Asia-Pacific Consensus Statement on integrated 24-hour activity guidelines for children and adolescents

Types of Adolescent Screen Use and Positive Wellbeing: Gender and Parental Education Influences

Research has contradictory findings because of different definitions of screen time, measures of wellbeing, and the examination of different groups of teenagers. This study distinguishes four types of screen activity using time diaries of UK adolescents: social screen time, internet browsing, playing e-games and video viewing, and examines their associations with adolescents' happiness in six domains, by gender and parental education. Any form of screen time is associated with lower happiness with looks, but worst for the former two activities. These activities are also associated with lower happiness in other domains, and excessive use equate to worse wellbeing. More screen time is worse for girls' happiness with their looks than boys, and parental education is not a protective factor.

Association Between Meeting 24-Hour Movement Guidelines and Health-Related Quality of Life in Adolescents

BACKGROUND

Evidence-based 24-hour movement guidelines have been developed to integrate recommendations for time spent on moderate to vigorous physical activity (MVPA), screen time (ST), and sleep. This study investigated the adherence to 24-hour movement guidelines and explored the relationship with health-related quality of life (HRQoL) in adolescents.

METHODS

Cross-sectional findings are based on 1774 adolescents (49.1% female) aged 13-16 years from the Shenyang region of China. MVPA, ST, and sleep duration were self-reported using the International Physical Activity Questionnaire, an ST questionnaire, and a wake-sleep time questionnaire. HRQoL was measured using the Pediatric Quality of Life Inventory, which encompasses physical, psychosocial, and total HRQoL. Adherence to 24-hour movement guidelines was classified by meeting general (eg, none, 1, 2, and 3 guidelines) and specific combinations (eg, MVPA and ST guidelines) within the 3 recommendations. Associations were examined using general linear models adjusted for age, sex, and parents' education.

RESULTS

A total of 5.1% of the sample met all three 24-hour movement guidelines. Additionally, compared with meeting no guideline, meeting all 3 guidelines was associated with better physical (β = 5.37; 95% CI, 0.69-9.49; P = .005), psychosocial (β = 3.76; 95% CI, 0.84-6.68; P = .012), and total HRQoL (β = 4.16; 95% CI, 1.35-6.98; P = .004). Compared with not meeting the specific combination guidelines, meeting MVPA and ST was associated with better physical HRQoL (β = 5.52; 95% CI, 1.30-9.74; P = .01).

CONCLUSIONS

These cross-sectional findings suggest that meeting all three 24-hour movement guidelines were associated with better HRQoL in adolescents. Since a low proportion of this sample was meeting the overall guidelines, future effort should encourage, and perhaps improve adherence to the 24-hour movement guidelines.

The Cross-Sectional and Longitudinal Association Between 24-Hour Movement Behavior Compositions With Body Mass Index, Waist Circumference, and Internalizing and Externalizing Symptoms in 6-Year-Old Children

BACKGROUND

Few studies have examined the association between 24-hour movement behaviors and health in children in their first 2 years of primary school. This study aimed to examine how 24-hour movement behavior compositions at age 6 were related to body mass index (BMI), waist circumference, and internalizing and externalizing symptoms at ages 6 and 10.

METHODS

A subsample of 361 children from the HealthNuts cohort study with valid accelerometer data was included in the cross-sectional analysis. Of these, 279 had longitudinal data for social-emotional outcomes and 113 had longitudinal anthropometric data. Children's 24-hour movement behaviors (ie, sleep, sedentary time, light-intensity physical activity, and moderate- to vigorous-intensity physical activity [MVPA]) were assessed over 8 days using accelerometery and activity logs. BMI z score and waist circumference were assessed using standardized protocols, and parents reported on their child's internalizing and externalizing behaviors. Cross-sectional and longitudinal associations were estimated using compositional data analysis and compositional isotemporal substitution analysis.

RESULTS

Overall, 24-hour movement behaviors were significantly related to internalizing symptoms cross-sectionally and longitudinally and BMI z-score cross-sectionally. Results from compositional isotemporal substitution models indicated that replacing sedentary time or light-intensity physical activity with MVPA was associated with fewer internalizing symptoms at ages 6 and 10. Replacing time spent sedentary and in light-intensity physical activity or MVPA with sleep was associated with lower BMI z score at age 6.

CONCLUSION

Spending more time in MVPA relative to other movement behaviors is associated with fewer internalizing symptoms. In additional, spending more time sleeping is associated with lower BMI z score and waist circumference in children.

Out-of-school Activities and Adherence to 24-hour Movement Guidelines

INTRODUCTION

The purpose of this study was to explore associations between participation in out-of-school/weekend organized activities and adherence to the 24-hour movement guidelines among US adolescents.

METHODS

Data from the 2022 National Survey of Children's Health (N=16,403, age=15.1±1.4 years, 48.1% female) was used for analyses in 2024. A parent/guardian completed surveys regarding adolescents' 24-hour movement behaviors (physical activity [PA], sleep [SL], and screentime [ST]), as well as participation in out-of-school and weekend activities (sports, clubs, other organized activities, and volunteering). Weighted logistic regression models were used to examine associations between participation in out-of-school and weekend organized activities and 24-hour movement guideline adherence, adjusted for sex, age, race/ethnicity, federal poverty level status, metropolitan statistical area status, and overweight/obesity status.

RESULTS

Only 4.8% of adolescents met all three guidelines concurrently. Adolescents who participated in sports teams/lessons had higher odds of meeting PA (OR=2.11, 95% CI: 1.67-2.66), ST (OR=1.31, 95% CI: 1.12-1.53), PA+ST (OR=2.24, 95% CI: 1.63-3.07), PA+SL (OR=2.00, 95% CI: 1.53-2.63), SL+ST (OR=1.40, 95% CI; 1.19-1.66), and all three guidelines (OR=2.33, 95% CI: 1.61-3.39). Participation in other organized activities/lessons was associated with higher odds of meeting ST (OR=1.32, 95% CI: 1.13-1.56), and SL+ST guidelines (OR=1.39, 95% CI: 1.16-1.66). Adolescents who volunteered had higher odds of meeting ST (OR=1.68, 95% CI: 1.42-1.98), PA+ST (OR=1.75, 95% CI: 1.25-2.45), SL+ST (OR=1.64, 95% CI: 1.38-1.95), and all three guidelines (OR=1.80, 95% CI: 1.20-2.72).

CONCLUSIONS

Participating in sports teams/lessons and community service/volunteer work is beneficially associated with concurrently meeting all three 24-hour movement guidelines and participating in other organized activities or lessons is associated with adherence to individual components of the 24-hour movement guidelines among US adolescents.

School-based factors influencing physical activity participation in children and adolescents with disabilities: A qualitative systematic review and meta-synthesis

BACKGROUND

Children and adolescents with disabilities (CAD) frequently encounter barriers to participation in physical activity (PA). Schools play a vital role in promoting PA, making it crucial to understand the school-based factors influencing CAD's PA participation.

OBJECTIVE

This qualitative systematic review and meta-synthesis aims to identify and elucidate the school-based factors influencing PA engagement among this population.

METHODS

A comprehensive search across six databases-Web of Science, PsycINFO, Scopus, SPORTDiscus, and Embase, CNKI-was conducted in August 2023, and subsequently updated in April 2024. English or Chinese peer-reviewed journal articles that contained substantial qualitative data regarding school-based factors affecting PA in CAD were included. The methodological quality of included studies was evaluated utilizing the Critical Appraisal Skills Program Qualitative Checklist. Qualitative data were analyzed through thematic synthesis.

RESULTS

A total of 16 studies (12 qualitative studies and 4 mixed-methods studies) were included, all of which were of moderate to high quality. Thematic synthesis identified four major themes: (a) physical environment (provision of facilities, specialized and adapted equipment, space for activities); (b) social environment (peers, school leaders, teachers and other school staff); (c) opportunities for PA (physical education, classroom movement integration, extra-curricular activities); and (d) characteristics of PA (adaption of rules and task difficulty, competition components, diversified activities, fun).

CONCLUSIONS

This review reveals the complex interplay of different school-based factors affecting PA participation among CAD. The findings provide valuable insights for educators, policymakers, and health professionals to enhance PA participation in this population.

Association Between 24-Hour Movement Behaviors and Adiposity in Malaysian Schoolchildren: A Compositional Isotemporal Substitution Analysis

BACKGROUND

Physical activity (PA), sedentary behavior (SB), and sleep are interrelated 24-hour movement behaviors that are important for the growth and well-being of children. This cross-sectional study examined the relationship between 24-hour movement behaviors and adiposity, and predicted changes in adiposity following compositional time reallocations in 7- to 12.9-year-old Malaysian children from the South East Asian Nutrition Surveys II Malaysia.

METHODS

A total of 381 children (mean age 9.7 [1.6] y, 57% girls) provided 24-hour wrist-worn GENEActiv accelerometry data which captured time spent for sleep, SB, light PA and moderate to vigorous PA (MVPA). Indicators of adiposity were derived from anthropometry and bioelectrical impedance analysis: body-mass-index-for-age, waist circumference, waist-to-height ratio, percent body fat, and body mass index. The composition of 4-part movement behaviors was expressed as isometric log-ratio coordinates which were entered into regression models. Isotemporal substitution analysis was used to assess changes in adiposity indicators when reallocating time between movement behaviors.

RESULTS

Relative to other movement behaviors, time spent on MVPA was significantly associated with waist circumference, waist-to-height ratio, percent body fat, and fat mass index. A 15-minute one-to-one reallocation from other movement behaviors to MVPA predicted lower body-mass-index-for-age (-0.03 to -0.11), smaller waist circumference (-0.67 to -1.28 cm), lower waist-to-height ratio (-0.004 to -0.008), percent body fat (-0.87% to -1.47%), and fat mass index (-0.23 to -0.42). Replacing SB and light PA with sleep or MVPA was associated with lower adiposity.

CONCLUSIONS

The overall composition of movement behavior was significantly associated with the adiposity of Malaysian schoolchildren. Promoting MVPA and sleep and reducing SB and light PA are important for prevention of childhood obesity.

24-hour movement behaviours in the early years, potential behavioural determinants and prospective associations with growth, motor and social-emotional development: the My Little Moves study protocol

INTRODUCTION

The early years are a critical period for establishing healthy 24-hour movement behaviours (physical activity, sedentary behaviour and sleep), yet studies examining prospective associations between all 24-hour movement behaviours and young children's growth and development are lacking. The My Little Moves study aims to (1) examine the prospective association between 24-hour movement behaviours of young children (ie, 0-4 years) and their growth, motor and social-emotional development; and (2) explore potential determinants of young children's 24-hour movement behaviours from an ecological perspective, to inform public health strategies aimed at promoting healthy behaviours and development.

METHODS AND ANALYSIS

My Little Moves is a longitudinal observational cohort study, with data collection at baseline, and after 9 and 18 months follow-up. Data are collected in three subcohorts. In all subcohorts, 24-hour movement behaviours are assessed by parent-report. Additionally in subcohort 1, data on potential determinants are collected by parental questionnaires, including child, parental and environmental factors. In subcohort 2, social-emotional development is assessed using the Dutch version of the Bayley Scales of Infant and Toddler Development-third edition (Bayley-III-NL) Social Emotional Scale. In subcohort 3, data on height and weight, gross motor development, using the Bayley-III-NL Gross Motor Scale, and 7 consecutive days of 24-hour accelerometer data are collected. Hybrid model analyses are used to assess the prospective associations of 24-hour movement behaviours with young children's growth and development. Potential determinants of young children's 24-hour movement behaviours are explored using regression analysis.

ETHICS AND DISSEMINATION

The Medical Ethics Committee of the VU University Medical Center approved the protocol for the My Little Moves study (2022.0020). The results of this study will be disseminated through the network of all authors, to inform public health strategies for promoting healthy 24-hour movement behaviours and contribute to the evidence-base of recommendations for ideal 24-hour movement behaviours in young children.

24-hour movement behavior adherence and associations with health outcomes: an umbrella review

Background

Physical activity, sedentary behavior, and sleep, collectively known as the 24-hour movement behaviors, demonstrate individual and joint benefits on physical and mental health. Examination of these behaviors has expanded beyond guideline adherence to reviews of isotemporal substitution models (ISM) and compositional data analysis (CoDA). This umbrella review sought to review existing systematic reviews to (1) characterize the breadth and scope, (2) examine prevalence estimates for 24-hour movement guideline adherence, and (3) examine the relationship between these behaviors with health outcomes based on various approaches.

Methods

Eight databases and multiple supplementary strategies were used to identify systematic reviews, meta-analyses and pooled analyses that included two or more of the three 24-hour movement behaviors and a multi-behavior assessment approach. Overall review characteristics, movement behavior definitions, approaches, and health outcomes assessed were extracted, and methodological quality was assessed using the AMSTAR2 tool. Review characteristics (Aim 1), guideline prevalence estimates (Aim 2), and associations with health outcomes (Aim 3) were examined.

Findings

Thirty-two reviews (20 systematic reviews, 10 meta-analyses, and 2 pooled analyses) were included. Reviews captured the entire lifespan, global regions, and several physical and mental health outcomes. Individual and total guideline adherence waned from preschool to adolescence, but reviews reported similar prevalence estimates and ranges (i.e., within 10%). Common approaches included ISM and CoDA, evaluating 24-hour movement behavior's interactive associations with health outcomes, guideline adherence, and profile-based analysis. Despite heterogeneous approaches, reviews found consistent evidence for beneficial associations between meeting all three guidelines and high amount of physical activity on physical and mental health outcomes, but varied assessment of sedentary behavior or sleep. Most reviews were rated as low or critically low quality.

Conclusions

The breadth and scope of current reviews on 24-hour movement behaviors was wide and varied in this umbrella review, including all ages and across the globe. Prevalence estimates among populations beyond children need to be synthesized. Amongst the variety of definitions and approaches, reviews found benefit from achieving healthy amounts of all three behaviors. Longitudinal multi-behavior original research studies with rigorous assessment of sleep and sedentary behavior may help improve future systematic reviews of these various approaches.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-024-00064-6.

A systematic review of research reporting practices in observational studies examining associations between 24-h movement behaviors and indicators of health using compositional data analysis

Background

Compositional data analysis (CoDA) techniques are well suited for examining associations between 24-h movement behaviors (i.e., sleep, sedentary behavior, physical activity) and indicators of health given they recognize these behaviors are co-dependent, representing relative parts that make up a whole day. Accordingly, CoDA techniques have seen increased adoption in the past decade, however, heterogeneity in research reporting practices may hinder efforts to synthesize and quantify these relationships via meta-analysis. This systematic review described reporting practices in studies that used CoDA techniques to investigate associations between 24-h movement behaviors and indicators of health.

Methods

A systematic search of eight databases was conducted, in addition to supplementary searches (e.g., forward/backward citations, expert consultation). Observational studies that used CoDA techniques involving log-ratio transformation of behavioral data to examine associations between time-based estimates of 24-h movement behaviors and indicators of health were included. Reporting practices were extracted and classified into seven areas: (1) methodological justification, (2) behavioral measurement and data handling strategies, (3) composition construction, (4) analytic plan, (5) composition-specific descriptive statistics, (6) model results, and (7) auxiliary information. Study quality and risk of bias were assessed by the National Institutes of Health Quality Assessment Tool for Observational Cohort and Cross-sectional Studies.

Results

102 studies met our inclusion criteria. Reporting practices varied considerably across areas, with most achieving high standards in methodological justification, but inconsistent reporting across all other domains. Some items were reported in all studies (e.g., how many parts the daily composition was partitioned into), whereas others seldom reported (e.g., definition of a day: midnight-to-midnight versus wake-to-wake). Study quality and risk of bias was fair in most studies (85%).

Conclusions

Current studies generally demonstrate inconsistent reporting practices. Consistent, clear and detailed reporting practices are evidently needed moving forward as the field of time-use epidemiology aims to accurately capture and analyze movement behavior data in relation to health outcomes, facilitate comparisons across studies, and inform public health interventions and policy decisions. Achieving consensus regarding reporting recommendations is a key next step.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-024-00062-8.

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.

Association between adherence to 24-h movement guidelines and sociodemographic factors among Malaysian preschoolers: Findings from SEANUTS II Malaysia

BACKGROUND

Adhering to 24-h movement guidelines (24-hMG) have health benefits for young children; yet research on Malaysian preschoolers' movement behaviors is limited. This study investigates the association between adherence to 24-hMG and sociodemographic factors of Malaysian preschoolers.

METHODS

Data from 939 preschoolers aged 3-6 years (mean age = 4.83 ± 0.04 years, 53.7% boys) from the Second South East Asian Nutrition Surveys (SEANUTS II) Malaysia study was analyzed. Socio-demography, physical activity, sedentary behaviors, and sleep were parent-reported via questionnaire. Associations between adherence of 24-hMG and sociodemographic factors were analyzed using complex samples logistic regression.

RESULTS

Only 12.1% of preschoolers adhered to the overall 24-hMG, and 67.1%, 54.7%, and 42.7% of preschoolers adhered to physical activity, sleep, and sedentary behavior guidelines, respectively; while 6.8% did not meet any guidelines. Compared to 3-4-year olds, preschoolers aged 5-6 years had higher odds of adhering to physical activity guidelines, sedentary behavior guidelines, and overall 24-hMG, but lower odds of adhering to sleep guidelines. Chinese and Indian preschoolers were more likely to adhere to sedentary behavior guidelines than Malay preschoolers; however, Chinese preschoolers had lower odds of adhering to physical activity guidelines. Paternal tertiary education was associated with a higher likelihood of adherence to sleep guidelines.

CONCLUSION

Our findings suggest that adherence to 24-hMG among Malaysian preschoolers is associated with age, ethnicity, and paternal education level. This underscores the importance of targeted interventions and health awareness program to promote healthy movement behaviors, particularly among children under 5, ethnic minorities, and educationally disadvantaged families.

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 between levels of physical literacy and adherence to the 24-h movement guidelines among university students: A cross-sectional study

Objectives

Emerging evidence indicates that the composition of movement behaviours within a 24-h period is associated with multiple health benefits across the lifespan. A concept that emphasises an individual's active lifestyle is physical literacy (PL), yet empirical research exploring the potential associations between PL and 24-h movement guidelines remains scarce. This study aimed to evaluate the associations between levels of PL and adherence to the guidelines among Chinese university students.

Study design

A cross-sectional study.

Methods

Seven hundred and ninety-eight university students (390 male, 19.2 ± 1.2 years) completed all the measurements. Levels of PL and participants' adherence to guidelines including physical activity, sedentary behaviour and sleep were self-reported through Perceived Physical Literacy Instrument, International Physical Activity Questionnaire and Pittsburgh Sleep Quality Index, respectively. Two-way ANOVA was conducted to determine the associations between the number of guidelines met (0, 1, 2, or 3) and levels of PL.

Results

The results demonstrate that 36.5% (n = 291) of the participants met all the three guidelines, while 4.1% (n = 33) met none. Further analysis indicated that meeting physical activity or sedentary behaviour guidelines was associated with significantly higher total PL scores, and scores in the sub-domains of Confidence and Physical Competence and Motivation.

Conclusions

The findings provide evidence that young adults who obtained higher PL scores may meet more guidelines during a 24-h period. Future studies should incorporate accelerometer-based physical activity measurements and investigate the causal relationship between PL and adherence to the movement guidelines.

Proportion and Correlates of Children in the US-Affiliated Pacific Region Meeting Sleep, Screen Time, and Physical Activity Guidelines

INTRODUCTION

Limited data on 24-hour movement behaviors of children aged 5-8 years exist globally. We describe the prevalence and sociodemographic associations of meeting physical activity (PA), sedentary recreational screen time (ST), and sleep guidelines among children from 11 jurisdictions in the US-Affiliated Pacific region.

METHODS

Cross-sectional representative data from 1192 children aged 5-8 years living in the US-Affiliated Pacific region were drawn from the baseline 2012-2014 Children's Healthy Living Program. Sleep and moderate- to vigorous-intensity PA were calculated from accelerometry. ST and sociodemographic data were collected from caregiver surveys. The percentage of children meeting the Asia-Pacific 24-hour movement guidelines for PA (≥60 min/d of moderate- to vigorous-intensity PA), sleep (≥9 and ≤ 11 h/d) and ST (≤2 h/d) were calculated. Generalized linear mixed models were used to examine associations with adiposity and sociodemographic variables.

RESULTS

Twenty-seven percent (95% confidence interval, 24.6-30.0) of children met integrated guidelines; 98% (96.2-98.0) met PA, 78% (75.4-80.0) met sleep, and 35% (32.6-38.0) met ST guidelines. Females (adjusted odds ratio = 1.40 [95% confidence interval, 1.03-1.91]) and those living in lower-middle-income jurisdictions (2.29 [1.49-3.54]) were more likely to meet ST guidelines. Overweight children (0.62 [0.40-0.96]), those aged 8 years (0.39 [0.22-0.69]), and children with caregivers of an education level of high school or beyond (0.44 [0.29-0.68]) were less likely to achieve ST guidelines. Children from midrange annual household incomes were less likely to meet combined guidelines (0.60 [0.39-0.92]).

CONCLUSIONS

Three-quarters of children are not meeting integrated Asia-Pacific 24-hour movement guidelines. Future strategies for reducing ST and increasing integrated guidelines compliance are needed.

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.

Is adherence to the 24-h movement guidelines associated with greater academic-related outcomes in children and adolescents? A systematic review and meta-analysis

The purpose of this systematic review was to synthesise the evidence for the association of adherence to the 24-h movement guidelines with academic-related outcomes in children and adolescents. This systematic review was based on the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. PubMed, PsycINFO, Scopus, WOS, SPORTDiscus, and EMBASE were searched from their inception to 12 December 2023. The Joanna Briggs Institute (JBI) Critical Appraisal Checklist was used to assess the risk of bias of included studies. In total, 4326 records were identified through database searches; 10 articles met the inclusion criteria and were included in this systematic review. There were eight cross-sectional studies and two longitudinal studies; the main academic-related outcomes were academic achievement and cognitive function. A small association between adherence to all three recommendations and academic achievement (k = 5, r = 0.17, 95% CI = 0.10-0.24, I2 = 49%) was found compared to those who did not adhere to any recommendations.   Conclusion: Findings from this systematic review and meta-analysis reveal a small association between adherence to all three recommendations and greater academic achievement in children and adolescents. Nevertheless, it is imperative to underscore the need for more studies to establish robust evidence underpinning this relationship.   Trial registration: PROSPERO (CRD42021295403). What is Known: • Regular physical activity, reduced screen time, and optimal sleep duration are independently associated with improved academic-related outcomes in children and adolescents. • The associations between adherence to the 24-h movement guidelines and academic-related outcomes in children and adolescents have not been quantitatively synthesised. What is New: • There is a small but positive association between adherence to all three recommendations of the 24-h movement guidelines and greater academic achievement in children and adolescents. • Further well-designed research is needed to focus on academic achievement, cognitive function and classroom behaviours in young individuals.

A comparison of the effects of two protocols of concurrent resistance and aerobic training on physical fitness in middle school students

Objective

This study aimed to compare the effects of two concurrent training (CT) protocols on the physical fitness of middle school students.

Method

A 12-week quasi-experimental pre-test/post-test study was conducted with 157 middle school students (age = 12.48 ± 0.34, n = 90 females) divided into three groups: CT group A (CT-0h) received combined resistance training (RT) and aerobic training (AT) in each physical education session, CT group B (CT-48h) received RT and AT across two separate physical education classes 48 h apart, and a control group (Con) received no training. Training occurred twice a week. Test indicators included cardiorespiratory fitness (CRF) measured by estimated VO2max and 20 m shuttle run (laps), as well as muscle strength assessed through long jump, vertical jump, and handgrip strength.

Results

The intervention groups exhibited significant increases in estimated VO2max and muscle strength compared to their baseline values (p < 0.05). Both CT-0h and CT-48h groups demonstrated significant improvements in 20 m shuttle run (laps) (mean difference: 8.88 laps, p < 0.01; mean difference: 4.81 laps, p < 0.01, respectively), standing long jump (mean difference: 6.20 cm, p < 0.01; mean difference: 3.68 cm, p < 0.01, respectively), vertical jump (mean difference: 4.95 cm, p < 0.01; mean difference: 4.04 cm, p < 0.01, respectively), and handgrip strength (mean difference: 11.17 kg, p < 0.01; mean difference: 6.99 kg, p < 0.01, respectively). CT-0h group exhibited significantly increased estimated VO2max (mean difference: 1.47 ml/kg/min, p < 0.01) compared to the CT-48h group.

Conclusion

Both CT programs effectively improved adolescents' physical fitness indicators. However, the program that integrated RT and AT within the same physical education class demonstrated superior enhancement in adolescents' CRF.

Thai Preschoolers' movement behaviors outside kindergarten: prevalence of meeting individual and integrated movement guidelines

BACKGROUND

This study aimed to investigate movement behaviors of Thai preschoolers (aged 3-6 years) occurring outside kindergarten in urban areas across Thailand.

METHODS

Surveillance of digital Media in eArLy chiLdhood Questionnaire® was used to collect data from 1051 parents recruited from 12 schools. Descriptive statistics and logistic regressions were applied for data analysis.

RESULTS

Thai preschoolers engaged in physical activity (PA), sedentary screen time, and sleep on weekends significantly more than weekdays with no significant sex differences. Preschoolers met the sleep guidelines the most (62.3%), followed by PA guidelines (48.0%), and screen time (ST) guidelines the least (44.1%). Only 14.6% met the integrated movement guidelines, and 11% met none of the guidelines. Age was positively associated with meeting the PA guidelines, and negatively associated with meeting the sleep and integrated movement guidelines. The number of digital devices at home and geographical region influenced preschoolers in meeting the PA and ST guidelines.

CONCLUSIONS

Thai preschoolers' time spent on all forms of activities outside kindergarten was significantly more on weekends than weekdays with no sex disparity. The prevalence of meeting the integrated movement guidelines was low, and needs to be addressed through comprehensive programs including all forms of activities concurrently.

IMPACT

Thai preschoolers engaged in physical activity (PA), screen time (ST), and sleep on weekends significantly more than weekdays with no significant sex differences. Only 14.6% of preschoolers met the integrated movement guidelines. Age had a significant relationship with meeting the PA, sleep, and integrated movement guidelines. Meeting the PA and ST guidelines in preschoolers was positively associated with the number of digital devices at home. Despite some limitations, this study presented preschoolers' time engaged in the three movement behaviors concurrently, and provided important inputs for development of the national strategic plan to promote PA among Thai children and youth.

GRADE-ADOLOPMENT of hyperthyroidism treatment guidelines for a Pakistani context

INTRODUCTION

The prevalence of hyperthyroidism in Pakistan is 2.9%, which is two times higher than in the United States. Most high-quality hyperthyroidism clinical practice guidelines (CPGs) used internationally originate from high-income countries in the West. Local CPGs in Pakistan are not backed by transparent methodologies. We aimed to produce comprehensive, high-quality CPGs for the management of hyperthyroidism in Pakistan.

METHODS

We employed the GRADE-ADOLOPMENT approach utilizing the 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis as the source CPG. Recommendations from the source guideline were either adopted as is, excluded, or adapted according to our local context.

RESULTS

The source guideline included a total of 124 recommendations, out of which 71 were adopted and 49 were excluded. 4 recommendations were carried forward for adaptation via the ETD process, with modifications being made to 2 of these. The first addressed the need for liver function tests (LFTs) amongst patients experiencing symptoms of hepatotoxicity while being treated with anti-thyroid drugs (ATDs). The second pertained to thyroid status testing post-treatment by radioactive iodine (RAI) therapy for Graves' Disease (GD). Both adaptations centered around the judicious use of laboratory investigations to reduce costs of hyperthyroidism management.

CONCLUSION

Our newly developed hyperthyroidism CPGs for Pakistan contain two context-specific modifications that prioritize patients' finances during the course of hyperthyroidism management and to limit the overuse of laboratory testing in a resource-constrained setting. Future research must investigate the cost-effectiveness and risk-benefit ratio of these modified recommendations.

Differential Associations of Sports Participation With Self-Rated Health and Depressive Symptoms Among Japanese Adolescents

INTRODUCTION

We aimed to evaluate the associations of sports participation with self-rated health and depressive symptoms in a nationally representative sample of Japanese adolescents.

METHODS

A questionnaire survey was conducted with 1,658 adolescents aged between 12 and 21 years. Sports participation levels were divided into high-frequency, moderate-frequency, low-frequency, and no-participation groups. Self-rated health was evaluated using a four-grade scale. Depressive symptoms were assessed using the Japanese version of the Patient Health Questionnaire-8. Other lifestyle behaviors were also surveyed. The associations of sports participation with self-rated health and depressive symptoms were examined using multiple logistic regression analysis.

RESULTS

The participants in the high- (odds ratio (OR), 0.45) and moderate-frequency (OR, 0.46) groups were less likely to self-report poor health than those in the non-participation group. By contrast, a U-shaped association was found between sports participation and depression, in which the participants in the moderate-frequency group (OR, 0.52) were less likely to have depressive symptoms. The OR for the high- (0.89) and low-frequency (0.91) groups were not significant. Furthermore, eating regular breakfasts, six or more days/week, and having shorter screen times of less than two hours/day were negatively associated with poor self-reported health and depressive symptoms.

CONCLUSION

Moderate- to high-frequency sports activities are associated with a reduced risk of poor self-rated health among Japanese adolescents. However, only moderate-frequency activities were associated with a reduced risk of depression. Participation in optimal sports activities may effectively lower the risk of poor health in adolescents.

24 h Activity Guidelines in Children and Adolescents: A Prevalence Survey in Asia-Pacific Cities

This study aimed to examine the prevalence of adherence to 24 h activity guidelines in children and adolescents from Asia-Pacific cities. In 1139 children aged 5-18 years, moderate-to-vigorous physical activity (MVPA), screen viewing time (SVT), sleep duration, child weight, height, sex, and age were parent-reported. Descriptive statistics were used to assess the number of guidelines met, and prevalence of adherence to activity guidelines by city and child sex. Prevalence of meeting all three 24 h activity guidelines was low across all countries (1.8-10.3%) (p < 0.05). Children from Thiruvananthapuram, India had the highest [10.3% (95% CI: 6.0-17.0)], while those from Tokyo, Japan had the lowest prevalence [1.8% (95% CI: 0.5-7.0)] of meeting all three guidelines. The highest prevalence of meeting individual MVPA, SVT and sleep guidelines was found in India [67.5% (95% CI: 58.8-75.1)], Kelaniya, Sri Lanka [63.2% (95% CI: 58.7-67.4)] and Kowloon, Hong Kong [59.4% (95% CI: 51.1-65.3)], respectively. Overall, a higher prevalence of boys met all three guidelines, compared to girls [5.9% (95% CI: 4.1-8.1) vs. 4.7% (3.1-6.6), p = 0.32]. The prevalence of adhering to all three activity guidelines was low in all five participating cities, with a higher proportion of boys meeting all guidelines.

Characteristics of 24-hour movement behaviours and their associations with mental health in children and adolescents

Background

Time-use estimates are typically used to describe 24-hour movement behaviours. However, these behaviours can additionally be characterised by other easily measured metrics. These include sleep quality (e.g., sleep efficiency), 24-hour rest-activity rhythmicity (e.g., between-day rhythm variability), and directly measured acceleration metrics (e.g., intensity gradient). Associations between these characteristics and youth mental health are unclear. This study aimed to [1] compare 24-hour movement behaviour characteristics by sex and age groups, [2] determine which movement behaviour characteristics were most strongly associated with mental health outcomes, and [3] investigate the optimal time-use behaviour compositions for different mental health outcomes.

Methods

Three-hundred-and-one children and adolescents (age 9-13 y; 60% girls) wore accelerometers for 24-hours/day over 7-days. Overall mental health, externalising, and internalising problems were self-reported using the Strengths and Difficulties Questionnaire. 24-hour movement behaviour characteristics were categorised as time-use estimates, sleep quality, 24-hour activity rhythmicity, and directly measured acceleration. Linear mixed models and compositional data analysis were used to analyse the data in alignment with the study aims.

Results

Time-use estimates, directly measured accelerations, and 24-hour rest-activity rhythm metrics indicated that children were significantly more physically active (p = .01-<0.001) than adolescents. Children were also less sedentary (p < .01), slept longer (p = .02-0.01), and had lower sleep efficiency. Boys were significantly more active than girls (p < .001) who in turn accrued more time in sleep (p = .02). The timing of peak activity was significantly later among adolescents (p = .047). Overall mental health and externalising problems were significantly associated with sleep, sedentary time, sleep efficiency, amplitude, and inter-daily stability (p = .04-0.01). The optimal time-use compositions were specific to overall mental health and externalising problems and were characterised by more sleep, light and vigorous physical activity, and less sedentary time and moderate physical activity than the sample's mean time-use composition.

Conclusions

Extracting and examining multiple movement behaviour characteristics from 24-hour accelerometer data can provide a more rounded picture of the interplay between different elements of movement behaviours and their relationships with mental health than single characteristics alone, such as time-use estimates. Applying multiple movement behaviour characteristics to the translation of research findings may enhance the impact of the data for research users.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-023-00021-9.

24-h Movement Guidelines and Overweight and Obesity Indicators in Toddlers, Children and Adolescents: A Systematic Review and Meta-Analysis

BACKGROUND

Engaging in physical activity increases energy expenditure, reducing total body fat. Time spent in sedentary behaviours is associated with overweight and obesity, and adequate sleep duration is associated with improved body composition. This systematic review aimed to analyse the relationship between compliance with the 24-h movement guidelines and obesity indicators in toddlers, children and adolescents.

METHODS

A systematic review and meta-analysis was conducted. PubMed, Web of Science and Scopus were searched from inception to December 2021. Cross-sectional and prospective studies that analysed the relationship between 24-h movement guidelines and overweight and obesity written in English, French, Portuguese or Spanish were included. PROSPERO registration number is CRD42022298316.

RESULTS

The associations between meeting the 24-h movement guidelines and standardised body mass index were null in the two studies for toddlers. Seven studies analysed the relationship between compliance with the 24-h movement guidelines and overweight and obesity among preschool children. Of these seven studies, six found no association between compliance with 24-h movement guidelines and body composition. Among children and adolescents, 15 articles were analysed. Of these 15 studies, in seven, it was found that children and adolescents who meet the 24-h movement guidelines were more likely to have lower risks of overweight and obesity. The meta-analysis yielded a pooled OR = 0.80 (95% CI = 0.68 to 0.95, p = 0.012, I² = 70.5%) in favour of compliant participants. Regarding participants' age groups, compliance with 24-h movement guidelines seems to exert greater benefits on overweight and obesity indicators among children-adolescents (OR = 0.62, p = 0.008) compared to participants at preschool (OR = 1.00, p = 0.931) and toddlers (OR = 0.91, p = 0.853).

CONCLUSION

Most included studies have not observed a significant relationship between compliance with the 24-h movement guidelines and overweight and obesity in toddlers, children and adolescents.

GRADE-ADOLOPMENT of clinical practice guidelines and creation of clinical pathways for the primary care management of chronic respiratory conditions in Pakistan

INTRODUCTION

In Pakistan, chronic respiratory conditions contribute a large burden of morbidity and mortality. A major reason for this is the lack of availability of local evidence-based clinical practice guidelines (EBCPGs) in Pakistan, particularly at the primary care level. Thus, we developed EBCPGs and created clinical diagnosis and referral pathways for the primary care management of chronic respiratory conditions in Pakistan.

METHODS

The source guidelines were selected by two local expert pulmonologists after a thorough literature review on PubMed and Google Scholar from 2010 to December 2021. The source guidelines covered idiopathic pulmonary fibrosis, asthma, chronic obstructive pulmonary disorders, and bronchiectasis. The GRADE-ADOLOPMENT process consists of three key elements: adoption (using recommendations as is or with minor changes), adaptation (effective context-specific changes to recommendations) or additions (including new recommendations to fill a gap in the EBCPG). We employed the GRADE-ADOLOPMENT process to adopt, adapt, adopt with minor changes, or exclude recommendations from a source guideline. Additional recommendations were added to the clinical pathways based on a best-evidence review process.

RESULTS

46 recommendations were excluded mainly due to the unavailability of recommended management in Pakistan and scope beyond the practice of general physicians. Clinical diagnosis and referral pathways were designed for the four chronic respiratory conditions, explicitly delineating the role of primary care practitioners in the diagnosis, basic management, and timely referral of patients. Across the four conditions, 18 recommendations were added (seven for IPF, three for bronchiectasis, four for COPD, and four for asthma).

CONCLUSION

The widespread use of the newly created EBCPGs and clinical pathways in the primary healthcare system of Pakistan can help alleviate the morbidity and mortality related to chronic respiratory conditions disease in the country.

Effects of running-based versus body-weight-based high-intensity interval training on physical fitness in healthy adolescents

Objectives: High-intensity interval training improves aerobic endurance, but the effectiveness of different training protocols is unclear. This study compared the effects of running-based high-intensity interval training (R-HIIT) and body weight-based high-intensity interval training (B-HIIT) on physical fitness in adolescents. Methods: This was a pre-and post-test quasi-experimental design in which a seventh-grade natural class was randomly selected from three homogeneous middle schools, and then the three natural classes were randomly divided into three groups: the R-HIIT group (n = 54), the B-HIIT group (n = 55), and the control group (Con, n = 57). Both intervention groups exercised twice a week for 12 weeks with a 2:1 (1 min:30 s) load-interval ratio and exercise intensity controlled at 70%-85% maximum heart rate. R-HIIT was in the form of running, and B-HIIT was in the form of resistance exercises using the participants' body weight. The control group was instructed to continue their normal behavior. cardiorespiratory fitness, muscle strength and endurance, and speed were measured before and after the intervention. Statistical differences between and within groups were determined using repeated measures analysis of variance. Results: Compared to the baseline, both the R-HIIT and B-HIIT intervention groups significantly improved CRF, muscle strength, and speed (p < 0.05). The B-HIIT group was significantly better than R-HIIT in improving CRF (4.48 mL/kg/min vs 3.34 mL/kg/min, p < 0.05), and only the B-HIIT improved sit-up muscle endurance (ηp 2 = 0.30, p < 0.05). Conclusion: The B-HIIT protocol was significantly more effective than the R-HIIT protocol in developing CRF and improving muscle health indicators.

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.

A Narrative Review of Screen Time and Wellbeing among Adolescents before and during the COVID-19 Pandemic: Implications for the Future

The COVID-19 pandemic has disrupted the lives of many. In particular, during the height of the pandemic, many experienced lockdowns, which in turn increased screen time drastically. While the pandemic has been declared an endemic and most activities have been reinstated, there appears to still be elevated screen time among adolescents due to poor habits formed during the pandemic lockdowns. This paper explores the factors by which screen time affects well-being among adolescents and how the pandemic may have influenced some of these factors. For example, beyond having greater screen time, many adolescents have also reduced their physical activities and picked up poor sleeping habits. These findings highlight the importance of having integrated activity guidelines that go beyond limiting adolescents' daily screen time. It is important to affirm that beyond ensuring that adolescents limit their daily screen time, they are also meeting physical activity and sleep guidelines so that they achieve a holistic sense of wellbeing.

Results from the Singapore 2022 report card on physical activity for children and adolescents

Background

While it has been established that physical activity (PA) is key to promote overall health and well-being, insufficient physical activity among children and adolescents is a global problem, including Singapore. It is important to understand the local PA landscape among children and adolescents to decrease surveillance gaps and identify areas for improvement in promoting PA. The present article provides an overview of the development of the 2022 Active Healthy Kids Singapore Report Card and the results, as well as underscore limitations and gaps in the available evidence related to PA among children and adolescents in Singapore.

Methods

Following the Global Matrix 4.0, the available data between July 2010 to July 2020 was synthesized for all 10 indicators by the work group and reviewed by a panel of experts. Data sources included published scientific articles, government and non-government reports, national surveys, and unpublished data from on-going research studies. Where possible, grades were informed by nationally representative surveys or large-scale longitudinal studies.

Results

The grades assigned were: Overall Physical Activity (C-), Organized Sport and Physical Activity (B-), Active Play (C-), Active Transportation (C), Sedentary Behaviours (C-), Physical Fitness (Incomplete), Family and Peers (C-), School (Incomplete), Community and Environment (A+), Government (B).

Conclusion

This is the first comprehensive evaluation of PA among children and adolescents in Singapore. It provides baseline grades valuable for future comparison. It also illustrates gaps in the existing evidence which can inform future surveillance, facilitate international comparisons and enable global efforts in promoting physical activity.

Associations between 24-h movement behaviors and self-rated health: a representative sample of school-aged children and adolescents in Okinawa, Japan

OBJECTIVES

This study aimed to determine the associations between adherence to 24-h movement behavior guidelines and self-rated health (SRH) among Japanese adolescents according to their age group.

STUDY DESIGN

This was a cross-sectional study.

METHODS

Probability proportional sampling data, which were collected from six regions of Okinawa Prefecture, Japan, considering the number of schools, included 2408 fifth-grade students (aged 10-11 years) in 31 elementary schools and 4360 eighth-grade students (aged 13-14 years) in 30 junior high schools. SRH, moderate-to-vigorous physical activity (MVPA), screen time (ST), sleep duration, and confounding factors (sex, weight status, family affluence, parental support, school satisfaction, and school demands) were self-reported.

RESULTS

The logistic regression models showed that adherence to ST and sleep recommendations in elementary school students was associated with a high prevalence of good health only, whereas adherence to only MVPA, only sleep, ST and sleep, MVPA and sleep, and all three recommendations were associated with a high prevalence of good health among junior high school students. All combinations that included achievement of the recommended sleep duration were associated with SRH.

CONCLUSIONS

Achieving 24-h movement behavior guidelines, particularly sleep recommendations, is associated with better perceived health in school-aged children, especially in adolescents.

Asia-Pacific consensus statement on integrated 24-hour activity guidelines for the early years

Background

Early childhood is a vital period for development and growth. Promoting beneficial lifestyle behaviours in early childhood can help optimise children's health, development and learning, shape their behaviours in adulthood and offer the best protection against future non-communicable diseases (NCDs). In the Asia-Pacific region, NCDs are significant causes of healthcare burden and mortality. Furthermore, there is also a high prevalence of adverse metabolic risk factors and unhealthy lifestyle behaviours among these children.

Method

Representatives from 19 Asia-Pacific nations and/or jurisdictions developed a consensus statement on integrated 24-hour activity guidelines for the early years using the GRADE-ADOLOPMENT framework.

Findings

These guidelines apply to all infants, toddlers and pre-schoolers below 5 years of age. The guidelines aim to provide a holistic and practical approach to lifestyle activities by framing physical activity, sedentary behaviour and sleep within a 24-hour period. Dietary patterns were included as they play an integral role in metabolic health and energy balance.

Interpretation

Aligned with the World Health Organization's Global Action Plan for the Prevention and Control of NCDs through health promotion interventions in early life, through cultivating healthy lifestyle behaviours in the children's early years, we aim to provide children with the best start in life and reduce the burden of future NCDs in the Asia-Pacific region.

Funding

Funded by Integrated platform for research in advancing metabolic health outcomes of women and children.

Global Matrix 4.0 physical activity report cards grades for children and adolescents: A comparison among 15 Asian countries and regions

Background

/Objective: This paper aimed to compare the report card grades among 15 Asian jurisdictions participating in the Global Matrix 4.0, and to explore differences in regional cultural and policy factors related to physical activity behaviors.

Methods

All participating jurisdictions followed a harmonized process to develop a country report card. Ten required common indicators were assessed, including five behavioral indicators (Overall Physical Activity, Organized Sport and Physical Activity, Active Play, Active Transportation, Sedentary Behavior), four sources of influence indicators (Family and Peers, School, Community and Environment, and Government), and an outcome indicator (Physical Fitness). Letter grades, ranging from A+ to F or incomplete (INC), were assigned to the indicators based on the predefined benchmarks and grading rubric, and were converted to numerical scale for analyses.

Results

The country average scores ranged from F (Indonesia) to B- (Japan), with C+/C/C- the most prevalent grades. The mean behavioral score (D+) was lower than sources of influence score (C+). Poor grades (D or F) were observed for Overall Physical Activity among 73.3% (11/15) of the jurisdictions. Government was the indicator with the highest proportion of A or B grades (66.7%), followed by School (53.3%). Physical Fitness (n = 10) and Active Play (n = 8) were two indicators with the largest number of INC grades.

Conclusions

Poor grades for physical activity and sedentary behavior were generally found in Asian jurisdictions. The better, though modest, grades on the sources of influence have not been translated into favorable behaviors among children and adolescents. The findings also suggested surveillance gaps for physical fitness, active play, and organized sport participation. National-level investments and action plans are needed to ensure physical activity interventions are developed, effectively implemented, and regularly evaluated in multiple settings.

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.