Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov 1;178(11):1199-1207.
doi: 10.1001/jamapediatrics.2024.3330.

Pooled Analysis of Physical Activity, Sedentary Behavior, and Sleep Among Children From 33 Countries

Kar Hau Chong  1 , Thomas Suesse  2 , Penny L Cross  3 , Sarah T Ryan  1 , Eivind Aadland  4 , Oluwayomi Aoko  5 , Ankhmaa Byambaa  6 , Valerie Carson  7 , Jean-Philippe Chaput  8 , Hayley Christian  9 , Dylan P Cliff  10 , Marieke De Craemer  11 , Clarice Maria de Lucena Martins  12 , Christine Delisle Nyström  13 , Catherine E Draper  14 , Asmaa El Hamdouchi  15 , Alex Antonio Florindo  16 , Hongyan Guan  17 , Amy S Ha  18 , Najmeh Hamzavi Zarghani  19 , Kylie D Hesketh  20 , Mohammad Sorowar Hossain  21 , Jajat Jajat  22 , Thanh Kim  23 , Denise Koh  24 , Anna V Kontsevaya  25 , Nicholas Kuzik  26 , Marja H Leppänen  27 , Marie Löf  13 , Himangi Lubree  28 , Kim Meredith-Jones  29 , Tawonga W Mwase-Vuma  30 , Johan Y Y Ng  18 , Rachel Novotny  31 , Jackline Jema Nusurupia  32 , Bang N Pham  33 , Bee Koon Poh  34 , John J Reilly  35 , Amanda E Staiano  36 , Kuston Sultoni  22 , Chiaki Tanaka  37 , Hong K Tang  23 , Rachael W Taylor  29 , Simone A Tomaz  38 , Mark S Tremblay  26   39 , Stewart G Trost  40 , Ali Turab  41 , Susana Vale  42 , V Pujitha Wickramasinghe  43 , Anthony D Okely  1
Affiliations

Pooled Analysis of Physical Activity, Sedentary Behavior, and Sleep Among Children From 33 Countries

Kar Hau Chong et al. JAMA Pediatr. .

Abstract

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.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr Christian reported grants from Telethon Kids Institute, University of Western Australia Western Australian Health Promotion Foundation (Healthway), Telethon Kids Institute, University of Western Australia Australian National Health & Medical Research Council (NHMRC), and Telethon Kids Institute, University of Western Australia Australian Research Council (ARC) during the conduct of the study and a National Heart Foundation Future Leader Fellowship outside the submitted work. Dr Cliff reported grants from Australian Research Council during the conduct of the study. Dr De Craemer reported grants from Seventh Framework Programme during the conduct of the study. Dr El Hamdouchi reported grants from Physical Activity Pioneers to fund the SUNRISE pilot study during the conduct of the study. Dr Kontsevaya reported grants from the World Health Organization during the conduct of the study. Dr Meredith-Jones reported grants from Health Research Council New Zealand during the conduct of the study. Dr Tanaka reported grants from Sasakawa Sports Foundation during the conduct of the study. Dr Taylor reported grants from Health Research Council of New Zealand during the conduct of the study. Dr Tremblay reported grants from Canadian Institutes of Health Research during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Accelerometry Data Processing and Analysis Procedures
MVPA indicates moderate- to vigorous-intensity physical activity; PA, physical activity; TPA, total physical activity.
Figure 2.
Figure 2.. Proportion of Children Meeting the World Health Organization Guidelines, Overall and by Income Group and Region
See this image and copyright information in PMC

References

    1. World Health Organization . Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. Accessed February 23, 2023. https://www.who.int/publications/i/item/9789241550536 - PubMed
    1. Tremblay MS. Introducing 24-hour movement guidelines for the early years: a new paradigm gaining momentum. J Phys Act Health. 2020;17(1):92-95. doi: 10.1123/jpah.2019-0401 - DOI - PubMed
    1. Leppänen MH, Ray C, Wennman H, et al. Compliance with the 24-h movement guidelines and the relationship with anthropometry in Finnish preschoolers: the DAGIS study. BMC Public Health. 2019;19(1):1618. doi: 10.1186/s12889-019-7967-7 - DOI - PMC - PubMed
    1. Feng J, Zheng C, Sit CH, Reilly JJ, Huang WY. Associations between meeting 24-hour movement guidelines and health in the early years: a systematic review and meta-analysis. J Sports Sci. 2021;39(22):2545-2557. doi: 10.1080/02640414.2021.1945183 - DOI - PubMed
    1. Kracht CL, Webster EK, Staiano AE. Relationship between the 24-hour movement guidelines and fundamental motor skills in preschoolers. J Sci Med Sport. 2020;23(12):1185-1190. doi: 10.1016/j.jsams.2020.06.021 - DOI - PMC - PubMed