PURPOSE

Specific combinations of 24-hour movement behaviors (high physical activity (PA), low sedentary behavior (SB), and high sleep) are associated with favorable health indicators for children under five years of age, including adiposity indicators. Evidence is, however, limited due to the small number of studies among these children. Additionally, the World Health Organization acknowledges the importance of targeting these behaviors in an integrated approach to prevent adiposity. This is reflected in the release of 24-hour movement behavior guidelines for children under five years in 2019. The present study is one of the first investigating the proportion of preschoolers complying with these behavior guidelines (on a total week, weekdays and weekend days), and the associations with adiposity in a cross-national European sample.

METHODS

This cross-sectional study included 2468 preschoolers (mean age: 4.75 years; 41.9% boys) from six European countries. PA was objectively assessed by pedometers. Parent-reported questionnaires provided screen time (ST) as a proxy for SB and sleep duration data. Generalized estimating equations were used to analyze the association between guideline compliance and adiposity, i.e., body mass index z-score (BMIz)  and waist to height ratio (WHR). The associations were investigated in the total sample and in girls and boys separately.

RESULTS

Only 10.1% of preschoolers complied with the 24-hour movement behavior guidelines, 69.2% with the sleep duration guideline, 39.8% with the ST guideline and 32.7% with the PA guideline. No association was found between guideline compliance with all three movement behaviors and adiposity. However, associations were found for isolated guideline compliance with weekday screen time (BMIz and WHR: p=0.04) and weekend day sleep duration (BMIz and WHR: p=0.03) with lower adiposity. The association for sleep duration was confirmed in girls (BMIz: p=0.02; WHR: p=0.03), but not in boys.

CONCLUSIONS

Overall, low compliance with the 24-hour movement behavior guidelines was found. No association was found between integrated guidelines and adiposity. Longitudinal studies, including intervention studies, are needed to increase preschoolers’ guideline compliance and to gain more insight into the association between 24-hour movement behaviors and adiposity from a young age onwards.

PURPOSE:

High levels of physical activity (PA), low levels of sedentary behaviour and sufficient amounts of sleep are important for children’s health. This resulted in the launch of integrated 24-hour movement behaviour (24-hMB) guidelines for children. There is a current need to understand children’s adherence to these guidelines, and to investigate how these behaviours interact to influence health. Given that childhood obesity has become a serious public health problem worldwide, this study investigates how compliance with the newly developed 24-hMB guidelines is associated with adiposity in children over time.

METHODS:

Analyses comprised 2,985 children (mean age: 6.20 ± 1.72 years; 49.7% boys) from eight European countries with valid ActiGraph GT3X data (i.e., sleep, light PA, moderate to vigorous PA and total PA) at baseline and 2-year follow-up. Screen time was obtained through a parental-reported questionnaire. Repeated Measures ANOVA were used to analyse if the evolution of BMI z-score (BMIz) and waist-to-hip ratio (WTHR) was associated with trajectories of compliance with the integrated 24-hMB guidelines. Trajectories of compliance were defined as children who: 1) remained compliers (RC), 2) became compliers (BC), 3) became non-compliers (BNC) and 4) remained non-compliers (RNC). Analyses were controlled for socio-economic status and age, and stratified by sex.

RESULTS:

At baseline, 17.5% of the children complied with the integrated 24-hMB guidelines and 12.3% of the children complied at 2-year follow-up. No difference in evolution of BMIz and WTHR was found between trajectories of compliance in boys (BMIZ: F=1.26, p=0.29; WTHR: F=0.45, p=0.72) and girls (BMIz: F=2.27; p=0.08; WTHR: F=2.32, p=0.08). For trajectories of guideline compliance, a significant main effect for WTHR was observed in boys (F=4.09, p=0.007) with the RNC group having a significant higher WTHR than the RC group (p=0.046) and the BNC group (p=0.006).

CONCLUSION:

Low compliance rates with the integrated 24-hMB guidelines in children were observed but guideline compliance was not associated with adiposity indicators over time. However, results suggest that complying with the integrated 24-hMB guidelines over time is beneficial in boys. 

PURPOSE:

The involvement of stakeholders in the early stages of the intervention development process is crucial for successful delivery and future implementation of any intervention. We report on stakeholder involvement in the development of an intervention based on the 24-hour movement behaviour (physical activity, sedentary behaviour, sleep) framework. The intervention aims to address inequalities in early-childhood obesity in Scotland

METHODS:

Stakeholders were defined as any individual, organisation or community with a direct interest in the process and outcomes of the research project. Pre-school education and parenting stakeholder organisations were identified through an online search. The research was also advertised to staff working in childhood obesity and pre-schooler health via public health networks. Participants were invited via email. At the time of writing four Zoom focus groups (90 minutes each) were recorded, professionally transcribed and analysed thematically using a reflexive approach.

RESULTS:

Focus groups included representatives from education and parenting charities (n=8), senior NHS public health and health promotion staff (n=6), researchers (n=3) and early years practitioners (n=1) in Scotland. Seven themes and related sub-themes were identified:

·        Parents as active collaborators;

·        Critical evaluation of language, messaging and branding;

·        Systems-based approach to intervention development and implementation;

·        Mapping to fill gaps, create connections and links;

·        Play based approach;

·        COVID-19 considerations;

·        Ongoing pressures within the sectors.

The consensus was that an intervention is needed but it should link with what is already in place. Participants felt that the 24-hour movement framework needs rebranding and reframing from the outset within any intervention. Language used should be less prescriptive, less “military” and be gentle to avoid creating feelings of failure in parents involved in an intervention. Other themes will inform intervention development and have implications for delivery.

CONCLUSIONS:

Speaking to stakeholders helped to establish the need for an intervention. However, what an intervention would look like was less clear. Themes highlight the need to further investigate or map the system to identify an appropriate context, then develop a theory of change and engage with parents and early years staff to co-develop the intervention including the underpinning theory, philosophy and resources.