Adherence to 24-h Movement Guidelines in children: a systematic review and meta-analysis.

UNLABELLED

Adherence to the 24-h Movement Guidelines (physical activity [PA], screen time [ST], and sleep duration) has been associated with positive health outcomes. However, meta-analyses on overall adherence to these guidelines among children remain limited. This study aimed to report children's adherence to the 24-h Movement Guidelines. Six databases were searched in November 2023, with an update conducted in April 2025. The review followed the PRISMA framework and included studies reporting the prevalence of adherence to the 24-h Movement Guidelines among children aged 5 to 13. A random-effects model was used to pool prevalence rates across studies. Subgroup analyses were conducted using sex, geographical region, and measurement method. Heterogeneity was assessed using the I statistic. This meta-analysis of 29 studies involving 126,129 children aged 5 to 13 revealed a low overall adherence rate of 10.4% (95% CI 8.8-12.0%) among children meeting all three 24-h Movement Guidelines. Subgroup analysis revealed lower adherence in girls (10.0%, 95% CI 6.9-13.1%) than in boys (13.2%, 95% CI 8.9-17.6%). Regarding geographical regions, South America (5.6%, 95% CI 1.3-9.9%) and Asia (6.8%, 95% CI 5.3-8.3%) showed lower adherence rates. For measurement methods, adherence was higher in device-measured (11.9%, 95% CI 8.8-14.9%) than self-reported (8.4%, 95% CI 6.5-10.3%).

CONCLUSION

These findings highlight the need for sex- and region-specific strategies to promote adequate PA, reduce ST, and ensure sufficient sleep among children. Future research should consider measurement methods when designing interventions to improve adherence to the 24-h Movement Guidelines.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO (CRD42024552497) What is known: • Many studies have examined adherence to the 24-h Movement Guidelines among school-aged children. However, a systematic review and meta-analysis of the existing evidence are still lacking.

WHAT IS NEW

• Subgroup analyses by sex showed lower adherence in girls than in boys, while analyses by geographic region revealed particularly low adherence in South America and Asia. Moreover, studies using device measures yielded higher adherence estimates than those using self-reports.