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

Abstract

BackgroundThe COVID-19 pandemic has greatly affected the level of physical activity (PA). However, little is known about its effect on health outcomes.MethodsArticles 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 (I2 ≥ 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.ResultsThirty-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%).ConclusionDuring 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.

COVID-19 and Sleep Disturbances: A Literature Review of Clinical Evidence

“…The impact of the COVID-19 pandemic has affected sleep in various ways through cytokine release, neuro-inflammation, and other ways discussed later in this review. The psycho-sociological effects of social distancing, isolation, and quarantine measures manifested as loneliness, detachment, boredom, and loss of freedom [ 7 , 13 , 14 , 15 , 16 , 17 ]. This diminished coping mechanisms, which likely contributed to new mental health issues.…”

“…This diminished coping mechanisms, which likely contributed to new mental health issues. As we already know, any amount of mental health concerns is an obvious link to sleep disturbances and vice-versa [ 7 , 13 , 14 , 15 , 16 , 17 ]. The increased morbidity and mortality in society further aggravated stress and led to sleep disorders.…”

“…Research studies indicate the link between infectious disease outbreaks and sleep dysfunction [ 9 , 10 , 11 , 12 ]. Similarly, associations between infectious outbreaks and sleep dysfunction can be applied during this COVID-19 pandemic in the setting of physical illness, separation from family and friends, environmental stresses, social isolation, and prior poor mental health [ 13 , 14 , 15 , 16 , 17 ]. Jaharmi et al, describe sleep changes as a common symptom among COVID-19-infected individuals [ 8 ].…”

Physical, psychological, and behavioral problems among children and adolescents in countries with different economic statuses during the COVID-19 pandemic: a systematic review and meta-analysis

“…Another meta-analysis reported a significant drop in the frequency of moderate-to-vigorous activities and step counts for those aged from 4 to 18 years ( 6 ). A decrease in PA has been significantly associated with psychological problems, including anxiety and depression symptoms, in children and adolescents during the pandemic ( 7 , 8 ). A large meta-analysis reported that the prevalence of anxiety and depression among children and adolescents could reach 19% [95% confidence interval (CI): 14%, 25%, data from 22 studies] and 15% (95% CI: 10%, 21%, data from 16 studies), respectively ( 9 ).…”

Urban Living Environment and Myopia in Children

“…First, the optometry results used for diagnosing myopia were conducted under nonciliary muscle paralysis, which may have led to an overestimation of the prevalence of myopia among students. Second, our study relied on myopia data collected from 2021 to 2023, during which the COVID-19 pandemic impacted regular urban living environments, potentially introducing variations in the analysis of the role of urbanization compared with previous years . Choi et al found a correlation between the size of one’s residence and both axial length and refractive error.…”