Systematic review of sedentary behaviour and health indicators in the early years (aged 0-4 years)

Reducing electronic media use in 2-3 year-old children: feasibility and efficacy of the Family@play pilot randomised controlled trial

Background

Participation in electronic media use among 2–3 year olds is high and associated with adverse health and developmental outcomes. This study sought to test the feasibility and potential efficacy of a family-based program to decrease electronic media (EM) use in 2–3-year-old children.

Methods

Family@play was a six-session pilot randomised controlled trial delivered to parents of 2–3 year-old children from August to September 2012 in a community environment in the Illawarra region of New South Wales, Australia. Development of program content was guided by Social Cognitive and Family Systems Theories. The primary outcome was children’s electronic media use. Secondary outcomes included children’s time in sitting, standing and stepping. Data collectors were blinded to group allocation. Parents completed comprehensive process evaluation measures and participated in focus group discussions following completion of the program. Regression analyses were undertaken and effect sizes calculated using principles of intention to treat.

Results

Twenty-two participants (n = 12 intervention; n = 10 control) provided complete baseline data; complete data from 16 participants (n = 6 intervention; n = 10 control) were available post-intervention. Process evaluation results were high, showing the acceptability of the program. Compared with children in the control group, there were greater decreases in total EM use among children in the intervention group (adjusted difference [95 % CI] = −31.2 mins/day [−71.0–8.6] Cohen’s d = 0.70). Differences for other outcomes were in the hypothesised direction and ranged from small for postural (sitting, standing, stepping) outcomes to moderate to large for individual electronic media (e.g. TV viewing, DVD/video viewing).

Conclusions

This is the first family-based study to engage families of 2–3 year old children outside the United States and target multiple EM behaviours. Family@play was shown to be a feasible and acceptable intervention to deliver to families of 2–3 year old children. Potential efficacy is evident from moderate to large effect sizes. A larger trial is warranted to test the efficacy of the program.

Trial registration

Australian New Zealand Clinical Trials Registry (ACTRN12612000470897).

[Detection and treatment of respiratory disorders in obese children: Obstructive sleep apnea syndrome and obesity hypoventilation syndrome]

Pediatric obesity may induce multiple complications, including cardiovascular and metabolic problems in adulthood. It may also cause respiratory disorders, which are not usually the first-intention diagnosis by physicians. The aim of this study was to evaluate how investigations had been performed in obese children referred to Timone Pediatric Hospital.

PATIENTS AND METHODS

A retrospective study of children referred to our department for severe non-syndromic obesity was conducted. The clinical features comprised history, anthropometric parameters, dietary habits, acanthosis nigricans, symptoms of obstructive sleep apnea syndrome (OSAS) as well as the paraclinical endocrine markers, blood gases, and sleep recordings.

RESULTS

Of 102 patients (mean age, 10.5±3.3 years; BMI Z-score, 4.52±1.5), 29.4% had OSAS symptoms (n=30). Nine had a pathological polysomnography confirming OSAS. Eight of them required ventilation: these children were the most severe with an earlier weight gain (2.17±1.2 years vs. 4.0±2.2 years; P=0.01) and a higher BMI Z-score (7.2±2.3 vs. 4.3±1.1; P=0.027). Obesity hypoventilation syndrome (OHS) was diagnosed in 3.9% of these children (n=4).

CONCLUSION

Diagnosis of OSAS and OHS, often overlooked in obese children, requires a systematic approach and early clinical detection of respiratory disorders. Better accessibility to sleep respiratory explorations would improve quality of care for these children.

Are BMI and Sedentariness Correlated? A Multilevel Study in Children

The purpose of this research was to investigate the relationship between body mass index (BMI) and sedentariness (Sed) in children and to examine the influence of child and school correlates on their variation. The sample comprises 580 children (337 girls, 9-11 years). Sedentariness was assessed with an accelerometer, and BMI was computed. Child- and school-level covariates were analyzed using multilevel models. No significant correlation between Sed and BMI was found. School context explains 5% and 1.5% of the total variance in Sed and BMI, respectively. At the child level, only moderate-to-vigorous physical activity was associated with both Sed (β = -0.02 ± 0.002) and BMI (β = -0.005 ± 0.002). Sleep time is related to Sed (β = -0.42 ± 0.04), while sex (β = 1.97 ± 0.13), biological maturity (β = 1.25 ± 0.07), media in the bedroom (β = 0.26 ± 0.08) and healthy (β = -0.09 ± 0.03) and unhealthy (β = -0.07 ± 0.04) diet scores were associated with BMI. None of the school-level covariates were related to BMI, but access to cafeteria (β = -0.97 ± 0.25), playground equipment (β = -0.67 ± 0.20) and restaurants (β = 0.16 ± 0.08) were related to Sed. In conclusion, Sed and BMI were not correlated. Further, they have different correlates, while children's traits seem to play more relevant roles in their differences in Sed and BMI than the school milieu. This information should be taken into account when strategies to reduce Sed and BMI are implemented.

Knowledge and awareness of Canadian Physical Activity and Sedentary Behaviour Guidelines: a synthesis of existing evidence

The aim of this review was to consolidate and synthesize existing evidence regarding current knowledge and awareness of the Canadian Physical Activity (PA) and Sedentary Behaviour (SB) Guidelines. MEDLINE, Embase, and PsycINFO were searched for peer-reviewed publications pertaining to the guidelines. Content experts, key organizations (i.e., ParticipACTION and the Canadian Fitness and Lifestyle Research Institute), journal Web sites, and service organizations (i.e., the Canadian Society for Exercise Physiology (CSEP) and the Public Health Agency of Canada) were consulted for additional evidence. Scientific publications (n = 6) and research from ParticipACTION and the Canadian Fitness and Lifestyle Research Institute reported that awareness of the guidelines is low, especially with respect to the SB guidelines. Less than 10% of survey respondents from the Canadian population were aware of the PA guidelines, and less than 5% were aware of the SB guidelines. Information on the guidelines was available on 51% of public health unit and CSEP partner Web sites. Online metrics (e.g., downloads, site accessions) from CSEP, the Public Health Agency of Canada, and journal Web sites showed that online accession of the guidelines was high (e.g., all “highly accessed” on journal Web sites). This review showed that awareness of the Canadian PA and SB Guidelines is low among the general population but higher among the scientific and stakeholder communities. Governmental, nongovernmental, and stakeholder organizations should collaborate in creating sustained, long-term, and well-resourced communication plans to reach the Canadian population to raise awareness of PA and SB guidelines and should implement programs to facilitate their uptake.

BMI and Healthcare Cost Impact of Eliminating Tax Subsidy for Advertising Unhealthy Food to Youth

INTRODUCTION

Food and beverage TV advertising contributes to childhood obesity. The current tax treatment of advertising as an ordinary business expense in the U.S. subsidizes marketing of nutritionally poor foods and beverages to children. This study models the effect of a national intervention that eliminates the tax subsidy of advertising nutritionally poor foods and beverages on TV to children aged 2-19 years.

METHODS

We adapted and modified the Assessing Cost Effectiveness framework and methods to create the Childhood Obesity Intervention Cost Effectiveness Study model to simulate the impact of the intervention over the 2015-2025 period for the U.S. population, including short-term effects on BMI and 10-year healthcare expenditures. We simulated uncertainty intervals (UIs) using probabilistic sensitivity analysis and discounted outcomes at 3% annually. Data were analyzed in 2014.

RESULTS

We estimated the intervention would reduce an aggregate 2.13 million (95% UI=0.83 million, 3.52 million) BMI units in the population and would cost $1.16 per BMI unit reduced (95% UI=$0.51, $2.63). From 2015 to 2025, the intervention would result in $352 million (95% UI=$138 million, $581 million) in healthcare cost savings and gain 4,538 (95% UI=1,752, 7,489) quality-adjusted life-years.

CONCLUSIONS

Eliminating the tax subsidy of TV advertising costs for nutritionally poor foods and beverages advertised to children and adolescents would likely be a cost-saving strategy to reduce childhood obesity and related healthcare expenditures.

Correlates of Total Sedentary Time and Screen Time in 9-11 Year-Old Children around the World: The International Study of Childhood Obesity, Lifestyle and the Environment

Purpose

Previously, studies examining correlates of sedentary behavior have been limited by small sample size, restricted geographic area, and little socio-cultural variability. Further, few studies have examined correlates of total sedentary time (SED) and screen time (ST) in the same population. This study aimed to investigate correlates of SED and ST in children around the world.

Methods

The sample included 5,844 children (45.6% boys, mean age = 10.4 years) from study sites in Australia, Brazil, Canada, China, Colombia, Finland, India, Kenya, Portugal, South Africa, the United Kingdom, and the United States. Child- and parent-reported behavioral, household, and neighborhood characteristics and directly measured anthropometric and accelerometer data were obtained. Twenty-one potential correlates of SED and ST were examined using multilevel models, adjusting for sex, age, and highest parental education, with school and study site as random effects. Variables that were moderately associated with SED and/or ST in univariate analyses (p<0.10) were included in the final models. Variables that remained significant in the final models (p<0.05) were considered correlates of SED and/or ST.

Results

Children averaged 8.6 hours of daily SED, and 54.2% of children failed to meet ST guidelines. In all study sites, boys reported higher ST, were less likely to meet ST guidelines, and had higher BMI z-scores than girls. In 9 of 12 sites, girls engaged in significantly more SED than boys. Common correlates of higher SED and ST included poor weight status, not meeting physical activity guidelines, and having a TV or a computer in the bedroom.

Conclusions

In this global sample many common correlates of SED and ST were identified, some of which are easily modifiable (e.g., removing TV from the bedroom), and others that may require more intense behavioral interventions (e.g., increasing physical activity). Future work should incorporate these findings into the development of culturally meaningful public health messages.

Active play opportunities at child care

BACKGROUND AND OBJECTIVES

Physical activity (PA) is important for children's health and development, yet preschoolers are not meeting PA recommendations. The objective of this study was to examine different PA opportunities at child care and how variation in indoor versus outdoor and free versus teacher-led opportunities relate to children's PA.

METHODS

An observational study of 98 children (mean age 4.5 years, 49% girls) from 10 child care centers. Classrooms were observed for at least 4 full days per center (total 50 days) to categorize time into (1) not an active play opportunity (APO); (2) naptime; (3) APO, outdoor free play; (4) APO, outdoor teacher-led; (5) APO, indoor free play; and (6) APO, indoor teacher-led. Children wore accelerometers during observations. Linear regression models examined the influence of APO categories on moderate-vigorous physical activity (MVPA) and sedentary time.

RESULTS

Children's activity was 73% sedentary, 13% light, and 14% MVPA. For 88% of time children did not have APOs, including 26% time as naptime. On average, 48 minutes per day were APOs (41% sedentary, 18% light, and 41% MVPA), 33 minutes per day were outdoors. The most frequent APO was outdoor free play (8% of time); outdoor teacher-led time was <1%. Children were more active and less sedentary outdoors versus indoors and during the child-initiated APOs (indoors and outdoors) versus teacher-led APOs.

CONCLUSIONS

Preschoolers were presented with significantly fewer than recommended opportunities for PA at child care. More APOs are needed for children to meet recommendations, particularly those that encourage more outdoor time, more teacher-led and child-initiated active play, and flexibility in naptime for preschoolers.

Tracking of maternal self-efficacy for limiting young children's television viewing and associations with children's television viewing time: a longitudinal analysis over 15-months

Background

Mothers’ self-efficacy for limiting their children’s television viewing is an important correlate of this behaviour in young children. However, no studies have examined how maternal self-efficacy changes over time, which is potentially important during periods of rapid child development. This study examined tracking of maternal self-efficacy for limiting young children’s television viewing over 15-months and associations with children’s television viewing time.

Methods

In 2008 and 2010, mothers (n = 404) from the Melbourne InFANT Program self-reported their self-efficacy for limiting their child’s television viewing at 4- and 19-months of age. Tertiles of self-efficacy were created at each time and categorised into: persistently high, persistently low, increasing or decreasing self-efficacy. Weighted kappa and multinomial logistic regression examined tracking and demographic and behavioural predictors of change in self-efficacy. A linear regression model examined associations between tracking categories and children’s television viewing time.

Results

Tracking of maternal self-efficacy for limiting children’s television viewing was low (kappa = 0.23, p < 0.001). Mothers who had persistently high or increasing self-efficacy had children with lower television viewing time at 19-months (β = −35.5; 95 % CI = −54.4,-16.6 and β = 37.0; 95 % CI = −54.4,-19.7, respectively). Mothers of children with difficult temperaments were less likely to have persistently high self-efficacy. Mothers who met adult physical activity guidelines had 2.5 greater odds of increasing self-efficacy.

Conclusions

Interventions to increase and maintain maternal self-efficacy for limiting children’s television viewing time may result in lower rates of this behaviour amongst toddlers. Maternal and child characteristics may need to be considered when tailoring interventions.

Physical activity and sedentary behaviour of toddlers and preschoolers in child care centres in Alberta, Canada

OBJECTIVE

To describe duration of physical activity and duration and bouts of sedentary behaviour during child care in a sample of toddlers and preschoolers (19-60 months) from Alberta, Canada, and to examine whether duration and bouts differed among sex, age and parental immigration status groups.

METHODS

One hundred and fourteen children aged 19-60 months from eight child care centres throughout Alberta participated. Data were collected at baseline of a study examining revised Alberta Child Care Accreditation Standards. Duration of physical activity (light (LPA), moderate-to-vigorous (MVPA)) and duration and bouts (1-4, 5-9, 10-14, and ≥15 minutes) of sedentary behaviour during child care were accelerometer-derived using 15-second epochs during October/November, 2013. Median [Interquartile ranges] and ANOVAs, accounting for the clustered nature of the data, were calculated.

RESULTS

Minutes/hour spent in sedentary behaviour, LPA and MVPA were 36.9 [32.9, 40.7], 18.4 [16.0, 20.9] and 4.2 [2.5, 5.6] respectively. Frequency/hour of sedentary bouts lasting 1-4, 5-9, 10-14 and ≥15 mins were 6.7 [6.1, 7.6], 0.9 [0.6, 1.1], 0.4 [0.2, 0.5] and 0.3 [0.2, 0.4] respectively. Preschoolers participated in less sedentary behaviour and more LPA and MVPA, and had fewer sedentary bouts lasting 10-14 and ≥15 mins compared to toddlers (p &lt; 0.05).

CONCLUSION

This is the first Canadian study to report on the duration of physical activity and duration and bouts of sedentary behaviour among both toddlers and preschoolers attending child care centres. These findings suggest child care interventions are needed to increase MVPA and decrease total sedentary behaviour while continuing to promote short sedentary bouts.

Weekly trends in preschoolers' physical activity and sedentary time in childcare

This study sought to examine how the physical activity levels and sedentary time of preschoolers attending center-based childcare varied across the week. Sex differences were also explored. Participants (n=101) wore Actical™ accelerometers (15 s epoch) for five consecutive days during childcare hours only. A multivariate repeated measures analysis of variance was used to evaluate levels of sedentary, light, and moderate-to-vigorous (MVPA) physical activity across the five weekdays. Total physical activity (TPA) was analyzed separately in a univariate repeated measures ANOVA. Sex was entered as an additional between-subjects factor. Levels of sedentary time, LPA, and TPA across the week were found to be statistically significant, and can best be described by quadratic effects. Participants' activity levels and sedentary time typically peaked mid-week. Levels of physical activity and sedentary time were not found to significantly differ based on sex. Childcare centers may benefit from the introduction and/or modification of active play-based programming and curricula, particularly at the start and end of the week where preschoolers' activity levels tend to be lower. Additional investigations are required to confirm these findings.

Longitudinal levels and bouts of objectively measured sedentary time among young Australian children in the HAPPY study

OBJECTIVES

To examine differences in sedentary time and bouts during and outside of childcare/school periods, and changes in sedentary time and bouts over 1-year among children who remained in childcare (childcare subsample) and among those who transitioned to school (school transition subsample).

DESIGN

Longitudinal study.

METHODS

Results are based on 177 children aged 3-5 years at baseline from the Healthy Active Preschool and Primary Years study in Melbourne, Australia. Sedentary time and sedentary bouts (1-4, 5-9, ≥10min) for total days and during/outside of childcare/school on weekdays were accelerometer-derived at baseline (2008) and 1-year follow-up (2009), when 57% of participants had transitioned to school. Repeated-measures ANCOVAs adjusting for wear time were conducted.

RESULTS

Compared to the outside of childcare/school period, children in the school transition subsample spent more time (0.5min/day or 0.9% wear time) in ≥10min sedentary bouts at baseline, participated in 26 more min/day of sedentary time at follow-up, and all participants spent less time (2-16min/day or 2-3% of wear time) in 5-9min sedentary bouts at baseline and follow-up during the childcare/school period (P<0.05). Increases in sedentary time (34-54min/day or 2-3% wear time) and time spent in 1-4min sedentary bouts (18-29min/day or 1-2% of wear time) were observed from baseline to follow-up in both the total sample and school transition sub-sample, for total days and during the childcare/school period (P<0.05).

CONCLUSIONS

School transition was marked by increased sedentary time. School practices, policies, and environments to reduce sedentary time should be explored.

Calibration and cross-validation of a wrist-worn Actigraph in young preschoolers

OBJECTIVE

To calibrate the Actigraph GT3X+ accelerometer for wrist-worn placement in young preschoolers by developing intensity thresholds for sedentary, low- and high-intensity physical activity. Furthermore, to cross-validate the developed thresholds in young preschoolers.

METHODS

Actigraph GT3X+ was used to measure physical activity during structured activities and free play in 38 children (15-36 months). Activity was video recorded and scored into sedentary, low- and high-intensity physical activity based on Children's Activity Rating Scale (CARS) and combined with accelerometer data using a 5 s epoch. Receiver operating characteristic analysis was used to develop intensity thresholds in 26 randomly selected children. The remaining 12 children were used for cross-validation.

RESULTS

Intensity thresholds for sedentary were ≤89 vertical counts (Y) and ≤221 vector magnitude (VM) counts per 5 s and ≥440 Y counts and ≥730 VM counts per 5 s for high-intensity physical activity. Sensitivity and specificity were 60-100% for the developed intensity thresholds. Strong correlations (Spearman rank correlation 0.69-0.91) were found in the cross-validation sample between the developed thresholds for the accelerometer and CARS scoring time in all intensity categories.

CONCLUSION

The developed intensity thresholds appear valid to categorize sedentary behaviour and physical activity intensity categories in children 2 years of age.

Physical environments, policies and practices for physical activity and screen-based sedentary behaviour among preschoolers within child care centres in Melbourne, Australia and Kingston, Canada

BACKGROUND

Characteristics of preschool and child care centres have previously been shown to be associated with children's health behaviours such as physical activity and screen-based sedentary behaviour. This paper investigates differences in physical environments, policies and practices between child care centres in Melbourne, Australia and Kingston, Canada which may be associated with such behaviours.

METHODS

Audits of child care centres were undertaken by trained research assistants for the Healthy Active Preschool and Primary Years (Melbourne, Australia; n = 136) study and the Healthy Living Habits in Pre-School Children (Kingston, Canada; n = 46) study. Twenty-one of the audit items (nine physical environment; 12 policies and practices) were assessed in both samples. Example items included outdoor play and shaded areas, availability of equipment, physical activity instruction for children and staff, opportunities to use electronic media and staff/child interaction during physical activity time. Analyses were completed using SAS version 9.2.

RESULTS

Compared with Australian centres, a higher per cent of Canadian centres had a formal physical activity policy, reported children sat more frequently for 30 min or more and allowed children to watch television. A higher per cent of Australian centres provided an indoor area for physical activity, shade outdoors and physical activity education to staff. Children in Australian centres had access to more fixed play equipment and spent more time outdoors than in Canadian centres.

CONCLUSIONS

These findings may help inform the development of best practice and policy guidelines to enhance opportunities for healthy levels of physical activity and screen-based sedentary behaviour within child care centres in both countries.

Assessment of physical activity and sedentary behavior at preschools in Cape Town, South Africa

BACKGROUND

Overweight and obesity among young South African (SA) children have reached concerning levels. Preschool interventions to promote physical activity (PA) and reduce sedentary behavior (SB) could help curb these trends. However, research has not been conducted to assess these behaviors in SA preschools and how these might differ across income settings. This study aimed to (1) assess, by direct observation, PA and SB patterns of children in a range of preschool settings; (2) determine the influence of socioeconomic status on PA and SB; and (3) identify contextual and individual-level factors associated with PA.

METHODS

Eighty children (4-5 years old) from four low-income and four mid-/high-income preschools in Cape Town were observed using the Observational System for Recording Physical Activity in Children-Preschool Version.

RESULTS

Children spent 73% of their time engaged in SB. Low-income children spent 93% of their time indoors, compared to 79% among mid-/high-income children (p<0.001). Low-income children spent 11% of their time in moderate-to-vigorous PA (MVPA), compared to 8% among mid-/high-income children (p<0.05). Children across all settings were significantly more likely to engage in light PA (LPA) and MVPA if they were outside (relative risk ratio [RRR]=2.48 for LPA; RRR=6.95 for MVPA) and if their activity was adult-initiated (RRR=1.74 for LPA; RRR=1.66 for MVPA). Obese children were significantly less likely to do LPA (RRR=0.47); underweight children were significantly less likely to do LPA (RRR=0.63) and MVPA (RRR=0.26).

CONCLUSIONS

These findings provide information useful for the development of interventions to address PA and SB in SA preschool children.

Longitudinal changes in objectively measured sedentary behaviour and their relationship with adiposity in children and adolescents: systematic review and evidence appraisal

This review aimed to determine longitudinal changes in objectively measured overall sedentary behaviour, and to examine their associations with adiposity in children and adolescents. A search for longitudinal studies was performed using several electronic databases. Of 161 potentially eligible papers, 10 for change in sedentary behaviour and 3 for longitudinal associations with change in adiposity were included. Weighted mean increase in daily sedentary behaviour per year was 5.7% for boys and 5.8% for girls. Only one paper included preschool children, and it showed a decrease in sedentary behaviour. Nine studies were from Western countries. Null associations were reported between sedentary behaviour and adiposity in two studies, the other found that increases in sedentary behaviour were associated with increases in adiposity, but only in those with body mass index above the 50th percentile. There was consistent evidence that sedentary behaviour increases with age in school-age children and adolescents, by approximately 30 min extra daily sedentary behaviour per year. There was little evidence on the influence of changes in sedentary behaviour on changes in adiposity. There is a need for more longitudinal research, for more evidence from outside the Western world, and for more studies that examine 'dose-response' associations between changes in sedentary behaviour and changes in adiposity.

A review of preschool children's physical activity and sedentary time using objective measures

CONTEXT

Identifying current physical activity levels and sedentary time of preschool children is important for informing government policy and community initiatives. This paper reviewed studies reporting on physical activity and time spent sedentary among preschool-aged children (2-5 years) using objective measures.

EVIDENCE ACQUISITION

Databases were searched for studies published up to and including April 2013 that reported on, or enabled the calculation of, the proportion of time preschool children spent sedentary and in light- and moderate to vigorous-intensity physical activity. A total of 40 publications met the inclusion criteria for physical activity and 31 met the inclusion criteria for sedentary time. Objective measures included ActiGraph, Actiwatch, Actical, Actiheart, and RT3 accelerometers, direct observation, and Quantum XL telemetry heart rate monitoring. Data were analyzed in May 2013.

EVIDENCE SYNTHESIS

Considerable variation in prevalence estimates existed. The proportion of time children spent sedentary ranged from 34% to 94%. The time spent in light-intensity physical activity and moderate to vigorous-intensity physical activity ranged from 4% to 33% and 2% to 41%, respectively.

CONCLUSIONS

The considerable variation of prevalence estimates makes it difficult to determine the "true" prevalence of physical activity and sedentary time in preschool children. Future research should aim to reduce inconsistencies in the employed methodologies to better understand preschoolers' physical activity levels and sedentary behavior.

Sedentary behavior and health outcomes: an overview of systematic reviews

OBJECTIVE

1) To synthesize the current observational evidence for the association between sedentary behavior and health outcomes using information from systematic reviews. 2) To assess the methodological quality of the systematic reviews found.

METHODOLOGY/PRINCIPAL FINDINGS

Medline; Excerpta Medica (Embase); PsycINFO; and Web of Science were searched for reviews published up to September 2013. Additional publications were provided by Sedentary Behaviour Research Network members. The methodological quality of the systematic reviews was evaluated using recommended standard criteria from AMSTAR. For each review, improper use of causal language in the description of their main results/conclusion was evaluated. Altogether, 1,044 review titles were identified, 144 were read in their entirety, and 27 were included. Based on the systematic reviews with the best methodological quality, we found in children and adolescents, strong evidence of a relationship between time spent in sedentary behavior and obesity. Moreover, moderate evidence was observed for blood pressure and total cholesterol, self-esteem, social behavior problems, physical fitness and academic achievement. In adults, we found strong evidence of a relationship between sedentary behavior and all-cause mortality, fatal and non-fatal cardiovascular disease, type 2 diabetes and metabolic syndrome. In addition, there is moderate evidence for incidence rates of ovarian, colon and endometrial cancers.

CONCLUSIONS

This overview based on the best available systematics reviews, shows that sedentary behavior may be an important determinant of health, independently of physical activity. However, the relationship is complex because it depends on the type of sedentary behavior and the age group studied. The relationship between sedentary behavior and many health outcomes remains uncertain; thus, further studies are warranted.

Screen-viewing among preschoolers in childcare: a systematic review

Background

Screen-viewing is one of the most common sedentary behaviors among preschoolers. Despite the high prevalence of sedentary behaviors in childcare, little research exists on the context and/or type of activities that account for these particular behaviors. Accordingly, if the amount of screen-viewing accumulated by preschoolers in childcare is not considered, researchers may be underestimating total screen time among this population, as only a portion of their day is being captured (i.e., the home environment). This systematic review provides a synthesis of research on the levels of screen-viewing among preschool-aged children (2.5-5 years) attending childcare (i.e., centre- and home-based childcare). This review also examined the correlates of screen-viewing among preschoolers in this setting. To provide additional contextual information, availability of screen activities was used to help ameliorate the understanding of preschoolers’ screen-viewing behaviors in childcare.

Methods

Twelve electronic databases were searched to retrieve relevant articles for inclusion (dating from 2000 onwards). Additional studies were identified via manual searching techniques (i.e., hand searching and citation tracking). Only English, published peer-reviewed articles that examined preschoolers’ screen-viewing behaviors in childcare (i.e., rates of screen-viewing and access to/opportunities for related activities) were included. No restrictions to study design were applied.

Results

Seventeen international studies (4 experimental; 12 cross-sectional; 1 mixed-methods) published between 2004 and 2014 were examined. Of those, eight studies reported rates of screen-viewing and found that preschoolers spent approximately 0.1 to 1.3 hrs/day and 1.8 to 2.4 hrs/day engaged in this behavior in center- and home-based childcare, respectively. High staff education (negative association) and type of childcare arrangement (notably, home-based childcare in comparison to center-based childcare; positive association) were identified as two correlates in relation to preschoolers’ screen-viewing in childcare. Nine studies spoke to the availability of screen-viewing activities in childcare, and found the childcare environment to be conducive to this behavior.

Conclusions

Despite some variability, preschoolers appear to engage in somewhat high levels of screen-viewing while in childcare, particularly within home-based facilities. This paper also highlighted the conduciveness of the childcare environment with regard to screen-viewing among preschoolers. Additional exploration into the correlates of screen-viewing in childcare is required. (PROSPORO registration: CRD42013005552).

Appropriateness of the definition of 'sedentary' in young children: Whole-room calorimetry study

OBJECTIVES

The present study aimed to measure the energy cost of three common sedentary activities in young children to test whether energy expended was consistent with the recent consensus definition of 'sedentary' as 'any behaviour conducted in a sitting or reclining posture and with an energy cost ≤ 1.5 metabolic equivalents (METs)' (Sedentary Behaviour Research Network, 2012).

DESIGN

Observational study.

METHODS

Whole-room calorimetry measures of television viewing, sitting at a table drawing and reading, and sitting on the floor playing with toys were made in 40 young children (mean age 5.3 years, SD 1.0).

RESULTS

The energy cost of each sedentary activity was consistent with the recent consensus definition of sedentary: 1.17 METs (95% CI 1.07-1.27) for TV viewing; 1.38 METs (95% CI 1.30-1.46) for sitting at a table; and 1.35 METs (95% CI 1.28-1.43) for floor-based play.

CONCLUSIONS

Common sedentary activities in young children have energy costs which are consistent with the recent consensus definition of 'sedentary', and the present study is supportive of this definition.

Activity Begins in Childhood (ABC) - inspiring healthy active behaviour in preschoolers: study protocol for a cluster randomized controlled trial

Background

Today’s children are more overweight than previous generations and physical inactivity is a contributing factor. Modelling and promoting positive behaviour in the early years is imperative for the development of lifelong health habits. The social and physical environments where children spend their time have a powerful influence on behaviour. Since the majority of preschool children spend time in care outside of the home, this provides an ideal setting to examine the ability of an intervention to enhance movement skills and modify physical activity behaviour. This study aims to evaluate the efficacy of the Activity Begins in Childhood (ABC) intervention delivered in licensed daycare settings alone or in combination with a parent-driven home physical activity-promotion component to increase preschoolers’ overall physical activity levels and, specifically, the time spent in moderate to vigorous physical activity.

Methods/design

This study is a single site, three-arm, cluster-randomized controlled trial design with a daycare centre as the unit of measurement (clusters). All daycare centres in the National Capital region that serve children between the ages of 3 and 5, expressing an interest in receiving the ABC intervention will be invited to participate. Those who agree will be randomly assigned to one of three groups: i) ABC program delivered at a daycare centre only, ii) ABC program delivered at daycare with a home/parental education component, or iii) regular daycare curriculum. This study will recruit 18 daycare centres, 6 in each of the three groups. The intervention will last approximately 6 months, with baseline assessment prior to ABC implementation and follow-up assessments at 3 and 6 months.

Discussion

Physical activity is an acknowledged component of a healthy lifestyle and childhood experiences as it has an important impact on lifelong behaviour and health. Opportunities for physical activity and motor development in early childhood may, over the lifespan, influence the maintenance of a healthy body weight and reduce cardiovascular disease risk. If successful, the ABC program may be implemented in daycare centres as an effective way of increasing healthy activity behaviours of preschoolers.

Trial registration

Current Controlled Trials: ISRCTN94022291. Registered in December 2012, first cluster randomized in April 2013.

A qualitative examination of the perceptions of parents on the Canadian Sedentary Behaviour Guidelines for the early years

BACKGROUND

Minimizing sedentary behavior, in particular screen-based sedentary behavior, during the early years is important for healthy growth and development. Consequently, new Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0-4 years) were recently released. Researchers are unclear what messages should supplement the guidelines when disseminating them to parents and when using the guidelines in behaviour-change interventions to increase adoption. The objective of this study was to qualitatively examine parents' perceptions of the new Canadian Sedentary Behaviour Guidelines for the Early Years.

METHODS

Parents with a child ≤4 years who attended a child care centre were purposefully recruited from child care centres. A total of 7 semi-structured focus groups with 2 to 5 parents were conducted from August to November, 2013 by a trained and experienced moderator. Participants were asked a series of open-ended questions pertaining to the Sedentary Behaviour Guidelines information sheet. Initial themes were identified followed by further review and analysis.

RESULTS

For the most part parents thought the guidelines were clear and did not disagree with the recommendations per se. However, some confusion arose around the value of some sedentary activities, such as reading and coloring, for social and cognitive development. Many parents described feeling guilty after reading the guidelines and perceived several barriers in meeting the daily recommendations. Common barriers included the need to balance multiple demands of family life, the prevalence and accessibility of screen technology, and the weather and built environment where families live. Parents expressed the importance of communicating the guidelines early enough for good habits to be established and the need for realistic strategies and ideas to help them meet the recommendations.

CONCLUSIONS

Overall the findings indicate that gain-framed messages around the role of screen-based and non-screen-based sedentary behavior for children's cognitive and social development might be most effective for adoption of the guidelines. Furthermore, providing parents the guidelines early with resources for minimizing sedentary behavior should also be considered. Future research is needed in other demographic groups of parents to confirm these findings.

Early childhood physical activity, sedentary behaviors and psychosocial well-being: a systematic review

OBJECTIVES

Little is known about how health behaviors such as physical activity (PA) and sedentary behaviors (SB) may be associated with psychosocial well-being during the crucial early childhood period. The aim of this study was to undertake a systematic review of associations between PA, SB and psychosocial well-being during early childhood.

METHODS

In February 2013, MEDLINE, PsycINFO, SPORTDiscus and Embase electronic databases were searched. Inclusion criteria were: 1. peer-reviewed publication since 1980 in English; 2. children aged birth-5 years; 3. PA or SB measured during early childhood; 4. an indicator of child psychosocial well-being; and 5. association between PA/SB and psychosocial well-being reported. Studies could be observational or interventions. Data were extracted by one author and entered into a standardized form in February and March 2013.

RESULTS

19 studies were identified: four examined PA, 13 examined SB and two examined PA and SB. No interventions met the inclusion criteria; all included studies were observational. In total, 21 indicators of psychosocial well-being were examined, 13 only once with the remaining eight reported in more than one study. Some dose-response evidence was identified suggesting that PA is positively, and SB inversely, associated with psychosocial well-being.

CONCLUSIONS

Too few studies exist to draw conclusions regarding associations. Future high-quality cohort and intervention studies are warranted particularly investigating dose-response associations.

Sedentary behavior and health outcomes among older adults: a systematic review

Background

In the last decade, sedentary behavior has emerged as a new risk factor for health. The elderly spend most of their awake time in sedentary activities. Despite this high exposure, the impact of this sedentary behavior on the health of this population has not yet been reviewed. We systematically reviewed evidence for associations between sedentary behavior and multiple health outcomes in adults over 60 years of age.

Methods

We searched the Medline, Embase, Web of Science, SPORTDiscus, PsycINFO, CINAHL, LILLACS, and Sedentary Research Database for observational studies published up to May 2013. Additionally, we contacted members of the Sedentary Behaviour Research Network to identify articles that were potentially eligible. After inclusion, the methodological quality of the evidence was assessed in each study.

Results

We included 24 eligible articles in our systematic review, of which only 2 (8%) provided high-quality evidence. Greater sedentary time was related to an increased risk of all-cause mortality in the older adults. Some studies with a moderate quality of evidence indicated a relationship between sedentary behavior and metabolic syndrome, waist circumference, and overweightness/obesity. The findings for other outcomes such as mental health, renal cancer cells, and falls remain insufficient to draw conclusions.

Conclusion

This systematic review supports the relationship between sedentary behavior and mortality in older adults. Additional studies with high methodological quality are still needed to develop informed guidelines for addressing sedentary behavior in older adults.

Television time among Brazilian adolescents: correlated factors are different between boys and girls

Objective. The aim of this study was to identify the prevalence of excess television time and verify correlated factors in adolescent males and females. Methods. This cross-sectional study included 2,105 adolescents aged from 13 to 18 years from the city of Aracaju, Northeastern Brazil. Television time was self-reported, corresponding to the time spent watching television in a typical week. Several correlates were examined including age, skin color, socioeconomic status, parent education, physical activity level, consumption of fruits and vegetables, smoking status, alcohol use, and sports team participation. Results. The prevalence excess television time (≥2 hours/day) in girls and boys was 70.9% and 66.2%, respectively. Girls with low socioeconomic status or inadequate consumption of fruits and vegetables were more likely to have excess television time. Among boys, those >16 years of age or with black skin color were more likely to have excess television time. Conclusions. Excess television time was observed in more than two-thirds of adolescents, being more evident in girls. Correlated factors differed according to sex. Efforts to reduce television time among Brazilian adolescents, and replace with more active pursuits, may yield desirable public health benefits.

A cross-sectional study of the environment, physical activity, and screen time among young children and their parents

Background

To develop evidence-based interventions promoting healthy active lifestyles among young children and their parents, a greater understanding is needed of the correlates of physical activity and screen time in these dyads. Physical environment features within neighborhoods may have important influences on both children and their parents. The purpose of this study was to examine the associations between several features of the physical environment with physical activity and screen time among 511 young children (≤5 years old) and their parents, after adjusting for socio-demographic factors.

Methods

From May to September, 2011, parents of 0–5 year old children from Kingston, Canada completed a questionnaire that assessed socio-demographic characteristics, their physical activity and screen time, and their child’s physical activity and screen time. Guided by a previously developed conceptual framework, several physical environment features were assessed using Geographic Information Systems including, function (walkability), safety (road speed), aesthetics (streetscape), and destination (outdoor play/activity space, recreation facilities, distance to closest park, yard at home). Multilevel linear regression analyses were used to examine the relationships while adjusting for several socio-demographic factors.

Results

The only independent association observed for the physical environment features was between higher outdoor play/activity space and higher screen time levels among parents. Several associations were observed with socio-demographic variables. For physical activity, child age, child care status, and family socioeconomic status (SES) were independent correlates for children while sex was an independent correlate for parents. For screen time, child age and family SES were independent correlates for children while neighborhood SES was an independent correlate for parents.

Conclusions

The findings suggest that socio-demographic factors, including social environment factors, may be more important targets than features of the physical environment for future interventions aiming to promote healthy active lifestyles in young children and their parents. Given this was one of the first studies to examine these associations in young child–parent dyads, future research should confirm and build on these findings.

The Canadian Sedentary Behaviour Guidelines for the Early Years (zero to four years of age) and screen time among children from Kingston, Ontario

OBJECTIVES

To assess the proportion of children meeting the new Canadian Sedentary Behaviour Guidelines for the Early Years (zero to four years of age) and to describe parental attitudes toward and barriers to reducing screen time.

METHODS

Participants included 657 children zero to four years of age from the Kingston, Ontario, area. From May to September 2011, parents completed a questionnaire regarding their child's screen time and their attitudes toward and barriers to reducing their child's screen time.

RESULTS AND CONCLUSIONS

Approximately 32% of children younger than two years of age engaged in no screen time and approximately 46% of children two to four years of age engaged in <1 h per day; thereby, meeting the recommendations of the new guidelines. Most parents believed that their child did not engage in excessive screen time. Physicians and other health professionals should inform parents of these new guidelines and provide strategies to help their children meet targets.

Paediatricians' awareness of, agreement with and use of the new Canadian Physical Activity and Sedentary Behaviour Guidelines for children and youth zero to 17 years of age

OBJECTIVE

To examine the awareness of, agreement with and use of the new Canadian Physical Activity and Sedentary Behaviour Guidelines for children and youth zero to 17 years of age in a sample of Canadian paediatricians.

METHODS

The findings are based on responses from 331 paediatricians across Canada who completed an online survey in February 2013. Frequencies were calculated for each question.

RESULTS

Few paediatricians reported being very familiar with the physical activity (6% for the early years, and 9% for children and youth) or sedentary behaviour guidelines (5% for the early years, children and youth). When made aware of the guidelines, a large percentage strongly agreed or agreed with the physical activity (99% for the early years, and 96% for children and youth) and sedentary behaviour recommendations (96% for the early years, and 94% for children and youth). Of paediatricians who performed well-child visits, 16% and 27% reported almost always making physical activity and sedentary behaviour recommendations, respectively, to parents or caregivers of children in the early years, compared with 37% for both behaviours among children and youth. Thirty-nine per cent (for the early years) and 46% (for children and youth) of paediatricians reported it would be highly feasible to briefly explain the guidelines at a well-child visit. The most common barriers reported for recommending the guidelines were insufficient motivation or support from parents, caregivers or youth, and lack of time.

CONCLUSION

To increase the use of these new evidence-informed guidelines, strategies are needed to increase paediatricians' awareness and reduce perceived barriers.

Top 10 research questions related to physical activity in preschool children

The purpose of this article was to highlight important research needs related to physical activity in 3- to 5-year-old children. We identified research needs in 3 major categories: health effects, patterns of physical activity, and interventions and policies. The top research needs include identifying the health effects of physical activity, the effects of physical activity on the development of healthy weight, the effects of physical activity on learning and behavior, and the health implications of sedentary behavior. Research questions concerning patterns of physical activity include determining the prevalence of 3- to 5-year-olds meeting the current physical activity guidelines; the social and environmental factors that influence physical activity in home, preschool, and community settings; and how physical activity tracks into later childhood, adolescence, and adulthood. Research questions about interventions and policies include identifying the most effective strategies to promote physical activity in home, child care, and community settings and to reach diverse populations of young children, identifying effective intervention implementation and dissemination strategies, and determining the effectiveness of national, state, local, and institutional policies for increasing physical activity. In conclusion, research is needed to establish a full understanding of the health implications of physical activity in 3- to 5-year-old children, to better understand the nature of physical activity behavior in this group, and to learn how to promote physical activity in young children.

Calibration and validation of the ActiGraph GT3X+ in 2-3 year olds

OBJECTIVES

To calibrate and validate the ActiGraph GT3X+ to measure sedentary behaviour and physical activity in 2-3 year olds, using 5-s epochs; and to compare the predictive validity of the resulting cut-points with that of NHANES', Trost's, and Pate's 15-s cut-points.

DESIGN

Cross-sectional study.

METHODS

Eighteen children (2.86 ± 0.60 years) wore an ActiGraph GT3X+ during video-recorded semi-structured calibration activity sessions. Activity was coded following Children's Activity Rating Scale. Receiver Operating Characteristic analysis was used to derive Axis1 and vector magnitude cut-points for sedentary behaviour and moderate-to-vigorous physical activity at 5-s epochs. Agreement with Children's Activity Rating Scale was assessed with Cohen's kappa, Lin's concordance, and Bland-Altman plots. Predictive validity of all cut-points was assessed in an independent sample of 20 children (2.99 ± 0.48 years) video-recorded during free-play, using the same procedures as the calibration phase.

RESULTS

During calibration, vector magnitude cut-points (sedentary behaviour ≤ 96.12 counts; moderate-to-vigorous physical activity ≥ 361.94 counts) showed slightly better classification agreement with Children's Activity Rating Scale than Axis1 cut-points (sedentary behaviour ≤ 5 counts; moderate-to-vigorous physical activity ≥ 165 counts), but the latter showed the lowest bias in estimated sedentary behaviour and moderate-to-vigorous physical activity time. In the validation sample, 5-s Axis1 cut-points showed the best predictive validity and lowest mean differences of all cut-points between predicted and observed sedentary behaviour (-2.31%), light physical activity (-24.40%), and total physical activity time (-0.95%). Moderate-to-vigorous physical activity time was significantly overestimated by all cut-points (128.33-184.17%).

CONCLUSIONS

Because moderate-to-vigorous physical activity was highly overestimated, using only the 5-s Axis1 sedentary behaviour cut-point to distinguish sedentary behaviour from total physical activity is advised. The high accuracy indicates that these cut-points are useful for epidemiological studies involving the sedentary behaviour and physical activity of 2-3 year olds.

Associations of sedentary behavior, sedentary bouts and breaks in sedentary time with cardiometabolic risk in children with a family history of obesity

BACKGROUND

Although reports in adults suggest that breaks in sedentary time are associated with reduced cardiometabolic risk, these findings have yet to be replicated in children.

PURPOSE

To investigate whether objectively measured sedentary behavior, sedentary bouts or breaks in sedentary time are independently associated with cardiometabolic risk in a cohort of Canadian children aged 8-11 years with a family history of obesity.

METHODS

Data from 286 boys and 236 girls living in Quebec, Canada, with at least one biological parent with obesity (QUALITY cohort) were collected from 2005-2008, and analyzed in 2013. Sedentary behavior, light and moderate-to-vigorous physical activity were measured over 7 days using accelerometry. Leisure time computer/video game use and TV viewing over the past 7 days were self-reported. Outcomes included waist circumference, body mass index Z-score, fasting insulin, fasting glucose, triglycerides, HDL-cholesterol, C-reactive protein and a continuous cardiometabolic risk score.

RESULTS

After adjustment for confounders, breaks in sedentary time and the number of sedentary bouts lasting 1-4 minutes were associated with reduced cardiometabolic risk score and lower BMI Z-score in both sexes (all p<0.05). The number of sedentary bouts lasting 5-9 minutes was negatively associated with waist circumference in girls only, while the number of bouts lasting 10-14 minutes was positively associated with fasting glucose in girls, and with BMI Z-score in boys (all p<0.05). Leisure time computer/video game use was associated with increased cardiometabolic risk score and waist circumference in boys, while TV viewing was associated with increased cardiometabolic risk, waist circumference, and BMI Z-score in girls (all p<0.05).

CONCLUSIONS

These results suggest that frequent interruptions in sedentary time are associated with a favourable cardiometabolic risk profile and highlight the deleterious relationship between screen time and cardiometabolic risk among children with a family history of obesity.

Comparison of child morbidity in regions of Ostrava, Czech Republic, with different degrees of pollution: a retrospective cohort study

BACKGROUND

To confirm or refute the hypothesis that the morbidity of children (since birth to age 5) born and living in the heavily polluted (PM10, benzo[a]pyrene) eastern part of Ostrava, Czech Republic, was higher than the morbidity of children living in other parts of the city.

METHODS

Ten pediatricians in 5 districts of Ostrava abstracted the medical records of 1878 children born in 2001-2004 to list all illnesses of each child in ICD-10 codes. The children were divided into four groups according to their residence at birth and thereafter. Most of the children in the eastern area were living in the city district Radvanice and Bartovice.

RESULTS

We report on the incidence of acute illnesses in 1535 children of Czech ethnicity in the first 5 years of life. The most frequent acute illnesses (over 45% of all diagnoses) were upper respiratory infections (URI: J00-J02, J06). In the first year of life, the incidence of URI in 183 children in the eastern area - 372 illnesses/100 children/year - was more than twice as high as in the other 3 areas with a total number of 1352 children. From birth to the age of 5 years, the incidences of pneumonia, tonsillitis, viral infections (ICD-10 code B34) and intestinal infectious diseases were also several times higher in children living in the eastern part of Ostrava. The lowest morbidity was found in children living in the less polluted western part of the city.

CONCLUSIONS

The children born and living in the eastern part of the city of Ostrava had from birth through 5 years significantly higher incidence rates of acute illnesses than children in other parts of Ostrava. They also had a higher prevalence of wheezing, atopic dermatitis and allergic rhinitis.

The correlates of preschoolers' compliance with screen recommendations exist across multiple domains

OBJECTIVE

To investigate the individual, social and physical environment correlates of preschool children's compliance with Australian/Canadian and American Academy of Pediatrics (AAP) screen recommendations.

METHOD

An Ecological Model (EM) was used to identify constructs potentially associated with children's screen time. In 2008-2009, parents in Melbourne, Australia, reported their child's screen time and on a range of potential correlates. Children (n = 935; 54% boys, mean age 4.54 ± 0.70 years) were assessed as meeting or not meeting each of the screen recommendations. Logistic regression assessed bivariable and multivariable associations.

RESULTS

In total, 15 explanatory variables, across the three domains of the EM were associated with boys' and/or girls' compliance with either Australian/Canadian or AAP recommendations. Correlates varied by sex and recommendation. Maternal television viewing time was the only consistent correlate for both boys' and girls' compliance with both recommendations. No demographic groups were identified as being less likely to comply with screen recommendations.

CONCLUSION

Public health programs should take account of the sex-specific nature of correlates of preschool children's screen time. Preschool children across all demographic groups need support to engage in less screen use. Parents may benefit from education and parenting skills to minimize potentially harmful effects of excessive screen time for their child.

Tracking physical activity and sedentary behavior in childhood: a systematic review

CONTEXT

To date, no reviews have investigated the evidence of tracking of physical activity and sedentary behavior specifically during early childhood (aged 0-5.9 years) or from early childhood to middle childhood (aged 6-12 years). It is important to review the evidence of tracking of these behaviors to determine their stability during the foundational early years of life.

EVIDENCE ACQUISITION

A literature search of studies was conducted in seven electronic databases (January 1980 to April 2012). Studies were compared on methodologic quality and evidence of tracking of physical activity or sedentary behavior. Tracking was defined as the stability (or relative ranking within a cohort) of behaviors, such as physical activity and sedentary behavior, over time.

EVIDENCE SYNTHESIS

Eleven studies met the inclusion criteria. All studies reporting physical activity outcomes had high methodologic quality; 71% of studies reporting sedentary behavior outcomes had high methodologic quality. Of the tracking coefficients for physical activity, 4% were large, 60% were moderate, and 36% were small. Of the tracking coefficients for sedentary behavior, 33% were large, 50% were moderate, and 17% were small. Overall, there was evidence of moderate tracking of physical activity during early childhood, and from early childhood to middle childhood, and of moderate-to-large tracking of sedentary behavior during early childhood and from early childhood to middle childhood.

CONCLUSIONS

This review highlights the importance of establishing recommended levels of physical activity and sedentary behavior during the early years of life. Based on this review, the following recommendations are made: (1) early childhood should be targeted as a critical time to promote healthy lifestyle behaviors through methodologically sound prevention studies; and (2) future tracking studies should assess a broad range of sedentary behaviors using objective measures.

Physical activity and sedentary behavior during the early years in Canada: a cross-sectional study

BACKGROUND

Physical activity and sedentary behavior habits are established during early childhood, yet only recently has objectively measured data been available on children aged 5 years and younger. This study presents data on the physical activity and sedentary behaviors of Canadian children aged 3-5 years.

METHODS

Data were collected as part of the Canadian Health Measures Survey between 2009 and 2011. A nationally-representative sample (n = 459) of children aged 3-5 years wore Actical accelerometers during their waking hours for 7 consecutive days. Data were collected in 60-sec epochs and respondents with ≥4 valid days were retained for analysis. Parents reported their child's physical activity and screen time habits in a questionnaire.

RESULTS

Eighty-four percent of 3-4 year old children met the physical activity guideline of 180 minutes of total physical activity every day while 18% met the screen time target of <1 hour per day. Fourteen percent of 5 year old children met the physical activity guideline of 60 minutes of daily moderate-to-vigorous physical activity (MVPA) while 81% met the screen time target of <2 hours per day. Children aged 3-4 years accumulated an average of 352 min/d of total physical activity and 66 minutes of MVPA while 5 year old children accumulated an average of 342 min/d of total physical activity and 68 minutes of MVPA. Children were sedentary for approximately half of their waking hours and spent an average of 2 hours per day in front of screens. Only 15% of 3-4 year olds and 5% of 5 year olds are meeting both the physical activity and sedentary behavior guidelines.

CONCLUSIONS

Promoting physical activity while reducing sedentary behavior is important at all stages of life. The findings of the present study indicate that there remains significant room for improvement in these behaviors among young Canadian children.