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. 2025 Jul 28;23(1):75.
doi: 10.1186/s12955-025-02408-5.

Associations between 24-hour movement guidelines and health-related quality of life among urban preschool children in Singapore, Japan, and China

Ho Jin Chung  1 , Hyunshik Kim  1   2 , Jiameng Ma  1   2 , Terence Chua  1 , Seow Ting Low  1 , Dan Li  1 , Hongzhi Guo  3 , Michael Yong Hwa Chia  4
Affiliations

Associations between 24-hour movement guidelines and health-related quality of life among urban preschool children in Singapore, Japan, and China

Ho Jin Chung et al. Health Qual Life Outcomes. .

Abstract

Background: Health-related quality of life (HRQoL) is increasingly recognized as a critical indicator of well-being in early childhood, yet its associations with 24-hour movement behaviors-physical activity, screen time, and sleep-remain underexplored in Asian populations. This study aims to examine the association between adherence to the 24-hour movement guidelines (24-MG) and health-related quality of life (HRQOL) among preschoolers residing in major urban areas of Singapore, Japan, and China.

Methods: A cross-sectional survey was conducted among 6,634 children aged 3-6 years across Singapore (n = 3,672), Japan (n = 760), and China (n = 2,202). Movement behaviors were assessed using the validated SMALLQ® tool, and HRQoL was evaluated using the Pediatric Quality of Life Inventory (PedsQL™). Logistic regression models were applied to determine the associations between different patterns of 24-h MG adherence and HRQoL, adjusting for demographic variables.

Results: Full adherence to all three 24-h MG components was significantly associated with higher physical and psychosocial HRQoL scores in Singapore and China. In Japan, adherence to physical activity guidelines alone is associated with higher HRQoL. Notably, Chinese children had the highest adherence rates across all individual and combined movement behaviors. Conversely, Japanese children had the lowest rates of full adherence and were more likely to fall short of all guidelines.

Conclusions: This study provides novel evidence from three urban Asian contexts that adherence to the 24-hour movement guidelines positively correlates with HRQoL in preschool-aged children. The findings highlight the importance of integrated movement behavior frameworks and support the development of culturally tailored public health policies to improve early childhood well-being.

Keywords: 24-hour movement guidelines; Asia; Health-related quality of life; Physical activity; Preschool children; Screen time; Sleep duration; Urban health.

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Conflict of interest statement

Declarations. Human ethics and consent to participate and publish: All participating researchers adhered to the ethical standards outlined in the Declaration of Helsinki. The study protocols were approved by the institutional ethics committees in each respective country (Singapore: IRB2019-02-036; Japan: SU2019-31; China: HR 405 − 202). Considering the involvement of minor participants, informed consent for participation and publication of anonymized data was obtained from their parents and/or legal guardians prior to participation. Consent to publish: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Percentages meeting 24-h movement guidelines among Singapore (n = 3,672), Japan (n = 760) and China (n = 2,202) preschool children
Fig. 2
Fig. 2
Logistic regression examining the associations of number of 24-hour movement guidelines recommendations met with Health-Related Quality of Life. Abbreviations: OR, odds ratio; CI, confidence interval. The OR (95% CI) represents the adjusted results. Each model includes control variables, which consist of child sex, child age, child BMI, parent income, and educational level
See this image and copyright information in PMC

References

    1. The WHOQOL Group. The World Health Organization Quality of Life Assessment (WHOQOL). Position paper from the world health organization. Soc Sci Med. 1995;41(10):1403–9. - PubMed
    1. Ravens-Sieberer U, Herdman M, Devine J, Otto C, Bullinger M, Rose M, Klasen F. The European KIDSCREEN approach to measure quality of life and well-being in children: development, current application, and future advances. Qual Life Res. 2014;23(3):791–803. - PMC - PubMed
    1. Varni JW, Seid M, Kurtin PS. PedsQL 4.0: reliability and validity of the pediatric quality of life inventory version 4.0 generic core scales in healthy and patient populations. Med Care. 2001;39(8):800–12. - PubMed
    1. Solans M, Pane S, Estrada MD, Serra-Sutton V, Berra S, Herdman M, Alonso J, Rajmil L. Health-related quality of life measurement in children and adolescents: a systematic review of generic and disease-specific instruments. Value Health. 2008 Jul-Aug;11(4):742–64. - PubMed
    1. Varni JW, Burwinkle TM, Seid M, Skarr D. The PedsQL 4.0 as a pediatric population health measure: feasibility, reliability, and validity. Ambul Pediatr. 2003 Nov-Dec;3(6):329– 41. - PubMed