Physical fitness among children with diverse weight status during and after the COVID-19 pandemic: a population-wide, cohort study based on the Slovenian physical fitness surveillance system (SLOfit)

Background COVID-19 public health crisis has exerted immediate negative impacts on children's physical fitness, but the longer-term effects are not clear, and the impact on children with excess weight is yet unknown. We examined changes in multiple components of physical fitness in response to COVID-19 imposed restrictions, but also a year after the restrictions were terminated, and compared these trends in groups of boys and girls with normal weight, overweight, or obesity before the pandemic.Methods Information was gathered through Slovenia's national fitness surveillance system, and included 41,330 children (19,890 girls), aged 5-17, who had their fitness levels measured yearly from 2019 to 2022. Multilevel linear mixed models, fitted separately for boys and girls, were used to model the individual-level trends over time in centile score for each fitness test across 3 weight groups.Findings Overall fitness levels decreased markedly across all weight categories between 2019 and 2020, with the largest decreases in Total Fitness Index observed in children with normal weight and overweight (-8.4 and -7.7 centiles for boys and -8.3 and -8.8 for girls, respectively, p < 0.001). While there was some recovery in the overall fitness level between 2020 and 2022, it remained much lower in 2022 compared to 2019 across most groups, apart from boys with obesity. Fitness components that had the largest impact on general fitness trends were cardiorespiratory fitness, lower body power, body core, and upper body strength.Interpretation A severe decline in fitness that has not come close to returning to pre-pandemic levels in most population groups of youth begs for urgent population-wide initiatives that will provide additional opportunities for physical activity to youth. Among vulnerable groups, girls with overweight and obesity deserve a special focus of these policies.