Twenty-four-hour movement guidelines during adolescence and its association with obesity at adulthood: results from a nationally representative study

Comparative analysis of adherence to 24-hour movement guidelines in adolescents: Objective versus subjective measures

BACKGROUND AND AIMS

Previous studies have investigated the concordance between objective and subjective measures for assessing physical activity, sedentary behaviour, and sleep duration separately. However, no studies have compared adherence to the 24-h movement guidelines using both objective and subjective measures in adolescents. The aim of this study was to compare adherence to the 24-h movement guidelines using both objective and subjective measures.

METHODS AND RESULTS

A comprehensive search was conducted in PubMed, Scopus, Web of Science, EMBASE, CINAHL, and SPORTDiscus up to May 2024. A meta-analysis using a random-effects model was conducted, and a p-value of <0.05 was considered statistically significant of the 5968 studies identified, only 42 met the inclusion criteria, with the included studies reporting a mean age of participants ranging from 11.99 to 17.99 years, comprising a total sample of 856,235 participants. There was no statistically significant difference between objective and self-reported measures of adherence to the 24-h movement guidelines (p > 0.05). When analysing each behaviour separately, there was a statistically significant difference between objective and self-reported measures of physical activity and sleep time (p < 0.05). Regarding sedentary behaviour, all studies used subjective measures; therefore, no meta-analysis was performed for screen time as all studies relied on subjective measures.

CONCLUSION

Based on these findings, both objective and subjective measures can be used to assess adherence to the 24-h movement guidelines in adolescents. Thus, researchers and policymakers can choose either objective or subjective methods to assess adherence to the 24-h movement guidelines, with decisions tailored to the clinical context.

Adherence to 24-hour movement guidelines in adolescence and its association with lower risk of hypertension in adulthood

BACKGROUND

There is limited research on how adherence to 24 h movement guidelines from adolescence to adulthood affects long-term hypertension outcomes. This study examined the association between sustained adherence to these guidelines and hypertension risk.

METHODS

Analysis was done on data from adolescents 12- to 19-year-olds who took part in Waves I and V of the Add Health Study. Physical activity (PA), screen time, and sleep duration were assessed through self-report questionnaires. Blood pressure (BP) was assessed on the right arm following a 5 min seated rest, utilizing an oscillometric device, and hypertension was defined as systolic/diastolic BP ≥ 140/90 mmHg, physician-diagnosed hypertension, or current antihypertensive medication use.

RESULTS

This prospective study included a total of 3076 participants (60.3% female), and 802 were diagnosed with hypertension. Meeting sleep duration guidelines at Wave I was associated with reductions in systolic [- 0.568 mmHg, 95% bias-corrected and accelerated (BCa) confident interval (CI) - 2.128 to - 0.011, P = 0.044] and diastolic (- 0.331 mmHg, 95% BCa CI - 1.506 to - 0.071, P = 0.043) BP at Wave V. Adherence to PA and sleep duration guidelines at both waves further reduced BP, with the greatest decreases observed among participants meeting all three guidelines: systolic (- 6.184 mmHg, 95% BCa CI - 13.45 to - 0.915, P = 0.040) and diastolic BP (- 3.156 mmHg, 95% BCa CI - 6.413 to - 0.120, P = 0.047). The risk of hypertension was lower among those who met the PA guidelines individually [relative risk (RR) 0.710, 95% CI 0.516-0.976, P = 0.035] or adhered to all three recommendations (RR 0.699, 95% CI 0.311-0.899, P = 0.030) in both waves.

CONCLUSIONS

Our findings highlight the cardiovascular benefits of consistently adhering to healthy movement behaviors from adolescence through adulthood.

Associations of 24-h Movement Behaviors With Incidence of Cardiovascular Risk Factors: The Finnish Retirement and Aging Study

Low physical activity, high sedentary time (SED), and inadequate sleep increase cardiovascular disease risk, but the codependency between these 24-h movement behaviors has often been neglected. This study examined associations between 24-h movement behaviors and incidence of cardiovascular risk factors. The study included 866 adults (mean age 62.4 years, SD 1.1) from the Finnish Retirement and Aging study who participated in wrist-accelerometry measurements between 2014 and 2018. Incident register-based cardiovascular risk factors including hypertension, dyslipidemia, type 2 diabetes, and questionnaire-based obesity were followed up over on average 3-year follow-up. Compositional Cox regression models were adjusted for age, sex, occupation, smoking, and heavy alcohol consumption. We recorded 84 (17%) new cases of hypertension, 66 (9%) dyslipidemia, 28 (3%) type 2 diabetes, 43 (6%) obesity, and 94 (26%) any of these cardiovascular risk factors. Compared to mean composition (7.8 h sleep, 11.0 h SED, 4.2 h light physical activity [LPA], 60 min moderate-to-vigorous physical activity [MVPA]), having 10 min more MVPA at the cost of other behaviors was associated with 5%-7% risk reduction in hypertension, 10%-13% in obesity, and 6%-7% in any cardiovascular risk factor. Among the least active (sleep 7.9 h, SED 12.1 h, LPA 3.6 h, MVPA 24 min), the risk reductions were nearly twofold. In conclusion, when accounting the interdependence of movement behaviors, MVPA associated with highest risk reduction in hypertension and obesity, especially among the least active participants. This suggests that even a small increase in daily MVPA could help prevent development of cardiovascular risk factors.

Mapping the research using 24-h movement guidelines in children and adolescents: A bibliometric analysis

BACKGROUND

There are limited comprehensive bibliometric analyses that have examined research articles using the 24-h movement guidelines, which are necessary to evaluate the impact of the research field, map the scientific structure of the research landscape, and identify knowledge gaps.

OBJECTIVES

The aim of this study was to analyse the published research articles using the 24-h movement guidelines and assess their bibliometric characteristics.

METHODS

The search was conducted across all databases indexed in the Web of Science on March 6, 2024, and the bibliometric characteristics of studies published from 2016 onwards were analysed. Descriptive statistics and visualisations by the VOSviewer were used for the presentation of bibliometric characteristics.

RESULTS

120 studies using the 24-h movement guidelines in children and adolescents were included for analysis in this study. In general, number of the related publications using the 24-h movement guidelines increased from 2016 until now. 16 distinct clusters of author networking were displayed, of which the Canadian team was the strongest cluster with the highest research impacts. Of the included studies, cross-sectional studies accounted for the majority. North America and Europe were the leading two study locations across the included studies. Highly varied adherence rate to the 24-h movement guidelines across the included studies were observed. In terms of correlates and health outcomes of meeting the 24-h movement guidelines, separately, sociodemographic and health functioning characteristics were the most examined aspects.

CONCLUSIONS

This study provides a comprehensive scientific overview for research using the 24-h movement guidelines in children and adolescents, which may help guide potential research directions to improve the low compliance rates in this population.

Association between meeting 24-h movement guidelines and health in children and adolescents aged 5-17 years: a systematic review and meta-analysis

Twenty-four-hour movement behaviors have significant implications for physical and mental health throughout one's lifespan. Consistent with movement behaviors, several countries have formulated and published 24-h movement guidelines. This review summarized the studies related to 24-h movement guidelines among children and adolescents from six databases (MEDLINE, EMBASE, PubMed, Web of Science, CINAHL, and SPORTDiscus). In a total of 61 studies that discussed compliance with 24-h movement guidelines, the overall adherence rate was very low (7.1%), with boys exceeding girls, children surpassing adolescents, and regional differences. A total of 39 studies examined the associations between 24-h movement guidelines and health indicators. Findings indicated that meeting all three guidelines was favorably associated with adiposity, cardiometabolic health, mental and social health, physical fitness, health-related quality of life, academic achievement, cognitive development, perceived health, dietary patterns, and myopia. Future research should utilize longitudinal and experimental designs to enhance our understanding of the associations between 24-h movement guidelines and health indicators, thereby aiding the formulation and refinement of such guidelines.

Systematic review registration

https://www.crd.york.ac.uk/prospero/, CRD42023481230.

Meeting the 24-h movement recommendations and its relationship with Mediterranean dietary patterns in early childhood: the SENDO project

The aim of this study was twofold: (1) to assess the association between meeting all three 24-h movement recommendations and adherence to the Mediterranean diet (MedDiet) in early childhood and (2) to examine whether participants who meet all three 24-h movement recommendations have greater adherence to the individual MedDiet foods/components than those who do not meet these recommendations. A cross-sectional study was conducted using a sample of 822 participants from the Seguimiento del Niño para un Desarrollo Óptimo (SENDO) project (Pamplona, Spain). Physical activity was assessed through a questionnaire that covered 17 different types of activities. Screen time was assessed by averaging the daily hours spent on activities such as watching TV, using a computer, or playing video games. Sleep duration was determined by taking the average of sleep durations during both weekdays and weekends. Adherence to the MedDiet was evaluated using the Mediterranean Diet Quality Index in children and adolescents (KIDMED). Greater odds of having an optimal adherence to the MedDiet were found for participants meeting all three 24-h movement recommendations (odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.33-2.87, p = 0.001) in comparison with their counterparts not meeting these recommendations. Specifically, significant differences were found for "fruit or fruit juice every day" (p = 0.012), "second fruit every day" (p = 0.001), and "fresh or cooked vegetables regularly once a day" (p = 0.018) in relation to meeting all three 24-h movement recommendation status.    Conclusions: This study provides further evidence of the potential importance of meeting all three 24-h movement recommendations to adopt a healthier eating pattern. What is Known: • Only a limited number of studies have investigated the joint connection between the 24-h movement recommendations and dietary habits. • Integrating the 24-h movement recommendations with dietary recommendations could potentially yield greater effectiveness compared to promoting these recommendations independently within public health strategies. What is New: • This is the first study in assessing the relationship between 24-h movement recommendations and adherence to the Mediterranean diet in early childhood. • These findings provide further evidence of the potential importance of meeting all three 24-h movement recommendations to adopt a healthier eating pattern.

Secular trends in the prevalence of meeting 24-hour movement guidelines among U.S. adolescents: evidence from NHANES 2007-2016

Background

The 24-Hour Movement Guidelines (24-HMG) recommend a balanced combination of physical activity (PA), sedentary behavior (SB) and sleep (SLP) for optimal health. However, there is limited understanding of how well U.S. adolescents adhere to these guidelines. This study aims to analyze the prevalence trends of meeting the 24-HMG among a nationally representative sample of U.S. general adolescents.

Methods

The study included 2,273 adolescents (55.3% boys) aged 16-19 who participated in the National Health and Nutrition Examination Surveys (NHANES) from 2007 to 2016. The researchers categorized the adolescents based on whether they met various PA, SB, and SLP recommendations, as well as different combinations of these recommendations, separately for boys and girls. The prevalence rate, weighted by survey data, was calculated along with a 95% confidence interval (CI) to assess the changes in meeting the 24-HMG among U.S. adolescents across different survey years and sociodemographic subgroups.

Results

In the 2015-2016 cycle, approximately 6.3% of adolescents did not meet any of the three recommendations, while only 19.2% of adolescents achieved all three guidelines. Compliance with PA and SB recommendations among adolescents has decreased over time, from 72.5% (65.9% to 79.2%) to 64.2% (57.4% to 70.9%) for PA, and from 59.0% (49.6% to 68.4%) to 46.6% (37.8% to 55.5%) for SB, respectively, from 2007-2008 cycle to 2015-2016 cycle. Boys exhibited more favorable patterns in meeting different sets of recommendations compared to girls (p-value <0.001). This includes meeting both PA and SB guidelines (15.5% for boys and 11.1% for girls) and meeting both PA and SLP guidelines (19.5% for boys and 15.7% for girls). The level of parental education was found to have effect on meeting all three guidelines (Ptrend < 0.05).

Conclusion

We analyzed ten consecutive years of representative NHANES data to evaluate the prevalence meeting 24-HMG and found that the proportion of adolescents aged 16-19 in the U.S. who adhered to all three movement guidelines simultaneously has consistently remained low throughout each survey cycle. Notably, there has been a significant decline in the proportion of adolescents meeting the SB guideline.

The role of individual and contextual economic factors in obesity among adolescents: A cross-sectional study including 143 160 participants from 41 countries

Background

To our knowledge, no previous study has examined the role of index of economic freedom (IEF) in the prevalence of excess weight and obesity in adolescents. The aim of this study was to determine the association between both individual and contextual economic factors and the prevalence of overweight and obesity (i.e. excess weight) or obesity in adolescents from different countries.

Methods

A cross-sectional study was carried out using data from the 2017/2018 wave of the Health Behaviour School-Aged Children study. Body mass index z-score was determined following the International Obesity Task Force criteria and, subsequently, excess weight and obesity were computed. The Family Affluence Scale was used to assess socioeconomic status. The index of IEF was used to estimate the benefits of economic freedom, both for individuals and for society as a whole.

Results

An inverse association was shown between socioeconomic status (SES) and excess weight or obesity, with adolescents with high SES and medium SES being less likely to have excess weight compared to adolescents with low SES (medium SES: odds ratio (OR) = 0.79; 95% confidence interval (CI) = 0.77-0.82, P < 0.001; high SES: OR = 0.65; 95% CI = 0.62-0.68, P < 0.001). For obesity, lower odds were also found for adolescents with medium SES (medium SES: OR = 0.74; 95% CI = 0.69-0.80, P < 0.001) or high SES (high SES: OR = 0.55; 95% CI 0.49-0.61, P < 0.001), in comparison with their counterparts with low SES. On the other hand, it was observed a greater likelihood of having excess weight and obesity in mostly unfree countries (excess weight: OR = 0.72; 95% CI = 0.51-1.00, P = 0.052; obesity: OR = 0.60; 95% CI = 0.39-0.92, P = 0.019) compared to free/mostly free countries. These results remained significant after adjusting for several sociodemographic and lifestyle covariates.

Conclusions

Both individual and contextual factors seem to have a crucial role in the prevalence of excess weight and obesity in adolescents.

Environmental tobacco smoke exposure and 24-h movement guidelines in Spanish young people

Background

No prior research has investigated how exposure to environmental tobacco smoke is related to the combination of 24-h movement behaviors among young populations thus far. The aim of this study was to examine the associations between exposure to secondhand smoke and the 24-h movement guidelines.

Methods

This is a cross-sectional study using data from the last available wave of the Spanish National Health Survey [2017], a nationally representative survey of the Spanish children and adult population. The final sample included 4,378 (49.0% girls) Spanish young people aged 2-14 years.

Results

A lower likelikood of meeting screen time (ST) and all three 24-h movement guidelines were found in those exposed to environmental tobacco smoke in unadjusted models. After adjusting for several covariates, meeting screen time [odds ratio (OR) =0.76; 95% confidence interval (CI), 0.59-0.97], sleep duration (OR =0.75; 95% CI, 0.58-0.96), and all three 24-h movement guidelines (OR =0.63; 95% CI, 0.44-0.91) reached significance after adjusting for potential confounders.

Conclusions

Given the inverse associations found, environmental tobacco smoke exposure should be a relevant factor to consider when promoting 24-h behaviors in the young population. Avoiding exposure to tobacco smoke in the environment is essential, as it can potentially influence the 24-h movement behaviors of young people, and consequently, the health benefits associated with such behaviors.

Mediterranean Diet-Based Interventions to Improve Anthropometric and Obesity Indicators in Children and Adolescents: A Systematic Review with Meta-Analysis of Randomized Controlled Trials

To our knowledge, no systematic review with meta-analysis has separately synthesized the effects of Mediterranean diet-based interventions in children and adolescents in relation to the effects on anthropometric measures. A better understanding of the effects of Mediterranean diet-based interventions on anthropometric variables could facilitate their implementation in efforts to prevent obesity in the young population. The aim of the present meta-analysis was to evaluate the effects of Mediterranean diet-based interventions on anthropometric and obesity indicators among children and adolescents. Four databases were systematically searched (PubMed, Scopus, Web of Science, and Cochrane Database of Systematic Reviews), including all studies up until 15 March, 2023. Eligible articles were randomized controlled trials measuring the effect of an intervention based on the promotion of the Mediterranean diet and obesity-associated parameters. The effect size of each study was estimated by Cohen's d for continuous variables or risk difference for categorical variables. Compared to the control group, the Mediterranean diet-based interventions showed small and significant reductions in body mass index (d = -0.14; 95% CI: -0.26, -0.01; I2 = 77.52%). Participants in the Mediterranean diet-based interventions had a significant reduction in the percentage of obesity (risk difference = 0.12; 95% CI: 0.01, 0.23; I2 = 84.56%) in comparison with the control group. Interventions had greater effects when aiming at participants with excess weight (that is, overweight or obesity), both for body mass index, waist circumference, waist-to-height ratio, percentage of obesity, and percentage of abdominal obesity. Mediterranean diet-based interventions have a significant effect on reducing the body mass index as well as reducing obesity in children and adolescents (aged 3-18 y). This trial was registered at PROSPERO as CRD42023386789.

Toward an Integrated Consideration of 24 h Movement Guidelines and Nutritional Recommendations

While physical activity, sleep and sedentary behaviors are almost always considered independently, they should be considered as integrated human behaviors. The 24 h Movement approach proposes a concomitant consideration of these behaviors to promote overall health. Not only do these behaviors impact energy expenditure, but they have also been shown to separately impact energy intake, which should be further explored when considering the entire integration of these movement behaviors under the 24 h movement approach. After an evaluation of the prevalence of meeting the 24 h Movement and dietary recommendations, this review summarizes the available evidence (using English publications indexed in PubMed/MEDLINE) regarding the association between the 24 h Movement Guidelines and eating habits. Altogether, the results clearly show the beneficial impact of promoting the 24 h guidelines simultaneously, highlighting that the higher the number of respected movement recommendations, the better eating behaviors in both children and adults. Importantly, our results point out the importance of emphasizing the need to reach sedentary guidelines for better eating habits. Movement and dietary behaviors appear closely related, and giving recommendations on one might impact the other. Combining the 24 h Movement with dietary Guidelines might be more efficient than promoting them separately in public health strategies.