Title: Report Card Brazil: Health indicators for children and adolescents (3rd edition). Authors: Diego Augusto Santos Silva (Email: diegoaugustoss@yahoo.com.br) (1) Andreia Pelegrini (Email: andreia.pelegrini@udesc.br) (2) Diego Giulliano Destro Christofaro (Email: diego.christofaro@unesp.br) (3) Elisa Pinheiro Ferrari (Email: elisapinheiroferrari@gmail.com) (4) Gerson Luis de Moraes Ferrari (Email: gersonferrari08@yahoo.com.br) (5,6) Kelly Samara da Silva (Email: ksilvajp@gmail.com) (1) Luiz Rodrigo Augustemak de Lima (Email: luiz.lima@iefe.ufal.br) (7) Nelson Nardo Júnior (Email: nnjunior@uem.br) (8) Roberto Jerônimo dos Santos Silva (Email: rjeronimoss@gmail.com) (9) Valter Cordeiro Barbosa Filho (Email: valtercbf@gmail.com) (10) Institutions: 1. Universidade Federal de Santa Catarina. Florianópolis, SC. Brasil 2. Universidade do Estado de Santa Catarina. Florianópolis, SC. Brasil 3. Universidade Estadual Paulista "Júlio de Mesquita Filho". Presidente Prudente, SP. Brasil. 4. Universidade Católica de Brasília. Brasília, DF. Brasil. 5. Universidade Federal de São Paulo. São Paulo, SP. Brasil. 6. Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, USACH, Santiago, Chile 7. Universidade Federal de Alagoas. Maceió, AL. Brasil. 8. Universidade Estadual de Maringá. Maringá, PR. Brasil. 9. Universidade Federal de Sergipe. Aracaju, SE. Brasil. 10. Instituto Federal do Ceará. Boa Viagem, CE. Brasil. Research Question: 1) What is the evidence on health indicators for children and adolescents in Brazil investigated in the Global Matrix initiative? Update: This project is an update of the Report Card Brazil 2018, which dealt with health indicators for children and adolescents in Brazil. The 2018 project can be consulted in literature: Silva DAS, Christofaro DGD, Ferrari GLM, Silva KS, Nardo N Jr, Silva RJS, Fernandes RA, Barbosa Filho VC. Results from Brazil's 2018 Report Card on Physical Activity for Children and Youth. J Phys Act Health. 2018; 15 (S2): S323-S325. doi: 10.1123 / jpah.2018-0421. Financing: There are no sources of funding for the project. Rationality: This project is part of the Global Healthy Matrix 4.0 initiative of the Active Healthy Kids Global Alliance (https://www.activehealthykids.org/) and is aimed at raising the most current evidence of various health indicators for children and adolescents around the world. The current project will be an update of evidence raised in 2018 and is limited to such evidence, exclusively in Brazil, with the collaboration of a group of researchers involved in studies on the different health indicators investigated in the project. Monitoring the most current evidence of health indicators is important to assess and guide initiatives to promote active and healthy lifestyle in children and adolescents. Main aim: To synthesize, through systematic reviews and/or narrative reviews and/or original studies, the most current evidence on the prevalence related to health indicators for children and adolescents in Brazil considered in the Global Matrix 4.0 initiative of the Active Healthy Kids Global Alliance (https: //www.activehealthykids.org/). Indicators to be investigated: - Daily behaviors: global physical activity, participation in sports, active plays, active commuting, sedentary behavior and sleep. - Sources of influence: family and friends, school, community and built environment (spaces, structures). - Health outcomes: physical fitness (cardiorespiratory fitness, muscle strength, muscle resistance and flexibility), and obesity. - Government strategies and investments. Search: For each of the indicators to be investigated in the project, updates of systematic literature reviews that were carried out in the last version of the 2018 survey will be performed. For the new indicators included in this new version (i.e., sleep), a complete systematic literature review will be developed. For some indicators, narrative reviews and / or original studies will be developed from national databases that have been made publicly available since 2018, and official websites of the Brazilian government containing data with these indicators will also be consulted. Only scientific articles published until December 2019 will be included in the systematic reviews. This justification is because Brazil has registered cases of COVID-19 in 2020 and actions of social distancing / isolation have been adopted from then on, which results in changes in the outcomes investigated in this project. For updates of systematic reviews, the following databases will be consulted: LILACS, SciELO, SCOPUS, Medline/PUBMED and Web of Science. Complementary strategies (reading the references of retrieved articles and other reviews on the topic, consulting on specialized websites and contacting the authors) can also be carried out. For each of the indicators to be investigated, combinations of key descriptors related to the theme will be individually developed with the population of children and adolescents in Brazil aged 6-19 years or with average age within this age group. These descriptors can be consulted by contacting the project authors. Types of studies to be included: For health indicators that will require performing updates of systematic reviews published in 2018, articles published in 2018 and 2019 will be included. For health indicators that will require performing a complete systematic review, articles published from the beginning of the database until December 2019 will be included. For systematic reviews, original articles with cross-sectional or other designs (longitudinal, case-control and/or randomized clinical trials) that allow extracting the cross-section estimates for the indicator will be included. For systematic reviews, original articles will be considered. Information contained in dissertations/theses, communications/papers at scientific events, research protocols will not be included. For narrative reviews and / or original studies that will be written on any project indicator, national public domain databases and/or official Brazilian government websites containing microdata for the indicator should be used. Participants/Population: Studies including sample of Brazilian children and adolescents aged 6-19 years or with average age within this age group. Main outcomes: Studies will be considered when they have assessed (subjectively, for example, using questionnaires, or objectively, using motion sensors) and provided information on the following indicators: - prevalence of children and adolescents who meet recommendations for global physical activity; - prevalence of children and adolescents who participate in organized sports; - prevalence of children and adolescents who participate in active plays; - prevalence of sedentary behavior in children and adolescents; - prevalence of children and adolescents who meet recommendations for sleep habits; - prevalence of children and adolescents involved in active commuting to and from school; - prevalence of children and adolescents who meet the health zone criteria for physical fitness indicators (flexibility, cardiorespiratory fitness, muscle strength and resistance); - prevalence of overweight and obesity in children and adolescents; - prevalence of children and adolescents under the influence (positive and / or negative) of family and friends for the practice of physical activity; - prevalence of Brazilian schools with adequate physical and organizational structure for the promotion of physical activity for children and adolescents; - prevalence of community environment indicators (spaces, structures and programs) that influence the promotion of physical activity in children and adolescents; - strategies and investments of the Brazilian government in promoting physical activity for children and adolescents. Data extraction: For systematic reviews, after searching electronic databases, results will be imported into the reference manager and duplicate articles will be excluded. The selection process will be carried out independently by two researchers and discrepancies during the process will be discussed and resolved by a third researcher with experience in systematic reviews. An initial check of titles and abstracts of potential studies will be carried out. After this stage, articles will be read in full. Only studies that meet all criteria for each of the indicators will be considered for the final report. All studies excluded in each stage will be listed and informed of the reasons for exclusion. For each of the systematic reviews, a flowchart based on the PRISMA recommendation will be developed to report the process of searching and filtering articles. The results of each article will be extracted by a researcher and checked by another independent researcher. Disagreement in the data extraction process will be resolved through a consensus meeting with a third researcher. All information extracted from articles will correspond to the PICOS strategy. In principle, the following information will be extracted: reference, city, year and objective. The population will include: sample size, age, sampling method, sample eligibility criteria. For the outcome, the main results and measurement instruments will be described. In addition to this information, study design / type will also be informed. For health indicators that use national databases and / or Brazilian government websites, an analysis will be carried out by two independent researchers regarding the agreement between the variable available in the national database and/or Brazilian government websites with what it is investigated in the project. If there is discrepancy between the two researchers, a third researcher will be consulted at a consensus meeting to define the eligibility of the national database and/or the Brazilian government website. Data to be extracted from each of the national databases and/or Brazilian government websites must correspond to children and/or adolescents aged 6-19 years and/or with average age within this age group. The sampling process, sample size, locations and form of data collection, as well as the way the outcome was measured must be informed in the report. Bias risk assessment: For systematic reviews, bias risk will be assessed using specific instrument, considering the type of design of included studies. In principle, instruments and methodology available at the National Heart, Lung and Blood Institute (https://www.nhlbi.nih.gov/health-topics/study-quality-assessment-tools) will be considered. This process will be carried out by a researcher and checked by another independent researcher and disagreements will be resolved in consensus by a third researcher. Subgroup analysis: For indicators related to daily behaviors and health outcomes, information will be presented in general and stratified by sex (male and female) and by age group (children and adolescents) and types of indicator measure (subjective or objective). How results will be disclosed: Results will be disclosed through a research report entitled “Report Card Brazil”, to be available for free on the Active Healthy Kids Global Alliance website (https://www.activehealthykids.org/). In addition, for each of the investigated indicators, a scientific article will be written and published in an open-access academic journal. Project start date: March 01, 2020 Project end date: December 30, 2021 Start date of systematic searches: August 01, 2020 End date of systematic searches: December 01, 2020 Language: Portuguese and English Ethical aspects: Systematic reviews will not result in direct contact with human beings; therefore, there is no need for registration with the Human Research Ethics Committee. For the use of public domain databases, only databases whose research protocol was approved by the Human Research Ethics Committee will be considered, respecting all recommendations of the Declaration of Helsinki. Conflict of interests: The authors declare that there is no conflict of interest Country: Brazil