Pooled analysis of physical activity, sedentary behavior, and sleep among children from 33 countries

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Chong, Kar Hau and Suesse, Thomas and Cross, Penny L. and Ryan, Sarah T. and Aadland, Eivind and Aoko, Oluwayomi and Byambaa, Ankhmaa and Carson, Valerie and Chaput, Jean-Philippe and Christian, Hayley and Cliff, Dylan P. and De Craemer, Marieke and de Lucena Martins, Clarice Maria and Delisle Nyström, Christine and Draper, Catherine E. and El Hamdouchi, Asmaa and Florindo, Alex Antonio and Guan, Hongyan and Ha, Amy S. and Hamzavi Zarghani, Najmeh and Hesketh, Kylie D. and Hossain, Mohammad Sorowar and Jajat, Jajat and Kim, Thanh and Koh, Denise and Kontsevaya, Anna V. and Kuzik, Nicholas and Leppänen, Marja H. and Löf, Marie and Lubree, Himangi and Meredith-Jones, Kim and Mwase-Vuma, Tawonga W. and Ng, Johan Y. Y. and Novotny, Rachel and Nusurupia, Jackline Jema and Pham, Bang N. and Poh, Bee Koon and Reilly, John J. and Staiano, Amanda E. and Sultoni, Kuston and Tanaka, Chiaki and Tang, Hong K. and Taylor, Rachael W. and Tomaz, Simone A. and Tremblay, Mark S. and Trost, Stewart G. and Turab, Ali and Vale, Susana and Wickramasinghe, V. Pujitha and Okely, Anthony D. (2024) Pooled analysis of physical activity, sedentary behavior, and sleep among children from 33 countries. JAMA Pediatrics, 178 (11). pp. 1199-1207. ISSN 2168-6203 (https://doi.org/10.1001/jamapediatrics.2024.3330)

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Abstract

Importance The prevalence estimates of physical activity, sedentary behavior, and sleep (collectively known as movement behaviors) in 3- and 4-year-old children worldwide remains uncertain. Objective To report the proportion of 3- and 4-year-old children who met the World Health Organization guidelines for physical activity, sedentary behavior, and sleep across 33 countries. Design, Setting, and Participants Pooled analysis of data from 14 cross-sectional studies (July 2008 to September 2022) identified through systematic reviews and personal networks. Thirty-three countries of varying income levels across 6 geographical regions. Each study site needed to have at least 40 children aged 3.0 to 4.9 years with valid accelerometry and parent-/caregiver-reported screen time and sleep duration data. Data were analyzed from October 2022 to February 2023. Exposures Time spent in physical activity was assessed by reanalyzing accelerometry data using a harmonized data-processing protocol. Screen time and sleep duration were proxy reported by parents or caregivers. Main Outcomes and Measures The proportion of children who met the World Health Organization guidelines for physical activity (≥180 min/d of total physical activity and ≥60 min/d of moderate- to vigorous-intensity physical activity), screen time (≤1 h/d), and sleep duration (10-13 h/d) was estimated across countries and by World Bank income group and geographical region using meta-analysis. Results Of the 7017 children (mean [SD] age, 4.1 [0.5] years; 3585 [51.1%] boys and 3432 [48.9%] girls) in this pooled analysis, 14.3% (95% CI, 9.7-20.7) met the overall guidelines for physical activity, screen time, and sleep duration. There was no clear pattern according to income group: the proportion meeting the guidelines was 16.6% (95% CI, 10.4-25.3) in low- and lower-middle–income countries, 11.9% (95% CI, 5.9-22.5) in upper-middle–income countries, and 14.4% (95% CI, 9.6-21.1) in high-income countries. The region with the highest proportion meeting the guidelines was Africa (23.9%; 95% CI, 11.6-43.0), while the lowest proportion was in North and South America (7.7%; 95% CI, 3.6-15.8). Conclusions and Relevance Most 3- and 4-year-old children in this pooled analysis did not meet the current World Health Organization guidelines for physical activity, sedentary behavior, and sleep. Priority must be given to understanding factors that influence these behaviors in this age group and to implementing contextually appropriate programs and policies proven to be effective in promoting healthy levels of movement behaviors.

ORCID iDs

Chong, Kar Hau, Suesse, Thomas, Cross, Penny L., Ryan, Sarah T., Aadland, Eivind, Aoko, Oluwayomi, Byambaa, Ankhmaa, Carson, Valerie, Chaput, Jean-Philippe, Christian, Hayley, Cliff, Dylan P., De Craemer, Marieke, de Lucena Martins, Clarice Maria, Delisle Nyström, Christine, Draper, Catherine E., El Hamdouchi, Asmaa, Florindo, Alex Antonio, Guan, Hongyan, Ha, Amy S., Hamzavi Zarghani, Najmeh, Hesketh, Kylie D., Hossain, Mohammad Sorowar, Jajat, Jajat, Kim, Thanh, Koh, Denise, Kontsevaya, Anna V., Kuzik, Nicholas, Leppänen, Marja H., Löf, Marie, Lubree, Himangi, Meredith-Jones, Kim, Mwase-Vuma, Tawonga W., Ng, Johan Y. Y., Novotny, Rachel, Nusurupia, Jackline Jema, Pham, Bang N., Poh, Bee Koon, Reilly, John J. ORCID logoORCID: https://orcid.org/0000-0001-6165-5471, Staiano, Amanda E., Sultoni, Kuston, Tanaka, Chiaki, Tang, Hong K., Taylor, Rachael W., Tomaz, Simone A., Tremblay, Mark S., Trost, Stewart G., Turab, Ali, Vale, Susana, Wickramasinghe, V. Pujitha and Okely, Anthony D.;
CORE (COnnecting REpositories)