Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep.

BACKGROUND: The Canadian Society for Exercise Physiology convened representatives of national organizations, research experts, methodologists, stakeholders, and end-users who followed rigorous and transparent guideline development procedures to create the Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These novel guidelines for children of the early years embrace the natural and intuitive integration of movement behaviours across the whole day (24-h period). METHODS: The development process was guided by the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. Four systematic reviews (physical activity, sedentary behaviour, sleep, combined behaviours) examining the relationships within and among movement behaviours and several health indicators were completed and interpreted by a Guideline Development Panel. The systematic reviews that were conducted to inform the development of the guidelines, and the framework that was applied to develop the recommendations, followed the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Complementary compositional analyses were performed using data from the Canadian Health Measures Survey to examine the relationships between movement behaviours and indicators of adiposity. A review of the evidence on the cost effectiveness and resource use associated with the implementation of the proposed guidelines was also undertaken. A stakeholder survey (n = 546), 10 key informant interviews, and 14 focus groups (n = 92 participants) were completed to gather feedback on draft guidelines and their dissemination. RESULTS: The guidelines provide evidence-informed recommendations as to the combinations of light-, moderate- and vigorous-intensity physical activity, sedentary behaviours, and sleep that infants (<1 year), toddlers (1-2 years) and preschoolers (3-4 years) should achieve for a healthy day (24 h). Proactive dissemination, promotion, implementation, and evaluation plans were prepared to optimize uptake and activation of the new guidelines. CONCLUSIONS: These guidelines represent a sensible evolution of public health guidelines whereby optimal health is framed within the balance of movement behaviours across the whole day, while respecting preferences of end-users. Future research should consider the integrated relationships among movement behaviours, and similar integrated guidelines for other age groups should be developed.

The Young Canadians Roundtable on Health: promising practices for youth and adults working in partnership.

SETTING: Canadian youth (aged 15-29 years) are more diverse, educated, connected and socially engaged than ever before. However, many face health-related challenges, including mental health problems (10-20%), substance use concerns (14%) and obesity (45%). INTERVENTION: The Young Canadians Roundtable on Health (YCRH) was created in 2013 to be Canada's youth voice on health. Supported by the Sandbox Project, this youth-led advisory works primarily virtually, leading advocacy projects and wide-ranging health initiatives. OUTCOMES: Youth and adult allies engaged in a participatory research evaluation of the YCRH, which was identified as a living laboratory, where youth could experiment with ideas and provide new perspectives on health issues. Adult allies reported learning new skills from youth, and youth gained advocacy and leadership skills. Collaborative projects resulted in a sense of shared achievement. Further, youth increased their connections to health and youth-serving spaces across the country. Identified challenges included difficulties in coordinating a national roundtable and defining shared responsibilities. IMPLICATIONS: The researchers generated the following evidence-based promising practices for youth engagement in health systems and program planning: (1) provide a consistent platform for youth input; (2) appreciate different forms of knowledge, expertise and communication methods; (3) invest in relationships and build mutual understanding among youth and adults; (4) for adult allies, be patient and comfortable with the ambiguity and unpredictability of working with youth; and (5) continually revisit and renegotiate structure and flexibility.