Meeting the Australian 24-Hour Movement Guidelines for the Early Years is associated with better social-emotional development in preschool boys

Impact of the Play Active policy intervention on early childhood educator's sedentary behaviour-related practices, psychosocial influences and meeting policy recommendations: Results from a pragmatic cluster randomized trial

BACKGROUND

High levels of sedentary behaviour are associated with poor child health outcomes such as obesity. Early childhood education and care (ECEC) services are a key intervention setting. Most ECEC policy-based interventions focus on children's nutrition and physical activity with few aimed at children's sedentary behaviour.

OBJECTIVE

To evaluate the effect of the Play Active ECEC policy intervention on educator adherence to sedentary behaviour policy recommendations, educator's practices and educator psychosocial influences related to children's sedentary behaviour.

METHODS

Pragmatic cluster randomized trial in 81 ECEC services in Perth, Western Australia. Services implemented the Play Active policy over three months. Outcomes were educator-reported changes in adherence to sedentary behaviour policy recommendations, practices and psychosocial influences related to children's sedentary behaviour. Analysis involved descriptive statistics and generalized linear mixed-effects models.

RESULTS

Adherence to sedentary behaviour policy recommendations and educator's practices and psychosocial influences related to children's sedentary behaviour was high at baseline and did not significantly change in response to the Play Active policy intervention.

CONCLUSIONS

Educators appeared to adhere to best-practice guidelines for children's sedentary behaviour in ECEC. Clear evidence informed policy, standards and legislation to maintain children's low levels of sedentary behaviours in ECEC is warranted.

Profile of the PLAY spaces & environments for children's physical activity, sedentary behaviour and sleep (PLAYCE) cohort study, Western Australia

BACKGROUND

Childhood is a critical period for the development of movement behaviours such as physical activity, sleep and sedentary behaviour. The PLAYCE Cohort was established to investigate how movement behaviours change over early to middle childhood, across key behaviour settings and relationships with health and development. An overview of the PLAYCE cohort, summary of key findings to date, and future research opportunities are presented.

METHODS

Children were recruited at 2-5 years of age (preschool; Wave 1) via early childhood education and care (ECEC) services and were followed up in junior primary school (5-7 years; Wave 2) at 8-10 years (Wave 3) and again at 11-13 years (Wave 4; in progress). Children's movement behaviours were measured via parent-report and accelerometry. Social-emotional development, motor development, weight status, diet, and child and family socio-demographics were parent-reported. Physical environmental features of children's key behaviour settings (home, neighbourhood, ECEC and school) were collected using geo-spatial and audit data.

RESULTS TO DATE

At wave 1 (2-5 years), only 8% of children met all three recommendations of the Australian 24-hour Movement Guidelines for the Early Years. Meeting all recommendations (8%) was positively associated with boys social-emotional development. Physical environment features of the home yard (size, play equipment, natural features) were positively associated with preschool children's physical activity. Tree canopy and more portable play equipment in ECEC outdoor areas was also positively associated with children's outdoor time and physical activity.

CONCLUSIONS

Wave 4 (11-13 years) data collection will be completed in early 2026. Traditional longitudinal and compositional data analysis of the PLAYCE cohort will be undertaken. Four waves of data will provide detailed patterns of movement behaviours and their effect on child health and development as well as the environmental influences on children's movement behaviours across early to middle childhood. The findings can be used to inform national and international 24-Hour Movement Guidelines and behaviour setting-specific as well as population-level interventions to benefit child health and wellbeing across early to middle childhood.

Effects of movement behaviors on preschoolers' cognition: a systematic review of randomized controlled trials

BACKGROUND

Movement behaviors, including physical activity (PA), sedentary behavior (SB), and sleep, are fundamental to early childhood development. These behaviors interact dynamically within a 24-hour period, creating a complex balance that influences not only physical health but also cognitive and emotional well-being in young children. While the physical health benefits of movement behaviors are well-documented, systematic evaluations of how interventions targeting these behaviors affect cognitive development in preschool-aged children remain limited.

METHODS

This review was guided through PRISMA 2020 guidelines. We conducted a systematic review of randomized controlled trials (RCTs) to evaluate the impact of interventions targeting PA, SB, and sleep on cognitive outcomes in preschool-aged children. A comprehensive search was performed across five databases: PubMed, PsycInfo, Web of Science, Embase, and CINAHL, covering studies published between January 2000 and December 2023. Eligible studies were those that focused on at least one movement behavior, had a minimum intervention duration of four weeks, and assessed cognitive development as a primary outcome. The cognitive outcomes evaluated included executive function, attention, memory, and other key domains critical to early childhood development, such as language, processing speed, and social cognition.

RESULTS

Twenty-two RCTs (14 individual, 8 cluster) met the inclusion criteria. Of these, 21 studies focused on PA, while only one targeted SB, and none specifically addressed sleep or combined movement behaviors. PA interventions, particularly those involving cognitively engaging activities, significantly improved cognitive domains such as executive function, inhibition, and attention, with effect sizes ranging from moderate to large (Cohen's d > 0.5). The SB-focused study did not report significant cognitive improvements. A clear gap exists in understanding the effects of sleep and multi-behavior interventions on cognitive outcomes.

CONCLUSIONS

Cognitively engaging PA interventions demonstrated the largest effects, while motor skill-focused and general PA programs produced moderate to smaller gains. Evidence on SB and sleep interventions remains limited, with no studies exploring the combined effects of these three movement behaviors. Future research should focus on integrated interventions that address PA, SB, and sleep to achieve a more comprehensive understanding of their collective impact on cognitive development in early childhood.

TRIAL REGISTRATION

This study was registered with PROSPERO under the registration number CRD42023479156.

Adherence to the 24-h Movement Behaviors Guidelines and Associations With Cognitive and Behavioral Self-Regulation Among Brazilian Preschoolers

BACKGROUND

Adherence to 24-h movement guidelines has been associated with early health benefits, including neurodevelopmental outcomes. However, the associations between these guidelines and Cognitive (CSR) and Behavioral (BSR) self-regulation in preschoolers are underexplored. This study investigated the associations between adherence to 24-h movement guidelines and CSR and BSR in Brazilian preschoolers.

METHODS

A total of 223 preschoolers (4.76 ± 0.32 years old; 50.67% boys) participated. Physical activity (PA) was assessed with Actigraph wGT3X. Parents reported children's sleep and screen time. CSR was evaluated through iPad games, and BSR was assessed using the Head, Toes, Knees, Shoulders test revised.

RESULTS

Boys showed higher adherence to the PA recommendation than girls (52.2% vs. 32.7%, χ2 = 0.003), whereas a higher percentage of girls did not adhere to any recommendations (23.6% vs. 12.4%, χ2 = 0.029). Positive association was found between adherence to combined PA and screen time with cognitive flexibility (β = 4.091 [95% CI: 0.699, 7.754]). Adherence to PA was associated with lower BSR scores (β = -7.104 [-13.52, -0.623]), as was adherence to combined PA and sleep duration (β = -8.813 [-15.794, -1.397]).

CONCLUSION

This study highlighted differences in adherence to movement behavior guidelines between boys and girls, as well as demonstrated that different combinations of these behaviors can affect preschoolers' cognitive and behavioral levels of self-regulation in distinct ways.

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.

24-H movement behaviours research in Chinese population: A scoping review

Background

Numerous studies examining 24-h movement behaviours have been exponentially published globally. However, no comprehensive reviews summarized and synthesized the evidence on the Chinese population. This review aimed to map the most recent research state and fill the gaps related to 24-h movement behaviours in the Chinese population.

Methods

Five electronic databases (Web of Science, PubMed, Scopus, EBSCOhost, and CNKI (Chinese database)) were searched from their inceptions through October 2023. Quantitative studies published in English and/or Chinese were included if they were related to 24-h movement behaviours in the Chinese population.

Results

From 9431 documents screened, 53 met the inclusion criteria. All the included studies were published between 2019 and 2023, showing a notable increasing trend over the years. Most studies used cross-sectional designs (96.2 %) and self-reported measures (56.6 %). Nearly all the studies targeted general healthy population (96.2 %), especially children and adolescents (64.2 %). The main three research topics observed were health outcomes (81.1 %), prevalence (66.0 %), and correlates (15.1 %) of 24-h movement behaviours.

Conclusion

24-h movement behaviours in the Chinese population has been an increasingly important research topic in the literature, with predominant focus on children and adolescents (study population), self-report measure (measurement), cross-sectional design (study design), guidelines adherence (study topic), and health outcomes examination (study topic). These findings delineate a research landscape in the Chinese population, and highlight the research gaps needed to be addressed. Future studies are suggested to target these research gaps, expanding evidence base for the Chinese populations. For instance, more studies using device-based measures, longitudinal or interventional designs, as well as qualitative and mixed-methods approaches are required.

Adherence to the WHO physical activity, screen time and sleep guidelines and associations with socio-demographic factors among Ethiopian preschool children: The SUNRISE study

BACKGROUND

The World Health Organisation (WHO) has called for more evidence on 24-hour movement behaviours from low- and middle-income countries. We examined the proportion of Ethiopian children aged 3.0-4.9 years who met the WHO guidelines on physical activity, screen time and sleep for children under the age of five, and the associations between meeting the guidelines and socio-demographic factors.

METHODS

A cross-sectional study was conducted in Adama and Lume district, Ethiopia. Children were recruited through kindergartens in Adama city and rural villages of Lume district, Ethiopia. Physical activity and sleep were measured using ActiGraph accelerometer. Screen time and restrained sitting were parent-reported. Multivariable logistic regression models tested associations between meeting the individual and combined WHO guidelines and socio-demographic factors.

RESULTS

A total of 430 children participated in the study (mean age 4.2 ± 0.6 years). More than half the children (58.0%) met all the WHO guidelines. A higher proportion met the physical activity (96.1%) and sleep guidelines (91.9%) compared to the screen time guideline (63.5%). Children who lived in rural areas were more likely to meet the screen time (84.6% vs. 38.2%, AOR = 7.31; 95%CI: 3.93, 14.02), sleep (98.6% vs. 83.8%, AOR = 8.60; 95%CI: 3.55, 23.73) and combined (81.3% vs. 30.1%, AOR = 7.41; 95%CI: 4.04, 13.97) guidelines than those who lived in urban areas.

CONCLUSIONS

Children from rural Ethiopia were more compliant with the WHO guidelines than their urban counterparts. Strategies to reduce screen time and promote healthy movement behaviours in urban areas are needed. Further studies with a larger representative sample might provide better insight across the regions within the country.

Associations between 24-h movement behaviors and indicators of mental health and well-being across the lifespan: a systematic review

Researchers have adopted a variety of analytical techniques to examine the collective influence of 24-h movement behaviors (i.e., physical activity, sedentary behaviors, sleep) on mental health, but efforts to synthesize this growing body of literature have been limited to studies of children and youth. This systematic review investigated how combinations of 24-h movement behaviors relate to indicators of mental ill-being and well-being across the lifespan. A systematic search of MEDLINE, PsycINFO, Embase, and SPORTDiscus was conducted. Studies were included if they reported all three movement behaviors; an indicator of mental ill-being or well-being; and were published in English after January 2009. Samples of both clinical and non-clinical populations were included. A total of 73 studies (n = 58 cross-sectional; n = 15 longitudinal) met our inclusion criteria, of which 47 investigated children/youth and 26 investigated adults. Seven analytical approaches were used: guideline adherence (total and specific combinations), movement compositions, isotemporal substitution, profile/cluster analyses, the Goldilocks method and rest-activity rhythmicity. More associations were reported for indicators of mental ill-being (n = 127 for children/youth; n = 53 for adults) than well-being (n = 54 for children/youth; n = 26 for adults). Across the lifespan, favorable benefits were most consistently observed for indicators of mental well-being and ill-being when all three components of the 24-h movement guidelines were met. Movement compositions were more often associated with indicators of mental health for children and youth than adults. Beneficial associations were consistently observed for indicators of mental health when sedentary behavior was replaced with sleep or physical activity. Other analytic approaches indicated that engaging in healthier and more consistent patterns of movement behaviors (emphasizing adequate sleep, maximizing physical activity, minimizing sedentary behaviors) were associated with better mental health. Favorable associations were reported less often in longitudinal studies. Collectively, these findings provide further support for adopting an integrative whole day approach to promote mental well-being and prevent and manage mental ill-being over the status quo of focusing on these behaviors in isolation. This literature, however, is still emerging-for adults in particular-and more longitudinal work is required to make stronger inferences.

Organizational readiness and implementation fidelity of an early childhood education and care-specific physical activity policy intervention: findings from the Play Active trial

BACKGROUND

Many children do not accumulate sufficient physical activity for good health and development at early childhood education and care (ECEC). This study examined the association between ECEC organizational readiness and implementation fidelity of an ECEC-specific physical activity policy intervention.

METHODS

Play Active aimed to improve the ECEC educator's physical activity practices. We investigated the implementation of Play Active using a Type 1 hybrid study (January 2021-March 2022). Associations between organizational readiness factors and service-level implementation fidelity were examined using linear regressions. Fidelity data were collected from project records, educator surveys and website analytics.

RESULTS

ECEC services with higher levels of organizational commitment and capacity at pre-implementation reported higher fidelity scores compared to services with lower organizational commitment and capacity (all Ps < 0.05). Similarly, services who perceived intervention acceptability and appropriateness at pre-implementation to be high had higher fidelity scores (P < 0.05). Perceived feasibility and organizational efficacy of Play Active were associated with higher but nonsignificant fidelity scores.

CONCLUSIONS

Results indicate that organizational readiness factors may influence the implementation of ECEC-specific physical activity policy interventions. Therefore, strategies to improve organizational readiness should be developed and tested. These findings warrant confirmation in the ECEC and other settings and with other health behavior interventions.

Effects of eHealth Interventions on 24-Hour Movement Behaviors Among Preschoolers: Systematic Review and Meta-Analysis

BACKGROUND

The high prevalence of unhealthy movement behaviors among young children remains a global public health issue. eHealth is considered a cost-effective approach that holds great promise for enhancing health and related behaviors. However, previous research on eHealth interventions aimed at promoting behavior change has primarily focused on adolescents and adults, leaving a limited body of evidence specifically pertaining to preschoolers.

OBJECTIVE

This review aims to examine the effectiveness of eHealth interventions in promoting 24-hour movement behaviors, specifically focusing on improving physical activity (PA) and sleep duration and reducing sedentary behavior among preschoolers. In addition, we assessed the moderating effects of various study characteristics on intervention effectiveness.

METHODS

We searched 6 electronic databases (PubMed, Ovid, SPORTDiscus, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) for experimental studies with a randomization procedure that examined the effectiveness of eHealth interventions on 24-hour movement behaviors among preschoolers aged 2 to 6 years in February 2023. The study outcomes included PA, sleep duration, and sedentary time. A meta-analysis was conducted to assess the pooled effect using a random-effects model, and subgroup analyses were conducted to explore the potential effects of moderating factors such as intervention duration, intervention type, and risk of bias (ROB). The included studies underwent a rigorous ROB assessment using the Cochrane ROB tool. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment.

RESULTS

Of the 7191 identified records, 19 (0.26%) were included in the systematic review. The meta-analysis comprised a sample of 2971 preschoolers, which was derived from 13 included studies. Compared with the control group, eHealth interventions significantly increased moderate to vigorous PA (Hedges g=0.16, 95% CI 0.03-0.30; P=.02) and total PA (Hedges g=0.37, 95% CI 0.02-0.72; P=.04). In addition, eHealth interventions significantly reduced sedentary time (Hedges g=-0.15, 95% CI -0.27 to -0.02; P=.02) and increased sleep duration (Hedges g=0.47, 95% CI 0.18-0.75; P=.002) immediately after the intervention. However, no significant moderating effects were observed for any of the variables assessed (P>.05). The quality of evidence was rated as "moderate" for moderate to vigorous intensity PA and sedentary time outcomes and "low" for sleep outcomes.

CONCLUSIONS

eHealth interventions may be a promising strategy to increase PA, improve sleep, and reduce sedentary time among preschoolers. To effectively promote healthy behaviors in early childhood, it is imperative for future studies to prioritize the development of rigorous comparative trials with larger sample sizes. In addition, researchers should thoroughly examine the effects of potential moderators. There is also a pressing need to comprehensively explore the long-term effects resulting from these interventions.

TRIAL REGISTRATION

PROSPERO CRD42022365003; http://tinyurl.com/3nnfdwh3.

The Association between 24 h Movement Guidelines and Internalising and Externalising Behaviour Problems among Chinese Preschool Children

This study examined the relationship between adherence to 24 h movement guidelines (24 h MGs) and internalising and externalising behavioural problems in Chinese children aged 3-6 years, with a specific focus on the differences between weekdays and weekends. The guidelines include recommendations for physical activity (PA), screen time (ST), and sleep duration (SD). The results indicated a stronger association between adherence to these guidelines and behavioural problems on weekends compared to weekdays. Specifically, the odds of experiencing internalising problems were 1.33 higher (95% CI: 1.05-1.69) when not satisfying all three behaviours compared to not satisfying one or two. Moreover, on weekends, when ST was not fulfilled, there was a higher likelihood of externalising behaviour problems compared to when it was fulfilled (OR, 1.18, 95% CI, 1.01-1.38), and when all three behaviours were not met, the likelihood was even higher (OR, 1.50, 95% CI, 1.04-2.18). Children who met all three guidelines had fewer internalising and externalising behavioural problems, suggesting a potential beneficial effect on mental health. The study revealed that a higher adherence to these recommendations corresponded to a lower risk of mental health problems. Additionally, higher screen time was linked to an increase in externalising behavioural issues. These findings underscore the importance of adherence to 24 h MGs for optimal mental health in children. Future interventions should consider these behavioural factors and incorporate strategies to promote adherence to these guidelines, particularly on weekends.

Adherence to the World Health Organization's physical activity recommendation in preschool-aged children: a systematic review and meta-analysis of accelerometer studies

BACKGROUND

The World Health Organization (WHO) recommend that preschool-aged children should engage in 180 min of total physical activity (TPA) including 60 min of moderate-to-vigorous physical activity (MVPA) each day. No systematic reviews or meta-analyses have pooled adherence to the recommendation across multiple studies. This study aimed to estimate the prevalence of preschool-aged children achieving the WHO's physical activity recommendation for young children, and determine if the prevalence differed between boys and girls.

METHODS

Primary literature searches were conducted on six online databases and a machine learning assisted systematic review was used to identify relevant studies. Studies written in English reporting on the prevalence of children aged 3-5 years achieving overall WHO physical activity recommendation or the individual TPA or MVPA aspects of the recommendation measured using accelerometers were eligible for inclusion. Random effects meta-analysis was used to determine the prevalence of preschools achieving the overall WHO recommendation and the individual TPA and MVPA aspect of the recommendation, and to determine difference in prevalence between boys and girls.

RESULTS

Forty-eight studies reporting on 20,078 preschool-aged children met the inclusion criteria. Based on the most commonly employed accelerometer cut-points across all aspects of the recommendation, 60% (95% Confidence Interval [CI] = 37%, 79%) of preschool-aged children adhered to the overall physical activity recommendation, 78% (95% CI = 38%, 95%) adhered to the TPA aspect of the recommendation, and 90% (95% CI = 81%, 95%) adhered to the MVPA aspect of the recommendation. There was substantial variability is prevalence estimates between different accelerometer cut-points. Girls were significantly less likely to achieve the overall recommendation and the MVPA aspect of the recommendation than boys were.

CONCLUSIONS

Although there was substantial variability in estimated prevalence of preschool-aged children adhering the WHO physical activity recommendation between various accelerometer cut-points, the weight of available evidence suggests that the majority of young children are adhering to the overall recommendation and the individual TPA and MVPA aspects of the recommendation. Large-scale, intercontinental surveillance studies are needed to further strengthen the evidence regarding the prevalence of preschool-aged children achieving physical activity recommendation globally.

Prevalence and correlates of compliance with 24-h movement guidelines among children from urban and rural Kenya-The Kenya-LINX project

BACKGROUND

Like many countries in sub-Saharan Africa, Kenya has experienced rapid urbanization in recent years. Despite the distinct socioeconomic and environmental differences, few studies have examined the adherence to movement guidelines in urban and rural areas. This cross-sectional study aimed at examining compliance to the 24-hour movement guidelines and their correlates among children from urban and rural Kenya.

METHOD

Children (n = 539) aged 11.1 ± 0.8 years (52% female) were recruited from 8 urban and 8 rural private and public schools in Kenya. Physical activity (PA) and sleep duration were estimated using 24-h raw data from wrist-worn accelerometers. Screen time (ST) and potential correlates were self- reported. Multi-level logistic regression was applied to identify correlates of adherence to combined and individual movement guidelines.

RESULTS

Compliance with the combined movement guidelines was low overall (7%), and higher among rural (10%) than urban (5%) children. Seventy-six percent of rural children met the individual PA guidelines compared to 60% urban children while more rural children also met sleep guidelines (27% vs 14%). The odds of meeting the combined movement guidelines reduced with age (OR = 0.55, 95% CI = 0.35-0.87, p = 0.01), was greater among those who could swim (OR = 3.27, 95% CI = 1.09-9.83, p = 0.04), and among those who did not engage in ST before school (OR = 4.40, 95% CI = 1.81-10.68, p<0.01). The odds of meeting PA guidelines increased with the number of weekly physical education sessions provided at school (OR = 2.1, 95% CI = 1.36-3.21, p<0.01) and was greater among children who spent their lunch break walking (OR = 2.52, 95% CI = 1.15-5.55, p = 0.02) or running relative to those who spent it sitting (OR = 2.33, 95% CI = 1.27-4.27, p = 0.01).

CONCLUSIONS

Prevalence of meeting movement guidelines among Kenyan children is low and of greatest concern in urban areas. Several correlates were identified, particularly influential were features of the school day, School is thus a significant setting to promote a healthy balance between sleep, sedentary time, and PA.