Move More, Sit Less, Sleep Soundly: An integrated approach for healthy children and youth

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1 Move More, Sit Less, Sleep Soundly: An integrated approach for healthy children and youth Alberta Centre For Active Living 2018 Physical Activity Forum Dr. Valerie Carson

2 Outline 1) Background and rationale 2) Evidence and guidelines 3) Surveillance and monitoring 4) Resources and ideas

3 Background and Rationale Sleep, sedentary behaviour, and physical activity are three behaviours that fall on the movement continuum. Together these three movement behaviours make up the full 24-hour period. Movement Continuum Sleep Sedentary Behaviour Light PA (Light Play) Moderate PA (Energetic Play) Vigorous PA (Very Energetic Play) PA = physical activity

4 Sedentary Behaviour Sitting/lying/reclining No to little movement While awake Background and Rationale Light PA (Light play) Standing Slower movement Moderate to Vigorous PA (Energetic Play/Very Energetic Play) Faster movement Breathing heavy Warmer Short bursts PA = physical activity

5 Background and Rationale Traditionally movement behaviours have been both researched and promoted in isolation. Large focus on moderate to vigorous physical activity Chaput et al., IJERPH 12

6 Background and Rationale Movement behaviours have natural interactions. Share with a partner one example of how a movement behaviour has impacted another movement behaviour in your own day to day life. Carson et al.,2016. Prev Med

7 Separate physical activity and sedentary behaviour guidelines No sleep guidelines Background and Rationale New approach integrated guidelines Informed by emerging evidence and stakeholder feedback

8 Outline 1) Background and rationale 2) Evidence and guidelines 3) Surveillance and monitoring 4) Resources and ideas

9 Evidence 4 Systematic Reviews Compositional Expert Stakeholder Methodological = Analyses Consensus Feedback Advice Foundation of Evidence

10 Evidence: Systematic Review Health indicators Adiposity Motor development Cardiometabolic health Fitness Growth Bone and skeletal health Psychosocial health / emotional regulation / psychological distress / behavioural conduct / pro-social behaviour / self-esteem Quality of life/well-being Cognitive development / cognition Academic achievement SB / PA *indicator in the sleep review only Risks (injury) / harm Tremblay et al., Appl Physiol Nutr Metab; Tremblay et al., BMC Public Health

Evidence: Physical Activity Systematic Review (5-17 years) 162 studies 204,171 participants; 31 countries Quality of evidence: very low to moderate Key findings: Evidence continued to support the

11 Evidence: Physical Activity Systematic Review (5-17 years) 162 studies 204,171 participants; 31 countries Quality of evidence: very low to moderate Key findings: Evidence continued to support the importance of at least 60 min/day of moderate to vigorous physical activity for health benefits. There may also be potential health benefits of light physical activity. More physical activity (duration, frequency, and/or intensity) was associated with better health. Poitras et al., Appl Physiol Nutr Metab

Evidence: Sedentary Behaviour Systematic Review (5-17 years) 235 studies (2010-2014) 1,657,064 participants; 71 countries Quality of evidence: very low to moderate Key findings: Different types of

12 Evidence: Sedentary Behaviour Systematic Review (5-17 years) 235 studies ( ) 1,657,064 participants; 71 countries Quality of evidence: very low to moderate Key findings: Different types of sedentary behaviour had different impacts on health indicators. Higher duration of TV viewing and/or screen time was associated with unfavourable health. A gradient was observed indicating less sedentary behaviour, especially screen time, was associated with better health. Carson et al., Appl Physiol Nutr Metab

13 Evidence: Sleep Systematic Review (5-17 years) 141 studies 592,215 participants; 40 countries Quality of evidence: very low to high Key findings: Shorter sleep duration was associated with higher adiposity, poorer emotional regulation, poorer academic achievement, and worse quality of life. Chaput et al., Appl Physiol Nutr Metab

combinations of sleep + sedentary behaviour + physical activity The most optimal health benefits were observed when

14 Evidence: Integrated Systematic Review (5-17 years) 14 studies 36,560 participants 20 countries Quality of evidence: low Key findings: Combinations of: sleep + sedentary behaviour + physical activity were more favorable for health then combinations of sleep + sedentary behaviour + physical activity The most optimal health benefits were observed when replacing sedentary behaviour with moderate to vigorous physical activity. Saunders et al., Appl Physiol Nutr Metab

17 Evidence: Physical Activity Systematic Review (0-4 years) 96 studies 71,291 participants; 36 countries Quality of evidence: very low to high Key Findings: Specific types of physical activity, higher total physical activity, and higher physical activity of at least moderate- to vigorous-intensity were favourably associated with multiple health indicators, with evidence that more tends to be better. For infants, 30 minutes of tummy time per day while awake appears beneficial for motor development. Carson et al., BMC Public Health

18 Evidence: Sedentary Behaviour Systematic Review (0-4 years) 96 studies 195,430 participants; 33 countries Quality of evidence: very low to moderate Key Findings: More time in front of screens was associated with unfavourable adiposity, motor and cognitive development, and psychosocial health. More time in car seats/strollers, and in the supine position were associated with unfavourable adiposity and motor development or no relationship. More reading and story-telling with a caregiver was associated with better cognitive development or no relationship. Poitras et al., BMC Public Health

19 Evidence: Sleep Systematic Review (0-4 years) 69 studies 148,524 participants; 23 countries Quality of evidence: very low to high Key Findings: Shorter sleep duration was associated with higher adiposity, poorer emotional regulation, impaired growth, more screen time, and higher risk of injuries. Chaput et al., BMC Public Health

Evidence: Integrated Systematic Review (0-4 years) 10 studies 7,549 participants; 5 countries Quality of evidence: very low to moderate Key Findings: Ideal combinations of physical activity and

20 Evidence: Integrated Systematic Review (0-4 years) 10 studies 7,549 participants; 5 countries Quality of evidence: very low to moderate Key Findings: Ideal combinations of physical activity and sedentary behaviour: Favourable motor development and fitness (preschoolers) Favourable adiposity or unrelated (toddlers and preschoolers) Ideal combinations of sleep duration and sedentary behaviour: Favourable adiposity (infants and toddlers) Kuzik et al., BMC Public Health

25 Outline 1) Background and rationale 2) Evidence and guidelines 3) Surveillance and monitoring 4) Resources and ideas

26 Surveillance and monitoring Canadian Children and Youth (5-17 years) Sleep: 75% Screen time: 49% % All three Two out of three One out of three None Carson et al., Prev Med; Roberts et al., Health Reports

27 Surveillance and monitoring Canadian Children and Youth (5-17 years) Physical Activity 70 % All days 6/7 days 5/7 days Average MVPA 60 min/day Colley et al., Health Reports

28 Surveillance and monitoring Canadian Preschoolers (3-4 years) Physical Activity: 62% All three: 13% Screen time: 24% Sleep: 84% Chaput et al., BMC Public Health

29 Surveillance and monitoring (%) PA+ST+SLP PA + ST Edmonton Toddlers (1-2 years) 81.5 PA + SLP 11.9 ST + SLP 99.3 PA 15.2 ST 82.1 SLP 11.9 Three 72.9 Two PA = physical activity ST = screen time SLP = sleep 15.2 One 0 None Lee et al., BMC Public Health

30 Outline 1) Background and rationale 2) Evidence and guidelines 3) Surveillance and monitoring 4) Resources and ideas

31 Resource and Ideas The guidelines are available at: Canadian Society for Exercise Physiology: ParticipACTION:

32 Resource and Ideas

33 Resource and Ideas

34 Resource and Ideas

Acknowledgments Research experts: Kristi Adamo, PhD Valerie Carson, PhD* Jean-Philippe Chaput, PhD* Guy Faulkner, PhD* Gary Goldfield, PhD Reut Gruber, PhD* Ian Janssen, PhD* Nickolas Kuzik, MSc* Amy

Tremblay, PhD* Research Assistants: Kevin Belanger, MSc Michael Borghese, MSc Laura Callender Sheniz Eryuzlu Linda Hewitt, BAppSc Stephen Hunter, MSc* Cally Jennings, PhD Geneviève Leduc, PhD

Canada, PhD Mary Duggan, CSEP* Katherine Janson, ParticipACTION Claire LeBlanc, CPS, MD, FRCPC Joanna MacLaen, Canadian Sleep Society, MD Andrea Phillips Mary-Ellen Raynor, Sandbox Project Sophie

37 Acknowledgments Research experts: Kristi Adamo, PhD Valerie Carson, PhD* Jean-Philippe Chaput, PhD* Guy Faulkner, PhD* Gary Goldfield, PhD Reut Gruber, PhD* Ian Janssen, PhD* Nickolas Kuzik, MSc* Amy Latimer-Cheung, PhD* John Spence, PhD Travis Saunders, PhD Brian Timmons, PhD Mark S. Tremblay, PhD* Research Assistants: Kevin Belanger, MSc Michael Borghese, MSc Laura Callender Sheniz Eryuzlu Linda Hewitt, BAppSc Stephen Hunter, MSc* Cally Jennings, PhD Geneviève Leduc, PhD Eun-Young Lee, PhD Helena Lee, BSc Jodie Stearns, MSc Stephanie Powley Unrau, BSc Stakeholder groups & knowledge users: Lousie Choquette, Best Start Resource Centre Thy Dinh, The Conference Board of Canada, PhD Mary Duggan, CSEP* Katherine Janson, ParticipACTION Claire LeBlanc, CPS, MD, FRCPC Joanna MacLaen, Canadian Sleep Society, MD Andrea Phillips Mary-Ellen Raynor, Sandbox Project Sophie Rodenburg James Stone, MD, PhD Shelly Weiss, Canadian Sleep Society, MD, FRCPC Lori Zehr, CSEP, MSc Funding: International collaborators: Harriette Carr, MD Xanne Janssen, PhD Peter Katzmarzyk, PhD Anthony Okely, PhD* Timothly Olds, PhD Russell Pate, PhD John Reilly, PhD Gareth Stratton, PhD Methodology consultants & project management: Salomé Aubert, MSc Joel Barnes, MSc Alejandra Jaramillo Garcia, MSc Casey Gray, PhD* Michelle Kho, PhD Veronica Poitras, PhD* Margaret Sampson, PhD* Sebastien Chastin, PhD*

38 References 1) Carson, V., Hunter, S., Kuzik, N., Gray, C.E., Poitras, V.J., Chaput, J-P., Saunders, T.J., Katzmarzyk, P.T., Okely, A.D., Conner Gorber, S., Kho, M.E., Sampson, M., Lee, H., Tremblay, M.S. (2016). Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update. Applied Physiology, Nutrition and Metabolism 41(6): S240-S265 2) Carson, V., Chaput, J-P., Janssen, I., Tremblay, M. (2016). Health associations with meeting new 24-hour movement guidelines for Canadian children and youth. Preventive Medicine 95: ) Carson, V., Lee, E-Y., Hewitt, L., Hunter, S., Jennings, C., Kuzik, N., Stearns, J., Unrau Powley, S., Poitras, V., Gray, C.E., Adamo, K., Janssen, I., Okely, A., Spence, J., Timmons, B., Sampson, M., Tremblay, M. (2017). Systematic review of the relationships between physical activity and health indicators in the early years (aged 0-4 years). BMC: Public Health 17 (Suppl 5): 854 4) Chaput, J-P, Carson, V., Gray, C., Tremblay, M.S. (2014). Importance of All Movement Behaviors in a 24 Hour Period for Overall Health. International Journal of Environmental Research and Public Health 11(12): ) Chaput, J-P., Poitras, V., Gray, C., Carson, V., Gruber, R., Olds, T., Weiss, S., Connor Gorber, S., Kho, M., Sampson, M., Belanger, K., Eryuzlu, S., Challender, L., Tremblay, M.S. (2016). Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth. Applied Physiology, Nutrition and Metabolism 41(6): S266-S282 6) Chaput, J-P., Gray, C.E., Poitras, V.J., Carson, V., Gruber, R., Birken, C.S., MacLean, J.E., Aubert, S., Sampson, M., Tremblay, M.S. (2017). Systematic review of the relationships between sleep duration and health indicators in children aged 0-4 years. BMC: Public Health 17 (Suppl 5): 855 7) Chaput, J-P., Colley, R., Aubert, S., Carson, V., Janssen, I., Roberts, K.C., Tremblay, M.S. (2017). Proportion of preschool-aged children meeting the Canadian 24- Hour Movement Guidelines and associations with adiposity: Results from the Canadian Health Measures Survey. BMC: Public Health 17 (Suppl 5):829 8) Colley, R.C., Carson, V., Garriguet, D., Janssen, I., Roberts, K.C., Tremblay, M.S. (2017). Moderate-to-vigorous physical activity of Canadian children and youth: Accelerometer results from the 2007 to 2015 Canadian Health Measures Survey. Health Reports 28(10): ) Kuzik, N., Poitras, V.J., Tremblay, M.S., Lee, E-Y., Hunter, S., Carson, V. (2017). Systematic review of the relationships between combinations of movement behaviors and health indicators in the early years (aged 0 to 4 years). BMC Public Health 17 (Suppl 5): ) Lee, E-Y., Hesketh, K., Hunter, S., Kuzik, N., Rhodes, R.E., Rinaldi, C., Spence, J.C., Carson, V. (2017). Meeting new Canadian 24-hour Movement Guidelines for the Early Years and associations with adiposity among toddlers living in Edmonton, Canada. BMC Public Health 17 (Suppl 5):840 11) Poitras, V., Gray, C., Borghese, M., Carson, V., Chaput, J-P., Janssen, I., Katzmarzyk, P., Pate, R. R., Connor Gorber, S., Kho, M., Sampson, M., Tremblay, M.S. (2016). Systematic review of the relationships between objectively-measured physical activity and health indicators in school-aged children and youth. Applied Physiology, Nutrition and Metabolism 41(6): S197-S239 12) Poitras, V.J., Gray, C.E., Janssen, X., Aubert, S., Carson, V., Faulkner, G., Goldfield, G.S., Reilly, J.J., Sampson, M., Tremblay, M.S. (2017). Systematic review of the relationships between sedentary behavior and health indicators in the early years (aged 0-4 years). BMC: Public Health 17 (Suppl 5): ) Roberts, K.C., Yao, X., Carson, V., Chaput, J-P., Janssen, I., Tremblay, M.S. (2017). Meeting Canada s new 24-hour movement guidelines for children and youth: Results from the Canadian Health Measures Survey. Health Reports 28(10): ) Saunders, T., Gray, C., Poitras, V., Chaput, J-P., Janssen, I., Katzmarzyk, P., Olds, T., Conner Gorber, S., Kho, M.S., Sampson, M., Tremblay, M., Carson, V. (2016). Combinations of physical activity, sedentary behaviour and sleep: relationships with health indicators in school-aged children and youth. Applied Physiology, Nutrition and Metabolism 41(6): S283-S293 15) Tremblay, M.S., Carson, V., Chaput, J-P., Dinh, T., Duggan, M., Faulkner, G., Connor Gorber, S., Gray, CE., Gruber, R., Janson, K., Janssen, I., Katzmarzyk, PT., Kho, ME., Latimer-Cheung, AE., LeBlanc, C., Okely, AD., Olds, T., Pate, RR., Phillips, A., Poitras, VJ., Rodenburg, S., Saunders, TJ., Sampson, M., Stone, J., Stratton, G., Weiss, SK., Zehr, L. (2016). Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. Applied Physiology, Nutrition and Metabolism 41(6): S311-S327 16) Tremblay, M., Chaput, J-P., Adamo, K., Aubert, S., Barnes, J., Choquette, L., Duggan, M., Faulkner, G., Goldfield, G., Gray, C., Gruber, R., Janson, K., Janssen, I., Janssen, X., Jaramillo Garcia, A., Kuzik, N., LeBlanc, C., MacLean, J., Okely, A., Poitras, V., Rayner, M-E., Reilly, J., Sampson, M., Spence, J., Timmons, B., Carson, V. (2017). Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years): An Integration of Physical Activity, Sedentary Behaviour, Sleep. BMC Public Health 17 (Suppl 5): 874

39 References 1) Carson, V., Hunter, S., Kuzik, N., Gray, C.E., Poitras, V.J., Chaput, J-P., Saunders, T.J., Katzmarzyk, P.T., Okely, A.D., Conner Gorber, S., Kho, M.E., Sampson, M., Lee, H., Tremblay, M.S. (2016). Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update. Applied Physiology, Nutrition and Metabolism 41(6): S240-S265 2) Carson, V., Chaput, J-P., Janssen, I., Tremblay, M. (2016). Health associations with meeting new 24-hour movement guidelines for Canadian children and youth. Preventive Medicine 95: ) Carson, V., Lee, E-Y., Hewitt, L., Hunter, S., Jennings, C., Kuzik, N., Stearns, J., Unrau Powley, S., Poitras, V., Gray, C.E., Adamo, K., Janssen, I., Okely, A., Spence, J., Timmons, B., Sampson, M., Tremblay, M. (2017). Systematic review of the relationships between physical activity and health indicators in the early years (aged 0-4 years). BMC: Public Health 17 (Suppl 5): 854 4) Chaput, J-P, Carson, V., Gray, C., Tremblay, M.S. (2014). Importance of All Movement Behaviors in a 24 Hour Period for Overall Health. International Journal of Environmental Research and Public Health 11(12): ) Chaput, J-P., Poitras, V., Gray, C., Carson, V., Gruber, R., Olds, T., Weiss, S., Connor Gorber, S., Kho, M., Sampson, M., Belanger, K., Eryuzlu, S., Challender, L., Children Tremblay, and M.S. (2016). youth: Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth. Applied Physiology, Nutrition and Metabolism 41(6): S266-S282 6) Open Chaput, access J-P., Gray, supplemental C.E., Poitras, V.J., Carson, Issue V., Gruber, of Applied R., Birken, C.S., Physiology, MacLean, J.E., Nutrition Aubert, S., Sampson, and M., Metabolism Tremblay, M.S. (2017). 41(6), Systematic 2016review of the relationships between sleep duration and health indicators in children aged 0-4 years. BMC: Public Health 17 (Suppl 5): 855 7) Chaput, J-P., Colley, R., Aubert, S., Carson, V., Janssen, I., Roberts, K.C., Tremblay, M.S. (2017). Proportion of preschool-aged children meeting the Canadian 24- Hour Movement Guidelines and associations with adiposity: Results from the Canadian Health Measures Survey. BMC: Public Health 17 (Suppl 5):829 8) Colley, R.C., Carson, V., Garriguet, D., Janssen, I., Roberts, K.C., Tremblay, M.S. (2017). Moderate-to-vigorous physical activity of Canadian children and youth: Accelerometer results from the 2007 to 2015 Canadian Health Measures Survey. Health Reports 28(10): ) Kuzik, N., Poitras, V.J., Tremblay, M.S., Lee, E-Y., Hunter, S., Carson, V. (2017). Systematic review of the relationships between combinations of movement behaviors and health indicators in the early years (aged 0 to 4 years). BMC Public Health 17 (Suppl 5): ) Lee, E-Y., Hesketh, K., Hunter, S., Kuzik, N., Rhodes, R.E., Rinaldi, C., Spence, J.C., Carson, V. (2017). Meeting new Canadian 24-hour Movement Guidelines for the Early Years and associations with adiposity among toddlers living in Edmonton, Canada. BMC Public Health 17 (Suppl 5):840 11) Poitras, V., Gray, C., Borghese, M., Carson, V., Chaput, J-P., Janssen, I., Katzmarzyk, P., Pate, R. R., Connor Gorber, S., Kho, M., Sampson, M., Tremblay, M.S. (2016). Early Systematic Years: review of the relationships between objectively-measured physical activity and health indicators in school-aged children and youth. Applied Physiology, Nutrition and Metabolism 41(6): S197-S239 12) Open Poitras, access V.J., Gray, supplemental C.E., Janssen, X., Aubert, Issue S., Carson, of BMC V., Faulkner, Public G., Goldfield, Health G.S., 17(Suppl. Reilly, J.J., Sampson, 5), 2017 M., Tremblay, M.S. (2017). Systematic review of the relationships between sedentary behavior and health indicators in the early years (aged 0-4 years). BMC: Public Health 17 (Suppl 5): ) Roberts, K.C., Yao, X., Carson, V., Chaput, J-P., Janssen, I., Tremblay, M.S. (2017). Meeting Canada s new 24-hour movement guidelines for children and youth: Results from the Canadian Health Measures Survey. Health Reports 28(10): ) Saunders, T., Gray, C., Poitras, V., Chaput, J-P., Janssen, I., Katzmarzyk, P., Olds, T., Conner Gorber, S., Kho, M.S., Sampson, M., Tremblay, M., Carson, V. (2016). Combinations of physical activity, sedentary behaviour and sleep: relationships with health indicators in school-aged children and youth. Applied Physiology, Nutrition and Metabolism 41(6): S283-S293 15) Tremblay, M.S., Carson, V., Chaput, J-P., Dinh, T., Duggan, M., Faulkner, G., Connor Gorber, S., Gray, CE., Gruber, R., Janson, K., Janssen, I., Katzmarzyk, PT., Kho, ME., Latimer-Cheung, AE., LeBlanc, C., Okely, AD., Olds, T., Pate, RR., Phillips, A., Poitras, VJ., Rodenburg, S., Saunders, TJ., Sampson, M., Stone, J., Stratton, G., Weiss, SK., Zehr, L. (2016). Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. Applied Physiology, Nutrition and Metabolism 41(6): S311-S327 16) Tremblay, M., Chaput, J-P., Adamo, K., Aubert, S., Barnes, J., Choquette, L., Duggan, M., Faulkner, G., Goldfield, G., Gray, C., Gruber, R., Janson, K., Janssen, I., Janssen, X., Jaramillo Garcia, A., Kuzik, N., LeBlanc, C., MacLean, J., Okely, A., Poitras, V., Rayner, M-E., Reilly, J., Sampson, M., Spence, J., Timmons, B., Carson, V. (2017). Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years): An Integration of Physical Activity, Sedentary Behaviour, Sleep. BMC Public Health 17 (Suppl 5): 874

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CANADIAN 24-HOUR MOVEMENT GUIDELINES FOR THE EARLY YEARS (0-4 YEARS): AN INTEGRATION OF PHYSICAL ACTIVITY, SEDENTARY BEHAVIOUR, AND SLEEP

CANADIAN 24-HOUR MOVEMENT GUIDELINES FOR THE EARLY YEARS (0-4 YEARS): AN INTEGRATION OF PHYSICAL ACTIVITY, SEDENTARY BEHAVIOUR, AND SLEEP Dr. Mark Tremblay, PhD Dr. Valerie Carson, PhD Dr. Guy Faulkner,