The impacts of physical activity on psychological and behavioral problems, and changes in physical activity, sleep and quality of life during the COVID-19 pandemic in preschoolers, children, and adolescents: A systematic review and meta-analysis

Background: The COVID-19 pandemic has greatly affected the level of physical activity (PA). However, little is known about its effect on health outcomes.

Methods: Articles without language restrictions published from the database inception through March 16, 2022, were retrieved using the CINAHL Complete, Cochrane Library, EMBASE, Medline, PubMed, and PsycINFO databases. High-quality articles assessing the effect of PA on psychological and behavioral problems. Additionally, PA, QoL, and/or sleep problems before and during the pandemic were included. Articles without data regarding PA or involving non-general populations were excluded. The PRISMA and MOOSE guidelines were followed. Data quality of the selected articles was assessed using the Newcastle-Ottawa Scale and GRADE approach. Data were pooled using a random-effects model and sensitivity analysis if heterogenicity was high (I^2 ≥50%). The relationship between PA and psychological and behavioral problems; and changes in PA, QoL, and sleeping patterns before and during the pandemic in preschoolers, children, and adolescents were investigated. A meta-analysis was conducted; odds ratios (ORs), mean differences (MD), and standardized MDs (SMDs) were calculated.

Results: Thirty-four articles involving 66,857 participants were included. The results showed an overall significant protective effect between PA and psychological and/or behavioral problems (OR = 0.677; 95% CI = 0.630, 0.728; p-value <0.001; I²= 59.79%). This relationship was also significant in the subgroup analysis of children (OR = 0.690; 95% CI = 0.632, 0.752; p-value <0.001; I²= 58.93%) and adolescents (OR = 0.650; 95% CI = 0.570, 0.741; p-value <0.001; I²= 60.85%); however, no data on the relationship in preschoolers were collected. In addition, the overall time spent on PA significantly decreased by 23.2 min per day during the COVID-19 pandemic (95% CI = −13.5, −32.9; p-value <0.001; I²= 99.82%). Moreover, the results showed an overall significant decrease in QoL (SMD = −0.894, 95% CI = −1.180, −0.609, p-value <0.001, I²= 96.64%). However, there was no significant difference in sleep duration during the COVID-19 pandemic (MD = 0.01 h per day, 95% CI = −0.027, 0.225; p-value = 0.125; I²= 98.48%).

Conclusion: During the pandemic, less PA was contributed to poor QoL and sleep quality. However, increases in PA are associated with reduced occurrences of psychological and behavioral problems. Implementing recovery plans to address the health effect of the pandemic is essential.

1. Introduction

On March 11, 2020, coronavirus disease (COVID-19) was declared a global pandemic by the World Health Organization (1). The long incubation period, high transmission rate, and ongoing viral mutation and evolution have posed great challenges to pandemic control (2). As of March 21, 2022, this highly contagious disease had affected 227 countries, resulting in 471,079,831 confirmed cases and 6,101,020 deaths globally (3). In addition to the loss of human life, the estimated loss of global economic output reached 2.96 trillion USD in 2020 (4). To contain the spread of COVID-19 and minimize such losses, countries around the world adopted preventive measures with varying levels of stringency (5), including the prohibition of mass gatherings, closure of schools and public places, physical distancing, or even lockdowns. These restrictive measures had a negative impact on the overall Physical activity (PA) levels in MET-min/weeks, as well as increased in sedentary behavior in young population (6). The measures had also caused changes in PA among children, and adolescents. For instance, a meta-analysis reported decrease in PA levels across all age groups during the pandemic (7). Among the total of 57 included studies, 16 of them reported solely on children and adolescents, and half of those indicated reduction in PA parameters (7). In addition, moderate-to-vigorous activities and step counts were significantly reduced in children and adolescents (7). Moreover, PA restrictions have negatively affected the psychological health of children and adolescents (8), further exacerbating their anxiety and depression. It is estimated that the pooled prevalence of clinically elevated depression and anxiety in children and adolescents increased to 25.2% and 20.5% respectively, which is twice the pre-pandemic estimate (9). Another study involving more than 59,000 young participants reported increased depressive symptoms and deteriorated psychological health during the pandemic (10). In addition to affecting psychological health, disturbing daily routines may induce changes in behavioral problems (11, 12), sleep quality (13, 14), and resulting quality of life (QoL) (15) in children and adolescents. Yet, a systematic review revealed a positive correlation between PA and psychological health in children and adolescent during the pandemic, indicating PA improves psychological health among them (8). In addition, a study with adult participants reported PA was associated with anxiety, emotional, psychological and social well-being, and sleep quality during the pandemic (16). And participants who were more active reported lower levels of anxiety, higher levels of well-beings and better sleep quality than those who were less active (16). Whereas the pandemic restrictive measures appeared to decrease PA participation, active lifestyle should still be encouraged as PA is beneficial to psychological health, sleep quality, and emotion and social well-being.

When faced with high psychological distress during the pandemic, increasing the level of PA is a coping strategy to mitigate the associated negative effects. In a study involving more than 1.2 million adult participants (17), those who exercised regularly experienced fewer days of poor psychological health than those who did not. Although the effects of increasing PA of preschoolers, children, and adolescents on psychological health (18) had been reported in several studies, the quality of those remains unclear. One systematic review (19) investigating the association between PA and psychological health in children and adolescents during the first year of the COVID-19 pandemic reported that an increasing level of PA is associated with fewer depressive symptoms, lower anxiety and stress, and an improved well-being and QoL. However, this association was analyzed only qualitatively. Furthermore, the study time frame was limited to the first year of the COVID-19 pandemic, and only four studies included preschoolers, children, and adolescents. Another systematic review (8) reported an association between PA and psychological health in preschoolers, children, and adolescents. Yet, this study only used PubMed as a search engine to identify potential articles, and no meta-analysis was conducted. Moreover, the quality of the selected articles was not assessed. Therefore, the selected articles may have had a risk of bias, potentially compromising the overall results. In addition, the extent of psychological health changes has not been reported; thus, the effect of PA changes cannot be quantified. The effect of PA on psychological and/or behavioral problems or sleep quality remains unknown in these reviews. As preschoolers, children and adolescents are considered a vulnerable population who are susceptible to mental health issues (18); their difficulties may be underestimated, and more investigations are needed in this group. Therefore, a systematic analysis of the aforementioned aspects is required.

This meta-analysis aimed to quantitatively analyze the relationship between PA changes and psychological problems in particular depression, anxiety, stress and mood disturbance and/or behavioral problems including irritability, peer problems, conduct problem, hyperactivity or inattention, and prosocial behavior in preschoolers, children and adolescents. The study also explored the changes of PA levels with the differences in sleeping patterns and QoL before and during the pandemic among those population. We hypothesized that increasing PA levels are associated with decreasing the occurrence of psychological and/or behavioral problems in preschoolers, children and adolescents. Additionally, we hypothesized there will be significant differences in PA levels, sleeping patterns and QoL before and during the pandemic in preschooler, children and adolescents. The null hypothesis was that there would be no relationship between PA and psychological and/or behavioral problems and no differences in PA levels, sleeping patterns and QoL among those population. This study may provide valuable references for resource allocation and the formulation of effective management policies to address the needs of PA interventions for preschoolers, children, and adolescents.

2. Methods

2.1. Search strategy and selection criteria

This meta-analysis adhered to the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) (20) and Meta-Analysis of Observational Studies in Epidemiology (MOOSE) (21) guidelines. The protocol for this meta-analysis was published in the PROSPERO database (registration number: CRD42022309209). The current study was conducted in adherence with the published protocol. A comprehensive literature search of the CINAHL Complete, Cochrane Library, EMBASE, Medline, PubMed, and PsycINFO databases without language restrictions was conducted on March 16, 2022, for all relevant articles containing quantitative data. The reference lists of all relevant articles were also manually searched to minimize the possibility of missing data. For non-English articles, we initially used “Google Translate,” followed by consultation of professional translations by native speakers. The search history is presented in Supplementary Table S1, while the search terms are listed in Supplementary Table S2. In order to identify the relationship between PA and psychological and/or behavioral problems as well as the pattern of changes of PA levels with sleeping patterns and QoL, articles that either provide correlational quantitative data assessing the effect of changes in PA on psychological and/or behavioral problems during the COVID-19 pandemic, or mean changes in various parameters regarding to PA levels, sleeping patterns and/or QoL before and during the COVID-19 pandemic in preschoolers (age 0–5 years), children (age 6–11 years), and adolescents (age 12–18 years) were included. Moreover, only articles with a low risk of bias were included in order to provide rigorous findings. We excluded articles that involved participants who were not representative of the general preschool, child, and adolescent populations (e.g., articles that exclusively involved participants with pre-existing physiological or psychological health problems and athletes). Abstracts, editorial comments, and unpublished studies were also excluded.

2.2. Risk of bias and certainty assessment

The quality and certainty of the included articles were assessed by two independent reviewers (JP and KR) using the Newcastle-Ottawa Scale (NOS) (22) for cohort studies and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the quality of evidence (23). The NOS has a maximum score of 9 points. The cut-off score for adequate quality in this meta-analysis was 7 points. Articles that scored 7–9, 4–6, and 0–3 points were considered to have a low, moderate, and high risk of bias, respectively (22). The GRADE includes four levels of certainty in evidence: very low, low, moderate, and high (23). The quality of evidence was applied to each outcome as this may vary across outcomes. A third reviewer resolved any disagreements regarding the scoring of the included articles.

2.3. Data extraction and statistical analysis

Based on the inclusion and exclusion criteria, the titles and abstracts of potential articles were screened by two independent reviewers, and the full texts of the remaining articles were evaluated. Disagreements were resolved by a third reviewer. Relevant data were extracted from the included articles by five reviewers using a standardized data extraction sheet. The variables are descripted as follow:

Relationship between PA and psychological and/or behavioral problems: quantitative data representing the relationship between PA and psychological and/or behavioral problems were retrieved. The impact of PA was measured by participants who were either being physically active, participated in moderate or high level of PA or indication of participation in PA during the pandemic on their occurrence of psychological problems, notably depression, anxiety, stress and mood disturbance and/or behavioral problems such as irritability, peer problems, peer problems, conduct problem, hyperactivity or inattention, and prosocial behavior. The participants’ levels of PA and their occurrence of psychological and/or behavioral problems were quantified by their responses in the selected parameters in the included articles.

PA levels, sleeping patterns and QoL: the differences in participants’ PA levels sleeping patterns including sleep duration and sleep quality, and QoL before and during the COVID-19 pandemic were extracted. Particularly, articles that reported the difference in time spent on PA and sleep duration were recorded to identify the mean time spent change in PA and sleep duration before and during the pandemic. For articles that did not provide changes in time spent in PA, and rather adopted other parameters, we provided standardized mean differences to identify the changes. Similarly, standardized mean differences were calculated for changes in sleep quality and QoL before and during the pandemic.

Additionally, confounding variables, including participants’ age, were assessed in a subgroup analysis. The authors of the selected articles would be contacted and any missing data were reported. Comprehensive Meta-Analysis version 3.0 (Biostat, Englewood, New Jersey, United States) was used for the statistical analysis. The targeted outcomes were presented as the mean difference (MD) with 95% confidence intervals (CIs) for data reported in hours per day and standardized MD (SMD) with 95% CIs for data reported with other measures. To identify the relationship between PA and psychological and/or behavioral changes, we generated pooled effects estimated as odd ratios (ORs) with 95% CIs. All p-values in this meta-analysis were two-tailed, and statistical significance was set at ≤0.05. The risk of heterogenicity was assessed by the I² index, and a random-effects model was selected if the heterogeneity was ≥50%. The risk of publication bias was assessed by funnel plots and Egger’s test (24). An asymmetric plot and p ≤ 0.05 indicated the risk of publication bias. A sensitivity analysis was conducted to evaluate the robustness of the relationship (pooled ORs ratio) between PA and psychological and/or behavioral problems by removing each included study from the analysis one by one.

3. Results

3.1. Study characteristics

In total, 12,735 potential articles were retrieved from the literature search. After removing duplicates and screening titles and abstracts, 307 full-text articles were reviewed, of which 263 articles were further removed, leaving 44 articles (11, 14, 23, 25–66). The PRISMA flowchart of the study selection is shown in Figure 1, and the reasons for exclusion are detailed in Supplementary Table S3. The authors of the selected articles were not contacted to obtain additional data, as this was not required in this meta-analysis.

FIGURE 1

Figure 1. PRISMA flow chart of study selection in the systematic review.

The NOS scores of all included articles are documented in Supplementary Table S4. After excluding studies with a high-to-moderate risk of bias, 34 articles (25, 27, 29–34, 36–50, 53, 55, 56, 58, 61, 62, 64–66), comprising 66,857 participants and 23 different countries, were included in the analysis. The included articles had NOS scores between 7 and 8 out of 9 points and were classified as having a low risk of bias and had a rating of 4 under the modified Oxford Centre for Evidence-based Medicine (67). The certainty of the included studies was assessed by GRADE (Supplementary Table S5). The characteristics of the included articles are summarized in Table 1.

TABLE 1

Table 1. Characteristics of included articles.

3.2. Outcomes

3.2.1. Relationship between PA, and psychological and/or behavioral problems during the COVID-19 pandemic

Overall, 14 articles (29, 33, 39, 40, 43, 44, 48, 50, 55, 58, 61, 62, 64, 66) reported the relationship between PA and psychological and/or behavioral problems during the COVID-19 pandemic (Table 2). To measure the PA levels, ten studies (29, 33, 40, 43, 44, 50, 58, 62, 64, 66) used a self-designed questionnaire, three studies adopted a validated questionnaire including the International Physical Activity Questionnaire Short Form (IPAQ-SF) (48, 55) and Goldin-Shepard Leisure—The Physical Activity Questionnaire (61), and one study utilized an accelerometer (39). To identify the occurrence of psychological and/or behavioral problems, nine studies (29, 33, 40, 43, 44, 58, 62, 64, 66) used a self-designed questionnaire where 5 studies employed a validate questionnaire such as the simplified Chinese Profile of Mood Status (POMS) (48), Depression, Anxiety, Stress Scale-21 (DASS-21) (39), The Psychological Distress Index (50), 9-Items Patient Health Questionnaire (PHQ-9) (55) and Generalized Anxiety Disorder Scale (GAD-7) (55), and Brief Symptom Inventory (BSI) (61). Our results showed an overall significant protective effect between PA and psychological problems include depression, anxiety, stress and mood disturbance and/or behavioral problems such as irritability, peer problems, conduct problem, hyperactivity or inattention, and prosocial behavior (OR = 0.677; 95% CI = 0.630, 0.728; p-value <0.001; I²= 59.79%). This relationship was also significant in the subgroup analysis of children (OR = 0.690; 95% CI = 0.632, 0.752; p-value <0.001; I²= 58.93%) and adolescents (OR = 0.650; 95% CI = 0.570, 0.741; p-value <0.001; I²= 60.85%); however, no data on the relationship in preschoolers were collected. The funnel plot analysis is shown in Supplementary Figure S1.

TABLE 2

Table 2. The relationship between PA and psychological and/or behavior problems.

3.2.2. Changes in PA before and during the COVID-19 pandemic

The mean time changes in PA before and during the COVID-19 pandemic were identified in nine articles (27, 31, 38, 41, 42, 45, 49, 53) (Table 3A). Overall, the time spent on PA significantly decreased by 23.2 min per day during the COVID-19 pandemic (95% CI = −13.5, 32.9; p-value <0.001; I²= 99.82%). In the subgroup analysis, the time spent on PA also significantly decreased for preschoolers by 29.6 min per day (95% CI = −14.1, −45.1; p-value <0.001; I²= 99.89%), for children by 18.8 min per day (95% CI = −2.0, −35.4; p-value = 0.028; I²= 97.34%), and for adolescents by 19.4 min per day (95% CI = −1.0, −37.9; p-value = 0.039; I²= 84.54%). In addition, six articles (25, 32, 34, 44, 47, 65) reported changes in PA using various measurements (Table 3B). There was no significant difference in the pooled SMD in PA during the COVID-19 pandemic (SMD = −0.506, 95% CI = −1.070, 0.059; p-value = 0.079; I²= 99.51%).

TABLE 3A

Table 3A. Outcomes: the mean time change in PA before and during COVID-19.

TABLE 3B

Table 3B. Outcomes: the standardized mean difference in quality of life, PA and sleep quality.

3.2.3. Sleeping patterns

The sleep duration before and during the COVID-19 pandemic was reported in 15 articles (25, 27, 34, 36–38, 41, 42, 45–47, 53, 56) (Table 3C). There was no significant difference in sleep duration during the COVID-19 pandemic (MD = 0.01 h per day, 95% CI = −0.027, 0.225; p-value = 0.125; I²= 98.48%). The subgroup analysis also showed no significant difference in sleep duration across age groups: preschoolers (MD = 0.01 h per day, 95% CI = −0.169, 0.190; p-value = 0.908; I²= 93.85%), children (MD = 0.17 h per day, 95% CI = −0.010, 0.357; p-value = 0.064; I²= 95.10%) and adolescents (MD = 0.36 h per day, 95% CI = −0.346, 1.074; p-value = 0.315; I²= 99.24%). However, five articles (25, 27, 44, 56) investigated changes in the sleep quality using different measurements (Table 3B). The pooled SMD indicated a significant decrease in sleep quality during the COVID-19 pandemic (SMD = −1.785, 95% CI = −3.392, −0.177; p-value = 0.030; I²= 99.80%).

TABLE 3C

Table 3C. Outcomes: the mean time change in sleep duration before and during COVID-19.

3.2.4. QoL

Changes in QoL before and during the COVID-19 pandemic were revealed in two articles (30, 65) (Table 3B). The results showed an overall significant decrease in QoL (SMD = −0.894, 95% CI = −1.180, −0.609, p-value <0.001, I²= 96.64%).

3.3. Publication bias

Funnel plot analysis and Egger’s test (24) were performed to assess publication bias for the correlation between PA and psychological and behavioral problems. The shape of the funnel plots appeared fairly symmetrical, which suggested that the risk of publication bias was low. The findings from Egger’s test for odds ratios further confirmed that there was no publication bias (t = 0.48, p = 0.6312) (Supplementary Figure S1). Additionally, Egger’s test for the changes of PA, sleep duration, sleep quality and QoL before and after pandemic also confirmed that were no publication bias (t = 0.06, p = 0.118; t = 0.09, p = 0.464; t = 1.00, p = 0.195; t = 0.55, p = 0.680).

3.4. Quality of evidence

In our meta-analysis, only the cohort studies with the data comparing pre and during COVID-19 were included for the analysis of the changes in PA, sleep pattern and QoL. Additionally, those cohort studies reported the correlation of PA and psychological and behavior problems were selected. Overall quality of evidence for different outcomes and assessing the relationship between the changes in PA and psychological and behavioral changes was high to moderate. The heterogeneity of outcomes and small sample size downgraded the quality of evidence (Supplementary Table S5).

3.5. Sensitivity analysis

The pooled ORs of the relationship between PA and psychological and/or behavioral problems during the COVID-19 pandemic were not modified when removing each included study one by one. Further details are displayed in (Supplementary Table S6).

4. Discussion

This meta-analysis included more than 66,000 participants (preschoolers, children, and adolescents) from 23 countries. The findings support that increased PA (protective exposure) is associated with a reduced occurrence of psychological and behavioral problems during the COVID-19 pandemic for children (OR = 0.690, p < 0.001) and adolescents (OR = 0.650 p < 0.001). There was a significant decrease in the overall PA, sleep quality and QoL during the COVID-19 lockdown or constraints. However, the sleep duration was not significant change during the pandemic. Similar finding was reported by (68) that the duration of sleep time was not significant change (p = 0.11) though the sleep quality showed significant change that affect children’s psychological difficulties (b = 0.14, t = 6.87, p < 0.01). Besides, previous systematic review reported the magnitude of change in PA before and during the pandemic was difficult to be evaluated due to the limitation of lacking baseline data and heterogenicity of measurements (69). To our knowledge, this meta-analysis is the largest and most comprehensive evaluation of this relationship, with substantial evidence (overall OR = 0.677, p < 0.001), and quantified the changes of PA, sleep duration, sleep quality and QoL. Although the outcomes showed high heterogenicity due to the limitation of using varies measurements in the included studies, we have used random model to minimize the influence and we monitored the risk of publication bias. The current meta-analysis was based on the relative symmetrical shape of the funnel plot and the results from Egger’s test, and the quality of evidence was high to moderate by using a GRADE approach.

In addition, the association between the reduction in PA and psychological and behavioral problems during the COVID-19 pandemic remained when we performed subgroup analyses by age. Among the three groups, preschoolers were the most vulnerable, with significant reductions in PA (MD = −0.50, p < 0.001), followed by adolescents (MD = −0.32, p = 0.039) and children (MD = −0.31, p = 0.028). Policymakers and health-care professionals should provide more resources to cope with potential problems in these two groups. However, the change in sleep duration only increased by 0.001 h (p = 0.908). A significant overall decrease in PA may indicate that lifestyles become more sedentary (29, 66). In addition, the overall QoL decreased (SMD = −0.894, p < 0.001), and the sleep quality decreased (SMD = −1.785, p = 0.030), which may also be associated with adapted PA and a more sedentary lifestyle (29, 70). The potential adverse effects on the health of preschoolers, children, and adolescents are of great concern.

The relationship between interventions and the overall psychological well-being has not been established through meta-analyses. PA has inconsistent effects on mental health problems among younger and older children (9, 71); in addition, studies had highlighted the importance of prevention in mental health and behavioral problems in children and adolescents by limiting risk exposure and identifying high risk individuals early (72–75). Decrease in PA has shown to have detrimental effects in children and adolescents’ psychological and behavioral problem (76–78). Hence, a strategy for the early identification and prevention of decreased PA is essential.

Although the underlying mechanisms responsible for the effects of decreased PA on the psychological and behavioral status of preschoolers, children, and adolescents remain unclear, several hypotheses have been proposed. First the decreased participation in PA may elicit feelings of loneliness that negatively affect mental health (25). Second, restrictive measures during the pandemic may lead to social isolation and, hence, to psychological and behavioral problems (80). Those measures may also lead to less time participating in PA (81). Third, replacing healthy with unhealthy behaviors may have negative consequences for preschoolers, children, and adolescents. Given the limited evidence, more studies focusing on potential mechanisms between decreased PA and the psychological and behavioral status are needed to confirm these hypotheses. As the exact mechanisms are unknown, we investigated the relationship through a meta-analysis of valid studies focusing on preschoolers, children, and adolescents worldwide.

The strength of our meta-analysis lies in three key aspects. First, we included all available high-quality prospective studies based on the NOS. The quality of evidence was further analyzed by GRADE and the publication bias was evaluated by sensitivity analysis. Second, we quantified the amount of PA and assessed its association with psychological and behavioral problems in children and adolescents, thereby obtaining more meaningful information. Third, we did not exclude any non-English publications. As the pandemic is a worldwide health concern, it is necessary to include and analyze all scientific studies of different cultures in different countries.

4.1. Clinical implications

Previous studies reported that in reaction to the drastic decrease in PA among children and adolescents due to the policy restrictions in different countries, the change in healthy lifestyle triggered the changes in sleep quality and QoL (66, 82). In addition, prolonged stays at home increase the risk of inactivity that may contribute different psychological and behavior problems. However, there is no conclusion of the extent of the changes during the pandemic. Our study provides scientistic evidence to quantify the extent of changes in the PA, sleep pattern and QoL in the preschoolers, children and adolescents before and during the pandemic. Previous studies reported PA or physical exercise had little effect on psychological status (83–85). However, the current situation is changed during the pandemic. This meta-analysis was one of the first to reveal the association between PA and psychological and behavioural problems of preschoolers, children and adolescents of different countries in the context of the pandemic. Our findings provide robust evidence and theoretical guidance for related health promotion and psychological rehabilitation of preschoolers, children and adolescents in the epidemic or post-epidemic era. Our meta-analysis can also provide effective reference for relevant health promotion and policy implementation to help young people to recover from the adverse effects of the social isolation period in the epidemic.

4.2. Limitations

First, a limited amount of empirical data retrieved during the pandemic met the inclusion criteria. The aims were to identify the relationship of PA and psychological and/or behavioral problems and compare different aspects before and during the pandemic. Thus, only articles involving before and during pandemic comparisons or those reporting the relationship between PA and psychological and/or behavioral problems were included. Some articles that reported either only PA or only psychological or behavioral problems were excluded. Consequently, some data from cross-sectional investigations on PA and psychological or behavioral problems in some worldwide populations were excluded. The association between changes in PA and psychological and behavioral problems in preschoolers remains unknown as no empirical study has yet been conducted. This limitation may be caused by difficulties in assessing the psychological and behavioral changes of subjects who are too young to express themselves through questionnaires or formal interviews. Data from caregiver and parental observations may have risks of bias and inaccuracy. Further development of the direct silent observation of preschoolers is needed to solve this gap for future studies (86). Third, although we searched six scientific databases and expected the findings to cover nearly all relevant published articles without any language limitations, we cannot exclude the possibility that additional relevant articles may have been missed. However, in addition to manually searching other databases, the reference lists of all relevant articles were searched; thus, the number of missed articles was likely small and would have little effect on the analysis. Fourth, most studies included in the analysis collected information via self-report questionnaires and from different outcome measures, which could have led to errors in the measurement of PA. Consequently, the heterogeneity of the outcomes was high, which may indicate the high diversity of the effects with different level of PA. The variability derives mainly from the clinical heterogeneity that is difficult to minimize, because the selection of outcome measures is always diverse in empirical studies (87). The risk of methodological heterogeneity among the included studies was examined and minimized. Our findings support that the included studies share a similar cohort study design. The quality of these studies was assessed, and the risk of publication bias was evaluated. In addition, the statistical heterogeneity among the included study was controlled by using a random effect model as the heterogeneity I² was ≥50% (88). Fifth, we could not entirely rule out the possibility that the caregivers or the children and/or adolescents themselves may have missed preclinical or undiagnosed psychological and behavioral problems. Based on our meta-analysis, further prospective studies are necessary to confirm the effect of decreased PA on psychological and behavioral problems in preschoolers, children, and adolescents. The potential reverse causality between decreased PA and psychological and behavioral problems should be identified early. Consequently, policymakers, health-care providers, and caregivers can minimize the risks of the adverse effects of decreased PA on society.

4.3. Conclusion

During the COVID-19 pandemic, less PA and longer screen times may induce a sedentary lifestyle. This may increase the risk of poor QoL and poor sleep quality. Increased PA is associated with fewer psychological and behavioral problems. Our results showed an overall significant protective effect between PA and psychological and/or behavioral problems. This relationship was also significant in terms of the subgroup analysis of children and adolescents. These findings may guide caregivers, health-care providers, and health-care policy makers in making recommendations and developing guidelines with respect to the degree of PA to help reduce the risk of psychological and behavioral problems at both the individual and population levels. More epidemiological studies with larger sample sizes and detailed quantifications of PA and psychological and behavioral problems will establish more precise information regarding this association. The influence of decreased PA on preschoolers’ psychological and behavioral problems remains uncertain due to the paucity of studies. The scientific gap can be resolved using sophisticated technology to provide accurate observations and assessments of preschoolers in the future.

Data availability statement

The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/Supplementary Material.

Author contributions

JP initiated this study. All authors contributed to the design of the review structure and performed the literature search. JP and KR performed selection and interpretation of data, and drafted the manuscript including tables and figures. All authors contributed in critical revision of the manuscript and approval for the final version. All authors contributed to the article and approved the submitted version.

Funding

This study was supported by a grant from the Caritas Institute of Higher Education for the publication (reference code IDG210101 and IDG220227P).

Acknowledgments

The authors would also like to acknowledge Charis Pang Wai Yue for her contributions to the study design and editing of the figures and tables.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fped.2023.1015943/full#supplementary-material.

References

1. World Health Organization. WHO director-general’s opening remarks at the media briefing on COVID-19–11 March 2020. Available at: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020 (Accessed March 21, 2022).

2. Paul S, Lorin E. Distribution of incubation periods of COVID-19 in the Canadian context. Sci Rep. (2021) 11:12569. doi: 10.1038/s41598-021-91834-8

PubMed Abstract | CrossRef Full Text | Google Scholar

3. Worldometer. COVID-19 coronavirus pandemic. Available at: https://www.worldometers.info/coronavirus/ (Accessed March 21,2022).

4. Szmigiera M. Impact of the coronavirus pandemic on the global economy - statistics & facts. Statista. Available at: https://www.statista.com/topics/6139/covid-19-impact-on-the-global-economy/#topicHeader__wrapper (Accessed March 21, 2022).

5. European Centre for Disease Prevention and Control (2022). (Accessed March 17, 2022).

6. Gjaka M, Feka K, Bianco A, Tishukaj F, Giustino V, Parroco AM, et al. The effect of COVID-19 lockdown measures on physical activity levels and sedentary behaviour in a relatively young population living in Kosovo. J Clin Med. (2021) 10(4):763. doi: 10.3390/jcm10040763

PubMed Abstract | CrossRef Full Text | Google Scholar

7. Wunsch K, Kienberger K, Niessner C. Changes in physical activity patterns due to the COVID-19 pandemic: a systematic review and meta-analysis. Int J Environ Res Public Health. (2022) 19:2250. doi: 10.3390/ijerph19042250

PubMed Abstract | CrossRef Full Text | Google Scholar

8. Okuyama J, Seto S, Fukuda Y, Funakoshi S, Amae S, Onobe J, et al. Mental health and physical activity among children and adolescents during the COVID-19 pandemic. Tohoku J Exp Med. (2021) 253:203–15. doi: 10.1620/tjem.253.203

PubMed Abstract | CrossRef Full Text | Google Scholar

9. Racine N, McArthur BA, Cooke JE, Eirich R, Zhu J, Madigan S. Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: a meta-analysis. JAMA Pediatr. (2021) 175:1142–50. doi: 10.1001/jamapediatrics.2021.2482

PubMed Abstract | CrossRef Full Text | Google Scholar

10. Thorisdottir IE, Asgeirsdottir BB, Kristjansson AL, Valdimarsdottir HB, Jonsdottir Tolgyes EM, Sigfusson J, et al. Depressive symptoms, mental wellbeing, and substance use among adolescents before and during the COVID-19 pandemic in Iceland: a longitudinal, population-based study. Lancet Psychiatry. (2021) 8:663–72. doi: 10.1016/S2215-0366(21)00156-5

PubMed Abstract | CrossRef Full Text | Google Scholar

11. Alonso-Martínez AM, Ramírez-Vélez R, García-Alonso Y, Izquierdo M, García-Hermoso A. Physical activity, sedentary behavior, sleep and self-regulation in spanish preschoolers during the COVID-19 lockdown. Int J Environ Res Public Health. (2021) 18:693. doi: 10.3390/ijerph18020693

CrossRef Full Text | Google Scholar

12. Haug E, Mæland S, Lehmann S, Bjørknes R, Fadnes LT, Sandal GM, et al. Increased gaming during COVID-19 predicts physical inactivity among youth in Norway-a two-wave longitudinal cohort study. Front Public Health. (2022) 10:812932. doi: 10.3389/fpubh.2022.812932

PubMed Abstract | CrossRef Full Text | Google Scholar

13. Camacho-Montaño LR, Iranzo A, Martínez-Piédrola RM, Camacho-Montaño LM, Huertas-Hoyas E, Serrada-Tejeda S, et al. Effects of COVID-19 home confinement on sleep in children: a systematic review. Sleep Med Rev. (2022) 62:101596. doi: 10.1016/j.smrv.2022.101596

CrossRef Full Text | Google Scholar

14. Medrano M, Cadenas-Sanchez C, Oses M, Arenaza L, Amasene M, Labayen I. Changes in lifestyle behaviours during the COVID-19 confinement in spanish children: a longitudinal analysis from the MUGI project. Pediatr Obes. (2021) 16:e12731. doi: 10.1111/ijpo.12731

PubMed Abstract | CrossRef Full Text | Google Scholar

15. Ravens-Sieberer U, Kaman A, Erhart M, Otto C, Devine J, Löffler C, et al. Quality of life and mental health in children and adolescents during the first year of the COVID-19 pandemic: results of a two-wave nationwide population-based study. Eur Child Adolesc Psychiatry. (2021) 31(6):879–89. doi: 10.1007/s00787-021-01726-5

PubMed Abstract | CrossRef Full Text | Google Scholar

16. Akbari H, Pourabbas M, Yoosefi M, Briki W, Attaran S, Mansoor H, et al. How physical activity behavior affected well-being, anxiety and sleep quality during COVID-19 restrictions in Iran. Eur Rev Med Pharmacol Sci. (2021) 25(24):7847–57. doi: 10.26355/eurrev_202112_27632

PubMed Abstract | CrossRef Full Text | Google Scholar

17. Chekroud SR, Gueorguieva R, Zheutlin AB, Paulus M, Krumholz HM, Krystal JH, Chekroud AM. Association between physical exercise and mental health in 1.2 million individuals in the USA between 2011 and 2015: a cross-sectional study. Lancet Psychiatry. (2018) 5:739–46. doi: 10.1016/S2215-0366(18)30227-X

PubMed Abstract | CrossRef Full Text | Google Scholar

18. Farley HR. Assessing mental health in vulnerable adolescents. Nursing. (2020) 50:48–53. doi: 10.1097/01.NURSE.0000697168.39814.93

PubMed Abstract | CrossRef Full Text | Google Scholar

19. Marconcin P, Werneck AO, Peralta M, Ihle A, Gouveia ÉR, Ferrari G, et al. The association between physical activity and mental health during the first year of the COVID-19 pandemic: a systematic review. BMC Public Health. (2022) 22:209. doi: 10.1186/s12889-022-12590-6

PubMed Abstract | CrossRef Full Text | Google Scholar

20. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. (2009) 151:264–9. doi: 10.7326/0003-4819-151-4-200908180-00135

PubMed Abstract | CrossRef Full Text | Google Scholar

21. Stroup DF, Berlin JA, Morton SC, Olkin I, David Williamson G, Rennie D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. meta-analysis of observational studies in epidemiology (MOOSE) group. J Am Med Assoc. (2000) 283:2008–12. doi: 10.1001/jama.283.15.2008

CrossRef Full Text | Google Scholar

22. Wells GA, Shea B, O'Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Available at: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (Accessed March 21, 2021).

23. Granholm A, Alhazzani W, Møller MH. Use of the GRADE approach in systematic reviews and guidelines. Br J Anaesth. (2019) 123(5):554–9. doi: 10.1016/j.bja.2019.08.015

PubMed Abstract | CrossRef Full Text | Google Scholar

24. Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. Br Med J. (1997) 315:629–34. doi: 10.1136/bmj.315.7109.629

CrossRef Full Text | Google Scholar

25. Abid R, Ammar A, Maaloul R, Souissi N, Hammouda O. Effect of COVID-19-related home confinement on sleep quality, screen time and physical activity in Tunisian boys and girls: a survey. Int J Environ Res Public Health. (2021) 18:3065. doi: 10.3390/ijerph18063065

PubMed Abstract | CrossRef Full Text | Google Scholar

26. Acosta D, Fujii Y, Joyce-Beaulieu D, Jacobs KD, Maurelli AT, Nelson EJ, et al. Psychosocial health of K-12 students engaged in emergency remote education and in-person schooling: a cross-sectional study. Int J Environ Res Public Health. (2021) 18:8564. doi: 10.3390/ijerph18168564

PubMed Abstract | CrossRef Full Text | Google Scholar

27. Aguilar-Farias N, Toledo-Vargas M, Miranda-Marquez S, Cortinez-O'Ryan A, Cristi-Montero C, Rodriguez-Rodriguez F, et al. Sociodemographic predictors of changes in physical activity, screen time, and sleep among toddlers and preschoolers in Chile during the COVID-19 pandemic. Int J Environ Res Public Health. (2020) 18:176. doi: 10.3390/ijerph18010176

PubMed Abstract | CrossRef Full Text | Google Scholar

28. Sancho NB, Mondragon NI, Santamaria MD, Munitis AE. The well-being of children in lock-down: physical, emotional, social and academic impact. Child Youth Serv Rev. (2021) 127:106085. doi: 10.1016/j.childyouth.2021.106085

PubMed Abstract | CrossRef Full Text | Google Scholar

29. Breidokienė R, Jusienė R, Urbonas V, Praninskienė R, Girdzijauskienė S. Sedentary behavior among 6-14-year-old children during the COVID-19 lockdown and its relation to physical and mental health. Healthcare. (2021) 9:756. doi: 10.3390/healthcare9060756

CrossRef Full Text | Google Scholar

30. Bringolf-Isler B, Hänggi J, Kayser B, Suggs S, Dössegger A, Probst-Hensch N. COVID-19 pandemic and health related quality of life in primary school children in Switzerland: a repeated cross-sectional study. Swiss Med Wkly. (2021) 151:w30071. doi: 10.4414/SMW.2021.w30071

PubMed Abstract | CrossRef Full Text | Google Scholar

31. Brzęk A, Strauss M, Sanchis-Gomar F, Leischik R. Physical activity, screen time, sedentary and sleeping habits of Polish preschoolers during the COVID-19 pandemic and WHO’s recommendations: an observational cohort study. Int J Environ Res Public Health. (2021) 18:11173. doi: 10.3390/ijerph182111173

CrossRef Full Text | Google Scholar

32. Andreas JB, Brunborg GS. Self-reported mental and physical health among Norwegian adolescents before and during the COVID-19 pandemic. JAMA Netw Open. (2021) 4:e2121934. doi: 10.1001/jamanetworkopen.2021.21934

PubMed Abstract | CrossRef Full Text | Google Scholar

33. Chen X, Qi H, Liu R, Feng Y, Li W, Xiang M, et al. Depression, anxiety and associated factors among Chinese adolescents during the COVID-19 outbreak: a comparison of two cross-sectional studies. Transl Psychiatry. (2021) 11:148. doi: 10.1038/s41398-021-01271-4

PubMed Abstract | CrossRef Full Text | Google Scholar

34. Chen X, Qi H, Liu R, Feng Y, Li W, Xiang M, et al. Impact of COVID-19 pandemic on mental health and health behaviors in Swedish adolescents. Scand J Public Health. (2022) 50:26–32. doi: 10.1177/14034948211021724

PubMed Abstract | CrossRef Full Text | Google Scholar

35. Chi X, Liang K, Chen ST, Huang Q, Huang L, Yu Q, et al. Mental health problems among Chinese adolescents during the COVID-19: the importance of nutrition and physical activity. Int J Clin Health Psychol. (2021) 21:100218. doi: 10.1016/j.ijchp.2020.100218

PubMed Abstract | CrossRef Full Text | Google Scholar

36. Dragun R, Veček NN, Marendić M, Pribisalić A, Đivić G, Cena H, et al. Have lifestyle habits and psychological well-being changed among adolescents and medical students due to COVID-19 lockdown in Croatia? Nutrients. (2020) 13:97. doi: 10.3390/nu13010097

PubMed Abstract | CrossRef Full Text | Google Scholar

37. Francisco R, Pedro M, Delvecchio E, Espada JP, Morales A, Mazzeschi C, et al. Psychological symptoms and behavioral changes in children and adolescents during the early phase of COVID-19 quarantine in three European countries. Front Psychiatry. (2020) 11:570164. doi: 10.3389/fpsyt.2020.570164

PubMed Abstract | CrossRef Full Text | Google Scholar

38. Ghanamah R, Eghbaria-Ghanamah H. Impact of COVID-19 pandemic on behavioral and emotional aspects and daily routines of arab Israeli children. Int J Environ Res Public Health. (2021) 18:2946. doi: 10.3390/ijerph18062946

PubMed Abstract | CrossRef Full Text | Google Scholar

39. Ghorbani S, Afshari M, Eckelt M, Dana A, Bund A. Associations between physical activity and mental health in Iranian adolescents during the COVID-19 pandemic: an accelerometer-based study. Children. (2021) 8:1022. doi: 10.3390/children8111022

PubMed Abstract | CrossRef Full Text | Google Scholar

40. Gilbert AS, Schmidt L, Beck A, Kepper MM, Mazzucca S, Eyler A. Associations of physical activity and sedentary behaviors with child mental well-being during the COVID-19 pandemic. BMC Public Health. (2021) 21:1770. doi: 10.1186/s12889-021-11805-6

PubMed Abstract | CrossRef Full Text | Google Scholar

41. Hossain MS, Deeba IM, Hasan M, Kariippanon KE, Chong KH, Cross PL, et al. International study of 24-h movement behaviors of early years (SUNRISE): a pilot study from Bangladesh. Pilot Feasibility Stud. (2021) 7:176. doi: 10.1186/s40814-021-00912-1

PubMed Abstract | CrossRef Full Text | Google Scholar

42. Hyunshik K, Jiameng M, Sunkyoung L, Ying G. Change in Japanese children's 24-hour movement guidelines and mental health during the COVID-19 pandemic. Sci Rep. (2021) 11:22972. doi: 10.1038/s41598-021-01803-4

PubMed Abstract | CrossRef Full Text | Google Scholar

43. Ishimoto Y, Yamane T, Matsumoto Y, Takizawa Y, Kobayashi K. The impact of gender differences, school adjustment, social interactions, and social activities on emotional and behavioral reactions to the COVID-19 pandemic among Japanese school children. SSM Ment Health. (2022) 2:100077. doi: 10.1016/j.ssmmh.2022.100077

PubMed Abstract | CrossRef Full Text | Google Scholar

44. Jackson SB, Stevenson TS, Larson LR, Peterson MN, Seekamp E. Outdoor activity participation improves adolescents’ mental health during the COVID-19 pandemic. Int J Environ Res Public Health. (2021) 18:2506. doi: 10.3390/ijerph18052506

PubMed Abstract | CrossRef Full Text | Google Scholar

45. Jáuregui A, Argumedo G, Medina C, Bonvecchio-Arenas A, Romero-Martínez M, Okely AD. Factors associated with changes in movement behaviors in toddlers and preschoolers during the COVID-19 pandemic: a national cross-sectional study in Mexico. Prev Med Rep. (2021) 24:101552. doi: 10.1016/j.pmedr.2021.101552

CrossRef Full Text | Google Scholar

46. Jester N, Kang P. COVID-19 pandemic: is teenagers’ health in crisis? An investigation into the effects of COVID-19 on self-reported mental and physical health of teenagers in secondary education. Public Health Pract. (2021) 2:100099. doi: 10.1016/j.puhip.2021.100099

CrossRef Full Text | Google Scholar

47. Jovanović GK, Zubalj ND, Majanović SK, Rahelić D, Rahelić V, Lončar JV, et al. The outcome of COVID-19 lockdown on changes in body mass index and lifestyle among Croatian schoolchildren: a cross-sectional study. Nutrients. (2021) 13:3788. doi: 10.3390/nu13113788

CrossRef Full Text | Google Scholar

48. Kang S, Sun Y, Zhang X, Sun F, Wang B, Zhu W. Is physical activity associated with mental health among Chinese adolescents during isolation in COVID-19 pandemic? J Epidemiol Glob Health. (2021) 11:26–33. doi: 10.2991/jegh.k.200908.001

PubMed Abstract | CrossRef Full Text | Google Scholar

49. Kuhn AP, Kowalski AJ, Wang Y, Deitch R, Selam H, Rahmaty Z, et al. On the move or barely moving? Age-related changes in physical activity, sedentary, and sleep behaviors by weekday/weekend following pandemic control policies. Int J Environ Res Public Health. (2022) 19:286. doi: 10.3390/ijerph19010286

CrossRef Full Text | Google Scholar

50. Laurier C, Pascuzzo K, Beaulieu G. Uncovering the personal and environmental factors associated with youth mental health during the COVID-19 pandemic: the pursuit of sports and physical activity as a protective factor. Traumatology. (2021) 27:354–64. doi: 10.1037/trm0000342

CrossRef Full Text | Google Scholar

51. Lee DJ, So WY, Lee SM. The relationship between Korean adolescents’ sports participation, internal health locus of control, and wellness during COVID-19. Int J Environ Res Public Health. (2021) 18:2950. doi: 10.3390/ijerph18062950

PubMed Abstract | CrossRef Full Text | Google Scholar

52. Lee SM, So WY, Youn HS. Importance-performance analysis of health perception among Korean adolescents during the COVID-19 pandemic. Int J Environ Res Public Health. (2021) 18:1280. doi: 10.3390/ijerph18031280

PubMed Abstract | CrossRef Full Text | Google Scholar

53. Lim MTC, Ramamurthy MB, Aishworiya R, Rajgor DD, Tran AP, Hiriyur P, et al. School closure during the coronavirus disease 2019 (COVID-19) pandemic – impact on children's sleep. Sleep Med. (2021) 78:108–14. doi: 10.1016/j.sleep.2020.12.025

PubMed Abstract | CrossRef Full Text | Google Scholar

54. Liu Q, Zhou Y, Xie X, Xue Q, Zhu K, Wan Z, et al. The prevalence of behavioral problems among school-aged children in home quarantine during the COVID-19 pandemic in China. J Affect Disord. (2021) 279:412–6. doi: 10.1016/j.jad.2020.10.008

PubMed Abstract | CrossRef Full Text | Google Scholar

55. Lu C, Chi X, Liang K, Chen ST, Huang L, Guo T, et al. Moving more and sitting less as healthy lifestyle behaviors are protective factors for insomnia, depression, and anxiety among adolescents during the COVID-19 pandemic. Psychol Res Behav Manag. (2020) 13:1223–33. doi: 10.2147/PRBM.S284103

PubMed Abstract | CrossRef Full Text | Google Scholar

56. Łuszczki E, Bartosiewicz A, Pezdan-Śliż I, Kuchciak M, Jagielski P, Oleksy Ł, et al. Children’s eating habits, physical activity, sleep, and media usage before and during COVID-19 pandemic in Poland. Nutrients. (2021) 13:2447. doi: 10.3390/nu13072447

CrossRef Full Text | Google Scholar

57. Mâsse LC, Edache IY, Pitblado M, Hutchison SM. The impact of financial and psychological wellbeing on children’s physical activity and screen-based activities during the COVID-19 pandemic. Int J Environ Res Public Health. (2021) 18:8694. doi: 10.3390/ijerph18168694

CrossRef Full Text | Google Scholar

58. McArthur BA, Racine N, McDonald S, Tough S, Madigan S. Child and family factors associated with child mental health and well-being during COVID-19. Eur Child Adolesc Psychiatry. (2021) 110(10):2805–7. doi: 10.1111/apa.15966

CrossRef Full Text | Google Scholar

59. Min SK, Son WH, Choi BH, Lee HJ, Ahn CY, Yoo J, et al. Psychophysical condition of adolescents in coronavirus disease 2019. J Exerc Rehabil. (2021) 17:112–9. doi: 10.12965/jer.2142198.099

PubMed Abstract | CrossRef Full Text | Google Scholar

60. Mitra R, Waygood EOD, Fullan J. Subjective well-being of Canadian children and youth during the COVID-19 pandemic: the role of the social and physical environment and healthy movement behaviours. Prev Med Rep. (2021) 23:101404. doi: 10.1016/j.pmedr.2021.101404

PubMed Abstract | CrossRef Full Text | Google Scholar

61. Mzadi AE, Zouini B, Kerekes N, Senhaji M. Mental health profiles in a sample of Moroccan high school students: comparison before and during the COVID-19 pandemic. Front Psychiatry. (2022) 12:752539. doi: 10.3389/fpsyt.2021.752539

PubMed Abstract | CrossRef Full Text | Google Scholar

62. Ren H, He X, Bian X, Shang X, Liu J. The protective roles of exercise and maintenance of daily living routines for Chinese adolescents during the COVID-19 quarantine period. J Adolesc Health. (2021) 68:35–42. doi: 10.1016/j.jadohealth.2020.09.026

PubMed Abstract | CrossRef Full Text | Google Scholar

63. Tulchin-Francis K, Stevens W Jr, Gu X, Zhang T, Roberts H, Keller J, et al. The impact of the coronavirus disease 2019 pandemic on physical activity in U.S. children. J Sport Health Sci. (2021) 10:323–32. doi: 10.1016/j.jshs.2021.02.005

PubMed Abstract | CrossRef Full Text | Google Scholar

64. Wang L, Chen L, Jia F, Shi X, Zhang Y, Li F, et al. Risk factors and prediction nomogram model for psychosocial and behavioural problems among children and adolescents during the COVID-19 pandemic: a national multicentre study: risk factors of childhood psychosocial problems. J Affect Disord. (2021) 294:128–36. doi: 10.1016/j.jad.2021.06.077

PubMed Abstract | CrossRef Full Text | Google Scholar

65. Wunsch K, Nigg C, Niessner C, Schmidt SCE, Oriwol D, Hanssen-Doose A, et al. The impact of COVID-19 on the interrelation of physical activity, screen time and health-related quality of life in children and adolescents in Germany: results of the motorik-modul study. Children. (2021) 8:98. doi: 10.3390/children8020098

PubMed Abstract | CrossRef Full Text | Google Scholar

66. Zhang X, Zhu W, Kang S, Qiu L, Lu Z, Sun Y. Association between physical activity and mood states of children and adolescents in social isolation during the COVID-19 epidemic. Int J Environ Res Public Health. (2020) 17:7666. doi: 10.3390/ijerph17207666

PubMed Abstract | CrossRef Full Text | Google Scholar

67. Oxford center for evidence based medicine. Available at: http://www.cebm.net/index.aspx?o=5653 (Accessed April 12, 2022).

68. Cellini N, Di Giorgio E, Mioni G, Di Riso D. Sleep and psychological difficulties in Italian school-age children during COVID-19 lockdown. J Pediatr Psychol. (2021) 46(2):153–67. doi: 10.1093/jpepsy/jsab003

PubMed Abstract | CrossRef Full Text | Google Scholar

69. Do B, Kirkland C, Besenyi GM, Carissa Smock MPH, Lanza K. Youth physical activity and the COVID-19 pandemic: a systematic review. Prev Med Rep. (2022) 29:101959. doi: 10.1016/j.pmedr.2022.101959

PubMed Abstract | CrossRef Full Text | Google Scholar

70. Kharel M, Sakamoto JL, Carandang RR, Ulambayar S, Shibanuma A, Yarotskaya E, et al. Impact of COVID-19 pandemic lockdown on movement behaviours of children and adolescents: a systematic review. BMJ Global Health. (2022) 7(1):e007190. doi: 10.1136/bmjgh-2021-007190

PubMed Abstract | CrossRef Full Text | Google Scholar

71. Andermo S, Hallgren M, Nguyen TTD, Jonsson S, Petersen S, Friberg M, et al. School-related physical activity interventions and mental health among children: a systematic review and meta-analysis. Sports Med Open. (2020) 6:25. doi: 10.1186/s40798-020-00254-x

PubMed Abstract | CrossRef Full Text | Google Scholar

72. Costello EJ. Early detection and prevention of mental health problems: developmental epidemiology and systems of support. J Clin Child Adolesc Psychol. (2016) 45(6):710–7. doi: 10.1080/15374416.2016.1236728

PubMed Abstract | CrossRef Full Text | Google Scholar

73. Biglan A, Mrazek PJ, Carnine D, Flay BR. The integration of research and practice in the prevention of youth problem behaviors. American Psychologist. (2003) 58(6-7):433. doi: 10.1037/0003-066X.58.6-7.433

PubMed Abstract | CrossRef Full Text | Google Scholar

74. Membride H. Mental health: early intervention and prevention in children and young people. Br J Nurs. (2016) 25(10):552–7. doi: 10.12968/bjon.2016.25.10.552

PubMed Abstract | CrossRef Full Text | Google Scholar

75. Bernaras E, Jaureguizar J, Garaigordobil M. Child and adolescent depression: a review of theories, evaluation instruments, prevention programs, and treatments. Front Psychol. (2019) 10:543. doi: 10.3389/fpsyg.2019.00543

PubMed Abstract | CrossRef Full Text | Google Scholar

76. Asare M, Danquah SA. The relationship between physical activity, sedentary behaviour and mental health in Ghanaian adolescents. Child Adolesc Psychiatry Ment Health. (2015) 9(1):1–8. doi: 10.1186/s13034-015-0043-x

PubMed Abstract | CrossRef Full Text | Google Scholar

77. Rodriguez-Ayllon M, Cadenas-Sánchez C, Estévez-López F, Muñoz NE, Mora-Gonzalez J, Migueles JH, et al. Role of physical activity and sedentary behavior in the mental health of preschoolers, children and adolescents: a systematic review and meta-analysis. Sports Med. (2019) 49(9):1383–410. doi: 10.1007/s40279-019-01099-5

PubMed Abstract | CrossRef Full Text | Google Scholar

78. Arat G, Wong PW-C. The relationship between physical activity and mental health among adolescents in six middle-income countries: a cross-sectional study. Child Youth Serv. (2017) 38(3):180–95. doi: 10.1080/0145935X.2017.1297202

CrossRef Full Text | Google Scholar

79. Abid R, Ammar A, Maaloul R, Souissi N, Hammouda O. Effect of COVID-19-related home confinement on sleep quality, screen time and physical activity in Tunisian boys and girls: a survey. Int J Environ Res Public Health. (2021) 18:3065. doi: 10.3390/ijerph18063065

PubMed Abstract | CrossRef Full Text | Google Scholar

80. Wong SMY, Li YY, Hui CLM, Wong CSM, Wong TY, Cheung C, et al. Impact of restrictive COVID-19 measures on daily momentary affect in an epidemiological youth sample in Hong Kong: an experience sampling study. Curr Psychol. (2022). doi: 10.1007/s12144-022-03183-y

CrossRef Full Text | Google Scholar

81. Braksiek M, Lindemann U, Pahmeier I. Physical activity and stress of children and adolescents during the COVID-19 pandemic in Germany-A cross-sectional study in rural areas. Int J Environ Res Public Health. (2022) 19(14):8274. doi: 10.3390/ijerph19148274

PubMed Abstract | CrossRef Full Text | Google Scholar

82. Yanovski JA, Yanovski SZ, Sovik KN, Nguyen TT, O'Neil PM, Sebring NG. A prospective study of holiday weight gain. N Engl J Med. (2000) 342:861–7. doi: 10.1056/NEJM200003233421206

PubMed Abstract | CrossRef Full Text | Google Scholar

83. Spruit A, Assink M, van Vugt E, van der Put C, Stams GJ. The effects of physical activity interventions on psychosocial outcomes in adolescents: a meta-analytic review. Clin Psychol Rev. (2016) 45:56–71. doi: 10.1016/j.cpr.2016.03.006

PubMed Abstract | CrossRef Full Text | Google Scholar

84. Brown HE, Pearson N, Braithwaite RE, Brown WJ, Biddle SJ. Physical activity interventions and depression in children and adolescents. Sports Med. (2013) 43(3):195–206. doi: 10.1007/s40279-012-0015-8

PubMed Abstract | CrossRef Full Text | Google Scholar

85. Ruotsalainen H, Kyngäs H, Tammelin T, Kääriäinen M. Systematic review of physical activity and exercise interventions on body mass indices, subsequent physical activity and psychological symptoms in overweight and obese adolescents. J Adv Nurs. (2015) 71(11):2461–77. doi: 10.1111/jan.12696

PubMed Abstract | CrossRef Full Text | Google Scholar

86. González SA, Godoy R, Veas P. Science and technology congress for preschoolers as a strategy for the initiation of science. Early Child Dev Care. (2020) 190:594–614. doi: 10.1080/03004430.2018.1485672

CrossRef Full Text | Google Scholar

87. Glasziou PP, Sanders SL. Investigating causes of heterogeneity in systematic reviews. Statist Med. (2002) 21:1503–11. doi: 10.1002/sim.1183

CrossRef Full Text | Google Scholar

88. Langan D. Assessing heterogeneity in random-effects meta-analysis. In: Evangelou E, Veroniki AA, editors. Meta-research. Methods in molecular biology, vol 2345. New York: Humana (2022) 2345:67–89.