Assessing the impact of COVID-19 on the physical activity of 10-11-year-old children and their parents: Active-6 a mixed-methods study

Rationale for research and background

Physical activity is associated with many health benefits for children and adults, including reduced risk of obesity and improved cardiovascular health, health-related quality of life and cognitive and mental health. 2,3 Physical activity tends to track from childhood into adulthood, so ensuring that children engage in regular physical activity is essential for their current and future health. 4,5 The UK Chief Medical Officers recommend that all children and young people should accumulate an average of an hour or more of moderate to vigorous intensity physical activity (MVPA) per day. This is physical activity that raises the heart rate and makes children slightly hot, slightly sweaty and slightly out of breath. However, longitudinal data collected pre-pandemic between 2012 and 2018 observed that MVPA decreases by 2.2 minutes per weekday per year throughout primary school and that, by the age of 11 years, only 41% of children met the hour per day recommendation, down from 61% at age 6 years. 6 On average, girls participate in less physical activity than boys,7,8 and differences in physical activity patterns by family socioeconomic position have also been identified. 9

The COVID-19 pandemic and the associated social changes had a marked impact on physical activity patterns for adults and children around the world, as various lockdowns and social distancing measures were enacted throughout 2020–2. In England, national lockdowns occurred in March–May 2020, November 2020 and January–March 2021, including school closures and restrictions on access to leisure and sports centres and playgrounds. From March 2021, various social distancing measures remained and responded to fluctuating levels of COVID-19 and emerging variants, until February 2022 when all legal COVID-19 restrictions in England were lifted. The timeline in Figure 1 outlines these changes. These restrictions likely impacted physical activity among parents and children during their enforcement, but the extent to which the pandemic and restrictions had a longer-term effect on parent/carer and children’s physical activity is unclear. Evaluating these effects is therefore warranted to provide evidence to inform policy and practice to ensure that any adverse effects on physical activity are addressed on a population level.

FIGURE 1.

Timeline of COVID-19 policies in England. SATs, standard assessment tasks.

The Active-6 study sought to measure the impact of the pandemic on accelerometer-measured physical activity among year 6 children (aged 10–11 years) and their parents/carers in England following the final lockdown (January–March 2021). Using a baseline dataset collected in 2017/18, we sought to measure MVPA among year 6 children from the same schools to identify changes in the short-term period after the final lockdown had been lifted (May–December 2021), and if that change was maintained in the medium term (January–July 2022), indicating a more lasting change in activity levels. We also collected questionnaire data from both children and their parents/carers related to the type of activities in which they engage, health-related quality of life, household finances and well-being. We undertook qualitative data collection with parents, children and school staff to explain changes observed in quantitative analyses. Data related to school curriculum and extracurricular physical activity provision were collected from school staff, as well as an audit of school facilities. Our findings were then combined to provide rapid feedback to local and national policy-makers so that any negative impacts could be considered and addressed.

Objectives

The Active-6 study had seven interlinked objectives, reproduced from the study protocol:1

1. To assess the short-term effect of the COVID-19 pandemic on the weekday MVPA of year 6 children by comparing data from 2021 (wave 1) to data sampled from the same schools in 2017/18 (wave 0). Assess whether effects differ by socioeconomic position and/or gender.

2. To determine if there are differences between the physical activity and sedentary behaviour of year 6 children and their parents when compared with data sampled from the same schools in 2017/18 (wave 0) for the following secondary outcomes in 2021 (wave 1):

   1. parent accelerometer-measured weekday minutes of weekday MVPA

   2. child accelerometer-measured weekend minutes of MVPA

   3. parent accelerometer-measured weekend minutes of MVPA

   4. child accelerometer-measured weekday sedentary minutes

   5. child accelerometer-measured weekend sedentary minutes

   6. parent accelerometer-measured weekday sedentary minutes

   7. parent accelerometer-measured weekend sedentary minutes.

3. To assess the medium-term effects of the COVID-19 pandemic on the primary and secondary outcomes listed in objectives 1 and 2 with data sampled from the same schools in 2022 (wave 2).

4. To examine the extent to which differences in total volume of physical activity and sedentary time in both 2021 (wave 1) and 2022 (wave 2) are explained by the variation in the frequency that the child is active, child physical activity enjoyment and motivation, mode of travel to school, child screen time, after-school club attendance, parent physical activity motivation and self-efficacy.

5. To examine the specific impact of school walking, cycling and play provision, curriculum physical activity, school grounds and school physical activity policies on differences in physical activity.

6. To produce rapid interim reports from the project to UK policy-makers to inform the development of effective strategies to increase physical activity in groups who may have been disproportionately affected by changes due to COVID-19.

7. To understand the implications of COVID-19 on the time and resources allocated to physical activity by schools and households by addressing four subaims:

   1. To describe the implications of COVID-19 on household finances and spending on extracurricular physical activities.

   2. To describe changes in the allocation of school budgets to physical activity before and after COVID-19 and explore the reallocation of time between academic activities and physical activity.

   3. To assess the economic implications and affordability of potential mitigation strategies for schools and families.

   4. To explore the associations between measures of health-related quality of life and capabilities in children and adults and examine the possible impact of inequalities.

8. To use qualitative methods to further explore changes in physical activity during COVID-19, including factors that influenced activity during this time, and potential solutions to mitigate long-term negative impact on physical activity.

Methods for data collection and analysis

Detailed methods are provided in the study protocol. 1 Specific study methods and analyses are published in detail elsewhere, summarised in the overview of synopsis papers (Table 1) and signposted in the relevant discussion sections.

Mixed-methods data were collected in two waves. Wave 1 quantitative data collection took place between May 2021 to December 2021 when lockdowns had finished but some COVID-19 mitigation policies were still in place in schools and across society and provided data on the short-term impacts of the COVID-19 lockdowns on physical activity and associated behaviours. Wave 2 took place between January and July 2022 when most restrictions had been removed, to provide data on the medium-term impact (Figure 1). Wave 1 qualitative data was collected between August and December 2021 and wave 2 between February and July 2022 and provided insights and explanation into any observed changes in MVPA.

To provide baseline comparator accelerometer and questionnaire data, all participants were recruited from schools in the wider Bristol area (England) that had previously participated in B-Proact1v, a longitudinal cohort study. Both waves of Active-6 quantitative data (wave 1 n = 393; wave 2 n = 436) were compared with data from similar year 6 children and parents/carers from the third phase of the B-Proact1V study between March 2017 and June 2018, which we will refer to as wave 0 (n = 1296). 6 Participants at wave 0 provided written consent/assent, and online consent/assent was provided at waves 1 and 2. Figure 2 provides summary of data collection waves and participants, and Appendix 1 contains details on recruitment and consent processes.

FIGURE 2.

Data collected across all waves.

The study has three main components, summarised in Figure 3, and further detailed in Appendix 2.

FIGURE 3.

Diagram of study components. Objv, objective; PPI, patient and public involvement.

Overview of papers synthesised in synopsis

Table 1 provides details of all papers that have been published from the Active-6 study, how they link to study objectives and publication status at time of publication.

Child physical activity and screen viewing in the short-term recovery phase of the COVID-19 pandemic

This section summarises wave 1 child accelerometer data (Paper 1), wave 1 qualitative data (Paper 2) and wave 1 screen-viewing data (Paper 3). Full details of the methods and findings can be found in those papers (Table 1) and cover objectives 1, 2, 4, 5 and 7.

Child physical activity in the medium-term recovery period of the COVID-19 pandemic

This section summarises the change over time across all waves for child accelerometer data (Paper 4) and wave 2 qualitative data (Paper 5). Full details of the methods and findings can be found in those papers (Table 1) and cover objectives 3, 5 and 7.

Understanding the new normal: child activity profiles and active club participation

This section summarises the findings of further analysis of child accelerometer data from all waves to explore child activity profiles (Paper 6), and qualitative, questionnaire, and cost data from waves 1 and 2 on active clubs (Paper 7). Full details of the methods and findings can be found in those papers (Table 1) and covers objectives 4, 5, 6 and 7.

The analysis in the previous section gives a picture of average MVPA change over time, and qualitative insights into why these changes took place (Papers 4 and 5). However, it was important to go beyond these analyses to explore the impact of the COVID-19 lockdowns on child physical activity in more detail. Specifically, we wanted to explore changes in typical patterns of child activity since the lockdowns to understand how physical activity has changed for different kinds of children, and movement between these groups (Paper 6). Additionally, recognising the importance of structured physical activity in the post-lockdown new normal, we wanted to look at changes to active club participation, cost and location (Paper 7).

The role of schools

This section summarises qualitative data on changes to the school physical activity environment (Paper 8) and any school-level variation in MVPA outcomes (Paper 10). Full details of the methods and findings can be found in those papers (Table 1) and cover objectives 4, 6 and 7.

The primary school environment is a significant context for child physical activity. The structured nature of a school day regulates obesogenic behaviours24–28 and, for some children, school days are where they have greatest opportunity to engage in diverse physical activities, with around 15% of the total variability in child MVPA attributable to school-level factors. 29 In 2020 and 2021, English schools closed to most children on several occasions to mitigate the spread of COVID-19. When schools reopened, COVID-19 social distancing policies were in place for several months, which impacted schools’ physical activity environments, such as policies on sanitation of equipment, how much space children had access to, how active play could be supported and active travel.

Parent/carer physical activity and household well-being across the pandemic

This section summarises the parent accelerometer data across both waves (Paper 4), questionnaire and interview data on parents’ physical activity motivation across both waves (Paper 9) and household health, well-being and financial strain data across both waves (Paper 11). Full details of the methods and findings can be found in those papers (Table 1) and cover objectives 3, 4, 6 and 7.

We collected data on parent/carer physical activity, including accelerometer-measured MVPA, to provide information on household contexts. Health-related quality-of-life measures added to our evidence base for any changes in physical activity behaviour post lockdowns and allowed us to examine any associations with household finances and inequalities. The financial strain measure was included to understand the financial impact of COVID-19 on families, and which would potentially build into the narrative around solutions to increase physical activity (if needed) which must be mindful of the economic climate. We were also interested in the impact of the lockdowns on parent/carer motivation for physical activity.

Contribution to existing knowledge

The findings of Active-6 make several valuable contributions to existing knowledge, providing layered and multiperspective insight into how the COVID-19 lockdowns impacted child and parent/carer physical activity in the short and medium terms (Figure 4).

FIGURE 4.

Summary of Active-6 key findings. MVPA, moderate to vigorous intensity physical activity.

It was expected that prolonged lockdowns would have a negative impact on child and adult physical activity, and studies undertaken during the lockdowns have evidenced this,30–33 but of greater importance is how behaviour was impacted in the longer term once lockdowns and restrictions were removed, as society recovered from the pandemic. Active-6 has found that it has taken a year since lockdowns were lifted for children’s MVPA to recover to pre-pandemic levels, and weekday sedentary behaviour remains elevated. But the fluctuations in MVPA we observed over the course of the study suggest that the recovery in children’s MVPA may be susceptible to temporary disruptions to physical activity provision, such as school closures. To our knowledge, this is the first peer-reviewed research to explore this in a UK context. Our data are broadly consistent with Sport England’s 2022 Active Lives Survey, which suggested that average activity levels had returned to pre-pandemic levels among children. 7 However, our study provides novel insight into the short- and medium-term impact of the lockdowns and restrictions in England using accelerometer-measured physical activity, rather than relying on self-report methods, such as those in the Active Lives survey.

Despite an overall recovery in levels of physical activity among children to their pre-pandemic levels, we found that still only 41% of children were meeting physical activity guidelines, and that the way in which children are active has changed. We have termed this the ‘new normal’ for children’s physical activity, characterised by a reliance on structured activities such as active clubs. This finding contributes to existing knowledge by providing unique insight into post-lockdown physical activity patterns among children in the UK. In our evaluation of the current status of active club participation among children, financial pressures were driving a shift from community-based to school-based clubs where children are physically active. Furthermore, schools were at times struggling to meet this increased demand, and the quality of community clubs may also be impacted by lower attendance. These findings add novel and timely insight into the post-lockdown challenges to children’s participation in physical activity and provide specific recommendations to address disparities and promote physical activity.

We have found that the post-lockdown school environment is highly pressured, impacting the extent to which schools can support and encourage child physical activity. Research shows schools are important contexts for child physical activity,27,34 so strategies sensitive to the post-lockdown school environment are needed to support schools to enable child physical activity and future research is needed to further explore the impact of post-lockdown changes on physical activity environments in schools, particularly over the longer-term, as schools continue to adapt post lockdowns. 35 However, our analysis highlights the importance of relatively simple changes, such as ensuring that PE is prioritised even when space is an issue, a cycle training scheme, a strong active club environment and, to a lesser extent, encouraging active travel to school where possible, which could potentially reduce post-lockdown differences between schools.

Across the range of our studies and analyses we found that the detrimental impact of the COVID-19 lockdowns has been worse for those least active, girls and lower socioeconomic families, evidencing a widening of socioeconomic inequalities. Socioeconomic health inequalities is a key public health issue in the UK; 35.6% of premature deaths are attributable to socioeconomic inequality36 We know that physical activity is a habit established in childhood for life and that it is beneficial for lifelong physical and mental health life. 2–5 Therefore, supporting more children from lower socioeconomic households to meet physical activity guidelines can therefore help address socioeconomic health inequalities. The Active-6 project provides unique insight into the post-lockdown challenges facing children from lower socioeconomic households, which has been identified in Sport England’s Active Lives Survey 2022. 7 Namely, cost-related barriers are creating challenges to participating in the new normal for children’s physical activity, which is exacerbating pre-existing disparities. However, due to sampling limitations, we feel that further research is warranted that explores physical activity among children from lower socioeconomic households.

We observed gender disparities in physical activity, with girls being less active than boys. Before the pandemic, there was clear evidence that girls participated in less physical activity than boys in the UK,8 which has continued following the pandemic. 7 Our results suggest that extended interruptions to physical activity during periods of lockdowns and restrictions impacted girls’ perceptions of self and physical activity. Recent reports echo the challenges of these negative perceptions among girls. 37 Subsequently, when combined with increased costs for girls community-based active clubs, these may be barriers to participation in the physical activity new normal for children. Thus, there is a need to promote physical activity among girls, and perhaps especially girls from lower socioeconomic groups.

Take home messages

• After a short-term drop, average children’s physical activity recovered to pre-pandemic levels, but this recovery took nearly a year after the lockdowns and may be susceptible to future disruptions to physical activity, such as school closures and stay-at-home orders.

• Most children are more sedentary than before the pandemic and 59% of 10- to 11-year-old children do not meet physical activity guidelines. There is a pressing need to promote and support physical activity in children.

• Some groups have been more adversely impacted, particularly families with lower socioeconomic position, girls and children who were less active before the pandemic. Our findings suggest a widening gap and growing inequalities.

• Strategies to support child physical activity must recognise how it has changed, with the ‘new normal’ suggesting there should be a stronger focus on access to structured activities, especially for those groups who typically engage in less activity.

Strengths and weaknesses of the study

The key strength of this study is that child physical activity post-COVID-19 lockdowns was measured through independent data collection and analysis methods (quantitative and qualitative) and then combined into one narrative that provides nuance and depth to our understanding. Collecting accelerometer-measured physical activity was a particular strength, as other major studies rely on self-report data, which are subject to social desirability and recall bias. 7 Additionally, this study used baseline data collected before the pandemic, rather than relying on recall, and the collection of two additional post-lockdown waves of data, to measure change over time. These data came from the same schools and the same-aged children, which reduced school-level variability in estimates. Active-6 collected data in the post-lockdown recovery phase of the pandemic to focus on the longer-term impacts of COVID-19 and implications for policy and practice beyond immediate restrictions. We applied novel statistical techniques to model change over time and account for important factors that influence differences, such as seasonality. Our qualitative data gathered multiple perspectives of parents, children and school staff to triangulate perspectives. Again, two waves of this data enabled us to note and observe any changes over time and provide explanation for the device-measured changes we observed. Lastly, our mixed-methods design means accelerometer and questionnaire data are supported and enhanced by the qualitative study, and vice versa.

This study does, however, have weaknesses. The natural experiment design means that it is possible that observed differences are due to factors that have changed between 2017/18 and 2021/22 other than COVID-19 and associated lockdowns. Our sample is biased towards households with higher educational qualifications, with only 40% of our families from non-graduate households. Therefore, we can generalise to some extent but not explore socioeconomic factors in detail. Finally, the adult sample of our study is not typical of adults as a whole. These are specifically parents/carers of 10- to 11-year-old children between the ages of 35–49 years and, importantly, 75% of our adult sample is female, so these data mainly represent the experiences of mothers. These sample biases must be considered when interpreting the study findings and suggest that future research to target low socioeconomic families and fathers could be warranted.

Challenges faced and limitations

The major challenge this study faced was undertaking participant recruitment and data collection through primary schools during the COVID-19 pandemic, when social distancing restrictions and case numbers fluctuated. Protocols had to be flexible to both virtual and in-person study briefings and data collection, with child height and weight data, particularly in wave 1, at times not possible to collect due to social distancing guidelines. The purpose of this study was to provide rapid insight on the impact of the pandemic on child physical activity and, as such, recruitment and data collection began as soon as possible. This prevented taking time for deeper school community engagement, and this, combined with an uneven impact of the pandemic, may have limited participation of schools and families.

Parents

Parent members have sat on the study oversight groups – the study management group and study steering committee – and have shaped and steered the day-to-day management of the study, provided feedback on draft materials including interview guides, protocols and school feedback materials and contributed to publications.

Schools and children

We have worked closely with school staff and children to provide two-way dialogue on data collection processes and study findings. We ran two PPI sessions with children, which explored reflections on wave 1 data collection processes to build upon in wave 2 and provided feedback on several relevant dissemination materials. Year 6 teachers and senior leadership team staff were consulted on data collection processes and all school or classroom-focused materials we have produced.

Policy

At the outset of the study, an impact advisory group (IAG) was established, drawing advisors from a variety of local and national organisations working to promote children’s physical activity, including Department for Health and Social Care, Office for Health Improvement and Disparities, Sport England, Public Health Scotland, Active Scotland and Public Health Wales. Support from many of these organisations was established during the grant application process and the aim of this group was to share rapid findings for feedback and dialogue between the Active-6 team and policy colleagues as the study developed and the findings emerged. Members of the IAG advised the study team on relevant dissemination materials and channels, both in the IAG meetings and through targeted conversations with members about dissemination in their particular field. Several suggestions for dissemination materials and channels emerged from these conversations.

Practitioners

Senior staff from local club providers and national charity and third-sector organisations such as Wesport, Active Gloucestershire, Bristol Sport Foundation and the Youth Sport Trust sat on the IAG and contributed the perspective of child sport and physical activity providers on the data collection, interim findings and dissemination materials. A PPI session was run with on-the-ground club provider staff to review and improve the specific dissemination materials tailored to the practitioner audience. We additionally had a representative from the local authority public health team as co-applicant on the study and who sat on the study management group, providing a unique and valuable perspective on study decision-making.

Policy

We worked with PolicyBristol to produce a policy briefing that identifies key findings from the study and a list of policy recommendations that can support children’s physical activity. The briefing was disseminated to a comprehensive list of contacts and stakeholders beyond the members of our IAG, including Members of Parliament, Peers and Councillors who sit on relevant all-party parliamentary groups or with relevant portfolios. Additionally, PPI and consultation with IAG members told us policy colleagues were keen for a slide deck of study findings. Both the policy briefing and the slide deck were launched with the IAG at a final study meeting in September 2023.

We have worked to present findings and content directly with policy partners in their spaces and to their audiences. We submitted evidence to the Prevention Inquiry for the Health and Social Care Select Committee to explore how to improve child physical activity since COVID-19 lockdowns. Professor Jago presented study findings at the Youth Sport Trust annual conference, the UK’s leading charity working to improve young people’s education and development through sport and play, where he was one of four speakers in the room with the aim to bring together policy-makers, academics and insight specialists to share the latest evidence on children’s activity and school sport. Locally, we presented findings to the NHS Bristol, North Somerset and South Gloucestershire Clinical Commissioning Group via their Research Showcase Seminar, to the Office for Health Improvement and Disparities’ South West Children’s Healthy Weight and Physical Activity community of practice meeting at the Southwest Public Health Conference 2023, which convenes regional academics and practitioners, and Active-6 was featured as a case study in the 2022/23 Director of Public Health Report for Bristol City Council, which was presented to the Bristol Health and Wellbeing Board and the Bristol City Council Cabinet.

To focus dissemination in the areas and communities that participated in the study, we worked to share study findings to the relevant teams in the four local authorities in which the study took place. Colleagues in these local authorities have shared tailored summaries of the study’s key messages via newsletters and bulletins across public health, children and young people and education teams. This summary was also shared through the local authorities to primary school head teachers, so that the study reached primary school decision-makers and senior leadership team members.

Primary schools

The primary school environment is an important context for children’s physical activity and school staff a key audience for our findings. In addition to dissemination to senior leadership team members in the wider Bristol area described above, we wanted to maintain communication with the Active-6 schools so we produced and disseminated a classroom poster suggesting ‘4 things we can do to get active’, which had input from year 6 children and teaching staff. This poster was printed for study schools as children and staff felt this would be a useful presence in the classroom to remind them of the importance of activity and movement in the school day. We also shared the animation with study schools, and primary school staff told us that within schools the animation was a useful tool for engagement with physical activity post-lockdowns that can be watched in key stage 2 assembly and classrooms (with a class discussion), and shared with wider school and academy communities via their communication platforms.

We wanted the Active-6 schools to be able to engage with their data, so we shared school-level aggregated data on MVPA and sedentary time on weekdays and weekends for children and parents after each wave of data collection. We did this via tailored A2-sized posters which were printed for each study school and an electronic PDF copy was also shared with parents and families via school mailing lists or newsletters. We created two lesson plans (with input from study year 6 teachers), which we shared with these posters, exploring different themes around physical activity that were relevant to the key stage 2 science and maths curriculums. These materials were well received, with examples of staff feedback such as:

I have sent the data to share in our newsletter and shared the lesson plan so that it can be used in Upper KS2 as we think about active travel and healthy schools.

Year 6 teacher

It is good to see the feedback to understand more about how exercise habits have changed in recent years.

Year 6 teacher

[The resources are] absolutely brilliant and will help to back-up and inform what we do

PE coordinator

Beyond study and local primary schools, it was essential to communicate our findings with PE teachers at a national scale. We worked with the Youth Sport Trust (YST), whose main audience base is PE teachers, to collaborate and share findings. Active-6 papers are included in the YST ‘knowledge bank’, evidence is included in their 2023 PE and School Sport report, and we shared study findings in a post for the YST blog. We have written an article for PE Matters, the official journal for the Association for Physical Education, the membership organisation for PE teachers in the UK (Autumn 2023 issue), and Professor Jago shared findings in an analysis piece in the Times Education Supplement, to reach a wider teaching and school staff body.

Club providers

After consulting with club provider members of our IAG, we identified the need for a summary of findings and implications tailored to providers who deliver active clubs at schools and in the community. With input from staff who run clubs in primary schools, we created a one-page PDF provider summary and shared it through local networks of club commissioners and providers.

This summary was also an appropriate format for schools, particularly PE teachers and senior leadership team members, so was also disseminated via the local authority networks and channels.

Families/general public

The families that took part in Active-6 are a particular group with which we undertook steps to engage and share study findings. We shared the animation and hub directly with all Active-6 families via e-mail.

When key study papers were published we worked on a media release to share their findings with the general public and industry. These successful in gaining media traction and Active-6 findings have been covered by over 20 news outlets including nationally in The Times, The Guardian, the BBC, and internationally in France, the USA and India. We have worked to enhance the publication of key study papers by publishing blog posts in relevant partner blogs and online media in order to provide a plain language and accessible summary of the key messages. We published a thought leadership piece in The Conversation on the wave 1 accelerometer data, the blog for the Youth Sport Trust mentioned above sharing the findings on the ‘new normal’, and a post on our findings on club participation post-lockdown on We Can Move’s blog. Finally, we provide a plain language summary of each academic paper we publish on the Active-6 hub, with a link to the full paper.

Academics

To disseminate our findings to academic audiences we have 11 study papers in various stages of publication, outlined in Table 1, and have been accepted to presented findings at several relevant conferences. This included the Scottish Physical Activity Research Connections conference 2023, which brings together a network of physical activity researchers as well as policy-makers and practitioners.

Further dissemination

As described above, our dissemination plan has been underway alongside the publication of study papers. We build on work to date and continue discussions and dissemination that ensure the outcomes of our research are taken forward by stakeholders.

Many of the key ideas that have emerged from this project are being taken forward in a UK Research and Innovation-funded project called PASSPORT, which seeks to develop a context-specific intervention for primary school physical activity. 35 We intend to continue our IAG into the PASSPORT study to continue the useful and engaged dialogue we have had in Active-6.

Impact

Findings from the study that have been published to date have had some impact in the general public, study schools, policy-makers and practitioners. Longer term, we are hoping to see the impact of the dissemination of the study findings. The study findings and implications can be brought into key policy agendas and decisions in the areas of child physical activity and schools. We have set up search and track functions on Overton, a policy database, to track any policy impact.

Lessons learned for future research

The Active-6 study has provided lessons to draw on for both research design and the focus of future studies in the field. Working with schools particularly through the challenge of COVID-19 has been informative, and we have learned that successful schools-based research depends on close collaboration between a school and the research team and recognising the specific and unique context and needs of each school and school community. 35 The findings of Active-6 are building a picture of an uneven impact of the pandemic on child physical activity, with certain groups of children more adversely affected and at risk of long-term health consequences of low physical activity. In Active-6, we identified a need for future research to undertake careful recruitment of under-represented groups, particularly schools with higher deprivation indicators and the families from these schools in turn, through long-term engagement and relationship building in schools.

The PASSPORT study seeks to explore and evaluate a context-specific model for child physical activity interventions in English primary schools, building on these reflections.

Quantitative component

Health economics component