The voices of children on movement behaviours: implications for promoting international guidelines to support obesity-prevention efforts.

BACKGROUND: As a key factor for the prevention of childhood obesity, WHO recommends a specific balance of movement behaviours (ie, physical activity, sedentary behaviour, and sleep) across the 24-h day for children younger than 5 years. Substantial evidence underpins our understanding of the benefits for healthy growth and development; however, little is known about young children's experiences and perceptions, and whether context-specific factors that might influence movement behaviours differ across the globe. METHODS: Acknowledging children's agency as knowledgeable informants on matters affecting their lives, children aged 3-5 years from communities and preschools in urban and rural Australia, Chile, China, India, Morocco, and South Africa, were interviewed. Discussions were based on a socioecological framework of the multifactorial, complex influences on young children's movement behaviours. Prompts were adapted to ensure relevance across diverse study sites. Ethics approval and guardian consent were obtained, and the Framework Method used for analysis. FINDINGS: 156 children (101 [65%] from urban areas, 55 [45%] from rural areas; 73 [47%] female, 83 [53%] male) shared their experiences, perceptions, and preferences related to movement behaviours and the barriers and enablers of outdoor play. Physical activity, sedentary behaviour, and to a lesser degree screen time occurred predominantly through play. Barriers to outdoor play included weather, air quality, and safety concerns. Sleep routines varied considerably and were influenced by room or bed sharing. Screen use was ubiquitous, presenting a challenge to meeting recommendations. The effect of daily structure, degree of autonomy, and interactions were consistent themes, and differences in how these factors influenced movement behaviours across study sites were evident. INTERPRETATION: The findings highlight that although movement behaviour guidelines are universal, contextual realities need to be considered in how socialisation and promotion of the guidelines are enacted. How young children's sociocultural and physical environments are constructed and influenced can foster or disrupt healthy movement behaviours, which might have implications for childhood obesity. FUNDING: Beijing High Level Talents Cultivation Project for Public Health Academic Leader; Beijing Medical Research Institute (Public service development and reform pilot project); British Academy for the Humanities and Social Sciences; KEM Hospital Research Centre; Ministry of Education and Universidad de La Frontera (Innovation in Higher Education Program); and National Health and Medical Research Council (Investigator Grant Leadership Fellow, Level 2).

Feasibility, acceptability and potential efficacy of a virtual physical activity program in primary and secondary schools in New South Wales, Australia: A quasi-experimental study.

ISSUE ADDRESSED: Child and youth participation in physical activity (PA) is fundamental for healthy development and obesity prevention. Government policy requires schools to offer 150 minutes of PA each week, however compliance is low. Race around Australia (RAA) is a New South Wales (NSW) Department of Education, virtual PA program aimed at assisting schools in meeting the PA guidelines. METHODS: A pre- and post-intervention, quasi-experimental study was conducted using a mixed-methods approach comprising teacher interviews, a student questionnaire and a 1.6 kilometre (km) timed run. Data were collected from April to September 2021 among students and teachers in Grades 5 to 8, from 10 schools in NSW, Australia. RESULTS: The analytical sample included data from 918 students and 17 teachers. The RAA program was deemed feasible and acceptable in primary schools, whereas there were several systemic and intrapersonal barriers to implementation success for secondary schools. In primary schools, RAA increased PA opportunities and the 1.6 km timed runs revealed a statistically significant treatment by time effect in favour of the intervention group for cardiorespiratory fitness (-36.91 seconds, 95% CI [-63.14, -10.68], P = .006). CONCLUSIONS: RAA has demonstrated feasibility and potential efficacy in improving cardiorespiratory fitness. We recommend that program refinement be made to deliver an intervention that addresses the unique barriers of the secondary school setting through a multi-level ecological approach. SO WHAT?: Despite evident benefits, implementation of PA initiatives in the school setting reveals many challenges. Stronger consideration of the Health Promotion with Schools Framework is evidently needed.

Advocating for Implementation of the Global Action Plan on Physical Activity: Challenges and Support Requirements.

BACKGROUND: There is limited understanding of the challenges experienced and supports required to aid effective advocacy of the Global Action Plan on Physical Activity (GAPPA). The purpose of this study was to assess the challenges experienced and supports needed to advocate for the GAPPA across countries of different income levels. METHODS: Stakeholders working in an area related to the promotion of physical activity were invited to complete an online survey. The survey assessed current awareness and engagement with the GAPPA, factors related to advocacy, and the perceived challenges and supports related to advocacy for implementation of the GAPPA. Closed questions were analyzed in SPSS, with a Pearson's chi-square test used to assess differences between country income level. Open questions were analyzed using inductive thematic analysis. RESULTS: Participants (n = 518) from 81 countries completed the survey. Significant differences were observed between country income level for awareness of the GAPPA and perceived country engagement with the GAPPA. Challenges related to advocacy included a lack of support and engagement, resources, priority, awareness, advocacy education and training, accessibility, and local application. Supports needed for future advocacy included guidance and support, cooperation and alliance, advocacy education and training, and advocacy resources. CONCLUSIONS: Although stakeholders from different country income levels experience similar advocacy challenges and required supports, how countries experience these can be distinct. This research has highlighted some specific ways in which those involved in the promotion of physical activity can be supported to scale up advocacy for the GAPPA. When implementing such supports, consideration of regional, geographic, and cultural barriers and opportunities is important to ensure they are effective and equitable.

Levels and Correlates of Objectively Measured Sedentary Behavior in Young Children: SUNRISE Study Results from 19 Countries.

PURPOSE: There is a paucity of global data on sedentary behavior during early childhood. The purpose of this study was to examine how device-measured sedentary behavior in young children differed across geographically, economically, and sociodemographically diverse populations, in an international sample. METHODS: This multinational, cross-sectional study included data from 1071 children 3-5 yr old from 19 countries, collected between 2018 and 2020 (pre-COVID). Sedentary behavior was measured for three consecutive days using activPAL accelerometers. Sedentary time, sedentary fragmentation, and seated transport duration were calculated. Linear mixed models were used to examine the differences in sedentary behavior variables between sex, country-level income groups, urban/rural settings, and population density. RESULTS: Children spent 56% (7.4 h) of their waking time sedentary. The longest average bout duration was 81.1 ± 45.4 min, and an average of 61.1 ± 50.1 min·d-1 was spent in seated transport. Children from upper-middle-income and high-income countries spent a greater proportion of the day sedentary, accrued more sedentary bouts, had shorter breaks between sedentary bouts, and spent significantly more time in seated transport, compared with children from low-income and lower-middle-income countries. Sex and urban/rural residential setting were not associated with any outcomes. Higher population density was associated with several higher sedentary behavior measures. CONCLUSIONS: These data advance our understanding of young children's sedentary behavior patterns globally. Country income levels and population density appear to be stronger drivers of the observed differences, than sex or rural/urban residential setting.

Cross-sectional examination of 24-hour movement behaviours among 3- and 4-year-old children in urban and rural settings in low-income, middle-income and high-income countries: the SUNRISE study protocol.

INTRODUCTION: 24-hour movement behaviours (physical activity, sedentary behaviour and sleep) during the early years are associated with health and developmental outcomes, prompting the WHO to develop Global guidelines for physical activity, sedentary behaviour and sleep for children under 5 years of age. Prevalence data on 24-hour movement behaviours is lacking, particularly in low-income and middle-income countries (LMICs). This paper describes the development of the SUNRISE International Study of Movement Behaviours in the Early Years protocol, designed to address this gap. METHODS AND ANALYSIS: SUNRISE is the first international cross-sectional study that aims to determine the proportion of 3- and 4-year-old children who meet the WHO Global guidelines. The study will assess if proportions differ by gender, urban/rural location and/or socioeconomic status. Executive function, motor skills and adiposity will be assessed and potential correlates of 24-hour movement behaviours examined. Pilot research from 24 countries (14 LMICs) informed the study design and protocol. Data are collected locally by research staff from partnering institutions who are trained throughout the research process. Piloting of all measures to determine protocol acceptability and feasibility was interrupted by COVID-19 but is nearing completion. At the time of publication 41 countries are participating in the SUNRISE study. ETHICS AND DISSEMINATION: The SUNRISE protocol has received ethics approved from the University of Wollongong, Australia, and in each country by the applicable ethics committees. Approval is also sought from any relevant government departments or organisations. The results will inform global efforts to prevent childhood obesity and ensure young children reach their health and developmental potential. Findings on the correlates of movement behaviours can guide future interventions to improve the movement behaviours in culturally specific ways. Study findings will be disseminated via publications, conference presentations and may contribute to the development of local guidelines and public health interventions.

International study of 24-h movement behaviors of early years (SUNRISE): a pilot study from Bangladesh.

BACKGROUND: The World Health Organization (WHO) released guidelines for physical activity, sedentary behavior, and sleep for children under 5 years of age in 2019. In response to these guidelines, this pilot study aimed to (i) determine the proportion of preschool children (ages 3-4 years) who met the WHO guidelines; (ii) examine the feasibility of the proposed protocol for the SUNRISE study; and (iii) assess the impact of the COVID-19 pandemic on movement behaviors of preschool children in Bangladesh. METHODS: Time spent in physical activity, sedentary behavior and sleep were objectively measured using two types of accelerometers (ActiGraph wGT3x-BT and ActivPAL4). Screen time and sleep quality were assessed via parent questionnaire. Fine and gross motor skills were measured using the Ages and Stages Questionnaire (3rd edition). Three executive functions were assessed using the Early Years Toolbox. Focus groups were conducted with parents and childcare staff to determine the feasibility of the protocol. Follow-up data during COVID-19 pandemic was collected from parents over phone. RESULTS: Data from 63 preschool-aged children and their parents was analyzed in this pilot study. Only three children (4.7%) met all components of the WHO guidelines. Separately, children meeting physical activity, sedentary screen time and sleep guidelines were 71.9%, 17.5%, and 59.7% respectively. The proportion of all children who were developmentally on-track for the gross and fine motor skills was 58.7% and 50.8%, respectively. Parents and educators reported that the protocol was feasible except for the activPAL-4 accelerometer. Approximately, 39% of children (14 out of 37) who wore this device developed itchy skin and rashes resulting in the suspension of using this device mid-way through data collection. During COVID-19, there was a significant decrease in children's total physical activity (- 193 min/day), and time spent outside on weekdays (- 75 min/day) and weekend days (- 131 min/day) and a significant increase in sedentary screen time (+85 min/day). CONCLUSION: Only a low proportion of children met the WHO guidelines. Methods and devices (except ActivPAL4) used in this pilot study proved to be feasible and this has paved the way to conduct the main SUNRISE study in Bangladesh. Future measures should be taken to address the issue of movement behaviors of children during the time of pandemics like COVID-19.

Global effect of COVID-19 pandemic on physical activity, sedentary behaviour and sleep among 3- to 5-year-old children: a longitudinal study of 14 countries.

BACKGROUND: The restrictions associated with the 2020 COVID-19 pandemic has resulted in changes to young children's daily routines and habits. The impact on their participation in movement behaviours (physical activity, sedentary screen time and sleep) is unknown. This international longitudinal study compared young children's movement behaviours before and during the COVID-19 pandemic. METHODS: Parents of children aged 3-5 years, from 14 countries (8 low- and middle-income countries, LMICs) completed surveys to assess changes in movement behaviours and how these changes were associated with the COVID-19 pandemic. Surveys were completed in the 12 months up to March 2020 and again between May and June 2020 (at the height of restrictions). Physical activity (PA), sedentary screen time (SST) and sleep were assessed via parent survey. At Time 2, COVID-19 factors including level of restriction, environmental conditions, and parental stress were measured. Compliance with the World Health Organizations (WHO) Global guidelines for PA (180 min/day [≥60 min moderate- vigorous PA]), SST (≤1 h/day) and sleep (10-13 h/day) for children under 5 years of age, was determined. RESULTS: Nine hundred- forty-eight parents completed the survey at both time points. Children from LMICs were more likely to meet the PA (Adjusted Odds Ratio [AdjOR] = 2.0, 95%Confidence Interval [CI] 1.0,3.8) and SST (AdjOR = 2.2, 95%CI 1.2,3.9) guidelines than their high-income country (HIC) counterparts. Children who could go outside during COVID-19 were more likely to meet all WHO Global guidelines (AdjOR = 3.3, 95%CI 1.1,9.8) than those who were not. Children of parents with higher compared to lower stress were less likely to meet all three guidelines (AdjOR = 0.5, 95%CI 0.3,0.9). CONCLUSION: PA and SST levels of children from LMICs have been less impacted by COVID-19 than in HICs. Ensuring children can access an outdoor space, and supporting parents' mental health are important prerequisites for enabling pre-schoolers to practice healthy movement behaviours and meet the Global guidelines.

School Flexible Learning Spaces, Student Movement Behavior and Educational Outcomes among Adolescents: A Mixed-Methods Systematic Review.

BACKGROUND: To achieve sustainability, we must consider scalable improvements in student movement behavior in the classroom setting, educational priorities. Flexible learning spaces that employ student-centered pedagogy and contain a range of furniture and layout options, implemented to improve educational outcomes, may enable unintended health benefits. In this review, we summarize the evidence on the effects of flexible learning spaces on adolescent student movement behaviors and educational outcomes. METHODS: We searched 5 databases, retrieving 5 quantitative and one qualitative article meeting the review criteria. RESULTS: Students in flexible learning spaces spent less time sitting, and more time standing and moving. Students were also more engaged, on-task, and collaborated and interacted more. Academic results for English, Mathematics and Humanities for those in flexible learning spaces were higher than peers in traditional classrooms. CONCLUSION: Evidence from the reviewed studies suggests that there may be beneficial outcomes across some movement behaviors as well as learning outcomes in classrooms that employ student-centered pedagogy and use a built environment that facilitates autonomy and choice around where and how to learn. These learning environments present an opportunity for an interdisciplinary approach to address sedentary behavior in classrooms.

Flexible learning spaces facilitate interaction, collaboration and behavioural engagement in secondary school.

Globally, many schools are replacing traditional classrooms with innovative flexible learning spaces to improve academic outcomes. Little is known about the effect on classroom behaviour. Students from nine secondary schools (n = 60, M age = 13.2±1.0y) were observed via momentary time sampling for a 30 minute period, in both a traditionally furnished and arranged classroom and a flexible learning space containing a variety of furniture options to accommodate different pedagogical approaches and learning styles. The teaching approaches in both conditions were documented. In traditional classrooms the approach was predominantly teacher-led and in the flexible learning space it was student-centred. Students in flexible learning spaces spent significantly more time in large group settings (d = 0.61, p = 0.001), collaborating (d = 1.33, p = 0.001), interacting with peers (d = 0.88, p = 0.001) and actively engaged (d = 0.50, p = 0.001) than students in traditional classrooms. Students also spent significantly less class time being taught in a whole class setting (d = -0.65, p = 0.001), engaged in teacher-led instruction (d = -0.75, p = 0.001), working individually (d = -0.79, p = 0.001), verbally off-task (d = -0.44, p = 0.016), and using technology (d = -0.26, p = 0.022) than in traditional classrooms. The results suggest that the varied, adaptable nature of flexible learning spaces coupled with the use of student-centred pedagogies, facilitated a higher proportion of class time interacting, collaborating and engaging with the lesson content. This may translate into beneficial learning outcomes in the long-term.

Flexible learning spaces reduce sedentary time in adolescents.

OBJECTIVES: Many schools internationally are replacing traditional classrooms (TC) with innovative flexible learning spaces (FLS) to improve academic outcomes. Via a stealth approach, there may be additional unintended health benefits if students reduce their total and prolonged sitting. The aim of this study was to compare student sitting patterns between TC and FLS. DESIGN: School-based cross-over trial. METHODS: Students at nine secondary schools (n=191, M age=13.2±1.0years) wore activPAL accelerometers in both a traditionally furnished and arranged classroom (TC), and a FLS containing a variety of furniture and layout options, utilizing student-centered pedagogies, for the duration of one double classroom lesson (M=76min). The lesson content and teacher were consistent across both conditions. Data were analyzed using multilevel mixed-effects linear regression. RESULTS: In FLS, students spent less class time sitting (mean=18%; 95% CI: -20.8, -15.0), and accumulated more breaks in sitting (2.1; 95% CI: 0.8, 3.5 per 60min), more bouts of intermittent (≤9min) sitting (2.2; 95% CI: 0.8, 3.6 per 60min), and fewer bouts of prolonged (≤30min) sitting (-0.2; 95% CI: -0.3, -0.1 per 60min), than in TC. Students also spent more class time standing (15%; 95% CI: 12.7, 18.0) and stepping (3%; 95% CI: 2.0, 3.1) in FLS than TC. CONCLUSION: The results suggest that, by stealth, elements of FLS including a variety of furniture and resources, and greater use of student-centered pedagogies, facilitate improvements in adolescents' sedentary profiles during class time. This may translate into beneficial health impacts over a longer period given the health benefits of reducing total and breaking up prolonged sitting.