Physical activity (PA) is a very important aid to maintain children’s health1 and increasing it during childhood increases the likelihood of a general practice of PA throughout life,2 which can help reduce the risk of chronic disease, as low levels of PA (or high levels of sedentary behavior) are associated with short- and long-term negative psycho-physiological health consequences.3,4
Failure to meet recommendations for sufficient PA and increasing screen time have been well-documented among children and youth worldwide for decades.5 For the same period, a negative trend for physical fitness6 and overweight7,8 was also well documented. These parameters were considered conditioned by each other, so the assumption is that increasing PA would produce a favorable trend of the remaining parameters,9,10 that is, stop, or at least mitigate, this adverse trend. In order to achieve this, it is necessary to mark/state the current position, that is, accurately diagnose the current condition, and later act promptly to improve the existing condition. It is recommended to periodically monitor the previously mentioned parameters in order to control their change and control the validity of policies implemented by the community in order to improve them.
Despite the methodology that monitors PA, physical fitness and obesity of children and youth have been established and documented; however, Montenegro has not investigated these aspects. Following the good practice and benefits of having an established system, like one that exists in Slovenia, Montenegro decided to make their own system that will promote and monitor PA and physical fitness. Therefore, led by experience from neighboring countries such as Slovenia, Montenegro has recognized the need to establish a system for monitoring and promoting PA and physical fitness in children and youth. Based on the experience of one of the best global examples of a surveillance system for physical and motor development of children, and youth, which is initiated by the Active Healthy Kids Global Alliance (AHKGA), and currently includes 57 territories (54 countries and 3 regions). Collection of all available data across the country has started, at the same time, a beginning of the creation of a new system that can identify and target the needs of Montenegrin society.
The aim of this study was to summarize the results of the Montenegrin 2022 Report Card on PA for children and youth, which is used to evaluate, and grade, the present state, and offer a good foundation for the creation of a prospective evaluation/tracking system. A secondary aim was to identify undertreated, or underdeveloped, more narrow research areas in Montenegro, and find the best way to prevent/solve the issues in terms of observed negative trends in physical inactivity and increased screen time and therefore to offer more content for the active outdoor play and more time spent outdoor.
Methods
Following the methodology established by the AHKGA,5 Montenegro’s 2022 Report Card was prepared and conceived by an expert consortium (Montenegrin Research Team) composed of researchers from several institutions. The initiative came from 3 researchers from the Faculty of Sports and Physical Education, University of Montenegro and was supported by the Western Balkan Sport Innovation Lab (1 member) and Center for Corrective Gymnastics Niksic (1 member). The methodology is reflected in the assessment of individual behavior, health-related characteristics of Montenegrin children and adolescents, and also in the assessment of environmental influences. The Montenegrin 2022 Report Card included 10 indicators (overall PA, organized sport and PA, active play, active transportation, sedentary behaviors, physical fitness, family and peers, school, community and environment, and government), endorsed by the Global Matrix 4.0, and 2 facultative indicators (sleep duration and obesity) chosen according to the previous good practices from neighboring countries. Furthermore, to evaluate each of these indicators, the standardized benchmarks and grading scheme provided by the AHKGA was used.5 A 14-point grading scale was employed, the grades were defined according to the percentage of children who met the established criteria: A+ = 94% to 100%, A = 87% to 93%, A− = 80% to 86%, B+ = 74% to 79%, B = 67% to 73%, B− = 60% to 66%, C+ = 54% to 59%, C = 47% to 53%, C− = 40% to 46%, D+ = 34% to 39%, D = 27% to 33%, D− = 20% to 26%, F = 0% to 19%, and INC = incomplete, insufficient, or inadequate information to assign a grade. Corresponding numerical values of this for grades is necessary for calculating the average grade for all indicators, range from 15 points for an A+ grade to 2 points for an F grade.5 The grades were evaluated, analyzed, and assigned according to data found in articles that were available and published until January 2022. The grey literature, government and nongovernment reports, and online content from this same time period was reviewed. Google scholar and electronic databases (PubMed, Scopus, and Web of Science) were searched. Google was used to searched for government and nongovernment reports, and online content needed to evaluate the 12 indicators (Figure 1).
—All 22 published resources used to evaluate the 12 indicators.
Citation: Journal of Physical Activity and Health 22, 2; 10.1123/jpah.2024-0323
When there was a conclusion from multiple studies, a grade was constructed as an average calculated between the groups. The data were synthesized, and a set of benchmarks was used to assign the grades (the results of all available research for a particular indicator were collected, and the obtained value was divided by the total number of researches). Final grades were completed upon consensus of 2 researchers independently rating the studies. If there were any observed differences, the final grade was decided by mutual agreement.
Results
Various factors were taken into consideration when grades were awarded (research articles, government and nongovernment reports, and online content). The ratings for each indicator are shown in Table 1.
Grades and Rationales for Montenegro 2022 Report Card
| Indicator | Grade | Rationale |
|---|---|---|
| Overall physical activity | C− | 34.71% of preschool children in Montenegro accumulate at least 20–30 min of exercise and running 4 d or more per week; 49.7% of children accumulate at least 20–30 min of exercise and running 3 d or more per week; 15.5% of children accumulate at least 20–30 min of exercise and running 2 or less days per week.11 |
| Organized sport and physical activity | C | 47.8% of school children (aged 6–9 y) in Montenegro were members of a sport or dancing club.12 |
| Active play | B | Approximately 70.96% of preschool children and school children (aged 6–9 y) in Montenegro were engaged in unstructured/unorganized active play at least 1 h/d.11,12 |
| Active transportation | D+ | 38.6% of school children (aged 6–9 y) in Montenegro traveled to school by a combination of active transport and motorized vehicles.11 |
| Sedentary behaviors | B | Approximately 72.1% of preschool children and school children (aged 6–9 y) in Montenegro meet the recommendation of no more than 2 h of recreational screen time per day.11,12 |
| Physical fitness | C+ | The fitness capacity of boys and girls (school students aged 13–16 y) in Montenegro was approximately 57.67 and 52.89 tabular centiles, respectively.13–21 |
| Family and peers | A | 95.43% of parents in Montenegro encouraged their children (preschool children) to be physically active, 87.26% of parents participated in physical activities with children, and 75.05% were providing logistic support for physical activity (30.03% of them paid a fee).11 |
| School | A− | 100% of schools in Montenegro provide mandatory physical education hours 2 to 3 times per week to their students; 45% of students in elementary school classes and 100% in secondary school classes are taught by a physical education specialist; over 60% of the schools have school sport halls (remaining schools have outdoor courts and organize classes there), and less than 0.5% of students avoid physical education classes for various reasons.22–24 |
| Community and environment | C | 55.01% of the Montenegrin preschool children parents described their neighborhood safe to some extent, while only 5.01% of the parents described their neighborhood safe without a doubt (for their child to play outside with peers and without adult supervision).11 |
| Government | C | Promotion strategies and initiatives exist in the Government of Montenegro documents, but they are more focused toward professional sports, and less improvement of physical activity opportunities (school and leisure sports) for children and adolescents across the country is evident; the evaluation of program and strategy fulfillment is unknown; sports budget for 2022 has been reduced.25–29 |
| Sleep duration | A+ | 87.8% of school children (aged 6–9 y) in Montenegro slept for 9–11 h per night, while most of the remaining 12.2% are children who sleep more than 11 h.12 |
| Obesity | B− | Approximately 61.4% of boys and 70.55% of girls from Montenegrin elementary school (aged 6–12 y) were in category normal weight.30–32 |
Overall PA
Three studies evaluating the PA of children and youth in Montenegro have been found, but only one used objective tools to evaluate the overall PA. Studies that evaluated PA based on the parameters sports, walk to school, or outdoor play were excluded because the task of this study was to measure organized sports, active transportation, and active play as separate categories. A study conducted by Bjelica et al11 was accepted as the only acceptable one for forming a grade for the parameter of overall PA of children in Montenegro. A sample used included 1356 parents of preschool children from 24 Montenegrin municipalities. The main finding was that 34.71% of children generate minimum 20 to 30 minutes of exercise and running 4 days or more per week, 49.7% of children accumulate at least 20 to 30 minutes of exercise and running 3 days or more per week, and 15.5% of children accumulate at least 20 to 30 minutes of exercise and running 2 or less days per week. Based on these findings, it cannot be concluded how many children met the minimum recommended by the World Health Organization of 60 minutes of moderate to vigorous PA per day,33 but if the data on the parameters examined later (organized sport and PA active play, active transportation, and sedentary behaviors) are taken into account, the score could only be higher than the percentages shown above. Therefore, the overall PA indicator was graded as C.
Organized Sport and PA
Two studies that investigated evaluation of the participation of children and adolescents in organized sport were analyzed.11,12 The results of the first study11 revealed that only 25% of preschool children participate in organized sport or PA programs. Most of them were involved in the practice of basketball (28.41%), dance (22.52%), football (19.30%), martial arts (17.42%), and tennis clubs (4.02%) while other children (8.33%) found their place in other sports clubs. The results of the second study12 showed that 47.8% of children were members of a sport or dancing club. The sample of this study include 3179 family members (usually a parents/guardians) of children 6–9 years of age, randomly selected (to create a nationally representative sample; 1589 boys and 1590 girls) from Montenegro. Given that the first study included only preschool children and that the usual start of inclusion in organized sports occurs later, the second study, in which the sample is more comprehensive (children aged 6–9 y), was considered more representative for reaching a final conclusion. Therefore, the organized sport and PA indicator was graded as C.
Active Play
Based on the 2 previous studies, an evaluation of the participation of children in active play was performed.11,12 According to the results of the Bjelica et al11 study, 44.98% of children play actively at least 30 min/d, and 64.53% of children prefer to play outdoors than in their homes. According to the results of the Whiting et al12 study, there are many more children who participate in active play, at least 1 hour/day actively playing, even a 96.4% of children in Montenegro. Since it was difficult to give preference to 1 of the studies, the mean value (70.96%) was used to reach the final conclusion, on the basis of which the active play indicator was graded as B.
Active Transportation
Unfortunately, only one study contains information to evaluate the widespread use of active transport to get to and from places among children in Montenegro.12 This study indicates that in Montenegro, 38.6% children traveled to school by a combination of active transport and motorized vehicles.12 Since it is not possible to separate which of these 2 ways traveled to school prevails, reducing the grade that will be awarded for this parameter was considered. However, as the questions asked to the parents did not include transport to the park, mall, or friends’ house (which could increase the percentage of positive answers), only to the school, so, it was decided that the score for this parameter be in line with the above-mentioned percentages. Therefore, the active transportation indicator was graded as D+.
Sedentary Behaviors
Evaluation of sedentary behaviors was performed by recreational screen time (per day) data (television, computer, gaming, internet, and mobile phone) retrieved from studies mentioned in the previous paragraphs.11,12 The results of the Bjelica et al11 study indicated that 94.2% of children met the recommendation of no more than 2 hours of recreational screen time per day, while the results of the Whiting et al12 study indicate that this percentage is lower and that this recommendation was met bythe children.50% of children. Since the advantage of 1 of the studies was difficult to determine, the mean value (72.1%) was used to reach the final conclusion on the basis of which the sedentary behaviors, thus thisindicator was graded as B.
Physical Fitness
Nine studies conducted in Montenegro up until 2021 that investigated physical fitness evaluation were used in the further analysis.13–21 The complete sample gathered a total of 1807 school children (1108 boys and 699 girls), aged 13–16 years, from different Montenegrin municipalities. In each study, the EUROFIT test battery was applied to measure components of physical fitness, which made this analysis sufficiently comparable. The results achieved by Montenegrin boys and girls are estimated with the international normative values of physical fitness based on the normative values published by Tomkinson et al.34 Nine motor skills tests were found and evaluated (in tabular centiles): flamingo balance (n/60 s), plate tapping (in seconds), sit and reach (in centimeters), standing broad jump (in centimeters), handgrip (kilograms), sit ups (n/30 s), bent arm hang (in seconds), 10 × 5 m agility shuttle run (in seconds), and 20-m shuttle run (in seconds). The mean results (9 mentioned studies) achieved in fitness capacity was 57.67 tabular centiles in boys and 52.89 tabular centiles in girls. Based on these, the physical fitness indicator is graded as C+.
Family and Peers
Objective tools to evaluate the influence of family and peers on participation of children in sports and PA was limited in the study of Bjelica et al.11 The results showed that 95.4% of parents encouraged children to be physically active, 87.3% of parents participated in physical activities with children, and 75.0% were providing logistic support for PA (30.0% of them were paid a fee).11 These facts undoubtedly confirm that a large majority of parents in Montenegro participate in children’s PA on a daily basis; consequently, the family and peers indicator cannot be graded lower than A.
School
Based on several parameters (mandatory physical education classes, physical education specialist in teaching, infrastructure, and avoidance of physical education classes), as described below, an evaluation of the PA in school was performed. In Montenegro, physical education classes are mandatory in both primary and secondary schools and according to official data from the Ministry of Education, Science, Culture, and Sports,22–24 On hundred percent of schools in Montenegro provide mandatory physical education classes 2 to 3 times per week to their students. The number of compulsory physical education classes vary by grade (3 classes per week for first to sixth grade students, 2 h/wk for seventh to ninth grade students, and 2 h/wk for all grades of students in secondary school). The educational structure of teachers directly involved in conducting the PE classes also varies by grade. In elementary school, classroom teacher and physical education specialist with a university degree share classes (from first to third grade of elementary school, the provider of physical education classes are classroom teachers exclusively; in fourth and fifth grades, the provider can be both classroom teacher and physical education specialist; and from sixth to ninth grade, the providers are physical education specialists, exclusively), while in the secondary school classes can be taught by a specialist exclusively.35 The majority of students are taught by a physical education specialist (in 45% elementary schools classes and in 100% secondary school classes). Further, the sports infrastructure that schools in Montenegro possess differ from case to case. Over 60% of the schools have the school sport halls, while remaining schools have outdoor courts and organize classes there.35 Finally, we would like to acknowledge that an extremely small percentage of students (lower than 0.5%), does not participate in PE classes, and the reasons vary.35 Based on all the above, school indicator was graded as A−.
Community and Environment
The only data available on community and environment can be found in the study of Bjelica et al11 and is attached to the opinion of parents about the safety of the neighborhood in which they live. The main findings of this mentioned study have revealed that 50% of the parents described their neighborhood as safe to some extent, while only 5.0% of the parents described their neighborhood as safe for their child to play outside with peers and without adult supervision. Since those data do not allow adequate evaluation of community and environment, it was decided that the grade for this parameter be 1 degree lower than the percentages show. Therefore, the community and environment indicator was graded as C.
Government
An evaluation of government activity in the field of PA and sport was performed by searching for official documents available online,26,28 the content of which will be are discussed/summarized below. Within the fourth priority of the Government’s Work Program for 2021 “Education and knowledge-based society,” the necessity of sports development in children and youth was recognized as recommending, children and youth should compete in the spirit of sports from kindergarten to university. Also, one of the goals is to increase by 10% of students engaged in sports extracurricular activities in 2021.25,26 Further, the Sport Development Strategy 2018–2021 focuses on improving the work of sport organizations and spreading the idea of children, students, and persons with disabilities engaging in sport; promotion of, and support of excellence in sport; improved infrastructure and fostering research, development, education, and expertise in sport; putting in place the assumptions for preparation, participation, and achieving top results in the Olympic Games, Paralympics, and other significant international sport competitions; as well as professional development in sport; and strengthening international cooperation.26,27 Finally, the budget for sports, in 2022, envisages less funds for national sports federations than was the case in 2021.28,29 According to the official data, the existence of promotion strategies and initiatives are obvious. On the other hand, the focus is directed toward professional sports less to PA for children because the lack of multiannual strategy that would improve PA opportunities (school and leisure sports) for children and adolescents across the country is evident. If we add to this that the sports budget has been reduced, while the evaluation of program and strategy fulfillment is unknown, it is impossible to grade this parameter above average. Therefore, the government indicator was graded as C.
Sleep Duration
Sleep duration was evaluated by data retrieved from the already mentioned Whiting et al study.12 The results showed that 87.8% of children slept for 9 to 11 hours per night, while most of the remaining 12.2% slept more than 11 hours per night.12 Given that the previous literature supports longer sleep in children,36 this indicator can be rated the highest. Therefore, the sleep duration indicator was graded as A+.
Obesity
There are numerous studies evaluating the obesity of children and adolescents in Montenegro; however, since most of them were conducted a long time ago, they cannot represent the current situation or, if included there were insufficiently large samples related to a specific location therefore they too were excluded as they were considered as insufficiently representative. Therefore, it was decided to evaluate the obesity of children in Montenegro on the basis of data from the latest World Health Organization Childhood Obesity Surveillance Initiative study and data from the website of the Faculty for Sport and Physical Education, University of Montenegro.30–32 The results of the first study show that 37.4% of boys and 28.8% of girls (aged 7 y) in Montenegro were classified as overweight (including obesity), while 0.8% of boys and 1% of girls were classified as underweight.30 On the other hand, the results of the second study show that 32.7% of boys and 21.4% of girls (aged 6–9 y) in Montenegro were classified as overweight (including obesity), while 6.3% of boys and 7.7% of girls were classified as underweight. The sample in the first study included 1683 randomly selected children (to create a nationally representative sample), while the sample of the second study included 4565 children, from 22 out of 24 Montenegrin municipalities. As it was difficult to give preference to one of the studies, a mean value (61.4% of normally fed boys and 70.55% of normally fed girls) was used to reach a final conclusion based on which the obesity indicator was graded as B−.
Discussion
The Montenegrin Research Team has created the first Montenegrin 2022 Report Card on PA for children and youth. Based on the results synthesized from the available data, the average grade for all indicators is B− (an average of 9.5 points for 10 AHKGA mandatory indicators or 10 points if 2 additional elective indicators are considered). Individual indicators were rated very differently: 6 indicators were rated above average (3 of each in the range of grades A and B), while the remaining 6 were rated slightly lower (5 in the range of grade C, and 1 in the range of grade D), and in this way, it is clear which parameters can be improved.
The best rated groups, in the range of grade A, are additional indicators of sleep duration, family and peers, and school. It is interesting to highlight the highest grade for indicator, sleep duration (A+), says that children in Montenegro do not sleep less than is recommended (per night). From the 23 countries covered by the Childhood Obesity Surveillance Initiative study, they are in a high 11th place, ahead of Italy, Denmark, Romania, and Bulgaria.12 However, although this maximum grade suggests that the condition of the field is great, the study by Whiting et al12 reports that about 10% of Montenegrin children sleep longer than 11 h a day. Future studies should investigate this phenomenon further since the literature suggests that longer than usual sleep duration (per night) may be an indicator of poor physical and mental health.37–39 A high score for the family and peers (A) indicator confirms that a high percentage of parents take part in children’s PA and encourage them to participate in some activities by themselves and that is higher compared with their counterparts in far more developed European countries such as Czech Republic, Slovenia, and Finland,40–42 which is extremely encouraging because it indicates that parents understand the importance of being active, for both the health of children, and their own personal health. Indicator school (graded as A−) was graded high in the following areas: number of physical education classes, a high percentage of qualified personnel, and a low number of students who do not attend physical education classes for various reasons. According to the number of physical education classes and a percentage of qualified personnel Montenegro can be compared here with the Czech Republic as well40 but not with Slovenia.41 However, the high percentage of children who are always present in physical education classes is extremely encouraging and could, perhaps, be indicative of their personal awareness related to the benefits of PA, among other factors (not necessarily though).
The group of indicators rated in the range of grades B are active play, sedentary behaviors, and additional indicator obesity. Grades B for both active play and sedentary behaviors confirms children and youth in Montenegro adopted adequate habits, both for active playing and screen-related habits, and that they spend more time playing outside and less in front of screens inside than their counterparts in France, the Netherland, and Germany.43–45 Grade B− for additional indicator obesity would seem that at first glance, it also indicates an extremely favorable situation when it comes to the body composition of children and youth. However, 38.6% and 29.45% of overweight and obese boys and girls, respectively, point to the obligation of the community to be more active in solving this extremely important problem in the future because 35 years ago, the number of overweight and obese adolescents in Montenegro was far lower.6,46–48
The group rated in the rank of grade C are the largest number of indicators, 5 of them, physical fitness, organized sport and PA, community and environment, government, and overall PA. Grade C+ for physical fitness confirms that children and youth achieved good scores on certain physical fitness indicators based on the EUROFIT normative values and that they are here on a par with their counterparts in a far more developed European country such as the Czech Republic.40 However, the backlog for their counterparts in France and Slovenia is noticeable41,43 and shows that there is still room for improvement. Grade C for the next 3 indicators, organized sport and PA, community and environment, and government, suggest that some results have been achieved in these fields but that there is still plenty of room for improvement. For example, percentage of children who are inactive in sports is large (52.2%), which is not common in Denmark, Germany, Spain, or Sweden.45,49–51 Also, the fact that almost 45% of Montenegrin parents believe that their neighborhood is not safe enough for their children is a concerning. Unfortunately, the study from which this data was taken11 does not give further explanations of parent concerns regarding safety of their kids. This information would have revealed more about the security, and some recommendations would be able to be considered. Another finding of this study was parents do not allow their children to play outside if there is a concern regarding security. In contrast, parents have a strong agreement that if the safety issue might be decreased, participation in PA would surely increase. This study indicated those issues that might improve several indicators from this study and enable them to have a higher rating. More investment in professional sports, compared with school, and leisure sports is also an extremely big problem and an alarm to pay special attention to this fact in the future. Last, grade C− for overall PA confirms that PA among children in Montenegro is not at the recommended level, mostly because just one-third of the participants were actively engaged in an extracurricular PA for a minimum of 4 days a week and for at least 20 minutes. These indicators are rated much worse than in Slovenia,41 a country from the region whose example should be followed.
The only indicator rated in the D rating range is active transportation, with grade D+. This shows that children and youth in Montenegro do not have habits at the level of their counterparts across Europe. Only 38.6% of Montenegrin children commute to school by a combination of active transport and motorized vehicles, which indicates that the number of children who do so exclusively by active transport may be half as small. This data is not at the level of the European average because only Poland reported a similar situation,52 so the alarm when it comes to this indicator should not be commented on. It has to be noted that there is a general opinion that towns and cities in Montenegro are not equipped with enough cycling lanes and that traffic generally is not considered friendly for cyclists, in terms of safety.35,53 One of the reasons why cycling and walking are not considered more is the absence of pedestrian and bicycle infrastructure, as well as the actual or perceived dangers of walking and cycling9; it is recommended that in the future, attention should be focused on the construction of cycling paths and the improvement of safety in Montenegrin traffic. Also, more attention should be paid to better education of students in relation to traffic rules, as well as the practical mastery of special bicycle polygons. Special attention was paid to this in the era of socialism, when cycling had a great primacy, as a very important cyclical movement structure.
These results reflect the present situation in Montenegro through evaluation of all available scientific articles as well as grey (nonscientific, official documents) literature, such as government and nongovernment reports, and online content, because, it represents a tool for the creation of a system for monitoring the PA and physical fitness of children and youth in Montenegro and also for preparation of adequate development strategy at the national level. This study and its findings can be of great use to the decision makers when offering a practitioner appropriate guidelines on how to manage PA and physical fitness for children and adolescents in Montenegro. Moreover, scientists will get useful feedback for which directions further studies should go.
If all parameters of the Montenegrin 2022 Report Card on PA for children and youth are taken into account, the overall condition can be described as above average in general. Children in Montenegro have a long enough sleep (which is very important in the aspect of growth and development, ie, adequate functioning of the central nervous system and endocrine glands), they have strong support from their parents (encouragement, material support, and understanding) to deal with sports, have adequate human and organizational potential for PA in schools, have adequate healthy habits (more time is dedicated to outdoor activities, in play, compared with activities in front of screens, at home). On the other hand, the percentage of overweight and obese children is not negligible (should aim for it to be lower), and the fitness potential of children and the engagement of children in sports clubs are not enough (they should aim for it to be higher). Therefore, the active lifestyle of children and youth in Montenegro should continue to be intensively promoted. More activity in school and sports clubs would improve body composition and physical fitness. Finally, the community’s focus on creating a safe environment and investing in “sport for all” is also not sufficient because the results show that the volume of total PA and the percentage of children walking and cycling to school are graded lowest. Improving safety would be the ultimate goal so children and adolescents would be able to achieve more diverse content in the environment (eg, safe bike paths), body composition, physical fitness, and active transportation; thus, overall PA can be improved.
Despite new findings that this study provides, we would like to acknowledge certain limitations. If we review the quantity of the studies based on which the grades were awarded, it is still insufficient. Five out of 12 indicators were extracted from the only study written 8 years ago. This study was specific because it was the only study that was investigating these issues in Montenegrin society. Also, the 2 most used studies11,12 cover the age from preschool children to children aged 9 years, so any conclusion that included the entire population of children and adolescents might have serious limitations; therefore, the findings cannot be generalized. However, compared with a study conducted several years ago,35 a step further has been taken because the quality of collected the data is now higher. In the future, the diagnosis of PA for children and youth should be carried out periodically because it is necessary to monitor the situation in the field and its changes; thus, every flaw of this report card will be turned into additional strength, as a recommendation to researchers for further work, because it is now known which parameters need to be further tested and which parameters need to be more precisely assessed.
Conclusions
Based on the results synthesized from the available data, the average grade for all indicators is B− (average 9.5 points for 10 AHKGA mandatory indicators or average 10 points if considerate 2 additional elective indicators). Individual indicators were rated very differently: 6 indicators were rated above average (3 of each in the range of grades A and B) while the remaining 6 were rated slightly lower (5 in the range of grade C and 1 in the range of grade D), and in this way, it is clear which parameters can be improved. Physical fitness, organized sport and PA, community and environment, government, overall PA, and active transportation are indicators with the lower grades compared with the others, so they should be given the most attention in the future therefore it is clear they can be improved.
Acknowledgments
The authors would like to acknowledge the AHKGA for developing the Report Card methodology, as well as for modifying, and standardizing the benchmarks and grading rubric, and leading this international initiative. Author Contributions: Concept and design: Masanovic. Data collection: Masanovic. Overview of previous studies: Masanovic, Popovic. Data analysis: Masanovic. Writing of the manuscript: Masanovic. Revision of the manuscript: Gardasevic, Banjevic, Petrovic. Results discussion: Gardasevic, Popovic. Reading and approval of the final version of the manuscript: All authors.
References
- 1.↑
Janssen I, LeBlanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010;7(1):40–16. doi:
- 2.↑
Vaquero-Solís M, Iglesias Gallego D, Tapia-Serrano MÁ, et al. School-based physical activity interventions in children and adolescents: a systematic review. Int J Environ Res Public Health 2020; 17(3):999. doi:
- 3.↑
Li L, Zhang J, Cao M, Hu W, et al. The effects of chronic physical activity interventions on executive functions in children aged 3–7 years: a meta-analysis. J Sci Med Sport. 2020;23(10):949–954. PubMed ID: 32360243 doi:
- 4.↑
Katzmarzyk PT, Church TS, Craig CL, Bouchard C. Sitting time and mortality from all causes, cardiovascular disease, and cancer. Med Sci Sports Exerc. 2009;41(5):998–1005. doi:
- 5.↑
Aubert S, Barnes JD, Demchenko I, et al. Global matrix 4.0 physical activity report card grades for children and adolescents: results and analyses from 57 countries. J Phys Act Health. 2022;19(11):700–728. PubMed ID: 36280233 doi:
- 6.↑
Masanovic B, Gardasevic J, Marques A, et al. Trends in physical fitness among school-aged children and adolescents: a systematic review. Front Pediatr. 2020;8:627529. doi:
- 8.↑
NCD Risk Factor Collaboration. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390(10113):2627–2642. doi:
- 9.↑
Emeljanovas E, Mieziene B, Gruodyte-Raciene R. Results from Lithuania’s 2018 report card on physical activity for children and youth. J Phys Act Health. 2018;15:S382–S383.
- 10.↑
Veljovic V, Spalevic Z, Bubanja M, Masanovic B. Body mass index and body fat percentage of police force in Montenegro in different age groups. Nutr Hosp. 2021;38(3):679–680. PubMed ID: 33851536
- 11.↑
Bjelica D, Krivokapic D, Doina Tanase G, et al. The analysis of parents’ attitudes concerning the level of physical activity of their pre-school children. Proceeding of the XVII International Scientific Conference “FIS Communications 2013.” University of Nis; 2013:151–160.
- 12.↑
Whiting S, Buoncristiano M, Gelius P, et al. Physical activity, screen time, and sleep duration of children aged 6–9 years in 25 countries: an analysis within the who European Childhood Obesity Surveillance Initiative (COSI) 2015–2017. Obes Facts. 2021;14(1):32–44. PubMed ID: 33352575
- 13.↑
Idrizovic K, Vlahovic A. Diferencija motoričkog profila fudbalera kadeta i njihovih vršnjaka nesportista [Difference in the motor profile of cadet soccer players and their non-athlete peers]. U Zborniku radova Druge međunarodne konferencije “Sportske nauke i zdravlje”, Panevropski univerzitet “APEIRON”; 2012:57–68.
- 14.
Radulovic B, Krivokapic D. Physical development and physical skills of fourteen years old pupils in Montenegro compared to the peers from European Countries. Sport Mont. 2013;1(37–39):218–224.
- 15.
Radulovic B. Monitoring of dance program effects, as the chosen sports activity in the psysical education course, focused on motor skills transformation of ninth grade pupils. Sport Mont. 2013;1(37–39):225–231.
- 16.
Morina B, Salihu H, Hadzic R. Homogeneity of applied Eurofit test battery with 13-year-old pupils from Kosovo and Montenegro. Sport Sci. 2015;8(2):19–21.
- 17.
Ljubojevic M, Muratovic A, Bubanja M. Effects of various physical education curriculum on motor skills in students of final grades in primary school. Sport Mont. 2016;14(1):25–28.
- 18.
Morina B, Salihu H, Hadzic R. Reliability of Eurofit test battery with children in primary school. Acta Kinesiol. 2017;11(suppl 1):63–66.
- 19.
Morina B, Georgiev G, Hadzic R. Some indicators of fatness and fitness in Kosovian and Montenegro adolescents. Int J Morphol. 2018;36(3):864–870. doi:
- 20.
Morina B, Tahiraj EN, Bahtiri A, et al. Comparative analysis of anthropometric body dimensions between primary school students from Kosovo and Montenegro, in relation to their age. Int J Appl Exerc Physiol. 2018;7(4):41–49.
- 21.↑
Morina B, Miftari F, Badau D. Fitness level differences between students in Kosovo and Montenegro. Educ Sci. 2021;11(3):140. doi:
- 22.↑
Bureau for Education Services. Informator O Devetogodišnjoj Osnovnoj Školi [Information About the Nine-Year Primary School]. Ministarstvo Prosvjete i Nauke i Zavod Za Školstvo; 2004.
- 23.
Bureau for Education Services. Katalog Znanja – Predmetni Program Fizičko Vaspitanje I, II, III, IV Razred Srednje Stručne Škole [Catalog of Knowledge - Subject Program Physical Education I, II, III, IV Grade Of Secondary Vocational School]. Zavod Za Školstvo; 2009.
- 24.↑
Government of Montenegro. Uporedna analiza nastavnog plana osnovnog obrazovanja i vaspitanja u Crnoj Gori, zemljama Regiona i zemljama Evropske unije (za verifikaciju) [Comparative analysis of the curriculum of basic education and upbringing in Montenegro, the countries of the Region and the countries of the European Union (for verification)]. 2013. https://www.gov.me/dokumenta/e9680ad2-3597-4cb0-8228-58917430c288
- 25.↑
Sport policy in SDGs by 2030. Policy Area Sport. n.d. https://javnepolitike.me/en/policy/sport-2/
- 26.↑
Government of Montenegro. Ciljevi, prioritet 4 – Obrazovanje i društvo zasnovano na znanju [Goals, priority 4 – Education and knowledge-based society]. 2021. https://www.gov.me/dokumenta/a13a916b-4298-4f33-9d37-42271bfac999
- 27.↑
Ministry of Education, Science, Culture and Sports. Strategija razvoja sporta u Crnoj Gori za period 2018 do 2021 godina [Sport development strategy in Montenegro for the period 2018 to 2021]. 2018. https://www.gov.me/en/documents/bd433b88-f987-43c6-a730-1d6a63f72271
- 28.↑
City Portal. Budžet za sport kao nikad siromašan: Savezima malo, najvećim klubovima ništa [Budget for sports as poor as ever: Federations little, biggest clubs nothing]. 2022. https://gradski.me/budzet-za-sport-kao-nikad-siromasan-savezima-malo-najvecim-klubovima-nista/
- 29.↑
Government of Montenegro. Budžet za građane 2022 [Budget for citizens 2022]. 2021. https://wapi.gov.me/download/f167dfe7-f053-4c3d-8711-e4a80308fd07?version=1.0
- 30.↑
Spinelli A, Buoncristiano M, Nardone P, et al. Thinness, overweight, and obesity in 6‐to 9‐year‐old children from 36 countries: the world health organization European childhood obesity surveillance initiative—COSI 2015–2017. Obes Rev. 2021;22:e13214.
- 31.
Faculty for Sport and Physical Education. Višegodišnji monitoring tjelesne kompozicije djece - dječaci gojazniji od djevojčica, procenat prekomjerno uhranjene i gojazne djece u Crnoj Gori visok [Multi-year monitoring of body composition in children – boys are more obese than girls, the percentage of overweight and obese children in Montenegro is high]. 2021. https://www.ucg.ac.me/objava/blog/1259/objava/125362-visegodisnji-monitoring-tjelesne-kompozicije-djece-djecaci-gojazniji-od-djevojcica-procenat-prekomjerno-uhranjene-i-gojazne-djece-u-crnoj-gori-visok
- 32.↑
Faculty for Sport and Physical Education. Najgojaznije djevojčice u Kotoru i Mojkovcu, dok su najgojazniji dječaci stanovnici Ulcinja i Plužina – neuhranjenost dominira u Budvi i Kolašinu [The most obese girls are in Kotor and Mojkovac, while the most obese boys are residents of Ulcinj and Pluzine – underweight dominates in Budva and Kolasin]. 2022. https://www.ucg.ac.me/objava/blog/1259/objava/134724-najgojaznije-djevojcice-u-kotoru-i-mojkovcu-dok-su-najgojazniji-djecaci-stanovnici-ulcinja-i-pluzina-neuhranjenost-dominira-u-budvi-i-kolasinu
- 33.↑
Jurak G, Soric M, Starc G, et al. School day and weekend patterns of physical activity in urban 11-year-olds: a cross-cultural comparison. Am J Hum Biol. 2014;27(2):192–200. PubMed ID: 25270287 doi:
- 34.↑
Tomkinson GR, Carver KD, Atkinson F, et al. European normative values for physical fitness in children and adolescents aged 9–17 years: results from 2 779 165 Eurofit performances representing 30 countries. Br J Sports Med. 2018;52(22):1445–1456. PubMed ID: 29191931 doi:
- 35.↑
Masanovic B, Popovic S, Bjelica D, et al. The 2018 national report on children’s and adolescents’ physical activity and physical fitness for Montenegro. Iran J Public Health. 2020;49(10):1992–2000. PubMed ID: 33346220
- 36.↑
Min L, Wang D, You Y, et al. Effects of high-intensity interval training on sleep: a systematic review and meta-analysis. Int J Environ Res Public Health. 2021;18(20):10973. doi:
- 37.↑
Stamatakis KA, Punjabi NM. Long sleep duration: a risk to health or a marker of risk? Sleep Med Rev. 2007;11(5):337. doi:
- 38.
Grandner MA, Jackson N, Gerstner JR, Knutson KL. Dietary nutrients associated with short and long sleep duration. Data from a nationally representative sample. Appetite. 2013;64:71–80. PubMed ID: 23339991 doi:
- 39.↑
Lallukka T, Sivertsen B, Kronholm E, Bin YS, Øverland S, Glozier N. Association of sleep duration and sleep quality with the physical, social, and emotional functioning among Australian adults. Sleep Health. 2018;4(2):194–200. PubMed ID: 29555134 doi:
- 40.↑
Gába A, Rubín L, Badura P, et al. Results from the Czech Republic’s 2018 report card on physical activity for children and youth. J Phys Act Health. 2018;15(suppl 2):S338–S340. PubMed ID: 30475132 doi:
- 41.↑
Sember V, Morrison SA, Jurak G, et al. Results from Slovenia’s 2018 report card on physical activity for children and youth. J Phys Act Health. 2018;15(suppl 2):S404–S405. PubMed ID: 30475124 doi:
- 42.↑
Kämppi K, Aira A, Halme N, et al. Results from Finland’s 2018 report card on physical activity for children and youth. J Phys Act Health. 2018;15(suppl 2):S355–S356. PubMed ID: 30475141 doi:
- 43.↑
Fillon A, Genin P, Larras B, et al. France’s 2020 report card on physical activity and sedentary behaviors in children and youth: results and progression. J Phys Act Health. 2021;18(7):811–817. PubMed ID: 34039777 doi:
- 44.
Takken T, de Jong N, Duijf M, et al. Results from the Netherlands’ 2018 report card and report card+ on physical activity for children and youth with and without chronic medical condition. Public Health. 2020;185:161–166. PubMed ID: 32634607 doi:
- 45.↑
Demetriou Y, Bucksch J, Hebestreit A, et al. Germany’s 2018 report card on physical activity for children and youth. Ger J Exerc Sport Res. 2019;49(2):113–126. doi:
- 46.↑
Popovic S, Masanovic B, Martinovic S, Bjelica D, Gardasevic J. Trajectories in body height, body weight, BMI, and nutrition status from 1979 to 1987: a measurement-based analysis of 15,717 male adolescents from the capital city of Montenegro. Front Public Health. 2020;8:610358. doi:
- 47.
Bjelica D, Gardasevic J, Milosevic Z, Bozic PR, Masanovic B. Trajectories of body height, body weight, BMI, and nutrition status from 1979 to 1987: a measurement-based analysis of 8740 Montenegrin male adolescents from the municipality of Berane. Int J Environ Res Public Health. 2021;18(10):5490.
- 48.↑
Masanovic B, Martinovic S, Zoric G, et al. Trends in body height, body weight, and body mass index from 1979 to 1987: an analysis of the young male population from the municipality of cetinje. J Anthropol Sport Phys Educ. 2020;4(2):3–7. doi:
- 49.↑
Johansen DLN, Christensen BFN, Fester M, et al. Results from Denmark’s 2018 report card on physical activity for children and youth. J Phys Act Health. 2018;15(suppl 2):S341–S343.
- 50.
Roman-Viñas B, Zazo F, Martínez-Martínez J, et al. Results from Spain’s 2018 report card on physical activity for children and youth. J Phys Act Health. 2018;15(suppl 2):S411–S412. PubMed ID: 30475128
- 51.↑
Nyström CD, Larsson C, Alexandrou C, et al. Results from Sweden’s 2018 report card on physical activity for children and youth. J Phys Act Health. 2018;15(suppl 2):S413–S414.
- 52.↑
Zembura P, Korcz A, Cieśla E, et al. Results from Poland’s 2018 report card on physical activity for children and youth. J Phys Act Health. 2018;15(suppl 2):S395–S397. PubMed ID: 30475115
- 53.↑
Maslovar S. Scope of Physical Activity of Students of the 6th Grade of the Primary School Njegos from Cetinje [Unpublished Bachelor Thesis]. Faculty for sport and Physical Education, University of Montenegro; 2022.
