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International study of 24-hour movement behaviours among preschool children (SUNRISE): A pilot study from Nepal
Narayan Subedi1,2, Anthony D Okely3, Buna Bhandari4
1Nepal Development Society, Kathmandu, Nepal. n.subedi@nedsnepal.org.np.
Insights
Only 10% of Nepali preschoolers met WHO movement guidelines, with screen time being the biggest challenge. This pilot study found the main SUNRISE study methods feasible and acceptable in Nepal.
Area of Science:
- Child Health
- Public Health
- Behavioral Science
Background:
- Assessing adherence to World Health Organization (WHO) 24-hour movement guidelines in Nepali preschoolers (3-4 years).
- Evaluating executive functions and motor skills in relation to movement behaviors.
- Examining feasibility and acceptability of the SUNRISE study protocol in diverse settings.
Purpose of the Study:
- Determine the proportion of Nepali preschool children meeting WHO 24-hour movement guidelines (physical activity, sedentary behavior, sleep).
- Analyze adherence by sex and place of residence (urban vs. rural).
- Assess the feasibility and acceptability of the SUNRISE study methods.
Main Methods:
- Pilot study involving 99 preschool children and their parents/caregivers in Syangja District, Nepal.
- Objective assessment of physical activity, sedentary behavior, and sleep using ActiGraph accelerometers.
- Evaluation of executive functions (Early Years Toolbox) and motor skills (NIH Toolbox).
- Qualitative data collection through focus group discussions and interviews with parents/caregivers and teachers.
Main Results:
- Only 10% of children met all WHO movement guidelines; sleep (81%) and physical activity (79%) adherence were higher than screen time (56%).
- Males and rural children showed higher moderate-to-vigorous physical activity than females and urban children, respectively.
- Females demonstrated better screen time adherence and inhibition control; rural children exhibited better working memory.
- Study procedures, including accelerometer use, were reported as acceptable and feasible by parents/caregivers and teachers.
Conclusions:
- Very low adherence to WHO 24-hour movement guidelines among Nepali preschoolers, with screen time being a major barrier.
- Targeted interventions are necessary to promote healthier movement behaviors, especially reducing screen time.
- The study confirms the feasibility and acceptability of the SUNRISE protocol for future research in Nepal.
Background:
This study aimed to determine the proportion of Nepali preschool children (3-4 years of age) meeting the World Health Organization (WHO) 24- hour movement guidelines for physical activity (PA), sedentary behaviour and sleep by sex (male vs. female) and place of residence (urban vs. rural) and evaluate their executive functions and motor skills. Furthermore, it evaluated the feasibility and acceptability of methods proposed for the main SUNRISE study in diverse settings.
Methods:
In this pilot study, a total of 99 preschool children, balancing sex and place of residence, each with one parent/caregiver, from Syangja District were recruited. Physical activity, sedentary behaviour and sleep were assessed using waist-worn ActiGraph accelerometers (ActiGraph wGT3x-BT) with ≥ 1 valid 24-hour period of data, motor skills (gross and fine) were evaluated using the NIH Toolbox motor battery, and executive functions were assessed using the Early Years Toolbox. Eight focus group discussions (FGDs) were carried out with parents/caregivers, and a short interview was conducted with eight Early Childhood Development (ECD) centre teachers to explore the feasibility and acceptability of implementing the SUNRISE protocol.
Results:
Only 10% of children met all components of the WHO 24-hour movement guidelines (≥ 180 min total PA, of which ≥ 60 min were MVPA, ≤ 1 h of screen time, and 10-13 h of sleep). Proportions of those meeting the guidelines were higher for sleep (81%) and physical activity (79%) than for screen time (56%). Altogether, 96 children wore the accelerometer, of which 78 had at least ≥ 1 valid 24-hour period of data. Males and rural children accumulated more daily moderate-to-vigorous and vigorous physical activity than females and urban children, respectively. In contrast, females were more likely to meet screen time guidelines than males (66% vs. 42%, p = 0.018). Additionally, females had better inhibition control than males, and rural children had better working memory than urban children. Parent/caregivers and ECD teachers reported that the study procedures, including accelerometer use, were acceptable and feasible.
Conclusions:
Adherence to the full set of WHO movement guidelines was very low among preschool children in this study, with screen time emerging as the most challenging component. Targeted strategies are needed to promote healthier movement behaviours, particularly to reduce screen time. The findings support the feasibility and acceptability of conducting the main SUNRISE study in Nepal.
