A collaborative approach to adopting/adapting guidelines. The Australian 24-hour movement guidelines for children (5-12 years) and young people (13-17 years): An integration of physical activity, sedentary behaviour, and sleep

Abstract

Background

In 2018, the Australian Government updated the Australian Physical Activity and Sedentary Behaviour Guidelines for Children and Young People. A requirement of this update was the incorporation of a 24-hour approach to movement, recognising the importance of adequate sleep. The purpose of this paper was to describe how the updated Australian 24-Hour Movement Guidelines for Children and Young People (5 to 17 years): an integration of physical activity, sedentary behaviour and sleep were developed and the outcomes from this process.

Methods

The GRADE-ADOLOPMENT approach was used to develop the guidelines. A Leadership Group was formed, who identified existing credible guidelines. The Canadian 24-Hour Movement Guidelines for Children and Youth best met the criteria established by the Leadership Group. These guidelines were evaluated based on the evidence in the GRADE tables, summaries of findings tables and recommendations from the Canadian Guidelines. We conducted updates to each of the Canadian systematic reviews. A Guideline Development Group reviewed, separately and in combination, the evidence for each behaviour. A choice was then made to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. We then conducted an online survey (n=237) along with three focus groups (n=11 in total) and 13 key informant interviews. Stakeholders used these to provide feedback on the draft guidelines.

Results

Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Guideline Development Group agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, maintain the wording of the guidelines, preamble, and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-hours), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for children (5-12 years) and young people (13-17 years).

Conclusions

To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used to develop movement behaviour guidelines. The judgments of the Australian Guideline Development Group did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian Guidelines were adopted with only very minor alterations. This allowed the Australian Guidelines to be developed in a shorter time frame and at a lower cost. We recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines that was developed using the GRADE approach is available with all supporting materials. Other countries may consider this approach when developing and/or revising national movement guidelines.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01236-2.

The Effect of GSM Electromagnetic Field Exposure on the Waking Electroencephalogram: Methodological Influences

Although there is consistent evidence that exposure to radiofrequency electromagnetic fields (RF-EMF) increases the spontaneous resting alpha spectral power of the electroencephalogram (EEG), the reliability of this evidence is uncertain as some studies have also failed to observe this effect. The present study aimed to determine whether the effect of RF-EMF exposure on EEG alpha power depends on whether EEG is derived from eyes open or closed conditions and assessed earlier (<5-min) versus later (>25-min) in the exposure interval. Thirty-six adults participated in three experimental sessions, each involving one exposure: "Sham," "Low," and "High" RF-EMF corresponding to peak spatial specific absorption rates averaged over 10 g of 0, 1, and 2 W/kg, respectively. Resting EEG was recorded at baseline (no exposure), during, and after exposure. Alpha power increase was found to be greater for the eyes open than eyes closed EEG during both the High (P = 0.04) and Low (P = 0.04) RF-EMF exposures. There was also a trend toward it being larger at the end, versus the start of the "High" 30-min exposure (P < 0.01; eyes open condition). This suggests that the use of eyes closed conditions, and insufficient RF-EMF exposure durations, are likely explanations for the failure of some studies to detect an RF-EMF exposure-related increase in alpha power, as such methodological choices decrease signal-to-noise ratios and increase type II error.

Framing effects in risk communication messages - Hazard identification vs. risk assessment

The way in which risk communication messages are framed can influence recipients' risk perceptions. Despite this, there is a limited understanding of how framing is responsible for influencing risk perception. One particularly important element may be whether a risk communication message is framed as a completed 'risk assessment' (specifying a magnitude of risk to the public as a function of the exposure level), or as a 'hazard identification' (a statement regarding whether an environmental agent could in principle cause detrimental health effects in humans, without addressing whether such effects may occur in practice). The current study aimed to investigate for the first time whether framing a risk communication message regarding 'mobile phones and health' as a hazard identification or as a risk assessment affects the reader's risk perception. Using an online survey, participants were separated into three groups and shown either an original press release from the International Agency for Research on Cancer regarding mobile phones and cancer (Group 1), or the press release with additional text modules intended to frame the press release as either a risk assessment (Group 2) or a hazard identification (Group 3). The experimental manipulation was successful in that framing the message as a hazard identification reduced the number of people that believed the press release was a risk assessment, whereas framing it as a risk assessment was not able to increase the number of people who thought that it was a risk assessment. However, no differences in risk perception were found between the groups. In an attempt to ascertain the reason for this lack of framing effect on the radiofrequency electromagnetic fields risk perception measures, it was found that pre-existing interpretations of risk and hazard strongly predicted risk perception, regardless of experimental group. Participants who believed that the International Agency for Research on Cancer conducted a hazard identification perceived lower risks and were less convinced that radiofrequency electromagnetic field exposure from mobile phones increases cancer risks. The results of the study demonstrate the importance of understanding the distinction between a hazard identification and a risk assessment, and suggest that radiofrequency electromagnetic field risk communication needs to develop means for empowering the public to differentiate between hazards and risks.

Radiofrequency Electromagnetic Field Exposure and the Resting EEG: Exploring the Thermal Mechanism Hypothesis

There is now strong evidence that radiofrequency electromagnetic field (RF-EMF) exposure influences the human electroencephalogram (EEG). While effects on the alpha band of the resting EEG have been repeatedly shown, the mechanisms underlying that effect have not been established. The current study used well-controlled methods to assess the RF-EMF exposure effect on the EEG and determine whether that effect might be thermally mediated. Thirty-six healthy adults participated in a randomized, double-blind, counterbalanced provocation study. A water-perfusion suit (34 °C) was worn throughout the study to negate environmental influences and stabilize skin temperature. Participants attended the laboratory on four occasions, the first being a calibration session and the three subsequent ones being exposure sessions. During each exposure session, EEG and skin temperature (8 sites) were recorded continuously during a baseline phase, and then during a 30 min exposure to a 920 MHz GSM-like signal (Sham, Low RF-EMF (1 W/kg) and High RF-EMF (2 W/kg)). Consistent with previous research, alpha EEG activity increased during the High exposure condition compared to the Sham condition. As a measure of thermoregulatory activation, finger temperature was found to be higher during both exposure conditions compared to the Sham condition, indicating for the first time that the effect on the EEG is accompanied by thermoregulatory changes and suggesting that the effect of RF-EMF on the EEG is consistent with a thermal mechanism.

Can explicit suggestions about the harmfulness of EMF exposure exacerbate a nocebo response in healthy controls?

While there has been consistent evidence that symptoms reported by individuals who suffer from Idiopathic Environmental Intolerance attributed to Electromagnetic Fields (IEI-EMF) are not caused by EMF and are more closely associated with a nocebo effect, whether this response is specific to IEI-EMF sufferers and what triggers it, remains unclear. The present experiment tested whether perceived EMF exposure could elicit symptoms in healthy participants, and whether viewing an 'alarmist' video could exacerbate a nocebo response. Participants were randomly assigned to watch either an alarmist (N = 22) or control video (N = 22) before completing a series of sham and active radiofrequency (RF) EMF exposure provocation trials (2 open-label, followed by 12 randomized, double-blind, counterbalanced trials). Pre- and post-video state anxiety and risk perception, as well as belief of exposure and symptom ratings during the open-label and double-blind provocation trials, were assessed. Symptoms were higher in the open-label RF-ON than RF-OFF trial (p < .001). No difference in either symptoms (p = .183) or belief of exposure (p = .144) was observed in the double-blind trials. Participants who viewed the alarmist video had a significant increase in symptoms (p = .041), state anxiety (p < .01) and risk perception (p < .001) relative to the control group. These results reveal the crucial role of awareness and belief in the presentation of symptoms during perceived exposure to EMF, showing that healthy participants exhibit a nocebo response, and that alarmist media reports emphasizing adverse effects of EMF also contribute to a nocebo response.

Does precautionary information about electromagnetic fields trigger nocebo responses? An experimental risk communication study

BACKGROUND

Regarding electromagnetic fields from mobile communication technologies, empirical studies have shown that precautionary information given to lay recipients increases their risk perceptions, i.e. the belief that electromagnetic fields are dangerous. Taking this finding one step further, the current study investigates whether precautionary information also leads to higher symptom perceptions in an alleged exposure situation. Building on existing research on nocebo responses to sham electromagnetic fields, an interaction of the precautionary information with personality characteristics was hypothesised.

METHODS

An experimental design with sham exposure to an electromagnetic field of a WLAN device was deployed. The final sample is constituted by N = 137 participants. Participants received either only basic information about the safety of current WLAN exposure limits or in addition also precautionary information (e.g. 'prefer wired connections if wireless technology can be relinquished'). Subsequently, symptoms and other variables were assessed before and after sham exposure to a WLAN electromagnetic field.

RESULTS

Results are not in favour of the hypothesised effects. There was neither a main effect of precautionary information, nor were there any of the hypothesised interaction effects of precautionary information and personality characteristics on perceived symptoms under sham exposure. Exploratory analyses highlight the role of prior risk perception as a predictor of nocebo responses, and of symptom expectations as a mediator between these two variables.

CONCLUSIONS

As the statistical power to detect even small effects was relatively high, we interpret this as a robust indication that precautionary information does not lead to increased nocebo responses by itself. The implications for health authorities´ communication with the public are discussed.

A collaborative approach to adopting/adapting guidelines - The Australian 24-Hour Movement Guidelines for the early years (Birth to 5 years): an integration of physical activity, sedentary behavior, and sleep

Background

In 2017, the Australian Government funded the update of the National Physical Activity Recommendations for Children 0–5 years, with the intention that they be an integration of movement behaviours across the 24-h period. The benefit for Australia was that it could leverage research in Canada in the development of their 24-h guidelines for the early years. Concurrently, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group published a model to produce guidelines based on adoption, adaption and/or de novo development using the GRADE evidence-to-decision framework. Referred to as the GRADE-ADOLOPMENT approach, it allows guideline developers to follow a structured and transparent process in a more efficient manner, potentially avoiding the need to unnecessarily repeat costly tasks such as conducting systematic reviews. The purpose of this paper is to outline the process and outcomes for adapting the Canadian 24-Hour Movement Guidelines for the Early Years to develop the Australian 24-Hour Movement Guidelines for the Early Years guided by the GRADE-ADOLOPMENT framework.

Methods

The development process was guided by the GRADE-ADOLOPMENT approach. A Leadership Group and Consensus Panel were formed and existing credible guidelines identified. The draft Canadian 24-h integrated movement guidelines for the early years best met the criteria established by the Panel. These were evaluated based on the evidence in the GRADE tables, summaries of findings tables and draft recommendations from the Canadian Draft Guidelines. Updates to each of the Canadian systematic reviews were conducted and the Consensus Panel reviewed the evidence for each behaviour separately and made a decision to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. An online survey was then conducted (n = 302) along with five focus groups (n = 30) and five key informant interviews (n = 5) to obtain feedback from stakeholders on the draft guidelines.

Results

Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Consensus Panel agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, keep the wording of the guidelines, preamble and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-h), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for infants (<1 year), toddlers (1–2 years) and preschoolers (3–5 years).

Conclusions

To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used. Following this approach, the judgments of the Australian Consensus Panel did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian recommendations were adopted with very minor alterations. This allowed the Guidelines to be developed much faster and at lower cost. As such, we would recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines, with all supporting materials and developed using a transparent process, is available. Other countries may consider using this approach when developing and/or revising national movement guidelines.

IEI-EMF provocation case studies: A novel approach to testing sensitive individuals

The etiology of Idiopathic Environmental Intolerance attributed to Electromagnetic Fields (IEI-EMF) is controversial. While the majority of studies have indicated that there is no relationship between EMF exposure and symptoms reported by IEI-EMF sufferers, concerns about methodological issues have been raised. Addressing these concerns, the present experiment was designed as a series of individual case studies to determine whether there is a relationship between radiofrequency-electromagnetic field (RF-EMF) exposure and an IEI-EMF individual's self-reported symptoms. Three participants aged 44-64 were tested during a series of sham and active exposure trials (2 open-label trials; 12 randomized, double-blind, counterbalanced trials), where symptom severity and exposure detection were scored using 100 mm visual analogue scales. The RF-EMF exposure was a 902-928 MHz spread spectrum digitally modulated signal with an average radiated power output of 1 W (0.3 W/m² incident power density at the participant). In the double-blind trials, no significant difference in symptom severity or exposure detection was found for any of the participants between the two conditions. Belief of exposure strongly predicted symptom severity score for all participants. Despite accounting for several possible limitations, the present experiment failed to show a relationship between RF-EMF exposure and an IEI-EMF individual's symptoms. Bioelectromagnetics. 39:132-143, 2018. © 2017 Wiley Periodicals, Inc.