A collaborative approach to adopting/adapting guidelines - The Australian 24-Hour Movement Guidelines for the early years (Birth to 5 years): an integration of physical activity, sedentary behavior, and sleep

Okely, Anthony D.; Ghersi, Davina; Hesketh, Kylie D.; Santos, Rute; Loughran, Sarah P.; Cliff, Dylan P.; Shilton, Trevor; Grant, David; Jones, Rachel A.; Stanley, Rebecca M.; Sherring, Julie; Hinkley, Trina; Trost, Stewart G.; McHugh, Clare; Eckermann, Simon; Thorpe, Karen; Waters, Karen; Olds, Timothy S.; Mackey, Tracy; Livingstone, Rhonda; Christian, Hayley; Carr, Harriette; Verrender, Adam; Pereira, João R.; Zhang, Zhiguang; Downing, Katherine L.; Tremblay, Mark S.

doi:10.1186/s12889-017-4867-6

Table 7 Surveillance recommendations for the Australian 24-Hour Movement Guidelines for the Early Years (birth to 5 years). (adapted from the Surveillance recommendations for the Canadian 24-Hour Movement Guidelines for the Early Years)

From: A collaborative approach to adopting/adapting guidelines - The Australian 24-Hour Movement Guidelines for the early years (Birth to 5 years): an integration of physical activity, sedentary behavior, and sleep

Physical activity
Australian Guideline	Specific Surveillance Recommendation	Rationale for specific surveillance recommendation	Recommendation for minimum inclusion in overall guideline surveillance^a
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	No
For those not yet mobile, this includes at least 30 min of tummy time spread throughout the day while awake	Total tummy time on the previous day is ≥30 min while awake^b	A representative day provides a more accurate recall and hence better estimate of the prevalence of the guideline in a population representative sample [37, 38].	Yes
Toddlers (aged 1–2 years)
At least 180 min spent in a variety of physical activities at any intensity, spread throughout the day; more is better.	Previous day physical activity is ≥180 min with at least some energetic play (MVPA)^b	A representative day provides a more accurate recall and hence better estimate of the prevalence of the guideline in a population representative sample [37, 38]. It allows direct comparison with previous national representative data from the Australian Health Survey [39]	Yes
Including energetic play	Previous day total physical activity is ≥180 min with at least some energetic play (MVPA)^b	As there are no benchmarks for duration we suggest not having a minimum threshold for energetic play or MVPA in this age group.	No
Preschoolers (aged 3–5 years)
At least 180 min spent in a variety of physical activities spread throughout the day	Previous day total physical activity is ≥180 minutes^b	A representative day provides a more accurate recall and hence better estimate of the prevalence of the guideline in a population representative sample [37, 38]. It allows direct comparison with previous national representative data from the Australian Health Survey [39]	Yes
Of which at least 60 min is energetic play; more is better	Previous day MVPA is ≥60 minutes^b		Yes
Sedentary behaviour
Guideline	Specific Surveillance Recommendation	Rationale for specific surveillance recommendation	Recommendation for minimum inclusion in overall guideline surveillance
Infants (aged <1 year)
Infants
Not being restrained for more than 1 h at a time (e.g., in a stroller, car seat or high chair).	Time spent restrained is ≤1 h at a time^d	Empirical evidence substantiating this threshold is lacking though this threshold is aligned with earlier guidelines and has met with stakeholder and end-user acceptance	No
When sedentary, engaging in pursuits such as reading and storytelling with a caregiver is encouraged	None	Currently there are no available benchmarks, further research is required.	No
Toddlers (aged 1–2 years)
Not being restrained for more than 1 h at a time (e.g., in a stroller, car seat or high chair).	Time spent restrained is ≤1 h at a time^d	Empirical evidence substantiating this threshold is lacking though this threshold is aligned with earlier guidelines and has met with stakeholder and end-user acceptance	No
Or sitting for extended periods	None	Currently there are no available benchmarks to be more specific for “sitting for extended periods”, further research is required.	No
When sedentary, engaging in pursuits such as reading and storytelling with a caregiver is encouraged	None	Currently there are no available benchmarks, further research is required
Preschoolers (aged 3–5 years)
Not being restrained for more than 1 h at a time (e.g., in a stroller or car seat).	Time spent restrained is ≤1 h at a time^d	Empirical evidence substantiating this threshold is lacking though this threshold is aligned with earlier guidelines and has met with stakeholder and end-user acceptance	No
Or sitting for extended periods	Bouts of sedentary time	Currently there are no available benchmarks to be more specific for “sitting for extended periods”, further research is required.	No
When sedentary, engaging in pursuits such as reading and storytelling with a caregiver is encouraged	None	Currently there are no available benchmarks, further research is required	No
Screen time
Guideline	Specific Surveillance Recommendation	Rationale for specific surveillance recommendation	Recommendation for minimum inclusion in overall guideline surveillance
Infants (aged <1 year)
Screen time is not recommended.	Previous day includes no screen time^c	A representative day provides a more accurate recall and hence better estimate of the prevalence of the guideline in a population representative sample [37, 38]. This threshold is aligned with earlier guidelines and has met with stakeholder and end-user acceptance, and is consistent with evidence in this age group indicating that no screen time is better than some screen time and that less screen time is better than more screen time, for health and development.	Yes
Toddlers (aged 1–2 years)
For those younger than 2 years, sedentary screen time is not recommended.	Previous day includes no screen time^c	A representative day provides a more accurate recall and hence better estimate of the prevalence of the guideline in a population representative sample [37, 38].	Yes
For those aged 2 years, sedentary screen time should be no more than 1 h per day; less is better	Sedentary screen time on previous day is ≤1 hour^b	A representative day provides a more accurate recall and hence better estimate of the prevalence of the guideline in a population representative sample [37, 38]. It allows direct comparison with previous national representative data from the Australian Health Survey [39]	Yes
Preschoolers (aged 3–5 years)
Sedentary screen time should be no more than 1 hour per day; less is better.	Sedentary screen time on previous day is ≤1 hour^b	A representative day provides a more accurate recall and hence better estimate of the prevalence of the guideline in a population representative sample [37, 38]. It allows direct comparison with previous national representative data from the Australian Health Survey [39]	Yes
Sleep
Guideline	Specific Surveillance Recommendation	Rationale for specific surveillance recommendation	Recommendation for minimum inclusion in overall guideline surveillance
Infants (aged <1 year)
14 to 17 h (for those aged 0–3 months) of good quality sleep, including naps.	Sleep period time on previous night (offset minus onset), plus daytime naps for previous day.	Currently recommended by NSF, based on expert opinion. https://sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times/page/0/1	Yes
12 to 16 h (for those aged 4–11 months) of good quality sleep, including naps.	Sleep period time on previous night (offset minus onset), plus daytime naps for previous day.	Currently recommended by NSF^e, based on expert opinion. https://sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times/page/0/1	Yes
Toddlers (aged 1–2 years)
11 to 14 h of good quality sleep, including naps,	Sleep period time on previous night (offset minus onset), plus daytime naps for previous day.	Currently recommended by NSF, based on expert opinion. https://sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times/page/0/1	Yes
With consistent sleep and wake-up times	Day-to-day variability in sleep onset and offset times.^f	Recommended as part of sleep hygiene. No evidence in this age group, but there is some evidence in adolescents (https://www.ncbi.nlm.nih.gov/pubmed/28129442) and adults (https://www.ncbi.nlm.nih.gov/pubmed/27091639)	No
Preschoolers (aged 3–5 years)
10 to 13 h of good quality sleep, which may include a nap,	Sleep period time on previous night (offset minus onset), plus daytime naps for previous day.	Currently recommended by NSF, based on expert opinion. https://sleepfoundation.org/press-release/national-sleep-foundation-recommends-new-sleep-times/page/0/1	Yes
With consistent sleep and wake-up times	Day-to-day variability in sleep onset and offset times.^f Bedtime and wake-up time should not typically vary by more than ±30 min including on weekends^g	Recommended as part of sleep hygiene. No evidence in this age group, but there is some evidence in adolescents (https://www.ncbi.nlm.nih.gov/pubmed/28129442) and adults (https://www.ncbi.nlm.nih.gov/pubmed/27091639)	No

^aThese 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
^bIf multiple representative day recalls are available (e.g., last three days) it is recommended to use these over just the previous day
^cIt is understood that under special circumstances exposure to screen time may happen but should be rare or unusual
^dIt is understood that under special circumstances being restrained in excess of 1 h at a time may occur but should be rare or unusual
^eNote that the NSF actually recommends 12–15 h for this age group
^fSurveillance requires the use of sleep diaries recording onset and offset times. Until there are better dose-response relationships between sleep variability and health outcomes, it is premature to recommend a particular goal (e.g. “within 30 min”). There are many ways this can be quantified. The simplest is the SD of onset and offset times over one week
^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

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