To comprehensively analyse the available surveillance data on PA behaviours, outcomes, and influencing factors in Slovakian children and adolescents, we used the AHKGA-GM project methodology. Data from 34 relevant resources were extracted for grading the 10 core indicators and 1 additional indicator. The overall average of the 10 core indicators was graded a C, which suggests room for improvement in all 10 core indicators.

Overall physical activity (B–)

The grade for the Overall Physical Activity indicator was based on the questionnaire data from the WHO’s collaborative HBSC, which was conducted in 2018 in Slovakia (n = 8710; [24]). Approximately two-thirds (66%) of adolescents met the PA recommendation, with higher compliance with the recommendations observed in younger adolescents (< 14 years old; 68%) compared with older adolescents (> 14 years old; 62%). This corresponds to the grading B– according to harmonised grading rubric. Boys (70%) reported meeting this recommendation more often than girls (62%). A similar result was observed in younger versus older adolescent boys and girls (71% and 68% in boys vs. 65% and 56% in girls). The high percentage of adolescents who complied with the recommendations is the result of the cut-off value used, which was based on the comparative analyses of questionnaire and device-measured PA data [25]. The results suggest that the previously used cut-off value for self-reported PA data underestimated compliance with recommendations by nearly three times (66% vs. 23%). The lack of device-measured PA data is therefore the main limitation identified in the analysis of data for this indicator. Furthermore, an absolute gap in the data was identified for children aged 6–9 years. Therefore, to improve the surveillance of Overall Physical Activity, we recommend the use of device-based measurements of PA in both children and adolescents to obtain more accurate data on PA levels.

Organised sports and physical activity (C–)

Similar to the previous indicator, data from the HBSC were used to grade the Organised Sports and Physical Activity indicators (unpublished data). Data for organised team sports (n = 8574) and organised individual sports (n = 8392) were used to calculate the average grade. Overall, 41% of adolescents participated in organised sports, with 51% participating in organised team sports and 31% in organised individual sports. Boys reported participating in organised team sports more often than girls (62% vs. 40%), as did younger (64% vs. 41%) and older adolescents (56% vs. 38%). In contrast, girls reported participating in organised individual sports more often than boys (35% vs. 27%), mainly owing to the higher prevalence of participation in organised individual sports reported by younger girls compared with boys (41% vs. 27%). The prevalence of participation in organised individual sports was similar in older adolescent girls and boys (25% vs. 26%). As these data suggest, half of the Slovakian adolescent population does not participate in organised sports. This should be addressed within PA promotion activities, since organised sports may play a significant role in meeting PA recommendations in children and adolescents [26]. Meanwhile, since a gap in the data for children was identified for this indicator, we recommend focusing on this age group in future surveillance efforts.

Active play (C–)

The Active Play indicator was graded using data from only one pilot study (n = 625; [27]) and only one of the two proposed benchmarks. Therefore, the grade for this indicator should be considered with caution. In the aforementioned study, nearly 44% of children under 9 years of age reported being outdoors for more than 2 h per day, and boys reported being outdoors more often than girls (47% vs. 41%). The reported proportions were rather low considering the growing evidence of physical, mental, and social benefits of outdoor activities [28,29,30,31,32]. The main limitation of grading this benchmark was the use of questionnaire-type data. Among the identified gaps was the lack of data for the second benchmark and other age groups. Improved surveillance within this indicator may therefore require device-based measurement of different types of PAs (unstructured/unorganised and outdoor) in various age groups.

Active transportation (C)

Unpublished data from the HBSC (n = 1062) indicated that 49% of adolescents used active modes of transportation to school, with a similar prevalence observed in girls (50%) and boys (48%). Younger adolescent girls reported using active modes of transportation more often than boys (54% vs. 49%), although in older adolescents the opposite was observed, with boys reporting more frequent use of active modes of transportation (48% vs. 43%). When analysing published data from the HBSC [33] one particular pattern was observed within this indicator, namely that more adolescents walked home from school versus to school. This could be the result of parents driving adolescents to school in the morning. A data gap was identified for children; therefore, we recommend collecting surveillance data for this age group as well.

Sedentary behaviour (C–)

The grade for the Sedentary Behaviour indicator was based on unpublished HBSC composite data from the HBSC, which consisted of watching television, digital video discs, or videos (including videos on the Internet, e.g. YouTube) (n = 1053) and playing games on a personal computer (PC), play station, or phone for less than 2 h per weekday (n = 1052). Among 10- to 16-year-olds, 44% met the screen time recommendation. Girls (62%) reported compliance with the screen-time recommendation twice as often as boys (31%), with similar results observed in younger (61% vs. 32%) and older (62% vs. 30%) adolescents. The grading of this indicator was limited in that the data used did not fully reflect the wording of the recommendations. Other possible resources of data were not used for the analyses for the same reason since they solely focused either on time spent on the Internet or PC without differentiating between potentially beneficially and not beneficially (e.g. studying) time spent in front of the screen. Therefore, we recommend unifying the surveillance method for this indicator to reflect the recommendations. Moreover, another limitation existed owing to the use of questionnaire-based data. Therefore, we recommend obtaining device-based measurements of sedentary behaviour, which could promote understanding of the movement behaviours of children and adolescents. Similar to previous indicators, a gap in the data was identified for children; therefore, we recommend focusing on this age group during surveillance.

Physical fitness (D+)

In accordance with the benchmark, the Physical Fitness indicator was graded based on the average number of laps completed within the 20-metre shuttle run. Data on 9- to 15-year-old children and adolescents from four resources (n = 4209; [34,35,36,37]) were weighted and assessed against age- and sex-specific international normative data. This led to placement of the Slovak children and adolescents on 38th percentile (35th in boys and 40th in girls). The grading of this indicator was limited in that it was not possible to include the results of the first mandatory nationwide assessment of the physical abilities of first graders in 2018 (n = 38 690; [38]) because the international normative data were only available for 9-year-olds. Another limitation was caused by the coronavirus disease pandemic, which restricted the nationwide assessment of the physical abilities of third graders planned for the year 2020. However, since the assessment of first and third graders will be performed annually, it will provide data for the surveillance of the Physical Fitness indicator in the future. Moreover, since a gap in the data was identified for other age groups, we recommend expanding the assessment to all elementary school grades. This recommendation is currently being considered within the legislative process of the Slovak National Council, based on the initiative of RWG members.

Family and peers (C–)

One benchmark was used to grade the Family and Peers indicator, which reflects tangible parental support (i.e. doing activities with their children). Based on unpublished data from the HBSC, 39% of adolescents reported that their parents played sports with them (whole sample = 6179), and 54% of adolescents reported that their parents took walks with them was 54% (whole sample = 6184), for a weighted average of 46% of adolescents doing some type of PA with their parents. Girls and boys reported walking with their parents once a week or more at similar rates (both 54%). Among both younger and older adolescents, boys and girls reported similar frequencies of walking with parents once a week or more (60% in younger adolescents and 44% in older adolescents). The grading of this indicator was limited in that only one of the benchmarks was used, and at the same time, was graded based on data from children rather than parents. Gaps in data were observed in the data gathered directly from parents regarding the facilitation of PA in their children, PA of the parents (either self-reported or device-measured), and for the children.

School (B)

The average percentage for the School indicator was calculated based on various benchmarks. Physical education (PE) is mandatory in all schools in Slovakia, with two mandatory PE classes per week and one optional class if the school decides to incorporate it. Therefore, 100% of schools offered the mandated amount of PE. The situation with PE specialists was less favourable, as only 80.2% of teachers teaching PE were qualified PE specialists in 2014 [39]. The infrastructure of schools has been of concern to agencies such as the State School Inspection and Ministry of Education, Science, Research, and Sport of the Slovak Republic for some time now, as only 78% of schools have facilities for PA [40]. In addition, the proportion of 10-to 17-year-olds who reported having spaces in school for PA and sports outside of PE class was 86% (HBSC unpublished data). Regarding opportunities for PA in addition to PE classes, 63% of schools offered non-curricular PAs, 34% offered courses or training, and 46% offered non-regular (one-time) PAs [33]. Therefore, the situation within this indicator can be improved. The RWG members are currently involved in two initiatives, including the legislative process of increasing the number of mandatory PE classes from two to three and incorporating the Active School concept [41] into the reformed school curricula in Slovakia. An initiative to improve school infrastructure by investing in the reconstruction of old facilities or the construction of new ones is also ongoing.

Community and environment (B–)

Two benchmarks related to the availability of facilities, programmes, parks, and playgrounds in the community and the safety of the neighbourhoods were used to grade the Community and Environment indicator. According to unpublished data from the HBSC, 60% (whole sample size = 1052) of 10- to 17-year-old adolescents reported that quality and appropriate activities or conditions were available in their neighbourhood, 77% (whole sample size = 1056) reported the availability of playgrounds or parks where they can play, 73% (whole sample size = 1060) reported they felt safe walking or playing during the day in their neighbourhood, and 58% (whole sample size = 5757) reported that it was safe for small children to play on the street during the day. The weighted average of the aforementioned data was 67% (68% for boys and 65% for girls). The main limitation in grading this indicator was the use of only some benchmarks and use of questionnaire data only from the adolescents. Since gaps in data from parents, communities/municipalities, and children were identified, we recommend focusing on these groups in further surveillance efforts. Surveillance methods should also include specific criteria that could be used by communities/municipalities for self-evaluation with respect to the infrastructure specifically geared towards promoting PA.

Government (B–)

Nine policy instruments were identified and analysed against the six criteria using the scoring rubric published by Ward et al. (2021) [22], [42,43,44,45,46,47,48,49,50]. Although observable efforts are apparent, including action plans, legislation, concepts, and strategies to promote PA in children and adolescent, no evidence exists regarding the impact of these policies on PA levels or increases. Therefore, the lack of policy evaluation and accountability was identified as a major gap in the surveillance data for this indicator.

Sleep (C–)

Sleep, as an additional indicator, was classified according to unpublished self-reported data from the HBSC (n = 8697; 9–17 years old) and according to the age-specific sleep time duration recommendations of the National Sleep Foundation. In general, 48% of children and adolescents met the recommended amount of sleep per night. Within both age categories, boys and girls had similar compliance rates with the aforementioned recommendations (42% vs. 40% in children < 13 years old and 55% vs. 53% in children > 14 years old). Based on these data, half of the adolescents did not meet the sleep duration recommendation. A surveillance gap was identified in the data for the other two benchmarks related to sleep quality as well as a gap in the data for younger children, thereby limiting the grading of this indicator. Simultaneously, a surveillance gap in the device-measured sleep duration data was identified.

Practical applications and future research

Following the structure used by Tremblay et al. [17] we can outline various practical applications of the RC in Slovakia in different areas (Table 2).

Table 2 Practical applications of the Slovak Report Card

Identified surveillance gaps are important for planning of future research activities in Slovakia in order to enhance surveillance system. Since most of the available data come from adolescents via HBSC study (age group 10–15(17)), the focus should be put as well on younger children and parents. The study like WHO’s European Childhood Obesity Surveillance Initiative (COSI; age group 6–9 years) can potentially serve as a valuable complementary sources of quality surveillance PA data.

At the same time, since all available data was questionnaire-based, the future research should focus on the usage of device-based measurements of the movement behaviours in children, adolescents and their parents. The first such a research using accelometry was conducted in reaction to our findings in the sample of 100 adolescents of one high-school in 2022 in Prešov, Slovakia (no data published yet).

Further research activities should be focused on Active Play indicator widening the scope of such a research to outdoor physical activities. In reaction to our findings, there were two grant applications submitted within two Slovak national grant agencies (one scientific and one educational) in 2022, and, another grant application is currently under preparation within the EU’s Interreg programme. Furthermore, research cooperation within the European Network of Outdoor Sports (ENOS) was initiated, and RC Country leader became member of the steering committee of the 10-Year Anniversary of the Position Statement on Active Outdoor Play [54].

Finally, future research should focus on policy evaluation which can help improve public policies for the promotion of PA.

Strengths and limitations

The study’s strengths include a usage of harmonised methodology used by the 57 countries and regions that participated in the AHKGA-GM 4.0 project. Another strength is usage of comprehensive multilevel data search strategy which allowed for extensive identification of relevant data resources. Two study limitations need to be mentioned. Firstly, varied surveillance methods used among countries included in the AHKGA-GM project make comparisons among countries challenging and often invalid. Therefore, these results should be considered with caution. Secondly, the variability of data resources did not allow for usage of any other quality assessment tool and therefore non-standardised tool was used. And, thirdly, numerous surveillance gaps were identified, which limit the overall informative value of the current grade.