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Association of COVID-19 Mitigation Measures With Changes in Cardiorespiratory Fitness and Body Mass Index Among Children Aged 7 to 10 Years in Austria

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Key Points

Question  Were COVID-19 mitigation measures associated with changes in cardiorespiratory fitness measures and body mass index among primary schoolchildren in Austria?

Findings  In this cohort study of 764 primary schoolchildren aged 7 to 10 years, COVID-19 mitigation measures were associated with substantial reductions in cardiorespiratory fitness measures and increases in body mass index SD scores and the proportion of children with overweight or obesity.

Meaning  The findings suggest that collaborative efforts are needed to improve children’s health and fitness to prevent long-term negative health outcomes.

Abstract

Importance  Previous studies have shown reductions in self-reported physical activity levels in children associated with implementation of COVID-19 mitigation measures, and data on objectively assessed health parameters are limited.

Objective  To examine the association of COVID-19 mitigation measures with changes in cardiorespiratory fitness (CRF) measures and body mass index (BMI) among primary schoolchildren.

Design, Setting, and Participants  This cohort study included children aged 7 to 10 years from 12 randomly selected primary schools in urban and rural districts of Klagenfurt, Austria. Baseline CRF and BMI measurements were obtained in September 2019 before COVID-19 mitigation measures were implemented, and follow-up measurements were obtained in June and September 2020.

Exposures  COVID-19 mitigation measures.

Main Outcomes and Measures  Cardiorespiratory fitness was measured with a 6-minute endurance run test. Height and weight were objectively measured. Standard deviation scores were calculated for CRF and BMI. Changes over time were analyzed using analyses of variance. Secondary analyses were performed for subgroups stratified by sex.

Results  A total of 764 children (383 girls [50.1%]) aged 7 to 10 years had all measurements completed. From September 2019 to September 2020, CRF SD scores changed by −1.06 (95% CI, −1.13 to −1.00), with a similar decrease in both boys and girls. Body mass index SD scores had increased by 0.12 (95% CI, 0.06-0.16) in June 2020 and by 0.16 (95% CI, 0.12-0.20) in September 2020 compared with September 2019. The increase in BMI SD scores (from September 2019 to September 2020) was greater among boys (0.23; 95% CI, 0.18-0.29) than among girls (0.09; 95% CI, 0.04-0.15). During the 1-year period, the percentage of children with overweight or obesity increased from 20.3% (155 children) to 24.1% (184 children) (difference, 3.8% [29 children]).

Conclusions and Relevance  In this cohort study of children in Austria, COVID-19 mitigation measures were associated with decreases in CRF measures and increases in BMI. The findings suggest that collaborative efforts are needed to reverse these changes in children’s health to prevent long-term negative health outcomes.

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Article Information

Accepted for Publication: June 12, 2021.

Published: August 26, 2021. doi:10.1001/jamanetworkopen.2021.21675

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Jarnig G et al. JAMA Network Open.

Corresponding Author: Gerald Jarnig, MSc, Institute of Human Movement Science, Sport and Health, University of Graz, Mozartgasse 14, 8010 Graz, Austria (gerald.jarnig@gmx.at).

Author Contributions: Messrs Jarnig and Jaunig contributed equally to this work. Messrs Jarnig and Jaunig had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Jarnig, van Poppel.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Jarnig, Jaunig.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Jarnig, Jaunig.

Obtained funding: Jarnig.

Administrative, technical, or material support: Jarnig.

Supervision: van Poppel.

Conflict of Interest Disclosures: Mr Jarnig reported receiving grants from the Austrian Federal Ministry for Arts, Culture, Civil Service and Sport during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was funded by grant GZ205.410/0014-II/B/5/2018 (Mr Jarnig) from the Austrian Federal Ministry for Arts, Culture, Civil Service and Sport. The University of Graz funded open access publishing.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We thank all participants and their guardians and the trainers and staff who assisted with this study. Wolfgang Modritz (Nachwuchsmodell, Austria) initiated the study; Rodrigo A. Lima, PhD (University of Graz, Austria), and Dr Peter Hofmann (University of Graz, Austria) provided support in the conception phase; Dr Robert Klinglmair (Education Directorate of Carinthia, Austria) authorized assessments in schools; Mag. Christian Günter (Austrian Federal Ministry of Sport) and Mag. Hannes Wolf (Education Directorate of Carinthia, Austria) helped continue the assessments after the COVID-19 lockdown. None of the individuals listed were financially compensated.

Additional Information: The study was organized by Nachwuchsmodell Austria. The Austrian Working Group on Pediatric Endocrinology and Diabetics provided the calculations for the Austrian reference values for height SD scores and body mass index centile curves (ie, equicurves).

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