Global Matrix 4.0 Physical Activity Report Card Grades for Children and Adolescents: Results and analyses from 57 countries

Background and Objectives

The lifelong benefits of physical activity (PA) for the physical and mental health and well-being of children and adolescents are now widely accepted by the international scientific community.1,2 The World Health Organization (WHO) recommends that children and adolescents aged 5–17 years should accumulate at least 60 minutes per day of moderate- to vigorous-intensity PA (MVPA), on average, and incorporate vigorous-intensity aerobic activities as well as muscle- and bone-strengthening activities at least 3 days per week.1. While there has been global understanding over the importance of promoting healthy levels of PA for years,3,4 international studies and reports continue to show that child and adolescent PA levels are low across the globe.5–12 Recent research has shown that some of the public health measures/mandates implemented to contain the coronavirus disease (COVID-19) pandemic have further adversely impacted PA levels worldwide.13–16 The Global Matrix on PA for children and adolescents is an initiative launched under the leadership of the Active Healthy Kids Global Alliance (AHKGA; www.activehealthykids.org) to achieve a comprehensive understanding of the global variation in child and adolescent PA, related indicators, and key sources of influence.

With guidance from the AHKGA, Report Card teams of national experts from countries/jurisdictions (hereafter referred to as countries for simplicity) participating in the Global Matrix developed. PA Report Cards based on the Canadian Report Card model.17 Report Card teams used a harmonized process for gathering, assessing data and assigning grades to PA indicators. Since its creation, the Global Matrix framework has evolved, expanded, become more robust, and is now widely disseminated and used to inform policy and practice.18,19 Fifteen countries participated in the inaugural Global Matrix 1.0 (2014),20 38 countries participated in the Global Matrix 2.0 (2016),21 and 49 countries participated in the Global Matrix 3.0 (2018).22 These Global Matrices highlighted international research, and surveillance gaps and limitations showed evidence of higher PA and lower sedentary behavior in countries reporting poorer infrastructure for supporting PA, and lower PA and higher sedentary behavior in countries reporting better infrastructure for supporting PA. The Global Matrices also presented examples of good practice promoting more PA and less sedentary behaviors in children and adolescents.20–22 Although the COVID-19 pandemic challenged the timeline and development of the Global Matrix 4.0, a total of 60 national/ territorial Report Card teams of PA experts registered for the initiative. A total of 57 Report Card teams completed the harmonized process to grade the 10 common PA indicators (an increase of 8 countries [16%] compared with the Global Matrix 3.0). The objectives of this manuscript are (1) to combine, compare, and summarize the findings from the 57 Global Matrix 4.0 Report Cards; (2) to compare indicators across countries exploring trends related to geo-cultural regions and Human Development Index (HDI) classifications based on the most recent data available in participating countries; (3) to investigate the impact of the COVID-19 pandemic, war, climate change, and economic change on the PA grades of children and adolescents in participating countries; and (4) to present the global top priorities for improving the grades of each indicator.