Movement behaviours, air pollution and health in school-aged children: a cross-sectional study to guide the co- creation of healthier environments - The MOVE-AIR Project

The MOVE-Air study was designed to explore the role of movement behaviours on the association between air pollutants and health outcomes in Portuguese children. Secondarily, it aims to characterize the settings (both indoor and outdoor) where children are exposed to air pollutants and to co-create solutions with participants to mitigate the exposure to air pollutants in children´s daily life. This study aims to detailed describe the MOVE-AIR study protocol. Data from at least 22 primary school children aged 9-to-11 years will be assessed for indoor and outdoor air pollutants (PM _2.5 and PM _10, and carbon dioxide), geo-tracked for distinct settings ( i.e., home/school, indoor/ outdoor) along the day, through an optical monitoring sensor with global position system incorporated. Health-related biological outcomes, such as Interleukin 6 (IL6), Tumor Necrosis Factor Alpha (TNF- α), and oxidative parameters, including Total Antioxidant Status (TAS), and Total Oxidant Status (TOS) will be evaluated, and the Oxidative Stress Index (OSI) will be calculated. Children´s cardiopulmonary fitness will be assessed through the Shuttle-run Test, and movement behaviours will be evaluated through accelerometers (wGT3-x). Children´s sex, age, and parental socioeconomic status will be provided by parents through a questionnaire. The influence of movement behaviours in the link between pollution and health will be analyzed through compositional analysis and structural equation models using R software (4.2.0). A sub-sample of class teachers, school leaders, parents, and children will be invited to a co-creation process to create solutions to mitigate their daily exposure to air pollutants. The results will contribute to further understanding the influence of movement behaviours in the association between air pollution and health, adding a biological layer to the mechanistic links underlying these potential relationships that have not been explored in this target population. Finally, enhancing our comprehension of the living environments and contexts where children are more exposed to air pollution can help to cooperatively create solutions to mitigate their daily exposure to those harmful pollutants.