Document Type : original article

Authors

1 Department of Community and Family Medicine, School of Medicine, Medical Education Research Center, Guilan University of Medical Science and Health Services, Rasht, Iran.

2 Research Department, Farzanegan Nik Andish Institute for the Development of Knowledge and Technology, Tehran, Iran

3 Pediatrician, Head of Adolescent Youth and School Health Office MOH, Tehran, Iran

4 Pediatrician, Child Health Expert, Ministry of Health and Medical Education, Tehran, Iran

5 Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Imam Hossein Children's Hospital, Isfahan, Iran

6 Health Expert of Adolescent Youth and School Office, Deputy of Health, Guilan University of Medical Science, Rasht, Iran

7 Pediatric Disease Research Center, Guilan University of Medical Sciences, Rasht, Iran

8 Research Department, Founder and Managing Director of Farzanegan Nik Andish Institute for the Development of Knowledge and Technology, Tehran, Iran

Abstract

Background: During the two years of COVID-19 lockdown and its related restrictions, the level of physical activity has decreased among children. Considering the adverse effects of insufficient physical activity (PA) on the health of children and adolescents, this study was conducted with the aim of investigating the level of physical activity during the COVID-19 pandemic among children and adolescents aged 8-19 years, in Iran.
Methods: This cross-sectional study was conducted among 16,500 urban and rural students 8-19 year-old from 31 provinces across the country, during the COVID-19 pandemic in Iran. Multistage sampling was used to select the participants. Data was gathered in January 2022 using the Persian version of the PA Questionnaire (PAQ) for older children and adolescents, based on the WHO- Global School-based Student Health Survey (GSHS) questionnaire.
Results: 14893 cases were included in the study. The result of this study showed that more than half of the participants had a medium level of PA, and 32.5 had a low level of PA and only 12.6% of the participants had a high level of PA. Males and those in the age group of 14 to 19 years had significantly higher levels of PA (P<0.05). The regression analysis showed that for a one-year increase in age, the PA score would decrease by 0.256 times (p=0.000). The mean PAQ score was significantly higher among children whose parents did not have a health-related occupation or were unemployed.
Conclusion: Although the finding of this study showed controversial results considering the decrease in children’s PA scores during the COVID-19 pandemic, it demonstrated a low PA level among Iranian children in general.

Keywords

  1. World Health Organization (WHO). WHO guidelines on physical activity and sedentary behavior: web annex: evidence profiles. Geneva: World Health Organization; 2020. Report No.: CC BY-NC-SA 3.0 IGO.
  2. Kandola A, Lewis G, Osborn DP, Stubbs B, Hayes JF. Depressive symptoms and objectively measured physical activity and sedentary behavior throughout adolescence: a prospective cohort study. Lancet Psychiatry 2020; 7(3): 262-71. doi: 10.1016/S2215-0366(20)30034-1.
  3. World Health Organization (WHO). New WHO-led study says majority of adolescents worldwide are not sufficiently physically active, putting their current and future health at risk [Internet]. Geneva: World Health Organization; 2019. Available from: https://www.who.int/news/item/22-11-2019-new-who-led-study-says-majority-of-adolescents-worldwide-are-not-sufficiently-physically-active-putting-their-current-and-future-health-at-risk.
  4. Okuyama J, Seto S, Fukuda Y, Funakoshi S, Amae S, Onobe J, Izumi S, Ito K, Imamura F. Mental health and physical activity among children and adolescents during the COVID-19 pandemic. Tohoku J Exp Med 2021; 253(3): 203-15. doi: 10.1620 /tjem. 253.203.
  5. Wright LJ, Williams SE, Veldhuijzen van Zanten JJ. Physical activity protects against the negative impact of coronavirus fear on adolescent mental health and well-being during the COVID-19 pandemic. Front Psychol 2021; 12: 737. doi: 10.3389/fpsyg.2017.01280.
  6. Esmaeilzadeh S. The association between depressive symptoms and physical status including physical activity, aerobic and muscular fitness tests in children. Environ Health Prev Med 2015; 20(6): 434-40. doi: 10.1007/s12199-015-0484-0.
  7. Brodersen NH, Steptoe A, Williamson S, Wardle J. Sociodemographic, developmental, environmental, and psychological correlates of physical activity and sedentary behavior at age 11 to 12. Ann Behav Med 2005; 29: 2-11. doi: 10.1207/s15324796abm2901_2.
  8. Caroli M, Argentieri L, Cardone M, Masi A. Role of television in childhood obesity prevention. Int J Obes Relat Metab Disord 2004; 28(Suppl3): 104-8. doi: 10.1038/sj.ijo.0802802.
  9. Hancox RJ, Milne BJ, Poulton R. Association between child and adolescent television viewing and adult health: a longitudinal birth cohort study. Lancet 2004; 364: 257-262. doi: 10.1016/S0140-6736(04)16675-0.
  10. Ekelund U, Brage S, Froberg K, Harro M, Anderssen SA, Sardinha LB, Riddoch C, Andersen LB. TV viewing and physical activity are independently associated with metabolic risk in children: the European Youth Heart Study. PLoS Med 2006; 3(12): e488. doi: 10.1371/journal.pmed.0030488.
  11. Mavrovouniotis F. Inactivity in childhood and adolescence: a modern lifestyle associated with adverse health consequences. Sport Sci. Rev. 2012; 21(3-4):75.
  12. Chung S. Growth and puberty in obese children and implications of body composition. J Obes Metab Syndr 2017; 26(4): 243.
  13. Keykhaei F, Shahraki M, Sargolhosseinzadeh E, Shahraki T, Dashipour A. Correlation of body mass index and physical activity among 7-to 11-year children at Zahedan, Iran. Food Nutr Bull 2016; 37(3): 364-74. Doi:10.1016/j.metabol.2009.08.019.
  14. Mushtaq MU, Gull S, Mushtaq K, Shahid U, Shad MA, Akram J. Dietary behaviors, physical activity and sedentary lifestyle associated with overweight and obesity, and their socio-demographic correlates, among Pakistani primary school children. Int J Behav Nutr Phys Act 2011; 8(1): 1-3. Doi: 10.1186/1479-5868-8-130.
  15. Guthold R, Stevens GA, Riley LM, Bull FC. Global trends in insufficient physical activity among adolescents: a pooled analysis of 298 population-based surveys with 1.6 million participants. Lancet Child Adolesc Health 2020; 4(1): 23-35. doi: 10.1016/S2352-4642(19)30323-2.
  16. Kargarfard M, Kelishadi R, Ziaee V, Ardalan G, Halabchi F, Mazaheri R, Poursafa P, Hayatbakhsh MR. The impact of an after-school physical activity program on health-related fitness of mother/daughter pairs: CASPIAN study. Prev Med 2012; 54(3-4): 219-23. doi: 10.1016/j.ypmed.2012.01.010.
  17. Runacres A, Mackintosh KA, Knight RL, Sheeran L, Thatcher R, Shelley J, Shelley J, McNarry MA. Impact of the COVID-19 pandemic on sedentary time and behavior in children and adults: A systematic review and meta-analysis. Int J Environ Res Public Health 2021; 18(21): 11286. doi: 10.3390/ijerph182111286.
  18. Kowalski KC, Crocker PR, Donen RM. The physical activity questionnaire for older children (PAQ-C) and adolescents (PAQ-A) manual. College of Kinesiology, University of Saskatchewan 2004; 87(1): 1-38.
  19. Kowalski KC, Crocker PR, Faulkner RA. Validation of the physical activity questionnaire for older children. Pediatr Exerc Sci 1997; 9(2): 174-86. doi: 10.1123/pes.9.2.174.
  20. Moore JB, Hanes JC, Barbeau P, Gutin B, Treviño RP, Yin Z. Validation of the Physical Activity Questionnaire for Older Children in children of different races. Pediatr Exerc Sci 2007; 19(1): 6-19. doi: 10.1123/pes.19.1.6.
  21. Wang JJ, Baranowski T, Lau WP, Chen TA, Pitkethly AJ. Validation of the physical activity questionnaire for older children (PAQ-C) among Chinese children. Biomed Environ Sci 2016; 29(3): 177-86. doi: 10.3967/bes2016.022.
  22. Faghihimani Z, Nourian M, Nikkar AH, Farajzadegan Z, Khavariyan N, Ghatrehsamani S, Poursafa P, Kelishadi R. Validation of the Child and Adolescent International physical activity questionnaires in Iranian children and adolescents. ARYA Atheroscler 2010; 5(4).
  23. Zameni L, Yeylaghi Ashrafi MR, Kalaji H. Psychometric features of the Persian version of the "Physical Activity of Infants" questionnaire. Sport physiology 2021; 11(44): 123-42.‎
  24. Alizadeh A, Negarandeh R, Amiri FB, Yazdani Z. The study of Iranian children and adolescents’ physical activity: a systematic review and meta-analysis. Int J Adolesc Med Health 2021; 33(3): 65-74. doi: 10.1515/ijamh-2020-0302.
  25. Esmaeilzadeh S. Socioeconomic Status, Physical Activity, Physical Fitness and Sedentary Activity in 7-to 11-year-old Iranian Children. Pertanika J Soc Sci Humanit 2014; 22(1).
  26. Sallis JF, Prochaska JJ, Taylor WC, Hill JO, Geraci JC. Correlates of physical activity in a national sample of girls and boys in grades 4 through 12. Health Psychol 1999; 18(4): 410. doi: 10.1037/0278-6133.18.4.410.
  27. Park AH, Zhong S, Yang H, Jeong J, Lee C. Impact of COVID-19 on physical activity: A rapid review. J Glob Health 2022; 12. doi: 10.7189/jogh.12.05003.
  28. Rossi L, Behme N, Breuer C. Physical Activity of Children and Adolescents during the COVID-19 Pandemic-A Scoping Review. Int J Environ Res Public Health 2021; 18(21): 11440. doi: 10.3390/ijerph182111440.
  29. Velde GT, Lubrecht J, Arayess L, Loo Cv, Hesselink M, Reijnders D, Vreugdenhil A. Physical activity behavior and screen time in Dutch children during the COVID‐19 pandemic: Pre‐, during‐and post‐school closures. Pediatric Obes 2021; 16(9): e12779. doi: 10.1111/ijpo.12779.
  30. Štveráková T, Jačisko J, Busch A, Šafářová M, Kolář P, Kobesová A. The impact of COVID-19 on Physical Activity of Czech children. Plos One 2021; 16(7): e0254244. doi: 10.1371/journal.pone.0254244.
  31. Kalantari HA, Esmaeilzadeh S. Association between academic achievement and physical status including physical activity, aerobic and muscular fitness tests in adolescent boys. Environ Health Prev Med 2016; 21(1): 27-33. doi: 10.1007/s12199-015-0495-x.
  32. Motamed-Gorji N, Qorbani M, Nikkho F, Asadi M, Motlagh ME, Safari O, Arefirad T, Asayesh H, Mohammadi R, Mansourian M, Kelishadi R. Association of screen time and physical activity with health-related quality of life in Iranian children and adolescents. Health Qual Life Outcomes 2019; 17(1): 1-1. doi: 10.1186/s12955-018-1071-z.
  33. Hadianfard AM, Mozaffari-Khosravi H, Karandish M, Azhdari M. Physical activity and sedentary behaviors (screen time and homework) among overweight or obese adolescents: a cross-sectional observational study in Yazd, Iran. BMC Pediatr 2021; 21(1): 1-0. doi: 10.1186/s12887-021-02892-w.
  34. Rostami-Moez M, Hazavehei SM, Karami M, Karimi-Shahanjarini A, Nazem F, Rezapur-Shahkolai F. Decline in physical activity among Iranian girl students aged 10 to 16 and the related factors. Health Scope 2017; 6(4): e62422. doi: 10.5812/jhealthscope.62422.
  35. Zare M, Hamedinia MR, Haghighi A, Yarahmadi H. Relationship Physical Activity level and sedentary behaviors with diet patterns among 12-14 year-old student’s boys in Sabzevar. JSUMS 2013; 19(4).
  36. Kelishadi R, Qorbani M, Djalalinia S, Sheidaei A, Rezaei F, Arefirad T, Safiri S, Asayesh H, Motlagh ME. Physical inactivity and associated factors in Iranian children and adolescents: the Weight Disorders Survey of the CASPIAN-IV study. J Cardiovasc Thorac Res 2017; 9(1): 41. doi: 10.15171/jcvtr.2017.06.
  37. Patnode CD, Lytle LA, Erickson DJ, Sirard JR, Barr-Anderson D, Story M. The relative influence of demographic, individual, social, and environmental factors on physical activity among boys and girls. Int J Behav Nutr Phys Act 2010; 7(1): 1-0. doi: 10.1186/1479-5868-7-79.
  38. Trost SG, Pate RR, Sallis JF, Freedson PS, Taylor WC, Dowda M, Sirard J. Age and gender differences in objectively measured physical activity in youth. Med Sci Sports Exerc 2002; 34(2): 350-5. doi: 10.1097/00005768-200202000-00025.