Physical literacy in Europe: The current state of implementation in research, practice, and policy.

Background/objective: The holistic concept of physical literacy (PL) embraces different person-centered qualities (physical, cognitive, affective/psychological) necessary to lead physically active lifestyles. PL has recently gained increasing attention globally and Europe is no exception. However, scientific endeavors summarizing the current state of PL in Europe are lacking. Therefore, the goal of this study was to comprehensively assess and compare the implementation of PL in research, policy, and practice across the continent. Methods: We assembled a panel of experts representing 25 European countries. Employing a complementary mixed-methods design, the experts first prepared reviews about the current state of PL in their countries (categories: research, practice/policy). The reviews underwent comparative document analysis, ensuring a transnational four-eyes principle. For re-validation purposes, the representatives completed a quantitative survey with questions reflecting the inductive themes from the document analysis. Results: The document analysis resulted in ten disjunct themes (related to "concept", "research", "practice/policy", "future/prospect") and yielded a heterogenous PL situation in Europe. The implementation state was strongly linked to conceptual discussions (e.g., existence of competing approaches), linguistic issues (e.g., translations), and country-specific traditions. Despite growing scholarly attention, PL hesitantly permeates practice and policy in most countries. Nevertheless, the experts largely anticipate increasing popularity of PL for the future. Conclusion: Despite the heterogeneous situation across Europe, the analysis has uncovered similarities among the countries, such as the presence of established yet not identical concepts. Research should intensify academic activities (conceptual-linguistic elaborations, empirical work) before PL may gain further access into practical and political spheres in the long term.

WALES 2021 Active Healthy Kids (AHK) Report Card: The Fourth Pandemic of Childhood Inactivity.

This is the fourth Active Healthy Kids (AHK) Wales Report Card. The 2021 card produced grades on children and young people's physical activity (PA) using pre-COVID-19 data that were not used in previous versions. Eleven quality indicators of PA were graded through expert consensus and synthesis of the best available evidence. Grades were assigned as follows: Overall PA-F; Organised Sport and PA-C; Active Play-C+; Active Transportation-C-; Sedentary Behaviours-F; Physical Fitness-C-; Family and Peer Influences-D+; School-B-; Community and the Built Environment-C; National Government and Policy-C; and Physical Literacy-C-. All but three grades remained the same or decreased from the 2018 AHK-Wales Report Card (Active Play increased from C- to C+; Active Transportation, D+ to C-; Family and Peers, D to D+). This is concerning for children's health and well-being in Wales, particularly given recent evidence that PA has further decreased during the COVID-19 pandemic. The results from the Report Card should be used to inform the decision making of policy makers, practitioners and educators to improve children and young people's PA levels and opportunities and decrease PA inequalities.

Telephone consultations to manage paediatric outpatient clinics during the COVID-19 pandemic: a service evaluation.

BACKGROUND: North West Wales is predominantly rural with a relatively small population spread over a large geographical area. The rapid development of the COVID-19 pandemic led to a radical re-thinking of how to provide continuing paediatric outpatient care in the face of a lockdown. The solution adopted was to use telephone consultations. AIMS: This study took place during the summer of 2020, after the first lockdown had been relaxed. The purpose of this study was to evaluate the acceptability of telephone consultations as an alternative to conventional paediatric outpatient appointments and assess whether it could continue to have a useful role beyond the pandemic. METHODS: Two hundred ninety-five telephone surveys were conducted with respondents, most of whom were carers of paediatric outpatients. Questions explored the child's underlying condition, respondents' attitudes towards the service received, social factors including distance previously travelled to the hospital and whether they would find ongoing telephone review acceptable or not. RESULTS: Sixty-one percent of respondents expressed a positive interest in ongoing telephone consultations. They commented particularly on compatibility with work commitments, childcare arrangements and travel times. Those travelling more than 1 h were particularly positive in their support. Respondents expressed the continued need for face-to-face review if the child's condition changed acutely. CONCLUSION: Telephone consultations are an acceptable means of improving clinic punctuality, accessibility and convenience for families in rural areas, with ongoing potential beyond the pandemic. Careful consideration is required of the individual's needs and requirement for physical examination when extending the use of telephone consultations.

Associations between swimming & cycling abilities and fitness in 9-11 year old boys and girls.

The associations between swimming and cycling abilities and fitness levels in 9-11-year-old children were examined. A cross-sectional study involving 2258 children (50.7% boys; aged 10.52 ± 0.6 years) from 33 schools across Wales, participated in Swan/BridgeLinx health, fitness, and lifestyle programmes between 2013-2019. Health and fitness data were collected; namely body composition, cardiorespiratory fitness, muscular strength, flexibility, power, and speed using standardised measures. Children completed an online survey collecting data on swimming and cycling abilities and sports club attendance. Multivariate multilevel regressions were used to examine the associations between measures. The ability to swim and cycle was significantly (p < 0.05) associated with all components of fitness when accounting for age, body mass index (BMI), deprivation, gender, and sports club attendance. Boys outperformed girls with significant interactions between swimming, cycling and cardiorespiratory fitness for gender by swim (p = 0.001) and gender by cycle (p = 0.015). The gender by cycle interaction significantly predicted grip strength and power (p < 0.05). Swimming and cycling are important "milestones" in the journey of motor development and are associated with higher levels of fitness. These activities should be promoted to allow for an optimal development of motor skills, fitness, and health.

The AHK-Wales Report Card 2018: Policy Measures - is it possible to 'score' qualitative data?

Comprehensive and meaningful policy analysis in the field of physical activity is difficult, not least because of the variable influence of other policy domains. However, in 2011 a Policy Assessment Tool (PAT) was developed by members of the WHO European Network for the Promotion of Health-Enhancing Physical Activity (HEPA Europe) and tested in several different countries. In 2014, Wales joined a global initiative, active healthy kids (AHK) Global Alliance, that supported the development of country level 'Report Cards' scoring a range of indicators that influence physical activity amongst children and young people, one of which was labelled 'Government Strategies and Investments'. For the first two Report Cards this indicator and its associated 'score' was informed subjectively by expert consensus. In 2018, it was decided to utilize the Policy Audit Tool Version 2 (PAT v2) developed by HEPA Europe to aid analysis and to develop and test a scoring rubric aligned to the tool. The subsequent process indicated that the tool could be applied and translated into a 'grade' that could be used in conjunction with the other indicators of the AHK Report Card to generate overall Report Card grades. The use of both the HEPA PAT v2 and the scoring rubric offers an opportunity to provide greater consistency and potential for developing both comparative and trend data when assessing policy impact on physical activity in children and young people. These tools should be utilized by the AHK Global Alliance in future Report Cards.

Identifying factors associated with spontaneous restoration of hearing in children with otitis media with effusion.

OBJECTIVES: To identify predictors of acceptable hearing at 5 weeks, 6 and 12 months in children with bilateral otitis media with effusion (OME). DESIGN AND SETTING: Secondary analysis of OSTRICH data, conducted in hospital ear, nose and throat (ENT) and paediatric audiology and audiovestibular medicine departments across Wales and England. PARTICIPANTS: The OSTRICH study included 389 children aged 2-8 years with bilateral hearing loss attributable toOME for at least 3 months. MAIN OUTCOME MEASURES: Baseline, 5-week, 6- and 12-month audiology measurements were collected and logistic regression models used to identify pre-randomisation baseline variables that predicted return of acceptable hearing, which was defined as less than or equal to 20 dB hearing loss averaged within the frequencies of 0.5, 1, 2 and 4 kHz in at least one ear in children assessed by pure tone audiometry, ear-specific insert visual reinforcement audiometry or ear-specific play audiometry less than or equal to 25 dB hearing loss averaged within the frequencies of 0.5, 1, 2 and 4 kHz in children assessed by sound-field visual reinforcement audiometry or sound-field performance/play audiometry, based on national guidelines. RESULTS: Less severe baseline hearing loss across both ears most consistently predicted acceptable hearing at 5 weeks (adjusted odds ratio [aOR] 0.91, 95% CI 0.87-0.95), 6 months (0.94 [0.90-0.98]) and 12 months (0.93 [0.89-0.97]). Negative history of atopy (2.05 [1.16-3.61]), never using hearing aids (aOR 2.16 [1.04-4.48]), and being male (1.75 [1.02-2.99]) were significant at 6 months, but not at 12 months. Symptom duration was a predictor at 5 weeks, but not at 6 or 12 months. CONCLUSIONS: Milder baseline hearing loss most consistently predicts acceptable hearing at 5 weeks, 6 and 12 months in children with chronic OME. Negative history of atopy, never using hearing aids, and male gender are associated with better prognosis. These predictors can be used to identify children that may not require treatment.

Youth motor competence promotion model: a quantitative investigation into modifiable factors.

OBJECTIVES: This study aimed to quantify the relationships between enabling, predisposing and reinforcing ecological factors on motor competence and investigate potential sex, weight status, and school level differences. METHODS: Data were collected from 429 children (52% boys; aged 11.1±0.6 years; 87% white British). Cardiorespiratory fitness (20m Multistage Shuttle Run), muscular strength (Handgrip Strength) and online questionnaire (Child Health and Activity Tool; CHAT) data on moderate-to-vigorous physical activity, sport participation and available surrounding physical activity facilities were included as enabling variables. Three predisposing variables were determined from self-report data on benefits/barriers to exercise, adequacy, and predilection. Parental/guardian physical activity levels and persons whom participate in physical activity and sport with the participant (CHAT) were selected as reinforcing variables. Motor competence was determined from cumulative scores for Dragon Challenge tasks (Balance Bench, Core Agility, Wobble Spot, Overarm Throw, Basketball Dribble, Catch, Jumping Patterns, T-Agility, Sprint). Confirmatory Factor Analysis assessed the fit of measured variables into latent factors. Structural equation modelling evaluated relationships between these latent factors. RESULTS: Motor competence was directly affected by the enabling factor (ß=0.50,p<0.001) but indirectly affected by reinforcing and predisposing factors, mediated by the enabling factor (ß=0.13, p=0.014; ß=0.25, p=0.002). Multi-group comparisons showed that each of these effects did not differ by sex, weight status or school level (p>0.05). CONCLUSIONS: This study demonstrated that enabling factors are crucial for the development of motor competence. This is the first study to quantify an ecological model with motor competence as the endogenous variable and is key to future interventions.

Global Matrix 3.0 Physical Activity Report Card Grades for Children and Youth: Results and Analysis From 49 Countries.

BACKGROUND: Accumulating sufficient moderate to vigorous physical activity is recognized as a key determinant of physical, physiological, developmental, mental, cognitive, and social health among children and youth (aged 5-17 y). The Global Matrix 3.0 of Report Card grades on physical activity was developed to achieve a better understanding of the global variation in child and youth physical activity and associated supports. METHODS: Work groups from 49 countries followed harmonized procedures to develop their Report Cards by grading 10 common indicators using the best available data. The participating countries were divided into 3 categories using the United Nations' human development index (HDI) classification (low or medium, high, and very high HDI). RESULTS: A total of 490 grades, including 369 letter grades and 121 incomplete grades, were assigned by the 49 work groups. Overall, an average grade of "C-," "D+," and "C-" was obtained for the low and medium HDI countries, high HDI countries, and very high HDI countries, respectively. CONCLUSIONS: The present study provides rich new evidence showing that the situation regarding the physical activity of children and youth is a concern worldwide. Strategic public investments to implement effective interventions to increase physical activity opportunities are needed.

Report Card Grades on the Physical Activity of Children and Youth Comparing 30 Very High Human Development Index Countries.

BACKGROUND: To better understand the childhood physical inactivity crisis, Report Cards on physical activity of children and youth were prepared concurrently in 30 very high Human Development Index countries. The aim of this article was to present, describe, and compare the findings from these Report Cards. METHODS: The Report Cards were developed using a harmonized process for data gathering, assessing, and assigning grades to 10 common physical activity indicators. Descriptive statistics were calculated after converting letter grades to interval variables, and correlational analyses between the 10 common indicators were performed using Spearman's rank correlation coefficients. RESULTS: A matrix of 300 grades was obtained with substantial variations within and between countries. Low grades were observed for behavioral indicators, and higher grades were observed for sources of influence indicators, indicating a disconnect between supports and desired behaviors. CONCLUSION: This analysis summarizes the level and context of the physical activity of children and youth among very high Human Development Index countries, and provides additional evidence that the situation regarding physical activity in children and youth is very concerning. Unless a major shift to a more active lifestyle happens soon, a high rate of noncommunicable diseases can be anticipated when this generation of children reaches adulthood.

'Measuring' Physical Literacy and Related Constructs: A Systematic Review of Empirical Findings.

BACKGROUND: The concept of physical literacy has received increased research and international attention recently. Where intervention programs and empirical research are gaining momentum, their operationalizations differ significantly. OBJECTIVE: The objective of this study was to inform practice in the measure/assessment of physical literacy via a systematic review of research that has assessed physical literacy (up to 14 June, 2017). METHODS: Five databases were searched using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Protocols guidelines, with 32 published articles meeting the inclusion criteria. English-language, peer-reviewed published papers containing empirical studies of physical literacy were analyzed using inductive thematic analysis. RESULTS: Qualitative methods included: (1) interviews; (2) open-ended questionnaires; (3) reflective diaries; (4) focus groups; (5) participant observations; and (6) visual methods. Quantitative methods included: (1) monitoring devices (e.g., accelerometers); (2) observations (e.g., of physical activity or motor proficiency); (3) psychometrics (e.g., enjoyment, self-perceptions); (4) performance measures (e.g., exergaming, objective times/distances); (5) anthropometric measurements; and (6) one compound measure. Of the measures that made an explicit distinction: 22 (61%) examined the physical domain, eight (22%) the affective domain; five (14%) the cognitive domain; and one (3%) combined three domains (physical, affective, and cognitive) of physical literacy. Researchers tended to declare their philosophical standpoint significantly more in qualitative research compared with quantitative research. CONCLUSIONS: Current research adopts diverse often incompatible methodologies in measuring/assessing physical literacy. Our analysis revealed that by adopting simplistic and linear methods, physical literacy cannot be measured/assessed in a traditional/conventional sense. Therefore, we recommend that researchers are more creative in developing integrated philosophically aligned approaches to measuring/assessing physical literacy. Future research should consider the most recent developments in the field of physical literacy for policy formation.

Definitions, Foundations and Associations of Physical Literacy: A Systematic Review.

BACKGROUND: The concept of physical literacy has stimulated increased research attention in recent years-being deployed in physical education, sport participation, and the promotion of physical activity. Independent research groups currently operationalize the construct differently. OBJECTIVE: The purpose of this systematic review was to conduct a systematic review of the physical literacy construct, as reflected in contemporary research literature. METHODS: Five databases were searched using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for systematic reviews. Inclusion criteria were English language, peer reviewed, published by March 2016, and seeking to conceptualize physical literacy. Articles that met these criteria were analyzed in relation to three core areas: properties/attributes, philosophical foundations and theoretical associations with other constructs. A total of 50 published articles met the inclusion criteria and were analyzed qualitatively using inductive thematic analysis. RESULTS: The thematic analysis addressed the three core areas. Under definitions, core attributes that define physical literacy were identified, as well as areas of conflict between different approaches currently being adopted. One relatively clear philosophical approach was prominent in approximately half of the papers, based on a monist/holistic ontology and phenomenological epistemology. Finally, the analysis identified a number of theoretical associations, including health, physical activity and academic performance. CONCLUSIONS: Current literature contains different representations of the physical literacy construct. The costs and benefits of adopting an exclusive approach versus pluralism are considered. Recommendations for both researchers and practitioners focus on identifying and clearly articulating the definitions, philosophical assumptions and expected outcomes prior to evaluating the effectiveness of this emerging concept.