LAUSR

Objectives To examine differences in rural community children’s moderate-to-vigorous physical activity (MVPA) and participation in out-of-school activities from fall 2019 to fall 2020 and explore enacted PA opportunity modifications post initial COVID-19 disruption. Design Mixed methods study using the validated Youth Activity Profile (YAP), administrator reports and stakeholder surveys and semistructured interviews. Setting Children and community stakeholders from one rural US Great Plains community in the state of Nebraska were recruited. Participants Third through fifth graders in fall 2019 (n=144) and fall 2020 (n=174) reported MVPA and participation in out-of-school activities using the YAP. School administrators reported weekly physical education (PE) and recess minutes. Community stakeholders reported pandemic-related changes in community social structures in semistructured interviews (n=4) and surveys (n=19). Results Average daily MVPA minutes increased from 2019 to 2020 (75.0 vs 81.3, SE=1.6, p<0.05). Minutes of MVPA increased during: school hours (MD=2.7, SE=0.5, p<0.5); out-of-school time on weekdays (MD=3.9, SE=1.3, p<0.5); and on weekends (MD=5.5, SE=2.4, p<0.5). On average, fewer children participated in youth sport (42.5% vs 47.2%), youth clubs (10.3% vs 16.0%) and other out-of-school activities (24.1% vs 38.2%) in 2020, compared with 2019. Weekly PE/recess minutes increased from 208.3 to 241.7 from 2019 to 2020. Stakeholder surveys revealed community-driven modifications to PA opportunities, and interviews suggested children played outside more frequently, especially when school was closed and out-of-school activities were shut down. Conclusions Increased minutes of PE and recess, and decreased out-of-school activity participation may have increased children’s overall free play and MVPA during the pandemic. Free play was an important contributor to children’s PA during the pandemic and should be prioritised by educators, coaches and other leaders of child PA opportunities. Trial registration number NCT03380143.