The world changed in early 2020 as the COVID-19 pandemic spread, and countries struggled to respond effectively to reduce transmission, disease, and death. One of the many aspects of life affected was physical activity. Across the globe, efforts to promote social distancing directly affected physical activity of youth by closing schools, which affected physical activity opportunities including physical education, recess, after-school sports and activities, and walking and biking to school. All in-person recreation was closed, including youth sports, dance, martial arts, and exercise classes. In many places, parks, playgrounds, trails, and even beaches were closed. On the positive side, in the US, exercise was generally considered an “essential activity” so people could use streets and sidewalks for walking, running, and biking. It was encouraging that people quickly developed creative approaches to stay active and help their children continue activities. There was an explosion of online activity classes, sales of bicycles and home exercise equipment skyrocketed, and physical education programs went online, including “SPARK at Home” videos.
This boardwalk and beach in San Diego, California is typically full of active people of all ages. This photo from June 2020 shows that no one was active here during COVID-19 closures.
Many federal, state, and local restrictions were introduced in 2020-2021 to slow the spread of the virus. Implementation of these restrictions raised questions about what happened to physical activity during the pandemic, and investigators got busy trying to answer those questions and the related question of what happened to sedentary behavior (sitting). By 2021, it was possible to summarize 64 studies from around the world on this topic. Most of the studies dealt with adults. Here is a summary of the findings [SJ1].
- Among adults
- 45 studies: the vast majority showed decreases in physical activity
- 26 studies: all showed increases in sedentary behavior
- Among youth
- 6 studies: all showed decreases in physical activity
- 5 studies: all showed increases in sedentary behavior
Although the findings are clear and cause for concern, it was not possible to quantify the amount of change because studies used a variety of survey measures and results differed across studies.
A study of Northern California [SJ2] adolescents found that not all health habits got worse during the pandemic. Though reported intake of tobacco, alcohol, and cannabis did not change during school closures, adolescents were less likely to report 5 or more days of vigorous physical activity. It makes sense that the negative effects were seen mainly for physical activity, because closing schools dramatically reduced structured and programmed opportunities for physical activity. Opportunities were further reduced throughout the community.
Based on these results, we can predict negative health effects of the pandemic-related decline in physical activity for youth, and we address the mental health connection below. But there is a possibility the reduction in physical activity could impact the COVID-19 pandemic itself.
Pandemic benefits of physical activity
Physical activity provides many health benefits to children and adolescents [SJ3] , mainly related to mental health, obesity, and risk factors for future chronic diseases such as diabetes and heart disease. However, there is substantial but little-known scientific evidence about physical activity benefits of direct relevance to infectious diseases [SJ4] . Of particular importance are the effects of moderate-intensity physical activity on functioning of the immune system, which protects us from viral and bacterial infections. Physical activity helps the immune system detect infections early and reduce the severity [SJ5] of infections. Early in the pandemic it was unclear whether these physical activity benefits applied to COVID-19, but studies quickly provided encouraging answers. One study of almost 50,000 adult patients [SJ6] diagnosed with COVID-19 showed those who consistently met physical activity guidelines prior to diagnosis were substantially less likely to be hospitalized, be admitted to the intensive care unit, and die than those who were consistently inactive. It was notable that physical inactivity was a stronger risk factor for severe COVID-19 than commonly-discussed pre-existing conditions like obesity, diabetes, heart disease, cancer, and smoking. However, the immunity benefits of physical activity have seldom been studied in children or adolescents [SJ7] , so we don’t know to what extent the adult findings apply to youth.
Physical activity’s benefits for youth mental health [SJ8] and stress have been known for decades. But stress interferes with immune functioning and increases inflammation [SJ9] , both of which are relevant to the body’s ability to fight infections. Thus, the stress-reduction effects of physical activity are also likely relevant to COVID-19, but this pathway of infectious disease benefits has been rarely studied in youth.
Even though it is not known whether children’s physical activity reduces their risk of severe COVID-19 outcomes, the adult evidence is reason enough to justify action to keep young people active during the pandemic. It could be counterproductive to close the most common places for youth physical activity during the pandemic, so we call for research to help guide public health decisions in the future. If there is concern about overcrowded parks, playgrounds, sports facilities, and trails, alternatives are requiring masks and physical distancing or setting up an appointment system to prevent crowding.
Youth Physical Activity and Mental Health During the COVID-19 Pandemic
One of the most alarming effects of the COVID-19 pandemic has been an accompanying epidemic of mental health problems among youth. In October 2020 the American Academy of Pediatrics joined with two other major national organizations to declare a “state of emergency” for child and adolescent mental health. [SJ10] Among the evidence supporting this declaration, the US Centers for Disease Control and Prevention (CDC) released a study [SJ11] showing youth mental health emergency department visits increased almost immediately after most schools were closed in March 2020, as shown in the graph. Six months after the school closures, the increases were 24% for 5-11 year olds and 31% for 12-17 year olds, and there was no indication of the situation improving.
It is easy to understand the stress on young people and their families, especially during the first year of the pandemic. With the closing of schools and restrictions on gatherings, children lost most of their opportunities to socialize with friends. Many struggled with the stress of virtual schooling, inadequate technology and tech support, and boredom of being at home almost all the time. Many young people were in homes where parents lost jobs or had reduced incomes, many families spent months in crowded living spaces, and families experienced hospitalizations and deaths of loved ones. These situations caused inter-related mental health problems of loneliness, depression, and anxiety among all family members.
A national survey of 1000 parents [SJ12] identified several sources of ill-health among children, and social isolation was the biggest concern followed by remote learning, as shown below. However, two physical activity-related behaviors were identified as important concerns—too much screen time and lack of physical activity.
In the same survey, it was clear parents understood the importance of physical activity for their children’s mental health. Parents reported the pandemic’s negative effect on child mental health was mostly due to reduced socialization and less exercise. Parents believed the mental health consequences were worse for children than adults, and those consequences will be lasting. This is a sobering assessment by parents, but these results reveal how much they value the benefits of physical activity for their children, which might translate into support for increased action to support children’s physical activity.
Parents’ perceptions about the essential role of physical activity in children’s mental health was supported by a different study of 1000 youth [SJ13] aged 6-17 years and parents during the pandemic (Fall 2020). The number of COVID-19 stressors was associated with worse mental health scores among both younger (6-11 years) and older (12-17 years) youth. Youth in both age groups who did more physical activity had better mental health scores, but the findings were stronger for the 12-17 year olds. More screen time was associated with worse mental health scores in both groups. This is valuable evidence that, even during the very stressful time of the pandemic, physical activity appears to be helpful for children’s and adolescents’ mental health.
What Can Schools Do to Keep Students Active During the Pandemic?
Just like most other aspects of the pandemic, we expect the burdens of decreased physical activity and increased mental health problems to fall most heavily on communities of color and low-income communities. Schools serving student populations most at risk are also underfunded, with limited space and resources for promoting physical activity. As such, it is imperative to understand the needs and limitations of teachers and school staff when promoting physical activity and other health behaviors. Building on the existing infrastructure and capacity of the school system is the first logical step in promoting activity in students.
Several frameworks can be adopted to facilitate a physical activity promoting environment. An example of these frameworks is the Whole School, Whole Community, Whole Child [SJ14] (WSCC) model, developed by the CDC. This model is based on the idea that schools need to support healthy and successful child development in multiple ways through policies, practices, programs, and environments. The WSCC model places a strong emphasis on meeting the physical health and social-emotional needs of children as part of the learning environment. Even the best schools cannot meet all children’s needs, so schools are encouraged to coordinate with community partners to provide additional resources both in and out of school. Community partners can provide after-school physical activity and sports programs both on- and off-campus.
Another framework is “Educating the Student Body[SJ15] ,” which is a report from the Institute of Medicine (now National Academy of Medicine). This report recommends a “whole-of-school” approach to physical activity that is compatible with the WSCC model and emphasizes integrating physical activity throughout the school day, including before and after school. Though physical education is required in all states and is the cornerstone of school physical activity, it is not sufficient to meet recommendations for providing at least 30 minutes of physical activity each day at school [SJ16] . Physical education should teach through physical activity, and there are several evidence-based programs available, including SPARK.
Recess is a common opportunity for physical activity in pre-K and elementary schools, but its implementation is typically less than optimal. There are guidelines and evidence-based programs for ensuring valuable recess time is used effectively [SJ17] to provide inclusion and enjoyable physical activity for children.
Short physical activity breaks in classrooms [SJ18] have been shown to get students more active, and they can be used to teach academic content through movement. Some programs have materials and professional development for classroom teachers, and other programs use videos to lead student activities. SPARK has the “Active Classroom” program.
Classroom education programs can be used to teach students how to develop and manage their own physical activity out-of-school. Some programs help students improve additional health behaviors like reducing screen time and eating healthier foods, such as the School Wellness Integration Targeting Child Health (SWITCH)[SJ19] . This capacity-building process provides schools with the training and technical support to build and sustain health promotion environments, increasing the likelihood school-based interventions will promote activity and healthy living in youth.
There are practical and effective ways schools can work with partners to promote physical activity outside the school day, such as after-school programs [SJ20] and safe walking and biking to school[SJ21] . We encourage schools to develop a diverse team to implement the WSCC model and involve students in the decision making process.
Virtual learning has presented numerous challenges to engaging students in physical activity, as teachers are not as easily able to directly control the learning climate compared with classrooms and gymnasiums. As such, online programs such as SPARK and SWITCH can provide teachers with resources and lesson plans to avoid them having to “reinvent the wheel” given the limited time teachers have to plan and the constant uncertainty they face as educators in the current pandemic. We encourage teachers to collaborate with diverse school stakeholders such as students, administrators, and other staff, to enhance the reach and penetration of their efforts to promote physical activity opportunities throughout the school day. Through such a broad and collaborative approach, students may benefit from multiple opportunities to be active, and teacher burnout may be avoided. Investing in children’s futures by aligning health and learning goals is essential given the global challenges we continue to face as a result of the pandemic.
[SJ1] Stockwell S, Trott M, Tully M, Shin J, Barnett Y, Butler L, McDermott D, Schuch F, Smith L. Changes in physical activity and sedentary behaviours from before to during the COVID-19 pandemic lockdown: a systematic review. BMJ Open Sport & Exercise Medicine. 2021 Jan 1;7(1):e000960. doi:10.1136/bmjsem-2020-000960
[SJ2] Chaffee BW, Cheng J, Couch ET, Hoeft KS, Halpern-Felsher B. Adolescents’ Substance Use and Physical Activity Before and During the COVID-19 Pandemic. JAMA pediatrics. 2021 doi:10.1001/jamapediatrics.2021.0541
[SJ4]Sallis, J.F., and Pratt, M. (2020). Multiple benefits of physical activity during the coronavirus pandemic. Brasilian Journal of Physical Activity/Revista Brasileira de Atividade Fisica & Saude, 25, 14268. https://rbafs.org.br/RBAFS/article/view/14268
[SJ5]Chastin SF, Abaraogu U, Bourgois JG, Dall PM, Darnborough J, Duncan E, Dumortier J, Pavón DJ, McParland J, Roberts NJ, Hamer M. Effects of regular physical activity on the immune system, vaccination and risk of community-acquired infectious disease in the general population: systematic review and meta-analysis. Sports Medicine. 2021 Apr 20:1-14. https://link.springer.com/article/10.1007/s40279-021-01466-1
[SJ6]Sallis, R., Rohm Young, D., Tartof, S.Y., Sallis, J.F., Sall, J., Li, Q., Smith, G.N., and Cohen, D.A. (2021). Physical inactivity is associated with a higher risk for severe COVID-19 outcomes: A study in 48 440 adult patients. British Journal of Sports Medicine. https://bjsm.bmj.com/content/early/2021/04/07/bjsports-2021-104080
[SJ7]Timmons BW. Exercise and immune function in children. American Journal of Lifestyle Medicine. 2007 Jan;1(1):59-66. https://doi.org/10.1177/1559827606294851
[SJ8]Biddle SJ, Ciaccioni S, Thomas G, Vergeer I. Physical activity and mental health in children and adolescents: An updated review of reviews and an analysis of causality. Psychology of Sport and Exercise. 2019 May 1;42:146-55.
[SJ9]Sallis, J.F., and Pratt, M. (2020). Multiple benefits of physical activity during the coronavirus pandemic. Brasilian Journal of Physical Activity/Revista Brasileira de Atividade Fisica & Saude, 25, 14268. https://rbafs.org.br/RBAFS/article/view/14268
[SJ10]https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/
[SJ11]Leeb, R. T., Bitsko, R. H., Radhakrishnan, L., Martinez, P., Njai, R., & Holland, K. M. (2020). Mental Health-Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic – United States, January 1-October 17, 2020. MMWR. Morbidity and mortality weekly report, 69(45), 1675–1680. https://doi.org/10.15585/mmwr.mm6945a3
[SJ12] https://www.luriechildrens.org/en/blog/childrens-mental-health-pandemic-statistics/
[SJ13]Tandon PS, Zhou C, Johnson AM, Gonzalez ES, Kroshus E. Association of children’s physical activity and screen time with mental health during the COVID-19 pandemic. JAMA Network Open. 2021 Oct 1;4(10):e2127892.
doi:10.1001/jamanetworkopen.2021.27892
[SJ14] https://www.cdc.gov/healthyyouth/wscc/model.htm
[SJ16] https://www.cdc.gov/healthyschools/npao/pdf/mmwr-school-health-guidelines.pdf
[SJ17]McLoughlin GM, Massey WV, Lane HG, Calvert HG, Turner L, Hager ER. Recess as a practical strategy to implement the Whole School, Whole Community, Whole Child model in schools. Health Education Journal. 2021 Mar;80(2):199-209. https://journals.sagepub.com/doi/full/10.1177/0017896920959359
[SJ18]Watson A, Timperio A, Brown H, Best K, Hesketh KD. Effect of classroom-based physical activity interventions on academic and physical activity outcomes: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity. 2017 Dec;14(1):1-24.
[SJ19]McLoughlin GM, Candal P, Vazou S, Lee JA, Dzewaltowski DA, Rosenkranz RR, Lanningham-Foster L, Gentile DA, Liechty L, Chen S, Welk GJ. Evaluating the implementation of the SWITCH® school wellness intervention and capacity-building process through multiple methods. International Journal of Behavioral Nutrition and Physical Activity. 2020 Dec;17(1):1-8.
[SJ20] https://sparkpe.org/curriculum/spark-curriculum-after-school-curriculum
[SJ21] https://www.saferoutespartnership.org/safe-routes-school/101
