The associations between meeting 24-hour movement guidelines and adiposity in Asian Adolescents: The Asia-Fit Study

Compliance with the 24-h movement behaviors guidelines among urban and rural Brazilian preschoolers

BACKGROUND

The importance of movement behaviors for health is well-known, although few studies have examined the compliance with movement guidelines in preschoolers from different living contexts. This study reported the compliance with the 24-h movement behaviors guidelines among low-income Brazilian preschoolers from rural and urban areas, according to age.

METHODS

A total of 453 preschoolers (n = 222 urban), aged between 3 and 5 years, provided physical activity (PA) data (Actigraph wGT3X). Sleep duration, and screen time were parent-reported. Preschoolers were classified as compliant/non- compliant with the 24-h movement guidelines, according to age. The association between prevalence of compliance with the recommendations and the children's living setting were estimated (SPSS; 27.0).

RESULTS

Preschoolers were active (mean = 299.19 ± 76.42; and 369.76 ± 95.56 min/day in urban and rural areas, respectively), though moderate-to-vigorous physical activity (MVPA) time was below the 60 daily minutes recommended in both urban and rural settings (mean = 38.39 ± 21.36; and 47.32 ± 24.28, respectively). None of the urban children complied with the three recommendations simultaneously, while in the rural area, only 2.6% were compliant. Single movement behaviors compliances in the urban setting were 6.8%, 28.8% and 5.4% for PA, sleep, and screen time, respectively; while for rural settings were 16.5%, 21.2%, and 7.4%. Living in the rural area was related to the compliance with PA recommendation for the 5-year-old preschoolers.

CONCLUSION

In both urban and rural Brazilian areas, very few preschoolers are compliant with the guidelines, and more than one third of the children do not comply with any of the recommendations. Strategies and programs to promote compliance with movement behaviors guidelines should consider children's living setting and their age groups.

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.

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

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

Adherence to 24-h movement behaviour guidelines in families with multiple children

BACKGROUND

In 2019, the World Health Organization (WHO) launched the first global movement guidelines for children that combined sleep, physical activity and screen time. Our previous research showed that adherence to age-specific guidelines for screen time was challenging for families with children in different age groups. We aimed to determine whether families with children in different age-based movement guideline categories have poorer adherence to the broader 24-h movement guidelines than those with all children in the same age category.

METHODS

Data were from the 1973-1978 cohort of the Australian Longitudinal Study on Women's Health (seventh survey, 2015) and the women's three youngest children (aged ≤12) (Mothers and their Children's Health sub-study, 2016/2017). The sample was 1787 women (families) with 4064 children (mean age 7.2 [SD 2.9]). Whether children in the family were in the same or different age-based category was determined by matching children's ages in a family against age-based guideline categories for the 24-h movement behaviours. The association between children in the family being in the same or different age-based guideline category on adherence to 24-h movement guidelines, both collectively and individually, was analysed by adjusted logistic regression (binary and multinomial).

RESULTS

Families with children in the same age guideline categories had double the odds of having all children meet 24-h movement guidelines (adjusted odds ratio [OR] 1.95 [95% confidence interval, CI: 1.32, 2.86]). Families with children in the same age categories on the screen guideline had higher odds of all children meeting (2.25 [1.73, 2.93]) and lower odds of some meeting/some failing the screen guideline (0.18 [0.14, 0.25]), than families with all children in different age categories. Families with children in the same age categories on the physical activity guideline had lower odds of all children meeting (0.57 [0.43, 0.75]) or some meeting/some failing the physical activity guideline (0.08 [0.06, 0.12]). No associations were found for sleep guidelines.

CONCLUSIONS

Families with multiple children may need practical advice and strategies on how to adhere to guidelines when children span age categories. This could form part of public health strategies that raise awareness of the guidelines and may improve guideline adherence.

Integrating perceived physical environments and the theory of planned behaviors when explaining adherence to 24-hour movement guidelines in Chinese adolescents

PURPOSES

Most adolescents worldwide do not meet 24-h movement guidelines, which recommend specific level of physical activity, sedentary behavior, and sleep for optimal health. Nevertheless, there remains a lack of understanding regarding how social cognitive and physical environmental factors influence adolescents' compliance with these guidelines. This prospective study aimed to examine the associations between perceived physical environments, constructs of the theory of planned behavior (TPB), habit strength, and adherence to 24-h movement guidelines in Chinese adolescents over a three-month period.

METHODS

A total of 629 Chinese adolescents (Mage  = 14.59 years, SD = 0.64) completed a set of questionnaires comprising perceived physical environmental characteristics, constructs of the TPB, habit strength, and 24-h movement behaviors at baseline and 3 months later. Data analysis was conducted using variance-based structural equation modeling.

RESULTS

Attitude, subjective norm, and perceived behavioral control had a direct effect on intention and intention had a direct effect on number of the guidelines being met. Habit strength was a significant predictor of adherence to the guidelines, although its moderating effect on the intention-behavior relationship was not significant. Perceived neighborhood facility accessibility, school facility availability, and home physical activity equipment had significant indirect effects on intention through attitude, subjective norm, and perceived behavioral control. However, constructs of the TPB did not serve as mediators in the relationship between perceived physical environments and the number of guidelines being met.

CONCLUSION

This study offers preliminary evidence supporting the integration of perceived physical environments and the TPB in predicting adolescents' adherence to 24-h movement guidelines. Future research should consider using experimental study designs with rigorous measures of 24-h movement behaviors to establish causal relationships.

Adherence to 24-Hour Movement Guidelines in Relation to the Risk of Overweight and Obesity Among Children and Adolescents

PURPOSE

Adherence to overall 24-hour Movement Guidelines (24HGs) has been associated with childhood obesity in cross-sectional studies. However, few longitudinal studies have examined such associations, especially in China. We aimed to explore prospective associations between adherence to recommendations of 24HGs and risks of developing overweight and obesity among children and adolescents.

METHODS

We included participants (aged 6-17 years) without overweight and obesity at enrollment from the China Health and Nutrition Survey in 2004-2011 surveys and followed them till 2015. We assigned one point each to the adherence of guidelines for moderate-to-vigorous physical activity, recreational screen time and sleep, and summed them up to indicate the overall level of adherence to 24HGs (range: 0-3 points). The primary outcome was the first occurrence of overweight or obesity. Multivariable cox proportional hazard models were used to evaluate the corresponding associations.

RESULTS

Among 1,382 participants (mean age: 10.3 ± 3.2 years; 48.4% girls), a total of 152 (11%) individuals were identified as incident overweight and obesity during an average of 4.7 years of follow-up. Compared with participants nonadherent to any of the guidelines, those adhering to one (hazard ratio [HR] = 0.38, 95% confidence interval [CI]: 0.21-0.71, p < .01), two (HR = 0.49, 95% CI: 0.28-0.88, p = .02), and three (HR = 0.40, 95% CI: 0.17-0.91, p = .03) recommendations had significantly lower risks of developing overweight and obesity.

DISCUSSION

Children and adolescents who met any recommendations of 24HGs had significantly lower risks of developing subsequent overweight and obesity. Setting achievable goals such as adopting at least one recommendation could be considered in future public health recommendations to accelerate progress in childhood obesity prevention.

Are 24-hour movement recommendations associated with obesity-related indicators in the young population? A meta-analysis

OBJECTIVE

This study aimed to determine the relationship between meeting all three 24-hour movement recommendations (i.e., physical activity, sleep duration, and screen time) and obesity-related indicators among young people.

METHODS

Four databases were systematically searched (PubMed, Scopus, Web of Science, and Cochrane Library).

RESULTS

Meeting the 24-hour movement recommendations was cross-sectionally associated with lower overall obesity-related indicators (r = -0.09, 95% CI: -0.11 to -0.06), but no longitudinal association was found. Regarding each obesity-related indicator separately, meeting all three recommendations was related to lower odds of overweight/obesity (odds ratio = 0.65, 95% CI: 0.56 to 0.76) and obesity alone (odds ratio = 0.28, 95% CI: 0.16 to 0.50). An inverse relationship between meeting 24-hour movement recommendations and BMI, BMI z score, waist circumference, and body fat was also found. Regarding subgroup analysis, the association between 24-hour movement recommendations and overall obesity-related indicators was similar regardless of sex, comparison used (meeting all three vs. not meeting [i.e., those who met zero to two of the movement behaviors] or meeting all three vs. none), and type of measure to assess 24-hour movement recommendations (i.e., self-reported or accelerometer-based measures).

CONCLUSIONS

Meeting all 24-hour movement recommendations may be a crucial factor in maintaining a healthy weight status in the young population.

Associations between combinations of 24-h movement behaviors and physical fitness among Chinese adolescents: Sex and age disparities

OBJECTIVE

To analyze the relationship between 24-h movement behaviors and adolescents' physical fitness, with sex difference and age disparity explored specifically.

METHODS

A total of 135 852 Chinese adolescents aged 13-22 years were included in this cross-sectional study. Self-reported 24-h movement behavioral times, including moderate to vigorous physical activity (MVPA), recreational screen, and sleep, were identified as meeting guidelines based on Canadian recommendations. Physical fitness indicator (PFI) was calculated through sex- and age-specific z scores of body mass index, forced vital capacity, 50 m dash, sit-and-reach, standing long jump, body muscle strength, and endurance running, and then classified as: low level (<20th), middle level (20th-80th), and high level (>80th). Mixed effect logistic regression was applied to analyze the association, and interaction terms were constructed to prove the sex and age disparities.

RESULTS

Only 12.4% of adolescents aged 13-22 years met all three recommendations. The number of meeting guidelines exhibited a typical dose-response relationship with high level PFI (OR = 1.22 [95% CI: 1.19-1.25]), and in detail, meeting MVPA + recreational screen (OR = 2.29 [95% CI: 2.09-2.51]) or MVPA-only (OR = 2.16 [95% CI: 1.93-2.41]) guidelines were better associated with high-level PFI. Besides, meeting MVPA-only guideline was proved with stronger association with high-level PFI for boys (p-interaction = 0.005). The dose-response relationship in boys of the number of guidelines met with PFI was stronger in 19- to 22-year-olds (p-interaction <0.001) and 16- to 18-year-olds (p-interaction = 0.001) than that in 13- to 15-year-olds.

CONCLUSION

The prevalence of meeting 24-h movement behaviors guidelines among Chinese adolescents aged 13-22 years was relatively low. It was associated with adolescents' physical fitness, with meeting MVPA + recreational screen or MVPA-only guidelines bringing greater benefits, and sex difference and age disparity existing.

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.

Association between Types of Screen Time and Weight Status during the COVID-19 Pandemic: A Longitudinal Study in Children and Adolescents

BACKGROUND

This study aimed to investigate the changes in distinct types of screen time and explore their longitudinal association with children and adolescents' weight status.

METHODS

A two-wave longitudinal study was conducted among 2228 children and adolescents (6-19 years) in Shanghai, China, before and during the pandemic. Recreational screen time (watching TV/videos, online gaming, using social media, and browsing webpages), educational screen time (online homework and online class), and BMI were measured using a self-reported questionnaire. Mixed-effects models were constructed to assess the associations between screen time and weight status.

RESULTS

The prevalence of overweight and obesity was 20.5% and 10.2% at baseline, respectively. Both recreational and educational screen time increased significantly over two months. While recreational screen time was found to be a risk factor for obesity, it was not the case for educational screen use. Specifically, adolescents who spent more time watching TV/videos had a higher obesity risk (OR = 1.576). No significant associations were found in children.

CONCLUSIONS

Overweight and obesity were prevalent among children and adolescents in China. Reducing screen-based activities is a promising strategy to prevent unhealthy weight gain in Chinese children and adolescents, while it is necessary to consider the content and distinguish between educational and recreational screen use.

Heatwave and mental health

Physical health has been associated with ambient temperature and heatwave. With the frequent occurrence of heatwave, the adaptive effects and mechanisms on mental health remain uncertain. On the basis of the China Health and Nutrition Survey, we estimated the relationship between heatwaves and self-assessed mental health scores in the Chinese population aged 50 and above. This study has identified that with each additional heatwave event, mental health scores decreased by an average of 0.027 points, which is equivalent to 0.3% of the average level. Heat is more likely to affect groups with low education, no medical insurance, and living in rural areas. In mechanistic exploration, we found that stress emotion is a fully mediating effect. Heat led to reduced health activities and more frequent drinking, which may lead to lower psychological well-being. Moreover, good dietary preference is a regulator that can help mitigate the adverse effects of heat on mental health. This study corroborates the impact of heat on spiritual welfare, and demonstrates the mechanisms and channels of impact, which can help reduce global economic losses due to mental health problems.

Obesity in South and Southeast Asia-A new consensus on care and management

Obesity is a chronic disease in which the abnormal or excessive accumulation of body fat leads to impaired health and increased risk of mortality and chronic health complications. Prevalence of obesity is rising rapidly in South and Southeast Asia, with potentially serious consequences for local economies, healthcare systems, and quality of life. Our group of obesity specialists from Bangladesh, Brunei Darussalam, India, Indonesia, Malaysia, Philippines, Singapore, Sri Lanka, Thailand, and Viet Nam undertook to develop consensus recommendations for management and care of adults and children with obesity in South and Southeast Asia. To this end, we identified and researched 12 clinical questions related to obesity. These questions address the optimal approaches for identifying and staging obesity, treatment (lifestyle, behavioral, pharmacologic, and surgical options) and maintenance of reduced weight, as well as issues related to weight stigma and patient engagement in the clinical setting. We achieved consensus on 42 clinical recommendations that address these questions. An algorithm describing obesity care is presented, keyed to the various consensus recommendations.

Results from the Hong Kong's 2022 report card on physical activity for children and adolescents

Background/objective

This paper aimed to summarize the findings of the third (2022) Active Healthy Kids Hong Kong Report Card on Physical Activity for Children and Adolescents and evaluate the secular trends of physical activity related indicators.

Methods

Five behavioral indicators (Overall Physical Activity, Organized Sport and Physical Activity, Active Play, Active Transportation, and Sedentary Behavior), three outcome indicators (Physical Fitness, Sleep, and Obesity) and four sources of influence indicators (Family and Peers, School, Community and Environment, and Government) were assigned a letter grade (ranging from A+ to F or incomplete) based on the best available evidence following a harmonized approach developed by the Active Healthy Kids Global Alliance. Data sources included published journal articles, government reports, manual searches, and personal contacts; and consisted of both pre-COVID-19 and after-COVID-19 evidence.

Results

Grades for Overall Physical Activity (D−∗∗) and Sedentary Behavior (D) deteriorated compared to the 2018 Report Card. The other three behavioral indicators, Organized Sport and Physical Activity, Active Play, and Active Transportation, were assigned B−, D, and B+, respectively. Physical Fitness (D), Sleep (C−), and Obesity (D−) obtained the same grades as in the 2018 Report Card. School (B) and Government (C+) grades slightly improved, while Community and Environment grade (B) was stable. Family and Peers was not graded due to insufficient evidence.

Conclusions

Despite slight improvements in influence indicators, physical activity and sedentary behavior have changed unfavorably for children and adolescents in Hong Kong. Strategic investments are needed to improve adoption and implementation of effective interventions.

Associations between 24-h Movement Behavior and Internet Addiction in Adolescents: A Cross-Sectional Study

OBJECTIVE

This study aimed to explore the relationship between 24-h activity behavior and Chinese adolescents' Internet addiction.

METHODS

A survey of 2045 adolescents (56.5% boys) was conducted, and adolescents' 24-h movement behavior and Internet addiction were measured via a questionnaire. Descriptive statistics were used to analyze the basic situation of the respondents; chi-square analysis was used to compare gender differences, and logistic regression was used to analyze the relationship between 24-h exercise guide entries and Internet addiction.

RESULTS

From the number of 24-h movement behavior guides, 25.3% of the children did not meet the recommended amount of any kind of activity behavior guide, while 50.4% and 21.7% of the children reached the recommended amount of one and two activity behavior guidelines, respectively; only 3.2% of the children met the recommended amount of all three activity behavior guidelines. Adolescents who did not meet the recommended 24-h activity behavior guidelines were more likely to have Internet addiction (OR = 8.46, 95 CI = 3.06-23.36), and were more likely to have one item (OR = 4.50, 95 CI = 1.64-12.39) or two items (OR = 3.12, 95 CI = 1.11-8.74).

CONCLUSIONS

Physical activity, static behavior, and sleep may all have a greater impact on adolescents' Internet addiction, among which physical activity has a greater impact on adolescents' Internet addiction. Different combinations of 24-h movement behavior have different effects on adolescents' Internet addiction.

Examining Relationships among Chinese Preschool Children's Meeting 24-Hour Movement Guidelines and Fundamental Movement Skills

Background: Few studies have investigated associations between meeting 24-Hour Movement Guidelines and preschool children’s fundamental movement skills (FMS). This study aimed to investigate the associations between Chinese preschoolers meeting various combinations of the Guidelines and FMS, as well as examining gender differences across those outcomes. Methods: A total of 322 preschool children (181 boys and 141 girls) aged 3−6 years old were recruited from five early-childhood education and care services in China. Children’s 7-day physical activity (PA) was assessed using accelerometry, and screen time (ST) and sleep duration were reported by their parents. FMS were assessed by Test of Gross Motor Development 3. Descriptive statistics and gender differences in children’s meeting the Guidelines and FMS were calculated using t-tests for continuous variables and Chi-square tests for categorical variables. Results: Most preschoolers met the sleep and ST guidelines, but only 22.3% met the PA guidelines; 4% of preschoolers did not meet any of the recommendations, while 9.3% met all three recommendations. Boys reported significantly higher compliance with all combined recommendations. There were positive associations between meeting the PA guidelines and both locomotor (β = 0.49; p < 0.001) and object control skills (β = 0.21; p < 0.001). A significantly positive relationship was identified between meeting PA + sleep guidelines and locomotor skills (β = −0.16; p = 0.02). A significantly negative association was observed between preschoolers’ meeting sleep + ST guidelines and locomotor skills (β = 0.31; p = 0.001). Conclusion: Few preschoolers met all three movement behavior guidelines. The findings suggest that PA levels, especially MVPA, are important for the promotion of FMS. Meanwhile, the impacts of ST and sleep on motor development cannot be neglected.

Relationship of 24-Hour Movement Behaviors with Weight Status and Body Composition in Chinese Primary School Children: A Cross-Sectional Study

24 h movement behaviors, specifically physical activity (PA), sedentary behavior, and sleep, play a crucial role in the prevention and intervention of childhood obesity. This study aimed to examine the association of 24 h movement behaviors with weight status and body composition among Chinese primary school children. Using a random stratified sampling, 978 eligible participants (9.1 ± 1.4 years, 53.2% boys) were recruited from 1 May to 15 July 2021. Demographics included children’s age, gender, grade, parents’ education level, and household income. Movement behaviors were measured by validated self-reported scales. Weight status and body composition (percent of body fat, PBF; fat-free mass, FFM; skeletal muscle mass, SMM) were measured objectively. Results indicated that participants who were younger, boys, and at lower grade showed higher guidelines adherence. PA was inversely associated with PBF, while screen time (ST) was positively associated with overweight/obesity risk and FFM. Sleep showed no association with any health indicators. Meeting the behavioral guidelines was associated with better weight status and lower PBF, yet not with FFM and SMM. Interventions to improve the Children’s weight status and PBF should involve enhancing their overall movement behaviors and considering their demographic differences. More research on examining the association of movement guidelines adherence with body composition indicators is needed.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

The Combinations of Physical Activity, Screen Time, and Sleep, and Their Associations with Self-Reported Physical Fitness in Children and Adolescents

Much evidence has indicated that adherence to the 24 h movement guidelines (physical activity, screen time and sleep) is associated with physical health, while little is known about the adherence to the 24 h movement guidelines and self-reported physical fitness in adolescents. This study, therefore, aims to explore the association between the 24 h movement guidelines (in isolation or combination) and self-reported physical fitness in a sample of Chinese adolescents in an age range of 10-17.

METHODS

A convenient sample of 3807 children and adolescents from 12 schools was adopted in the present study. A questionnaire based on the Health Behaviour in School-aged Children was used to assess physical activity and screen time, and the Pittsburgh Sleep Scale was utilized to measure sleep duration. The International Fitness Scale was used to assess physical fitness in study participants. Ordinal logistic regression was performed to estimate the association between adherence to the 24 h movement guidelines and self-reported physical fitness.

RESULTS

Of all study participants, 0.9% of them met the 24 h movement guidelines, and meeting the guidelines was significantly associated with higher levels of self-reported physical fitness. The analysis for the association between specific combinations of 24 h movement guidelines and self-reported physical fitness underscored the importance of meeting the physical activity recommendations.

CONCLUSION

Adherence to more recommendations contained in the 24 h movement guidelines was associated with higher self-reported physical fitness, especially cardiorespiratory fitness and muscular strength. Our study also stressed the importance of promoting moderate to vigorous physical activity in children and adolescents. Further works should focus on the association of a recommendation of adherence with other health indicators and replicate this study on larger samples among Chinese children and adolescents. Additionally, longitudinal or interventional studies that include more socio-demographic factors are needed to explore the association between 24 h movement guidelines and self-reported physical fitness, and the 24 h movement guidelines also should be promoted on a large scale in Chinese children and adolescents. Moreover, it is also needed to gain better insights into the directionality of the relationship between compliance with 24 h movement guidelines and self-reported physical fitness, as well as the mechanisms underlying the associations in Chinese children and adolescents.

Prevalence and trends in Australian adolescents' adherence to 24-hour movement guidelines: findings from a repeated national cross-sectional survey

Background

24-hour movement guidelines recommend a healthy balance of high levels of physical activity, low levels of sedentary behaviour and appropriate sleep duration each day. At present, surveillance data on how Australian adolescents are performing against these guidelines are lacking. This study aims to describe the extent to which Australian secondary school students are adhering to the physical activity, sedentary recreational screen time and sleep duration recommendations outlined in the national 24-hour movement guidelines for children and young people. It also examines whether there are socio-demographic differences in levels of compliance and if there have been significant changes in these behaviours over time.

Methods

A repeated national cross-sectional survey of students in grades 8 to 11 (ages 12-17 years) was conducted in 2009-2010 (n=13,790), 2012-2013 (n=10,309) and 2018 (n=9,102). Students’ self-reported physical activity, screen time and sleep behaviours were assessed using validated instruments administered in schools via a web-based questionnaire.

Results

In 2018, around one in four students (26%) did not meet any of the 24-hour movement guidelines, while only 2% of students met all three. Adherence to the sleep duration recommendation was highest (67%), with substantially smaller proportions of students meeting the physical activity (16%) and screen time (10%) recommendations. Differences in adherence by sex, grade level and socio-economic area were apparent. Students’ compliance with the screen time recommendation has declined over time, from 19% in 2009-2010 to 10% in 2018. However, there has been no significant change in the proportion meeting the physical activity (15% in 2009-2010 cf. 16% in 2018) and sleep duration (69% in 2009-2010 cf. 67% in 2018) recommendations. Compliance with all three guidelines has remained very low (<3%) across each survey round.

Conclusions

There is considerable scope to improve Australian adolescents’ physical activity and sedentary behaviours in line with the national 24-hour movement guidelines. Policy proposals and environmental interventions, particularly those focused on replacing sedentary screen time with physical activity (e.g. promotion of active commuting to/from school), are needed to better support Australian adolescents in meeting the 24-hour movement guidelines.

Independent and combined influences of physical activity, screen time, and sleep quality on adiposity indicators in Indian adolescents

BACKGROUND

Inadequate physical activity (PA), excess screen time (ST), and sub-optimal sleep quality tend to co-occur during adolescence. Yet, little is known about the associations of these behaviors as a cluster with adiposity indicators in Indian adolescents. This study aimed to evaluate the independent and combined influences of PA, ST, and sleep quality on body mass index (BMI) and waist to height ratio (WHtR) in 10-15 years old adolescents in Mumbai, India. A secondary aim was to explore if these influences vary between sexes.

METHODS

Cross-sectional study. Adolescents (n = 772, mean age 13.2 (1.4) years) reported frequency and duration of moderate to vigorous PA (MVPA) and time spent using screens on a previously validated instrument. Sleep quality was estimated using the Pittsburg Sleep Quality Index (PSQI). Weight, height, and waist circumference were measured. Mixed effect logistic regression analyses were performed to explore associations between adiposity indicators (BMI z scores > +1SD and WHtR > 0.5) and unhealthy behaviors (PA < 60 min/d, ST > 120 min/d and PSQI scores > 5), stratified by sex.

RESULTS

The combined prevalence of overweight and obesity was 38.3%. Overall, 62.0 and 85.0% reported MVPA< 60 min/d and ST > 120 min/d respectively. Girls reported higher ST (218.21 (69.01) min/d) as compared to boys (165.3 (101.22) min/d, p < 0.001). Clustering of low PA and excess ST was observed in 69.2% and of all three unhealthy behaviors in 18.8%. Among girls, MVPA < 60 min/d (OR = 1.78, 95% CI 1.54-1.92, p < 0.001) and PSQI scores > 5 (OR = 2.01, 95% CI 1.78-2.25, p < 0.001) predicted increased BMI. The odds of overweight/obesity were 2.10 times higher in boys reporting low PA and 4.13 times higher in those with low PA+ ST > 120 min/d. Clustering of all three unhealthy behaviors increased prevalence of obesity in both sexes.

CONCLUSIONS

The results indicated a co-existence of multiple unhealthy lifestyle factors of obesity and that clustering of these behaviors can further aggravate obesity risk as compared to their independent effects. Integrated interventions that leverage the cumulative benefits of being active, less sedentary and sufficient sleep are warranted to facilitate greater improvements in obesity risk behaviors.