Compositional analysis of 24-h movement behavior and its associations with physical and mental health: a protocol for...

The 24-h movement behavior framework includes all physical activity (PA), sedentary behavior (SB), and sleep as interdependent components of a full day. While evidence highlights the benefits of higher PA, lower SB, and adequate sleep for health, the combined effects of these behaviors on mental and physical health remain unclear. This systematic review will explore the associations between 24-h movement behavior compositions and mental and physical health outcomes, providing insights for developing balanced movement behavior guidelines.

This systematic review will follow the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline. PubMed, PsycINFO, Embase, Web of Science, and Sport Discus will be searched for studies published between 2015 and 2025. Eligible studies must report 24-h movement behavior metrics-the composition of time allocated to sleep, sedentary behavior, light-intensity physical activity (LPA), and moderate-to-vigorous physical activity (MVPA). Included studies must also examine at least one mental (e.g., depression, anxiety) or physical (e.g., BMI, systolic blood pressure, all-cause mortality) health outcome. For each study, we will extract the time allocated to each behavior and effect estimates with 95% CIs (e.g., percent change in BMI, odds ratios for depression, hazard ratios for mortality) to quantify the magnitude and direction of associations. Screening, data extraction, and quality assessment will be conducted independently by two reviewers. The quality of evidence for each outcome will be assessed using the GRADE approach. Due to expected heterogeneity in study designs, a meta-analysis will not be performed. Instead, a structured narrative synthesis will be presented, stratified by age group and health condition, to summarize findings and identify key research gaps.

The proposed systematic review will be the first to comprehensively review how combinations of PA, SB, and sleep are associated with mental and physical health using compositional data analysis. By emphasizing the interdependent nature of 24-h movement behaviors, the findings will provide a clearer understanding of how time spent among these behaviors influences health outcomes. The review aims to support evidence-based recommendations for optimizing daily movement behavior patterns to improve health across diverse populations.

PROSPERO (CRD42023445730).