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Abstract
Background: The Canadian Society for Exercise Physiology convened representatives of national organizations,
research experts, methodologists, stakeholders, and end-users who followed rigorous and transparent guideline
development procedures to create the Canadian 24-Hour Movement Guidelines for the Early Years (0–4 years): An
Integration of Physical Activity, Sedentary Behaviour, and Sleep. These novel guidelines for children of the early
years embrace the natural and intuitive integration of movement behaviours across the whole day (24-h period).
Methods: The development process was guided by the Appraisal of Guidelines for Research and Evaluation (AGREE) II
instrument. Four systematic reviews (physical activity, sedentary behaviour, sleep, combined behaviours) examining the
relationships within and among movement behaviours and several health indicators were completed and interpreted
by a Guideline Development Panel. The systematic reviews that were conducted to inform the development of the
guidelines, and the framework that was applied to develop the recommendations, followed the Grading of
Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Complementary compositional
analyses were performed using data from the Canadian Health Measures Survey to examine the relationships between
movement behaviours and indicators of adiposity. A review of the evidence on the cost effectiveness and resource use
associated with the implementation of the proposed guidelines was also undertaken. A stakeholder survey (n = 546),
10 key informant interviews, and 14 focus groups (n = 92 participants) were completed to gather feedback on draft
guidelines and their dissemination.
Results: The guidelines provide evidence-informed recommendations as to the combinations of light-, moderate- and
vigorous-intensity physical activity, sedentary behaviours, and sleep that infants (<1 year), toddlers (1–2 years) and
preschoolers (3–4 years) should achieve for a healthy day (24 h). Proactive dissemination, promotion, implementation,
and evaluation plans were prepared to optimize uptake and activation of the new guidelines.
Conclusions: These guidelines represent a sensible evolution of public health guidelines whereby optimal health is
framed within the balance of movement behaviours across the whole day, while respecting preferences of end-users.
Future research should consider the integrated relationships among movement behaviours, and similar integrated
guidelines for other age groups should be developed
The Author(s) BMC Public Health 2017, 17(Suppl 5):874
DOI 10.1186/s12889-017-4859-6
Mark S. Tremblay1, Jean-Philippe Chaput, Kristi B. Adamo et al
