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      Keeping children healthy during and after COVID-19 pandemic: meeting youth physical activity needs

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          Abstract

          Background

          The purpose of this study was to: 1) examine the maintenance of Physical Education and physical activity during the distance learning time, 2) determine the resources educators are utilizing to deliver PE curricula, and 3) understand the challenges experienced by educators during distance learning.

          Methods

          A survey was sent to a cohort of school-based fitness assessment software users. Respondents were largely school-based individuals including PE teachers ( n = 1789), school ( n = 62) and district administrators ( n = 64), nurses ( n = 3), and “other” ( n = 522).

          Results

          Of 2440 respondents, most were from a city or suburb (69.7%), elementary or middle school (72.3%), and had Title 1 status (60.4%), an indicator of low socioeconomic status. Most campuses were closed during the COVID-19 pandemic (97.8%). Of the schools closed during the pandemic, only 2.8% had no prior PE requirements and that increased to 21% during the pandemic. In schools that remained open during the pandemic, 7.7% had no prior PE requirements and this increased to 60.5%. Importantly, 79% of respondents reported that students were either “significantly less” or “somewhat less” physically active during the closure. For closed schools, the most frequently cited challenges included “student access to online learning“, “teacher/student communication” and “teacher remote work arrangements”. For open schools, the most commonly reported challenges included “social distancing”, “access to gymnasium/equipment”, and “concern for personal health and wellbeing”.

          Conclusion

          The COVID-19 pandemic has caused important reductions in PE requirements and time engaged in physical activity. Challenges experienced by teachers were identified for closed and open schools.

          Supplementary Information

          The online version contains supplementary material available at 10.1186/s12889-021-10545-x.

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          Most cited references19

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          Effects of COVID‐19 Lockdown on Lifestyle Behaviors in Children with Obesity Living in Verona, Italy: A Longitudinal Study

          Abstract Objective To test the hypothesis that youths with obesity, when removed from structured school activities and confined to their homes during the COVID‐19 pandemic, will display unfavorable trends in lifestyle behaviors. Methods The sample included 41 children and adolescents with obesity participating in a longitudinal observational study located in Verona, Italy. Lifestyle information including diet, activity, and sleep behaviors were collected at baseline and three weeks into the national lockdown during which home confinement was mandatory. Changes in outcomes over the two study time points were evaluated for significance using paired t‐tests. Results There were no changes in reported vegetable intake; fruit intake increased (p=0.055) during the lockdown. By contrast, potato chip, red meat, and sugary drink intakes increased significantly during the lockdown (p‐value range, 0.005 to <0.001). Time spent in sports activities decreased (X±SD) by 2.30±4.60 hours/week (p=0.003) and sleep time increased by 0.65±1.29 hours/day (p=0.003). Screen time increased by 4.85±2.40 hours/day (p<0.001). Conclusions Recognizing these adverse collateral effects of the COVID‐19 pandemic lockdown is critical in avoiding depreciation of weight control efforts among youths afflicted with excess adiposity. Depending on duration, these untoward lockdown effects may have a lasting impact on a child’s or adolescent’s adult adiposity level.
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            Scientific and ethical basis for social-distancing interventions against COVID-19

            On Dec 31, 2019, the WHO China Country Office received notice of a cluster of pneumonia cases of unknown aetiology in the Chinese city of Wuhan, Hubei province. 1 The incidence of coronavirus disease 2019 (COVID-19; caused by severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) has since risen exponentially, now affecting all WHO regions. The number of cases reported to date is likely to represent an underestimation of the true burden as a result of shortcomings in surveillance and diagnostic capacity affecting case ascertainment in both high-resource and low-resource settings. 2 By all scientifically meaningful criteria, the world is undergoing a COVID-19 pandemic. In the absence of any pharmaceutical intervention, the only strategy against COVID-19 is to reduce mixing of susceptible and infectious people through early ascertainment of cases or reduction of contact. In The Lancet Infectious Diseases, Joel Koo and colleagues 3 assessed the potential effect of such social distancing interventions on SARS-CoV-2 spread and COVID-19 burden in Singapore. The context is worthy of study, since Singapore was among the first settings to report imported cases, and has so far succeeded in preventing community spread. During the 2003 severe acute respiratory syndrome coronavirus (SARS-CoV) outbreak in Singapore, numerous non-pharmaceutical interventions were implemented successfully, including effective triage and infection control measures in health-care settings, isolation and quarantine of patients with SARS and their contacts, and mass screening of school-aged children for febrile illness. 4 Each of these measures represented an escalation of typical public health action. However, the scale and disruptive impact of these interventions were small compared with the measures that have been implemented in China in response to COVID-19, including closure of schools, workplaces, roads, and transit systems; cancellation of public gatherings; mandatory quarantine of uninfected people without known exposure to SARS-CoV-2; and large-scale electronic surveillance.5, 6 Although these actions have been praised by WHO, 5 the possibility of imposing similar measures in other countries raises important questions. Populations for whom social-distancing interventions have been implemented require and deserve assurance that the decision to enact these measures is informed by the best attainable evidence. For a novel pathogen such as SARS-CoV-2, mathematical modelling of transmission under differing scenarios is the only viable and timely method to generate such evidence. Koo and colleagues 3 adapted an existing influenza epidemic simulation model 7 using granular data on the composition and behaviour of the population of Singapore to assess the potential consequences of specific social-distancing interventions on the transmission dynamics of SARS-CoV-2. The authors considered three infectivity scenarios (basic reproduction number [R 0] of 1·5, 2·0, or 2·5) and assumed between 7·5% and 50·0% of infections were asymptomatic. The interventions were quarantine with or without school closure and workplace distancing (whereby 50% of workers telecommute). Although the complexity of the model makes it difficult to understand the impact of each parameter, the primary conclusions were robust to sensitivity analyses. The combined intervention, in which quarantine, school closure, and workplace distancing were implemented, was the most effective: compared with the baseline scenario of no interventions, the combined intervention reduced the estimated median number of infections by 99·3% (IQR 92·6–99·9) when R 0 was 1·5, by 93·0% (81·5–99·7) when R 0 was 2·0, and by 78·2% (59·0–94·4) when R 0 was 2·5. The observation that the greatest reduction in COVID-19 cases was achieved under the combined intervention is not surprising. However, the assessment of the additional benefit of each intervention, when implemented in combination, offers valuable insight. Since each approach individually will result in considerable societal disruption, it is important to understand the extent of intervention needed to reduce transmission and disease burden. New findings emerge daily about transmission routes and the clinical profile of SARS-CoV-2, including the substantially underestimated rate of infection among children. 8 The implications of such findings with regard to the authors' conclusions about school closure remain unclear. Additionally, reproductive number estimates for Singapore are not yet available. The authors estimated that 7·5% of infections are clinically asymptomatic, although data on the proportion of infections that are asymptomatic are scarce; as shown by Koo and colleagues in sensitivity analyses with higher asymptomatic proportions, this value will influence the effectiveness of social-distancing interventions. Additionally, the analysis assumes high compliance of the general population, which is not guaranteed. Although the scientific basis for these interventions might be robust, ethical considerations are multifaceted. 9 Importantly, political leaders must enact quarantine and social-distancing policies that do not bias against any population group. The legacies of social and economic injustices perpetrated in the name of public health have lasting repercussions. 10 Interventions might pose risks of reduced income and even job loss, disproportionately affecting the most disadvantaged populations: policies to lessen such risks are urgently needed. Special attention should be given to protections for vulnerable populations, such as homeless, incarcerated, older, or disabled individuals, and undocumented migrants. Similarly, exceptions might be necessary for certain groups, including people who are reliant on ongoing medical treatment. The effectiveness and societal impact of quarantine and social distancing will depend on the credibility of public health authorities, political leaders, and institutions. It is important that policy makers maintain the public's trust through use of evidence-based interventions and fully transparent, fact-based communication. © 2020 Caia Image/Science Photo Library 2020 Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
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              Wuhan coronavirus (2019-nCoV): The need to maintain regular physical activity while taking precautions

              The on-going Wuhan coronavirus (2019-novel coronavirus, 2019-nCoV) outbreak in China has become the world's leading health headline and is causing major panic and public concerns. On January 30, 2020, the World Health Organization (WHO) declared that the new coronavirus outbreak is a public health emergency of international concern. 1 The virus has already had a direct impact on more than 10 million people in the city of Wuhan and has reached other parts of China as well, posing a health threat of unknown magnitude globally. As of February 8, 2020, WHO reported 34,886 confirmed cases of 2019-nCoV globally, with 34,589 of them occurring in China (including 6101 severe cases and 723 deaths). A total of 288 other confirmed cases (with 1 death) have been reported in 24 countries, including Japan, Australia, Germany, and United States. 2 However, these daily estimates are expected to rise even higher as reports from health authorities in China 3 are gathered and near real-time updates of the Johns Hopkins virus dashboard are made. 4 The outbreak has caused governments in various countries to take swift and protective measures. In China, these included putting cities on lockdown, 5 implementing travel warnings/bans and cancellations, 6 extending national holidays, and closing schools and postponing classes. 7 Currently, there is no vaccine for the prevention or treatment of the illness caused by the virus; its origins and the ultimate extent of this epidemic remain unknown. There have been more than 50 research papers published within the last 20 days 8 that have allowed for the rapid sharing of scientific information about the virus, but serious questions regarding the causes or mechanisms of transmission, incubation period, risk assessments, and options for effective treatment or intervention of the virus remain largely unanswered. 9 There have been reports of significant shortages of medical staff, a lack of clinics that can handle and treat infected patients, and high demands for face masks for protection. The Chinese central government is working with extraordinary diligence to mobilize resources, including building new hospitals and developing new coronavirus vaccine, as well as sending medical experts and clinicians to the city of Wuhan 10 to help contain the highly transmittable virus outbreak from spreading further. With the continuing coronavirus spur, the public has been advised by various health authorities to reduce traveling and stay at home as a basic means of limiting people's exposure to the virus. Health authorities, including the National Health Commission of the People's Republic of China, 11 WHO, 12 and U.S Centers for Disease Control and Prevention, 13 have issued safety recommendations for taking simple precautions to reduce exposure to and transmission of the virus. Unfortunately, the mandated restrictions on travel and directives against participating in outdoor activities, including regular physical activity and exercise, will inevitably disrupt the routine daily activities of tens of millions of people. While containing the virus as quickly as possible is the urgent public health priority, there have been few public health guidelines for the public as to what people can or should do in terms of maintaining their daily exercise or physical activity routines. Arguably, staying home, while a safe measure, may have unintended negative consequences since such efforts to avoid human-to-human transmission of the virus may lead to reduced physical activity. It is likely that prolonged home stay may lead to increased sedentary behaviors, such as spending excessive amounts of time sitting, reclining, or lying down for screening activities (playing games, watching television, using mobile devices); reducing regular physical activity (hence lower energy expenditure); or engaging in avoidance activities that, consequently, lead to an increased risk for and potential worsening of chronic health conditions. 14 Therefore, there is a strong health rationale for continuing physical activity in the home to stay healthy and maintain immune system function in the current precarious environment. Exercise at home using various safe, simple, and easily implementable exercises is well suited to avoid the airborne coronavirus and maintain fitness levels. Such forms of exercise may include, but are not limited to, strengthening exercises, activities for balance and control, stretching exercises, or a combination of these. Examples of home exercises include walking in the house and to the store as necessary, lifting and carrying groceries, alternating leg lunges, stair climbing, stand-to-sit and sit-to-stand using a chair and from the floor, chair squats, and sit-ups and pushups. In addition, traditional Tai Ji Quan, Qigong exercises, 15 and yoga 16 should be considered since they require no equipment, little space, and can be practiced at any time. The use of eHealth and exercise videos, which focuses on encouraging and delivering physical activity through the Internet, mobile technologies, and television 17 are other viable avenues for maintaining physical function and mental health during this critical period. Official measures that restrict people's movements in the presence of the coronavirus crisis do not necessarily mean that physical activity must be limited or that all forms of exercise must be eliminated entirely. Exercise has been shown to have clear health benefits for healthy individuals 18 and for patients with various diseases. 19 In this respect, we strongly echo Dr. Steven Blair's quote from Dr. Ken Powell: “Some activity is better than none, and more is better than less” (p. 525). 20 The aim should be to undertake at least 30 min of moderate physical activity every day and/or at least 20 min of vigorous physical activity every other day. 18 Ideally, a combination of both intensities of physical activities is preferable in addition to practicing strengthening-type activities on a regular basis. 18 Children, the elderly, and those who have previously experienced symptoms of illness or are susceptible to chronic cardiovascular or pulmonary disease should seek advice from health care providers about when it is safe to exercise. Given the concerns about the increasing spread of 2019-nCoV, it is imperative that infection control and safety precautions be followed. Home stay is a fundamental safety step that can limit infections from spreading widely. But prolonged home stays can increase behaviors that lead to inactivity and contribute to anxiety and depression, which in turn can lead to a sedentary lifestyle known to result in a range of chronic health conditions. Maintaining regular physical activity and routinely exercising in a safe home environment is an important strategy for healthy living during the coronavirus crisis.
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                Author and article information

                Contributors
                apavlovic@cooperinst.org
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                11 March 2021
                11 March 2021
                2021
                : 21
                : 485
                Affiliations
                [1 ]GRID grid.281728.6, ISNI 0000 0004 0393 8811, The Cooper Institute, ; 12330 Preston Road, Dallas, TX 75230 USA
                [2 ]GRID grid.267308.8, ISNI 0000 0000 9206 2401, Univeristy of Texas Health Science Center at Houston School of Public Health, ; Houston, TX USA
                [3 ]GRID grid.168010.e, ISNI 0000000419368956, Department of Cardiovascular Medicine, , Stanford University, ; Palo Alto, California USA
                [4 ]GRID grid.89336.37, ISNI 0000 0004 1936 9924, University of Texas at Austin, ; Austin, TX USA
                Author information
                http://orcid.org/0000-0002-4400-5466
                Article
                10545
                10.1186/s12889-021-10545-x
                7948663
                33706744
                8a73012d-0e16-41d3-803e-3c4cef36037a
                © The Author(s) 2021

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 27 October 2020
                : 3 March 2021
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2021

                Public health
                physical education,physical activity,pandemic
                Public health
                physical education, physical activity, pandemic

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