Physical activity, screen time, and sleep duration of children aged 6–9 years in 25 countries: An analysis within the WHO European childhood obesity surveillance initiative (COSI) 2015–2017
Open accessAbstract
Background: Children are becoming less physically active as opportunities for safe active play, recreational activities, and active transport decrease. At the same time, sedentary screen-based activities both during school and leisure time are increasing. Objectives: This study aimed to evaluate physical activity (PA), screen time, and sleep duration of girls and boys aged 6–9 years in Europe using data from the WHO European Childhood Obesity Surveillance Initiative (COSI). Method: The fourth COSI data collection round was conducted in 2015–2017, using a standardized protocol that included a family form completed by parents with specific questions about their children’s PA, screen time, and sleep duration. Results: Nationally representative data from 25 countries was included and information on the PA behaviour, screen time, and sleep duration of 150,651 children was analysed. Pooled analysis showed that: 79.4% were actively playing for >1 h each day, 53.9% were not members of a sport or dancing club, 50.0% walked or cycled to school each day, 60.2% engaged in screen time for <2 h/day, and 84.9% slept for 9–11 h/night. Country-specific analyses of these behaviours showed pronounced differences, with national prevalences in the range of 61.7–98.3% actively playing for >1 h/day, 8.2–85.6% were not members of a sport or dancing club, 17.7–94.0% walked or cycled to school each day, 32.3–80.0% engaged in screen time for <2 h/day, and 50.0–95.8% slept for 9–11 h/night. Conclusions: The prevalence of engagement in PA and the achievement of healthy screen time and sleep duration are heterogenous across the region. Policymakers and other stakeholders, including school administrators and parents, should increase opportunities for young people to participate in daily PA as well as explore solutions to address excessive screen time and short sleep duration to improve the overall physical and mental health and well-being of children.
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Decades of observational research show a correlation between screen media duration and higher risk of adiposity and unhealthy weight among children and teens.
“Decades of observational research has demonstrated correlation between screen media duration and higher risk of adiposity and unhealthy weight among children and teens.247,248”
From Digital Ecosystems, Children, and Adolescents: Technical Report (2026) · cites this paper as [248]
The Background links screen-device use to sedentary behaviour and higher energy intake, while the Screen Time section reports duration distributions for children aged 6–9; neither reports a correlation with adiposity or unhealthy weight. Searches for screen time, BMI, weight status, obesity, and adiposity found no passage establishing the claimed association in children and teens or describing decades of observational research. (LLM, conf=0.72)
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- Authors
- Whiting, S., Buoncristiano, M., Gelius, P., Abu-Omar, K., Pattison, M., Hyska, J., Duleva, V., Musić Milanović, S., Zamrazilová, H., Hejgaard, T., Rasmussen, M., Nurk, E., Shengelia, L., Kelleher, C. C., Heinen, M. M., Spinelli, A., Nardone, P., Abildina, A., Abdrakhmanova, S., Aitmurzaeva, G., Usuopva, Z., Pudule, I., Petrauskiene, A., Sant’Angelo, V. F., Kujundzic, E., Popovic, S., Fismen, A.-S., Bergh, I. H., Fijalkowska, A., Rito, A. I., Cucu, A., Brinduse, L. A., Peterkova, V., Gualtieri, A., García-Solano, M., Gutiérrez-González, E., Abdurrahmonova, Z., Boymatova, K., Yardim, N., Tanrygulyyeva, M., Weghuber, D., Schindler, K., Stojisavljević, D., Filipović Hadžiomeragić, Markidou Ionnaidu, E., Ahrens, W., Hassapidou, M., Kovacs, V. A., Ostojic, S. M., Ticha, L., Starc, G., Russell Jonsson, K., Spiroski, I., Rutter, H., Mendes, R., Williams, J., Rakovac, I., & Breda, J.
- Affiliations
- Universidade do Porto (PT)
- WHO European Office for the Prevention and Control of NCD (RU)
- Friedrich-Alexander-Universität Erlangen-Nürnberg (DE)
- Institute of Public Health (AL)
- National Center of Public Health and Analyses (BG)
- Institute of Endocrinology (CZ)
- University of Southern Denmark (DK)
- National Institute for Health Development (EE)
- National Center for Disease Control and Public Health (GE)
- University College Dublin (IE)
- Istituto Superiore di Sanità (IT)
- Ministry of Health of the Republic of Kazakhstan (KZ)
- Primary HealthCare (MT)
- University of Montenegro (ME)
- Norwegian Institute of Public Health (NO)
- National Institute of Health Dr. Ricardo Jorge (PT)
- Institutul National de Sanatate Publica (RO)
- Endocrinology Research Center (RU)
- Paracelsus Medical University (AT)
- Medical University of Vienna (AT)
- University of Banja Luka (BA)
- University of Bremen (DE)
- International Hellenic University (GR)
- Hungarian School Sport Federation (HU)
- University of Ljubljana (SI)
- Institute of public health of Republic of Macedonia (MK)
- University of Bath (GB)
- ORCID
- Whiting, Stephen
- Buoncristiano, Marta
- Gelius, Peter
- Hyska, Jolanda
- Duleva, Vesselka
- Rasmussen, Mette
- Nurk, Eha
- Shengelia, Lela
- Heinen, Mirjam M.
- Spinelli, Angela
- Nardone, Paola
- Abildina, Akbota
- Abdrakhmanova, Shynar
- Aitmurzaeva, Gulmira
- Popovic, Stevo
- Fismen, Anne-Siri
- Bergh, Ingunn Holden
- Rito, Ana Isabel
- Cucu, Alexandra
- Peterkova, Valentina
- Weghuber, Daniel
- Stojisavljević, Dragana
- Ahrens, Wolfgang
- Hassapidou, Maria
- Kovacs, Viktoria Anna
- Ostojic, Sergej M.
- Starc, Gregor
- Spiroski, Igor
- Rutter, Harry
- Mendes, Romeu
- Williams, Julianne
- Breda, João
- Venue
- Obesity Facts
- Publisher
- S. Karger AG
- Published
- 2020-12-22
- Volume
- 14
- Issue
- 1
- Pages
- 32-44
- ISSN
- 1662-4025 (ISSN-L)
- 1662-4033
- PMC
- PMC7983588
- OpenAlex
- W3117196198
- Cited by
- 154
- References
- 5
- Citations by year
- 2026: 23 · 2025: 27 · 2024: 27 · 2023: 29 · 2022: 26 · 2021: 22
- FWCI
- 11.58
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Obesity Facts (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Pure (University of Bath) (acceptedVersion, cc-by-nc)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- Informationszentrum Lebenswissenschaften (ZB MED) (submittedVersion, cc-by-nc)
- Lithuanian University of Health Sciences (submittedVersion, cc-by)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, cc-by-nc)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, cc-by-nc)
- Funders
- World Bank Group
- World Health Organization
- Health Service Executive
- Ministero della Salute
- Ministeriet Sundhed Forebyggelse
- Lietuvos Sveikatos Mokslų Universitetas
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- physical activity, screen time, sleep duration, children aged 6-9 years, childhood obesity, active play, sports club participation, active school transport, sedentary behavior, cross-national comparison
- MeSH terms
- Screen Time, Child, Europe, Female, Humans, Leisure Activities, Male, Motor Activity, Parents, Schools, Sleep, Sports, World Health Organization, Exercise, Pediatric Obesity
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