Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study

Blanca Romàn-Viñas, Jean Philippe Chaput, Peter T. Katzmarzyk, Mikael Fogelholm, Estelle Victoria Lambert, Carol Ann Maher, José António Maia, Tim Olds, Vincent Ochieng Onywera, Olga Sarmiento, Martyn Standage, Catrine E. Tudor- Locke, Mark S. Tremblay, Timothy S. Church, Denise G. Lambert, Tiago V. Barreira, Stephanie T. Broyles, Ben P. Butitta, Catherine M. Champagne, Shannon H. CocrehamKara D. Denstel, Katy Drazba, Deirdre Harrington, William D. Johnson, Dione Milauskas, Emily F. Mire, Allison Tohme, Ruben Q. Rodarte, Bobby Amoroso, John Luopa, Rebecca H. Neiberg, Scott Rushing, Lucy Kate Lewis, Katia Ferrar, Effie Georgiadis, Rebecca Megan Stanley, Victor Keihan Rodrigues Matsudo, Sandra Matsudo, Timóteo Leandro Araújo, Luís Carlos De Oliveira, Luis Fabiano, Diogo Bezerra, Gerson Luis Ferrari, Priscilla Bélanger, Michael Marc Borghese, Charles Boyer, Allana G.W. LeBlanc, Claire E. Francis, Geneviève Leduc, Pei Zhao, Gang Hu, Chengming Diao, Wei Li, Weiqin Li, Enqing Liu, Gongshu Liu, Hongyan Liu, Jian Ma, Yijuan Qiao, Huiguang Tian, Yue Wang, Tao Zhang, Fuxia Zhang, Olga Sarmiento, Julio Acosta, Yalta Alvira, María Paula Díaz, Rocio Gámez, Maria Paula Garcia, Luis Guillermo Gómez, Lisseth Heras González, Silvia Alejandra González, Carlos Grijalba, Leidys Gutiérrez, David Leal, Nicolás Lemus, Etelvina Mahecha, Maria Paula Mahecha, Rosalba Mahecha, Andrea Ramírez Varela, Paola Ríos, Andres Suarez, Camilo A. Triana, Elli Hovi, Jemina Kivelä, Sari M. Räsänen, Sanna Roito, Taru Saloheimo, Leena Valta, Anura Vishwanath Kurpad, Rebecca Kuriyan, Deepa P. Lokesh, Michelle Stephanie D'Almeida, R. Annie Mattilda, Lygia F.M. Correa, Vijay Dakshina Murthy, Lucy Joy Wachira, Stella Kagwiria Muthuri, Alessandra da Silva Borges, Sofia Oliveira Sá Cachada, Raquel Nichele De Chaves, Thayse Natacha Gomes, Sara Isabel Pereira, Daniel Monteiro De Vilhena E Santos, Fernanda Karina Dos Santos, Pedro Gil Da Silva, Michele Caroline De Souza, Vicki E. Lambert, Matthew April, Monika Uys, Nirmala Naidoo, Nandi Synyanya, Madelaine T. Carstens, Sean P. Cumming, Clemens Drenowatz, Lydia G. Emm, Fiona Bridget Gillison, Julia Kirstey Zakrzewski, Ashley Braud, Sheletta G. Donatto, Corbin Lemon, Ana Jackson, Ashunti Pearson, Gina Pennington, Daniel Ragus, Ryan C. Roubion, John M. Schuna, Derek Wiltz, Alan Mark Batterham, Jacqueline Kerr, Michael W. Pratt, Angelo Pietrobelli

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Background: The Canadian 24-h movement guidelines were developed with the hope of improving health and future health outcomes in children and youth. The purpose of this study was to evaluate adherence to the 3 recommendations most strongly associated with health outcomes in new 24-h movement guidelines and their relationship with adiposity (obesity and body mass index z-score) across countries participating in the International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE).

Methods: Cross-sectional results were based on 6128 children aged 9-11years from the 12 countries of ISCOLE. Sleep duration and moderate-to-vigorous physical activity (MVPA) were assessed using accelerometry. Screen time was measured through self-report. Body weight and height were measured. Body mass index (BMI, kgm2) was calculated, and BMI z-scores were computed using age- and sex-specific reference data from the World Health Organization. Obesity was defined as a BMI z-score>+2 SD. Meeting the overall 24-h movement guidelines was defined as: 9 to 11h/night of sleep, ≤2h/day of screen time, and at least 60min/day of MVPA. Age, sex, highest parental education and unhealthy diet pattern score were included as covariates in statistical models. Associations between meeting vs. not meeting each single recommendation (and combinations) with obesity were assessed with odds ratios calculated using generalized linear mixed models. A linear mixed model was used to examine the differences in BMI z-scores between children meeting vs. not meeting the different combinations of recommendations.

Results: The global prevalence of children meeting the overall recommendations (all three behaviors) was 7%, with children from Australia and Canada showing the highest adherence (15%). Children meeting the three recommendations had lower odds ratios for obesity compared to those meeting none of the recommendations (OR=0.28, 95% CI 0.18-0.45). Compared to not meeting the 24-h movement recommendations either independently or combined, meeting them was significantly associated with a lower BMI z-score. Whenever the MVPA recommendation was included in the analysis the odds ratios for obesity were lower.

Conclusions: For ISCOLE participants meeting these 3 healthy movement recommendations the odds ratios of being obese or having high BMI z-scores were lower. However, only a small percentage of children met all recommendations. Future efforts should aim to find promising ways to increase daily physical activity, reduce screen time, and ensure an adequate night's sleep in children. Trial registration: The International Study of Childhood Obesity, Lifestyle and the Environment (ISCOLE) was registered at (Identifier NCT01722500) (October 29, 2012).

Original languageEnglish
Article number123
Number of pages10
JournalInternational Journal of Behavioral Nutrition and Physical Activity
Issue number1
Publication statusPublished - 25 Nov 2016
Externally publishedYes

Bibliographical note

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.


  • obesity
  • Adiposity
  • physical activity
  • movement behaviours
  • Recommendations
  • Obesity
  • Screen time
  • Prevalence
  • Sleep
  • Physical activity
  • Children


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