Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth: A national survey

Abstract

Background:
Healthy childhood development is fostered through sufficient physical activity (PA; including time outdoors), limiting sedentary behaviours (SB), and adequate sleep; collectively known as movement behaviours. Though the COVID-19 virus outbreak has changed the daily lives of children and youth, it is unknown to what extent related restrictions may compromise the ability to play and meet movement behaviour recommendations. This secondary data analysis examined the immediate impacts of COVID-19 restrictions on movement and play behaviours in children and youth.

Methods:
A national sample of Canadian parents (n = 1472) of children (5-11 years) or youth (12-17 years) (54% girls) completed an online survey that assessed immediate changes in child movement and play behaviours during the COVID-19 outbreak. Behaviours included PA and play, SB, and sleep. Family demographics and parental factors that may influence movement behaviours were assessed. Correlations between behaviours and demographic and parental factors were determined. For open-ended questions, word frequency distributions were reported.

Results:
Only 4.8% (2.8% girls, 6.5% boys) of children and 0.6% (0.8% girls, 0.5% boys) of youth were meeting combined movement behaviour guidelines during COVID-19 restrictions. Children and youth had lower PA levels, less outside time, higher SB (including leisure screen time), and more sleep during the outbreak. Parental encouragement and support, parental engagement in PA, and family dog ownership were positively associated with healthy movement behaviours. Although families spent less time in PA and more time in SB, several parents reported adopting new hobbies or accessing new resources.

Conclusions:
This study provides evidence of immediate collateral consequences of the COVID-19 outbreak, demonstrating an adverse impact on the movement and play behaviours of Canadian children and youth. These findings can guide efforts to preserve and promote child health during the COVID-19 outbreak and crisis recovery period, and to inform strategies to mitigate potential harm during future pandemics.

Full text

R E S E A R C H Open Access
Impact of the COVID-19 virus outbreak on
movement and play behaviours of
Canadian children and youth: a national
survey
Sarah A. Moore
1,2
, Guy Faulkner
3
, Ryan E. Rhodes
4
, Mariana Brussoni
5,6
, Tala Chulak-Bozzer
7
, Leah J. Ferguson
8
,
Raktim Mitra
9
, Norm O’Reilly
10
, John C. Spence
11
, Leigh M. Vanderloo
7,12
and Mark S. Tremblay
13,14*
Abstract
Background: Healthy childhood development is fostered through sufficient physical activity (PA; including time
outdoors), limiting sedentary behaviours (SB), and adequate sleep; collectively known as movement behaviours.
Though the COVID-19 virus outbreak has changed the daily lives of children and youth, it is unknown to what
extent related restrictions may compromise the ability to play and meet movement behaviour recommendations.
This secondary data analysis examined the immediate impacts of COVID-19 restrictions on movement and play
behaviours in children and youth.
Methods: A national sample of Canadian parents (n= 1472) of children (5–11 years) or youth (12–17 years) (54%
girls) completed an online survey that assessed immediate changes in child movement and play behaviours during
the COVID-19 outbreak. Behaviours included PA and play, SB, and sleep. Family demographics and parental factors
that may influence movement behaviours were assessed. Correlations between behaviours and demographic and
parental factors were determined. For open-ended questions, word frequency distributions were reported.
Results: Only 4.8% (2.8% girls, 6.5% boys) of children and 0.6% (0.8% girls, 0.5% boys) of youth were meeting
combined movement behaviour guidelines during COVID-19 restrictions. Children and youth had lower PA levels,
less outside time, higher SB (including leisure screen time), and more sleep during the outbreak. Parental
encouragement and support, parental engagement in PA, and family dog ownership were positively associated
with healthy movement behaviours. Although families spent less time in PA and more time in SB, several parents
reported adopting new hobbies or accessing new resources.
Conclusions: This study provides evidence of immediate collateral consequences of the COVID-19 outbreak,
demonstrating an adverse impact on the movement and play behaviours of Canadian children and youth. These
findings can guide efforts to preserve and promote child health during the COVID-19 outbreak and crisis recovery
period, and to inform strategies to mitigate potential harm during future pandemics.
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licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain
permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the
data made available in this article, unless otherwise stated in a credit line to the data.
* Correspondence: mtremblay@cheo.on.ca
13
Children’s Hospital of Eastern Ontario Research Institute, 401 Smyth Road,
Ottawa, ON K1H 8L1, Canada
14
Department of Pediatrics, University of Ottawa, 401 Smyth Road, Ottawa,
ON K1H 8L1, Canada
Full list of author information is available at the end of the article
Moore et al. International Journal of Behavioral Nutrition and Physical Activity
(2020) 17:85
https://doi.org/10.1186/s12966-020-00987-8
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Introduction
Healthy movement behaviours contribute to the physical
and mental health of children and youth [1] including a
more robust immune system [2]. The evidence of move-
ment behaviours for healthy growth and development is
sufficiently compelling that many countries, including
Canada [3], and the World Health Organization (WHO)
[4] have released 24-h integrated movement behaviour
guidelines for children and youth. These guidelines rec-
ommend age-specific physical activity, sedentary behav-
iour, and sleep thresholds for school-aged children and
youth [3]. Children and youth who meet movement rec-
ommendations have better cardiometabolic, musculo-
skeletal, cognitive, and mental health, and immune
function compared with their less active peers [1–4].
Despite the evidence indicating the benefits of increased
physical activity, reduced sedentary behaviours, and ad-
equate sleep, the prevalence of Canadian children and
youth meeting the 24-h movement recommendations
was recently reported to be only 12.7% [5]. Notwith-
standing the notion that indoor physical activity can
contribute to overall levels, the additional benefits of
playing outside [6] and in nature are clear [7]. Spending
time outside and in nature provides a critical venue for
healthy movement behaviours, permitting children and
youth to accumulate more daily physical activity, less
sedentary behaviour, and sleep better [6].
On March 11, 2020, the WHO characterized the
COVID-19 virus outbreak as a global pandemic [8].
COVID-19 is caused by a coronavirus which can result
in acute respiratory distress in humans and is transmit-
ted through respiratory droplets and contact routes [9].
Current estimates suggest a 1–2% case fatality rate,
which varies by age and health of the patient [10].
Though healthy children and youth are less vulnerable
to COVID-19 [11], there remains genuine concern about
transmission of the virus, especially the spread to older
people and those with underlying medical conditions.
Consequently, the COVID-19 virus outbreak has led to
significant changes in daily life for children, youth, and
their families, with specific recommendations and re-
strictions varying within and between countries. Like
many countries, Canada imposed restrictions requiring
physical distancing (two metres), and limited community
and social gatherings and interactions, sport, and play-
ground and park use [12]. Most children and youth are
no longer attending school, with classroom lessons re-
placed by home-schooling and online learning activities.
During the initial response to the COVID-19 outbreak
and recommendations for physical distancing, behaviour
restrictions, and overall instructions to ‘stay home’, fam-
ilies are seeking guidance and solutions to preserve
healthy routines, including healthy movement behav-
iours and opportunities to spend time outdoors [13,14].
Although differences exist in the number of COVID-19
cases across geographic jurisdictions [15], preliminary data
demonstrate that Canada is moving towards ‘flattening
the curve’.[16] Federal and provincial politicians and
Medical Officers of Health have continued to encourage
Canadian families to get active and outdoors [17]. Yet,
how the ‘stay home’versus ‘get active and outdoors’para-
dox is interpreted is unknown. Like the number of cases,
COVID-19 restrictions and recommendations vary be-
tween jurisdictions [15]. It is timely to assess whether
COVID-19 and related behavioural requirements have im-
pacted the movement and play behaviours of Canadian
children and youth, and to identify strategies that families
are taking to stay healthy during this pandemic. Accord-
ingly, the purpose of this secondary data analysis was to
provide a rapid and large-scale assessment of the immedi-
ate changes in physical activity, play, sedentary behaviours,
leisure screen time, and sleep in children and youth across
Canada during the initial period of the COVID-19 crisis.
We anticipate these finding will inform efforts to preserve
and promote child health behaviours and establish prior-
ities for post-COVID-19 public health initiatives.
Methods
Study design and population
ParticipACTION is a Canadian non-profit organization
promoting physical activity. It recently conducted a survey
(Additional File 1) assessing changes in children and youth
movement behaviours during the COVID-19 virus out-
break to inform the upcoming release of its biennial Re-
port Card of Physical Activity for Children and Youth.
Accordingly, a cross-sectional sample of 1503 parents of
Canadian children and youth aged 5–17 years was re-
cruited via a third-party market research company. Maru/
Matchbox has a consumer online database of >120,000
Canadian panellists. Manu/Matchbox panel participants
are recruited through a variety of online and offline
methods and receive small cash incentives ($0.50–$3.00
CDN) and prize opportunities after completing surveys.
The panel is comparable with the Canadian census in
terms of age, gender, region, income, employment, and
language spoken [18]. This sampling strategy is routinely
employed by national organizations given the ability to
rapidly recruit large, representative Canadian samples
[19]. Maru/Matchbox panellists consent to participate in
survey-based research when they sign-up for the panel.
Subsequently, participants passively consented to partici-
pate when they agreed to complete the survey. This sec-
ondary data analysis was approved by the University of
British Columbia’s Research Ethics Board (#H20–01371).
In reporting this secondary data analysis the authors were
attentive to the STROBE Statement (STROBE checklist;
Additional File 2).
Moore et al. International Journal of Behavioral Nutrition and Physical Activity (2020) 17:85 Page 2 of 11
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Measures
Survey development
Health behaviours for children and youth were defined
according to the Canadian 24-Hour Movement Guide-
lines for Children and Youth [1,3]. Key content areas
were developed by applying the socioecological model;
the survey included parental and child demographics,
current movement behaviours, change in child’s move-
ment and play behaviours, and parental support for their
child’s movement and play behaviours (Additional File
1). Selected items were used in this secondary analysis
(Table 1). Test-retest (one week) reliability was assessed
(similar to other ParticipACTION surveys [19]) via bi-
variate Pearson correlation (n= 100 participants). Strong
reliability across 12 of the 13 items was demonstrated
(correlation range = 0.79–0.99, magnitude of strength =
.6 < | r| < .9, p< 0.001). A non-statistically significant
linear relationship (correlation = 0.76, 0.53, p= 0.06) was
reported for ‘inside physical activity’.
Survey content
Respondents provided parental and child demographic
information and assessments of their child’s movement
behaviours in the last week. They were subsequently
asked to compare their child’s behaviours before and
during the COVID-19 outbreak. Similarly, based on pre-
vious surveys, respondents were also asked to compare
their support of their child’s movement behaviours be-
fore and during the COVID-19 outbreak. Responses
were reported using a 5-point Likert type scale, ranging
from ‘a lot less’(score = 1) to ‘no change’(score 3) to ‘a
lot more’(score = 5).
Data collection
Approximately 1 month after the WHO declared
COVID-19 a global pandemic [8], eligible participants
were invited to complete an online survey (French or
English). During recruitment, the sample was stratified
by gender and age of the child (families with a child aged
5–11 years and families with a youth aged 12–17 years).
Potential participants were screened out if they or their
child had been diagnosed with COVID-19 or if the fam-
ily was in self-isolation or quarantine due to COVID-19.
Potential respondents were sent an email link to the sur-
vey, which required approximately 15 min to complete.
Parents with more than one child were asked to think of
the child whose given name came first alphabetically and
to use that child as the referent for the survey (i.e., the
index child). After data collection was complete, a
cleaned dataset (.csv file) was received by ParticipAC-
TION from Maru/Matchbox. Further data cleaning and
verification was completed by the investigators (RER,
SAM, GF, MST).
Table 1 Selected items used in the current analysis from the
children and youth movement and play behaviours during
COVID-19 virus outbreak survey (copy of full survey in
Additional File 1)
Survey Details
A. Screening questions
Question Response option
Has anyone in your household been diagnosed
with COVID-19?
- Yes [thank you,
terminate]
- No [continue]
Is your household under a self-isolation or quar-
antine order?
- Yes [thank you,
terminate]
- No [continue]
B. Demographic characteristics
Parent: Age and gender
Geographic region
Education; Marital status; Ethnicity Postal code
Household make-up (number of adults/children)
[dropdown, age
rollup]
[dropdown,
provinces rollup]
[dropdown, specify]
[dropdown, number
rollup]
Child: Age and gender
Disability or chronic condition
Type of residence (e.g., house, apartment)
Dog ownership
[dropdown, age
rollup]
[dropdown, specify]
[dropdown, specify]
[dropdown, yes/no]
C. Current movement behaviours
In the last week, how many total hours and
minutes per day did your child watch TV, use the
computer, use social media and play inactive
video games?
- Weekdays (hrs,
mins)
- Weekend days
(hrs, mins)
In the last week, on how many days did your
child engage in moderate-to-vigorous physical
activity for a total of at least 60 min per day?
[dropdown, 0–7
days]
In the last week, how many hours did your child
usually spend sleeping in a 24-h period (including
naps but excluding time spent resting)?
[dropdown, 0–24 h]
D. Change in movement and play behaviours
Compared to before the COVID-19 outbreak
and related restrictions:
- My child walks or bikes in the
neighbourhood?
- My child is doing physical activities or sport
outside?
- My child is doing physical activities or sport
inside?
- My child is doing household chores (e.g.
cleaning, yard work)?
- My child plays outside?
- My child plays inside?
- My child watches TV, movies, uses the
computer for leisure?
- My child uses social media?
- My child does other sedentary leisure
activities not in front of screens?
- My child sleeps?
- Our family time spent in physical activity is?
- Our family time spent in sedentary
behaviours is?
- A lot less
- A little less
- Same
- A little more
- A lot more
- My child’s sleep quality is?
- The balance of my child’s overall healthy
movement behaviours are?
- A lot worse
- A little worse
- Same
Moore et al. International Journal of Behavioral Nutrition and Physical Activity (2020) 17:85 Page 3 of 11
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Statistical analyses
Quantitative analyses, close-ended questions
Data were analysed in SPSS 20 (SPSS Inc., Chicago, IL,
USA). Overall, age group, and gender specific means
(standard deviations) for all variables were calculated.
Factorial analyses of variance (by age-group and gender)
were used to test for differences between continuous
variables and chi-square tests were used to assess differ-
ences between categorical variables. Statistical signifi-
cance was set at p< 0.01. The proportion of children
meeting the Canadian 24-Hour Movement Behaviour
Guidelines [3] was determined. Associations between
movement and play behaviours and demographic and
parental factors were assessed by Pearson and point-
biserial correlation. Means (standard errors) were plot-
ted for selected variables. Analyses were completed and
checked by the analysis team (RER, SAM, GF, MST).
Qualitative analyses, open-ended questions
Two independent assessors (LJF, LMV) reviewed re-
sponses of the open-ended survey items. Given the brev-
ity of responses, assessors adopted a word frequency
distribution approach to review the data and elicit com-
monalities in responses across each of the questions
[20]. Approximately 19.0% of responses were in French
and translated to English by one of the coders (LMV).
To establish reliability and consistency across coders,
the first 100 responses of the ‘inside activities or hobbies’
question was independently coded by each assessor and
then compared. A total agreement of 98.3% was
achieved; discrepancies were due to differences in code
labels (e.g., ‘making videos’vs. ‘video production’) rather
than a misattribution in classification by coders.
Results
Parent and child characteristics
Descriptive statistics for parent and child characteristics
are provided in Table 2. A total of 1503 parents com-
pleted the survey. Respondents with missing or implaus-
ible data were excluded from these analyses (n= 31; e.g.,
parental age 15 years and child age 10 years). The final
sample included 1472 participants. Geographic, ethnic,
and age distribution of the sample was reflective of Can-
adian demographics. Respondents were primarily female
(54.0%), married or cohabiting (84.2%), college or uni-
versity graduates (88.7%), and working fulltime (70.1%).
Type of home residence was predominantly a detached
house (72.1%), and approximately one-third (35.4%) re-
ported having a dog. Children (mean 8.1 years, range 5–
11 years) and youth (mean 14.9 years, range 12–17 years)
were primarily typically developing (91.4%). While most
children and youth (71.1%) were meeting sleep recom-
mendations, most were not meeting physical activity or
screen time guidelines (18.2 and 11.3%, respectively).
Only 2.6% of children and youth were meeting the com-
bined 24-h movement behaviour (physical activity, sed-
entary behaviour, sleep) recommendations.
Children and youth’s current behaviours and changes in
behaviours
A summary of the current movement behaviours of the
child and changes in movement and play behaviours of
the child by age category and gender are presented in
Table 3and a summary in Fig. 1. More children (23.8%)
were meeting the physical activity recommendations
compared with youth (13.2%). Children engaged in less
leisure screen time (5.1 h/day) compared with youth (6.3
h/day). Very few children and youth were meeting the
combined 24-h guidelines (4.8% of children, 0.6% of
youth). Fewer girls aged 5–11 years were engaging in
sufficient physical activity compared with boys the same
age (19.0% girls, 27.9% boys).
Children and youth experienced a significant decline
in all physical activities (Table 3), except household
chores. The most dramatic decline was with outdoor
physical activity and sport (2.28/5.00 and 1.96/5.00 for
children and youth, respectively), whereas leisure screen
time and social media use was reported as much higher
than before the COVID-19 outbreak (leisure screen time
4.10/5.00 and 4.21/5.00 for children and youth respect-
ively; social media 3.30/5.00 and 3.78/5.00 for children
and youth, respectively). Parents of girls in both age
groups reported significantly more social media use
(child: 3.46/5.00 [girls] versus 3.16/5.00 [boys]; youth:
3.97/5.00 [girls] versus 3.62/5.00 [boys]) and more time
Table 1 Selected items used in the current analysis from the
children and youth movement and play behaviours during
COVID-19 virus outbreak survey (copy of full survey in
Additional File 1)(Continued)
Survey Details
- My child’s overall time spent outside is? - A little better
- A lot better
Compared to before the COVID-19 outbreak
and related restrictions:
- Is there an inside leisure activity or hobby
that your child is doing a lot more?
- Is there an outside leisure activity or hobby
that your child is doing a lot more
- Has your family begun any new or novel
activities not previously practiced?
- Has your family used any online resources/
apps to support healthy movement?
- Has there been a decrease in your child’s
health (e.g., existing condition worsened or
new condition developed)?
- Yes [specify]
-No
Do you have any advice for families trying to
achieve a healthy balance of movement
behaviours (physical activity, screen time, sleep)
of their children during the COVID-19 outbreak
and related restrictions?
- Yes [specify]
-No
Moore et al. International Journal of Behavioral Nutrition and Physical Activity (2020) 17:85 Page 4 of 11
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sleeping (child: 3.30/5.00 [girls] versus 3.14/5.00 [boys];
youth: 3.74/5.00 [girls] versus 3.53/5.00 [boys]) as a re-
sult of COVID-19 compared with boys. Respondents re-
ported more family time was being spent in sedentary
behaviours (3.87/5.00 and 3.88/5.00 in children and
youth, respectively) and less in physical activities (2.72/
5.00 and 2.57/5.00 in children and youth, respectively)
compared with before the COVID-19 outbreak.
Parent support of child movement and play behaviours
A complete description of the associations between per-
ceived changes in child movement behaviours and par-
ental demographic, social, and environmental factors are
reported in Table 4. Only selected associations (r> 0.1,
p< 0.01) [21] are highlighted here. Being a younger par-
ent was associated with less decline in child physical ac-
tivity (−0.11), outdoor (−0.16) and indoor play (−0.10),
family physical activity (−0.11), less social media use (−
0.13) and more sleep (0.12). Parental marital status (co-
habitation) was correlated with more child outdoor play
(0.10) and household chores (0.10). Children that lived
in detached homes had more outside physical activity
(0.12) and spent more time walking and biking (0.13).
Having a dog was associated with more outdoor play
(0.11) and less indoor play (−0.10). Parental encourage-
ment was associated with higher child outdoor physical
activity (0.17), time spent walking and biking (0.12), out-
door play (0.14), indoor physical activity (0.12), and fam-
ily physical activity (0.24). Parent co-participating was
associated with more child outdoor physical activity
(0.32), time spent walking and biking (0.32), outdoor
play (0.39), indoor physical activity (0.14), household
chores (0.18), and family physical activity (0.44).
New ways families are approaching movement
behaviours
Half of respondents (50.4%) indicated their child was
doing a lot more inside hobbies or activities, and 22.7%
reported increased outside hobbies or activities. Among
those that provided a written response, the top three in-
creased inside activities were arts and crafts (12.9%),
puzzles and games (11.3%), and video games (10.2%).
Among the reported increased inside activities, 17.5%
were screen-based (e.g., phone, tablet, television) while
2.6% were active hobbies (e.g., dancing, physical
Table 2 Description of parent, child, and youth characteristics
(N= 1472)
Parent demographic profile
Age, M (SD) 45.12 (7.55)
Gender female, n(%) 689 (47.00)
Ethnicity, n(%)
European 1166 (79.21)
Asian 194 (13.18)
Indigenous 61 (4.14)
Other 51 (3.46)
Marital status, n(%)
Married or common-law 1239 (84.17)
Divorced or separated 153 (10.39)
Single 70 (4.76)
Widowed 10 (0.68)
Education, n(%)
High school or less 166 (11.28)
College/Technical 558 (37.91)
University 508 (34.51)
Advanced degree 240 (16.30)
Annual household income, n(%)
≤$50,000 219 (14.88)
$51,000 to $99,000 499 (33.90)
$100,000+ 586 (39.81)
Undisclosed 168 (11.41)
Employment status, n(%)
Full-time (> 30 h/week) 1032 (70.11)
Part-time 165 (11.21)
Homemaker 159 (10.80)
Other 79 (7.32)
Child and youth demographic profile
Age, M (SD) / n(%)
5–11 years 8.12 (2.04) / 693 (47.1)
12–17 years 14.85 (1.68) / 779 (52.9)
Gender female, n(%) 775 (52.6)
Disability, n(%) 127 (8.6)
Household makeup, M (SD)
Adults 2.10 (0.67)
Children 1.81 (0.84)
Child’s residence type, n(%)
House 1062 (72.1)
Apartment/Townhouse 392 (26.7)
Other 18 (1.2)
Dog ownership, n(%) 521 (35.4)
Parental assessed child and youth movement behaviours
Meeting guidelines, n(%)
Table 2 Description of parent, child, and youth characteristics
(N= 1472) (Continued)
Moderate to vigourous physical activity 268 (18.21)
Sleep (5–13 years) / Sleep (14–17 years) 613 (67.80) / 433 (76.20)
Screen time 166 (11.30)
24-h combined 39 (2.60)
Moore et al. International Journal of Behavioral Nutrition and Physical Activity (2020) 17:85 Page 5 of 11
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education exercises, treadmill). The top three increased
outside activities were biking (6.1%), walking or hiking
(5.5%) and sport activities (3.5%; e.g., badminton, basket-
ball on driveway, road hockey). New family hobbies as a
result of the COVID-19 outbreak were also reported
(273 responses), with the most common new activities
including puzzles and games (7.1%), arts and crafts
(4.4%), and physical activity (1.0%). Among respondents,
16.4% reported using online resources or apps to sup-
port healthy movement behaviours. Complete details of
open-ended questions are provided in Additional File 3.
Discussion
The purpose of this study was to assess the immediate
changes in physical activity, play, sedentary behaviours,
leisure screen time, and sleep in school-aged children
and youth across Canada during the initial period of the
COVID-19 crisis. We found that children and youth
were less active, played outside less, were more
sedentary, engaged in more recreational screen-based ac-
tivities, and slept more during the initial COVID-19
virus outbreak compared with before the restrictions.
We observed commonly found gender and age group re-
lated differences [22].In general, girls were less active
than boys and youth (12–17 years) were less active than
children (5–11 years). Girls engaged in more social
media use and slept more than boys. The largest re-
ported change in behaviours related to leisure screen-
based activities, where children and youth were watching
upwards of 6.5 h per day. On average, younger children
experienced less change from their pre-COVID-19
movement behaviours compared with older children.
These findings are the first to confirm speculations that
pandemic-related restrictions are unfavourably related to
movement behaviours of children and youth [13,23].
This observation has triangulated support from quantita-
tive (descriptive and correlational) and qualitative (con-
textual) evidence.
Table 3 Summary of the movement and play behaviours in children and youth during the COVID-19 virus outbreak
Children Youth
Total (n= 690) Girls (n= 321) Boys (n= 369) Total (n= 774) Girls (n= 368) Boys (n= 406)
Current child health behaviours, M (SD)
MVPA ≥60 min (days/week) 3.55 (2.33) 3.35
a
(2.26) 3.73
a
(2.38) 2.59 (2.33) 2.60 (2.28) 2.57 (2.38)
Sleep (hours/day) 9.19 (2.33) 9.28 (2.18) 9.12 (2.45) 9.01 (2.30) 9.10 (2.10) 8.93 (2.46)
Screen time (hours/day) 5.14 (3.54) 5.06 (3.26) 5.21 (3.78) 6.53 (3.31) 6.31
a
(3.21) 6.72
a
(3.39)
Proportion of children meeting guidelines (%)
MVPA 23.8 19.0
a
27.9
ga
13.2 11.4 14.8
Sleep†69.9 72.6 67.5 72.1 73.6 70.7
Screen time 16.5 16.2
a
16.8
a
6.6 7.9 5.4
24 h combined 4.8 2.8 6.5
ga
0.6 0.8 0.5
Change in child movement and play behaviours during COVID-19 outbreak, M (SD)
a
Walks or bikes in neighbourhood 2.57 (1.35) 2.54
a
(1.36) 2.61
a
(1.34) 2.19 (1.20) 2.24 (1.24) 2.15 (1.17)
Physical activity or sport outside 2.28 (1.22) 2.26
a
(1.25) 2.30
a
(1.20) 1.96 (1.13) 1.93 (1.11) 1.99 (1.15)
Physical activity or sport inside 2.94 (1.15) 3.01
a
(1.19) 2.88
a
(1.11) 2.59 (1.21) 2.64 (1.55) 2.55 (1.15)
Household chores 3.35 (0.80) 3.38 (0.83) 3.33 (0.78) 3.29 (0.84) 3.33 (0.81) 3.25 (0.86)
Plays outside 2.58 (1.31) 2.57
a
(1.30) 2.59
a
(1.31) 2.24 (1.08) 2.20 (1.03) 2.27 (1.13)
Plays inside 3.85 (1.00) 3.86
a
(1.02) 3.84
a
(0.99) 3.60 (1.00) 3.58 (0.97) 3.62 (1.03)
Watches television (TV) or screens 4.10 (0.87) 4.10 (0.92) 4.11 (0.84) 4.21 (0.92) 4.21 (0.91) 4.21 (0.93)
Uses social media 3.30 (0.89) 3.46
g
(0.91) 3.16 (0.85) 3.78 (0.94) 3.97
ag
(0.86) 3.62
a
(0.97)
Sleep quantity 3.21 (0.70) 3.30
g
(0.70) 3.14 (0.69) 3.63 (0.84) 3.74
ag
(0.78) 3.53
a
(0.88)
Sleep quality 3.05 (0.66) 3.05 (0.68) 3.05 (0.65) 3.04 (0.73) 3.05 (0.71) 3.02 (0.75)
Overall healthy movement behaviours 2.66 (0.83) 2.68
a
(0.81) 2.65
a
(0.84) 2.44 (0.90) 2.49 (0.91) 2.38 (0.89)
Overall time spent outside 2.38 (1.26) 2.35
a
(1.25) 2.41
a
(1.28) 2.08 (1.15) 2.05 (1.13) 2.11 (1.17)
Family time in physical activity 2.72 (1.16) 2.70 (1.17) 2.74 (1.16) 2.57 (1.11) 2.58 (1.06) 2.56 (1.15)
Family time in sedentary behaviours 3.87 (0.81) 3.90 (0.83) 3.85 (0.79) 3.88 (0.88) 3.94 (0.82) 3.83 (0.93)
MVPA Moderate to vigorous physical activity;
a
= significant age effect.
g
= significant gender effect; †= for sleep, the column ‘children’age is 5–13 years and
‘youth’age is 14–17 years as per the 24-h sleep guidelines
a
Range from 1 to 5, 3 represents no change (see Table 1for details)
Moore et al. International Journal of Behavioral Nutrition and Physical Activity (2020) 17:85 Page 6 of 11
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

The prevalence of children and youth meeting the
Canadian 24-Hour Movement Behaviour Guidelines [3]
was much lower in this sample (2.6%, Table 2) compared
to other national samples collected before the COVID-
19 outbreak. For example, based on similar data collec-
tion methods, Rhodes et al. (2019) reported 12.7% of
Canadian 5–17 year-olds met the guideline [5]. Using
more robust measures, including accelerometer-
measured physical activity, Carson et al. (2017) reported
17.1% Canadian children and youth (5–17 years) met the
overall guidelines [1]. An international sample of 9–11
year-old children from 12 countries reported an average
of 7.2% (Canada 14.0%) meeting the guidelines in 2016
before the COVID-19 virus outbreak [24]. These com-
parisons suggest a dramatic reduction in the proportion
of Canadian children and youth meeting these guidelines
during the COVID-19 outbreak.
The reported reduction in outdoor play may contrib-
ute to or even exacerbate the decline reported in phys-
ical activity. Correlations between moderate-to-vigorous
(r = 0.34; p< 0.01) and light physical activity (r= 0.28;
p< 0.01) and changes in outdoor time supports this
point. Spending time outdoors is associated with greater
physical activity, less sedentary time, improved sleep,
and a number of other benefits (e.g., mental health, im-
mune function) [6,7]. Active play indoors does not seem
to replace active play outdoors resulting in a net decline
in reported play-based activity. To prevent the unin-
tended unhealthy behaviour consequences of COVID-19
restrictions and ‘stay home’advice, health promotion
messaging needs to be balanced with disease prevention
messaging [25]. With attentive and responsible spatial
and temporal distancing a healthy marriage of “stay
home”and “get outside and play”is achievable.
We identified several factors that helped to support
physical activity, outdoor play, and sleep, and reduce
time spent in screen-based and other sedentary behav-
iours. This highlights that the impact of the pandemic
has not been uniform for all Canadian children and
youth. Living in a detached house, being a younger
Fig. 1 Forest plot of parent-reported changes in 24-h movement behaviours of Canadian children and youth. Forest plot of parent-reported
changes in 24-h movement behaviours of Canadian children and youth (5–17 years) based on responses to a 5-point scale ranging from “a lot
less”(scored 1) to “about the same”(scored 3) to “a lot more”(scored 5). PA = physical activity. See Table 1and Additional File 1for more details
on the questions and response options. Data points are means with standard error bars (generally too small to be seen)
Moore et al. International Journal of Behavioral Nutrition and Physical Activity (2020) 17:85 Page 7 of 11
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

parent, and owning a dog were all favourably associated
with healthy movement behaviours. Children living in a
house versus an apartment may have easier access to
front or back yards for outdoor play and physical activity
[26].The largest associations were noted with parental
encouragement for and engagement in healthy move-
ment behaviours. Similar to previous research [5,19,
27],we found that parent support was a key correlate of
children and youth movement behaviours. The most sig-
nificant relationship was parental co-participation [27].
Although parents and their children are undoubtedly ex-
periencing higher stress during the COVID-19 outbreak
[28],promoting physical activity and outdoor play by
targeting co-participation, while respecting public health
restrictions, may be one strategy to enhance health be-
haviours of children and youth [28,29].The associations
observed with parental age are consistent with typical
age-related declines in physical activity [29].Finally,
families who had a dog had higher physical activity and
outdoor time. A recent systematic review also showed
that dog-related interventions increased physical activity
[30].
There are emerging calls bringing attention to the
likely impact of the global pandemic on the movement
behaviours of adults, children and youth [31,32]. Our
findings describe some of the ways Canadian parents are
adapting to this challenge. In the open-ended questions,
respondents of this survey identified several creative
ways that they were using their leisure-time to develop
or renew new family hobbies. Families are reconnecting
through leisure, though primarily sedentary leisure activ-
ities. Carving out time for family leisure and starting
new hobbies and activities may be helpful strategies to
reduce the mental health challenges (e.g., depression,
anxiety) that are being exacerbated by lockdown condi-
tions [33,34]. Where possible, families should consider
substituting sedentary leisure for more active leisure
pursuits. A recent review of reviews demonstrated that
increased physical activity was associated with decreased
depressive symptoms in children and youth [35] and
Table 4 Associations between perceived changes in movement behaviours and demographic, social, and environmental factors
Outside
physical
activity
Walking
and
biking
Outside
play
Overall
time
outdoors
Inside
physical
activity
Household
chores
Inside
play
Family
physical
activity
Family
sedentary
behaviour
Screen
time
Social
media
Sleep Sleep
quality
Parent’s age −0.11* −0.11* −0.16* −0.14* −0.10* −0.02 −0.07* −0.11* −0.01 0.04 −0.13* 0.12* −0.07
Parent’s gender
(1=M;2=F)
−0.01 0.00 0.04 0.02 −0.02 0.06 0.08* 0.03 0.05 0.08* 0.08* 0.07* 0.01
Parent’s
education
−0.05 0.02 −0.06 −0.07* −0.01 −0.01 0.02 −0.05 0.09* 0.03 0.09* −
0.01
0.03
Parent’s work
status
(1 = U; 2 = E)
0.02 0.04 0.01 0.03 0.02 −0.02 −0.02 0.04 0.03 −0.03 0.03 0.01 0.04
Household
income
0.03 0.13* 0.11* 0.05 0.01 0.07* −0.03 0.04 0.07* 0.04 0.11* 0.01 0.02
Marital status
a
0.06 0.06 0.11* 0.08* 0.05 0.10* 0.01 0.08* −0.02 −0.05 −0.06 −
0.05
0.05
Household
type
b
0.12* 0.13* 0.18* 0.14* −0.01 0.09* −0.09* 0.09* 0.01 0.01 0.04 −0.04 −0.03
Dog ownership
(1 = no; 2 = yes)
0.07* 0.03 0.11* 0.10* 0.00 0.09* −0.10* 0.06 −0.02 −0.01 0.09* 0.07* 0.02
Parent
encourages
physical activity
0.17* 0.12* 0.14* 0.13* 0.12* 0.08* −0.02 0.24* 0.05 0.07* 0.04 0.10* 0.07*
Parent
participates in
physical activity
0.32* 0.32* 0.39* 0.39* 0.14* 0.18* −0.10* 0.44* 0.04 −0.02 0.00 −0.02 0.04
Parent
supports
physical activity
0.14* 0.10* 0.12* 0.15* 0.09* −0.01 −0.10* 0.13* −0.10 −0.07* −0.03 −
0.03
−0.02
Parent
discourages
screen time
−0.06 −0.05 −0.01 −0.06 0.00 0.08* 0.11* 0.00 0.06 0.13* 0.09* 0.09* 0.00
Parent
encourages
sleep
0.00 −0.03 −0.07* −0.04 0.05 0.09* 0.13* −0.01 0.07* 0.06 0.04 0.16* 0.15*
*=p< 0.01; MMale, FFemale, UUnemployed, EEmployed,
a
Marital status, 1 = single, 2 = cohabited;
b
Household type, 1 = other, 2 = detached house
Moore et al. International Journal of Behavioral Nutrition and Physical Activity (2020) 17:85 Page 8 of 11
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suggested that physical activity should be included in in-
terventions to reduce the public health burden of mental
illness. Many children and their families may
characterize the COVID-19 virus outbreak and lock-
down as traumatic [36]. Adopting healthy movement be-
haviours may help to mitigate the negative effects on
children and youth of this pandemic [13].
Acknowledging the challenges in meeting movement
behaviour guidelines and based on the advice of parents
surveyed in this study, we recommend that:
1) Parents continue to be creative in their home-based
leisure activities and support and encourage their
children to play and be active in innovative and safe
ways. Suggestions include co-participation in activ-
ities, trying new leisure hobbies, using online health
and/or physical activity apps, and getting outdoors
as much as possible (while following public health
requirements). It is recommended that children and
youth aim to accumulate 60 min per day of
moderate-to-vigorous physical activity and play out-
doors regularly [3,4,6,7].
2) Parents continue to set routines for their children,
including supervised time for screens, regular sleep
and wake times, and time for quality family time.
Limit leisure screen time to 2 h per day and swap
screen time for play time wherever possible [3,4].
3) Public health officials support parents by
implementing safe physical distancing measures
that provide extra space for everyone to walk, cycle,
wheel, and scoot. This could include temporary
reallocation of roadway space and keeping
expansive green spaces open.
Strengths, limitations, and future directions
Given that the evidence on the effect of the COVID-19
virus outbreak on children’s health-related behaviours is
scarce, this study has many of strengths. First, the sam-
ple was a nationally representative cohort of over 1500
parents of school-aged children and youth. Second, we
assessed parental-related factors to determine associa-
tions between parental behaviours (e.g., co-play) and
child and youth behaviours. Our study was limited by its
cross-sectional design although given our aim this ap-
proach was appropriate. The parent-report nature of the
study and the possibility of social desirability and/or re-
call bias may affect our findings. While we were able to
assess associations between parent work status and child
movement and play behaviours, we did not have data to
indicate whether or not parents were working from
home or had lost their job as a result of the pandemic.
Further, sampled parents represented the geographic,
cultural, and socioeconomic make up of Canada, how-
ever it should be noted that parents received a small
financial incentive for participation in each survey (up to
$3.00). Results may not generalize to other countries.
Future studies should evaluate the longer-term conse-
quences of the COVID-19 virus outbreak and recovery
on the movement behaviours of children and youth. To
develop targeted health promotion strategies [25], it
would be useful to identify province-specific or geo-
graphic differences influencing health behaviours of chil-
dren and youth.
Conclusion
This study provides evidence of immediate collateral
consequences of the COVID-19 outbreak, demonstrating
an adverse impact on the movement and play behaviours
of Canadian children and youth. The findings highlight
the challenge of, but need for, a balance of disease pre-
vention and health promotion efforts specific to integra-
tive movement behaviours. Accordingly, these findings
can guide efforts to preserve and promote child health
during the COVID-19 outbreak and crisis recovery
period, and inform strategies to mitigate potential harm
during future pandemics.
Supplementary information
Supplementary information accompanies this paper at https://doi.org/10.
1186/s12966-020-00987-8.
Additional file 1:. Complete children and youth movement and play
behaviours survey items.
Additional file 2:. STROBE statement checklist of items for cross-
sectional studies.
Additional file 3: Table 1. Inside and outside hobbies during COVID-19
virus outbreak. Table 2. New or returning family hobbies during the
COVID-19 virus outbreak. Table 3. Use of online resources during the
COVID-19 virus outbreak.
Acknowledgements
We would like to thank the survey participants for their support of the
project. This project was distributed to participants through Maru/Matchbox
and was funded by ParticipACTION, a national non-profit organization with a
mission to help Canadians sit less and move more (Toronto, Canada).
Authors’contributions
SAM, GF, and MST conceptualized the study design; drafted the survey,
oversaw the acquisition, analysis, and interpretation of data; and drafted the
initial draft of the manuscript. RER conducted the data analysis, populated
data tables and created figures. LJF and LMV summarized qualitative
responses using content analysis and drafted related results. All authors read,
reviewed, and approved the final version of the manuscript.
Funding
The survey upon which this paper is based was funded by ParticipACTION.
ParticipACTION is a national non-profit organization that helps Canadians sit
less and move more. ParticipACTION had no editorial privileges in the prep-
aration of this manuscript. ParticipACTION funded the study, distributed the
survey via Maru/Matchbox, received the data, and distributed the data to the
authors. –Acknowledgements.
Availability of data and materials
The dataset supporting the conclusion of this article is available from
ParticipACTION upon reasonable request and the completion of a data
transfer agreement.
Moore et al. International Journal of Behavioral Nutrition and Physical Activity (2020) 17:85 Page 9 of 11
Content courtesy of Springer Nature, terms of use apply. Rights reserved.

Ethics approval and consent to participate
Participants consent to participate in survey-based research when they sign-
up for the panel from which the sample was drawn. Subsequently, partici-
pants passively consented to participate when they agreed to complete the
survey. This secondary data analysis was approved by the University of British
Columbia’s Research Ethics Board (#H20–01371).
Consent for publication
Not applicable.
Competing interests
SAM, MB, RM have no conflicts of interest to declare. GF, RER, LJF, NO, JCS,
and MST are members of the ParticipACTION Research Advisory Group
(RAG). The RAG provides advice to ParticipACTION about the direction that
should be pursued with respect to its research, evaluation, and knowledge
translation. ParticipACTION provides meeting expenses for the RAG to meet
but does not provide any additional compensation. TCB and LMV are
employed by ParticipACTION in the roles of Behavioural Insights Manager
and Knowledge Translation Manager, respectively.
Author details
1
Department of Therapeutic Recreation, Faculty of Child, Family, and
Community Studies, Douglas College, 1250 Pinetree Way, Coquitlam, BC V3B
7X3, Canada.
2
School of Health and Human Performance, Dalhousie
University, PO Box 15000, Halifax, NS B3H 4R2, Canada.
3
School of
Kinesiology, University of British Columbia, 6081 University Blvd, Vancouver,
BC V6T 1Z1, Canada.
4
Behavioural Medicine Laboratory, School of Exercise
Science, Physical and Health Education, University of Victoria, PO Box 1700
STN CSC, Victoria, BC V8W 2Y2, Canada.
5
Department of Pediatrics, University
of British Columbia, 4480 Oak Street, Vancouver, BC V6H 0B3, Canada.
6
School of Population and Public Health, University of British Columbia, 2206
East Mall, Vancouver, BC V6T 1Z3, Canada.
7
ParticipACTION, 77 Bloor Street
West, Suite 1205, Toronto, ON M5S 1M2, Canada.
8
College of Kinesiology,
University of Saskatchewan, 87 Campus Drive, Saskatoon, SK S7N 5B2,
Canada.
9
School of Urban and Regional Planning, Ryerson University, 105
Bond Street, 4th Floor, Toronto, ON M5B 2K3, Canada.
10
Gordon S. Lang
School of Business and Economics, University of Guelph, 50 Stone Road East,
Guelph, ON N1G 2W1, Canada.
11
Faculty of Kinesiology, Sport, and
Recreation, University of Alberta, 1-153 Van Vliet Complex, Edmonton, AB
T6G 2H9, Canada.
12
Child Health Evaluative Sciences, The Hospital for Sick
Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
13
Children’s
Hospital of Eastern Ontario Research Institute, 401 Smyth Road, Ottawa, ON
K1H 8L1, Canada.
14
Department of Pediatrics, University of Ottawa, 401
Smyth Road, Ottawa, ON K1H 8L1, Canada.
Received: 5 May 2020 Accepted: 19 June 2020
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