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Adherence to 24-h Movement Guidelines in children: a systematic review and meta-analysis
Chenglin Du1, Minjie Xu2, Xi Yang3
1Physical Education Department, Northeastern University, Shenyang, China.
Insights
Children
Area of Science:
- Pediatric Health
- Public Health
- Behavioral Science
Background:
- Adherence to 24-hour Movement Guidelines (physical activity, screen time, sleep) is linked to positive child health outcomes.
- Existing meta-analyses on overall adherence to these guidelines are limited.
- A systematic review and meta-analysis of existing evidence is lacking.
Purpose of the Study:
- To determine the prevalence of adherence to the 24-hour Movement Guidelines among children aged 5 to 13.
- To identify factors influencing adherence, including sex, geographical region, and measurement method.
Main Methods:
- A systematic review and meta-analysis of 29 studies involving 126,129 children (aged 5-13) were conducted.
- Studies were identified through six databases, adhering to the PRISMA framework.
- A random-effects model was used to pool prevalence rates, with subgroup analyses performed.
Main Results:
- Overall adherence to the 24-hour Movement Guidelines was low, at 10.4%.
- Adherence was lower in girls (10.0%) compared to boys (13.2%).
- Lower adherence rates were observed in South America (5.6%) and Asia (6.8%), with device-measured adherence (11.9%) higher than self-reported (8.4%).
Conclusions:
- Urgent need for sex- and region-specific strategies to promote physical activity, reduce screen time, and ensure adequate sleep in children.
- Future interventions should consider measurement methods to improve adherence to movement guidelines.
- Findings underscore the critical importance of addressing children's movement behaviors for long-term health.
Abstract:
Adherence to the 24-h Movement Guidelines (physical activity [PA], screen time [ST], and sleep duration) has been associated with positive health outcomes. However, meta-analyses on overall adherence to these guidelines among children remain limited. This study aimed to report children's adherence to the 24-h Movement Guidelines. Six databases were searched in November 2023, with an update conducted in April 2025. The review followed the PRISMA framework and included studies reporting the prevalence of adherence to the 24-h Movement Guidelines among children aged 5 to 13. A random-effects model was used to pool prevalence rates across studies. Subgroup analyses were conducted using sex, geographical region, and measurement method. Heterogeneity was assessed using the I2 statistic. This meta-analysis of 29 studies involving 126,129 children aged 5 to 13 revealed a low overall adherence rate of 10.4% (95% CI 8.8-12.0%) among children meeting all three 24-h Movement Guidelines. Subgroup analysis revealed lower adherence in girls (10.0%, 95% CI 6.9-13.1%) than in boys (13.2%, 95% CI 8.9-17.6%). Regarding geographical regions, South America (5.6%, 95% CI 1.3-9.9%) and Asia (6.8%, 95% CI 5.3-8.3%) showed lower adherence rates. For measurement methods, adherence was higher in device-measured (11.9%, 95% CI 8.8-14.9%) than self-reported (8.4%, 95% CI 6.5-10.3%).
Conclusion:
These findings highlight the need for sex- and region-specific strategies to promote adequate PA, reduce ST, and ensure sufficient sleep among children. Future research should consider measurement methods when designing interventions to improve adherence to the 24-h Movement Guidelines.
Systematic Review Registration:
PROSPERO (CRD42024552497) What is known: • Many studies have examined adherence to the 24-h Movement Guidelines among school-aged children. However, a systematic review and meta-analysis of the existing evidence are still lacking.
What Is New:
• Subgroup analyses by sex showed lower adherence in girls than in boys, while analyses by geographic region revealed particularly low adherence in South America and Asia. Moreover, studies using device measures yielded higher adherence estimates than those using self-reports.
