerable change in the children’s overall levels of PA (TPA and MVPA) from before to during the COVID-19 pandemic. Further research is required to explore differences in PA at the individual country level, to determine how the associated factors vary across different contexts and levels of restrictions and what the implications of this are.