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  • OPEN ACCESS
    Combinations of physical activity, sedentary behaviour and sleep: relationships with health indicators in school-aged children and youth
    Applied Physiology, Nutrition, and Metabolism • Vol. 41 • No. 6 (Suppl. 3) • pp. S283 - S293
    The purpose of this systematic review was to determine how combinations of physical activity (PA), sedentary behaviour (SB), and sleep were associated with important health indicators in children and youth aged 5–17 years. Online databases (MEDLINE, EMBASE, SPORTdiscus, CINAHL, and PsycINFO) were searched for relevant studies examining the relationship between time spent engaging in different combinations of PA, SB, and sleep with the following health indicators: adiposity, cardiometabolic biomarkers, physical fitness, emotional regulation/psychological distress, behavioural conduct/pro-social behaviour, cognition, quality of life/well-being, injuries, bone density, motor skill development, and self-esteem. PA had to be objectively measured, while sleep and SB could be objectively or subjectively measured. The quality of research evidence and risk of bias for each health indicator and for each individual study was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. A total of 13 cross-sectional studies and a single prospective cohort study reporting data from 36 560 individual participants met the inclusion criteria. Children and youth with a combination of high PA/high sleep/low SB had more desirable measures of adiposity and cardiometabolic health compared with those with a combination of low PA/low sleep/high SB. Health benefits were also observed for those with a combination of high PA/high sleep (cardiometabolic health and adiposity) or high PA/low SB (cardiometabolic health, adiposity and fitness), compared with low PA/low sleep or low PA/high SB. Of the 3 movement behaviours, PA (especially moderate- to vigorous-intensity PA) was most consistently associated with desirable health indicators. Given the lack of randomized trials, the overall quality of the available evidence was low.
  • OPEN ACCESS
    Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth
    Applied Physiology, Nutrition, and Metabolism • Vol. 41 • No. 6 (Suppl. 3) • pp. S266 - S282
    The objective of this systematic review was to examine the relationships between objectively and subjectively measured sleep duration and various health indicators in children and youth aged 5–17 years. Online databases were searched in January 2015 with no date or study design limits. Included studies were peer-reviewed and met the a priori-determined population (apparently healthy children and youth aged 5–17 years), intervention/exposure/comparator (various sleep durations), and outcome (adiposity, emotional regulation, cognition/academic achievement, quality of life/well-being, harms/injuries, and cardiometabolic biomarkers) criteria. Because of high levels of heterogeneity across studies, narrative syntheses were employed. A total of 141 articles (110 unique samples), including 592 215 unique participants from 40 different countries, met inclusion criteria. Overall, longer sleep duration was associated with lower adiposity indicators, better emotional regulation, better academic achievement, and better quality of life/well-being. The evidence was mixed and/or limited for the association between sleep duration and cognition, harms/injuries, and cardiometabolic biomarkers. The quality of evidence ranged from very low to high across study designs and health indicators. In conclusion, we confirmed previous investigations showing that shorter sleep duration is associated with adverse physical and mental health outcomes. However, the available evidence relies heavily on cross-sectional studies using self-reported sleep. To better inform contemporary sleep recommendations, there is a need for sleep restriction/extension interventions that examine the changes in different outcome measures against various amounts of objectively measured sleep to have a better sense of dose–response relationships.
  • OPEN ACCESS
    Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update
    Applied Physiology, Nutrition, and Metabolism • Vol. 41 • No. 6 (Suppl. 3) • pp. S240 - S265
    This systematic review is an update examining the relationships between objectively and subjectively measured sedentary behaviour and health indicators in children and youth aged 5–17 years. EMBASE, PsycINFO, and Medline were searched in December 2014, and date limits were imposed (≥February 2010). Included studies were peer-reviewed and met the a priori-determined population (apparently healthy children and youth, mean age: 5–17 years), intervention (durations, patterns, and types of sedentary behaviours), comparator (various durations, patterns, and types of sedentary behaviours), and outcome (critical: body composition, metabolic syndrome/cardiovascular disease risk factors, behavioural conduct/pro-social behaviour, academic achievement; important: fitness, self-esteem) study criteria. Quality of evidence by outcome was assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework. Due to heterogeneity, a narrative analysis was conducted. A total of 235 studies (194 unique samples) were included representing 1 657 064 unique participants from 71 different countries. Higher durations/frequencies of screen time and television (TV) viewing were associated with unfavourable body composition. Higher duration/frequency of TV viewing was also associated with higher clustered cardiometabolic risk scores. Higher durations of TV viewing and video game use were associated with unfavourable behavioural conduct/pro-social behaviour. Higher durations of reading and doing homework were associated with higher academic achievement. Higher duration of screen time was associated with lower fitness. Higher durations of screen time and computer use were associated with lower self-esteem. Evidence ranged from “very low” to “moderate” quality. Higher quality studies using reliable and valid sedentary behaviour measures should confirm this largely observational evidence.
  • OPEN ACCESS
    Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth
    Applied Physiology, Nutrition, and Metabolism • Vol. 41 • No. 6 (Suppl. 3) • pp. S197 - S239
    Moderate-to-vigorous physical activity (MVPA) is essential for disease prevention and health promotion. Emerging evidence suggests other intensities of physical activity (PA), including light-intensity activity (LPA), may also be important, but there has been no rigorous evaluation of the evidence. The purpose of this systematic review was to examine the relationships between objectively measured PA (total and all intensities) and health indicators in school-aged children and youth. Online databases were searched for peer-reviewed studies that met the a priori inclusion criteria: population (apparently healthy, aged 5–17 years), intervention/exposure/comparator (volumes, durations, frequencies, intensities, and patterns of objectively measured PA), and outcome (body composition, cardiometabolic biomarkers, physical fitness, behavioural conduct/pro-social behaviour, cognition/academic achievement, quality of life/well-being, harms, bone health, motor skill development, psychological distress, self-esteem). Heterogeneity among studies precluded meta-analyses; narrative synthesis was conducted. A total of 162 studies were included (204 171 participants from 31 countries). Overall, total PA was favourably associated with physical, psychological/social, and cognitive health indicators. Relationships were more consistent and robust for higher (e.g., MVPA) versus lower (e.g., LPA) intensity PA. All patterns of activity (sporadic, bouts, continuous) provided benefit. LPA was favourably associated with cardiometabolic biomarkers; data were scarce for other outcomes. These findings continue to support the importance of at least 60 min/day of MVPA for disease prevention and health promotion in children and youth, but also highlight the potential benefits of LPA and total PA. All intensities of PA should be considered in future work aimed at better elucidating the health benefits of PA in children and youth.
  • OPEN ACCESS
    Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep
    Applied Physiology, Nutrition, and Metabolism • Vol. 41 • No. 6 (Suppl. 3) • pp. S311 - S327
    Leaders from the Canadian Society for Exercise Physiology convened representatives of national organizations, content experts, methodologists, stakeholders, and end-users who followed rigorous and transparent guideline development procedures to create the Canadian 24-Hour Movement Guidelines for Children and Youth: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These novel guidelines for children and youth aged 5–17 years respect the natural and intuitive integration of movement behaviours across the whole day (24-h period). The development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument and systematic reviews of evidence informing the guidelines were assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Four systematic reviews (physical activity, sedentary behaviour, sleep, integrated behaviours) examining the relationships between and among movement behaviours and several health indicators were completed and interpreted by expert consensus. Complementary compositional analyses were performed using Canadian Health Measures Survey data to examine the relationships between movement behaviours and health indicators. A stakeholder survey was employed (n = 590) and 28 focus groups/stakeholder interviews (n = 104) were completed to gather feedback on draft guidelines. Following an introductory preamble, the guidelines provide evidence-informed recommendations for a healthy day (24 h), comprising a combination of sleep, sedentary behaviours, light-, moderate-, and vigorous-intensity physical activity. Proactive dissemination, promotion, implementation, and evaluation plans have been prepared in an effort to optimize uptake and activation of the new guidelines. Future research should consider the integrated relationships among movement behaviours, and similar integrated guidelines for other age groups should be developed.
  • OPEN ACCESS
    Sleep timing, sleep consistency, and health in adults: a systematic review
    Applied Physiology, Nutrition, and Metabolism • Vol. 45 • No. 10 (Suppl. 2) • pp. S232 - S247
    The objective of this systematic review was to examine the associations between sleep timing (e.g., bedtime/wake-up time, midpoint of sleep), sleep consistency/regularity (e.g., intra-individual variability in sleep duration, social jetlag, catch-up sleep), and health outcomes in adults aged 18 years and older. Four electronic databases were searched in December 2018 for articles published in the previous 10 years. Fourteen health outcomes were examined. A total of 41 articles, including 92 340 unique participants from 14 countries, met inclusion criteria. Sleep was assessed objectively in 37% of studies and subjectively in 63% of studies. Findings suggest that later sleep timing and greater sleep variability were generally associated with adverse health outcomes. However, because most studies reported linear associations, it was not possible to identify thresholds for “late sleep timing” or “large sleep variability”. In addition, social jetlag was associated with adverse health outcomes, while weekend catch-up sleep was associated with better health outcomes. The quality of evidence ranged from “very low” to “moderate” across study designs and health outcomes using GRADE. In conclusion, the available evidence supports that earlier sleep timing and regularity in sleep patterns with consistent bedtimes and wake-up times are favourably associated with health. (PROSPERO registration no.: CRD42019119534.)Novelty This is the first systematic review to examine the influence of sleep timing and sleep consistency on health outcomes.Later sleep timing and greater variability in sleep are both associated with adverse health outcomes in adults.Regularity in sleep patterns with consistent bedtimes and wake-up times should be encouraged.
  • OPEN ACCESS
    Sleep duration and health in adults: an overview of systematic reviews
    Applied Physiology, Nutrition, and Metabolism • Vol. 45 • No. 10 (Suppl. 2) • pp. S218 - S231
    The objective of this overview of systematic reviews was to examine the associations between sleep duration and health outcomes in adults. Four electronic databases were searched in December 2018 for systematic reviews published in the previous 10 years. Included reviews met the a priori determined population (community-dwelling adults aged 18 years and older), intervention/exposure/comparator (various levels of sleep duration), and outcome criteria (14 outcomes examined). To avoid overlap in primary studies, we used a priority list to choose a single review per outcome; reviews that examined the effect of age and those that looked at dose–response were prioritized. A total of 36 systematic reviews were eligible and 11 were included. Reviews included comprised 4 437 101 unique participants from 30 countries. Sleep duration was assessed subjectively in 96% of studies and 78% of studies in the reviews were prospective cohort studies. The dose–response curves showed that the sleep duration that was most favourably associated with health was 7–8 h per day. Modification of the effect by age was not apparent. The quality of the evidence ranged from low to high across health outcomes. In conclusion, the available evidence suggests that a sleep duration of 7–8 h per day is the one most favourably associated with health among adults and older adults. (PROSPERO registration no.: CRD42019119529.)Novelty This is the first overview of reviews that examines the influence of sleep duration on a wide range of health outcomes in adults.Seven to 8 h of sleep per day was most favourably associated with health.Effect modification by age was not evident.
  • OPEN ACCESS
    A systematic review of compositional data analysis studies examining associations between sleep, sedentary behaviour, and physical activity with health outcomes in adults
    Applied Physiology, Nutrition, and Metabolism • Vol. 45 • No. 10 (Suppl. 2) • pp. S248 - S257
    This systematic review determined if the composition of time spent in movement behaviours (i.e., sleep, sedentary behaviour (SED), light physical activity, and moderate-to-vigorous physical activity (MVPA)) is associated with health in adults. Five electronic databases were searched in August 2019. Studies were eligible for inclusion if they were peer-reviewed, examined community-dwelling adults, and used compositional data analysis to examine the associations between the composition of time spent in movement behaviours and health outcomes. Eight studies (7 cross-sectional, 1 prospective cohort) of >12 000 unique participants were included. Findings indicated that the 24-h movement behaviour composition was associated with all-cause mortality (1 of 1 analyses), adiposity (4 of 4 analyses), and cardiometabolic biomarkers (8 of 15 analyses). Reallocating time into MVPA from other movement behaviours was associated with favourable changes to most health outcomes and taking time out of SED and reallocating it into other movement behaviours was associated with favourable changes to all-cause mortality. The quality of evidence was very low for all health outcomes. In conclusion, these findings support the notion that the composition of movement across the entire 24-h day matters, and that recommendations for sleep, SED, and physical activity should be combined into a single public health guideline. (PROSPERO registration no.: CRD42019121641.)Novelty The 24-h movement behaviour composition is associated with a variety of health outcomes.Reallocating time into MVPA is favourably associated with health.Reallocating time out of SED is associated with favourable changes to mortality risk.
  • OPEN ACCESS
    Resistance training and health in adults: an overview of systematic reviews
    Applied Physiology, Nutrition, and Metabolism • Vol. 45 • No. 10 (Suppl. 2) • pp. S165 - S179
    The objective of this overview of systematic reviews was to determine the benefits and harms of resistance training (RT) on health outcomes in adults aged 18 years or older, compared with not participating in RT. Four electronic databases were searched in February 2019 for systematic reviews published in the past 10 years. Eligibility criteria were determined a priori for population (community dwelling adults), intervention (exclusively RT), comparator (no RT or different doses of RT), and health outcomes (critical: mortality, physical functioning, health-related quality of life, and adverse events; important: cardiovascular disease, type 2 diabetes mellitus, mental health, brain health, cognitive function, cancer, fall-related injuries or falls, and bone health). We selected 1 review per outcome and we used the GRADE process to assess the strength of evidence. We screened 2089 records and 375 full-text articles independently, in duplicate. Eleven systematic reviews were included, representing 364 primary studies and 382 627 unique participants. RT was associated with a reduction in all-cause mortality and cardiovascular disease incidence, and an improvement in physical functioning. Effects on health-related quality of life or cognitive function were less certain. Adverse events were not consistently monitored or reported in RT studies, but serious adverse events were not common. Systematic reviews for the remaining important health outcomes could not be identified. Overall, RT training improved health outcomes in adults and the benefits outweighed the harms. (PROSPERO registration no.: CRD42019121641.)Novelty This overview was required to inform whether there was new evidence to support changes to the recommended guidelines for resistance training.
  • OPEN ACCESS
    Sedentary behaviour and health in adults: an overview of systematic reviews
    Applied Physiology, Nutrition, and Metabolism • Vol. 45 • No. 10 (Suppl. 2) • pp. S197 - S217
    The purpose of this overview of systematic reviews was to determine the relationship between different types and patterns of sedentary behaviour and selected health outcomes in adults and older adults. Five electronic databases were last searched in May, 2019, with a 10-year search limit. Included reviews met the a priori population (community-dwelling adults aged 18 years and older), intervention/exposure/comparator (various types and/or patterns of sedentary behaviour), and outcomes criteria. Eighteen systematic reviews were included in the evidence synthesis. High levels of sedentary behaviour are unfavourably associated with cognitive function, depression, function and disability, physical activity levels, and physical health-related quality of life in adults. Reducing or breaking up sedentary behaviour may benefit body composition and markers of cardiometabolic risk. Total sedentary behaviour and TV viewing were most consistently associated with unfavourable health outcomes, while computer and Internet use may be favourably associated with cognitive function for older adults. The quality of evidence within individual reviews (as assessed by review authors) varied from low to high, while the certainty of evidence was low to very low. These findings have important public health implications, suggesting that adults should avoid high levels of sedentary behaviour and break-up periods of prolonged sitting. (PROSPERO registration nos.: CRD42019123121 and CRD42019127157.)Novelty High levels of sedentary behaviour are unfavourably associated with important health outcomes in adults.Reducing or breaking up sedentary behaviour may benefit body composition and markers of cardiometabolic risk.Computer and Internet use may be favourably associated with cognitive function in older adults.
  • OPEN ACCESS
    Balance and functional training and health in adults: an overview of systematic reviews
    Applied Physiology, Nutrition, and Metabolism • Vol. 45 • No. 10 (Suppl. 2) • pp. S180 - S196
    This overview of systematic reviews examined the effect of balance and functional strength training on health outcomes in adults aged 18 years or older, to inform the Canadian 24-hour Movement Guidelines. Four electronic databases were searched for systematic reviews published between January 2009 and May 2019. Eligibility criteria were determined a priori for population (community-dwelling adults), intervention (balance and functional training), comparator (no intervention or different types/doses), and outcomes (critical: falls and fall-related injuries; adverse events; important: physical functioning and disability; health-related quality of life; physical activity; and sedentary behaviour). Two reviewers independently screened studies for eligibility and performed AMSTAR 2 assessment. One review was selected per outcome. Of 3288 records and 355 full-text articles, 5 systematic reviews were included, encompassing data from 15 890 participants in 23 countries. In adults 65 years and older, balance and functional training and Tai Chi reduced the rate of falls and the number of people who fell, and improved aspects of physical functioning and physical activity. The effect on health-related quality of life and falls requiring hospitalization was uncertain. While inconsistently monitored, only 1 serious adverse event was reported. No evidence was available in adults under age 65 years. Included systematic reviews and primary evidence reported by review authors ranged in quality. Overall, participation in balance and functional training reduced falls and improved health outcomes in adults 65 years of age and older. PROSPERO registration no.: CRD42019134865.Novelty This overview informs updated guidelines for balance training in adults.Balance and functional training reduced falls and improved health outcomes.
  • OPEN ACCESS
    Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older: an integration of physical activity, sedentary behaviour, and sleep
    Applied Physiology, Nutrition, and Metabolism • Vol. 45 • No. 10 (Suppl. 2) • pp. S57 - S102
    The Canadian Society for Exercise Physiology assembled a Consensus Panel representing national organizations, content experts, methodologists, stakeholders, and end-users and followed an established guideline development procedure to create the Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older: An Integration of Physical Activity, Sedentary Behaviour, and Sleep. These guidelines underscore the importance of movement behaviours across the whole 24-h day. The development process followed the strategy outlined in the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument. A large body of evidence was used to inform the guidelines including 2 de novo systematic reviews and 4 overviews of reviews examining the relationships among movement behaviours (physical activity, sedentary behaviour, sleep, and all behaviours together) and several health outcomes. Draft guideline recommendations were discussed at a 4-day in-person Consensus Panel meeting. Feedback from stakeholders was obtained by survey (n = 877) and the draft guidelines were revised accordingly. The final guidelines provide evidence-based recommendations for a healthy day (24-h), comprising a combination of sleep, sedentary behaviours, and light-intensity and moderate-to-vigorous-intensity physical activity. Dissemination and implementation efforts with corresponding evaluation plans are in place to help ensure that guideline awareness and use are optimized.Novelty First ever 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older with consideration of a balanced approach to physical activity, sedentary behaviour, and sleepFinalizes the suite of 24-Hour Movement Guidelines for Canadians across the lifespan
  • OPEN ACCESS
    Development and application of an outcome-centric approach for conducting overviews of reviews
    Applied Physiology, Nutrition, and Metabolism • Vol. 45 • No. 10 (Suppl. 2) • pp. S151 - S164
    There are gaps in current guidance concerning how to conduct overviews of systematic reviews in an outcome-centric manner. Herein we summarize the methods and lessons learned from conducting 4 outcome-centric overviews to help inform the Canadian 24-Hour Movement Guidelines for Adults aged 18–64 years and Adults aged 65 years or older on the topics of resistance training, balance and functional training, sedentary behaviour, sleep duration. We defined “critical” and “important” outcomes a priori. We used AMSTAR 2 to assess review quality and sought 1 systematic review per outcome. If multiple reviews were required to address subgroups for an outcome, we calculated the corrected covered area (CCA) to quantify overlap. We report our methodology in a PRISMA table. Across the 4 overviews, authors reviewed 1110 full texts; 45 were retained (low to high quality per AMSTAR 2), representing 950 primary studies, enrolling over 5 385 500 participants. Of 46 outcomes, we identified data for 35. Nineteen outcomes required >1 review (CCA range: 0% to 71.4%). Our outcome-centric overviews addressed unique aspects of overviews, including selection and quality assessment of included reviews, and overlap. Lessons learned included consistent application of methodological principles to minimize bias and optimize reporting transparency.Novelty Overviews of reviews synthesize systematic reviews in a rigorous and transparent manner.Outcome-centric systematic reviews assess the quality of evidence for primary studies contributing to an outcome.This manuscript describes the development and application of extending the concept of outcome-centric systematic reviews to the design and conduct of outcome-centric overviews.
  • OPEN ACCESS
    New Canadian Physical Activity Guidelines
    Applied Physiology, Nutrition, and Metabolism • Vol. 36 • No. 1 • pp. 36 - 46
    The Canadian Society for Exercise Physiology (CSEP), in cooperation with ParticipACTION and other stakeholders, and with support from the Public Health Agency of Canada (PHAC), has developed the new Canadian Physical Activity Guidelines for Children (aged 5–11 years), Youth (aged 12–17 years), Adults (aged 18–64 years), and Older Adults (aged ≥65 years). The new guidelines include a preamble to provide context and specific guidelines for each age group. The entire guideline development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guidelines have gone through a rigorous and transparent developmental process; we based the recommendations herein on evidence from 3 systematic reviews, and the final guidelines benefitted from an extensive online and in-person consultation process with hundreds of stakeholders and key informants, both domestic and international. Since 2006, the products of our efforts resulted in the completion of 21 peer-reviewed journal articles (including 5 systematic reviews) that collectively guided this work. The process that Canadian researchers undertook to update the national physical activity guidelines represents the most current synthesis, interpretation, and application of the scientific evidence to date.
  • OPEN ACCESS
    Nouvelles Directives canadiennes en matière d’activité physique
    Applied Physiology, Nutrition, and Metabolism • Vol. 36 • No. 1 • pp. 47 - 58
    La Société canadienne de physiologie de l’exercice (SCPE) en collaboration avec ParticipACTION et des parties prenantes et avec l’appui de l’Agence de santé publique du Canada (ASPC) a élaboré de nouvelles Directives canadiennes en matière d’activité physique à l’intention des enfants (âgés de 5 à 11 ans), des jeunes (âgés de 12 à 17 ans), des adultes (âgés de 18 à 64 ans) et des aînés (âgés de 65 ans et plus). Les nouvelles directives sont composées d’un préambule situant le contexte et de directives spécifiques à chaque tranche d’âge. L’élaboration complète des directives a respecté la Grille II d’évaluation de la qualité des recommandations pour la pratique clinique (AGREE), un outil reconnu internationalement pour l’élaboration des lignes directrices en pratique clinique. L’élaboration des directives résulte d’un processus rigoureux et transparent. Les recommandations présentées dans cet article sont basées sur les données probantes relevées dans trois analyses documentaires systématiques, et les directives finales ont bénéficié des fruits d’une vaste consultation en ligne et en personne auprès de centaines d’intervenants concernés et de sources de premier plan, sur la scène nationale et internationale. Depuis 2006, les résultats de nos efforts se retrouvent entre autres dans 21 articles (dont 5 analyses documentaires systématiques) sanctionnés par des pairs. La démarche entreprise par les chercheurs canadiens pour la mise à jour des directives en matière d’activité physique a abouti à la synthèse, l’interprétation et l’application des données probantes les plus récentes à ce jour.
  • OPEN ACCESS
    Canadian Sedentary Behaviour Guidelines for Children and Youth
    Applied Physiology, Nutrition, and Metabolism • Vol. 36 • No. 1 • pp. 59 - 64
    The Canadian Society for Exercise Physiology (CSEP), in partnership with the Healthy Active Living and Obesity Research Group (HALO) at the Children’s Hospital of Eastern Ontario Research Institute, and in collaboration with ParticipACTION, and others, has developed the Canadian Sedentary Behaviour Guidelines for Children (aged 5–11 years) and Youth (aged 12–17 years). The guidelines include a preamble to provide context, followed by the specific recommendations for sedentary behaviour. The entire development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guidelines have gone through a rigorous and transparent developmental process and the recommendations are based on evidence from a systematic review and interpretation of the research evidence. The final guidelines benefitted from an extensive online consultation process with 230 domestic and international stakeholders and key informants. The final guideline recommendations state that for health benefits, children (aged 5–11 years) and youth (aged 12–17 years) should minimize the time that they spend being sedentary each day. This may be achieved by (i) limiting recreational screen time to no more than 2 h per day — lower levels are associated with additional health benefits; and (ii) limiting sedentary (motorized) transport, extended sitting time, and time spent indoors throughout the day. These are the first evidence-based Canadian Sedentary Behaviour Guidelines for Children and Youth and provide important and timely recommendations for the advancement of public health based on a systematic synthesis, interpretation, and application of the current scientific evidence.
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    Directives canadiennes en matière de comportement sédentaire à l’intention des enfants et des jeunes
    Applied Physiology, Nutrition, and Metabolism • Vol. 36 • No. 1 • pp. 65 - 71
    La Société canadienne de physiologie de l’exercice (SCPE) en collaboration avec le groupe de recherche Healthy Active Living and Obesity Research Group (HALO) de l’Institut de recherche du Centre hospitalier pour enfants de l’est de l’Ontario, de ParticipACTION et d’autres organismes a élaboré les Directives canadiennes en matière de comportement sédentaire à l’intention des enfants âgés de 5 à 11 ans et des jeunes âgés de 12 à 17 ans. Les directives comprennent un préambule situant le contexte et des recommandations spécifiques en matière de comportement sédentaire. L’élaboration complète des directives a respecté la Grille II d’évaluation de la qualité des recommandations pour la pratique clinique (AGREE), un outil reconnu internationalement pour l’élaboration des lignes directrices en pratique clinique. L’élaboration des directives est donc le résultat d’un processus rigoureux et transparent, et les recommandations présentées dans cet article sont basées sur l’interprétation des données probantes relevées dans une analyse documentaire systématique. Les directives finales sont le fruit d’une vaste consultation en ligne auprès de 230 intervenants concernés et de sources de premier plan sur la scène nationale et internationale. Les directives finales énoncent ce qui suit : Afin de profiter des bienfaits pour leur santé, les enfants âgés de 5 à 11 ans et les jeunes âgés de 12 à 17 ans doivent diminuer chaque jour le temps consacré à des activités sédentaires. Ceci peut être accompli (i) en limitant le temps de loisir passé devant l’écran à moins de 2 h par jour; moins de temps passé devant l’écran est associé à des bienfaits supplémentaires pour la santé; (ii) en diminuant les déplacements en véhicule motorisé et en réduisant le temps passé assis à l’intérieur pendant la journée. Ces directives sont les premières Directives canadiennes en matière de comportement sédentaire à l’intention des enfants et des jeunes; elles résultent de la synthèse, de l’interprétation et de l’application des données probantes les plus récentes à ce jour et comportent des recommandations importantes qui arrivent à un moment opportun dans la promotion de la santé publique.
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    Canadian Physical Activity Guidelines for the Early Years (aged 0–4 years)
    Applied Physiology, Nutrition, and Metabolism • Vol. 37 • No. 2 • pp. 345 - 356
    The Canadian Society for Exercise Physiology (CSEP), with assistance from multiple partners, stakeholders, and researchers, developed the first Canadian Physical Activity Guidelines for the Early Years (aged 0–4 years). These national guidelines were created in response to an urgent call from public health, health care, child care, and fitness practitioners for healthy active living guidance for the early years. The guideline development process was informed by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument and the evidence assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. The recommendations are informed by evidence from a systematic review that examined the relationships between physical activity and health indicators (healthy body weight, bone and skeletal health, motor skill development, psychosocial health, cognitive development, and cardio-metabolic disease risk factors) for three age groups (infants aged <1 year; toddlers aged 1–2 years; preschoolers aged 3–4 years). The new guidelines include a preamble to provide context, followed by the specific recommendations. The final guidelines benefitted from an extensive on-line consultation process with input from over 900 domestic and international stakeholders, end-users, and key informants. The final guideline recommendations state that for healthy growth and development, 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, and progression toward at least 60 min of energetic play by 5 years of age. More daily physical activity provides greater benefits.
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    Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0–4 years)
    Applied Physiology, Nutrition, and Metabolism • Vol. 37 • No. 2 • pp. 370 - 380
    The Canadian Society for Exercise Physiology (CSEP), with assistance from multiple partners, stakeholders, and researchers, developed the first Canadian Sedentary Behaviour Guidelines for the Early Years (aged 0–4 years). These national guidelines are in response to a call from health and health care professionals, child care providers, and fitness practitioners for guidance on sedentary behaviour in the early years. The guideline development process followed the Appraisal of Guidelines for Research Evaluation (AGREE) II framework. The recommendations are informed by evidence from a systematic review that examined the relationships between sedentary behaviour (predominantly screen time) and health indicators (healthy body weight, bone and skeletal health, motor skill development, psychosocial health, cognitive development, and cardio-metabolic disease risk factors) for three age groups (infants aged <1 year; toddlers aged 1–2 years; preschoolers aged 3–4 years). Evidence from the review was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. The new guidelines include a preamble to provide context, followed by the specific recommendations. The final guidelines benefitted from extensive on-line consultations with input from >900 domestic and international stakeholders, end-users, and key informants. The final guidelines state: for healthy growth and development, caregivers should minimize the time infants (aged <1 year), toddlers (aged 1–2 years), and preschoolers (aged 3–4 years) spend being sedentary during waking hours. This includes prolonged sitting or being restrained (e.g., stroller, high chair) for more than 1 h at a time. For those under 2 years, screen time (e.g., TV, computer, electronic games) is not recommended. For children 2–4 years, screen time should be limited to under 1 h per day; less is better.
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    Directives canadiennes en matière d’activité physique pour la petite enfance (enfants âgés de 0 à 4 ans)
    Applied Physiology, Nutrition, and Metabolism • Vol. 37 • No. 2 • pp. 357 - 369
    La Société canadienne de physiologie de l’exercice (SCPE) en collaboration avec plusieurs partenaires, parties prenantes et chercheurs a élaboré de nouvelles Directives canadiennes en matière d’activité physique pour la petite enfance (enfants âgés de 0 à 4 ans). Ces directives nationales répondent à une demande pressante des praticiens en santé publique, en soins de santé, en pédiatrie et en condition physique désireux de promouvoir une vie active saine dès les premières années de la vie. L’élaboration complète des directives a respecté la Grille II d’évaluation de la qualité des recommandations pour la pratique clinique (AGREE) et la qualité des données a été évaluée au moyen de la méthodologie GRADE (Grading of Recommendations Assessment, Development and Evaluation). Les recommandations présentées dans cet article sont basées sur les données probantes d’une analyse documentaire systématique portant sur les relations entre l’activité physique et des indicateurs de santé (masse corporelle saine, santé des os et du squelette, développement des habiletés motrices, santé psychosociale, développement cognitif et facteurs de risque de maladie cardiométabolique) chez trois groupes d’âge (nourrissons <1 an, tout-petits âgés de 1–2 ans, enfants d’âge préscolaire, 3–4 ans). Les nouvelles directives sont composées d’un préambule situant le contexte et de directives spécifiques. Les directives finales ont bénéficié des fruits d’une vaste consultation en ligne auprès de plus de 900 intervenants concernés, d’utilisateurs finaux et de sources de premier plan, sur la scène nationale et internationale. La directive finale énonce ce qui suit : pour favoriser une croissance et un développement sains, les nourrissons (âgés de <1 an) devraient être physiquement actifs plusieurs fois par jour, particulièrement par l’entremise de jeux interactifs au sol. Les tout-petits (âgés de 1–2 ans) et les enfants d’âge scolaire (âgés de 3–4 ans) devraient être physiquement actifs chaque jour, quelle que soit l’intensité, pendant au moins 180 min réparties sur toute la journée, cela devrait comprendre une variété d’activités dans divers environnements à différentes intensités, des activités qui permettent de développer les habiletés motrices et une progression vers au moins 60 min de jeu actif à l’âge de 5 ans. S’adonner chaque jour à encore plus d’activité physique entraîne plus de bienfaits.