Abstract
BackgroundThe Canadian 24-h movement guidelines were developed with the hope of improving health and future health outcomes in children and youth. The purpose of this study was to evaluate adherence to the 3 recommendations most strongly associated with health outcomes in new 24-h movement guidelines and their relationship with adiposity (obesity and body mass index z-score) across countries participating in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).MethodsCross-sectional results were based on 6128 children aged 9–11 years from the 12 countries of ISCOLE. Sleep duration and moderate-to-vigorous physical activity (MVPA) were assessed using accelerometry. Screen time was measured through self-report. Body weight and height were measured. Body mass index (BMI, kg · m−2) was calculated, and BMI z-scores were computed using age- and sex-specific reference data from the World Health Organization. Obesity was defined as a BMI z-score > +2 SD. Meeting the overall 24-h movement guidelines was defined as: 9 to 11 h/night of sleep, ≤2 h/day of screen time, and at least 60 min/day of MVPA. Age, sex, highest parental education and unhealthy diet pattern score were included as covariates in statistical models. Associations between meeting vs. not meeting each single recommendation (and combinations) with obesity were assessed with odds ratios calculated using generalized linear mixed models. A linear mixed model was used to examine the differences in BMI z-scores between children meeting vs. not meeting the different combinations of recommendations.ResultsThe global prevalence of children meeting the overall recommendations (all three behaviors) was 7%, with children from Australia and Canada showing the highest adherence (15%). Children meeting the three recommendations had lower odds ratios for obesity compared to those meeting none of the recommendations (OR = 0.28, 95% CI 0.18–0.45). Compared to not meeting the 24-h movement recommendations either independently or combined, meeting them was significantly associated with a lower BMI z-score. Whenever the MVPA recommendation was included in the analysis the odds ratios for obesity were lower.ConclusionsFor ISCOLE participants meeting these 3 healthy movement recommendations the odds ratios of being obese or having high BMI z-scores were lower. However, only a small percentage of children met all recommendations. Future efforts should aim to find promising ways to increase daily physical activity, reduce screen time, and ensure an adequate night’s sleep in children.Trial registrationThe International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was registered at ClinicalTrials.gov (Identifier NCT01722500) (October 29, 2012).
Highlights
The Canadian 24-h movement guidelines were developed with the hope of improving health and future health outcomes in children and youth
The highest adherence to the sleep time recommendation was found in Australia and the UK (76%), and the lowest was found in Portugal (18%)
The adherence to the moderate-to-vigorous physical activity (MVPA) recommendation was the one that was associated with the lowest body mass index (BMI) z-score. This is the first study showing that adherence to 3 key healthy behaviors of the 24-h movement guidelines (4) was associated with lower odds ratios for obesity in an international sample of children
Summary
The Canadian 24-h movement guidelines were developed with the hope of improving health and future health outcomes in children and youth. Physical activity guidelines for children and adolescents have traditionally focused on recommendations to achieve a certain quantity of physical activity at defined intensities (e.g., 60 min of moderate to vigorous physical activity (MVPA)) [1] Adhering to such guidelines accounts for a low proportion of the overall 24-h period [2], and does not consider other movement behaviors associated with health and obesity, such as screen time and sleeping habits [3]. The 24-h movement guidelines recently developed in Canada represent a paradigm shift in thinking about movement behaviors [4] from a focus on a single specific movement behavior type (e.g., MVPA) to an integrated movement behavior model They include recommendations for the 24-h period, taking into account those behaviors related to health outcomes, MVPA and recreational screen time (no more than 2 h per day) and adequate sleep duration (e.g., between 9 and 11 h per night for children aged 5–13 years). The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) has assessed MVPA, screen time and sleep duration in relation to obesity in countries with a wide range of economic level of development [19,20,21]
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