Meeting new Canadian 24-Hour Movement Guidelines for the Early Years and associations with adiposity among toddlers living in Edmonton, Canada

Compliance with the 24-hour movement behavior guidelines and the impact of sleep methods among toddler, preschool, and school-aged children enrolled in the Guelph Family Health Study

Canadian movement guidelines focused on physical activity (PA), sleep, and screen time support childhood development and reduce the risk of chronic disease. Accelerometers are often used to capture these behaviors; however, they are limited in their ability to record daytime sleep due to potential misclassification.

OBJECTIVES

The objectives of this study were to 1) determine the prevalence of children enrolled in the Guelph Family Health Study who met the guidelines and to 2) compare the impact of different sleep measurement methods.

DESIGN/METHODS

Toddlers (1.5-<3 years; n = 128; valid data for all movement behaviors, n = 70), preschoolers (3-<5 years; n = 143; valid data for all movement behaviors, n = 104), and school-aged (5-<6 years; n = 49; valid data for all movement behaviors, n = 31) children were included. Screen time and sleep habits were obtained through parental report and published normative data. PA and sleep were recorded using accelerometers (wGT3X-BT ActiGraph; right hip).

RESULTS

It was found that 66 % of toddler, 44 % of preschool, and 63 % of school-aged children met the screen time guidelines. Further, 63 % of toddler, 98 % of preschooler, and 80 % of school-aged children met PA guidelines. Sleep guideline compliance ranged from 3 % to 83 % in toddler, 27 % to 92 % in preschooler, and 32 % to 90 % in school-aged children. These proportions were found to be significantly different (Cochran's Q and McNemar's tests).

CONCLUSIONS

Nearly all children met PA guidelines. In contrast, less than half to two-thirds met screen time guidelines. Compliance with sleep guidelines varied substantially with measurement method, highlighting the need for standardization.

Exploring Factors Associated With Accelerometer Validity Among Ethnically Diverse Toddlers

PURPOSE

Studying physical activity in toddlers using accelerometers is challenging due to noncompliance with wear time (WT) and activity log (AL) instructions. The aims of this study are to examine relationships between WT and AL completion and (1) demographic and socioeconomic variables, (2) parenting style, and (3) whether sedentary time differs by AL completion.

METHODS

Secondary analysis was performed using baseline data from a community wellness program randomized controlled trial for parents with toddlers (12-35 mo). Parents had toddlers wear ActiGraph wGT3x accelerometers and completed ALs. Valid days included ≥600-minute WT. Analysis of variance and chi-square analyses were used.

RESULTS

The sample (n = 50) comprised racial and ethnically diverse toddlers (mean age = 27 mo, 58% male) and parents (mean age = 31.7 y, 84% female). Twenty-eight families (56%) returned valid accelerometer data with ALs. Participants in relationships were more likely to complete ALs (P < .05). Toddler sedentary time did not differ between those with ALs and those without.

CONCLUSIONS

We found varied compliance with WT instructions and AL completion. Returned AL quality was poor, presenting challenges in correctly characterizing low-activity counts to improve internal validity of WT and physical activity measures. Support from marital partners may be important for adherence to study protocols.

Movement behaviour education for parents in prenatal, postnatal, and pediatric care in Canada: A needs assessment

BACKGROUND

Parents/guardians can greatly influence their child's movement behaviours (i.e., physical activity, sedentary behaviour, and sleep). Yet, they have reported to lack sufficient background knowledge to foster healthy movement habits, and little is known about specific educational gaps. The aim of this study was to explore the educational background and needs regarding promoting healthy movement behaviours in early childhood among parents/guardians living in Canada.

METHODS

A cross-sectional study was conducted with parents/guardians living in Canada who had at least one child under the age of 5 years. Participants completed an online survey capturing their demographics, information they received about movement behaviours in early childhood during their prenatal/postnatal care or child's pediatrician appointments, where they sourced information about these topics, content areas they would like more information on, and preferred format for delivery. Descriptive statistics and frequencies were calculated for all outcome variables and logistic regression was used to explore if sociodemographic variables were associated with receiving movement behaviour-related education across care types.

RESULTS

Among the 576 parents/guardians who completed the survey, many reported no mention of any movement behaviour in their prenatal (49.4%), postnatal (29.6%), and pediatric care (37.2%). Physical activity was the most cited movement behaviour across care types, with 42.4%, 57.9%, and 54.8% of participants indicating this was discussed in their prenatal, postnatal, and pediatric care, respectively. Only 41.7% of parents/guardians reported asking their child's pediatrician about movement behaviours, while most relied on social media (70.9%), internet websites/news articles (68.7%), and family/friends (67.6%). The most sought-after movement behaviour topics included incorporating movement into traditionally sedentary activities (68.8%) and activity ideas to break up sitting time (65.0%), and participants expressed preference to receive more information via social media (63.2%), an online resource package (47.8%), or email (46.6%).

CONCLUSIONS

Given the noted inconsistencies in education relating to movement behaviours in maternal and pediatric care, this study highlights the opportunity for greater integration of this type of education across care types. Ensuring all parents/guardians receive evidence-based and consistent guidance on their child's movement behaviours will help ensure young children receive the best start to a healthy active life.

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.

Suboptimal movement behaviours among children under two years old in early childhood education institutions in urban China: A cross-sectional study

Background

Healthy movement behaviours in early life promote better physical health and facilitate psychological development. Early childhood education (ECE) institutions provide opportunities for caregivers to improve children's movement behaviour practices, but little is known about the current status of movement behaviours among infants and young children in urban China in this context. We aimed to investigate the movement behaviour status of children under two years of age via ECE institutions and compare movement behaviour practices and knowledge between children attending ECE classes and those not attending.

Methods

We conducted the cross-sectional survey from 1 March to 30 April 2023 in Gymboree Play&Music, an ECE institution covering 31 provinces in China. We developed our survey instrument based on World Health Organization (WHO) guidelines to measure children's movement behaviour practices and caregivers' movement behaviour knowledge. We carried out the online questionnaire survey through Sojump, the largest professional online survey platform in China. We sent a quick response (QR) code to Gymboree Play&Music centres; the QR code was linked to a questionnaire intended for caregiver members and non-members coming for experience classes and activities.

Results

We surveyed 3355 primary caregivers, encompassing 504, 536, and 2315 children aged 0-5 months, 6-11 months, and 12-23 months, respectively. Overall, less than half of the children met recommendations in physical activity time (PAT) (19.2%), physical restraint (PR) (45.8%), and screen time (ST) (46.4%) during the last 24 hours. PAT, outdoor time (OT), and sleep duration (SD) in children aged 0-5 months were significantly lower than in the other two age groups, while ST was significantly higher than in the other two age groups during the last 24 hours (all P < 0.001). For children attending ECE classes, PAT, OT, and SD were significantly higher than those not attending ECE during the last 24 hours and the last two weeks (all P < 0.05). All indicators in the long-nursing care time (NCT) group were significantly higher than those in the short-NCT group, while there was no statistical difference in SD between the two groups (66.6% vs 65.6%; P = 0.558).

Conclusions

The status of movement behaviours for children under two years old in urban China is not optimistic, especially for PAT, PR, and ST. Additionally, attending early childhood education classes and primary caregivers' daily nurturing care time are important for infants and young children to adhere to movement guidelines. Consequently, more ECE institution-specific practical strategies and educational materials are needed to promote compliance with movement behaviour guidelines.

Association between maternal and infant screen time with child growth and development: A longitudinal study

BACKGROUND

Sedentary screen time is an early, modifiable risk factor for obesity and poor child development.

OBJECTIVES

To examine the relationship between maternal and infant screen time with child growth and development.

METHODS

Pregnant women were recruited for a cohort study related to maternal and infant development. Screen time was assessed in mothers during pregnancy, and subsequently in children at 3 months, 12 months, and 24 months of age. Child anthropometry was measured, and nuclear magnetic resonance quantified child fat mass. Fat mass index (FMI) was calculated. The Bayley Scales of Infant Development-III were used to assess child development. Linear regression models were used to assess the relationship between screen time and child growth and development, adjusted for covariates and stratified by sex.

RESULTS

Mother/child dyads (n = 89) were mainly white (92.1%), and half were boys (52%). Both sexes increased screen time between 12 months and 24 months (ps <0.05). Child screen time was positively associated with FMI and negatively associated with development scores. In adjusted models, screen time was positively associated with FMI in boys, and meeting the screen time guideline was associated with lower FMI in girls.

CONCLUSION

Greater infant screen time was related to higher adiposity. Though few relationships emerged, a cautionary approach to screen time early in life may benefit child health.

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.

Longitudinal Association of Changes in Parental Correlates With Screen Time in Chinese Preschoolers

BACKGROUND

This study aimed to explore the relationship between the changes in parent-related factors and preschoolers exceeding screen time (ST) recommendations.

METHODS

A longitudinal analysis using 2-year follow-up data from 4 kindergartens (n = 409) was conducted in Zhejiang, China, from 2019 to 2021. Multivariate logistic regression models were used to determine the potential parental modifiable predictors.

RESULTS

The significant associations of baseline ST, change in screen accessibility, and the interaction of preschooler ST with maternal ST change with preschooler follow-up ST were observed. For preschool-aged children with baseline ST ≤ 1 hour per day, the follow-up of preschoolers with ST > 1 hour per day increased significantly when parental clarity of their ST rules decreased or remained low. For preschool children with baseline ST > 1 hour per day, follow-up ST increased significantly when their father kept ST >2 hours per day, when the screen accessibility became or remained easy, or when parental awareness of the ST decreased.

CONCLUSIONS

Changes in parental correlates played an important role in preschooler ST based on 2-year longitudinal data. Early interventions should focus on improving the clarity of parental rules and perceptions, as well as on reducing parental ST and accessibility of home screens.

Examination of physical activity development in early childhood: protocol for a longitudinal cohort study of mother-toddler dyads

BACKGROUND

Physical activity (PA) development in toddlers (age 1 and 2 years) is not well understood, partly because of a lack of analytic tools for accelerometer-based data processing that can accurately evaluate PA among toddlers. This has led to a knowledge gap regarding how parenting practices around PA, mothers' PA level, mothers' parenting stress, and child developmental and behavioral problems influence PA development in early childhood.

METHODS

The Child and Mother Physical Activity Study is a longitudinal study to observe PA development in toddlerhood and examine the influence of personal and parental characteristics on PA development. The study is designed to refine and validate an accelerometer-based machine learning algorithm for toddler activity recognition (Aim 1), apply the algorithm to compare the trajectories of toddler PA levels in males and females age 1-3 years (Aim 2), and explore the association between gross motor development and PA development in toddlerhood, as well as how parenting practices around PA, mothers' PA, mothers' parenting stress, and child developmental and behavioral problems are associated with toddlerhood PA development (Exploratory Aims 3a-c).

DISCUSSION

This study will be one of the first to use longitudinal data to validate a machine learning activity recognition algorithm and apply the algorithm to quantify free-living ambulatory movement in toddlers. The study findings will help fill a significant methodological gap in toddler PA measurement and expand the body of knowledge on the factors influencing early childhood PA development.

Patterns of preschool children's screen time, parent-child interactions, and cognitive development in early childhood: a pilot study

BACKGROUND

The primary objective of this study was to explore the feasibility of a virtual study protocol for a future longitudinal study, including recruitment, study measures, and procedures. The secondary objective was to examine preliminary hypotheses of associations, including 1) the correlations between total duration and patterns of screen time and cognitive development, and 2) the differences in quality of parent-child interactions for two screen-based tasks and a storybook reading task.

METHODS

Participants included 44 children aged 3 years and their parents from Edmonton, Alberta and surrounding areas. Children's screen time patterns (i.e., type, device, content, context) were parental-reported using a 2-week online daily diary design. Children's cognitive development (i.e., working memory, inhibitory control, self-control, and language) was measured virtually through a recorded Zoom session. Parent-child interactions during three separate tasks (i.e., video, electronic game, and storybook reading) were also measured virtually through a separate recorded Zoom session (n = 42). The quality of the interactions was determined by the Parent-Child Interaction System (PARCHISY). Descriptive statistics, Intra-class correlations (ICC), Spearman's Rho correlations, and a one-way repeated measures ANOVA with a post-hoc Bonferroni test were conducted.

RESULTS

All virtual protocol procedures ran smoothly. Most (70%) participants were recruited from four 1-week directly targeted Facebook ads. High completion rates and high inter-rater reliability in a random sample (Diary: 95% for 13/14 days; Cognitive development: 98% 3/4 tests, ICC > 0.93; Parent-child interactions: 100% for 3 tasks, Weighted Kappa ≥ 0.84) were observed for measures. Across cognitive development outcomes, medium effect sizes were observed for five correlations, with positive correlations observed with certain content (i.e., educational screen time) and negative associations observed for total screen time and certain types (show/movie/video viewing) and contexts (i.e., co-use). Medium and large effect sizes were observed for the differences in parent-child interaction quality between the three tasks.

CONCLUSIONS

The virtual study protocol appeared feasible. Preliminary findings suggest it may be important to go beyond total duration and consider type, content, and context when examining the association between screen time and cognitive development. A future longitudinal study using this virtual protocol will be conducted with a larger and more generalizable sample.

Adherence to Canadian 24-Hour Movement Guidelines among infants and associations with development: a longitudinal study

BACKGROUND

To examine: 1) longitudinal adherence to the Canadian 24-Hour Movement Guidelines in a sample of infants and 2) associations between adherence to the guidelines over time and development.

METHODS

Participants were 250 parent-infant dyads from the Early Movers project in Edmonton, Alberta. At 2, 4, and 6 months of age, physical activity, sedentary behaviour, sleep, and development were measured with a parental questionnaire that included items from the Ages & Stages Questionnaire (ASQ-3). Parents also reported the dates six major gross motor milestones were acquired during the first 18 months of life according to World Health Organization criteria. In a sub-sample (n = 93), movement behaviours were also measured with a time-use diary at 2, 4, and 6 months and gross motor development was measured by a physiotherapist using the Alberta Infant Motor Scale (AIMS) at 6 months. Guideline adherence was defined as: 1) ≥ 30 min/day of tummy time, 2) no screen time, some reading time, no restrained bouts > 1 h (time-use diary only), and 3) 14-17 h (2 months) or 12-16 h (4 and 6 months) of sleep per 24-h period. Generalized estimating equations were conducted as well as linear mixed models and linear regression models that adjusted for demographic characteristics.

RESULTS

Few infants met the guidelines at all time-points (questionnaire: 2%; time-use diary: 0%). Infants that met a recommendation at 2 months, compared to those that did not, were 1.8-8.2 times more likely to meet that recommendation at subsequent time-points. Meeting more recommendations across time-points, according to both measures, was associated with a higher mean ASQ-3 gross motor score. Each additional time-point of tummy time recommendation adherence (questionnaire-measured) was associated with a 5-11-day earlier acquisition of independent sitting, crawling, and independent standing milestones. In the sub-sample, each additional time-point of guideline adherence was associated with a 16% higher AIMS score at 6 months.

CONCLUSIONS

Guideline adherence was low across the first 6 months of infancy. Overall, meeting more recommendations over this period appeared important for gross motor development. Parents and caregivers should be targeted as early as possible with guideline dissemination and activation strategies to promote healthy infant development.

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.

Reliability and validity of using the global school-based student health survey to assess 24 hour movement behaviours in adolescents from Saudi Arabia

This study aimed to examine the reliability and validity of Global School-based Student Health Survey (GSHS) to measure 24-hour movement behaviours (moderate-to-vigorous physical activity - MVPA; sedentary behaviour in the form of recreational screen time - ST; and sleep) in Saudi Arabian youths. A total of 120 (50% female) participants aged 12-15 years old were recruited from eight Saudi public middle schools. Participants completed GSHS survey twice and wore GENEActiv accelerometers for seven consecutive days and completed a diary log. ICC indicated moderate reliability in all 24-hour movement behaviours (ICC = 0.41 - 0.60), whereas ST and sleep were strongly reliable for females only (ICC = 0.61 - 0.80). Kappa agreements for all 24-hr movement behaviours were moderate (k = 0.41 - 0.60), but fair in MVPA and ST for males only (k = 0.21 - 0.40). Spearman's indicated low validity (r = 0.1 - 0.3) in MVPA and sleep between GSHS and GENEActiv. However, kappa test results indicated poor-to-slight agreements (k = <0.00 - 0.2) in MVPA and sleep, but fair in MVPA for males only (k = 0.21 - 0.4). GSHS provided good reliability for single items of 24-hour movement behaviours, and the validity was acceptable and in line with other comparable questionnaires.

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.

Screen time and developmental and behavioral outcomes for preschool children

BACKGROUND

One pressing question in the field of pediatrics is whether a dose-response relation is observed between hours of screen time and child outcomes. This study examined the association between hours of screen time (≤1 vs 2 vs ≥3 h/day) and children's developmental and behavioral outcomes.

METHODS

This study included data from 1994 mothers and children in Calgary, Canada, drawn from the All Our Families cohort. At 36 months, children's screen time (h/day), behavior problems, developmental milestones, and vocabulary acquisition were assessed via maternal report. Socio-demographic factors and baseline levels of performance at 24 months were included as covariates.

RESULTS

Compared to ≤1 h/day (47%; n = 935), children using screens 2 h (36%; n = 725) or ≥3 h/day (17%; n = 333) had an increased likelihood of reported behavioral problems (adjusted odds ratio (AOR) 1.30-1.90), delayed achievement of developmental milestones (AOR 1.41-1.68), and poorer vocabulary acquisition (AOR 1.94).

CONCLUSIONS

At 36 months, an association was observed between screen time and children's developmental, language, and behavioral outcomes, suggesting that duration of screen time is associated with poor child development outcomes. Findings provide support for screen time guidelines and emphasize the need for childcare professionals to discuss screen time guidelines with families.

IMPACT

International guidelines recommend that preschoolers spend no more than 1 h/day viewing screens. Research is needed to determine if there is a relation between screen time levels and child developmental and behavioral outcomes. Compared to ≤1 h/day, children viewing screens 2 or ≥3 h/day had an increased likelihood of behavioral problems, delayed achievement of developmental milestones, and poorer vocabulary acquisition. Findings highlight the association between duration of screen time and factors of child development.

Associations between screen time and cognitive development in preschoolers

OBJECTIVES

To examine the cross-sectional associations between screen time and cognitive development in preschoolers.

METHODS

Participants were 97 preschoolers (36 to 60 months) in Alberta and Ontario, Canada in the supporting Healthy physical AcTive Childcare setting (HATCH) study. The time that children spent watching television, videos or DVDs (television time) or playing video or computer games (video game time) on a television, computer, or portable device was assessed using a parental questionnaire. Television time and video game time were summed to calculate total screen time. Adherence to the screen time recommendation (≤1 hour/day) of the Canadian 24-Hour Movement Guidelines was calculated. Expressive vocabulary and working memory were assessed using the Early Years Toolbox. Due to the distribution of working memory, it was categorized as a binary variable based on the median score. The associations between screen time and cognitive development were examined using mixed models (expressive vocabulary) or generalized mixed models (working memory).

RESULTS

Screen time was not associated with expressive vocabulary. Preschoolers who had higher total screen time were less likely to have better working memory (OR=0.52; 95%CI:0.31, 0.88), despite the null associations for television time (P=0.155) and video game time (P=0.079). Preschoolers who met the screen time recommendation were more likely to have higher working memory capacity (OR=3.48; 95%CI:1.06, 11.47), compared to those who did not meet the recommendation.

CONCLUSION

Limiting total screen time to no more than one hour per day may facilitate working memory development in preschoolers. Screen time may be unrelated to expressive language development in this age group.

The impact of new government childcare accreditation standards on children's in-care physical activity and sedentary time

BACKGROUND

A new physical activity and sedentary behaviour accreditation standard criterion for childcare settings was introduced by the provincial government in Alberta, Canada. The primary objective of this study was to examine if changes for in-care physical activity and sedentary time (ST) differed between centres in and around Edmonton, Alberta after implementing the new accreditation standards and non-accredited control centres in and around Ottawa, Ontario. Secondary objectives were to examine whether baseline age group (toddler, preschooler) or the childcare environment moderated any group differences in change of the primary outcomes. Furthermore, accreditation and control group differences in change of children's body mass index (BMI) Z-scores or cognitive development as well as educators' perceptions of the primary outcomes were explored.

METHODS

Participants were 252 toddlers (19-35 months) and preschoolers (36-60 months) in childcare centres from Alberta (n = 11) and Ontario (n = 8) in the supporting Healthy physical AcTive CHildcare setting (HATCH) study. In-care ST, light-intensity physical activity (LPA), and moderate- to vigorous-intensity physical activity (MVPA) were accelerometer-derived before and 6 months after the implementation of the new standards. At both time points, cognitive development (working memory, expressive vocabulary), heights, and weights were measured, and BMI Z-scores were calculated. Additionally, the childcare environment was observed using the Environment and Policy Assessment and Observation (EPAO) and Movement Environment Rating Scale (MOVERS) tools. Demographic characteristics were parent-reported and weather variables were derived from Environment Canada data. Mixed models were conducted.

RESULTS

In adjusted models (n = 241), change in children's in-care ST (B = -0.07, 95%CI: - 1.43,1.29), LPA (B = 0.08, 95%CI: - 0.89,1.05), and log-transformed MVPA (B = 0.01, 95%CI: - 0.09,0.11) were not significantly different between accreditation and control groups. Age group and the childcare environment were not moderators. Significant increases in BMI Z-score (B = 0.19, 95%CI: 0.03,0.35) and high working memory (OR = 3.24, 95%CI: 1.32,7.97) were observed in the accreditation group and significant increases in expressive vocabulary (B = 3.18, 95%CI: 0.05,6.30) were observed in the control group.

CONCLUSIONS

The new accreditation criterion may not significantly change physical activity or ST in childcare settings and therefore may not explain findings for BMI Z-scores and cognitive development. Additional training and resources may be needed.

An Environmental Scan of Existing Canadian Childcare Resources Targeting Improvements in Health Behaviours

The objective was to conduct an environmental scan of existing Canadian childcare resources targeting nutrition, physical activity, sedentary behaviour, and/or sleep. A comprehensive search plan was conducted that involved four search strategies: (1) grey literature databases, (2) customized Google search engines, (3) targeted websites, and (4) consultation with content experts. A resource (i.e., information, materials) must have been created by government or an organization/agency within Canada, available in English, intended for childcare educators or directors working with children ≤ 5 years of age, and focused on targeting improvements in nutrition, physical activity, sedentary behaviour, and/or sleep. The quality of each included resource was assessed using a modified version of the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist. A total of 192 eligible resources were included. Most resources targeted only nutrition (n = 101) or physical activity (n = 60), and few resources targeted only sedentary behaviour (n = 2) or sleep (n = 1). The remaining 28 resources targeted more than one health behaviour. The 4 most common topics of resources were menu/meal planning (n = 55), healthy nutrition practices/environment (n = 37), physical activities/games (n = 33), and nutrition/food literacy (n = 20). Only 52 included resources cited evidence. One-third of the included resources (n = 64) were rated as high quality, including 55 that received a point for the significance criterion. Therefore, numerous high quality Canadian childcare resources exist for nutrition and physical activity. Future resource development is needed for sedentary behaviour and sleep. Findings can assist future intervention work and the database of resources can be utilized by relevant stakeholders to support other childcare initiatives.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10643-021-01266-2.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

Associations between meeting 24-hour movement guidelines and health in the early years: A systematic review and meta-analysis

This systematic review examined the compliance with the 24-h movement guidelines, and investigated its associations with health indicators for healthy children under 5 years of age. MEDLINE, PsycINFO, EMBASE, PubMed, Web of Science and SPORTDiscus were searched for peer-reviewed studies and the last search was conducted on 27 October 2020. The Newcastle-Ottawa Scales were used to assess the quality of included studies. Eighteen articles including 8,943 participants from 11 countries were included. On average around 13% of the children met all three guidelines. Meta-analyses of the associations between meeting all three guidelines and adiposity yielded no significant results (r = - 0.03; 95% CI = - 0.12, 0.06; I² = 51%; P = 0.48). Meeting more guidelines was associated with better psychosocial health (3/4 studies). Associations between meeting individual or combined guidelines and motor development yielded mixed results (2/2 studies), while no associations between meeting guidelines and cognitive development were observed (1 study). Compliance with all three guidelines was low. Further evidence is required to understand the associations between meeting the 24-h movement guidelines and health outcomes. Nevertheless, there was evidence of a dose-response relationship between meeting the guidelines and better psychosocial health in the early years.

Exploring Preschoolers' Physical Activity and Sedentary Time During Outdoor Play at Childcare: A Cross-Sectional Analysis of the Supporting Physical Activity in the Childcare Environment Study

BACKGROUND

Moderate-to-vigorous physical activity (MVPA) offers many health benefits for preschoolers (2.5-5 y). In childcare, MVPA is predominantly accumulated outdoors, with higher rates purported among children within the first few minutes outside. The Supporting Physical Activity in the Childcare Environment intervention included shorter, more frequent outdoor play sessions; this study sought to explore children's activity levels during various outdoor play schedules.

METHODS

During the final week of the Supporting Physical Activity in the Childcare Environment intervention, preschoolers wore an Actical™ accelerometer for 5 days during childcare and staff logged outdoor times. Separate linear mixed effects models were run to explore the effect of the intervention on preschoolers' physical activity (total and MVPA) and sedentary time during outdoor play. Sex was entered as an interaction effect.

RESULTS

Preschoolers (n = 292) were significantly more active in the first 10 minutes outdoors compared with remaining time (P < .0083). For total outdoor time, children in the experimental group engaged in significantly less sedentary time than those in the control group (P < .017), and experimental group boys and girls engaged in higher MVPA than boys and girls in the control group (P < .017).

CONCLUSIONS

Findings support scheduling more frequent outdoor play sessions in childcare to increase physical activity participation among young children.

Correlates of Sleep Duration in Early Childhood: A Systematic Review

OBJECTIVE

This systematic review aimed to summarize correlates of sleep duration in children under 5 years of age.

METHODS

Six electronic databases (PubMed, PsycINFO, MEDLINE, CINAHL, SPORTDiscus, and Scopus) were searched from inception to May 2019. Observational studies and intervention studies reporting cross-sectional results from baseline data were considered. Data were extracted using a predesigned form and potential correlates were categorized following a sociological framework.

RESULTS

One-hundred and sixteen studies, representing 329,166 children, met the inclusion criteria, with a high risk of bias in 62 included studies. A total of 83 correlates of sleep duration were identified. Among the associations studied four or more times, correlates of nap duration were child's age and nighttime sleep onset/bedtime; correlates of nighttime sleep duration were household income, parent marital status, parental adiposity level, nighttime sleep duration at younger age, nighttime sleep onset/bedtime, nighttime sleep wakeup time, and frequency of current bedtime routine; correlate of total sleep duration was screen time.

CONCLUSIONS

Young children from low-income households, single families, or having overweight parents may be at risk for short sleep duration. Promoting healthy sleep duration from an early age appears essential. Effective practices may include encouraging an earlier bedtime, limiting screen time, and establishing a regular bedtime routine. The absence of consistent evidence in the psychological, cognitive, and emotional domain as well as the physical environmental domain warrants further research.

Levels and correlates of physical activity and screen time among early years children (2-5 years): Cross-cultural comparisons between Canadian and South Korean data

BACKGROUND

Cross-cultural research can provide insight into whether levels and correlates of movement behaviours among early years children vary across different cultural contexts. This study (1) compared children's physical activity (PA) and screen time (ST) and parental and environmental correlates of PA and ST between samples of Canadian and South Korean (Korean thereafter) early years children (2-5 years) and (2) investigated parental and environmental correlates of PA and ST and whether country moderates the relationships.

METHODS

Cross-sectional data from 121 Canadian children (3.4 years; 49.6% girls) and 101 Korean children (3.4 years; 54.9% girls) who participated in the Parents' Role in Establishing healthy Physical activity and Sedentary behaviour habits (PREPS) study were used. Demographic information, children's PA, ST, PA- or ST-specific parental cognitions and behaviours, and home and neighbourhood environments were measured using a proxy-reported questionnaire. Two-tailed independent samples T test or Mann Whitney U test, chi-square tests, linear regression and moderation analyses were performed.

RESULTS

Canadian children spent more time in non-organized PA compared to Korean children (111 vs. 63 min/day), whereas time spent in organized PA was higher in Korean children than Canadian children (25 vs. 9 min/day). Canadian children had more ST than Korean children (159 vs. 110 min/day). Similarly, Canadian parents reported higher screen (142 vs. 116 min/day) and sitting time (317 vs. 286 min/day) than Korean parents. Though children's behaviours, as well as parental cognitions and behaviours, varied between the two samples, similar correlates of children's PA and ST were observed. The relationship between presence of electronics in children's bedrooms and children's ST was moderated by country, with Canadian children showing a stronger relationship than Korean children.

CONCLUSIONS

Supporting parents to adopt cognitions and behaviours that are conducive to healthy PA and ST patterns of their own and their early years children may be important for both Canada and Korea.

Association between Home Environment in Infancy and Child Movement Behaviors

Introduction: An adequate balance of movement behaviors, including physical activity (PA), sleep, and screen time, is important for preventing excess weight gain in children. This study examined the relationship between the infant home environment and movement behaviors later in life. Methods: Pregnant women were recruited for a cohort study related to maternal and child development. The home environment was assessed for developmental stimulation, organization, and toys by the Pediatric Review of Children's Environmental Support and Stimulation (PROCESS) questionnaire when the child was 6 months of age. At 2 years of age, mother-reported child screen time, and child PA and sleep duration were estimated by accelerometry. Child behaviors were compared with the 24-hour Movement Guidelines (≥180 minutes/day of total PA, 11-14 hours/day of sleep, and ≤1 hour/day of screen time). Logistic regression was used to assess the relationship between the home environment and movement behaviors, adjusting for maternal and child covariates. Results: Mother/child dyads (n = 141) were mainly white (84.4%), and middle (32.8%) or low income (48.9%). All children (100%) met the PA guideline, some met the sleep guideline (71.6%), fewer met the screen-time guideline (44.7%), and only one-third (34.0%) met all three guidelines. Children who met the screen-time guideline lived in homes with more developmental stimulation and toys (p < 0.05). Children who met all 3 guidelines lived in homes with more organization and toys (p < 0.05). Conclusion: The infant home environment was associated with appropriate amounts of movement behaviors at 2 years. Promoting organization (i.e., routines) and toys in infancy may help facilitate nonscreen-based habits and healthy development. The clinical trial registration number is NCT01131117.

Associations between Adherence to Combinations of 24-h Movement Guidelines and Overweight and Obesity in Japanese Preschool Children

The interactions between movement behaviors (physical activity, screen time, and sleep) affect the health of preschool children. Therefore, we examined the status of adherence to combinations of 24-hour movement guidelines (24-h MG) in Japanese preschool children and determined the associations between overweight/obesity and adherence to these 24-h MG. This cross-sectional study was conducted with 421 children aged 3–5 years (216 boys and 199 girls) living in the northeastern region of Japan. To evaluate the 24-h MG, physical activity over one week was measured using a three-axis accelerometer. For screen time and sleep duration, a questionnaire survey was conducted. Children who failed to meet all the 24-h MG had a higher probability of overweight/obesity than those who met all the 24-h MG (odds ratio 1.139, 95% confidence interval: 1.009, 1.285). The percentage of adherence to the 24-h MG was 91.6% for physical activity, 82.5% for sleep duration, and 33.7% for screen time, and only 21.5% of the children adhered to all three areas of the guidelines. Our findings have important implications for developing public health policies and effective intervention programs for preschool children.

Intervention Effects of the Health Promotion Programme "Join the Healthy Boat" on Objectively Assessed Sedentary Time in Primary School Children in Germany

Sedentary behaviour (SB) in children is related to negative health consequences that can track into adulthood. The programme "Join the Healthy Boat" promotes reduced screen time and a less sedentary lifestyle in schoolchildren. This study investigated the effects of the programme on children's SB. For one year, teachers delivered the programme. A total of 231 children (7.0 ± 0.6 years) participated in the cluster-randomised study; there were 154 one year later at follow-up. Children's SB was assessed using multi-sensor accelerometery, screen time via parental questionnaire. Effects were analysed using (linear) mixed effects regression models. At baseline, children spent 211 (±89) min daily in SB, at follow-up 259 (±109) min/day with no significant difference between the intervention (IG) and control group (CG). SB was higher during weekends (p < 0.01, for CG and IG). However, at follow-up, daily screen time decreased in IG (screen time of >1 h/day: baseline: 33.3% vs. 27.4%; follow-up: 41.2% vs. 27.5%, for CG and IG, respectively). This multi-dimensional, low-threshold intervention for one year does not seem to achieve a significant reduction in children's SB, although screen time decreased in IG. Therefore, it should be considered that screen time cannot be the key contributor to SB and should not solely be used for changing children's SB. However, if screen time is targeted, interventions should promote the replacement of screen time with active alternatives.

The whole day matters: Understanding 24-hour movement guideline adherence and relationships with health indicators across the lifespan

BACKGROUND

New research suggests that the composition (mix) of movement behaviors within a 24-h period may have important implications for health across the lifespan. Consistent with this integrated movement behavior paradigm, a number of countries across the world have developed and released 24-h movement guidelines for specific age groups. The purpose of this systematic review was to examine the associations between the 24-h time-use composition of movement behaviors, or adherence to 24-h movement guidelines, and multiple health indicators across the lifespan.

METHODS

Five online databases (PsycINFO, PubMed, SPORTDiscus, Web of Science, and Ovid MEDLINE) were searched for relevant peer-reviewed studies published between January 2015 and January 2020 that met the a priori inclusion criteria, with no study design limits. The methodological quality of research evidence for each individual study and for each health indicator was assessed by using a modified version of the Downs and Black checklist.

RESULTS

A total of 51 studies from 20 different countries met the inclusion criteria. A total of 31 studies examined adherence (meeting vs. not meeting) to 24-h movement guidelines, and 20 studies used compositional analyses to explore the 24-h time-use composition of movement behaviors. Findings indicated that meeting the 24-h movement guidelines were (1) not associated with adiposity among toddlers, (2) favorably associated with health-related quality of life, social-cognitive development, and behavioral and emotional problems among preschoolers, (3) favorably associated with global cognition, health-related quality of life, and healthy dietary patterns in children, and (4) favorably associated with adiposity, fitness, and cardiometabolic, mental, social, and emotional health among children and youth. Significant associations were also found between the composition of 24-h movement behaviors and indicators of (1) adiposity and bone and skeletal health among preschoolers, (2) health-related quality of life among children, (3) adiposity, fitness, and cardiometabolic, social, and emotional health among children and youth, (4) cardiometabolic health in adults, (5) adiposity and fitness among adults and older adults, and (6) mental health and risk of mortality among older adults. The quality of the available evidence ranged from poor to good.

CONCLUSION

The current evidence indicates that the composition of movement behaviors within a 24-h period may have important implications for health at all ages and that meeting the current 24-h movement guidelines is associated with a number of desirable health indicators in children and youth. Future studies should employ longitudinal and experimental designs, include valid and reliable measures of 24-h movement behaviors, and examine a wide array of health indicators across all age groups. Such studies would confirm the results from the primarily cross-sectional evidence drawn from studies included in our review and further advance our understanding of the relationships between 24-h movement behaviors and health.

Association of screen time and cardiometabolic risk in school-aged children

Screen use has become a pervasive behaviour among children and has been linked to adverse health outcomes. The objective of this study was to examine the association between screen time and a comprehensive total cardiometabolic risk (CMR) score in school-aged children (7-12-years), as well as individual CMR factors. In this longitudinal study, screen time was measured over time (average duration of follow-up was 17.4 months) via parent-report. Anthropometric measurements, blood pressure, and biospecimens were collected over time and used to calculate CMR score [sum of age and sex standardized z-scores of systolic blood pressure (SBP), glucose, log-triglycerides, waist circumference (WC), and negative high-density lipoprotein cholesterol (HDL-c)/square-root of 5]. Generalized estimating equations (GEE) were used to examine the association between screen time and total CMR score as well as individual CMR factors. A total of 567 children with repeated measures were included. There was no evidence of an association between parent-reported child screen time and total CMR score (adjusted β = -0.01, 95% CI [-0.03, 0.005], 0.16). Screen time was inversely associated HDL-c (adjusted β = -0.008, 95% CI [-0.011, -0.005], p = 0.016), but there was no evidence that the other CMR components were associated with screen time. Among children 7-12 years, there was no evidence of an association between parent-reported child screen time and total CMR, but increased screen time was associated with slightly lower HDL-c. Research is needed to understand screen-related contextual factors which may be related to CMR factors.

Parents and children active together: a randomized trial protocol examining motivational, regulatory, and habitual intervention approaches

Background

Regular physical activity (PA) is associated with many health benefits during childhood, and tracks into desirable PA patterns and health profiles in adulthood. Interventions designed to support these behaviours among young children are critical. Family-based interventions focusing on parent-child activities together (i.e., co-activity) among preschool-aged children are warranted. Targeting parental support practices can increase the frequency of co-activity, however interventions must move beyond merely building intention and planning skills for successful maintenance. Interventions designed to increase co-activity habit strength may facilitate the sustainability and thus impact child PA. The purpose of this study is to compare the effects of three intervention conditions designed to increase child PA through co-activity: a standard education condition (information about benefits), a planning (action planning, coping planning) + education condition and a habit (context-dependent repetition from prompts and cues) + planning +education condition.

Methods/design

A longitudinal three-arm parallel design randomized trial will compare three conditions over six months. Families are eligible if they have at least one child between 3y and 5y that is not meeting 60mins/day of moderate to vigorous physical activity (MVPA). The primary outcome (child MVPA) is assessed via accelerometry at baseline, six weeks, three months and six months (primary endpoint). Intervention materials targeting co-activity are delivered post baseline assessment, with booster sessions at six weeks and three months. Parental co-activity habit, parent-child co-activity and other behavioural constructs are also assessed via questionnaire at all measurement occasions. As tertiary outcomes, parental PA is measured via accelerometry and co-activity is measured via a Bluetooth-enabled proximity feature. A total of 106 families have been recruited thus far from the Greater Victoria region. The study is ongoing with a minimum target of 150 families and an anticipated recruitment completion date of August 2022.

Discussion

This protocol describes the implementation of a randomized trial evaluating the effectiveness of a habit formation group compared with a planning group and an education only group to increase child PA through targeting parent-child co-activity. This information could prove useful in informing public health initiatives to promote PA among families with preschool-aged children.

Trial registration

This trial was prospectively registered on clinicaltrials.gov in February 2016, identifier NCT03055871.

The association between screen time and cardiometabolic risk in young children

OBJECTIVES

While studies exist on the association between screen time and cardiometabolic risk among adolescents, research examining the effect of screen time on cardiometabolic risk in young children is lacking. The primary objective of this study was to examine the association between daily screen time and cardiometabolic risk (CMR) [sum of age- and sex-standardized z-scores of systolic blood pressure (SBP), glucose, log-triglycerides, waist circumference (WC), and negative high-density lipoprotein (HDL) cholesterol divided by the square root of five] in young children. Secondary objectives included examining individual CMR risk factors, including waist-to-height ratio and non high-density lipoprotein (non-HDL) cholesterol, as well as the individual cut-offs of these risk factors. Additional analyses include examining the association between screen time and CMR by handheld/non-handheld devices.

METHODS

A study was conducted among young children 3 to 6 years from the TARGet Kids! practice-based research network in Toronto and Montreal, Canada. Children with one or more measures of screen time and CMR were included in this study. Generalized estimating equation (GEE) multivariable linear regressions and multivariable logistic regressions, using published cut-offs, were conducted to evaluate these associations.

RESULTS

Data from 1317 children [mean age 52 months (SD = 13.36), 44.34% female] were included for analyses. There was no evidence of associations between screen time and total CMR score or individual risk factors (p > 0.05) after adjusting for confounders. A statistically significant, but small association between daily screen time and non-HDL cholesterol was found (B = 0.046; CI = [0.017 to 0.075]; p = 0.002.

CONCLUSIONS

Though no relationship was reported between daily screen time and the majority of CMR factors in early childhood, there was an association between daily screen time and non-HDL cholesterol. As the relationship between daily screen time and CMR factors may not be apparent in early childhood, studies to evaluate longer-term cardiometabolic effects of screen time are needed. Although there is an evidence-based rationale to reduce screen time in early childhood, prevention of cardiometabolic risk may not be the primary driver.

Understanding physical activity and sedentary behaviour among preschool-aged children in Singapore: a mixed-methods approach

OBJECTIVES

This study investigated physical activity (PA) and sedentary behaviour (SB) among preschool-aged children in Singapore and potential correlates at multiple levels of the socioecological model from in-school and out-of-school settings.

DESIGN

A cross-sectional study using a mixed-methods approach.

PARTICIPANTS

Parent-child dyads from six preschools in Singapore.

METHODS

PA and SB of children (n=72) were quantified using wrist-worn accelerometers for seven consecutive days. Three focus group discussions (FGDs) among 12 teachers explored diverse influences on children's activities, and System for Observing Play and Leisure Activity in Youth (SOPLAY) assessed PA environment and children's activity levels at preschools. Seventy-three parents completed questionnaires on home and neighbourhood factors influencing children's PA and SB. Descriptive analyses of quantitative data and thematic analysis of FGDs were performed.

RESULTS

Based on accelerometry, children (4.4±1.1 years) spent a median of 7.8 (IQR 6.4-9.0) hours/day in SB, and 0.5 (0.3-0.8) hours/day in moderate-to-vigorous physical activity (MVPA). MVPA was similar throughout the week, and SB was slightly higher on non-school days. In preschools, SOPLAY showed more children engaging in MVPA outdoors (34.0%) than indoors (7.7%), and absence of portable active play equipment. FGDs revealed issues that could restrict active time at preschool, including academic requirements of the central curriculum and its local implementation. The teachers had varying knowledge about PA guidelines and perceived that the children were sufficiently active. In out-of-school settings, parents reported that their children rarely used outdoor facilities for active play and spent little time in active travel. Few children (23.5%) participated in extracurricular sports, but most (94.5%) reported watching screens for 1.5 (0.5-3.0) hours/day.

CONCLUSION

MVPA was low and SB was high in preschool-aged children in an urban Asian setting. We identified diverse in-school and out-of-school correlates of PA and SB that should be taken into account in health promotion strategies.

Sedentary Time and Physical Activity Associations Between Child Care Educators and Children

INTRODUCTION

This study examines the associations between objectively measured sedentary time and physical activity among child care educators and children in their direct care and aims to determine if the associations differed between toddlers (aged 19-35 months) and preschoolers (aged 36-60 months).

METHODS

The participants were educators and children from 19 child care centers in Edmonton and Ottawa, Canada, as part of the Supporting Healthy Active Child Care Settings study. Sedentary time, light-intensity physical activity, and moderate to vigorous-intensity physical activity during child care were measured with accelerometers in 2017-2018. Nap time data were removed for children and educators based on room schedules. Children were matched with the main educator in their room that had the highest total physical activity, resulting in 187 children and 38 educators. Multilevel linear regression models with interaction terms were conducted in 2019.

RESULTS

Children engaged in 30.0, 23.1, and 6.9 minutes per hour of sedentary time, light-intensity physical activity, and moderate to vigorous-intensity physical activity, respectively. Educators engaged in 33.5, 23.6, and 2.9 minutes per hour of sedentary time, light-intensity physical activity, and moderate to vigorous-intensity physical activity, respectively. No significant interactions were observed, so age-stratified analyses were not conducted. Each additional 5 minutes per hour of educator sedentary time was significantly associated with 0.5 minutes per hour lower child moderate to vigorous-intensity physical activity. Each additional 5 minutes per hour of educator moderate to vigorous-intensity physical activity was significantly associated with 1.3 minutes per hour higher child moderate to vigorous-intensity physical activity. No other significant observations were observed.

CONCLUSIONS

The educators' sedentary time and moderate to vigorous-intensity physical activity may have a small but potentially meaningful influence on children's moderate to vigorous-intensity physical activity because educators directly care for multiple children. Targeting these educator behaviors may be one strategy to increase children's moderate to vigorous-intensity physical activity during child care.

Featured Article: Bidirectional Effects of Sleep and Sedentary Behavior Among Toddlers: A Dynamic Multilevel Modeling Approach

OBJECTIVE

To examine the bidirectional effects of objectively measured nighttime sleep and sedentary activity among toddlers.

METHOD

Actical accelerometer data were analyzed for 195 toddlers participating in an obesity prevention trial (mean age = 27 months). Toddlers wore the accelerometers for up to 7 consecutive days. Nighttime sleep was defined as the number of minutes asleep between the hours of 8 pm and 8 am the following morning. Sedentary behavior (in minutes) was defined using previously established Actical cut points for toddlers. Variables were lagged and parsed into latent within- and between-person components, using dynamic structural equation modeling (DSEM).

RESULTS

Toddlers spent an average of 172 min (∼3 hr) in sedentary activity and slept an average of 460 min (∼8 hr) per night. An autoregressive cross-lagged multilevel model revealed significant autoregression for both sleep and sedentary activity. Cross-lagged values revealed that decreased sleep predicted increased next-day sedentary activity, and sedentary activity predicted that night's sleep. For 89% of the sample, the within-person standardized cross-lagged effects of sleep on sedentary were larger than the cross-lagged effects of sedentary on sleep.

CONCLUSIONS

Results suggest that, on average, nighttime sleep is a stronger predictor of subsequent sedentary behavior (compared with the reverse), and this is the case for the majority of toddlers. Findings highlight the importance of interindividual associations between sleep and sedentary activity. The present study is an example of how DSEM methods can be used to ask questions about Granger-causal cross-lagged relations between variables, both within and between individuals.

Prospective associations with physiological, psychosocial and educational outcomes of meeting Australian 24-Hour Movement Guidelines for the Early Years

Background

Several countries have released movement guidelines for children under 5 that incorporate guidelines for sleep, physical activity and sedentary behavior. This study examines prospective associations of preschool children’s compliance with the 24-Hour Australian movement guidelines (sleep, physical activity, screen time) and physiological, psychosocial and educational outcomes during primary school.

Methods

Data were from the Healthy Active Preschool and Primary Years Study (Melbourne, Australia; n = 471; 3–5 years; 2008/9). Follow-ups occurred at 3 (2011/12; 6–8 years), 6 (2014/15; 9–11 years) and 7 (2016; 10–12 years) years post baseline. Multiple regression models assessed associations between compliance with guidelines at baseline and later outcomes.

Results

Children were 4.6 years at baseline (53% boys; 62% high socio-economic families). Most children met physical activity (89%) and sleep (93%) guidelines; 23% met screen-time guidelines; and 20% met all guidelines at baseline. Meeting all of the three guidelines was associated with lower BMI z-scores at 9–11 years of age (b = − 0.26, 95%CI -0.47, − 0.05). Meeting physical activity guidelines was associated with higher total body bone mineral density (b = 0.64, 95%CI 0.15, 1.13), and total body bone mineral content (b = 183.19, 95%CI 69.92, 296.46) at 10–12 years of age. Meeting sleep guidelines was associated with better reading (b = 37.60, 95%CI 6.74, 68.46), spelling (b = 34.95, 95%CI 6.65, 63.25), numeracy (b = 39.09, 95%CI 11.75, 66.44), language (b = 44.31, 95%CI 11.77, 76.85) and writing (b = 25.93, 95%CI 0.30, 51.57) at 8–9 years of age. No associations were evident for compliance with screen-time guidelines or for psychosocial outcomes.

Conclusions

Compliance with different movement behavior guidelines was associated with different outcomes. Strategies to support children in meeting all of the guidelines are warranted to maximize health and educational outcomes. Future research investigating dose-response associations, and potential mechanisms, is necessary.

Proportion of kindergarten children meeting the WHO guidelines on physical activity, sedentary behaviour and sleep and associations with adiposity in urban Beijing

Background

World Health Organisation (WHO) Guidelines on Physical Activity, Sedentary Behaviour and Sleep for Children under 5 Years of Age were released in 2019. The aim of this study was to examine the proportion of Chinese kindergarten children who met each individual guideline and each combination of the guidelines and the associations with adiposity.

Methods

Participants were 254 kindergarten children aged 4.1–6.3 years recruited from three kindergartens in urban area of Beijing. Physical activity, sedentary behaviour and sleep duration were assessed using 24-h accelerometry over three consecutive days. Screen time was reported by parents. Weight and height were measured; and children were categorised into normal weight and overweight/obese groups according to the WHO age- and sex- specific criteria. Frequency analyses were performed to examine the proportion of children meeting individual and combination of these guidelines. Logistics regression analyses were conducted to examine the associations between guideline compliance and adiposity.

Results

The proportion of children who met the physical activity (≥ 3 h daily physical activity, including ≥1 h daily moderate- to vigorous-intensity physical activity (MVPA)), sedentary screen time (< 1 h/day), and sleep guidelines (10-13 h/day) were 65.4, 88.2 and 29.5%, respectively; only 15.0% met all three guidelines and 2.7% did not meet any of the guidelines. Not meeting the physical activity guideline, sleep guideline, or combination of any two guidelines, or all three guidelines was not associated with overweight or obesity; however, children who did not meet the sedentary screen time guidelines were at higher risk for overweight and obesity (odds ratio = 3.76, 95% CI: 1.50–9.45).

Conclusions

In our study, only a small proportion of children met all three guidelines. Most Chinese kindergarten children met physical activity guidelines or screen time guidelines, whereas fewer children met sleep guideline. Not meeting sedentary screen time guidelines was associated with adiposity, which warrant further interventions for limiting screen time in young children.

Infants' and toddlers' physical activity and sedentary time as measured by accelerometry: a systematic review and meta-analysis

BACKGROUND

Early experiences in physical activity (PA) are important to shape healthy movement behaviours long-term; as such, it is critical that PA is promoted from infancy, and that detrimental behaviours (e.g., prolonged sedentary time [ST]) are minimized. The purpose of this systematic review and meta-analysis was to examine infants' and toddlers' movement behaviours across daytime hours.

METHODS

Seven online databases were searched for terms related to infants (< 12 months), toddlers (12-35.9 months), PA, ST, and accelerometry. Two independent reviewers examined 4873 articles for peer-reviewed original research, published in English, that assessed infants' (counts/min) and/or toddlers' PA or ST (min/day) using accelerometry across daytime hours. Infants' mean PA level (counts/min) was averaged across studies, and ranges were produced. Estimates of toddlers' movement behaviours were aggregated meta-analytically to produce average daily rates, and accelerometer placement, cut-point validity, device type, and epoch length were tested as a moderating variables.

RESULTS

Twenty-four studies from 16 countries (published 2011-2019), representing 3699 participants, were included in the systematic review. Five studies reported on infants' PA, which ranged from 78.2 to 2580.5 cpm. Across 20 studies, toddlers' total PA, light PA, moderate-to vigorous-intensity PA, and ST ranged from 72.9 to 636.5, 48.5 to 582.4, 6.5 to 89.9, and 172.7 to 545.0 min/day, respectively. After taking into account accelerometer placement, cut-point validity, device type, and epoch length, we found that toddlers engaged in 246.19 min/day (SE = 28.50; 95% CI: 190.34, 302.04) of total PA, 194.10 min/day (SE = 28.76; 95% CI: 137.73, 250.47) of light PA, and 60.16 min/day (SE = 5.88; 95% CI: 48.64, 71.69) of moderate-to vigorous-intensity PA. Toddlers engaged in 337.04 min/day (SE = 32.67; 95% CI: 273.01, 401.07) of ST.

CONCLUSIONS

With limited studies conducted in infants (n = 5), PA estimates are inconclusive and largely heterogeneous. Overall, toddlers tend to exceed the total PA recommendation of 180 min/day; however, very little of this time is spent at higher movement intensities. Even with high PA rates, toddlers still engage in substantial ST. More consistent and valid measurement protocols are needed to improve comparability across studies.

Association Between a Comprehensive Movement Assessment and Metabolically Healthy Overweight Obese Adults

Physical activity (PA) and sedentary behavior are associated with metabolic health in overweight and obese individuals. However, the role of comprehensive health-related movement guidelines on PA, recreational screen time, and sleep among Metabolically Healthy Overweight-Obese (MHO) individuals is unknown. We investigated differences in comprehensive movement assessment scores between adults classified as MHO or Non-MHO. The sample included 513 adults (46.2% male), aged 19 to 85 years, body mass index (BMI) ≥ 25, from cycle 2005–2006 of the National Health and Nutrition Examination Survey. Comprehensive movement assessment outcomes were defined as meeting modified 24-Hour Movement Guidelines criteria, with thresholds adapted for adults. 13.8% of participants were MHO (normal serum glucose, triglycerides, HDL-cholesterol, and systolic and diastolic blood pressure). Only 1.4% of MHO participants met all guidelines. MHO and Non-MHO participants had similar comprehensive movement assessment scores (MHO: 18.3% vs. Non-MHO: 10.9%; p = 0.072). MHO individuals had less continuous recreational screen time than Non-MHO individuals (1.8 ± 1.4 hrs/day vs. 2.5 ± 1.6 hrs/day; p < 0.001). Meeting the recreational screen time recommendation was the only variable associated with the MHO phenotype (OR:4.84 95%CI: 2.33–10.07). This association remained after adjusting for age, sex, ethnicity, education, and BMI (OR: 3.53 95%CI: 1.72–7.24). Our results suggest the importance of limiting recreational screen time in adults to optimize cardiometabolic risk profile in individuals living with overweight or obesity. Using movement guidelines with a screen time component to assess the risk associated with health outcomes in adults appears to provide a better assessment.

Objectively Measured Environmental Correlates of Toddlers' Physical Activity and Sedentary Behavior

PURPOSE

Examine objectively measured environmental correlates of physical activity and sedentary behavior in toddlers (12-35 mo).

METHODS

Participants were recruited at immunization appointments in Edmonton, Canada. Physical activity and sedentary time were objectively measured via accelerometers (n = 149). The parents reported screen time and demographic characteristics via a questionnaire (n = 249). Postal codes were used to link neighborhood data via geographic information systems. Neighborhood data included 4 environmental domains: functional (ie, walkability), safety (ie, crime), esthetic (ie, tree density), and destination (ie, cul-de-sac density, wooded area percentage, green space percentage, recreation density, park density). Weather data (temperature and precipitation) were obtained via historical weather records. Multilevel multiple linear regression models were used to account for clustering of participants within neighborhoods and adjustment of demographic variables.

RESULTS

Each additional 10°C of mean temperature was significantly associated with 5.74 (95% confidence interval, 0.96-10.50) minutes per day of higher light-intensity physical activity, though the effect size was small (f2 = 0.08). No other significant associations were observed.

CONCLUSIONS

The lack of significant findings for neighborhood environment factors suggests proximal factors (eg, features of the home environment) may be more important in predicting toddlers' physical activity and sedentary behavior. More indoor physical activity opportunities may be needed on colder days for toddlers.

Daily Physical Activity Among Toddlers: Hip and Wrist Accelerometer Assessments

Physical activity (PA) habits seem to track over time from as young as early childhood. For children under age 3 years, wearable sensor-measured PA levels have begun to be investigated. The aims of this study were to evaluate the feasibility of using hip- vs. wrist-worn accelerometers, and to report accelerometer-derived PA metrics among toddlers. A convenience sample of 22 toddlers aged 13 to 35 months and their mothers were recruited for this study. ActiGraph wGT3X-BT accelerometers were attached to wrist bands and waist belts. The mothers were asked to affix a wrist band and a waist belt to their participating children during waking hours for four days. They also completed an acceptability survey. Of the 22 toddlers, 19 (86%) had ≥ 3 valid days of hip data, while only 14 (64%) did so for wrist data (p = 0.16). In terms of acceptability, 18 mothers (82%) responded that the 4-day hip wear was easy, while only 13 (59%) responded that the 4-day wrist wear was easy (p = 0.19). Daily light-intensity PA (LPA) was on average 161 min, and daily moderate- and vigorous-intensity PA (MVPA) was on average 47 min, as determined using published hip accelerometer cut-points. There were no significant differences in LPA or MVPA by age or by sex. In conclusion, this study suggests that hip placement of an ActiGraph accelerometer is more feasible than wrist placement among toddlers.

Compliance With Physical Activity and Sedentary Behavior Guidelines and Associations With Abdominal Adiposity in a Sample of Infants and Toddlers From Soweto, South Africa

Background: This study reported compliance with 24-hour physical activity and sedentary behavior guidelines, and associations with adiposity in the first 2 years of life. Methods: Participants (N = 119) were recruited from Soweto, South Africa. Visceral and subcutaneous abdominal adipose tissue was measured by ultrasound. Participation in 2 movement behaviors (physical activity and sedentary time) was reported by mothers. Differences in adiposity between those meeting each individual guideline, as well as the combination of both movement guidelines, compared with those not meeting the guidelines were assessed. Results: Only 5% of infants met the sedentary guidelines; however, 58% met the physical activity guidelines. Subcutaneous adipose tissue was significantly higher in those meeting the physical activity guideline (0.50 [0.01] vs 0.47 [0.01] cm, P = .03) compared with those not meeting the guideline. Meeting the screen time component of the sedentary guideline was associated with higher visceral adipose tissue (β = 0.96, P < .01), while meeting one guideline compared with meeting none was associated with higher subcutaneous adipose tissue (β = 0.05, P = .01). Conclusions: Most infants and toddlers from this low- to middle-income setting were not meeting sedentary behavior guidelines. Both behaviors were associated with abdominal adiposity, but not with body mass index z score; implying these movement behaviors may impact abdominal fat deposition rather than body size.

Socio-demographic and maternal predictors of adherence to 24-hour movement guidelines in Singaporean children

PURPOSE

Integrated 24-Hour Movement Guidelines provide specific recommendations on screen viewing (SV), moderate-to-vigorous physical activity (MVPA) and sleep to improve health of children and youth. However, few studies have examined whether these guidelines are met in young children, particularly in Asia. We evaluated adherence to integrated and individual guidelines and its predictors in 5.5-year-old Singaporean children.

METHODS

Growing Up in Singapore towards Healthy Outcomes (GUSTO) is a mother-offspring birth cohort study. At age 5.5 years, child SV was reported by parents. Movement behaviours (MBs) were measured continuously using wrist-worn accelerometers over 7 consecutive days and nights. For accelerometer data including ≥3 days with ≥16 h/day we estimated mean (±SD) daily MVPA, SV and nighttime sleep duration across the week. Adherence to integrated (Canadian/Australian) guidelines was defined as meeting all individual guidelines: ≥60 min of MVPA/day, ≤2 h of screen time/day, and 9-11 h of sleep/night. Socio-demographic and maternal predictors collected at pregnancy enrolment and at 26-28 weeks' gestation were examined by multivariable logistic regression.

RESULTS

Of 864 children followed up age 5.5 years, 547 (63.3%) had both valid ActiGraph and questionnaire data (51.7% boys and 58.3% Chinese ethnicity). Children averaged 101.9 (± 88.7) min/day SV, 67.3 (± 23.7) min/day MVPA and 480.6 (± 57.2) min/night sleep. Few children met integrated guidelines. Specifically, the proportions of children who met none, SV, MVPA, sleep and integrated guidelines were 11.2, 70.2, 59.6, 13.7 and 5.5%, respectively. Multivariable analysis showed that maternal activity and television (TV) viewing were associated with meeting integrated guidelines (insufficiently vs. highly active (OR [95% CI]): 0.11 [0.01, 0.95]; 2-3 vs. ≥ 3 h TV: 3.52 [1.02, 12.22]). Examining higher adherence to individual guidelines, Chinese ethnicity, younger maternal age and lower maternal TV and sleep time were associated with greater SV; male sex, Malay ethnicity, higher birth order and higher maternal activity level were associated with greater MVPA; and older maternal age was associated with adherence to sleep guideline.

CONCLUSIONS

Beyond individual behaviours, consideration of the full spectrum of MBs may be important to improve children's health. However, few Singaporean children adhere to integrated 24-h movement guidelines. Maternal behaviours as early as during pregnancy could be important targets for future interventions aiming to promote these MBs in children.

Joint physical-activity/screen-time trajectories during early childhood: socio-demographic predictors and consequences on health-related quality-of-life and socio-emotional outcomes

Background

Understanding the early roots of physical activity and sedentary behaviors is critical to developing intervention programs that promote healthy lifestyle habits in infants and children. There is, however, no evidence on how these behaviors cluster and develop together during early childhood. The aim of this study was to identify single and joint longitudinal trajectories in physical activity and screen time amongst children aged 0 to 9 years, their social-demographic predictors and their prospective health-related quality-of-life and socio-emotional outcomes.

Methods

Three waves of data from The Longitudinal Study of Australian Children, a national study tracking two cohorts every 2 years (B-cohort, 0–5 years, n = 4,164; K-cohort, 4–9 years, n = 3,974) were analysed. Growth mixture modelling was applied to longitudinal time-use diary data to identify joint trajectories in children’s physical activity and screen time over Waves 1–3. Key socio-demographic variables measured at Wave 1 were used to predict membership in different trajectories. The prospective consequences (at Wave 3) of time-use trajectories on health-related quality-of-life and socio-emotional outcomes were assessed.

Results

Three physical-activity/screen-time trajectories were identified for both cohorts: Cluster-A—children who maintained low levels of physical activity and screen time (∽50% of the sample), Cluster-B—children who progressively increased physical activity and maintained low screen-time levels (∽25%), and Cluster-C—children who maintained low physical-activity levels and increased screen time (∽25%). Children in Cluster-B experienced the best health-related quality-of-life and socio-emotional outcomes, while those in Cluster-C experienced the worst. Children who were female, Indigenous, from non-English-speaking backgrounds, not living with two biological parents, in more affluent households and neighbourhoods, without siblings and with parents with poor mental health were at greater risk of falling into Cluster-A or Cluster-C.

Conclusion

Our findings identified which children are most at-risk of falling into time-use trajectories that lead to poor health-related quality-of-life and socio-emotional outcomes later in life, increasing our ability to monitor, detect and prevent these suboptimal behaviours prior to their onset.

Electronic supplementary material

The online version of this article (10.1186/s12966-019-0816-3) contains supplementary material, which is available to authorized users.

Objective sleep and physical activity using 24-hour ankle-worn accelerometry among toddlers from low-income families

OBJECTIVES

Poverty is a risk for short sleep duration and limited physical activity. This study describes sleep, physical activity, and sedentary behavior of Women, Infants, and Children-eligible toddlers and the proportion of toddlers meeting recommendations for sleep and physical activity, and examines associations with body mass index z scores and poverty.

PARTICIPANTS/MEASUREMENTS

A total of 101 toddlers (12-32 months) from low-income families (62% African American) wore 24-hour ankle accelerometers over 3-7 consecutive days. Concurrent validity for daytime napping was assessed using parent-reported toddler wake/sleep between 08:00 and 20:00 collected using Ecological Momentary Assessment. Logistic regressions predicted odds of meeting guidelines.

RESULTS

Toddlers averaged 10.56 hours of sleep in 24 hours. All toddlers averaged ≥180 minutes of total activity per day, 38% had ≥60 minutes of moderate/vigorous physical activity per day, 32% of toddlers slept between 11 and 14 hours over 24 hours, and 26% had a bedtime before 9:00 pm. Body mass index z score was not associated with meeting guidelines. Poverty was associated with less than 60 minutes of moderate/vigorous physical activity.

CONCLUSIONS

Most toddlers were not meeting sleep guidelines. This study provides objective data on sleep and activity among a diverse sample of low-income toddlers. Objective measures of sleep and physical activity facilitate surveillance of children meeting guidelines for sleep and physical activity. Such norms are needed to examine disparities among children from varying racial and economic backgrounds. Future research should examine if meeting guidelines is related to other health indicators.

Healthy Nutrition and Physical Activity in Childcare: Views from Childcare Managers, Childcare Workers and Parents on Influential Factors

Childhood obesity is an important public health issue influenced by both personal and environmental factors. The childcare setting plays an important role in children’s energy balance-related behaviours (EBRB), such as physical activity, sedentary behaviour and healthy nutrition. This study aimed to explore facilitators and barriers of healthy EBRB in childcare in a comprehensive way, from the perspective of three crucial stakeholders: childcare managers, childcare workers and parents. A qualitative study was performed using semi-structured interviews. Content analysis was performed using the ‘Environmental Research framework for weight Gain prevention’ (EnRG framework) to guide the analysis. Forty-eight interviews were held with a total of 65 participants (9 childcare managers, 23 childcare workers and 33 parents). Influential factors in all types of environment (physical, sociocultural, economic and political) were mentioned. Although a need for change was not always expressed, the interviews revealed opportunities for improvement of healthy EBRB in childcare. These opportunities were related to the sociocultural, physical and political environment. Childcare workers and managers expressed an influence of the home setting on the childcare setting, resulting in a need for more congruence between these settings. There are opportunities for improvement in the childcare setting to promote healthy EBRB in young children in the Netherlands. It appears important to align intervention components between the childcare and home setting.

24-h movement behaviors from infancy to preschool: cross-sectional and longitudinal relationships with body composition and bone health

Background

New physical activity guidelines for children address all movement behaviors across the 24-h day (physical activity, sedentary behavior, sleep), but how each component relates to body composition when adjusted for the compositional nature of 24-h data is uncertain.

Aims

To i) describe 24-h movement behaviors from 1 to 5 years of age, ii) determine cross-sectional relationships with body mass index (BMI) z-score, iii) determine whether movement behaviors from 1 to 5 years of age predict body composition and bone health at 5 years.

Methods

24-h accelerometry data were collected in 380 children over 5–7 days at 1, 2, 3.5 and 5 years of age to determine the proportion of the day spent: sedentary (including wake after sleep onset), in light (LPA) and moderate-to-vigorous physical activity (MVPA), and asleep (including naps). BMI was determined at each age and a dual-energy x-ray absorptiometry (DXA) scan measured fat mass, bone mineral content (BMC) and bone mineral density (BMD) at 5 years of age. 24-h movement data were transformed into isometric log-ratio co-ordinates for multivariable regression analysis and effect sizes back-transformed.

Results

At age 1, children spent 49.6% of the 24-h day asleep, 38.2% sedentary, 12.1% in LPA, and 0.1% in MVPA, with corresponding figures of 44.4, 33.8, 19.8 and 1.9% at 5 years of age. Compositional time use was only related significantly to BMI z-score at 3.5 years in cross-sectional analyses. A 10% increase in mean sleep time (65 min) was associated with a lower BMI z-score (estimated difference, − 0.25; 95% CI, − 0.42 to − 0.08), whereas greater time spent sedentary (10%, 47 min) or in LPA (10%, 29 min) were associated with higher BMI z-scores (0.12 and 0.08 respectively, both p < 0.05). Compositional time use from 1 to 3.5 years was not related to future BMI z-score or percent fat. Although MVPA at 2 and 3.5 years was consistently associated with higher BMD and BMC at 5 years, actual differences were small.

Conclusions

Considerable changes in compositional time use occur from 1 to 5 years of age, but there is little association with adiposity. Although early MVPA predicted better bone health, the differences observed had little clinical relevance.

Trial registration

ClinicalTrials.gov number NCT00892983.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0753-6) contains supplementary material, which is available to authorized users.

Role of parental and environmental characteristics in toddlers' physical activity and screen time: Bayesian analysis of structural equation models

Background

Guided by the Socialization Model of Child Behavior (SMCB), this cross-sectional study examined direct and indirect associations of parental cognitions and behavior, the home and neighborhood environment, and toddlers’ personal attributes with toddlers’ physical activity and screen time.

Methods

Participants included 193 toddlers (1.6 ± 0.2 years) from the Parents’ Role in Establishing healthy Physical activity and Sedentary behavior habits (PREPS) project. Toddlers’ screen time and personal attributes, physical activity- or screen time-specific parental cognitions and behaviors, and the home and neighborhood environment were measured via parental-report using the PREPS questionnaire. Accelerometry-measured physical activity was available in 123 toddlers. Bayesian estimation in structural equation modeling (SEM) using the Markov Chain Monte Carlo algorithm was performed to test an SMCB hypothesized model. Covariates included toddlers’ age, sex, race/ethnicity, main type of childcare, and family household income.

Results

In the SMCB hypothesized screen time model, higher parental barrier self-efficacy for limiting toddlers’ screen time was associated with higher parental screen time limiting practices (β = 0.451), while higher parental negative outcome expectations for limiting toddlers’ screen time was associated with lower parental screen time limiting practices (β = − 0.147). In turn, higher parental screen time limiting practices was associated with lower screen time among toddlers (β = − 0.179). Parental modeling of higher screen time was associated with higher screen time among toddlers directly (β = 0.212) and indirectly through the home environment. Specifically, higher screen time among parents was associated with having at least one electronic device in toddlers’ bedrooms (β = 0.146) and, in turn, having electronics in the bedroom, compared to none, was associated with higher screen time among toddlers (β = 0.250). Neighborhood safety was not associated with toddlers’ screen time in the SEM analysis. No significant correlations were observed between the SMCB variables and toddlers’ physical activity; thus, no further analyses were performed for physical activity.

Conclusions

Parents and their interactions with the home environment may play an important role in shaping toddlers’ screen time. Findings can inform family-based interventions aiming to minimize toddlers’ screen time. Future research is needed to identify correlates of toddlers’ physical activity.

Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep

BACKGROUND

The Canadian Society for Exercise Physiology convened representatives of national organizations, research experts, methodologists, stakeholders, and end-users who followed rigorous and transparent guideline development procedures to create the Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These novel guidelines for children of the early years embrace the natural and intuitive integration of movement behaviours across the whole day (24-h period).

METHODS

The development process was guided by the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Four systematic reviews (physical activity, sedentary behaviour, sleep, combined behaviours) examining the relationships within and among movement behaviours and several health indicators were completed and interpreted by a Guideline Development Panel. The systematic reviews that were conducted to inform the development of the guidelines, and the framework that was applied to develop the recommendations, followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Complementary compositional analyses were performed using data from the Canadian Health Measures Survey to examine the relationships between movement behaviours and indicators of adiposity. A review of the evidence on the cost effectiveness and resource use associated with the implementation of the proposed guidelines was also undertaken. A stakeholder survey (n = 546), 10 key informant interviews, and 14 focus groups (n = 92 participants) were completed to gather feedback on draft guidelines and their dissemination.

RESULTS

The guidelines provide evidence-informed recommendations as to the combinations of light-, moderate- and vigorous-intensity physical activity, sedentary behaviours, and sleep that infants (<1 year), toddlers (1-2 years) and preschoolers (3-4 years) should achieve for a healthy day (24 h). Proactive dissemination, promotion, implementation, and evaluation plans were prepared to optimize uptake and activation of the new guidelines.

CONCLUSIONS

These guidelines represent a sensible evolution of public health guidelines whereby optimal health is framed within the balance of movement behaviours across the whole day, while respecting preferences of end-users. Future research should consider the integrated relationships among movement behaviours, and similar integrated guidelines for other age groups should be developed.

Proportion of preschool-aged children meeting the Canadian 24-Hour Movement Guidelines and associations with adiposity: results from the Canadian Health Measures Survey

BACKGROUND

New Canadian 24-Hour Movement Guidelines for the Early Years have been released in 2017. According to the guidelines, within a 24-h period, preschoolers should accumulate at least 180 min of physical activity (of which at least 60 min is moderate-to-vigorous physical activity), engage in no more than 1 h of screen time, and obtain between 10 and 13 h of sleep. This study examined the proportions of preschool-aged (3 to 4 years) Canadian children who met these new guidelines and different recommendations within the guidelines, and the associations with adiposity indicators.

METHODS

Participants were 803 children (mean age: 3.5 years) from cycles 2-4 of the Canadian Health Measures Survey (CHMS), a nationally representative cross-sectional sample of Canadians. Physical activity was accelerometer-derived, and screen time and sleep duration were parent-reported. Participants were classified as meeting the overall 24-Hour Movement Guidelines if they met all three specific time recommendations for physical activity, screen time, and sleep. The adiposity indicators in this study were body mass index (BMI) z-scores and BMI status (World Health Organization Growth Standards).

RESULTS

A total of 12.7% of preschool-aged children met the overall 24-Hour Movement Guidelines, and 3.3% met none of the three recommendations. A high proportion of children met the sleep duration (83.9%) and physical activity (61.8%) recommendations, while 24.4% met the screen time recommendation. No associations were found between meeting individual or combined recommendations and adiposity.

CONCLUSIONS

Very few preschool-aged children in Canada (~13%) met all three recommendations contained within the 24-Hour Movement Guidelines. None of the combinations of recommendations were associated with adiposity in this sample. Future work should focus on identifying innovative ways to reduce screen time in this population, and should examine the associations of guideline adherence with health indicators other than adiposity.

Adherence to 24-Hour Movement Guidelines for the Early Years and associations with social-cognitive development among Australian preschool children

BACKGROUND

The new Australian 24-Hour Movement Guidelines for the Early Years recommend that, for preschoolers, a healthy 24-h includes: i) ≥180 min of physical activity, including ≥60 min of energetic play, ii) ≤1 h of sedentary screen time, and iii) 10-13 h of good quality sleep. Using an Australian sample, this study reports the proportion of preschool children meeting these guidelines and investigates associations with social-cognitive development.

METHODS

Data from 248 preschool children (mean age = 4.2 ± 0.6 years, 57% boys) participating in the PATH-ABC study were analyzed. Children completed direct assessments of physical activity (accelerometry) and social cognition (the Test of Emotional Comprehension (TEC) and Theory of Mind (ToM)). Parents reported on children's screen time and sleep. Children were categorised as meeting/not meeting: i) individual guidelines, ii) combinations of two guidelines, or iii) all three guidelines. Associations were examined using linear regression adjusting for child age, sex, vocabulary, area level socio-economic status and childcare level clustering.

RESULTS

High proportions of children met the physical activity (93.1%) and sleep (88.7%) guidelines, whereas fewer met the screen time guideline (17.3%). Overall, 14.9% of children met all three guidelines. Children meeting the sleep guideline performed better on TEC than those who did not (mean difference [MD] = 1.41; 95% confidence interval (CI) = 0.36, 2.47). Children meeting the sleep and physical activity or sleep and screen time guidelines also performed better on TEC (MD = 1.36; 95% CI = 0.31, 2.41) and ToM (MD = 0.25; 95% CI = -0.002, 0.50; p = 0.05), respectively, than those who did not. Meeting all three guidelines was associated with better ToM performance (MD = 0.28; 95% CI = -0.002, 0.48, p = 0.05), while meeting a larger number of guidelines was associated with better TEC (3 or 2 vs. 1/none, p < 0.02) and ToM performance (3 vs. 2, p = 0.03).

CONCLUSIONS

Strategies to promote adherence to the 24-Hour Movement Behaviour Guidelines for the Early Years among preschool children are warranted. Supporting preschool children to meet all guidelines or more guidelines, particularly the sleep and screen time guidelines, may be beneficial for their social-cognitive development.