Cross-sectional examination of 24-hour movement behaviours among 3- and 4-year-old children in urban and rural settings in low-income, middle-income and high-income countries: the SUNRISE study protocol

Prevalence and Correlates of Adherence to the Global Total Physical Activity Guideline Based on Step Counting Among 3- to 4-Year-Olds: Evidence From SUNRISE Pilot Studies From 17 Countries

BACKGROUND

There is limited evidence from globally diverse samples on the prevalence and correlates of meeting the global guideline of 180 minutes per day of total physical activity (TPA) among 3- to 4-year-olds.

METHODS

Cross-sectional study involving 797 (49.2% girls) 3- to 4-year-olds from 17 middle- and high-income countries who participated in the pilot phases 1 and 2 of the SUNRISE International Study of Movement Behaviours in the Early Years. Daily step count was measured using thigh-worn activPAL accelerometers. Children wore the accelerometers for at least one 24-hour period. Children were categorized as meeting the TPA guideline based on achieving ≥11,500 steps per day. Descriptive analyses were conducted to describe the proportion of meeting the TPA guideline for the overall sample and each of the sociodemographic variables, and 95% CIs were calculated. Multivariable logistic regression was used to determine the sociodemographic correlates of meeting the TPA guideline.

RESULTS

Mean daily step count was 10,295 steps per day (SD = 4084). Approximately one-third of the sample (30.9%, 95% CI, 27.6-34.2) met the TPA guideline. The proportion meeting the guideline was significantly lower among girls (adjusted OR [aOR] = 0.70, 95% CI, 0.51-0.96) and 4-year-olds (aOR = 0.50, 95% CI, 0.34-0.75) and higher among rural residents (aOR = 1.78, 95% CI, 1.27-2.49) and those from lower middle-income countries (aOR = 1.35, 95% CI, 0.89-2.04).

CONCLUSIONS

The findings suggest that a minority of children might meet the TPA guideline globally, and the risk of not meeting the guideline differed by sociodemographic indicators. These findings suggest the need for more surveillance of TPA in young children globally and, possibly, interventions to improve childhood health and development.

Development and validation of the Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ) in 14 countries: study protocol

INTRODUCTION

Global surveillance of physical activity (PA) of children and adolescents with questionnaires is limited by the use of instruments developed in high-income countries (HICs) lacking sociocultural adaptation, especially in low- and middle-income countries (LMICs); under-representation of some PA domains; and omission of active play, an important source of PA. Addressing these limitations would help improve international comparisons, and facilitate the cross-fertilisation of ideas to promote PA. We aim to develop and assess the reliability and validity of the app-based Global Adolescent and Child Physical Activity Questionnaire (GAC-PAQ) among 8-17 years old in 14 LMICs and HICs representing all continents; and generate the 'first available data' on active play in most participating countries.

METHODS AND ANALYSIS

Our study involves eight stages: (1) systematic review of psychometric properties of existing PA questionnaires for children and adolescents; (2) development of the GAC-PAQ (first version); (3) content validity assessment with global experts; (4) cognitive interviews with children/adolescents and parents in all 14 countries; (5) development of a revised GAC-PAQ; (6) development and adaptation of the questionnaire app (application); (7) pilot-test of the app-based GAC-PAQ; and, (8) main study with a stratified, sex-balanced and urban/rural-balanced sample of 500 children/adolescents and one of their parents/guardians per country. Participants will complete the GAC-PAQ twice to assess 1-week test-retest reliability and wear an ActiGraph wGT3X-BT accelerometer for 9 days to test concurrent validity. To assess convergent validity, subsamples (50 adolescents/country) will simultaneously complete the PA module from existing international surveys.

ETHICS AND DISSEMINATION

Approvals from research ethics boards and relevant organisations will be obtained in all participating countries. We anticipate that the GAC-PAQ will facilitate global surveillance of PA in children/adolescents. Our project includes a robust knowledge translation strategy sensitive to social determinants of health to inform inclusive surveillance and PA interventions globally.

International study of 24-h movement behaviors of the early years (SUNRISE): A pilot study from Iran

BACKGROUND

This study examined the proportion of Iranian children who met the World Health Organization (WHO) Guidelines for physical activity, sedentary behaviour and sleep for children under 5 years. Additionally, it investigated the feasibility and acceptability of the methods to be used in the SUNRISE study.

METHODS

This pilot study was conducted among 83 children aged 3 and 4 years in preschools and health care centres in Iran, in 2022. Physical activity, sedentary behaviour and sleep (ActiGraph wGT3x-BT); fine and gross motor skills (validated activities); and executive functions (the Early Years Toolbox) were assessed.

RESULTS

Only four (4.8%) children met all recommendations of the WHO guidelines. The proportion of children who met MVPA, TPA, screen time, restrained sitting and sleep were 44.6%, 38.6%, 19.3%, 38.6% and 65.1%, respectively. Fifty-two (62.6%) children wore the ActiGraph for at least three full days. A total of 97.6%, 95.1% and 91.5% of children completed anthropometric, EF and motor skill assessments, respectively.

CONCLUSION

This pilot study was feasible and acceptable among Iranian children. Regarding the low proportion of children who met the WHO guidelines, it is recommended that long-term and practical strategies be developed to promote healthier lifestyles among preschool children in Iran.

Prevalence and Health Associations of Meeting the World Health Organization Guidelines for Physical Activity, Sedentary Behavior, and Sleep in Preschool-Aged Children: The SUNRISE Mongolia Pilot and Feasibility Study

BACKGROUND

There is a lack of evidence regarding 24-hour movement behaviors of young children from low- and middle-income countries. This study examined Mongolian preschoolers' adherence to the World Health Organization's guidelines for physical activity, sedentary behavior, and sleep; their associations with health indicators, and the feasibility of the SUNRISE International study in Mongolia.

METHODS

Preschool-aged children were recruited from 5 kindergartens in urban and rural areas of Ulaanbaatar city and Tuv province in Mongolia. Physical activity and sedentary behavior were measured by an ActiGraph accelerometer worn for 5 consecutive days. Screen time and sleep were reported by parents. The National Institute of Health and Early Years Toolboxes were used to assess motor skills and executive function, respectively.

RESULTS

One hundred and one children participated in the study (mean age = 4.82 y, boys = 58), with 88% (n = 89) having complete data for analysis. The proportion of children who met the recommendations for physical activity, sedentary screen time, and sleep was 61%, 23%, and 82%, respectively. Only 7% met all recommendations. Meeting the sleep recommendation individually (P = .032) and in combination with the physical activity recommendation was associated with better gross (P = .019) and fine (P = .042) motor skills. Spending more time in physical activity was positively correlated with motor development. Results confirmed that the SUNRISE study protocol was feasible, age-appropriate, and enjoyable for children.

CONCLUSIONS

The results of the SUNRISE pilot study will help inform the SUNRISE Mongolia main study and lay the groundwork for future research into children's 24-hour movement behaviors in Mongolia.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

Exploring 24-Hour Movement Behaviors in Early Years: Findings From the SUNRISE Pilot Study in Tunisia

PURPOSE

The International Study of Movement Behaviors in the Early Years (SUNRISE) was conducted in Tunisia to assess the proportion of preschoolers who met the World Health Organization guidelines for physical activity, sedentary behavior, and sleep. The study also evaluated the feasibility of the methods for the SUNRISE study.

METHODS

Five kindergartens were recruited from urban and rural areas in Tunisia. Physical activity and sleep duration were assessed using a waist-worn ActiGraph. Screen time and sleep quality were assessed via an interview-administered parent questionnaire. The NIH Toolbox was used.

RESULTS

A total of 112 preschoolers were assessed (50 boys, age = 4.1 [0.58]). Only 18% of children met all recommendations of the World Health Organization guidelines, while 53% met the sedentary screen time (in minutes per day), and 41% met physical activity recommendation (in minutes per day). Eighty-one percent of children met the sleep duration recommendation (in minutes per day). There was good compliance with the ActiGraph protocol.

CONCLUSIONS

This pilot study provided important insights into the feasibility of the study and the movement behaviors of Tunisian preschool children. The results suggest there is a need to promote healthy levels of physical activity and sedentary screen time in children, which should be a priority in public health initiatives, including preschool curricula, in Tunisia.

[Use of screens, sedentary lifestyle, and physical activity in children under six years of age, during the period of preventive and compulsory social isolation in AMBA: online survey]

Introduction

Within the context of the COVID-19 pandemic, children were confined to their homes. The Buenos Aires Metropolitan Area (AMBA) region has the highest urban density in Argentina and has been the epicenter of COVID-19 infections and deaths. The objectives of this study are to characterize the habits of screen use, sedentary lifestyle and physical activity and describe their associations, in children under six years of age from AMBA, Argentina.

Methods

analytical and cross-sectional study, in which data from the online survey (Google Forms®) were used. Through a non-probabilistic convenience sampling, fathers, mothers, legal guardians, and caregivers of children under six years of age were invited to participate. The survey was available during four months of the quarantine period and was made up of 31 questions about screen use, physical activity, and sedentary lifestyle of children.

Results

256 surveys were answered, the majority (79.6%) were female and 50.8% in the age range of 31-40 years.

Conclusion

The television is the most used and children begin to use touch screens from one year. The play time of adults with children and the time that they usually carry out activities such as reading a book or drawing is one to two hours per day. There was an association between owning the screen and using it for more hours. The lower the income level, the more time adults play with their children.

FAMIly Physical Activity, Sedentary behaviour and Sleep (FAMIPASS) study: protocol for a cross-sectional study

INTRODUCTION

The development of children's healthy and active lifestyles, including habit formation for optimal 24-hour movement behaviour, is associated with their family environment. A whole-family study collecting comprehensive data that can evaluate family lifestyle behaviours in different settings in depth has the potential to provide the evidence-based information needed for national guidelines, for designing interventions and for supporting policy-makers' decisions.

METHODS AND ANALYSIS

The FAMIly Physical Activity, Sedentary behaviour and Sleep (FAMIPASS) study is a nationally representative cross-sectional study that will recruit 500 families (with at least 1 child aged between 3 and 8 years) from the urban and rural parts of all three regions of the Czech Republic. To examine the relationship between family environment and children's healthy development (eg, healthy weight) and children's active lifestyle behaviour, anthropometric measures, parents' health-related behaviour (including dietary habits, alcohol and tobacco use, screen time and bedtime rules and 24-hour movement behaviour), socioeconomic data and data about the characteristics of the home and neighbourhood will be collected from parents and children. The 24-hour movement behaviour (eg, sleep, sedentary behaviour and physical activity) will be monitored using wGT3X-BT and GT9X Link ActiGraph accelerometers placed on the non-dominant wrist of the children and their parents for 7 consecutive days. The accelerometers will be set up for each family separately, using the group proximity mode, allowing proximity tagging between devices and establishing the time spent together and parent-child coactivities.

ETHICS AND DISSEMINATION

The overarching methodological protocol of the FAMIPASS project was approved by the Ethics Committee of the Faculty of Physical Culture, Palacký University Olomouc, Czech Republic (reference number: 25/2021). The results and findings will be reported to: (1) the participating families and (2) school representatives and will be (3) presented at national and international conferences and (4) disseminated via peer-reviewed publications.

Prevalence and socio-demographic distributions of meeting RMI Guidelines for Healthy Living among elementary school children in Majuro, Republic of Marshall Islands: a cross-sectional population-based survey

Background

Childhood obesity is high in Republic of Marshall Islands (RMI). We report the prevalence and socio-demographic distribution of selected obesity-related risk factors among children in Majuro, RMI.

Methods

Sixteen elementary schools were approached and students and parents in Grades 1, 3, and 5 invited to participate in this cross-sectional population-based survey. Accelerometry and a questionnaire were used to collect data on children's physical activity (PA), sleep, screen time and dietary behaviours. Descriptive statistics and mixed-effects logistic regression were used to examine differences in the proportions of children meeting selected RMI Healthy Living Guidelines by sex, school grade and school sector.

Findings

Thirteen schools and 958 children were recruited, of which 892 (52.2% girls; mean age 9.3 ± 1.8 years) provided useable data. Around 90% met the PA, 29% screen time, 13% sleep, 69% sugar-sweetened beverage and 56% highly processed food guidelines. The proportion meeting individual guidelines was higher among children in Grade 1 compared with Grade 5. Being a girl (0.27; 95% CI 0.16, 0.46) was associated with lower odds of meeting the PA recommendation. Compared with children from Grade 1, those in Grade 5 had lower odds of meeting the PA (0.28; 95% CI 0.15, 0.55), screen time (0.60; 95% CI 0.40, 0.89), sleep duration (0.33; 95% CI 0.18, 0.59), sugar-sweetened beverage (0.35; 95% CI 0.23, 0.53), and consumption of highly processed foods recommendations (0.49; 95% CI 0.33, 0.72).

Interpretation

While most children in RMI are adequately active, resources are needed to promote healthier levels of screen time, sleep, sugar-sweetened beverage and highly processed food consumption, especially among older children.

Funding

This study was funded by World Diabetes Foundation; Canvasback Missions, RMI; NHMRC Australia (APP1176858); Pacific Community.

Validation of remote assessment of preschool children's anthropometrics and motor skills

Introduction

Remotely delivered treatment and research procedures were rapidly adopted in response to the COVID-19 pandemic. However, it is unclear if these measures are valid. The purpose of this study was to compare the validity of anthropometry and motor skill proficiency measurements collected in a remote-setting to in-person setting among a sample of children ages 3-4 years.

Methods

Child anthropometry and motor skill performance were measured in-person by trained assessors and by parents at home with remote supervision via videoconference by trained assessors. The following measures from the National Institutes of Health Toolbox were collected: anthropometry (height and weight), manual dexterity/manipulation (9-hole pegboard), motor coordination and agility (supine timed up and go), lower body strength (standing long jump), and postural stability (one-leg standing balance). Differences in expert and parent-based measurements were assessed using Bland-Altman plots, paired samples t-tests, and Pearson correlations.

Results

A total of n = 14 children completed the assessments. No significant differences were observed between measurement locations for weight and motor skills (p > .05). Remote measurement of height (M = 101.1 cm, SD = 5.40) was significantly greater than in-person measurements (M = 98.2 cm, SD = 5.16); p < .0001.

Discussion

Remote measurements of motor skills and weight are valid assessments for researchers and clinicians to utilize in young children. Remote assessment with guidance offers comparable and valid estimates as in-person assessment, potentially offering a solution to resource-constricted barriers in research and access to care. There is an opportunity for researchers to fine-tune remote height and individual-level assessment strategies.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Accelerometer-Measured Physical Activity and Sedentary Time among Children in Japan before and during COVID-19: A Cross-Sectional and Longitudinal Analysis

This study examined changes in physical activity (PA), sedentary behavior (SB), screen time, sleep, and executive function among Japanese preschoolers between COVID-19 pre-pandemic and pandemic periods, using cross-sectional and longitudinal data. Accelerometer data from 63 children aged 5-6 years were collected from three kindergartens in Tokyo, Japan, in late 2019 (pre-COVID-19). This was compared to the data of 49 children aged 5-6 years from the same kindergartens, collected in late 2020 (during COVID-19). Sixteen children in the pre-COVID-19 cohort also participated in the 2020 survey and provided data for the longitudinal analysis. The mean minutes of PA, SB, screen time, and sleep duration, as well as executive function, were compared between the pre- and during COVID-19 cohorts. After adjusting for school, sex, and accelerometer wear time, there were no significant differences in any of the measured outcomes between the two cohorts. However, the analysis of longitudinal data revealed significant increases in time spent in SB and on screens, and a decrease in light-intensity PA and sleep duration during the pandemic compared to the pre-pandemic period. Results suggest that, despite the COVID-19 pandemic, young children's activity levels and SB did not significantly differ from pre-pandemic levels. However, school-aged children's SB, light PA, and sleep time were affected, although this cannot be disentangled from the effects of the transition to school.

Reinvest to Assess: Advancing Approaches to Motor Competence Measurement Across the Lifespan

Measurement of motor competence is a vital process to advancing knowledge in the field of motor development. As motor competence is being more widely linked to research in other academic domains (e.g., public health, neuroscience, behavioral health), it is imperative that measurement methodology and protocols are reproducible with high degrees of validity and reliability. When addressing the plethora of available assessments, mostly developed for youth populations, there are potential questions and concerns that need to be addressed and/or clarified. One of the most prominent issues is the lack of a lifespan measure of motor competence, which is at odds with the premise of the field of motor development-studying changes in motor behavior across the lifespan. We address six areas of concern in lifespan assessment which include: (1) lack of assessment feasibility for conducting research with large samples, (2) lack of accountability for cultural significance of skills assessed, (3) limited sensitivity and discriminatory capabilities of assessments, (4) developmental and ecological validity limitations, (5) a problematic definition of 'success' in skill performance, and (6) task complexity and adaptability limitations. It is important to critically analyze current assessment methodologies as it will help us to envision the development and application of potential new assessments through a more comprehensive lens. Ultimately, we propose that reinvesting in how we think about assessment will be highly beneficial for integrating motor development from a holistic perspective, impact scientific advancements in other developmental domains, and increase global and lifespan surveillance of motor competence.

Surveillance to improve physical activity of children and adolescents

The global transition to current low levels of habitual physical activity among children and adolescents began in the second half of the last century. Low physical activity harms health in both the short term (during childhood and adolescence) and long term (during adulthood). In turn, low physical activity could limit progress towards several sustainable development goals, undermine noncommunicable disease prevention, delay physical and mental health recovery from the coronavirus disease 2019 pandemic, increase health-care costs and hinder responses to climate change. However, despite the importance of physical activity, public health surveillance among children and adolescents is very limited globally and low levels of physical activity in children is not on the public health agenda in many countries, irrespective of their level of economic development. This article details proposals for improvements in global public health surveillance of physical activity from birth to adolescence based on recent systematic reviews, international collaborations and World Health Organization guidelines and strategies. Empirical examples from several countries illustrate how improved surveillance of physical activity can lead to public health initiatives. Moreover, better surveillance raises awareness of the extent of physical inactivity, thereby making an invisible problem visible, and can lead to greater capacity in physical activity policy and practice. The time has arrived for a step change towards more systematic physical activity surveillance from infancy onwards that could help inform and inspire changes in public health policy and practice globally.

Integration of Time-Based Recommendations with Current Pediatric Health Behavior Guidelines: Implications for Obesity Prevention and Treatment in Youth

PURPOSE OF REVIEW

Youth-onset obesity is associated with negative health outcomes across the lifespan including cardiovascular diseases, type 2 diabetes, obstructive sleep apnea, dyslipidemias, asthma, and several cancers. Pediatric health guidelines have traditionally focused on the quality and quantity of dietary intake, physical activity, and sleep.

RECENT FINDINGS

Emerging evidence suggests that the timing (time of day when behavior occurs) and composition (proportion of time spent allocated to behavior) of food intake, movement (i.e., physical activity, sedentary time), and sleep may independently predict health trajectories and disease risks. Several theoretically driven interventions and conceptual frameworks feature behavior timing and composition (e.g., 24 h movement continuum, circadian science and chronobiology, intermittent fasting regimens, structured day hypothesis). These literatures are, however, disparate, with little crosstalk across disciplines. In this review, we examine dietary, sleep, and movement guidelines and recommendations for youths ages 0-18 in the context of theoretical models and empirical findings in support of time-based approaches. The review aims to inform a unifying framework of health behaviors and guide future research on the integration of time-based recommendations into current quantity and quality-based health guidelines for children and adolescents.

Movement behaviors during COVID-19 among Latin American/Latino toddlers and pre-schoolers in Chile, Mexico and the US

Movement behaviors (physical activity, sedentary behavior, and sleep) have been impacted by the COVID-19 pandemic. We report changes in and factors that influenced movement behaviors during COVID-19 among Latin American/Latino children aged 1 to 5 years in Chile, Mexico, and the USA. We conducted a cross-sectional study between April and August 2020. Caregivers of 4,136 children (mean age [SD], 3.1 [1.4] years; 51% boys) reported family and household characteristics and changes in their child's movement behaviors. The proportion of children who met the WHO Guidelines decreased significantly in all countries, with the largest declines in meeting the physical activity and screen time guidelines. Factors associated with negative changes in movement behaviors were being an older child, unable to attend an early childhood education and care service, higher parental education levels, not having the opportunity to play with someone, and not having access to spaces to play. The findings highlight the need to minimize disparities faced by families by providing access to early childhood education and care and safe places for children to play.

Associations between Parents' Digital Media Habits, Engagement, Awareness, and Movement Guidelines among Preschool-Age Children: International Ipreschooler Surveillance Study

The 24-hour movement guidelines (24-h MG) recommend behaviors (physical activity, screen time, sleep) to aid appropriate physical and mental development in early childhood. This research examined parents' digital media habits (DMH), engagement (DME), and awareness (DMA) among parents in relation to their preschool-aged children's 24-h MG in Japan and identified and compared the modifiable determinants of adherence to 24-h MG in urban and rural regions. This cross-sectional study included 867 participants and data were obtained from the International Ipreschooler Surveillance Study Among Asians and OtheRs (IISSAAR). The results revealed that adherence to weekend screen time recommendations and weekday sleep duration were higher in the urban region. The parents' digital media variables that predicted moderate-intensity to vigorous-intensity physical activity among preschool-aged children were parents' DME and DMA in the urban regions and parents' DME in the rural regions. The children's screen time was significantly associated with parents' DMH, DME, and DMA in the urban regions and with parents' DMH and DMA in the rural regions (p < 0.005, p < 0.001, respectively). This study confirmed that parents' DMH, DME, and DMA are strong predictors of adherence to 24-h MG among preschool-aged children living in both rural and urban regions in Japan.

Levels and Correlates of Objectively Measured Sedentary Behavior in Young Children: SUNRISE Study Results from 19 Countries

PURPOSE

There is a paucity of global data on sedentary behavior during early childhood. The purpose of this study was to examine how device-measured sedentary behavior in young children differed across geographically, economically, and sociodemographically diverse populations, in an international sample.

METHODS

This multinational, cross-sectional study included data from 1071 children 3-5 yr old from 19 countries, collected between 2018 and 2020 (pre-COVID). Sedentary behavior was measured for three consecutive days using activPAL accelerometers. Sedentary time, sedentary fragmentation, and seated transport duration were calculated. Linear mixed models were used to examine the differences in sedentary behavior variables between sex, country-level income groups, urban/rural settings, and population density.

RESULTS

Children spent 56% (7.4 h) of their waking time sedentary. The longest average bout duration was 81.1 ± 45.4 min, and an average of 61.1 ± 50.1 min·d-1 was spent in seated transport. Children from upper-middle-income and high-income countries spent a greater proportion of the day sedentary, accrued more sedentary bouts, had shorter breaks between sedentary bouts, and spent significantly more time in seated transport, compared with children from low-income and lower-middle-income countries. Sex and urban/rural residential setting were not associated with any outcomes. Higher population density was associated with several higher sedentary behavior measures.

CONCLUSIONS

These data advance our understanding of young children's sedentary behavior patterns globally. Country income levels and population density appear to be stronger drivers of the observed differences, than sex or rural/urban residential setting.

Thinking inside the box: The future of young children's physical activity and the home environment

Parrish et al.'s (2021) investigation of caregiver perceptions of preschoolers' physical activity (PA) within the home environment posits important opportunities for public policy to consider space and available opportunities for PA for preschoolers. This study uncovered qualitative themes on preschoolers' PA in the home, referencing the use of indoor and outdoor spaces, adaptations within the home, interplay between space and caregiving, and variability in child's PA. This work sparks a discussion into the current understanding of the home environment for preschooler PA and future research directions. We propose three main areas to bring forward physical activity and public health research, including 1) role of policies and community (e.g., societal norms) on the home environment and child physical activity, 2) reimagination of the home environment beyond the physical components as a complex system, and 3) advanced measurement of child physical activity using modern technology. Merging these new opportunities with past efforts may help design and facilitate healthier PA and movement patterns for preschoolers now and into the future.

Parental Views on the Acceptability and Feasibility of Measurement Tools Used to Assess Movement Behaviour of Pre-School Children: A Qualitative Study

Movement behaviours (physical activity, sedentary behaviour, and sleep) are important for the health and development of pre-school children (aged 3-4 years). There is limited qualitative research examining the acceptability and feasibility of tools used to assess movement behaviours in pre-schoolers. This study explored parental views on various measurement tools in three deprived areas in England, UK (West Yorkshire, County Durham and Northumberland). The study consisted of a demonstration of the different tools (accelerometers, a diary and a questionnaire), directly followed by focus group discussions. Three focus group discussions with a total of eleven parents and carers were transcribed verbatim and analysed using thematic analysis. Findings revealed four main themes: (1) importance of contextual information when using any measurement tool (e.g., child illness, capturing different routines); (2) practical issues associated with devices (e.g., aversion to devices being attached directly to the skin of their child; concern of larger devices during sleep time); (3) encouraging children to wear a device (e.g., making devices attractive to children-'superpowers'); and (4) presentation of diaries and questionnaires (e.g., age-appropriate movement activities, preference for real-time recording over recall). Practical recommendations for the use of the tools to measure movement behaviours of pre-school children are provided.