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Changes in Pediatric Movement Behaviors During the COVID-19 Pandemic by Stages of Lockdown in Ontario, Canada: A Longitudinal Cohort Study

Priya Patel, Xuedi Li, Charles D.G. Keown-Stoneman, Leigh M. Vanderloo, Laura M. Kinlin, Jonathon L. Maguire, and Catherine S. Birken

Background: Children’s movement behaviors have been affected by the COVID-19 pandemic; however, little is known regarding movement behavior patterns over time by government-issued lockdowns. Our primary objective was to evaluate how children’s movement behaviors changed by stages of lockdown/reopening in Ontario, Canada, from 2020 to 2021. Methods: A longitudinal cohort study with repeated measures of exposure and outcomes was conducted. The exposure variables were dates from before and during COVID-19 when child movement behavior questionnaires were completed. Lockdown/reopening dates were included as knot locations in the spline model. The outcomes were daily screen, physical activity, outdoor, and sleep time. Results: A total of 589 children with 4805 observations were included (53.1% boys, 5.9 [2.6] y). On average, screen time increased during the first and second lockdowns and decreased during the second reopening. Physical activity and outdoor time increased during the first lockdown, decreased during the first reopening, and increased during the second reopening. Younger children (<5 y) had greater increases in screen time and lower increases in physical activity and outdoor time than older children (≥5 y). Conclusions: Policy makers should consider the impact of lockdowns on child movement behaviors, especially in younger children.

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Association of Physical Activity and Cardiometabolic Risk in Children 3–12 Years

Leigh M. Vanderloo, Jonathan L. Maguire, David W. H. Dai, Patricia C. Parkin, Cornelia M. Borkhoff, Mark S. Tremblay, Laura N. Anderson, Catherine S. Birken, and on behalf of the TARGet Kids! Collaboration*

Background: This study aimed to examine the association between physical activity (PA) and a total cardio metabolic risk (CMR) score in children aged 3–12 years. Secondary objectives were to examine the association between PA and individual CMR factors. Methods: A longitudinal study with repeated measures was conducted with participants from a large primary care practice-based research network in Toronto, Canada. Mixed effects models were used to examine the relationship between parent-reported physical activity and outcome variables (total CMR score, triglycerides, glucose, high-density lipoprotein cholesterol, systolic blood pressure, waist circumference, weight-to-height ratio, and non-high-density lipoprotein cholesterol). Results: Data from 1885 children (6.06 y, 54.4% male) with multiple visits (n = 2670) were included in the analyses. For every unit increase of 60 minutes of PA, there was no evidence of an association with total CMR score (adjusted: −0.02 [−0.014 to 0.004], P = .11]. For the individual CMR components, there was evidence of a weak association between PA and systolic blood pressure (−0.01 [−0.03 to −0.01], P < .001) and waist-to-height ratio (−0.81 [−1.62 to −0.003], P < .001). Conclusion: Parent-reported PA among children aged 3–12 years was not statistically associated with total CMR, but was weakly associated with systolic blood pressure and waist-to-height ratio.

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Associations Between Meeting the 24-Hour Movement Guidelines and Cardiometabolic Risk in Young Children

Leigh M. Vanderloo, Jonathan L. Maguire, Charles D.G. Keown-Stoneman, Patricia C. Parkin, Cornelia M. Borkhoff, Mark S. Tremblay, Laura N. Anderson, Catherine S. Birken, and on behalf of the TARGet Kids! Collaboration*

Introduction: The authors aimed to examine the association between meeting the integrative movement behavior guidelines (physical activity, screen viewing, and sleep) and cardiometabolic risk (CMR) factors in young children. Methods: In this cross-sectional study, physical activity, screen viewing, and sleep were assessed using parent-reported data. The 24-Hour Movement Guidelines for the Early Years (0–4 y) were defined as 180 minutes of physical activity/day (of which ≥60 min should be moderate-to-vigorous intensity), ≤1 hour of screen viewing/day, and 10 to 13 hours of sleep/night. Waist circumference, glucose, high-density lipoprotein cholesterol, triglycerides, and systolic blood pressure were measured in a clinical setting by trained staff. A total CMR score and individual CMR factors served as primary and secondary outcomes, respectively. Results: Of the 767 participants (3–4 y), 26.4% met none of the guideline’s recommendations, whereas 41.3%, 33.1%, and 10.6% of the sample met 1, 2, or all 3 recommendations, respectively. The number of recommendations met was not associated with the total CMR score or individual CMR factors (P > .05), with the exceptions of high-density lipoprotein (odds ratio = 1.61; 95% confidence interval, 1.11 to 2.33; P = .01). Conclusion: Meeting the 24-Hour Movement Guidelines in early childhood was not associated with overall CMR, but was associated with favorable cholesterol outcomes.