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Surveillance of physical activity and sedentary behaviour in czech children and adolescents: a scoping review of the literature from the past two decades

Abstract

Background

This study aimed to map the available evidence related to physical activity (PA) and sedentary behaviour (SB) in Czech children and adolescents and suggest future directions and improvements to strengthen the surveillance of PA and SB in the Czech Republic.

Methods

The search of articles published between January 2000 and December 2020 included the Medline and Medvik databases and a manual search in eight Czech journals related to the topic. This review followed the “Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews”.

Results

Out of 350 identified articles, 79 articles met the criteria for selection and referred to 27 studies. The majority of the articles were cross-sectional (89%), approximately two-thirds of the articles (61%) examined only PA, and half of the articles (51%) employed device-based assessments. Approximately 47% of the articles reported the prevalence of physical inactivity on the basis of inconsistently defined recommendations. Approximately 14%, 23%, and 10% of the articles focused on active transportation, organized PA (including physical education or leisure-time PA), and parent-child PA, respectively.

Conclusions

Future studies need to focus on longitudinal design and interventions, randomly selected samples, a mix of device-based and self-reported methods, and the recognition of health-related 24-hour time use patterns. This review advocates the government-supported development of a national surveillance system that will help to reduce insufficient PA and excessive SB.

Peer Review reports

Background

In children and adolescents, physical activity (PA) is an important part of a healthy lifestyle. Sufficient PA is associated with improved physical fitness, cardiometabolic health, bone health, cognitive outcomes, and mental health, and reduces adiposity [1, 2]. Conversely, insufficient PA accompanied by high levels of sedentary behaviour (SB) has a negative influence on health [3] and together they are considered as the key drivers of non-communicable diseases [4] with a possible transfer to adulthood [5]. Currently, the Global Action Plan on PA 2018–2030, the mission of which is to ensure access to safe and enabling environments and to diverse opportunities to be physically active for all people, draws attention to the fact that 81% of adolescents are not sufficiently active [6]. Moreover, the prevalence of insufficient engagement in everyday PA increases during adolescence and seems to be higher among girls [7].

PA is complex movement behaviour and might be performed with varying intensities, body postures, domains, and bout duration, and for multiple reasons. In many countries across the globe, the relevant issues related to insufficient PA have resulted in the development of national PA guidelines which provide a consensus on the amount, intensity, frequency, and type of PA necessary for the prevention of chronic disease and for supporting collective health [8]. Besides promoting an optimal level of PA, limiting SB is also recommended in the majority of these countries. SB is defined as any waking behaviour characterized by an energy expenditure ≤1.5 metabolic equivalents (METs) while in a sitting, reclining, or lying posture [9]. Specifically, time spent using a device such as a computer, television, or games console, which is called “screen time” (ST), is a more specific component of total SB with several negative effects on health [10]. Achieving the required level of PA and SB offers significant health benefits and mitigates health risks which have been recently highlighted by the World Health Organization (WHO) in the most recent edition of the “WHO Guidelines on Physical Activity and Sedentary Behaviour” [1].

The WHO also announced national surveillance of PA as an essential part of the global initiatives [1]. A comprehensive surveillance system is required to monitor PA levels accurately at the population level. It provides essential information on compliance with the PA and SB guidelines and allows determinants and trends over time to be identified [11]. This information is required to guide, monitor, and evaluate policies and intervention programmes aimed at improving the level of PA among children and adolescents [12]. Moreover, the national data could help to adopt global PA and SB recommendations with appropriate adjustment to the social, cultural, and environmental conditions of the state.

In the Czech Republic, a national surveillance system, as well as country-specific recommendations for children’s and adolescentsʼ PA, is lacking. The absence of PA surveillance is partly compensated for by the national “Report Card on Physical Activity for Children and Youth”, the first edition of which was published in 2018 [13, 14]. Although the report card presents estimates of the level of physical inactivity and excessive ST that are based on the synthesis of the available evidence from 2013 to 2017, it draws attention to the inadequacy that exists in the area of PA research.

The inadequacy in the area of PA research is also visible in a recently published systematic review of global, regional, and national trends and patterns in PA research since 1950, in which the Czech Republic, with a total of 105 papers, is in nineteenth place among high-income European countries [15]. Likewise, no study has summarized and reviewed existing research on PA and SB in Czech children and adolescents. Such a comprehensive analysis describing up-to-date surveillance and its main findings is critical as a prelude to further steps which could lead to the development of a national surveillance system and recommendations.

Therefore, the purpose of this study was to systematically review the available evidence on PA and SB in Czech children and adolescents published in the last two decades. Specifically, we aimed to (1) summarize the descriptive characteristics and main conclusions of the available evidence and (2) suggest future directions and improvements to strengthen the surveillance of PA and SB in Czech children and adolescents.

Methods

The search strategy

This scoping review conforms to the “Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews” (PRISMA-ScR) [16]. The checklist was followed in reporting this study (Supplementary file 1). The search included the Medline (via Ovid) and Medvik databases. We searched for studies published from January 2000 to December 2020 but only studies whose data was obtained during this period were included in the review. The search strategy was arranged in three sets of terms that cover the target population (i.e. school-aged children), movement behaviours (i.e. PA and SB), and country (the Czech Republic). The search strategy builds mainly on the Medical Subject Heading (MeSH) terms. Subsequently, selected free-text terms were included in the search strategy to increase the sensitivity of the search. The complete search strategy used in the electronic databases is presented in Supplementary file 2. The search results were imported into the EndNote program (Version X7; Thomson Reuters, San Francisco, CA, USA), all duplicates were deleted, and an online Excel spreadsheet was produced for screening purposes. The final database included several unique identifiers for each study and several items of bibliographical information (article identifier, authors, year of publication, study title, abstract, and journal title).

Next, the title and abstract of the studies were screened by two independent evaluators. The studies were divided into three groups: relevant, irrelevant, and potentially relevant studies. In the case of potentially relevant studies, their full texts were analysed, and then the studies were included or excluded. In the event of a disagreement between the evaluators concerning the relevance of a particular study, the final decision as to inclusion or exclusion was made by a third person.

In addition to searching the databases mentioned above, the authors performed a manual search in the references of studies included in the review. A manual search was also carried out in the main Czech journals related to the topic of interest and which were not indexed in the Medline and Medvik databases during part or the whole of the past 20 years. Specifically, we performed a manual search in Tělesná kultura, Acta Gymnica, Česká Kinantropologie, Studia Kinanthropologica, Medicina Sportiva Bohemica et Slovaca, Tělesná výchova a sport mládeže, Acta Universitatis Carolinae – Kinanthropologica, and Studia Sportiva.

Inclusion and exclusion criteria for studies

Articles with any research design were included in this scoping review if they: (a) targeted Czech children and adolescents aged from six to 20 years, (b) reported PA (overall PA, organized sports and PA, leisure-time PA, physical fitness, steps per day, active transportation, cycling, walking, roller-skating, training, physical education lessons, active play, locomotion, or movement), SB (total sedentary time, ST, physical inactivity, sitting, or lying), or both, (c) were written in the English or Czech language, (d) were published between 2000 and 2020, and (e) were published as a peer-reviewed journal article. International studies without a clearly defined Czech sample were excluded. The minimum sample size was set to at least 50 participants for cross-sectional studies but none was set for longitudinal studies.

Data extraction

The basic characteristics about the studies that were included (design, primary outcomes, and main findings) and descriptive characteristics of the study samples (sample size, percentage of girls, age category or average age, and region of the Czech Republic) were extracted. We also extracted information on the use of methods used for measurement (self-reported, device-measured) and dealt with more detailed information on PA and SB. Finally, we summarized the main findings and results of the studies that were included.

Results

Data extraction procedure and bibliographic characteristics

In the Medline and Medvik databases, a total of 316 articles were identified on the basis of the search strategy, and 34 articles were identified by the manual search (Fig. 1). After the removal of duplicates, the exclusion of some articles on the basis of predetermined criteria was performed. Out of 160 full-text articles assessed for eligibility, there was a disagreement between the evaluators concerning the relevance of a particular study in eight cases, and the final decision as to whether to include or exclude them was made by a third person. Although these papers were related to the PA and SB of Czech children and adolescents, the main reasons for exclusion were: (a) the impossibility of separating the Czech results from the results of other countries [17], (b) PA and SB results related to very specific samples (with a different mental load or level of academic achievement) without clear summary findings [18,19,20], and (c) specific studies examined test-retest reliability [21, 22].

Fig. 1
figure 1

The flow of information through the different phases of the review.

The final sample included 79 articles [23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77, 79,80,81,82,83,84,85,86,87,88,89,90,91,92,93,94,95,96,97,98,99,100,101,102] referring to 27 studies. An overview of all articles is shown in Table 1. Out of 79 articles, 27 referred to the WHO study called Health Behaviour in School-aged Children (HBSC) with the data collections in 2009/2010 [29, 59, 61, 80, 83, 87, 101], 2013/2014 [23, 32, 35, 57, 79, 89, 91,92,93, 96, 98], 2017/2018 [31, 88] or in different periods within the trend analyses [30, 36, 58, 63, 64, 84, 86]. Six articles belonged to the intervention study in school-aged children in Olomouc region [42, 43, 49,50,51, 100], 2 articles were part of the Moravian study [52, 53], 3 articles are part of the 24-h movement behaviour study [58, 62, 81], 3 articles referred to one-year longitudinal study [39, 47, 48]. Nine articles were published within parents-children study [33, 72, 73, 76, 77, 82, 85, 95, 102]. Two articles were part of adolescent survey [67, 88], 2 articles referred to ActiTrainer accelerometer-based children study [65, 94], 3 articles referred to ActiTrainer accelerometer-based adolescent study [27, 28, 69], and 2 articles were related to 15-16year adolescent study [68, 90]. Six articles referred to adolescent study using pedometers and International Physical Activity Questionnaire (IPAQ) [24,25,26, 46, 60, 75]. Sixteen articles presented findings from independent studies [34, 37, 38, 40, 41, 44, 45, 54,55,56, 66, 70, 71, 74, 97, 99].

Table 1 Characteristics and findings of the studies included

Sixty-one articles were published in the English language and 18 were published in the Czech language. Out of 79 articles, 18 papers [23,24,25,26,27,28,29,30,31,32, 35, 46, 57, 68, 79, 90, 96, 97] were part of international surveys with clearly identified results related to PA and/or SB in Czech children and adolescents.

An apparent increasing trend of published articles is shown in Fig. 2. The first two papers related to the PA of Czech children and adolescents were published in 2007 [43, 71]. In addition, there are three papers published later on for which the data collection took place in 1998–2000 [33], 2001 [34], and 2002 [36], and thus the data related to the PA or SB of Czech children and adolescents in the identified articles covers the whole 20-year period.

Fig. 2
figure 2

An overview of the studies included considering their year of publication and primary outcomes. Note. PA= Physical activity; SB = Sedentary behaviour

Descriptive characteristics of the available evidence

Study purposes

The main purposes of the selected articles were mainly the description of: (1) PA [27, 38, 43, 45, 47, 48, 56, 66, 68, 71, 74, 94, 99] or SB [27, 55, 66]; (2) the prevalence of sufficient PA [46, 54, 55, 90] or excessive SB [79, 80, 83], and (3) trends or changes in PA [26, 30, 33, 34, 36, 60, 63, 64, 86, 100] and SB [33, 36, 84]. The main aims of further articles were the examination of the relationships between PA or SB and (1) school settings and school-related factors [25, 28, 32, 57, 69, 87, 89, 92, 101]; (2) behavioural and psychosocial factors (e.g. health-related behaviours [29, 44, 81, 89, 91,92,93], psychological factors [24, 46, 56, 59, 67, 69, 75, 88], or social and family factors [42, 61, 72, 73, 76,77,78, 82, 85, 95, 101]; 3) the social and built environment [23, 35, 70, 96, 98] and seasonal changes [37, 39, 40], and 4) obesity-related indicators [41, 44, 52, 53, 55, 58, 65]. In addition, several articles investigated the influence of school PA programmes on the incidence of obesity [49,50,51].

Study sample

This scoping review identified 70 cross-sectional articles, seven longitudinal articles, and two interventions. Out of all the cross-sectional articles including school-aged participants, 18 articles focused on children, 54 articles on adolescents, and seven articles on both. The ages of the study participants ranged between six and 20 years. The intervention studies employed only children aged from six to nine years. Girls represented more than 50% of the study sample in most of the articles and boys were not included in four articles [37,38,39,40]. Out of all 79 articles, randomly selected representative samples were identified in 28 articles.

In the cross-sectional articles, the sample size varied from 55 [38] up to 30,966 participants [41]. The longitudinal articles employed samples with from nine to 176 participants.

This scoping review identified data on the PA and SB of Czech children and adolescents in 18 international and 61 national articles. Some of the national articles narrowed their selection only to specific regions: 12 articles from the Olomouc region [34, 39, 42,43,44,45, 47,48,49,50,51, 79], two articles from the Hradec Králové region [34, 45], three articles from the Moravia region [37, 52, 53], two articles from the North-western Bohemia region [54, 55], and one article from each of the Plzeň [56] and Opava regions [38].

Measurement

None of the articles used qualitative research methods. All of them used quantitative methods and reported the measurement tool for the assessment of PA or SB (Table 1). The number of articles using self-reported (n = 39), device-measured (n = 32), and a combination of both (n = 8) assessments of PA and SB is shown in Fig. 3. Out of 40 articles using device-based measurements, accelerometers (ActiGraph GT3X, GT3X+, GT9X Link, wGT3X-BT, Caltrac, and ActiTrainer) were used in 19 articles, while pedometers (Digi-walker Yamax SW-200, SW-700, SW-701, Omron HJ-105) were used in 28 articles. Studies using self-reported measurements used HBSC questionnaires (n = 27), IPAQ long form (n = 13), and International Physical Activity and the Environment Network (IPEN) Adolescent questionnaires (n = 2), IPAQ-short form (n = 1), and other types of questionnaires (n = 9).

Fig. 3
figure 3

An overview of the studies included, considering their year of publication and the assessment tools

Of the 79 articles included (Fig. 2), PA-only articles comprised the largest proportion (61%), followed by articles of both PA and SB (34%) and SB-only articles (5%). PA was expressed as minutes, MET-minutes, or steps on an average day (waking time or 24 h) or a specific segment of the day (unorganized or organized leisure-time physical activity (OLTA), school PA in physical education (PE) lessons, or, during recesses, active transportation (AT). The SB articles reported minutes of total SB, sitting time, or ST, which was defined as TV viewing, playing games on a PC/console, chatting online, using the internet, emailing, etc.

Main findings related to PA and SB

Prevalence of sufficient/insufficient PA and SB

Thirty-seven articles (Supplementary file 3) also reported the prevalence of sufficient/insufficient PA, SB, or both. The prevalence of the adherence to the PA and ST recommendations ranges between 12.6 and 73% and 17.5 and 73.6%, respectively. However, the definition of a sufficient PA level was different in the articles that were included, ranging from achieving 60 min of moderate-to-vigorous physical activity (MVPA) daily or five times a week [23,24,25,26, 30, 32, 46, 49, 53, 58,59,60,61,62,63,64,65,66,67, 69], 20 min of VPA at least three times a week or 30 min of MPA or walking at least five times a week [24,25,26, 32, 46, 56, 59, 64, 66, 70, 71], and daily step counts ranging between 11,000 and 14,000 for boys and 10,000 and 13,000 for girls [26, 33, 43, 60, 69, 72,73,74,75,76,77,78, 90]. Moreover, the recommendation for school PA (i.e. 500 steps/school time) was met by 39% of Czech adolescents [28] and 83% of boys and 69% of girls on days with a PE lesson [69]. Excess SB was mostly defined as ≥ 2 h per day of ST [64, 72, 73, 80] and was accomplished by 40.4–80.7% of children and adolescents.

The correlates of meeting the PA and SB recommendations were examined in 28 [23,24,25,26, 28, 30, 32, 33, 36, 43, 46, 53, 56, 59,60,61,62, 65,66,67, 69,70,71, 74, 75, 77, 78, 90] and three articles [80, 84, 97], respectively. Six articles [58, 63, 64, 72, 73, 76] examined the correlates of meeting both the PA and SB recommendations. A greater likelihood of achieving the recommended level of PA was associated with lower age [32, 36, 37, 57,58,59, 62, 64, 67, 71, 81, 96], an environment perceived as activity-friendly [35], participation in PE lessons or intervention programmes [50, 65, 69], active transportation [24, 67], or OLTA [71, 77, 78, 82], or more specifically in sports clubs [32], sufficient PA on weekend days [73, 90], preferences for fitness activities [46, 56], different kinds of motives [26, 38, 44, 45, 59], and the agreement between preferred PA and that actually undertaken [26].

The proportion of children and adolescents not meeting the recommendation for SB or ST was positively associated with age [58, 79, 80, 83, 84] and more ST on weekend days compared to weekdays [27, 36, 55, 64, 73, 80, 84, 85]. Furthermore, longitudinal studies confirmed the variability of the achievement of sufficient PA and SB across the seasons, months, and days of the week [37, 39, 40, 47, 48].

Ten articles investigated the trends of sufficient PA or SB and found an increasing prevalence of sedentary time [36, 64] and a decreasing prevalence of children and adolescents meeting PA guidelines [26, 30, 33, 46, 60, 63, 64] and using active modes of travel when commuting [86]. However, two articles suggested that the way children and adolescents spent their time being sedentary had shifted from watching TV to computer use between 2002 and 2014 [63, 84]. Moreover, an increasing prevalence of SB and a decreasing prevalence of achievement of the PA recommendations in adolescents were in line with a concurrent increase in the prevalence of their overweight/obesity [36, 64].

Weekdays versus weekend days

In all the articles, a greater PA level was found for weekdays compared to weekend days. Moreover, this was confirmed in longitudinal studies [39, 48] which revealed that across all months and seasons, children and adolescents achieved notably more minutes in MVPA or steps on weekdays than at weekends, with Sunday being the least active day [39, 47, 48, 60]. Conversely, weekend days seem to be the “risk time” for excessive ST and insufficient PA levels [36, 60, 64, 73, 80, 85].

Active transportation

Out of 11 articles examining AT, nine focused on active commuting to and from school, including walking, cycling, and riding a scooter or skateboard. The proportion of children and adolescents using actively commuting to school ranged between 22.5% and 74.3% across the studies [31, 34, 61, 74, 86,87,88, 97, 101]. Living within a 20-minute walking distance to school [74], a place of residence being in the same municipality as the school [61, 101], high-walkable areas [34], and attending schools with policies and programmes promoting AT [87, 101] were positively associated with active commuting to school. According to one article [24], AT accounted for 22.5% and 24.9% of the weekly PA of Czech boys and girls, respectively. A long-term decrease in the AT of Czech adolescents was found in two articles. One article [34] found a decrease in the proportion of active commuting in 47% of the respondents and suggested a decrease of 2.7 times in the likelihood of commuting actively in 2011 in comparison to 2001. The second articles [86] showed an overall decrease in AT by 21.7% in boys and by 23% in girls between 2006 and 2014.

PE lessons and organized leisure-time activities

Participation in regular PE lessons contributed considerably to an increase in the volume and intensity of school PA [28, 65, 69], steps per day [39, 48], and daily MVPA [65], and a decrease in school-time SB [65]. This was apparent across all months and seasons [39, 40, 48]. In intervention study indicating the effect of school-based PA programmes on the incidence of obesity [49,50,51], PE lessons as a part of the school PA programme performed in compatible active environments were found to have a vital role in the reduction of obesity and overweight among younger pupils.

The proportion of children and adolescents who participated in OLTA ranged between 41 and 81% across articles [89, 91,92,93] and decreased with age [55, 91]. More specifically, 62% of Czech children and adolescents took part in sports club activities, according to [32]. In all 14 articles [32, 42, 47, 55, 71, 76, 77, 82, 89, 91,92,93, 97, 102] that investigated OLTA, only positive effects of this activity were suggested. Specifically, OLTA was positively associated with better physical and mental health [93], a lower rate of occurrence of repeated substance use and truancy, and inversely with higher odds of physical fights and injuries [91], higher school engagement, lower levels of school-related stress, and better academic achievement [92], and a lower prevalence of obesity [82, 85]. In addition, children with regular OLTA were more likely to meet the PA recommendations [32, 55, 77, 82, 102], having higher levels of VPA and spending less time sitting than children without participation in OLTA [42]. Longitudinal engagement in OLTA increased daily PA, regardless of the month and season [47]. In contrast, 34–37% of Czech children and adolescents were not engaged in any OLTA [89, 97]. However, involvement in peer-oriented unstructured activities was strongly associated with an increased risk of smoking, getting drunk, experience with sexual intercourse, and poorer academic achievement in 34% of adolescents [89].

Differences between boys and girls

The majority of articles investigating PA in both sexes suggested that boys are more active than girls [53, 71, 94]. This was obvious particularly in total PA [27, 32, 71], MVPA [25, 26, 30, 36, 52, 53, 57, 59, 60, 63,64,65, 94], school-based PA [27, 28, 69], leisure-time PA [55, 71, 82, 89, 92, 93], and active transportation [24, 34, 86, 87]. Although most articles found a higher daily number of steps in boys than in girls [26, 28, 49,50,51, 53, 54, 60, 68, 69, 72, 73, 82, 85, 94, 95, 102], four articles conversely suggested more steps per day in girls compared to boys [27, 33, 75, 77]. Sex-specific patterns related to PA were found in several articles. For example, boys were more likely to cycle to school [86] and the association between school policies and programmes and AT was stronger in boys compared to girls [80]. On the other hand, a higher rate of AT was significantly associated only with greater well-being in girls [24]. Girls had significantly lower odds of adherence to the combined movement guidelines [62] and appeared to be more influenced by social motives [59] and their participation in leisure-time PA decreased with age more than was the case for boys [55]. PA preferences differed between boys and girls and were longitudinally more stable for boys than for girls [46].

The gender differences were obvious in the relationship between PA or SB and obesity indicators. MVPA was negatively associated with body fatness indicators only in girls, while body fatness indicators in boys were strongly negatively associated only with vigorous PA [53].

In SB articles, the results related to sex differences were not so clear. In some device-based articles, girls were found to be more sedentary [33, 53, 65, 70], while in others, the time spent on SB was greater in boys compared to girls [41, 55, 63, 80, 83]. Moreover, in self-reported articles, boys reported higher overall ST [55, 83], computer use [27, 41, 80], or TV watching [41] than girls. On the contrary, chatting online was more common among girls [80]. Sex-specific SB was also found in a device-based article [52], where boys spent on average 9.9 min per day less on short sedentary bouts and 7.5 min per day more on long sedentary bouts compared with girls. Also, longitudinal increases in excessive ST on weekdays and at weekends were found only in boys [64]. Additionally, watching TV was positively associated with being overweight/obese only in adolescent girls, but not in boys [41].

Parent-child PA

The relationship between parentsʼ and childrenʼs PA and SB was investigated in eight articles [42, 72, 73, 77, 82, 85, 95, 102]. In conclusion, high levels of parental PA contributed to the achievement of the recommended daily PA in children [72, 73, 77, 85, 95, 102], and excessive ST of parents was associated with more time spent sitting in their children [42] and a reduced likelihood of their children achieving the recommended daily PA [72, 85]. The parent-child PA or SB relationship was found to be stronger for children younger than eight years of age [77, 95], on weekend days [72, 73, 85, 95], and in families participating in organized PA [42]. In addition, sufficient PA in mothers was associated with sufficient PA in their overweight/obese children [77].

24 h time use

In four articles, 24-hour movement behaviours were considered, including SB, PA, and sleep. On the evidence of one self-reported study [97], 95% of Czech children slept for nine to 11 h per night. Approximately three-quarters of children (71%) and adolescents (75.3%) slept for less than nine and eight hours, respectively [81]. In children, this short duration of sleep was associated with higher SB by 95 min per day and lower MVPA by 16 min per day. In adolescents, a higher SB by 67 min per day and lower light-intensity PA (LPA) by 2 min per day were found to be associated with a short duration of sleep [81]. Also, meeting the combined 24 h movement guidelines (≥ 60 min per day of MVPA, < 2 h per day of recreational ST, and uninterrupted sleep for 9–11 h per day for children or 8–10 h per day for adolescents) was investigated in two studies [58, 62]. All the recommendations of the combined 24 h movement guidelines were met by approximately 6.5% of the children and 2.2% of the adolescents [62]. While no associations were found between meeting all three (combined) recommendations and adiposity indicators, meeting only the ST recommendation or the combined ST and sleep recommendations was found to be negatively (favourably) associated with adiposity [58]. Furthermore, significantly lower odds of adherence to the combined movement guidelines were found in girls and participants with overweight or obese fathers [62].

Discussion

This scoping review examined 79 articles related to the PA or SB of Czech children and adolescents and summarized the descriptive characteristics and main conclusions of the available evidence. The majority of the articles were cross-sectional (88.6%), approximately two-thirds of the articles (61%) examined only PA, and half of the articles (50.6%) employed device-based assessments. Approximately 47% of the articles reported the prevalence of sufficient/insufficient PA and 14%, 23%, and 10% of studies focused on AT, organized PA (including PE or OLTA), and parent-child PA, respectively.

Although we searched for articles published in the past two decades, the articles included in this review were not published until 2007. Since then, the amount of PA and SB research has been on the rise, with 79 articles being published till December 2020. This is in line with the gradual increase in the number of Czech studies dealing with the PA of children and adolescents, often connected with international cooperation and participation in global studies, such as International Physical Activity and the Environment Network, Health Behaviour in School-Aged Children, or the Childhood Obesity Surveillance Initiative. Although the first two papers were published in 2007, data from several of the articles that were identified was collected much earlier. This is mainly apparent in trend articles, with the first round of assessments in 1998–2000 [33], 2001 [34], and 2002 [36]. Hence, the conclusions from selected articles reflect a more than 20-year period of the assessment of Czech children’s and adolescents’ PA.

In this review, we found a high proportion of cross-sectional articles and only nine articles with a longitudinal design. The follow-up periods of the longitudinal studies ranged between ten and 24 months and revealed differences across days of the week, months, and seasons, and in one specific life transition (i.e. from kindergarten to school). However, these studies mainly employed very small convenience samples, with a limited possibility of generalizing the results to the entire Czech school-aged population. Considering longitudinal studies as the way to define the causality and determinants of PA and SB, more longitudinally designed studies with a random sample are needed in the Czech Republic. Additionally, these studies should consider the year-round movement behaviours concerning different life transitions.

This study critically reviewed only the PA and SB research in the target populations, although the importance of sleep has been recognised and was included as an important health outcome when considering the impact of PA and SB [81]. This was done for two reasons. Firstly, the vast majority of Czech papers focused only on PA and/or SB, with the exception of four papers [52, 58, 62, 81] published very recently which examined movement behaviours (i.e. PA, SB, and sleep) using a 24-h wear time protocol. Secondly, this approach agrees with a recently published edition of the “WHO Guidelines on Physical Activity and Sedentary Behaviour” [1]. However, in recent years, the univariate paradigm in movement behaviour research has been replaced with a 24-h time-use paradigm that integrates the analysis of all daily movement behaviours relative to each other, rather than as individual entities [103]. This approach is apparent in world initiatives, such as developing time-use epidemiology [104] and in the creation of 24-h movement behaviour recommendations in several countries, such as Australia [105], Canada [106], Croatia [107], New Zealand [108], or Thailand [109]. In this review, the presence of studies covering all daily behaviours is a promise of the quality of the PA-related research that could be the core for developing a comprehensive surveillance system in the Czech Republic.

Consistent, valid, and reliable assessments of prevalence and trends in PA (ideally relative to other behaviours) are necessary to guide the development of policies and programmes to increase activity levels and to reduce the burden of non-communicable diseases associated with physical inactivity and elevated SB. In this review, 37 articles investigating the percentage of Czech children or adolescents who achieved the PA or SB recommendations were cross-sectional, with 62% not having a representative sample.

This review also identified several papers that examined trends in PA or SB or meeting the recommendations for these behaviours. Such studies with randomly selected samples mirrored the negative trends which were found in other countries [5], such as increased sedentary time, a decreasing percentage of children and adolescents meeting the PA guidelines, and using AT. However, these studies employed self-reported assessments of PA and SB that could be prone to both inaccurate reporting and reporting bias [110].

In this review, approximately half of the articles used self-reported assessments of PA or SB and half of them device-based ones. Among the device-based studies, pedometers have been widely used in the last twenty years in the Czech studies. However, the feasibility of using pedometers in a state-based surveillance system were modest at best [111]. Accelerometers seemed to be more accurate in the characterization of the entire activity pattern in school-aged children [112]. On the other hand, the domain- and type-specific differences in PA and SB (e.g. AT, ST) advocate the importance of assessing movement behaviours using a combination of self-reported and device-based methods. However, only eight articles were found to use this combination of methods and hence, an increase in the number of such studies in the future could be a possible direction for improving the surveillance system in the Czech Republic.

Furthermore, the variety of tools used to assess PA and SB and the way in which the data was processed (especially in accelerometers), as well as the different definitions of sufficient levels of PA and SB in the studies, have to be mentioned and may explain the inconsistency of findings related to sex-specific PA and SB or the prevalence of sufficient PA.

Strengths and limitations of the study

This is the first comprehensive study that systematically reviews the available evidence related to PA and SB in Czech children and youth. Moreover, within this review, we provide suggestions for future directions of the national surveillance system on these behaviours.

Several limitations have to be mentioned. Firstly, the search strategy does not cover “grey literature”. This could lead to publication bias as we might have missed some valuable data published in conference proceedings, Master’s or doctoral theses, or reports. On the other hand, our search strategy ensured that all the studies found for this review underwent a peer review process and demonstrated at least satisfactory methodological quality standards. Secondly, within this scoping review we described the study designs, samples, and methods of PA and SB assessments and the main findings of the selected studies. However, an assessment of methodological quality which could help in creating a comparison of the outcomes of the studies was not carried out. Last but not least, the main findings presented in this review were summarized from 79 individual articles referring to 27 original studies and using different tools, study samples, and definitions of PA and SB. The interpretation of these findings and their implications should be used with caution.

Conclusion and recommendations

This scoping review identified 79 articles from 27 studies related to PA and SB in Czech children and adolescents and revealed an increasing trend in the number of articles published during the past two decades. The results of studies suggested an increase in sedentary time or its proxy indicators and a decreasing percentage of Czech children and adolescents doing a sufficient amount of PA. On the evidence of this review, organized PA, including PE lessons as well as OLTA, increasing weekend PA, family inclusion, and an environment that supports movement might contribute to a reduction of unhealthy time use in Czech children and adolescents.

Although we reviewed 79 articles, standardized national surveillance was not recognised. This review identified limitations, including the large proportion of cross-sectional studies, the limited sample size in longitudinal studies, and the lack of studies using a mix of device-based and self-reported methods and focusing on health-related 24-h time use patterns.

In agreement with global calls [11, 113], the result of this review advocates the necessity of the government-supported development of a national surveillance system that would incorporate a combination of standardized device-based measures, such as those derived from accelerometers, and self-reported domain and type-specific assessments. Such a national surveillance system on movement behaviours, which would allow the recommended amount of these behaviours to be systematically assessed, is needed to reduce the decrease in sufficient PA and hence, improve the health of Czech children and adolescents or reduce the risk of different non-communicable diseases in this group.

With respect to the “WHO Global action plan on physical activity 2018–2030” call [11] and on the basis of this review of the available evidence, we identified several issues which might serve as a recommendation for future directions in Czech research and policy and be inspiring for other Central European countries lacking a national surveillance system:

  • We advocate the development of a national surveillance system on 24-h movement behaviours that would incorporate both device-based measures and self-reported domain and type-specific assessments.

  • The national surveillance system should systematically monitor the prevalence of sufficient PA and 24-h time use of PA, SB, and sleep and their associations with health outcomes.

  • Further evidence is needed to support national recommendations on PA, SB, and sleep and to enforce them in state and school policy and practice. Furthermore, longitudinally designed studies using both device-based measures and self-reported assessments and employing randomly selected samples of Czech children and adolescents are needed.

Availability of the data and materials

The data supporting the conclusion of this paper is available through the detailed reference list. No original datasets are presented since this was a review of previously existing literature. Data sharing is not applicable to this article as no datasets were generated or analysed during the current study.

Abbreviations

PA:

physical activity

SB:

sedentary behaviour

METs:

metabolic equivalents

WHO:

World Health Organization

OLTA:

organized leisure-time physical activity

PE:

physical education

AT:

active transportation

ST:

screen time

MVPA:

moderate-to-vigorous physical activity

LPA:

light-intensity physical activity

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Acknowledgements

We are thankful to Palacký University Olomouc for providing us with essential resources to complete this review.

Funding

The study was funded by the internal Palacký University Olomouc grant IGA_FTK_2018_007.

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EM, JP, and AG conceptualized the study. EM and JP wrote the manuscript. EM, JP, and AG contributed to the abstract and full-text screening. AG created the search strategy. AG and KF critically reviewed the manuscript and made revisions. All the authors approved the final draft.

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Correspondence to Jana Pelclová.

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This study is a systematic scoping review that relied solely on existing literature. Hence, ethical approval was not required since there were no human participants.

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The authors declared no competing interests.

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Materová, E., Pelclová, J., Gába, A. et al. Surveillance of physical activity and sedentary behaviour in czech children and adolescents: a scoping review of the literature from the past two decades. BMC Public Health 22, 363 (2022). https://doi.org/10.1186/s12889-022-12766-0

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Keywords

  • Prevalence
  • Insufficient physical activity
  • Youth
  • Health