Promoting hEalthy Diet and Active Lifestyle (PEDAL): a protocol for the development and feasibility study of a multicomponent intervention among primary school children in Singapore.

BACKGROUND: Setting healthy lifestyle habits during the formative years of childhood is critical as habits can track to adulthood and help prevent obesity and chronic disease risks in later life. While multicomponent interventions have been shown to be effective in changing the lifestyle behaviours of children, there is a limited understanding of the feasibility of such interventions in primary schools in Singapore. A multiphase mixed method study was conducted to develop and examine the feasibility of a theory-based multicomponent school-based intervention-Promoting hEatlthy Eating and Active Lifestyle (PEDAL). METHODS: Underpinned by Kincaid's ideation model, the PEDAL intervention was developed to increase fruit and vegetable consumption and decrease sedentary behaviours among children. This study consists of three phases. Phase 1 details the development of PEDAL, which consists of four components: (A) a series of interactive health education lessons, (B) actionable home activities to support habit formation, (C) parental/guardian engagement, and (D) optimising the school environment. In Phase 2, components A and B of PEDAL were implemented in two public, co-educational primary schools among Primary 5 students (aged 10-12 years) in Singapore. Data was collected quantitatively using questionnaires and qualitatively using focus group discussions (FGDs) with students and teachers. The feasibility dimensions of components A and B, including recruitment capability, data collection, social validity, and practicality were examined, and ideation on healthy eating and physical activity was explored. In Phase 3, the full PEDAL intervention was pilot-tested in two other public, co-education primary schools with the same target population, using a concurrent mixed method quasi-experimental study design. Feasibility dimensions and potential effectiveness of the intervention will be assessed. DISCUSSION: This study will provide insights into the feasibility of PEDAL and inform its refinement. Findings from the pilot test will guide the planning of a larger-scale definitive trial. TRIAL REGISTRATION: Registered with ISRCTN registry (ISRCTN16114046) on 16 October 2022.

Adherence to 24-hour integrated activity guidelines among infants, toddlers and preschool children in Singapore.

This study examined children's adherence to the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood in infants, toddlers and preschoolers aged 0-6 years. A total of 901 caregivers, comprising 219 infants, 379 toddlers, and 303 preschoolers, provided information regarding their children's physical activity (PA), screen viewing time (SVT), and sleep durations on both weekdays and weekends. Meeting the 24-hour integrated activity guidelines was defined as follows: for infants ≥ 30 minutes per day of tummy time or floor-based play; zero SVT; total sleep of 14-17 hours per day for ages 0-3 months, 12-16 hours per day for ages 4-11 months; for toddlers ≥ 180 minutes of total PA per day; zero SVT under 2 years; <1 hour for ages 2 to less than 3 years; and a total sleep of 11-14 hours per day; for preschoolers ≥ 180 minutes of total PA per day; SVT <1 hour per day; total sleep of 10-13 hours per day for those aged 3-5 years, and 10-11 hours per day for 6-year-olds. Chi-squared tests were used to examine the differences in guideline adherence between weekdays and weekends. Compared to weekdays, during weekends there was a higher proportion of toddlers and preschoolers adhering to the PA guidelines (68.9% vs 50.1%; 78.9% vs 55.4%, respectively, p<0.05), and a lower proportion of toddlers adhering to SVT (38.8% vs 21.8%; p = 0.001). There was a declining adherence to all three activity guidelines as age groups progressed from infants (44.7%) to toddlers (15.8%) and then to preschoolers (9.4%). Concurrently, there was a decrease in adherence to SVT recommendations across the age groups, with adherence rates being highest among infants (83.1%), followed by toddlers (15.8%), and preschoolers (9.4%). Decreasing compliance with all three guidelines, coupled with a corresponding decline in adherence to SVT guidelines as children transition from toddlerhood to preschool age, is a cause for concern. This underscores the need for proactive efforts to educate caregivers about reducing or eliminating SVT among infants and young children.

Adherence to the Singapore Integrated 24-Hour Activity Guidelines by Infants and Toddlers and Its Association With Well-Being.

BACKGROUND: This study estimated the prevalence of Singapore infants and toddlers who met the new Singapore Integrated 24-Hour Activity Guidelines for Early Childhood and examined its association with well-being. METHODS: A total of 267 parents of children aged between 0 and 2 years completed an online questionnaire that consists of the Singaporean Children Lifestyle Questionnaire and either the Pediatric Quality of Life (PedsQL) Inventory Infant Scale or the Strength and Difficulties Questionnaire. Well-being of infants was measured through parent responses to PedsQL and that of toddlers was measured through Strength and Difficulties Questionnaire. Data were benchmarked against age-specific guidelines for physical activity, screen time, and sleep in the Singapore Integrated 24-Hour Activity Guidelines for Early Childhood. RESULTS: A higher percentage of infants (37.3%) than toddlers (20.6%) had met 3 guidelines. In contrast, a lower percentage of infants than toddlers met at least one or did not meet any guidelines (3.8% and 0% for infants vs 22.4% and 1.8% for toddlers, respectively). Infants who met more guidelines had significantly higher parent-reported PedsQL total scale score than infants who met fewer guidelines (P < .05). However, the present study found that the number of guidelines met was not associated to infants' PedsQL scale score and toddlers' total difficulty score (P > .05). CONCLUSION: Adherence to this set of local guidelines should be widely publicized, so parents will have greater awareness and knowledge on cultivating good physical activity, screen time, and sleep habits for their child from a young age.

24 h Activity Guidelines in Children and Adolescents: A Prevalence Survey in Asia-Pacific Cities.

This study aimed to examine the prevalence of adherence to 24 h activity guidelines in children and adolescents from Asia-Pacific cities. In 1139 children aged 5-18 years, moderate-to-vigorous physical activity (MVPA), screen viewing time (SVT), sleep duration, child weight, height, sex, and age were parent-reported. Descriptive statistics were used to assess the number of guidelines met, and prevalence of adherence to activity guidelines by city and child sex. Prevalence of meeting all three 24 h activity guidelines was low across all countries (1.8-10.3%) (p < 0.05). Children from Thiruvananthapuram, India had the highest [10.3% (95% CI: 6.0-17.0)], while those from Tokyo, Japan had the lowest prevalence [1.8% (95% CI: 0.5-7.0)] of meeting all three guidelines. The highest prevalence of meeting individual MVPA, SVT and sleep guidelines was found in India [67.5% (95% CI: 58.8-75.1)], Kelaniya, Sri Lanka [63.2% (95% CI: 58.7-67.4)] and Kowloon, Hong Kong [59.4% (95% CI: 51.1-65.3)], respectively. Overall, a higher prevalence of boys met all three guidelines, compared to girls [5.9% (95% CI: 4.1-8.1) vs. 4.7% (3.1-6.6), p = 0.32]. The prevalence of adhering to all three activity guidelines was low in all five participating cities, with a higher proportion of boys meeting all guidelines.

Time to Play in Javanese Preschool Children-An Examination of Screen Time and Playtime before and during the COVID-19 Pandemic.

This comparative-descriptive multi-national research examined the screen time and playtime of preschool children aged 1-6 years before and during the COVID-19 pandemic. Parents reported on the play and screen habits of preschool-aged children on the weekday and weekends using a questionnaire on the lifestyle habits of their children. Results indicated a significant difference in screen time and playtime on the weekday and weekend before the pandemic (screen time: 1.91 ± 2.40 vs. 2.16 ± 2.60 h; playtime: 3.55 ± 2.49 vs. 4.11 ± 2.58 h, both p < 0.05), but during the COVID-19 pandemic, only the weekday-weekend difference in screen time was significantly different (screen time: 2.87 ± 3.15 vs. 3.26 ± 3.18 h, p < 0.05; playtime: 3.25 ± 3.41 vs. 3.48 ± 2.41, p > 0.05). Before- and during-COVID-19 comparisons showed that the average daily screen time increased by 150% from 2.04 h to 3.06 h (p < 0.05), while the average play time decreased by 12.3% (3.83 to 3.36 h, p < 0.05). Based upon international guidelines for movement behaviours of young children, special attention and actions are needed to manage the excessive daily screen time and preserve the average daily playtime of Javanese preschool children. These results present useful benchmarking data for parents, teachers, and health authorities to initiate ameliorative interventions to better balance children's screen time and playtime as Indonesia emerges from the COVID-19 pandemic to a COVID-19 endemic.

Play-Sleep Nexus in Indonesian Preschool Children before and during the COVID-19 Pandemic.

The COVID-19 pandemic has transformed Indonesians' behaviors and has had an impact on many facets of daily life. People's lives are becoming increasingly dependent on digital technologies, which is a phenomenon with conflicting effects on people's health and happiness. This cross-sectional study focused on one such influence, namely, how the shift from the period before to during COVID-19 has affected children's playtime and sleep duration. As part of a multicenter study, 618 adult caregivers (parents, family members, or babysitters) who visited the kindergarten in question on behalf of preschool children aged 2-5 years (4.04 ± 1.39) were surveyed on the children's play and sleep habits before and during the COVID-19 pandemic in Indonesia, particularly Java Island (before pandemic, N = 309; during pandemic, N = 309). ANOVA was used for a statistical analysis to describe the difference between groups and within time collections. Significant favorable relationships were found between pre-pandemic and post-pandemic playtime and sleeping time on weekdays, weekends, and averaged weekday-weekend (r = 0.437; 0.180 and 0.321, all p < 0.05) were detected. Before the pandemic, children's playtime (4.11 vs. 3.55 h) and sleep duration (10.92 vs. 10.70 h) were significantly greater on the weekend than on the weekday (p < 0.05) but not during the pandemic (playtime: 3.48 vs. 3.45 h and sleep duration: 10.83 vs. 10.80 h; all p > 0.05). The COVID-19 pandemic had no impact on sleep duration or playtime in Javanese preschool children. Efforts should be intensified to promote the value of playtime and sleep duration among children in this age range so that the future of Indonesian children's can be ensured.

Associations between Parent Attitudes and on- and off-Screen Behaviours of Preschool Children in Singapore.

The research aims were to examine the relationships between parent and child digital media use and to describe the characteristics of the top and bottom quartiles of child digital media use in meeting the 24 h integrated guidelines for sleep, physical activity, and sedentary behaviour. Parent-reported on- and off-screen habits and quality of life of children were collected from 1481 parents of preschool children aged 2-5 years in 2019. Significant relationships were detected between parent and child digital media use (weekday, r = 0.274; weekend, r = 0.421, p < 0.05) with no sex difference in daily child digital media use (p > 0.05). Age of first exposure to fixed screens, daily digital media use, and physical play durations were significantly different between heavy (child-TQ) and light (child-BQ) child users of digital media (p < 0.05). Parental perceived importance of child digital media use and parental awareness and practice of guidelines for child digital media use differed significantly between parents of child-TQs and parents of child-BQs (p < 0.05). The number of 24 h movement guidelines met between child-TQs and child-BQs differed (p < 0.05). Parents voiced serious concerns for child digital media use, including addiction (75-76%), poor eyesight (73%), access to inappropriate content (73-74%), a lack of parent-child interaction (65%), poor sleep (49-55%), and a lack of physical activity (55-59%), but these findings did not translate to parental enforcement of the guidelines. Parent education on how to get the best digital media use outcomes for preschool children is recommended.

Associations between Parents' Digital Media Habits, Engagement, Awareness, and Movement Guidelines among Preschool-Age Children: International Ipreschooler Surveillance Study.

The 24-hour movement guidelines (24-h MG) recommend behaviors (physical activity, screen time, sleep) to aid appropriate physical and mental development in early childhood. This research examined parents' digital media habits (DMH), engagement (DME), and awareness (DMA) among parents in relation to their preschool-aged children's 24-h MG in Japan and identified and compared the modifiable determinants of adherence to 24-h MG in urban and rural regions. This cross-sectional study included 867 participants and data were obtained from the International Ipreschooler Surveillance Study Among Asians and OtheRs (IISSAAR). The results revealed that adherence to weekend screen time recommendations and weekday sleep duration were higher in the urban region. The parents' digital media variables that predicted moderate-intensity to vigorous-intensity physical activity among preschool-aged children were parents' DME and DMA in the urban regions and parents' DME in the rural regions. The children's screen time was significantly associated with parents' DMH, DME, and DMA in the urban regions and with parents' DMH and DMA in the rural regions (p < 0.005, p < 0.001, respectively). This study confirmed that parents' DMH, DME, and DMA are strong predictors of adherence to 24-h MG among preschool-aged children living in both rural and urban regions in Japan.

Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents.

INTRODUCTION: Lifestyle activities, such as regular physical activity, are important for good metabolic health and the prevention of non-communicable diseases. Epidemiological studies highlight an increase in the proportion of overweight children in Singapore. A workgroup was formed to develop recommendations to encourage children and adolescents (aged 7-17 years) to adopt a holistic approach towards integrating beneficial activities within a daily 24-hour period for good metabolic and general health. METHODS: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework was employed to formulate the public health question, assess the evidence and draw conclusions for the guide. The evidence for international 24-hour movement guidelines, and guidelines for physical activity, sedentary behaviour, and sleep and eating habits were reviewed. An update of the literature review from August 2018 to end of September 2020 was conducted through an electronic search of Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. RESULTS: Ten consensus statements were developed. The statements focused on the overall aim of achieving good metabolic health through integration of these activities and initiatives: light and moderate- to vigorous-intensity physical activity on a regular basis; muscle- and bone-strengthening activities; limiting sedentary behaviour; regular and adequate sleep; good eating habits and choosing nutritionally balanced foods and drinks; practise safety in exercise; and aiming to achieve more or all aforementioned recommendations for the best results. CONCLUSION: This set of recommendations provides guidance to encourage Singapore children and adolescents to adopt health-beneficial activities within a 24-hour period.

Physical Activity Measurement Methodologies: A Systematic Review in the Association of South East Asian Nations (ASEAN).

Non-communicable diseases (NCDs) are a preventable threat to livelihood and longevity in the Association of South East Asian Nations (ASEAN) and insufficient physical activity (PA) is a primary cause of NCDs. A PRISMA-based systematic review of measurement methodologies used to assess PA was conducted. 564 studies published between 1978 and 2020 were reviewed. The majority of the PA measurement employed subjective methodologies and were observational and cross-sectional, with disproportionately fewer studies conducted in economically-challenged member nations, except for Brunei. PA research in Brunei, Cambodia, Laos and Myanmar constituted 0.4-1.1% while Malaysia, Singapore, Thailand and Indonesia contributed 12-37% of all PA research within ASEAN. A decision matrix can be used to determine the measurement methodology of choice to assess PA. Joint research across ASEAN using a common assessment or measurement template that is co-curated by ASEAN researchers that incorporates multi-level and whole-of-society criteria in terms of PA enablers is a recommendation. This could be co-led by more experienced and better-resourced countries so as to produce a unified and universal 'report card' for PA measurement within ASEAN.

Poorer Intermittent Sprints Performance in Ramadan-Fasted Muslim Footballers despite Controlling for Pre-Exercise Dietary Intake, Sleep and Training Load.

This study examines the effects of Ramadan fasting on sprint performance during prolonged intermittent exercise in trained Muslim footballers, under controlled pre-exercise conditions. A within-group, cross-over study design with two non-fasted or Control trials performed before (i.e., CON1) and after (CON2) the Ramadan month, and with the Ramadan-fasted (RAM) trials performed within the Ramadan month. After familiarization, 14 players completed a modified 60-min (4 × 15-min exercise blocks interspersed with 3-min intervals) of the Loughborough Intermittent Shuttle Test (mLIST) of fixed speeds of walking, jogging, running, but with all-out effort sprints. During the interval periods, capillary blood glucose and blood lactate measures were taken, rectal and skin temperatures were recorded and maximal voluntary isometric contractions (MVIC) of the dominant leg and hand-grip were performed to provide some indication to the cause(s) of 'fatigue' during exercise. Players were provided with standardized 24-h pre-packed meals prior to all trials. Sleep hours were objectively assessed and perceived training loads were monitored and these were equivalent between RAM and CON trials. Sprint times throughout mLIST were significantly faster in both CON1 and CON2 as compared to RAM trials (all P < 0.017; d = small to moderate), and this poorer performance in RAM was observed as early as during the first 15-min of the mLIST. Blood markers, MVIC and thermoregulatory results were not substantially different between both CON and RAM trials. In conclusion, despite similarities in dietary intake, sleeping hours and training loads between conditions, results still indicate that Ramadan fasting had an adverse effect on prolonged intermittent performance. Nocebo effects plays a dominant role during exercise in the Ramadan-fasted state.

Conducting an acute intense interval exercise session during the Ramadan fasting month: what is the optimal time of the day?

This study examines the effects of Ramadan fasting on performance during an intense exercise session performed at three different times of the day, i.e., 08:00, 18:00, and 21:00 h. The purpose was to determine the optimal time of the day to perform an acute high-intensity interval exercise during the Ramadan fasting month. After familiarization, nine trained athletes performed six 30-s Wingate anaerobic test (WAnT) cycle bouts followed by a time-to-exhaustion (T(exh)) cycle on six separate randomized and counterbalanced occasions. The three time-of-day nonfasting (control, CON) exercise sessions were performed before the Ramadan month, and the three corresponding time-of-day Ramadan fasting (RAM) exercise sessions were performed during the Ramadan month. Note that the 21:00 h session during Ramadan month was conducted in the nonfasted state after the breaking of the day's fast. Total work (TW) completed during the six WAnT bouts was significantly lower during RAM compared to CON for the 08:00 and 18:00 h (p < .017; effect size [d] = .55 [small] and .39 [small], respectively) sessions, but not for the 21:00 h (p = .03, d = .18 [trivial]) session. The T(exh) cycle duration was significantly shorter during RAM than CON in the 18:00 (p < .017, d = .93 [moderate]) session, but not in the 08:00 (p = .03, d = .57 [small]) and 21:00 h (p = .96, d = .02 [trivial]) sessions. In conclusion, Ramadan fasting had a small to moderate, negative impact on quality of performance during an acute high-intensity exercise session, particularly during the period of the daytime fast. The optimal time to conduct an acute high-intensity exercise session during the Ramadan fasting month is in the evening, after the breaking of the day's fast.