Compliance with the WHO 24-hour movement guidelines and associations with body weight status among preschool children in Hong Kong

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.

Adherence to 24-hour integrated activity guidelines among infants, toddlers and preschool children in Singapore

This study examined children's adherence to the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood in infants, toddlers and preschoolers aged 0-6 years. A total of 901 caregivers, comprising 219 infants, 379 toddlers, and 303 preschoolers, provided information regarding their children's physical activity (PA), screen viewing time (SVT), and sleep durations on both weekdays and weekends. Meeting the 24-hour integrated activity guidelines was defined as follows: for infants ≥ 30 minutes per day of tummy time or floor-based play; zero SVT; total sleep of 14-17 hours per day for ages 0-3 months, 12-16 hours per day for ages 4-11 months; for toddlers ≥ 180 minutes of total PA per day; zero SVT under 2 years; <1 hour for ages 2 to less than 3 years; and a total sleep of 11-14 hours per day; for preschoolers ≥ 180 minutes of total PA per day; SVT <1 hour per day; total sleep of 10-13 hours per day for those aged 3-5 years, and 10-11 hours per day for 6-year-olds. Chi-squared tests were used to examine the differences in guideline adherence between weekdays and weekends. Compared to weekdays, during weekends there was a higher proportion of toddlers and preschoolers adhering to the PA guidelines (68.9% vs 50.1%; 78.9% vs 55.4%, respectively, p<0.05), and a lower proportion of toddlers adhering to SVT (38.8% vs 21.8%; p = 0.001). There was a declining adherence to all three activity guidelines as age groups progressed from infants (44.7%) to toddlers (15.8%) and then to preschoolers (9.4%). Concurrently, there was a decrease in adherence to SVT recommendations across the age groups, with adherence rates being highest among infants (83.1%), followed by toddlers (15.8%), and preschoolers (9.4%). Decreasing compliance with all three guidelines, coupled with a corresponding decline in adherence to SVT guidelines as children transition from toddlerhood to preschool age, is a cause for concern. This underscores the need for proactive efforts to educate caregivers about reducing or eliminating SVT among infants and young children.

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.

Parental role-modeling on 24-hour movement behaviors among preschoolers during the COVID-19 pandemic

INTRODUCTION

Little is known about the association between parents' and children's 24-h movement behaviors during the pandemic. This cross-sectional study examined the association between the 24-h movement behaviors of parents and their preschoolers and investigated sex differences in this association.

METHODS

A total of 1740 preschoolers (4.5 ± 0.8 years old, 50.3% boys) and their parents (35.4 ± 4.9 years old, 24.3% males) in China participated in this study and provided valid and complete data. Parents completed an online survey or a written questionnaire in the period between October and December 2020. Preschoolers' and parents' movement behaviors (physical activity [PA], sedentary behavior [SB], screen time, and sleep) and demographic information were reported by the parents. Generalized linear models and logistic regression models were performed.

RESULTS

Positive associations were found between parents' and preschoolers' moderate-to-vigorous intensity PA (β = 0.28; 95% confidence interval [CI]: 0.20, 0.36), total PA (β = 0.21; 95% CI: 0.17, 0.24), and sleep (β = 0.05; 95% CI: 0.03, 0.06) with no apparent sex difference. No significant association was found between parents' and preschoolers' SB or screen time. Girls were more likely to meet all three 24-h movement guidelines when their parents met them (odds ratio = 2.38; 95% CI: 1.42, 4.01), but the relationship was not significant for boys.

CONCLUSIONS

Parental role-modeling was positively associated with children's PA and sleep. This finding suggests that supporting parents' movement behaviors has the potential to promote a healthy lifestyle among preschoolers.

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.

Translation, Cross-Cultural Adaptation and Validation of Movement Behaviour Questionnaire into Malay Language (MBQ-M) for Measuring Movement Behaviors among Preschool Children in Kelantan, Malaysia

Measuring movement behaviours such as physical activity, sedentary behaviour, and sleep throughout 24 h is critical for assessing early childhood development. A valid tool based on cultural adaptation is required to achieve an appropriate result. Thus, this study aims to translate, culturally modify, and validate the movement behaviour questionnaire (MBQ) into Malay (MBQ-M) for preschool children in Kelantan, Malaysia. Permission to translate was obtained and the MBQ was translated using a ten-step process. Ten independent experts evaluated the content validity in terms of the content validity ratio (CVR), scale-level content validity index-average (SCVI-average), item-level content validity index (I-CVI), and the modified kappa statistic. The original questionnaire had modest adjustments: CVR 0.91, SCVI-average 0.93 for clarity, 0.95 for simplicity, and 0.93 for ambiguity. The SCVI-average relevance was 0.95, and the majority kappa value was excellent (>0.74). All the data imply that the overall content validity of the MBQ items is appropriate. Thirty parents assessed face validity, and the scale-level face validity index (S-FVI/Ave) for clarity (0.95) and comprehension (0.95) was satisfactory. In conclusion, the MBQ-M has satisfactory and acceptable content validity and face validity. Thus, it can be used as a valid tool to measure 24-h movement behaviours among preschool children in Malaysia.

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.

Meeting the WHO 24-h guidelines among 2-6-year-old children by family socioeconomic status before and during the COVID-19 pandemic: a repeated cross-sectional study

Background

The World Health Organization (WHO) has developed guidelines for 24-h physical activity (PA), sedentary behaviour and sleep for young children. Lower socioeconomic status (SES) has been linked to a lower likelihood of meeting these guidelines. The outbreak of the novel coronavirus disease (COVID-19) raised concerns about young children's opportunities to meet the guidelines. The study focused on the prevalence of meeting the WHO's 24-h guidelines on screen time (ST), PA and sleep among 2-6-year-old children, in association with family SES, before COVID-19 outbreak in 2019, and during the pandemic in 2020 and 2021 in Finland.

Methods

Data were collected at three timepoints by an online survey through day-care centres. Meeting the WHO 24-h guidelines was defined for each behaviour, from a parent-reported seven-day recall of a typical day on weekdays and weekend days and adapted to the national context. Children were considered to meet the ST guideline if they had maximum of 60 min of ST, the PA guideline if they had minimum of 60 min of outdoor PA, and the sleep guidelines if they had minimum of 11/10/9 h (2/3-5/6 years) of good or very good quality sleep. Binary logistic regression models were used to examine the odds ratios of meeting the guidelines.

Results

The prevalence of meeting the ST guideline was highest before the COVID-19 pandemic in 2019. The PA guideline was most met during the strict pandemic restrictions in 2020. Children from higher SES families were more likely to meet the ST and sleep duration guidelines either on weekdays or weekends. The PA guideline was met more on weekdays by children whose parents had lower education levels at all timepoints. In 2020, sleep quality guideline was less likely met by children with parents with the highest education levels.

Conclusion

Higher SES may increase the odds of young children meeting the ST and sleep duration guidelines, but the results are more complex regarding PA and SES. The impact of the COVID-19 pandemic on ST, outdoor PA, and sleep of young children varied by family SES, and further research is recommended to identify causality of these relationships.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44167-022-00010-4.

Correlates of Physical Activity in 0- to 5-year-olds: A Systematic Umbrella Review and Consultation of International Researchers

BACKGROUND

Many children aged 0-5 years do not meet the WHO physical activity guidelines. To develop effective, evidence-based interventions, it is necessary to understand which factors are associated with physical activity in early childhood.

OBJECTIVE

To summarize the current evidence on correlates of physical activity in 0- to 5-year-old children.

METHODS

First, a systematic umbrella review was conducted following PRISMA guidelines. PubMed, Embase, PsycINFO, and SPORTDiscus were searched up to May 2020 for systematic reviews examining the association between potential correlates and quantitatively measured physical activity in children aged 0-5.9 years. Included reviews were assessed on methodological quality, and results were categorized according to the socio-ecological model. Second, 31 international researchers of physical activity in young children participated in an expert panel to reflect on the outcomes of the umbrella review and propose directions for future research.

RESULTS

Twenty-one reviews were included that examined a total of 98 potential correlates. When synthesizing all reviews, 23 correlates were found with consistent evidence for an association with a physical activity outcome. For most other potential correlates there was inconsistent evidence across reviews for associations with physical activity in young children. Although there was little overlap between the correlates identified in the umbrella review and determinants suggested by the expert panel, both confirmed the importance of socio-cultural, policy, and physical environmental factors in general.

CONCLUSION

Multiple correlates of young children's physical activity were identified. However, various methodological challenges (e.g., measurement instruments) and the large heterogeneity (e.g., study samples, correlates, and outcome measures) hindered formulating definitive conclusions. Moreover, none of the reviews reported on the interrelatedness between correlates, which would align with more holistic understandings of behavior. Our findings indicate the urgent need for establishing a common ground in definitions, assessment methods, and analytical methods to further the field of physical activity research in this tremendously important age group.

PROSPERO REGISTRATION NUMBER

CRD42020184159.

Demographic, parental and home environment correlates of traditional and mobile screen time in preschool-aged children

OBJECTIVES

Research on the correlates of screen time in young children, that could be targeted in future interventions to improve healthy development, has primarily focused on TV viewing with little consideration of mobile devices. The objectives of this study were to examine the associations between a range of demographic, parental, and home environment correlates and preschool-aged children's TV/video viewing, video/computer game playing, and total screen time across traditional and mobile devices.

METHODS

The results of this cross-sectional study are based on 106 preschool-aged children (3-5 years) and their parents recruited in 2018 in Edmonton, Alberta. Children's and parental demographic information, home characteristics, and information about parental and children's screen time use was measured using a parent questionnaire. Simple and multiple linear regression models were conducted.

RESULTS

Each additional hour/day of parental screen time was associated with 12 (95%CI = 5.2, 19.8) minutes/day of children's TV/video, 6 (95%CI = 1.5, 11.0), minutes/day of video/computer game playing, and 19 (95%CI = 8.9, 29.2) minutes/day of total screen time. Additionally, significant associations of technology interference and presence of electronics in the bedroom with children's screen time were attenuated in the multiple regression models.

CONCLUSIONS

Parental screen time appears important to target in future family-based screen time interventions and initiatives. Future studies should explore potential mediating or moderating variables between parental screen time and children's screen time.

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.

Parent-perceived neighbourhood environment, parenting practices and preschool-aged children physical activity and screen time: a cross-sectional study of two culturally and geographically diverse cities

BACKGROUND

Preschool-aged children's physical activity (PA) and screen time (ST) are important health-related behaviours likely influenced by PA opportunities, parental perceptions of neighbourhood safety and parenting practices pertaining to PA and ST. How these factors interact to impact on young children's PA and ST, and whether their effects are generalisable across cultures and geographical location is not known. This study addressed these knowledge gaps by conducting pooled analyses of comparable data from two culturally and geographically diverse samples - Chinese parent-child dyads from an ultra-dense city (Hong Kong, China) and Latino parent-child dyads from a low-density city (Houston, USA).

METHODS

The analytical sample consisted of 164 Hong Kong Chinese and 84 US Latino parent-child dyads with data on socio-demographic characteristics, parent-perceived neighbourhood destinations and facilities for children's PA, physical and social safety-related neighbourhood attributes, PA-related parenting practices and child's ST and accelerometer-assessed PA. Generalised linear models with robust standard errors accounting for neighbourhood-level clustering were used to estimate associations and interaction effects.

RESULTS

Hong Kong Chinese children accumulated less PA than US Latino children, although the latter had more ST. Hong Kong Chinese parents reported more parenting practices promoting inactivity. Neighbourhood PA opportunities were positively related to children's PA only if parental perceptions of neighbourhood safety were favourable, and the associations of physical neighbourhood environment characteristics with children's PA and ST depended on PA-related parenting practices. Community cohesion was positively related to children's PA and negatively related to ST, while parental promotion of ST was positively associated with children's ST. Correlates of children's PA and ST did not differ by city.

CONCLUSIONS

The substantial differences in activity patterns between Hong Kong Chinese and US Latino preschool-aged children observed in this study are likely due to a combination of cultural and built environmental factors. However, the fact that no between-city differences in correlates of PA and ST were detected indicates that both populations of children are equally affected by parent-perceived neighbourhood environmental characteristics and parenting practices. Overall, this study highlights the importance of considering how various individual-, home- and neighbourhood physical and social factors interact to influence young children's health-promoting activity levels.

Effectiveness of a Parent-Focused Intervention Targeting 24-H Movement Behaviors in Preschool-Aged Children: Study Protocol for a Randomized Controlled Trial

Background

Interventions targeting single behaviors of preschool-aged children have been mainstream for some time, but integrated interventions targeting all three 24-h movement behaviors (physical activity [PA], sedentary behavior [SB], and sleep hygiene) are less studied. The aims of this study will be to test the feasibility, acceptability, and effectiveness of a parent-focused intervention for preschool-aged children targeting multiple 24-h movement behaviors.

Methods

This three-arm randomized controlled trial will comprise a 12-week intervention and a 12-week follow-up. A total of 150 parent-child dyads will be recruited and randomly allocated to one of three arms: (1) a PA + SB group (dyadic approach), (2) a PA + SB + sleep group (integrated approach), and (3) a wait-list control group. The theory of planned behavior and behavioral change techniques will guide the development of the intervention via workshops, education materials, interactive questionnaires, and reminders. The intervention strategies for the integrated group will be the same as for the dyadic approach except that the intervention will also target sleep hygiene in addition to PA and SB. The primary outcomes will be preschoolers' 24-h movement behaviors (e.g., activity sleep index, compositional data of PA, SB, screen time, and sleep duration). The secondary outcomes will be preschoolers' sleep quality, weight status, cognitive function, and parents' movement behaviors. The feasibility and acceptability of the intervention will also be evaluated.

Discussion

The proposed study will be a theory-based, parent-focused intervention designed to improve all three 24-h movement behaviors among preschoolers. The trial is expected to improve preschoolers' movement behaviors and health outcomes, as well as their parents' movement behaviors. Given the urgent need to promote active lifestyles, our findings will help to determine best practices for movement behavior change among young children.

Trial Registration

The study is prospectively registered at the Chinese Clinical Trial Registry (ChiCTR2200055958).