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Pooled Analysis of Physical Activity, Sedentary Behavior, and Sleep Among Children From 33 Countries
Kar Hau Chong1, Thomas Suesse2, Penny L Cross3
1School of Health and Society, Early Start, Faculty of the Arts, Social Science and Humanities, University of Wollongong, Wollongong, New South Wales, Australia.
Insights
Most 3- and 4-year-old children worldwide do not meet WHO guidelines for physical activity, screen time, and sleep. Further research and targeted interventions are crucial for promoting healthy movement behaviors in early childhood.
Area of Science:
- Pediatrics
- Public Health
- Epidemiology
Background:
- Estimates of movement behaviors (physical activity, sedentary behavior, sleep) in 3- and 4-year-olds globally are uncertain.
- Understanding adherence to World Health Organization (WHO) guidelines is critical for child development.
Purpose of the Study:
- To determine the proportion of 3- and 4-year-old children meeting WHO guidelines for physical activity, sedentary behavior, and sleep across 33 countries.
- To analyze adherence by income level and geographical region.
Main Methods:
- Pooled analysis of 14 cross-sectional studies (2008-2022) involving 7017 children aged 3.0-4.9 years.
- Accelerometry data for physical activity, parent-reported data for screen time and sleep duration.
- Meta-analysis used to estimate proportions meeting WHO guidelines (physical activity ≥180 min/d total, ≥60 min/d moderate-to-vigorous; screen time ≤1 h/d; sleep 10-13 h/d).
Main Results:
- Only 14.3% of children met all WHO guidelines for movement behaviors.
- Adherence did not show a clear pattern by income group (Low/Lower-middle: 16.6%, Upper-middle: 11.9%, High: 14.4%).
- Africa had the highest proportion meeting guidelines (23.9%), while North and South America had the lowest (7.7%).
Conclusions:
- The majority of 3- and 4-year-olds do not meet current WHO movement behavior guidelines.
- Understanding influencing factors and implementing context-specific interventions are essential.
- Promoting healthy movement behaviors in early childhood requires targeted programs and policies.
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.
