COVID-19 Schools Infection Survey, England: physical activity and eating behaviours, March 2022

• A quarter (24.7%) of primary school pupils were physically active for the recommended 60 minutes every day in the past week compared with 14.3% of secondary school pupils in school Years 7 to 13.

• 2 in 5 females (41.9%) in school Years 7 to 13 answered "Yes" to two or more questions about experiencing eating difficulties, compared with one in five males (17.5%).

• 41.4% of secondary school pupils in school Years 7 to 13 who had experienced long COVID because of their most recent coronavirus (COVID-19) infection answered "Yes" to at least two of the five questions about experiencing eating difficulties.

• Analysis of the data did not identify a relationship between COVID-19 and physical activity level or any differences in physical activity between those who had experienced long COVID and those who had not.

The Wave 3 questionnaire included questions to assess pupils' current physical activity levels to understand whether these have been impacted by coronavirus (COVID-19). As part of our analysis we looked at whether there was a relationship between the impact of COVID-19 and physical activity levels. Our findings did not find any statistically significant differences in the physical activity levels of those who had had a positive COVID-19 test and those who had not, or between those with long COVID and those without.

Our results can be used to indicate how physical activity in school-aged pupils has changed over time. Please see results from Sport England for pre-coronavirus pandemic findings, although these results are not directly comparable because of differing data collection methods. Further information about comparing with other data sources can be found in the measuring the data section.

Time spent being physically active

The NHS recommends that children aged 5 to 18 years should aim for 60 minutes of physical activity every day. A quarter of parents of primary school pupils (24.7%) said their child had been physically active for at least 60 minutes every day in the past seven days, which was significantly higher than both the proportion of secondary school pupils (school Years 7 to 13) who reported this as their activity level themselves (14.3%) and of pupils in years 7 to 11 whose parents reported this as their activity level (12.1%).

We found that, on average, parents of primary school pupils said their child was physically active for 4.7 days in the past seven days. This was significantly higher than both what secondary school pupils in school Years 7 to 13 reported themselves (3.9 days) and what parents of secondary school pupils in school Years 7 to 11 reported (3.9 days).

Significantly more male pupils' (school Years 7 to 11) parents than female pupils' parents said they exercised every day in the past seven days (14.8% compared with 9.4%). A similar trend was found in responses from pupils in school Years 7 to 13 themselves, however, these differences were not statistically significant.

Outside of school hours, more secondary school pupils' (school Years 7 to 11) parents (4.5%) said their child never exercises in their free time compared with primary school pupils' parents (1.2%). Of secondary school pupils themselves (school Years 7 to 13), 6.3% said they never do exercise in their free time. We also found that male secondary school pupils (school Years 7 to 13) were more likely to do regular exercise outside of school hours compared with female pupils. Female secondary school pupils (school Years 7 to 13) were significantly more likely to say that they exercised once a week or less (40.6%) compared with male secondary school pupils (26.1%).

The most common amount of time spent exercising per week was two to three hours according to parents of those in primary school (36.0%), parents of those in secondary school (school Years 7 to 11) (32.0%), and secondary school pupils (school Years 7 to 13) themselves (29.2%). Over half of female secondary school pupils (school Years 7 to 13) (52.9%) said they only exercised for about one hour or less each week; this was significantly higher than male pupils (38.5%).

Time spent sitting during a typical day

Figure 3 shows the amount of time spent by pupils during a typical day sitting and watching television, playing computer games, talking with friends or using their mobile phone. Over half of primary school pupils' parents (55.9%) said their child spent one to two hours a day doing activities while sitting down. In comparison, 47.7% of secondary school pupils' (school Years 7 to 11) parents and 42.9% of secondary school pupils (school Years 7 to 13) themselves said they spent three to four hours doing activities while sitting down in their free time.

Of primary school pupils, 6.8% of male pupils' parents said their child spent five or more hours per day sitting outside of school hours. This was significantly higher than female pupils' parents (2.7%).

Of secondary school pupils (years 7 to 13), 28.9% said they spent five or more hours doing activities that did not involve much movement in their free time. Significantly, more pupils with a probable (47.8%) and possible (43.0%) mental health disorder said they spent five or more hours sitting in their free time than those with no mental health disorder (23.8%).

To explore the wider effects of the coronavirus (COVID-19) pandemic on young people and children, pupils and parents were asked five questions about the pupils' eating behaviours. The aim was to develop an idea of whether they were experiencing eating difficulties, which could indicate a disorder such as anorexia nervosa or bulimia nervosa. Answering "Yes" to any of these questions does not serve as a diagnosis of an eating disorder. Participants were advised to consult a GP if they thought they may have one.

As all questions were optional, we have only included those respondents who answered all five questions in the following analysis.

For pre-coronavirus pandemic measures, please see the Mental Health of Children and Young People survey (MHCYP). Please note this study is not directly comparable because of different methodologies.

Over half of secondary school pupils in school Years 7 to 13 (52.5%) who had experienced long COVID following their most recent COVID-19 infection, and 36.8% of those who had not, reported thinking they were fat even when told they were very thin. Nearly one in five (19.2%) of those pupils with long COVID reported making themselves vomit deliberately.

Among primary school pupils, the proportion reporting these behaviours were generally similar between those with long COVID and those without, except for the proportion reported to have thought they were fat when told they were thin, which was significantly higher among those with long COVID (29.8% compared with 9.7%).

1 in 10 (10.1%) primary school pupils were reported to have worries about eating that interfered with their life, with no significant difference in reporting between female and male pupils. Similar proportions (11.6% and 8.5% for female and male pupils, respectively) were reported to have thought they were fat even when other people told them that they were very thin.

19.5% of females and 17.7% of males in primary school were reported as exhibiting at least one behaviour relating to eating difficulties by their parents. The proportions of females and males whose parents answered “Yes” to two or more questions were also similar to each other, at 4.9% and 3.3%, respectively, with no significant difference.

Thinking they were fat even when told that they were very thin was the most frequently reported behaviour by both female and male pupils in school Years 7 to 13 (52.3% and 23.0%, respectively). For every question there were significantly more female pupils answering “Yes” than male pupils.

Significantly more female secondary school pupils in school Years 7 to 13 (41.9%) self-reported two or more behaviours associated with eating difficulties compared with 17.5% of males. Of secondary school pupils (school Years 7 to 11) who answered “Yes” to two or more questions, only a third (33.1%) of these had parents who responded “Yes” to two or more questions, suggesting differences in parent and pupil reporting of eating behaviours.

The Coronavirus (COVID-19) Schools Infection Survey analysis was produced by the Office for National Statistics (ONS) in collaboration with our research partners at the London School of Hygiene and Tropical Medicine and UK Health Security Agency. Of note are:

• Shamez Ladhani - UK Health Security Agency: Consultant Epidemiologist and Study Chief Investigator

• Georgina Ireland - UK Health Security Agency: Senior Scientist

• Patrick Nguipdop-Djomo - London School of Hygiene and Tropical Medicine: Associate Professor of Infectious Disease Epidemiology and Study Co-Principal Investigator

• Punam Mangtani - London School of Hygiene and Tropical Medicine: Professor of Infectious Disease Epidemiology and Study Co-Principal Investigator

Long COVID

The term long COVID is generally used to describe the persistence of symptoms, long after you would usually expect them to have resolved after coronavirus (COVID-19) infection, which can't be explained by another cause.

Delphi consensus on long COVID

The Delphi consensus approach is a well-established, systematic and iterative method that relies on a panel of experts to move towards agreement. Researchers working on the non-hospitalised children and young people with long COVID (CLoCK) study, funded by UK Research and Innovation (UKRI) and the National Institute for Health Research (NIHR), participated in the Delphi approach and agreed that long COVID could be defined by:

• a positive test for coronavirus (COVID-19) infection

• the presence of symptoms continuously over a 12-week period or longer

• everyday life being affected by these symptoms

This is a working definition for research purposes, rather than a clinical definition for diagnosing long COVID, such as those published by the National Institute for Health and Care Excellence (NICE) the World Health Organisation (WHO).

Definitions of long COVID can vary between studies and articles. The ONS prevalence of ongoing symptoms analysis uses different criteria, namely people who had a confirmed infection, or suspected they had COVID-19.

Strengths and Difficulties Questionnaire (SDQ)

The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioural screening questionnaire used for those aged 3-to 16-years. It exists in several versions to meet the needs of researchers, clinicians and educationalists. The questionnaire asks about 25 attributes, some positive and others negative. These 25 items are divided between five scales:

• emotional symptoms (five items)

• conduct problems (five items)

• hyperactivity/inattention (five items)

• peer relationship problems (five items)

• prosocial behaviour (five items)

The SDQ also includes an impact supplement, which asks whether the respondent considers the child or young person to have difficulties, how long the difficulties have been present, and the extent to which they cause distress and impairment in functioning in everyday life.

Responses provided in the SDQ were combined using a diagnostic algorithm to indicate whether each child was unlikely to be, possibly or probably demonstrating a mental health condition related to emotional, behavioural and hyperactivity disorders. The algorithm combines data from all available informants. A disorder is considered probably present if the scores on the relevant symptom indicate the child is above the 95th centile and the impact score is two or above, according to either informant for emotional difficulties and conduct problems, or two informants (if available) for hyperactivity. A disorder is considered unlikely if the scores for conduct and emotion were three or below from all informants, and if hyperactivity was five or below, with impact scores at zero. A disorder was considered possible with intermediate scores. More detail on how the algorithm works can be found on the SDQ website.

For the Schools Infection Survey (SIS), we have adapted this methodology in light of only obtaining information from the pupil questionnaire for those aged 11 to 16 years, and from the parent questionnaire information for those aged 4 to 11 years. The limitation of our approach is that it is not exactly comparable with other published mental health results, but it provides a measure against a validated methodology.

Data presented in this bulletin are from Round 3 of the COVID-19 Schools Infection Survey (SIS) carried out during March of the 2021 to 2022 academic year.

Data from the parent and pupil questionnaires are weighted to population totals for pupils in England. Headteacher questionnaire data are unweighted because of small sample sizes.

Our methodology article provides further information about response rates, survey design, how we process data and estimation methods.

Reference period

Coverage dates for each survey are:

• 15 March to 1 April 2022 for the pupil and parent questionnaire

• 23 March to 1 April 2022 for the headteacher questionnaire

Response rates

The estimated response rates are:

• 46% for the pupil questionnaire where 2,966 pupils responded from 6,511 eligible participants registered

• 62% for the parent questionnaire where parents responded on behalf of 7,448 children from 11,995 eligible children registered

• 64% for the headteacher questionnaire where 111 headteachers or delegated authority responded on behalf of 173 registered schools

Response rates are dependent on people voluntarily completing the questionnaire, which may introduce respondent bias.

Comparisons with other studies on physical activity

Our physical activity findings are lower than those reported by the Sports England Active Lives Children and Young People Survey. Before the coronavirus pandemic, Sport England found that 47% of students were active for at least 60 minutes per day during the 2018 to 2019 academic year, which lowered to 45% during the 2019 to 2020 academic year.

The Sports England study has a different methodology to the Schools Infection Study, which could explain some of these differences. The study prompted pupils to recall the sports and activities in which they have taken part and to estimate how much time they spent participating in each activity each day. This meant pupils could reflect on all kinds of activity rather than providing a broad estimate.

Please refer to the Strengths and limitations section of our previous bulletin.