Canadian 24-Hour Movement Guidelines for the Early Years (0–4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep

Tremblay, Mark S.; Chaput, Jean-Philippe; Adamo, Kristi B.; Aubert, Salomé; Barnes, Joel D.; Choquette, Louise; Duggan, Mary; Faulkner, Guy; Goldfield, Gary S.; Gray, Casey E.; Gruber, Reut; Janson, Katherine; Janssen, Ian; Janssen, Xanne; Jaramillo Garcia, Alejandra; Kuzik, Nicholas; LeBlanc, Claire; MacLean, Joanna; Okely, Anthony D.; Poitras, Veronica J.; Rayner, Mary-Ellen; Reilly, John J.; Sampson, Margaret; Spence, John C.; Timmons, Brian W.; Carson, Valerie

doi:10.1186/s12889-017-4859-6

Table 4 Surveillance recommendations for the Canadian 24-Hour Movement Guidelines for the Early Years

From: Canadian 24-Hour Movement Guidelines for the Early Years (0–4 years): An Integration of Physical Activity, Sedentary Behaviour, and Sleep

Movement Behaviour	Specific guideline recommendation for a healthy day	Specific surveillance recommendation	Rationale for specific surveillance recommendation	Recommendation for minimum inclusion in overall guideline surveillance^a
Age category
Physical activity
Infants (aged <1 year)	Being physically active several times in a variety of ways, particularly through interactive floor-based play; more is better	None	Currently there are no available benchmarks, further research is required.	✓ ^b
	For those not yet mobile, this includes at least 30 min of tummy time spread throughout the day while awake	Average total tummy time per day is ≥30 min while awake^c	The evidence upon which the guideline is based is predominantly comprised of studies that used average or typical tummy time per day in their analyses. An average allows for some normal day-to-day variability.	✓
Toddlers (aged 1–2 years)	At least 180 min spent in a variety of physical activities at any intensity, including energetic play, spread throughout the day; more is better	Average total physical activity per day is ≥180 min with at least some energetic play (MVPA)^c	The evidence upon which the guideline is based is predominantly comprised of studies that used average or typical physical activity per day in their analyses. An average allows for some normal day-to-day variability. There are currently no benchmarks for the recommended duration of energetic play in this age group.	✓
Preschoolers (aged 3–4 years)	At least 180 min spent in a variety of physical activities spread throughout the day	Average total physical activity per day is ≥180 minutes^c	The evidence upon which the guideline is based is predominantly comprised of studies that used average or typical physical activity per day in their analyses.	✓
	of which at least 60 min is energetic play; more is better	Average MVPA per day is ≥60 minutes^c	An average allows for some normal day-to-day variability.	✓
Sedentary behaviour
Infants	Screen time is not recommended	A typical day includes no screen time^d	The evidence upon which the guideline is based is predominantly comprised of studies that used average or typical screen time per day in their analyses.	✓
	Not being restrained for more than 1 h at a time (e.g., in a stroller or high chair)	Time spent restrained is ≤1 h at a time^e	Empirical evidence substantiating this threshold is lacking though this threshold is aligned with earlier guidelines and has met with stakeholder and end-user acceptance (Tremblay et al., 2012)^f.
	When sedentary, engaging in pursuits like reading and storytelling with a caregiver is encouraged	None	Currently there are no available benchmarks, further research is required.
Toddlers	For those younger than 2 years, sedentary screen time is not recommended	A typical day includes no sedentary screen time^d	The evidence upon which the guideline is based is predominantly comprised of studies that used average or typical sedentary screen time per day in their analyses.	✓
	For those aged 2 years, sedentary screen time should be no more than 1 h; less is better	Average sedentary screen time per day is ≤1 hour^c	The evidence upon which the guideline is based is predominantly comprised of studies that used average or typical sedentary screen time per day in their analyses. An average allows for some day-to-day variability in sedentary screen time.	✓
	Not being restrained for more than 1 h at a time (e.g., in a stroller or high chair) or sitting for extended periods	Time spent restrained is ≤1 h at a time^e	Empirical evidence substantiating this threshold is lacking though this threshold is aligned with earlier guidelines and has met with stakeholder and end-user acceptance (Tremblay et al., 2012)^f. Currently there are no available benchmarks to be more specific for “sitting for extended periods”, further research is required.
	When sedentary, engaging in pursuits like reading and storytelling with a caregiver is encouraged	None	Currently there are no available benchmarks, further research is required.
Preschoolers	Sedentary screen time should be no more than 1 h; less is better	Average sedentary screen time per day is ≤1 hour^c	The evidence upon which the guideline is based is predominantly comprised of studies that used average or typical sedentary screen time per day in their analyses. An average allows for some day-to-day variability in sedentary screen time.	✓
	Not being restrained for more than 1 hour at a time (e.g., in a stroller or car seat) or sitting for extended periods	Time spent restrained is ≤1 hour at a time^e	Empirical evidence substantiating this threshold is lacking though this threshold is aligned with earlier guidelines and has met with stakeholder and end-user acceptance (Tremblay et al., 2012)^f. Currently there are no available benchmarks to be more specific for “sitting for extended periods”, further research is required.
	When sedentary, engaging in pursuits like reading and storytelling with a caregiver is encouraged	None	Currently there are no available benchmarks, further research is required.
Sleep
Infants	14 to 17 h (for those aged 0–3 months) of good quality sleep, including naps	Average total sleep duration per 24 h is 14 to 17 hours^c	The evidence upon which the guideline is based is predominantly comprised of studies that used average or typical sleep duration per 24 h in their analyses. An average allows for some normal day-to-day variability.	✓
Infants	12 to 16 h (for those aged 4–11 months) of good quality sleep, including naps	Average total sleep duration per 24 h is 12 to 16 hours^c	The evidence upon which the guideline is based is predominantly comprised of studies that used average or typical sleep duration per 24 h in their analyses. An average allows for some normal day-to-day variability.	✓
Toddlers	11 to 14 h of good quality sleep, including naps	Average total sleep duration per 24 h is 11 to 14 hours^c	The evidence upon which the guideline is based is predominantly comprised of studies that used average or typical sleep duration per 24 h in their analyses. An average allows for some normal day-to-day variability.	✓
	Consistent bed and wake-up times	Bedtime and wake-up time should not typically vary by more than ±30 min including on weekends^g	Although the empirical support for a specific surveillance recommendation is weak (Allen et al., 2016)^h, we propose that sleep schedules (bedtime and wake-up times) should not vary by more than ±30 min each.
Preschoolers	10 to 13 h of good quality sleep, which may include a nap	Average total sleep duration per 24 h is 10 to 13 hours^c	The evidence upon which the guideline is based is predominantly comprised of studies that used average or typical sleep duration per 24 h in their analyses. An average allows for some normal day-to-day variability.	✓
	Consistent bed and wake-up times	Bedtime and wake-up time should not typically vary by more than ±30 min including on weekends^g	Although the empirical support for a specific surveillance recommendation is weak (Allen et al., 2016)^h, we propose that sleep schedules (bedtime and wake-up times) should not vary by more than ±30 min each.

MVPA moderate- to vigorous-intensity physical activity
^aThe check marks indicate the current recommended minimum inclusion recommendations for surveillance of meeting the 24-h guidelines. Other specific guideline recommendations, which have not been identified as recommended components for surveillance of meeting the 24-h guidelines, should still be measured for descriptive purposes and to determine if changes are occurring prospectively. As evidence grows and surveillance measures evolve for these other recommendations, updates to the minimum surveillance criteria may be required
^bIt is recognized that there is currently no benchmark for this recommendation; however, it remains a recommended component for surveillance of the 24-h guidelines for mobile infants. The implication is that at the present time surveillance of mobile (e.g., crawling or walking) infants meeting the 24-h guidelines is not possible; however, non-mobile infants meeting the tummy time recommendation can be considered to have met the physical activity recommendation and surveillance of meeting the 24-h guidelines for this sub-group is therefore possible
^cIf weekend and weekday measures are available, it is recommended that the average time engaged in each behaviour be weighted 2/7 for weekend days and 5/7 for weekdays to most accurately reflect average weekly measures
^dIt is understood that under special circumstances exposure to screen time may happen but this should be rare or unusual
^eIt is understood that under special circumstances being restrained in excess of 1 h at a time may occur but this should be rare or unusual
^fTremblay et al. Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0–4 years). Appl Physiol Nutr Metab 37:370–380, 2012
^gTo accurately assess consistency of bedtime and wake-up time data should be collected on both weekday and weekend days. If data from weekday and weekend days are available, it is recommended that the average variation in bedtime and wake-up time be weighted 2/7 for weekend days and 5/7 for weekdays to most accurately reflect average weekly measures
^hAllen et al. ABCs of SLEEPING: A review of the evidence behind pediatric sleep practice recommendations. Sleep Med Rev. 29:1–14, 2016

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