Pooled Analysis of Physical Activity, Sedentary Behavior, and Sleep Among Children From 33 Countries

Chong KH 1 , Suesse T 2 , Cross PL 3 , Ryan ST 1 , Aadland E 4 , Aoko O 5 Show all authors , Byambaa A 6 , Carson V 7 , Chaput JP 8 , Christian H 9 , Cliff DP 10 , De Craemer M 11 , de Lucena Martins CM 12 , Delisle Nyström C 13 , Draper CE 14 , El Hamdouchi A 15 , Florindo AA 16 , Guan H 17 , Ha AS 18 , Hamzavi Zarghani N 19 , Hesketh KD 20 , Hossain MS 21 , Jajat J 22 , Kim T 23 , Koh D 24 , Kontsevaya AV 25 , Kuzik N 26 , Leppänen MH 27 , Löf M 13 , Lubree H 28 , Meredith-Jones K 29 , Mwase-Vuma TW 30 , Ng JYY 18 , Novotny R 31 , Nusurupia JJ 32 , Pham BN 33 , Poh BK 34 , Reilly JJ 35 , Staiano AE 36 , Sultoni K 22 , Tanaka C 37 , Tang HK 23 , Taylor RW 29 , Tomaz SA 38 , Tremblay MS 26 , Trost SG 39 , Turab A 40 , Vale S 41 , Wickramasinghe VP 42 , Okely AD 1

Affiliations 

  • 1 School of Health and Society, Early Start, Faculty of the Arts, Social Science and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
  • 2 National Institute for Applied Statistics Research Australia, School of Mathematics and Applied Statistics, Faculty of Engineering and Information Sciences, University of Wollongong, Wollongong, New South Wales, Australia
  • 3 Research Services Office, Research and Innovation Division, University of Wollongong, Wollongong, New South Wales, Australia
  • 4 Department of Sport, Food and Natural Sciences, Faculty of Education, Arts and Sports, Western Norway University of Applied Sciences, Sogndal, Norway
  • 5 Human Kinetics and Health Education Department, University of Lagos, Lagos, Nigeria
  • 6 National Centre for Public Health, Ulaanbaatar, Mongolia
  • 7 Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
  • 8 Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  • 9 Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia
  • 10 School of Education, Early Start, Faculty of the Arts, Social Sciences and Humanities, University of Wollongong, Wollongong, New South Wales, Australia
  • 11 Department of Rehabilitation Sciences, Ghent University, Ghent, Belgium
  • 12 Research Centre in Physical Activity, Health and Leisure, and Laboratory for Integrative and Translational Research in Population Health, University of Porto, Porto, Portugal
  • 13 Department of Biosciences and Nutrition, Karolinska Institutet, Huddinge, Sweden
  • 14 South African Medical Research Council/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
  • 15 Unité de Recherche en Nutrition et Alimentation, Centre National de l'Énergie des Sciences et des Techniques Nucléaires, Rabat, Morocco
  • 16 School of Arts, Sciences, and Humanities, University of Sao Paulo, Sao Paulo, Brazil
  • 17 Child Healthcare Centre, Nurturing Care Research and Guidance Center, Beijing Municipal Key Laboratory of Child Development and Nutriomics, Capital Institute of Pediatrics, Beijing, China
  • 18 Department of Sports Science and Physical Education, Kwok Sports Building, The Chinese University of Hong Kong, Shatin, Hong Kong, China
  • 19 Department of Health Education and Health Promotion, Faculty of Medical Science, Tarbiat Modares University, Tehran, Iran
  • 20 Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Science, Deakin University, Geelong, Victoria, Australia
  • 21 Department of Emerging and Neglected Diseases, Biomedical Research Foundation, Dhaka, Bangladesh
  • 22 Faculty of Sport and Health Education, Universitas Pendidikan Indonesia, Bandung, Jawa Barat, Indonesia
  • 23 Department of Epidemiology, Faculty of Public Health, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
  • 24 Centre for Education and Community Well-being, Faculty of Education, Universiti Kebangsaan Malaysia, Bangi, Malaysia
  • 25 National Medical Research Center for Therapy and Preventive Medicine, Moscow, Russia
  • 26 Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
  • 27 Institute of Biomedicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
  • 28 Vadu Rural Health Program, KEM Hospital Research Centre, Rasta Peth, Pune, India
  • 29 Department of Medicine, University of Otago, Dunedin, New Zealand
  • 30 Centre for Social Research, University of Malawi, Zomba, Malawi
  • 31 Department of Human Nutrition, Food and Animal Sciences, College of Tropical Agriculture and Human Resources, University of Hawaii at Manoa, Honolulu
  • 32 Tanzania Food and Nutrition Centre, Dar es Salaam, Tanzania
  • 33 Papua New Guinea Institute of Medical Research, Goroka, Papua New Guinea
  • 34 Centre for Community Health Studies, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  • 35 Department of Psychological Sciences & Health, University of Strathclyde, Glasgow, Scotland
  • 36 Division of Population and Public Health Science, Pennington Biomedical Research Center, Baton Rouge, Louisiana
  • 37 Department of Human Nutrition, Tokyo Kasei Gakuin University, Chiyoda-ku, Tokyo, Japan
  • 38 Faculty of Health Sciences and Sport, University of Stirling, Stirling, United Kingdom
  • 39 School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
  • 40 Precision Health Consultants Global, Karachi, Pakistan
  • 41 Politécnico do Porto - Escola Superior de Educação, Porto, Portugal
  • 42 Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
JAMA Pediatr, 2024 Nov 01;178(11):1199-1207.
PMID: 39348138 DOI: 10.1001/jamapediatrics.2024.3330

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.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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