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.

Danish Health Authority Copenhagen Denmark

Department of Cardiology Institute of Mother and Child Warsaw Poland

Department of Health and Inequality Division of Mental and Physical Health Norwegian Institute of Public Health Bergen Norway

Department of Health Promotion Norwegian Institute of Public Health Bergen Norway

Department of Living Conditions and Lifestyle Public Health Agency of Sweden Solna Sweden

Department of Pediatrics Paracelsus Medical University Salzburg Austria

Department of Physiology and Monitoring of Nutrition Institute of Public Health Skopje North Macedonia

Department of Social and Policy Sciences University of Bath Bath United Kingdom

Department of Sport Science and Sport FAU Erlangen Germany

Diabetes and Metabolic Disorders Department Ministry of Health Public Health Institution Ankara Turkey

EPIUnit Instituto de Saúde Pública Universidade do Porto Porto Portugal

Faculty for Sport and Physical Education University of Montenegro Niksic Montenegro

Faculty of Sport and PE University of Novi Sad Novi Sad Serbia

Faculty of Sport University of Ljubljana Ljubljana Slovenia

Health Authority San Marino San Marino San Marino

Hungarian School Sport Federation Budapest Hungary

Institute of Endocrinology Obesity Management Centre Prague Czechia

Institute of Public Health of Federation of Bosnia and Herzegovina Banja Luka Bosnia and Herzegovina

Institute of Public Health of Montenegro Podgorica Montenegro

International Hellenic University Thessaloniki Greece

Italian National Institute of Health Rome Italy

Leibniz Institute for Prevention Research and Epidemiology BIPS Bremen Institute of Statistics University of Bremen Bremen Germany

Lithuanian University of Health Sciences Health Research Institute and Department of Preventive Medicine Kaunas Lithuania

Medical University of Vienna Vienna Austria

Ministry of Health Centre for Disease Prevention and Control Riga Latvia

Ministry of Health Limassol Cyprus

National Center for Disease Control and Public Health Tbilisi Georgia

National Center of Public Health and Analyses Sofia Bulgaria

National Centre of Public Health of the Ministry of Health of the Republic of Kazakhstan Nur Sultan Kazakhstan

National Institute for Health Development Tallinn Estonia

National Institute of Children Diseases Medical Faculty of Comenius University Bratislava Slovakia

National Institute of Health Dr Ricardo Jorge 1 P Lisbon Portugal

National Institute of Public Health Bucharest Romania

National Institute of Public Health University of Southern Denmark Copenhagen Denmark

National Nutrition Surveillance Centre University College Dublin Dublin Ireland

Nutrition and Food Safety Sector Institute of Public Health Tirana Albania

Primary Health Care Floriana Malta

Public Health Institute of Republic of Srpska the University of Banja Luka Faculty of Medicine Banja Luka Bosnia and Herzegovina

Republican Centre for Health Promotion Bishkek Kyrgyzstan

Republican Centre for Nutrition Ministry of Health and Social Protection of Population Duschanbe Tajikistan

School of Medicine University of Zagreb Croatian Institute of Public Health Zagreb Croatia

Scientific Research Institute of Maternal and Child Health Ashgabat Turkmenistan

Spanish Agency for Food Safety and Nutrition Ministry of Health Madrid Spain

The Endocrine Research Centre Moscow Russian Federation

University of Medicine and Pharmacy Carol Davila Bucharest Romania

WHO European Office for the Prevention and Control of NCDs Moscow Russian Federation

WHO Tajikistan Country Office Dushanbe Duschanbe Tajikistan

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