Travis’ Note: This morning the Canadian Society for Exercise Physiology released the first official national guidelines for sedentary behaviour and physical activity for pre-school aged children (0-4 years old). Below we have a post by one of the authors of the new guidelines papers, Allana Leblanc (more on Allana can be found at the bottom of the post). This post describes the physical activity guidelines – for a similar post outlining the sedentary behaviour guidelines please visit the Sedentary Behaviour Research Network.
The full text of the guidelines papers can be accessed for free via the Applied Physiology, Nutrition and Metabolism website (the sedentary behaviour paper is here, while the physical activity paper is here). Additional information can also be found on the CSEP website at www.csep.ca/guidelines.
Until recently, only one set of physical activity guidelines was available for children under the age of 5 years (National Association for Sport and Physical Education, 2009). These guidelines were useful recommendations for parents and caregivers with advice on healthy living, but were informed largely on expert consensus and not by the rigor of a systematic review. Last year, Australia and the United Kingdom (UK) were the first to release evidence-based guidelines and recommend that preschoolers be physically active for at least 180 minutes per day (Department of Health and Ageing, Australia 2011; Start Active, Stay Active, United Kingdom, 2011). The full guidelines can be found here and here. However, a systematic review was still not publicly available to inform the development Canadian guidelines for this age group.
The lack of guidance does not speak to the lack of interest as the demand for guidance on physical activity for the early years is clearly evident. A narrative review by Timmons et al. (2007) was downloaded 2-5 times more frequently (nearly 6,000 downloads) than other foundation papers used to inform updated guidelines for school-aged children, youth, adults, and older adults. So in March of 2011, we embarked on a rigorous and transparent process of guideline development.
Who are the guidelines for?
These guidelines are relevant to all apparently healthy infants (aged less than 1 year), toddlers (aged 1.0-3.0 years) and preschoolers (aged 3.0-4.99 years), irrespective of gender, race, ethnicity or socio-economic status of the family. The intended audience for these guidelines is parents, teachers, caregivers and health care providers responsible for healthy growth and development of children in the early years.
What we did
This process paper (available here) outlines the steps that were taken to arrive at the Canadian Physical Activity Guidelines for the Early Years (aged 0-4 years). These guidelines are presented through a partnership between the Canadian Society for Exercise Physiology (CSEP), the Healthy Active Living and Obesity Research Group (HALO) and ParticipACTION, with financial support from the Canadian Institutes of Health Research (CIHR), and made available to all Canadians. Following the framework explained in detail by Tremblay and Haskell (Tremblay and Haskell 2012), all components were guided by the AGREE II instrument (Appraisal of Guidelines for Research Evaluation) and evidence included in the systematic review was assessed using the GRADE approach (Grading of Recommendations Assessment, Development and Evaluation). See here for details on AGREE II and here for details on GRADE.
The full AGREE assessment and report can be found on the CSEP website; the systematic review to inform the guidelines has been submitted for publication in a peer review journal. The wording of the guidelines themselves were subject to input by a wide range of stakeholders including national and international content experts, health professionals, governmental and non-governmental organizations, teachers, and caregivers. Through the consultation process, 932 individuals (858 in English, 74 in French) completed the survey and 212 respondents provided additional written comments. A summary of the survey results can be found in English here and in French here.
Key evidence to inform these guidelines comes from a systematic review examining the relationship between physical activity and 6 health indicators (adiposity, bone and skeletal health, motor skill development, psychosocial health, cognitive development, cardio-metabolic health indicators) in the early years (aged 0-4 years). Eighteen unique studies, representing 22 papers met inclusion criteria. In brief, 5 reported results in infants, 2 in toddlers and 11 in preschoolers. Of these, included studies reported on the following health indicators: adiposity (n=11), bone and skeletal health (n=2), motor development (n=4), psychosocial health (n=3), cognitive development (n=1) and cardio-metabolic health indicators (n=3).
The systematic review found evidence to support a positive relationship between increased physical activity and favourable measures of adiposity, bone and skeletal health, motor skill development, psychosocial health, cognitive development, and aspects of cardio-metabolic health. However, due to the lack of information the review could not determine the specific amount, intensity, frequency, or type of physical activity needed to promote healthy growth and development. In the absence of available evidence, expert opinion and documents from other jurisdictions were used to draft the wording of the guidelines.
Areas for future research have been identified within the process paper, the systematic review (Timmons et al. submitted) as well as through the stakeholder consultations (see the survey results online). Despite a recent call to action by many funding bodies, research on physical activity and health in the early years is still in its infancy. There is a need for larger studies using direct and consistent measurements (i.e. larger and more diverse sample sizes, direct measures of physical activity, intent-to-treat analyses, reporting of adverse events). These larger studies should be able to clarify the proper dose (i.e. frequency, intensity, time and type) of physical activity needed for good health. Future research also needs to focus on standardizing methods for data collection and analysis so that meta-analysis can be performed. Finally, we encourage other organizations to create innovative messaging strategies so this information can be effectively disseminated to the general public.
What are the guidelines?
The guidelines include a preamble to provide context for the guidelines and specific recommendations for infants, toddlers and preschoolers. The preamble and other supporting documents can be found on the CSEP website and the ParticipACTION website.
Here are the guidelines:
- Infants (aged <1 year) should be physically active several times daily – particularly through interactive floor-based play.
- Toddlers (aged 1–2 years) and preschoolers (aged 3–4 years) should accumulate at least 180 min of physical activity at any intensity spread throughout the day, including
- A variety of activities in different environments.
- Activities that develop movement skills.
- Progression toward at least 60 min of energetic play by 5 years of age.
Tremblay MS, LeBlanc AG, Carson V, Choquette L, Connor Gorber S, Dillman C, Duggan M, Gordon MJ, Hicks A, Janssen I, Kho ME, Latimer-Cheung AE, LeBlanc C, Murumets K, Okely AD, Reilly JJ, Stearns JA, Spence JC, & Timmons BW (2012). Canadian Physical Activity Guidelines for the Early Years (aged 0–4 years) Applied Physiology, Nutrition and Metabolism
About the Author: Allana LeBlanc is a Certified Exercise Physiologist and Research coordinator. She is a co-author on the process papers outlining the new physical activity guidelines and systematic review, as well as lead author on the systematic review on which the sedentary behaviour guidelines are based.
Australian Government. Department of Health and Ageing 2011. Move and play every day. National physical activity recommendations for children 0-5 years. Commonwealth of Australia. Department of Health and Ageing.
National Association for Sport and Physical Education. 2009. Active Start: A Statement of Physical Activity Guidelines for Children From Birth to Age 5 – Second Edition. AAHPERD Publications, Oxon Hill, MD.
Start Active, Stay Active: A report on physical activity for health from the four home countries’ Chief Medical Officers. 2011. United Kingdom. www.dh.gov.uk/en/Publications/PublicationsPolicyAndGuidance/DH_128209 accessed 9th Jan. 2012.
Timmons, B.W., Naylor, P.J., Pfeiffer, K. 2007. Physical activity for preschool children – how much and how. Appl. Physiol. Nutr. Metab. 32:S122-S134.
Timmons, B.W., LeBlanc, A.G., Carson, V., Connor Gorber, S., Dillman, C., Janssen, I., et al. 2012. Systematic review of the relationship between physical activity and health indicators in the early years (ages 0-4 years). Appl. Physiol. Nutr. Metab. Submitted.
Tremblay, M.S., and Haskell, W.L. 2012a. From science to physical activity guidelines. In C. Bouchard, S.N. Blair, W.L. Haskell (Eds.) Physical Activity and Health (2nd Ed.). Human Kinetics Publishers, Champaign, IL. p. 359-378.