Compliance With 24-Hour Movement Patterns in Schoolchildren: Infant versus Primary Stage

Cumplimiento de las Pautas de Movimiento de 24 Horas en Escolares: Etapa Infantil versus Etapa Primaria

Introduction

The benefits of performing physical activity in the prevention or reduction of disease have been recognized by the scientific literature in the adolescent stage, especially at moderate (e.g., walking at a brisk pace) or vigorous (e.g., playing a game of basketball) intensities (Bull et al., 2020; Poitras et al., 2016).

According to the most recognized health recommendations, for ages 6 to 17 years, 60 min of moderate to vigorous physical activity (MVPA) is recommended, according to the Center for Disease Control and Prevention and the guidelines of the U.S. On the other hand, the guidelines set by the United Kingdom and the E.U. Physical Activity Guidelines established that, for ages under five years, it is recommended that a child perform 60 min of MVPA per day (Department of Health, Physical Activity, Health Improvement and Protection, 2011; Education and Culture of European Commission. EU Physical Activity Guidelines, 2008) and 180 min of total physical activity per day, according to the World Health Organization (WHO, 2019). In this regard, according to Miraflores et al. (2016), in children aged 3 to 6 years, it has been determined that they should perform 3 hours of physical activity per day, of any intensity and in different settings. Measuring physical activity in step volume is considered as an alternative, with recommendations around 13,000 steps per day for these ages (Cardon & De Bourdeaudhuij, 2007; Tanaka & Tanaka, 2009).

The adoption of a healthy lifestyle characterized by high levels of physical activity, low screen time, and optimal sleep duration has been found to provide more health benefits than the adoption of just one of these behaviors (Carson et al., 2017; Chaput et al., 2014). These health patterns have typically been studied in isolation, but, however, there is compelling evidence that these movement-related behaviors, interact throughout the day (24 hours) (Janssen et al., 2017; Poitras et al., 2016; Saunders et al., 2016). Time spent in physical activity inevitably and excludably interacts with sedentary and sleep time (Chaput et al., 2014). Consequently, both physical activity, sedentary behavior and sleep are the main behaviors that interact during the day. In this line, taking into account the time contained in a day and attending to scientific veracity, authors such as Tremblay et al. (2016) elaborated, for a healthy use of the 24 hours a day, the following recommendations regarding sedentary behavior and sleep: recreational screen time (< 2 hours) and sleep duration (9-11 hours in children between 5 and 13 years). In contrast, for the 3-6 years stage, according to Ramos Berzosa (2021), sedentary behavior time should be less than 1 hour per day. Furthermore, according to the American Academy of Pediatrics (A.A.P, 2016), the daily amount of sleep for children aged 3 to 5 years is 10 to 13 hours. Thus, attending to a holistic view of behavior throughout the 24 h can be employed as health indicators (Rollo et al., 2020; Tremblay et al., 2016), mainly associated with benefits at the physical, psychological and cognitive levels in children and adolescents (Carson et al., 2016; Chaput et al., 2016; Lissak, 2018; Poitras et al., 2016; Rollo et al., 2020; Tarokh et al., 2016; Wu et al., 2017). More specifically, a joint adherence to 24-hour movement recommendations (physical activity, sedentary behavior, and sleep duration) have been associated with additional health benefits, especially improved quality of life, diet, fitness, adiposity, and mental and social health (Carson et al., 2017; Janssen et al., 2017; Lee et al., 2018; Rollo et al., 2020; Walsh et al., 2018).

However, despite the independent and combined benefits of these three behaviors interacting 24 hours a day, a large percentage of young people do not meet the daily recommendations (Tremblay et al., 2016). Recently, a study conducted in more than 140 countries, showed that more than 75% of adolescents aged 11-17 years do not meet the international recommendations for physical activity, i.e., only 1 in 4 young people (Guthold et al., 2020).

The percentage of non-compliance can increase notably when the three 24h movement recommendations are examined together (Tapia-Serrano et al., 2022), especially in the transition from primary to secondary education (Chong et al., 2022). In this regard, a meta-analysis by authors such as Tapia-Serrano et al. (2022), with a sample of 387,437 young people from 63 studies and 23 countries, showed that only 11% of preschoolers, 10% of children and only 3% of adolescents meet the three recommendations (physical activity, sedentary behavior and sleep). Furthermore, it should be noted that only 9% of preschoolers, 16% of children and 28% of adolescents did not comply with any of the above three recommendations. In this regard, several studies have shown the benefits of physical activity in children, but little research has been conducted in children under three years of age (Díaz-Quesada et al., 2021).

In turn, it would be interesting to know at what times these recommendations are most clearly met. Among other circumstances, because the school has been considered an ideal place to promote the practice of physical activity and thus achieve the daily recommendations from an early age (Martínez-Gómez et al., 2014); even being indicated as the context where half of the daily physical activity time is spent (Pate et al., 2006). And is that, it has been shown that academic performance can be improved through physical activity at school (Carriedo & González, 2019).

Thus, in the scientific literature it has been shown that preschool children who regularly attend school perform the same amount of AFMV as those who do not go to school (Statler et al., 2020). Consequently, children have a higher level of physical activity outside school hours than during school time (Pate et al., 2006). In this line, different studies have also shown that preschool children perform more AFMV on weekdays compared to weekend days (Roscoe et al., 2019). Another study has reflected that Chinese preschool-aged children spent significantly more time performing vigorous physical activity on weekdays than on weekends (Ji et al., 2018). However, most studies examining the level of physical activity intensity focus on the primary and secondary educational stages, while studies at younger ages remain scarce, despite the health benefits of physical activity in younger children (González-Díaz et al., 2017). On the other hand, less empirical attention has been paid to Spanish children in this context (Díaz-Quesada et al., 2022). In turn, there is a lack of information on what happens according to the educational stage analyzed, not only in terms of physical activity, but also sedentary behavior and sleep.

Therefore, the objectives of the present study are: a) To analyze the level of compliance with the 24-hour movement patterns in schoolchildren (pre-school versus primary school) and, b) To determine the differences between different times of the week.

Method

Sample

A total of 260 schoolchildren were selected, 93 Infant Education (average age = 4 years; height = 1.08 m; mass = 19.30 kg; BMI = 16.29 kg/ m²) and 167 Primary Education (average age = 9.15 years; height = 1.40 m; mass = 37.06 kg; and BMI = 18.76 kg/ m²). The sample selection was performed through a purposive sampling method according to the criteria of accessibility and proximity (Otzen & Manterola, 2017). The guardians signed a written consent to participate in the study and this study is approved by the ethics committee of the local entity.

Procedure

Assessment of 24-hour movement patterns including physical activity, sedentary behavior and sleep duration was conducted.

Physical Activity

Minutes of daily physical activity were determined using Garmin vivofit® jr. fitness wristbands (Garmin Ltd., Schaffhausen, Switzerland) for students aged 3 to 5 years and Xiaomi mi Band 4 Anhui Huami Information Technology Co., Ltd., China) for students aged 6 to 12 years. Both physical activity wristbands are wearable and designed for ages from 3 years old (Müller-Riemenschneider et al., 2017; Wang et al., 2017). The design of this wristband is comfortable, durable, and waterproof. The wearable device is paired with its app via a cell phone or tablet (APP Vivofit Jr. Ltd., Schaffhausen, Switzerland; and, Mi Fit, Anhui Huami Information Technology Co., Ltd., China; respectively). Both devices have been shown to be accurate in assessing physical activity in minutes or steps (Alsubheen et al., 2016; El-Amrawy & Nounou, 2015; Wang et al., 2017), being previously employed with early age populations (Gorny et al., 2017; Diaz-Quesada et al., 2021).

The participants wore the physical activity bracelet for seven consecutive days of a week of school routine, not taking it off either to sleep or to take a shower. Subsequently, the data from the application were consulted to obtain the average number of daily steps throughout the week. Students were considered to meet the physical activity recommendations when they performed a minimum of 13,000 steps (Cardon & De Bourdeaudhuij, 2007; Tanaka & Tanaka, 2009) (NASPE, 2014; Tremblay et al., 2016; Tremblay et al., 2017).

Sedentary Behavior

Sedentary behavior was assessed by means of the Health Behaviour in School-aged Children (HBSC) questionnaire validated in Spanish children and adolescents (Moreno et al., 2008). Participants had to respond to six items indicating the number of hours per day they spent watching television or Tablet, using a computer or cell phone and doing homework, both on weekends and during the week. This questionnaire was completed by the parent or guardian in the case of children between 3 and 6 years of age. The mean daily time spent in each sedentary behavior was calculated using a ratio of 5:2; that is: (daily time in sedentary behavior on weekdays (5 days) + (daily time in sedentary behavior on weekends (2 days) / 7 days). The daily sedentary behavior time was measured by summing the different daily sedentary time behaviors (Tapia-Serrano et al., 2022). Students were considered to meet the sedentary behavior recommendations when students aged 3 and 4 years spent less than 1 hour/day (Tremblay et al., 2017) and, students aged 5 to 12 years spent less than 2 hours/day (Tapia-Serrano et al., 2022; Tremblay et al., 2016).

Sleep Duration

The participants in the physical activity diary recorded the hours of sleep on each day of the week. In the case of children aged 3 to 6 years, these were completed by parents or guardians. The daily hours of sleep were calculated based on the ratio 5:2; that is: (hours of sleep during the week (5 days) + (hours of sleep at the weekend (2 days) / 7 days). Students were considered to meet the sleep recommendations when students aged 3 and 4 years accumulated between 10 and 13 hours of sleep each day (Tremblay et al., 2017) and students aged 5 to 12 years accumulated between 9 and 11 hours of sleep each day (Tremblay et al., 2016).

Compliance With Recommendations

Participants were classified into one of eight possibilities based on their compliance with the 24h guidelines: 1) they did not meet any of the three guidelines; 2) they met only one guideline (physical activity, screen time or sleep duration); 3) they met two guidelines (physical activity + screen time; physical activity + sleep duration; screen time + sleep duration) or 4) they met all three 24 h guidelines assessed (physical activity screen time + sleep duration) based on previous studies (Tapia-Serrano et al., 2022).

Statistical Analysis

A descriptive analysis of the data was performed in the form of mean and standard deviation. Next, a Shapiro-Wilk normality test was performed which confirmed the non-normal distribution of the data. Next, a frequency analysis was performed to find out which participants met the individual 24-hour movement guidelines (met only sleep duration, met only physical activity, met only screen time, or met no recommendation) and in combination (met sleep duration + physical activity, met only sleep duration + screen time, met only physical activity + screen time, met only physical activity + screen time, or met all three recommendations). Subsequently, the variables were analyzed using the nonparametric Mann-Whitney U test, where the results are shown as mean and standard deviation, as well as the significance value .. The Mann-Whitney U test was used to observe the differences in the distribution of 24 h of movement between different times (all week, weekdays versus weekends and school hours versus after-school hours) between the Infant versus Primary stage, where physical activity, sedentary behavior and hours of sleep were evaluated. A confidence level of 95% was used for all analyses. The statistical program IBM SPSS Statistics 27.0 for Windows IBM Software (Group, Chicago, Illinois, United States) and the Jamovi program version 2.3.24 were used.

Results

Table 1 shows the compliance with the recommendations of 24 h of movement in terms of the eight possibilities of physical activity, sedentary behavior and hours of sleep.

Compliance with the established recommendations is above 75%. Likewise, compliance with the three guidelines is above 50%. The compliance with the recommendations regarding the hours of sleep between the Infant and Primary stages stands out, with 83.8%. It is also observed that the Primary stage always shows a higher percentage than the Infant stage.

Table 2 shows the differences in the distribution of 24 hours of movement between the Early Childhood Education stage versus the Primary Education stage.

In general, the Primary stage performs more physical activity, experiences higher values of sedentary behavior and consumes more hours of sleep compared to the Infant stage.

It was observed that, in terms of physical activity, in general, students in the infant stage performed less physical activity in steps/day compared to students in the primary stage throughout the week, with highly significant differences (p < .001) between the two stages. Regarding the steps taken in the variable’s weekdays (M-F) (steps/day) and weekends (S-D) (steps/day), significant differences (p < .001) were observed between the different stages, where the Primary stage showed more steps taken at both times compared to the Infant stage. In the analysis of the variables school time (steps/day) and out-of-school time (steps/day), significant differences were also observed (p < .001), with students in the Primary stage performing more physical activity in steps/day both at school and out-of-school time compared to the Infant stage.

The results regarding sedentary behavior showed that students in primary school had higher values than those in infant school (p < .001). When analyzing the variables between weekdays (M-F) (hours/day) and weekends (S-D) (hours/day), significant differences were observed, where the Primary stage had more sedentary behavior in relation to the Infant stage, at both times.

The analysis of the hours of sleep showed significant differences between the different stages. In general, the primary school subjects obtained more hours of sleep during the week compared to the infant stage. The results showed significant differences in the analysis of the variable weekend (S-D) (hours/day) (p = .004), where the Primary stage slept more compared to the Infant stage. No significant differences in hours of sleep were found in the analysis of the midweek variable (M-F) (hours/day).

Discussion

The objectives of the present study were to analyze the level of compliance with the 24-hour movement patterns in schoolchildren (infant versus primary) and to determine the differences between different times of the week. The results indicate that compliance with the three movement patterns is above 53%, with physical activity, sedentary behavior and sleep individually above 75%. Relatively speaking, the infant stage has a lower volume of steps, but also less sedentary behavior than the participants in the primary stage, an aspect that can be seen both throughout the week and at the different times evaluated.

Knowing the behavior with respect to movement patterns can generate strategies that involve healthy lifestyle habits in the future. The results of this study are very interesting if it is established that they are Spanish population. Regarding the infant stage, 78.4%, 79.5% and 83.8% comply with the recommendations for physical activity, sedentary behavior and sleep, respectively (Table 1). Regarding physical activity, different studies indicate that physical activity compliance is around 30-90% (Berglind et al., 2018; Chaput et al., 2017; Cliff et al., 2017; Kracht et al., 2019). This range is very wide, mainly due to the country (Berglind et al., 2018; Chaput et al., 2017) or the measurement instrument (accelerometer or questionnaire) (Cliff et al., 2017; Walsh et al., 2018), so the results of this study are above 50-60% (Chaput et al., 2017; Chia et al., 2020) in children from Canada or Singapore and below that determined in countries such as the USA or Australia (Cliff et al., 2017; Kracht et al., 2019). In the same way, it happens with sedentary behavior, where most researches mark around 17-31% (Carson et al., 2017; Chaput et al., 2017; Chia et al., 2020; Cliff et al., 2017), the present results being in line with those found by Berling et al. (2018) and Roberts et al. (2017) between 63 and 70%. The importance of compliance with sleep recommendations is currently one of the most discussed issues, due to its implication in lifestyle habits acquired from an early age (Rollo et al., 2020; Tremblay et al., 2016). The results of 83% are in line with research conducted by other investigators, who place sleep compliance at around 70-98% (Berling et al., 2018; Chaput et al., 2017; Chia et al., 2020; Cliff et al., 2017). To highlight that sleep is an essential activity that interacts and modulates a psychic and physiological balance in the individual (Fabres & Moya, 2021) and, in children, its lack, can cause low cognitive functioning (Hirshkowitz et al., 2015). Regarding the primary school stage, the results of the present study obtained percentage values similar to those of children, both in physical activity (78.4%), sedentary behavior (79.9%) and sleep (83.8%), respectively. Here there are differences to those found in other studies in the population aged 8-11 years. Physical activity is around 20-44% in studies even attending to twelve different countries, while sedentary behavior compliance is reduced at these ages around 20-30% and sleep around 30-40% (Dumuid et al., 2018; Laurson et al., 2014; Sampasa-Kanyinga et al., 2017; Thiyel et al., 2019). It is obvious that the reasons for these differences can be very varied as discussed above, what is certain is that, although there are fewer longitudinal studies, it seems that as age advances, compliance with 24 h movement recommendations tends to decrease (Chong et al., 2022). In turn, for example, in terms of physical activity values, percentages to those found are around 78% closer to 89% analyzed by Manyanga et al. (2019) in a total of 683 children aged 9 to 11 years in Mozambique; highlighting those differences in terms of the geographical area of the world and sociocultural variability may be important factors to consider when observing the causes and generating future intervention strategies (Sampasa-Kanyinga et al., 2017).

It is true that, from a more global approach, 53% of the total sample of this study complied with the three movement patterns (Table 1). This fact is very relevant, since scientific evidence indicates, on the one hand, differential values between ages 3-4 years and 9-11 years, ranging from 13-30% (Chaput et al., 2017; Chia et al., 2020; Cliff et al., 2017) and 5-10% (Dumuid et al., 2018; Guerrero et al., 2019; Laurson et al., 2014; Sampasa-Kanyinga et al., 2017; Thivel et al., 2019), respectively. In the present study, the data are substantially above and also without age being a determinant. As highlighted above, it may be due to social, cultural, economic or geographical factors, which may have a determining influence on the child population, where although they have not been taken into account in the present research, they are a possibility for future analysis. But it is a value to highlight, because what is evidenced is that compliance with the 3 24h guidelines is associated with a better quality of life (Sampasa-Kanyinga et al., 2017), less impulsivity (Guerrero et al., 2019), as well as the high use of screens can lead to psychosocial problems (Chong et al., 2022).

Another important question to consider is to know what this behavior is like at different times of the week. In this sense, when contrasting the absolute values, the differences between educational stages are more evident (Table 2). Thus, it can be seen that the primary school stage obtains a greater volume of steps (about 12,000 steps per day compared to approximately 9,500 steps in the infant stage), the difference being statistically significant, not only throughout the week but also at the different times evaluated (Table 2). It is true that the steps developed by the Infant Stage, are in accordance with other studies that mark a value of 10,000 steps/day during the week, although with lower values of 8,000 steps/day at the weekend (De Craemer et al., 2018), being the trend at ages of approximately two years lower (Díaz-Quesada et al., 2021). Independent of this casuistry, both in physical activity and sedentary behavior, it is shown how at the weekend compliance with the recommendations tends to fall (Chong et al., 2022; De Craemer et al., 2018; Leppanen et al., 2019). Regarding sleep, no such clear differences are shown, with both groups having a duration between 9 and 11 hours at the different times evaluated. It is interesting to note that, normally, the hours of sleep at the weekend tend to be longer than during the week (Chong et al., 2022; Leppanen et al., 2019), although no such trend was observed in this sample. Although it is necessary to further delve into the behavior of movement patterns at different times, these results may contribute to generate strategies involving a healthier daily habit.

Finally, this study is not without some limitations. The small size and difficulty of accessing the child sample would be one of the limitations. Also, due to the nature of the study itself, as it is a cross-sectional study, causal relationships cannot be established.

Conclusions

It is concluded that compliance with the recommendations of 24 h of movement in terms of physical activity, sedentary behavior and sleep in the schoolchildren analyzed are above 75% in both stages. In addition, the Primary stage performs more physical activity, experiences higher values of sedentary behavior; being the hours of sleep similar to those of the Infant stage. This study can contribute to future intervention policies to promote behaviors according to the 24h movement guidelines from early ages, from an integrated and holistic approach.

Practical Applications

The findings obtained in this study may provide useful information that will contribute to raise awareness of the importance of achieving a balance between physical activity, control of sedentary behavior, and hours of sleep. Likewise, at the school level, this study serves as a reference point to encourage the creation of strategies and educational programs to increase the levels of physical activity in the different educational stages and to reduce sedentary behavior. Finally, this study reflects a current framework of the behavior of children at an early age throughout the week and serves as a reference for future action points in this regard.

Ethics Committee Statement

The study was performed following the ethical standards of the Declaration of Helsinki (1975) and was approved by the Ethics Committee of the University of Jaén (JUN.22/1.PRY, 7/7/2022).

Conflict of Interest Statement

The funding bodies or institutions had no influence on the design of the study, the analysis of the data or the interpretation of the results.

Funding

This research was funded by University of Jaén, as part of the Plan de Innovación y Mejora Docente (PIMED-UJA 2022) project, PIMED31_202224.

Authors' Contribution

Conceptualization D.G.M., G.D.Q. & G.T.L.; Methodology G.D.Q. & G.T.L.; Software D.G.M., G.D.Q. & G.T.L.; Validation D.G.M. & G.D.Q.; Formal Analysis D.G.M. & G.D.Q.; Investigation D.G.M., G.D.Q. & G.T.L.; Resources D.G.M., G.D.Q. & G.T.L.; Data Curation D.G.M., G.D.Q. & G.T.L.; Writing – Original Draft D.G.M. & G.D.Q.; Writing – Review & Editing G.T.L.; Visualization G.T.L.; Supervision D.G.M., G.D.Q. & G.T.L.; Project Administration D.G.M., G.D.Q. & G.T.L.; Funding Acquisition G.T.L. All authors have read and agreed to the published version of the manuscript.

Data Availability Statement

The data that support the findings of this study are available on request from the corresponding author (gmdiaz@ujaen.es).

References

Author notes

* Correspondence: Gema Díaz-Quesada, gmdiaz@ujaen.es

Additional information

Short title: Compliance With Movement Patterns in Schoolchildren: Infant vs Primary

How to cite this article: García-Martínez, D., Díaz-Quesada, G., & Torres-Luque, G. (2024). Compliance with 24-hour movement patterns in schoolchildren: infant versus primary stage. Cultura, Ciencia y Deporte, 19(62), 2154. https://doi.org/10.12800/ccd.v19i62.2154