Journal of Physical Activity and Health, 2020, 17, 92-95

https://doi.org/10.1123/jpah.2019-0401
© 2020 Human Kinetics, Inc. BRIEF REPORT

Introducing 24-Hour Movement Guidelines for the Early Years:

A New Paradigm Gaining Momentum
Mark S. Tremblay

Background: Emerging research shows that the composition of movement behaviors throughout the day (physical activities,
sedentary behaviors, sleep) is related to indicators of health, suggesting previous research that isolated single movement
behaviors maybe incomplete, misleading, and/or unnecessarily constrained. Methods: This brief report summarizes evidence to
support a 24-hour movement behavior paradigm and efforts to date by a variety of jurisdictions to consult, develop, release,
promote, and study 24-hour movement guidelines. It also introduces and summarizes the accompanying series of articles related
specifically to 24-hour movement guidelines for the early years. Results: Using robust and transparent processes, Canada,
Australia, New Zealand, South Africa, and the World Health Organization have developed and released 24-hour movement
guidelines for the early years: an integration of physical activity, sedentary behavior, and sleep. Other countries are exploring a
similar approach and related research is expanding rapidly. Articles related to guideline development in South Africa, the United
Kingdom, Australia, and by the World Health Organization are a part of this special series. Conclusions: A new paradigm
employing 24-hour movement guidelines for the early years that combines recommendations for movement behaviors across the
whole day is gaining momentum across the globe.

Keywords: physical activity, sedentary behavior, screen time, sleep, tummy time

Interest in healthy active living behaviors has risen in recent
years as surveillance evidence suggests that such behaviors are
suboptimal and associated with the premature development of
noncommunicable diseases1–8 or what has been called by some
“socially transmitted conditions.”9 The developmental origins of
health and disease hypothesis posits that noncommunicable disease
processes originate prenatally and/or early in life10,11 with the first
1000 days of life being particularly important.12 In the specific
context of obesity, the World Health Organization (WHO) formed
a Commission on Ending Childhood Obesity13 anchored in the
developmental origins of health and disease hypothesis. Such an
approach is commensurate with the WHO Global Action Plan for
the Prevention and Control of NCDs1 and the recent Global Action
Plan for Physical Activity.14 Until recently, this attentiveness to a
life-course approach and focus on the early years of life had not
been embraced globally when it comes to movement behaviors.
Indeed, the WHO Global Recommendation on Physical Activity
for Health15 in 2010 did not speak to the early years (aged 0–5 y)
nor did the 2008 US Physical Activity Guidelines Report.16 More
recently, this deficit has been addressed and transformed.
In November 2018, the US Department of Health and Human
Services released the Physical Activity Guidelines for Americans,
second edition,17 and for the first time, the guidelines included
guidance for preschool-aged children (aged 3–5 y). These new
guidelines state that preschool-aged children should be physically
active throughout the day to enhance growth and development and
that adult caregivers of preschool-aged children should encourage
active play that includes a variety of activity types. Though
somewhat vague in terms of specific guidance, the inclusion of
recommendations targeted at preschool children reflects the
The author is with the Healthy Active Living and Obesity Research Group, CHEO
Research Institute, Ottawa, ON, Canada. Tremblay (mtremblay@cheo.on.ca) is
corresponding author.
92
accepted importance of healthy physical activity behaviors early
in life and a testament to the growing evidence base supporting
early physical activity for healthy growth and development.16,17 In
April 2019, the WHO also rectified the earlier omission of the
physical activity guidelines for the early years with the release of
WHO Guidelines on Physical Activity, Sedentary Behaviour and
Sleep for Children under 5 years of age.18 Not only did this release
of global guidelines cover the previously underserved early years
age group, but it also extended the guidance to include all behaviors
along the movement continuum (physical activities of all intensi-
ties, sedentary behaviors, and sleep).19 The integration of guidance
on all movement behaviors across the 24-hour day has conceptual,
intuitive, quantitative, and qualitative support.
Support for 24-Hour Guidelines
Support for 24-hour movement guidelines has emerged over the
past 12 years with distinct leadership from Canada.20–26 More
recently, support for an integrated 24-hour movement behavior
approach has come from Australia,27 New Zealand,28 South
Africa,29 the United Kingdom,30 the United States,31 and the
WHO.18 Growing evidence that the whole-day matters comes
from several sources. First, it seems common sense, if not intuitive,
that the whole-day matters when it comes to examining the impact
of movement behaviors on indicators of physical, mental, emo-
tional, cognitive, and social health. That the impact of acute or
habitual physical activity on health would likely be affected by the
quality of sleep the night before and/or how much extended sitting
occurred throughout the day seems obvious, in the same way one
would not examine the healthfulness of a diet based only on an
examination of breakfast or the amount of cereal consumed. The
quantitative exploration of this intuition has expanded rapidly in
recent years employing compositional analyses that allow for an
examination of the “cocktail” of behaviors that best relate to
desired health indicators or outcomes.32–34 Consistently, these
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analyses demonstrate that the composition of movement behaviors
throughout the day relate significantly to indicators of health in
adults,32,35 school-aged children and youth,36–42 and the early
years.43,44 While the relative importance of individual movement
behaviors may vary depending on the indicator of interest, the
cocktail of behaviors is important to examine and provides addi-
tional breadth of opportunity for behavior modification counseling.
Further support for a 24-hour movement approach comes from
analyses done examining the number of 24-hour guideline recom-
mendations met (ie, physical activity, screen time, sleep) and the
relationship with health indicators. Similar to the compositional
analyses, these assessments generally show that meeting one
guideline is better than meeting none, that meeting 2 guidelines
is better than meeting one, and that meeting all guidelines is
associated with the most desirable health profile, and this pattern
holds across a range of ages, countries, health indicators, and health
conditions.45–53
Support also derives from systematic reviews that examined
the associations of multiple movement behaviors with various
health outcomes in school-aged children and youth54 and among
the early years.55 Supporting the intuitive nature of integrated
movement guidelines, quantitative surveys, as well as focus groups
with stakeholders and end users shows wide support for a 24-hour
movement guideline approach.56–60 Finally, a new organization
called the International Network of Time-Use Epidemiologists
(https://www.intue.org) was recently formed with an aim to
draw together researchers and other public health stakeholders
interested in advancing the field of time-use epidemiology, an
example of which is compositional analyses of 24-hour movement
guidelines.
Recent Guideline Developments
Commensurate with the rapidly emerging evidence supporting the
24-hour guideline paradigm, several jurisdictions have developed
public health guidelines embracing this new approach. In 2016,
Canada released 24-Hour Movement Guidelines for Children and
Youth (5–17 y),24 and in 2019, Australia released similar guidelines
that were harmonized (ADOLOPED61) from the Canadian guide-
lines. In 2017, Canada,25 Australia,27 and New Zealand28 released
24-hour movement guidelines for the early years (0–4/5 y). In
December 2018, South African 24-hour movement guidelines for
birth to 5 years were released.30 New WHO integrated behavior
guidelines for children aged 5 years and younger were launched in
April 2019. These new WHO guidelines were developed in direct
response to the Commission on Ending Childhood Obesity recom-
mendation to provide “guidance to children and adolescents, their
parents, caregivers, teachers and health professionals on healthy
body size, physical activity, sleep behaviours and appropriate use of
screen-based entertainment”.13 Using GRADE-ADOLOPMENT
procedures61 similar to what was used by Australia27 and South
Africa,30 the United Kingdom proposed 24-hour movement behav-
ior recommendations and physical activity guidelines for the under
5s29; however, the chief medical officers of the United Kingdom did
not accept the 24-hour approach and isolated physical activity
guidelines for all age groups, including the under 5s, were released
in September 2019.
The 24-hour guidelines from all jurisdictions are essentially
the same.18,25,27–30 The rapid and diverse adoption of the 24-hour
movement paradigm for the early years in particular suggests a
global movement and creates a natural experiment for further
research and evaluation.
JPAH Vol. 17, No. 1, 2020
Early Years Movement Guidelines 93
Special Series
As part of this rapidly evolving area of research, this issue of the
Journal of Physical Activity and Health presents a short series of
articles further exploring movement behavior guidelines for chil-
dren in their early years (aged 0–4/5 y). This brief report serves as
an introduction and preface to the series, which is briefly summa-
rized below.
The series includes 5 original manuscripts. The first describes
the process used for the development of the WHO guidelines on
physical activity, sedentary behavior, and sleep for children aged 5
years and younger.62 These new, global guidelines represent the first
time the WHO has provided such guidance for the 5 years and
younger age group, as well as the first time the WHO has embraced
the 24-hour movement paradigm. The second article by Reilly et al29
presents the first European use of the GRADE-ADOLOPMENT
process to develop physical activity guidelines. They describe the
process as “robust, rapid, and inexpensive,” but also share lessons
learned that should help development of physical activity guidelines
in future. Despite the guideline development panel recommending a
24-hour guideline approach, decision-making authorities adhered to
physical activity–only guidelines. In the third article, Draper et al30
present the background and outcomes of the process to develop the
South African 24-hour movement guidelines for birth to 5 years: an
integration of physical activity, sitting behavior, screen time, and
sleep. These represent the first such guidelines developed in Africa
and highlight important relevant contextual challenges.
The final 2 articles report on consultations held with important
stakeholders in Australia59 and South Africa60 in relation to the
development of the new guidelines. They explore stakeholders’
perceptions of the acceptability, usability, and dissemination of the
new guidelines and provide insight to guide successful promotion
and uptake by stakeholders and end users.
Summary
A new paradigm employing 24-hour movement guidelines for the
early years that combines recommendations for movement behaviors
across the whole day (physical activities of all intensities, sedentary
behaviors, and sleep) is gaining momentum across the globe. A
research and surveillance agenda is emerging to facilitate the investi-
gation of the impact and uptake of this approach.63 The short series of
articles clustered together in this issue aims to raise awareness of this
momentum and stimulate further guideline development, dialog, and
research to inform, adapt, and challenge the current guidelines.
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