Public Health Research (Oct 2024)
School-level variation in children’s moderate to vigorous intensity physical activity before and after COVID-19: a multilevel model analysis
Abstract
Background and objectives Schools play a crucial role in facilitating physical activity among children, but the COVID-19 pandemic has affected both children’s physical activity and the school environment. It is essential to understand between-school differences in children’s physical activity post lockdown, to determine if and how the role of schools has changed. Design and participants Active-6 is a natural experiment comparing postlockdown accelerometer-estimated physical activity to a pre-COVID-19 comparator group. Accelerometer and individual data were collected on 1296 children aged 10–11 pre-COVID-19 (2017–8), with school characteristics collected from the 50 schools they attended. Post lockdown, we collected accelerometer, individual and school data from 393 children in 23 of the same schools and 436 children in 27 of the same schools in 2021 (Wave 1) and 2022 (Wave 2), respectively. Methods Sources of variation (between-school, between-pupil and within-pupil) in child weekday moderate to vigorous physical activity at each wave were modelled using linear mixed-effects models with school-level wave random coefficients. We extended the model to estimate the proportion of between-school variation explained by school policy, curriculum and physical environment factors and school-aggregated pupil characteristics. We also explored the extent to which postlockdown differences in moderate to vigorous physical activity were mediated by individual or school factors. Results Between-school variation comprised 13% of the total variation pre-COVID-19, 7% in Wave 1 and 13% in Wave 2. School factors associated with moderate to vigorous physical activity were the following: whether physical education was compromised due to space (often: 9 minutes lower moderate to vigorous physical activity; sometimes: 5.4 minutes lower); high after-school club attendance (7 minutes higher moderate to vigorous physical activity for each additional club attended on average in the school); cycle training policy (4 minutes higher moderate to vigorous physical activity); and higher prevalence of active travel (1 minute higher moderate to vigorous physical activity for each 10% point increase in prevalence). These factors explained 22% of the between-school variation pre-COVID-19, and 72% at Wave 2. The relative importance changed, with cycle training policy and active travel being the most important pre-COVID-19 and cycle training policy, active after-school clubs and compromised physical education space most important in Wave 2. No factors were found to mediate the postlockdown differences in moderate to vigorous physical activity, except compromised physical education space, which had a suppressor effect in Wave 2. Limitations Only 27 of the initial 50 schools participated post lockdown, limiting our ability to make comparisons across waves. Sample sizes were additionally affected by missing data for some variables. Conclusions and future work While schools continue to play an important role in facilitating children’s physical activity, the factors that contribute to this have changed post-COVID-19, with cycle training, active after-school clubs and ensuring physical education is prioritised even when space is limited now explaining nearly three-quarters of the between-school variation in children’s moderate to vigorous physical activity. School-level interventions that focus on these areas, and policies that support them, may offer the potential to increase children’s physical activity. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number NIHR131847. Plain language summary What was the question? Schools are important in helping children to be physically active. How active children are differs between schools. We wanted to know whether this has changed after the COVID-19 lockdowns. We also looked at features of the school, like equipment in the playground or being active in lessons, that might explain these differences. What did we do? We collected activity data from 10- to 11-year-olds from 50 schools around Bristol (United Kingdom) before and after the COVID-19 lockdowns. Children also told us about how they travelled to school and whether they went to after-school sports or exercise clubs. We asked schools about their policies and lessons. Finally, we collected data on the playground and surroundings. What did we find? In the first 6 months after lockdowns, schools had a much smaller role in children’s activity. But after a year, schools were once again an important influence on how active children were. We found that the school features that affected children’s activity had changed. Before the pandemic, the things that helped children most to be active were learning to ride a bike at school, and walking or cycling to school. After the pandemic, offering lots of after-school sports clubs was more important. Schools that struggled with physical education lessons because of a lack of space had fewer active pupils. What does this mean? Schools continue to play an important role in helping children be active. But this role has changed after the lockdowns. In the future, schools could help keep children active by offering plenty of after-school clubs and help children to learn to ride a bike. Also, it is important to make sure that physical education lessons are a priority, even when there is not much space.
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