24-Hour Movement Behaviors and Internalizing and Externalizing Behaviors Among Youth

Recent trends and disparities in 24-hour movement behaviors among US youth with mental, behavioral and neurodevelopmental conditions

BACKGROUND

Meeting 24-h movement behaviors (24-HMB: physical activity [PA], screen time [ST], and sleep [SL]) recommendations may be associated with positive health outcomes among youth with specific mental, behavioral, and neurodevelopmental (MBD) conditions. However, temporal trends and disparities in meeting 24-HMB guidelines in these higher-risk groups have not been investigated, hampering the development of evidence-based clinical and public health interventions.

METHODS

Serial, cross-sectional analyses of nationally National Survey of Children's Health (NSCH) data (including U.S. youth aged 6-17 years with MBD conditions) were conducted. The time-trends survey data was conducted between 2016 and 2021. The prevalence of 24-HMB adherence estimates were reported for the overall sample and for various sociodemographic subgroups. The subgroups analyzed included: age group (children[aged 6 to 13 years], adolescents[aged 14 to 17 years]), sex, socioeconomic status, and ethnicity.

RESULTS

Data on 52,634 individuals (mean age, 12.0 years [SD,3.5]; 28,829 [58.0 %] boys) were analyzed. From 2016 to 2021 the estimated trend in meeting PA + ST + SL guidelines declined (-0.8 % [95%CI, -1.0 % to -0.5 %], P for trend <0.001), whereas meeting none of 24-HMB guidelines increased (2.2 % [1.8 % to 2.6 %], P for trend <0.001). White participants, children, and boys reported higher estimated prevalence of meeting full integrated (PA + ST + SL) guidelines.

DISCUSSION

The temporal trends observed in this study highlight the importance of consistently monitoring movement behavior among MBD youth and identifying variations by sociodemographic groups in meeting 24-HMB guidelines for health promotion within these vulnerable groups.

Compliance with the 24-hour movement behaviour guidelines among children and adolescents with disabilities: a systematic review and meta-analysis

BACKGROUND

Compliance with the 24-Hour Movement Guidelines (24-HMG: physical activity (PA), screen time (ST), and sleep) has been associated with numerous beneficial health outcomes among children and adolescents. However, there is a lack of consensus on the overall compliance with the 24-HMG specifically among children and adolescents with disabilities. Therefore, this systematic review and meta-analysis aimed to examine the extent to which children and adolescents with disabilities adhere to the 24-HMG globally.

METHOD

Quantitative studies published in English until May 2023 were sought by searching seven electronic databases: Web of Science, PubMed, SPORTDiscus, CINAHL, MEDLINE, Scopus, Psychology and Behavioural Sciences Collection. This review included studies that identified participants as individuals with disabilities and reported the overall (non) compliance with the 24-HMG among children and adolescents with disabilities.

RESULTS

A total of 13 studies, involving 21,101 individuals (65.95% males), aged 6 to 21 years from 9 countries, were included in the analysis. In general, 7% (95%CI: 0.05-0.09, p < 0.01) of children and adolescents with disabilities met all three 24-HMG, while 16% (95%CI: 0.13-020, p < 0.01) did not meet any of the three recommendations. Regarding adherence to individual 24-hour movement behaviour, the rates of compliance were 22% (95%CI: 0.18-0.25, p < 0.01) for PA, 49% (95%CI: 0.41-0.56, p < 0.01) for ST, and 59% (95%CI: 0.56-0.61, p < 0.01) sleep. In relation to numbers of those meeting the 24-HMG, 43% (95%CI: 0.41-0.45, p < 0.01) met one guideline, while 32% (95%CI: 0.28-0.36, p < 0.01) met two guidelines.

CONCLUSION

There is a notable percentage of children and adolescents with disabilities who do not meet the recommended the 24-HMG, which encompasses PA, ST, and sleep. This underscores the pressing requirement to create and execute evidence-based strategies that effectively encourage and assist these individuals with disabilities in adopting and maintaining these movement behaviours.

Associations of 24-hour movement guidelines adherence with fruit and vegetable intake in university students

Background

Unhealthy eating habits, such as low vegetable and fruit intake, are associated with many health problems. 24-h movement behaviors have been reported to be positively associated with numerous health-related outcomes. Despite the importance of these two modifiable lifestyle behaviors in building healthy habits in university students, there is a paucity of relevant research in this population. Therefore, this study aims to examine the correlation between compliance with 24-h movement guideline (24-h MG) and intake of fruits and vegetables (IFV) in Chinese university students.

Methods

This study investigated the relationship between the compliance with 24-h MG and IFV in 1,793 Chinese university students using a convenience sampling method online. Physical activity (PA) and sedentary behavior (SB) were assessed by the International Physical Activity Questionnaire-Short Form, while sleep was measured using the Pittsburgh Sleep Quality Index. The Chinese version of the Health Promoting Lifestyle Profile II was used to measure IFV. Generalized linear models were applied to examine the correlation between compliance with the 24-h MG and eating habits.

Results

The proportion of participants who routinely consumed vegetables and fruits was 24.6% and 43.1%, respectively, while the proportion of meeting the three 24-h MG and a combination of any two guidelines was 27.8% and 40.1%, respectively. Meeting all three guidelines was associated with a greater IFV intake compared to not meeting either guideline. Meeting all three guidelines (OR = 2.42 [1.63, 3.58]) and the combination of moderate to vigorous PA (MVPA) and sleep (OR = 2.06 [1.37, 3.10]) were positively associated with the frequency of vegetable consumption (p < 0.05). As well, meeting all three guidelines (OR = 2.06 [1.37, 3.10]), the combination of MVPA and sleep (OR = 1.72 [1.04, 2.84]), and sleep only (OR = 1.88 [1.21, 2.92]) were positively associated with fruits consumption (p < 0.05).

Conclusion

Almost a third of the university students met the three 24-h MG, and compliance with all three guidelines was associated with a higher frequency of IFV. Furthermore, meeting the sleep guideline alone or in conjunction with the PA, and meeting the entire 24-h MG was associated with greater consumption of fruits.

Associations of 24-hour movement behaviors with emotional and behavioral problems among Chinese adolescents

PURPOSE

The role of adherence to the recommendations for 24-hour movement behaviors (24-HMB), including physical activity (PA), screen time (ST), and sleep duration (SLP), in relation to emotional and behavioral problems in Chinese adolescents remains uncertain. This study aimed to investigate these associations and explore potential sex differences.

METHODS

This school-based cross-sectional study included 15,071 Chinese adolescents with a mean age of 14.53 (SD: 1.65) years. Data on emotional and behavioral problems and 24-HMB (including PA, ST, and SLP) were collected. Analysis was performed using general linear mixed models, with additional sex-stratified analyses conducted.

RESULTS

The number of 24-HMB recommendations met was negatively associated with total difficulties (β estimate=-0.96, 95% CI: -1.07 to -0.85) and positively related to prosocial behavior (β estimate = 0.41, 95% CI: 0.37 to 0.46) among adolescents. Compared with none of the recommendations met, meeting all recommendations (total difficulties: β estimate=-2.98, 95% CI: -3.41 to -2.55; prosocial behaviors: β estimate = 1.05, 95%CI: 0.87 to 1.24) demonstrated the strongest association with both difficulties and prosocial behaviors, followed by meeting recommendations for PA + ST (total difficulties: β estimate=-2.15, 95% CI: -2.41 to -1.90; prosocial behaviors: β estimate = 0.98, 95% CI: 0.87 to 1.09). These associations were consistently significant in both boys and girls.

CONCLUSION

Adherence to more 24-HMB recommendations, particularly meeting all recommendations or combined PA + ST recommendations, could improve emotional and behavioral well-being among adolescent girls and boys. The significance of balanced movement behaviors for promoting adolescent mental health merits increased attention.

School-aged children's movement behaviours and subjective health complaints in Japan: a cross-sectional study during COVID-19 pandemic-related school closures and after school reopenings

BACKGROUND

Social restrictions associated with the COVID-19 pandemic have altered children's movement behaviours and impacted their mental health. However, the influence of social restrictions on subjective health complaints remains inadequately understood. This study compared adherence to 24-hour movement behaviour guidelines and the prevalence of subjective health complaints during school closure and one year after reopening. We also examined how combinations of adherence to movement behaviour recommendations relate to subjective health complaints.

METHODS

A repeated cross-sectional survey was conducted at two points. The first survey in May 2020 included 1535 (766 boys and 769 girls) participants during school closures, while the second survey from May to July 2021 involved 1125 (583 boys and 542 girls) participants one year after school reopening. The questionnaire covered socio-demographics, physical activity, screen time, sleep, and subjective health complaints. Differences between periods were analysed using chi-square tests. Logistic regression models assessed the association between adherence to guidelines and subjective health complaints.

RESULTS

During school closure, children were more likely to meet 'only sleep' recommendations and have irritability and lethargy symptoms. Irrespective of sex, those adhering to two or all three recommendations (excluding physical activity and screen time) had a lower risk of symptoms related to physical and mental pain, fatigue, irritability, and lethargy as compared to those who met none of the recommendations.

CONCLUSIONS

Children should meet at least one physical activity or screen time recommendation in addition to sleep recommendations for subjective health. Strategies considering the priority of each movement behaviour are crucial, even during abnormal situations, such as pandemic-related social restrictions. This study offers insightful findings concerning children's mental health issues during unprecedented and massive disasters or crises.

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.

Longitudinal associations of screen time, physical activity, and sleep duration with body mass index in U.S. youth

BACKGROUND

Youth use different forms of screen time (e.g., streaming, gaming) that may be related to body mass index (BMI). Screen time is non-independent from other behaviors, including physical activity and sleep duration. Statistical approaches such as isotemporal substitution or compositional data analysis (CoDA) can model associations between these non-independent behaviors and health outcomes. Few studies have examined different types of screen time, physical activity, and sleep duration simultaneously in relation to BMI.

METHODS

Data were baseline (2017-2018) and one-year follow-up (2018-2019) from the Adolescent Brain Cognitive Development Study, a multi-site study of a nationally representative sample of U.S. youth (N = 10,544, mean [SE] baseline age = 9.9 [0.03] years, 48.9% female, 45.4% non-White). Participants reported daily minutes of screen time (streaming, gaming, socializing), physical activity, and sleep. Sex-stratified models estimated the association between baseline behaviors and follow-up BMI z-score, controlling for demographic characteristics, internalizing symptoms, and BMI z-score at baseline.

RESULTS

In females, isotemporal substitution models estimated that replacing 30 min of socializing (β [95% CI] = -0.03 [-0.05, -0.002]), streaming (-0.03 [-0.05, -0.01]), or gaming (-0.03 [-0.06, -0.01]) with 30 min of physical activity was associated with a lower follow-up BMI z-score. In males, replacing 30 min of socializing (-0.03 [-0.05, -0.01]), streaming (-0.02 [-0.03, -0.01]), or gaming (-0.02 [-0.03, -0.01]) with 30 min of sleep was associated with a lower follow-up BMI z-score. In males, replacing 30 min of socializing with 30 min of gaming was associated with a lower follow-up BMI z-score (-0.01 [-0.03, -0.0001]). CoDA estimated that in males, a greater proportion of time spent in baseline socializing, relative to the remaining behaviors, was associated with a higher follow-up BMI z-score (0.05 [0.02, 0.08]). In females, no associations between screen time and BMI were observed using CoDA.

CONCLUSIONS

One-year longitudinal associations between screen time and BMI may depend on form of screen time, what behavior it replaces (physical activity or sleep), and participant sex. The alternative statistical approaches yielded somewhat different results. Experimental manipulation of screen time and investigation of biopsychosocial mechanisms underlying the observed sex differences will allow for causal inference and can inform interventions.

Examining the relationship between meeting 24-hour movement behaviour guidelines and mental health in Chinese preschool children

Background

Limited research has explored the relationship between adhering to 24-h Movement Behaviour guidelines and mental health in Chinese preschool children. The objectives of this study encompassed two primary goals: (1) to investigate the adherence of preschool children in China to the 24-h Movement Behaviour guidelines; and (2) to analyze the relationship between fulfilling various combinations of these guidelines and mental health, identifying the most advantageous combination.

Methods

Utilizing a convenience sampling approach, this study included 205 preschool children (117 boys and 88 girls, average age 4.8 ± 0.51 years) from five kindergartens in Hengyang, Hunan Province. The physical activity (PA) and sedentary behaviour of preschool children were objectively assessed using waist-worn accelerometers, while sleep duration and screen time were reported by the children's parents. To evaluate mental health, the parent version of the internationally validated Strength and Difficulties Questionnaire (SDQ) was employed, which measures externalizing problems, internalizing problems, and prosocial behaviour. Employing Mplus 8.0 for Structural Equation Modeling analysis, while controlling for demographic variables, the study explored the connection between preschool children's mental health and their adherence to the 24-h Movement Behaviour guidelines.

Results

Worryingly, merely 14.6% of preschoolers met the recommended guidelines for all three aspects (PA, sleep duration, and screen time). Positive correlations were identified between meeting PA guidelines and displaying prosocial behaviour (β = 0.184; p < 0.05), while screen time adherence exhibited a negative correlation with externalizing problems (β = -0.207; p < 0.05). Similarly, there was a negative association between sleep duration adherence and externalizing problems (β = -0.191; p < 0.05). Meeting all three recommended guidelines was notably linked to enhanced prosocial behaviour (β = 0.464; p < 0.05), while following the screen time and sleep duration guidelines was negatively associated with externalizing problems (β = -0.246; p < 0.05).

Conclusion

This study underscores the limited adherence of Chinese preschoolers to the comprehensive 24-h Movement Behaviour guidelines. Noteworthy findings include the positive influence of PA on prosocial behaviour, alongside the significant roles that sleep duration and screen time play in mitigating externalizing problems within this age group. Alignment with the 24-h Movement Behaviour guidelines is associated with more favorable mental health indicators in preschoolers.

Adherence to 24-hour movement guidelines and their association with depressive symptoms in adolescents: Evidence from Bangladesh

Healthy movement behaviours are associated with various physical and mental wellbeing; however, little is known about such associations in low- and middle-income countries. The aim of this study was to examine adherence to 24-hour (h) movement guidelines and their relationship with depressive symptoms in adolescents. Data were from 312 Bangladeshi adolescents aged 13-17 years (42% female). Meeting the guidelines was defined as: energy expenditure for physical activity (PA) ​≥ ​1 680 Metabolic Equivalent of Task (MET)-min/week, ≤ 2 ​h/day of recreational screen time (ST), and 8-10 ​h/night of sleep. Depressive symptoms were assessed using the 10-item Center for Epidemiological Studies Depression Scale (CESD-10) with a score of 10 or more indicating high depressive symptoms. Percentage of adolescents meeting the three recommendations was 2.2%, with 17.6% meeting two, and 31.2% meeting one recommendation. Generalized estimating equations showed that odds of having high depressive symptoms was a third (odds ratio [OR] ​= ​0.35, 95% confidence interval [CI], 0.19-0.57) for meeting the PA guidelines, and about a half (OR = 0.47, 95%CI, 0.18-0.87) for meeting the sleep guidelines. Odds of depressive symptoms reduced significantly for meeting PA and sleep (OR = 0.20, 95%CI, 0.09-0.59), or PA and ST (OR ​= ​0.24, 95%CI, 0.08-0.55) guidelines. About half of the adolescents did not meet any recommendations, which underscores the need for public health campaigns to promote adherence to the movement guidelines in this pediatric population. Further longitudinal research with larger sample size is recommended to explore the inter-relationships of these behaviours and their impact on health and wellbeing outcomes of adolescents in Bangladesh.

Examining the Bidirectional Associations Between Sleep Duration, Screen Time, and Internalizing Symptoms in the ABCD Study

PURPOSE

The likelihood of meeting sleep duration and screen time guidelines decreases as children develop toward adolescence. Simultaneously, the prevalence of internalizing symptoms increases. The purpose of this paper was to examine the bidirectional associations between sleep duration and screen time with internalizing symptoms in a one-year longitudinal study starting in late childhood.

METHODS

Participants were 10,828 youth (47.8% female) enrolled in the Adolescent Brain Cognitive Development Study. At baseline (mean age 9.9 years) and one-year follow-up (mean age 10.9 years), youth self-reported screen time for weekdays and weekend days. Responses were separately dichotomized as >2 versus ≤2 hours/day (meeting behavioral guidelines). Caregiver-reported youth sleep duration was dichotomized as <9 versus 9-11 hours/night (meeting behavioral guidelines). Caregivers reported internalizing symptoms via the child behavior checklist. The withdrawn/depressed, anxious/depressed, and somatic symptom child behavior checklist subscale t-scores were separately dichotomized as ≥65 (borderline clinical levels of symptoms and above) versus <65. Analyses were gender-stratified.

RESULTS

In females, longer baseline sleep duration was protective against withdrawn/depressed symptoms (odds ratio [OR] 0.6, 95% confidence interval [CI] 0.4-0.8) and somatic complaints (OR 0.8, 95% CI 0.6-0.97) one year later. In females, greater baseline weekend screen time was associated with increased risk of withdrawn/depressed symptoms (OR 1.6, 95% CI 1.1-2.2) one year later. No other significant associations were observed.

DISCUSSION

Longitudinal associations between sleep duration, weekend screen time, and internalizing symptoms were unidirectional (behavior preceding internalizing symptoms), among females only, and specific to withdrawn/depressed and somatic symptoms. These prospective study findings warrant attention and inform future research in this cohort.

Associations of 24-hour movement behaviors with externalizing and internalizing problems among children and adolescents prescribed with eyeglasses/contact lenses

Background

Emerging evidence points towards the psychological benefits of meeting 24-hour movement behavior (24-HMB) guidelines, but such associations have not yet been investigated among children and adolescents of prescribed eyeglasses/contact lenses. To this end, we examined associations of meeting 24-HMB guidelines with internalizing and externalizing challenges in this population.

Methods

We used data from the 2021 National Survey of Children's Health, a cross-sectional survey including a representative sample of US children and adolescents. Data on movement behaviors (physical activity [PA], sedentary behavior operationalized via screen time [ST], and sleep duration [SL]) and internalizing and externalizing problems were collected through caregiver proxy reports. Caregivers completed questionnaires for 6030 (2799 girls) US children and adolescents of prescribed eyeglasses/contact lenses. Logistic regression analyses were conducted to determine the above-presented associations.

Results

Only 7.1 % of those prescribed eyeglasses/contact lenses met all three 24-HMB guidelines, while they were more likely to meet SL guideline alone (32.1 %) in relation to other independent guidelines including PA (2.5 %) and ST (10.9 %). Compared to not meeting any of the three 24-HMB guidelines, meeting at least two guidelines (25.22 %) was significantly linked to lower odds of internalizing problems and externalizing problems.

Conclusion

Meeting at least two components of the 24-HMB guidelines was beneficially linked to internalizing and externalizing problems. Thus, strategies or intervention programs that focus on meeting 24-HMB guidelines should be implemented among children and adolescents of those prescribed eyeglasses/contact lenses to foster coping with psychological issues.

Associations between anxiety disorders and depression symptoms are related to 24-hour movement behaviors among Brazilian adolescents

BACKGROUND

We tested whether 24-hour movement behaviors modified the effect of the association between anxiety and depression symptoms among adolescents.

METHODS

This cross-sectional study included 4141 adolescents aged 15 to 19 years (50.0 % females) across all Brazilian geographic regions. Using self-reported data, 4.4 % (n = 180) reported having been diagnosed with anxiety disorders. We used the Patient Health Questionnaire (PHQ-9) to evaluate depressive symptoms. Accruing moderate-vigorous physical activity during leisure time, <3 h/day of recreational screen, and good sleep quality were the exposures investigated. We evaluated interactions between anxiety and movement behaviors in the association with depression symptoms adjusted by covariates.

RESULTS

Adolescents diagnosed with anxiety who met two (B: -4.93; 95%CI: -6.43; -3.44) or three (B: -5.71; 95%CI: -7.85; -3.57) movement behavior targets, and adolescents without diagnosis of anxiety who met one (B: -6.97; 95%CI: -8.15; -5.79), two (B: -8.21; 95%CI: -9.38; -7.03), or three (B: -8.46; 95%CI: -9.66; -7.27) of the movement behavior targets had lower PHQ-9 scores for depression symptoms than adolescents with anxiety who did not meet any of the movement behaviors. There was a significant interaction (B: -1.89; 95%CI: -3.24; -0.55) between anxiety disorders status and meeting the movement behavior targets.

LIMITATIONS

The cross-sectional design is a limitation.

CONCLUSIONS

Variations in meeting movement behaviors modified the effect of the association between anxiety disorders status and depressive symptoms, with favourable modifications seen in adolescents without anxiety who met one, two or three of the movement behavior targets and in adolescents with anxiety who met two or three of the behaviors.

Bidirectional associations of physical activity, sleep, and self-reported mental health in young adults participating in an online wellness intervention during the COVID-19 pandemic

Purpose

The purpose of this study was to examine the bidirectional associations of physical activity (PA), sleep, and mental health in young adults participating in an online wellness intervention from October 2021 to April 2022.

Methods

Participants were a sample of undergraduate students from one US university (N = 89; 28.0% freshman; 73.0% female). The intervention was a 1-h health coaching session that was delivered either once or twice by peer health coaches on Zoom during COVID-19. The number of coaching sessions was determined by random allocation of participants to experimental groups. Lifestyle and mental health assessments were collected at two separate assessment timepoints after each session. PA was assessed using the International Physical Activity Questionnaire-Short Form. Weekday and weekend sleep were assessed by two one-item questionnaires and mental health was calculated from five items. Cross-lagged panel models (CLPMs) examined the crude bidirectional associations of PA, sleep, and mental health across four-time waves (i.e., T1 through T4). To control for individual unit effects and time-invariant covariates, linear dynamic panel-data estimation using maximum likelihood and structural equation modeling (ML-SEM) was also employed.

Results

ML-SEMs showed that mental health predicted future weekday sleep (β = 0.46, p < 0.001) and weekend sleep predicted future mental health (β = 0.11, p = 0.028). Although CLPMs showed significant associations between T2 PA and T3 mental health (β = 0.27, p = 0.002), no associations were observed when unit effects and time-invariant covariates were accounted for.

Conclusion

Self-reported mental health was a positive predictor of weekday sleep and weekend sleep positively predicted mental health during the online wellness intervention.

Cross-sectional and longitudinal associations of adherence to the 24-hour movement guidelines with mental health problems among Chinese adolescents

OBJECTIVE

This study aimed to examine the cross-sectional and longitudinal associations between meeting the 24-Hour Movement Guidelines (recommendations for the optimal amount of moderate-to-vigorous physical activity, screen time, and sleep duration per day) and mental health problems among Chinese adolescents.

METHODS

A two-wave longitudinal survey was conducted in Huizhou, Guangdong province. A total of 906 junior high school students were recruited in the six-month follow-up survey. Moderate-to-vigorous physical activity, screen time, sleep duration, anxiety symptoms (GAD-7 score), and depressive symptoms (PHQ-9 score) were measured using a self-administered questionnaire. At baseline, participants were classified as meeting: 1) no recommendation, 2) one recommendation, 3) two recommendations, or 4) all three recommendations.

RESULTS

Overall, the proportions of adolescents meeting moderate-to-vigorous physical activity, screen time, and sleep recommendations at T₁ were 33.3%, 68.2%, and 64.7%, respectively. Cross-sectionally, the severity of anxiety and depressive symptoms at T₁ significantly decreased as the number of recommendations met increased (adjusted regression coefficients [95% CI] for three recommendations met versus none: -2.80 [-4.05, -1.55] and - 3.42 [-4.85, -1.99], respectively). Longitudinally, adolescents who met three recommendations at T₁ displayed lower anxiety and depressive symptoms six months later than those who did not (adjusted regression coefficients [95% CI]: -1.00 [-1.98, -0.02] and - 1.43 [-2.53, -0.32], respectively). Furthermore, meeting three recommendations was associated with the alleviation of depressive symptoms (adjusted OR [95% CI]: 0.39 [0.17, 0.90]).

CONCLUSIONS

Promoting adolescents to adhere to the 24-Hour Movement Guidelines could be considered an intervention target for mental health problems at a population level.

24-hour movement guideline adherence and mental health: A cross-sectional study of emerging adults with chronic health conditions and disabilities

BACKGROUND

Recent work has shown that individuals with chronic health conditions and disabilities (CCD) meet the 24-h movement guidelines at lower rates than population norms; however, the evidence base remains limited across different stages of the lifespan and very few studies have examined associations with mental health outcomes.

OBJECTIVE

This study examined 24-h movement guideline adherence among emerging adults with CCD compared to those without and associations between guideline adherence and indicators of mental health.

METHODS

This cross-sectional study used data from the 2020 cycle of the Canadian Campus Wellbeing Survey. A total of 17,874 emerging adults enrolled at 20 post-secondary institutions (mean age = 21.6 ± 2.94 years; 65.2% female), including 3336 who identified with a CCD, self-reported their movement behaviors (physical activity, sedentary behaviors, sleep) and completed measures of psychological distress and mental well-being. Logistic regressions models were computed to examine differences in guideline adherence. Propensity score weighted linear regression models were computed to examine associations between guideline adherence and indicators of mental health.

RESULTS

Emerging adults with CCD had significantly lower odds of meeting the 24-h movement guidelines than their peers, and disparities in guideline adherence were most pronounced among those with multimorbidity, developmental, and physical disabilities. Guideline adherence was associated with significantly more favorable scores for psychological distress and mental well-being among those with and without CCD.

CONCLUSIONS

Findings suggest emerging adults with CCD engage in less healthy movement behavior patterns than their peers, yet they appear to experience similar mental health benefits when they do meet the 24-h movement guidelines.

Adherence to 24-Hour Movement Recommendations and Health Indicators in Early Adolescence: Cross-Sectional and Longitudinal Associations in the Adolescent Brain Cognitive Development Study

PURPOSE

Adherence to 24-hour movement guidelines of ≥60 minutes of physical activity, ≤2 hours of screen time, and 9-11 hours of sleep has been shown to benefit cognitive, physical, and psychosocial health in children and young adolescents aged 5-13 years. However, these findings have mostly been based on cross-sectional studies or relatively small samples and the associations between adherence to guidelines and brain structure remain to be evaluated.

METHODS

Data from the Adolescent Brain Cognitive Development℠ (ABCD) study of 10,574 early adolescents aged 9-14 years from September 2016 to January 2021 were used to examine whether adherence to 24-hour movement guidelines benefits cognition (general cognitive ability, executive function, and learning/memory assessed by the National Institutes of Health Toolbox neurocognitive battery), body mass index, psychosocial health (internalizing, externalizing, and total problems from the parent-reported Child Behavior Checklist), and magnetic resonance imaging-derived brain morphometric measures at baseline (T1), ∼2 years later (T2), and longitudinally from T1 to T2 (T2-T1). Multivariable linear mixed models were used, with adjustments for sociodemographic confounders. Time elapsed and T1 outcome measures were also controlled for in longitudinal models.

RESULTS

Better cognitive scores, fewer behavioral problems, lower adiposity levels, and greater gray matter volumes were observed in those who met both sleep and screen time recommendations compared to those who met none. Longitudinal follow-up further supports these findings; participants who met both recommendations at T1 and T2 evidenced better outcome measures than those who met none.

DISCUSSION

These findings support consideration of integrated rather than isolated movement recommendations across the day in early adolescence for better cognitive, physical and psychosocial health. Although the associations between physical activity and health indicators were less consistent in this study, the significant findings from sleep and screen time demonstrate the importance of considering movement recommendations in an integrated rather than isolated manner for adolescent health. It is recommended that movement behaviors be simultaneously targeted for better developmental outcomes.

Meeting the WHO 24-h guidelines among 2-6-year-old children by family socioeconomic status before and during the COVID-19 pandemic: a repeated cross-sectional study

Background

The World Health Organization (WHO) has developed guidelines for 24-h physical activity (PA), sedentary behaviour and sleep for young children. Lower socioeconomic status (SES) has been linked to a lower likelihood of meeting these guidelines. The outbreak of the novel coronavirus disease (COVID-19) raised concerns about young children's opportunities to meet the guidelines. The study focused on the prevalence of meeting the WHO's 24-h guidelines on screen time (ST), PA and sleep among 2-6-year-old children, in association with family SES, before COVID-19 outbreak in 2019, and during the pandemic in 2020 and 2021 in Finland.

Methods

Data were collected at three timepoints by an online survey through day-care centres. Meeting the WHO 24-h guidelines was defined for each behaviour, from a parent-reported seven-day recall of a typical day on weekdays and weekend days and adapted to the national context. Children were considered to meet the ST guideline if they had maximum of 60 min of ST, the PA guideline if they had minimum of 60 min of outdoor PA, and the sleep guidelines if they had minimum of 11/10/9 h (2/3-5/6 years) of good or very good quality sleep. Binary logistic regression models were used to examine the odds ratios of meeting the guidelines.

Results

The prevalence of meeting the ST guideline was highest before the COVID-19 pandemic in 2019. The PA guideline was most met during the strict pandemic restrictions in 2020. Children from higher SES families were more likely to meet the ST and sleep duration guidelines either on weekdays or weekends. The PA guideline was met more on weekdays by children whose parents had lower education levels at all timepoints. In 2020, sleep quality guideline was less likely met by children with parents with the highest education levels.

Conclusion

Higher SES may increase the odds of young children meeting the ST and sleep duration guidelines, but the results are more complex regarding PA and SES. The impact of the COVID-19 pandemic on ST, outdoor PA, and sleep of young children varied by family SES, and further research is recommended to identify causality of these relationships.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-022-00010-4.

Differential Associations Between Meeting 24-Hour Movement Guidelines With Mental Wellbeing and Mental Illness Among Chinese Adolescents

PURPOSE

Contemporary mental health models simultaneously consider psychological distress and wellness. Researchers have proposed that adhering to the 24-hour movement guidelines (24-HMG) contributes to mental health. 24-HMG integrates recommendations of time distribution among sleep, screen use, and moderate to vigorous physical activity (MVPA). Yet, there are few studies on the relationship between meeting 24-HMG and mental health, especially mental wellbeing. This study aimed to examine the associations between adherence to 24-HMG with mental wellbeing and mental illness among Chinese adolescents.

METHODS

Cross-sectional data of 67,281 Chinese adolescents aged 10-17 years (mean age = 13.0 years, 51.9% males) were collected by sending online questionnaires to local primary and middle schools in Shenzhen in 2021. We used multilevel generalized linear models to analyze associations between meeting 24-HMG with mental wellbeing (subjective wellbeing, resilience, and positive youth development) and mental illness (depression and anxiety).

RESULTS

Only 1.7% of participants met recommendations for all three behaviors (sleep, screen use, and MVPA). Compared with meeting none of the recommendations, participants who met one or more recommendations reported significantly better performance in mental wellbeing (all p < .001); on the contrary, meeting one or more recommendations (except for only meeting the MVPA recommendation) were significantly related to lower severity of mental illness (all p < .001). The relationship between the number of recommendations met with mental well-being and mental illness indicators presented a dose-response pattern (all p < .001).

DISCUSSION

Meeting 24-HMG was associated with superior mental health, including a higher propensity for mental wellbeing and a lower risk of mental illness. The importance of limiting screen time and getting enough sleep should be highlighted in promoting mental health in adolescents.

Prevalence of meeting 24-Hour Movement Guidelines from pre-school to adolescence: A systematic review and meta-analysis including 387,437 participants and 23 countries

BACKGROUND

Meeting the 24-Hour Movement Guidelines (physical activity, screen time, and sleep duration) has been associated with positive health indicators. However, there are no previous meta-analyses that have examined the overall adherence to the 24-Hour Movement Guidelines from pre-school to adolescence across the world. Therefore, the main purpose of this systematic review and meta-analysis was to examine the overall (non)adherence to the 24-Hour Movement Guidelines among preschoolers, children, and adolescents worldwide.

METHODS

Four electronic databases (MEDLINE, Scopus, Web of Science, and Cochrane Database of Systematic Reviews) were searched for quantitative studies published in Spanish and English between January 2016 and May 2021. Studies that were conducted with apparently healthy participants and reported the overall (non)adherence to the 24-Hour Movement Guidelines in preschoolers and/or children and/or adolescents were included.

RESULTS

Sixty-three studies comprising 387,437 individuals (51% girls) aged 3-18 years from 23 countries were included. Overall, 7.12% (95% confidence interval (95%CI): 6.45%-7.78%) of youth met all three 24-Hour Movement Guidelines, and 19.21% (95%CI: 16.73%-21.69%) met none of the 3 recommendations. Concerning sex, adherence to all recommendations was significantly lower in girls (3.75%, 95%CI: 3.23%-4.27%) than in boys (6.89%, 95%CI: 5.89%-7.89%) (p < 0.001). However, there were no sex differences regarding adherence to any of the 3 individual recommendations (girls, 15.66%, 95%CI: 8.40%-22.92%; boys, 12.95%, 95%CI: 6.57%-19.33%). In terms of age group, adherence to the 3 recommendations was 11.26% (95%CI: 8.68%-13.84%), 10.31% (95%CI: 7.49%-13.12%), and 2.68% (95%CI: 1.78%-3.58%) in preschoolers, children, and adolescents, respectively. Conversely, 8.81% (95%CI: 5.97%-11.64%) of preschoolers, 15.57% (95%CI: 11.60%-19.54%) of children, and 28.59% (95%CI: 22.42%-34.75%) of adolescents did not meet any of the recommendations. South America was the region with the lowest adherence (all: 2.93%; none: 31.72%). Overall adherence to the 24-Hour Movement Guidelines was positively related to country Human Development Index (β = -0.37, 95%CI: -0.65 to -0.09; p = 0.010).

CONCLUSION

Most young people fail to meet the three 24-Hour Movement Guidelines, particularly adolescents, girls, and those who are from countries with a lower Human Development Index. Moreover, 1 in 5 young people did not meet any of these recommendations. Therefore, these results highlight the need to develop age- and sex-specific strategies to promote these movement behaviors from the early stages of life.

The Association of Soft Drink Consumption and the 24-Hour Movement Guidelines with Suicidality among Adolescents of the United States

Background: Evidence is lacking for the association of the behaviors of the 24 h movement guidelines including sleep duration, physical activity, screen time, and soft drink consumption with suicidality among adolescents. Methods: Data were extracted from a national representative sample of Youth Risk Behavior Surveys (YRBS) in the United States from 2011 to 2019. Binary logistic regression models with complex sampling designs were used to explore the association of the recommendations of the 24 h movement guidelines and soft drink consumption with suicidality. Results: The total prevalence of suicidal ideation, suicide plan, suicide attempt, and suicide attempt with medical treatment was higher among adolescents who did not meet all the recommendations in the 24 h movement guidelines and had a higher level of soft drink consumption. Totally, not meeting all the recommendations of the 24 h movement guidelines was significantly associated with an increased risk of suicidal ideation (OR: 1.69, 95% CI: 1.30–2.19) and suicide plan (OR: 1.76, 95% CI: 1.34–2.33) compared with adolescents who meet all the recommendations. Soft drink consumption of ≥3 times/day was associated with an increased risk of suicidality including suicidal ideation, suicide plan, suicide attempt, and suicide attempt with medical treatment, regardless of sex. Soft drink consumption of ≥3 times/day was significantly associated with an increased risk of suicide attempt and suicide attempt with medical treatment, regardless of whether the recommendations of physical activity, screen time, and sleep duration were met. Conclusion: Age-appropriate sleep duration, no more than 2 h of screen time per day, at least 1 h of physical activity per day as contained in the 24 h movement guidelines and less than one soft drink consumption per day are good targets to prevent involvement in suicidality. More actions for intervening in the movement and dietary behaviors among adolescents are needed to maintain physical and mental health.

The Canadian 24-hour movement guidelines and self-rated physical and mental health among adolescents

OBJECTIVE

The Canadian 24-hour movement guidelines for children and youth recommend a minimum of 60 min/day of moderate-to-vigorous physical activity, no more than 2 h/day of recreational screen time, and 8-11 h/night of sleep depending on age. The objective of this study was to examine the associations of meeting combinations of these recommendations with self-rated physical and mental health.

METHODS

This study used data from the 2017 (n = 5739) and 2019 (n = 6960) cycles of the Ontario Student Drug Use and Health Survey (OSDUHS), a biennially repeated cross-sectional study of Ontario students in grades 7 through 12. Multivariable ordered logistic regression models were adjusted for age, gender, ethnoracial background, subjective socio-economic status, and body mass index z-scores.

RESULTS

Similar patterns were seen in the 2017 and 2019 samples. Compared with meeting none of the recommendations, meeting different combinations of recommendations in the 2019 sample was associated with positive self-rated physical and mental health. A dose-response gradient between the number of recommendations met and self-rated physical (p < 0.001) and mental (p < 0.001) health was observed, with meeting one (AOR: 1.82; 95% CI: 1.58-2.09), two (AOR: 3.54; 95% CI: 2.98-4.22), or three recommendations (AOR: 6.34; 95% CI: 4.46-9.02) being increasingly associated with positive self-rated physical health compared with meeting none; and meeting one (AOR: 1.51; 95% CI: 1.33-1.71), two (AOR: 2.70; 95% CI: 2.31-3.17), or three recommendations (AOR: 3.58; 95% CI: 2.57-4.98) being increasingly associated with positive self-rated mental health compared with meeting none.

CONCLUSION

Meeting the 24-hour movement guidelines is associated with better self-rated physical and mental health among adolescents.

Canadian 24-h Movement Guidelines, Life Stress, and Self-Esteem Among Adolescents

Background

Adolescence is often considered a period of heightened stress, and healthy active living behaviors may help those experiencing it to better cope with life stressors and increase their self-esteem. The 24-h movement guidelines for children and adolescents recommend ≥60 min per day of moderate-to-vigorous physical activity, ≤ 2-h per day of recreational screen time, and 9–11-h of sleep per night for school-aged children or 8–10-h per night for adolescents. The objective of this study was to examine the association of meeting the 24-h movement guidelines with life stress and self-esteem among students in Ontario, Canada.

Methods

Self-reported data on movement behaviors, life stress and self-esteem were derived from the 2019 cycle of the Ontario Student Drug Use and Health Survey, a cross-sectional and province-wide survey of students in grades 7–12 aged 11 to 20 years (N = 6,932). Multivariable ordered logistic regression analyses were adjusted for the complex sample design of the survey and for important covariates.

Results

Overall, meeting all combinations of movement behavior recommendations were associated with lower life stress and better self-esteem compared with meeting none of the recommendations, except meeting the physical activity only or screen time only recommendations that were not associated with lower life stress. Meeting all 3 recommendations was associated with lower life stress (OR: 0.40; 95 CI: 0.30–0.53) and better self-esteem (OR: 0.29; 95% CI: 0.21–0.40). There was a dose-response gradient between the number of recommendations met (3 > 2 > 1) and lower life stress (p < 0.001) and higher self-esteem (p < 0.001), with meeting all 3 recommendations being the best combination.

Conclusions

These findings suggest that meeting the recommendations of the 24-h movement guidelines is associated with lower life stress and better self-esteem among adolescents.

Meeting 24-h movement guidelines: prevalence, correlates and associations with socioemotional behavior in Spanish minors

The aims of this study were to determine for the first time the prevalence of a national sample of Spanish minors meeting the 24‐h movement guidelines; to determine their correlates; and to examine their associations with socioemotional behavioral problems. Cross‐sectional data from the Spanish National Health Survey (2017) were analyzed for this study. A total of 3772 Spanish minors were included. Physical activity was parent‐reported by a modified short version of the International Physical Activity Questionnaire, which included a single question related to the participation in physical activity in free time. Recreational screen time was parent‐reported by asking respondents for weekdays and weekends independently: “How much time does your child typically spend in front of a screen, including a computer, tablet, television, video, video game, or cell phone screen?”. Sleep duration was parent‐reported by the following question: “Can you tell me approximately how many hours your child usually sleeps daily?”. The Strengths and Difficulties Questionnaire was applied for the evaluation of socioemotional behavioral problems. The prevalence of meeting of all the three guidelines was 13.5%. Compared to meeting all guidelines, higher odds of socioemotional behavioral problems were found in participants meeting two guidelines (OR = 1.42; CI95%, 1.10–1.83), one guideline (OR = 1.50; 95%CI,1.14–1.96), or none of the guidelines (OR = 1.92; 95%CI,1.30–2.83). Our study demonstrated that the proportion of Spanish minors who meet with all the 24‐h movement guidelines is low. Furthermore, it could be relevant to the promotion of the 24‐h movement guidelines to prevent the risk of socioemotional behavioral problems.

Associations between mild depression and anxiety and physical inactivity among school-going Ugandan adolescents aged 14 to 17 years

Objective: The aim of this cross-sectional study was to investigate associations between physical activity levels and emotional and behavioural problems in school-going adolescents aged 14 to 17 years in Uganda.Methods: Two-hundred and five adolescents [median (interquartile range) age = 16.0 (1.0) years; female = 61.9%] completed the interviewer-administered Strengths and Difficulties Questionnaire (SDQ), Patient Health Questionnaire-9 (PHQ-9), the Generalised Anxiety Disorder-7 questionnaire (GAD-7), and the Physical Activity Vital Sign (PAVS) measure. Spearman's rho correlations and Mann-Whitney U-tests were applied.Results: Among 205 adolescents, 97.1% were physically inactive (PAVS < 420min/week), while 64.4% reported either mild depressive (PHQ-9 ≥ 5) or anxiety (GAD-7 ≥ 5) symptoms. Higher PAVS scores correlated significantly with lower SDQ emotional problems (ρ = -0.23, p < 0.001), lower PHQ-9 (ρ = -0.26, p < 0.001), and lower GAD-7 (ρ = -0.22, p < 0.001) scores. Those with emotional problems (SDQ ≥ 5) (n = 86) were significantly less physically active than those without (n = 119) [30.0 (62.5) versus 60.0 (105.0) min/week, p < 0.001]. Those with depressive symptoms (PHQ-9 ≥ 5) were significantly less physically active than those without [35.0 (70.0) versus 60.0 (120.0) min/week, p < 0.001].Conclusion: Physical inactivity and mental health problems are related important public health concerns in school-going adolescents in low-income countries such as Uganda. The efficacy and effectiveness of school-based mental health literacy programs, including physical activity promotion, should be explored in these low-resource settings.

Associations of 24-Hour Movement Behavior with Depressive Symptoms and Anxiety in Children: Cross-Sectional Findings from a Chinese Sample

This study examined the associations between adherence to 24-hour movement behavior guidelines (24-HMB) and the mental-health-related outcomes of depressive symptoms and anxiety in Chinese children. Data on movement behavior from 5357 children (4th and 5th grades), including physical activity, recreational screen time and sleep, were self-reported using the Health Behavior School-Aged Children Survey. Depressive symptoms and anxiety were self-reported using the Chinese version of the nine-item Patient Health Questionnaire and the Generalized Anxiety Disorder Scale, respectively. Depressive symptoms and anxiety were treated as categorical variables. Only 3.2% of the participants met physical activity, screen time, and sleep 24-HMB guidelines. Ordinal logistic regressions showed that, compared with participants who met the 24-HMB guidelines, participants who met none (odds ratio (OR) = 2.62, 95% CI: 1.76-3.90) or any one of the guidelines (OR = 1.88, 95% CI: 1.27-2.77) had higher odds of depressive symptoms. Similarly, there were higher odds of anxiety in participants who met none (OR = 2.32, 95% CI: 1.45-3.70) or any one of the recommendations (OR = 1.62, 95% CI: 1.03-2.57) compared with participants who met all the 24-HMB guidelines. Meeting the 24-HMB guidelines is associated with better mental-health-related outcomes in Chinese children. Because of the low prevalence of Chinese children meeting the 24-HMB recommendations, the present findings highlight the need to encourage children to regularly engage in physical activity, decrease their time spent sitting, and improve their sleep patterns.

Sleep as a Priority: 24-Hour Movement Guidelines and Mental Health of Chinese College Students during the COVID-19 Pandemic

Research on the combined role of 24-hour movement behaviors (sleep, sedentary behavior [SB], and physical activity) in adult mental health, though important, is in its infancy. In the context of Canadian 24-hour movement guidelines integrating quantitative recommendations for sleep, SB, and moderate-to-vigorous physical activity (MVPA), this study aimed to examine the associations between meeting guidelines and mental health among college students. The study used a cross-sectional sample of 1846 Chinese college students surveyed online in August 2020. Through network analysis and multivariate analysis of covariance, the individual and combined associations between meeting 24-hour movement guidelines and the levels of depression and anxiety after adjusting sociodemographic factors were analyzed. Results indicated that meeting the sleep guideline had stronger associations with depression and anxiety than meeting the SB or MVPA guideline. Specifically, compared to meeting no guidelines, meeting the sleep guideline (alone or in combination with other guidelines) was associated with significantly lower levels of depression and anxiety; meeting both SB and MVPA guidelines was also associated with a significantly lower level of depression. Hence, meeting more guidelines, especially adhering to a healthy sleep routine, may play an important role in promoting the mental health of young adults.