Children need to sit less, play more to grow up healthy

Children under five must spend less time sitting watching screens, or restrained in prams and seats, get better quality sleep and have more time for active play if they are to grow up healthy, according to new guidelines issued by the World Health Organization (WHO).

“Achieving health for all means doing what is best for health right from the beginning of people’s lives,” says WHO Director-General, Dr. Tedros Adhanom Ghebreyesus. “Early childhood is a period of rapid development and a time when family lifestyle patterns can be adapted to boost health gains.”

A WHO panel of experts developed the new guidelines on physical activity, sedentary behaviour and sleep for children under five years of age. They assessed the effects on young children of inadequate sleep, and time spent sitting watching screens or restrained in chairs and prams. They also reviewed evidence around the benefits of increased activity levels.

“Improving physical activity, reducing sedentary time and ensuring quality sleep in young children will improve their physical, mental health and wellbeing, and help prevent childhood obesity and associated diseases later in life,” says Dr. Fiona Bull, programme manager for surveillance and population-based prevention of non-communicable diseases, at WHO.

Failure to meet current physical activity recommendations is responsible for more than five million deaths globally each year across all age groups. Currently, over 23 per cent of adults and 80 per cent of adolescents are not sufficiently physically active. If healthy physical activity, sedentary behaviour and sleep habits are established early in life, this helps shape habits through childhood, adolescence and into adulthood.

“What we really need to do is bring back play for children,” says Dr. Juana Willumsen, WHO focal point for childhood obesity and physical activity. “This is about making the shift from sedentary time to playtime, while protecting sleep. “

The pattern of overall 24-hour activity is key: replacing prolonged restrained or sedentary screen time with more active play, while making sure young children get enough good-quality sleep. Quality sedentary time spent in interactive non-screen-based activities with a caregiver, such as reading, storytelling, singing and puzzles, is very important for child development.

The important interactions between physical activity, sedentary behaviour and adequate sleep time, and their impact on physical and mental health and wellbeing, were recognized by the Commission on Ending Childhood Obesity, which called for clear guidance on physical activity, sedentary behaviour and sleep in young children.

Applying the recommendations in these guidelines during the first five years of life will contribute to children’s motor and cognitive development and lifelong health.

Meanwhile, a new study suggests, you can cancel out the harmful effects of sitting down all day if you walk to work and back home instead.

Researchers found those who sat for more than six hours a day and were inactive had the highest risk of dying from any cause or from cardiovascular disease.

But even meeting the lowest requirement for physical activity completely eliminated the risk of dying from any cause even among those who sat for most of the day.

The team, from the University of Sydney in Australia, says their findings confirm previous studies and are calling for doctors and healthcare professionals to encourage their patients to substitute sitting with brisk walking.

For the study, published in the Journal of the American College of Cardiology, the team recruited nearly 150,000 Australian men and women aged 45 years and older.

They were asked to complete a questionnaire about how many hours a day they spent sitting, standing and sleeping as well how much time they spent walking or engaging in physical activity.

Sitting time was broken into four categories: less than four hours, four to less than six hours, six to eight hours and more than eight hours.

Participants met the Australian weekly physical activity recommendations if they exercised moderately 150 to 300 minutes per week or exercised vigorously 75 to 150 minutes per week.

Researchers followed up with the participants for about nine years.

They found that those who sat for more than six hours, and did not meet the physical activity recommendations, faced the highest risk of dying from any cause or from cardiovascular disease.

Participants who met even the lowest requirement for physical activity eliminated the risk of dying from any cause, unless they sat for more than eight hours a day.

Even among those who sat less than four hours a day, their risk was much higher if they me the physical activity recommendations than those who were inactive.

“Our results support continued efforts to promote physical activity in those segments of the population that sit a lot for whatever reason,” said lead author Dr. Emmanuel Stamatakis, a professor of physical activity, lifestyle and population health at the University of Sydney in Australia.

“In the absence of some physical activity, merely reducing sitting times may be insufficient for better health.”

In an accompanying editorial, Dr. Charles Matthews, physical activity epidemiologist and investigator at the National Cancer Institute, says the findings show there are several ways to eliminate the mortality risks linked to sitting all day.

“It is more important than ever to attend to our daily physical activity and sitting time to try to optimize both behaviors for better health,” he wrote.

“To this end, the report from Stamatakis and colleagues provide new and actionable insights for translating their findings to clinical and public health practice. “

Meanwhile, the WHO recommendations at a glance:

Infants (less than one year) should:
*Be physically active several times a day in a variety of ways, particularly through interactive floor-based play; more is better. For those not yet mobile, this includes at least 30 minutes in prone position (tummy time) spread throughout the day while awake.

*Not be restrained for more than one hour at a time (example prams/strollers, high chairs, or strapped on a caregiver’s back). Screen time is not recommended. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.

*Have 14–17 hour (0–three months of age) or 12–16hour (four–11 months of age) of good quality sleep, including naps.

Children one-two years of age should:

*Spend at least 180 minutes in a variety of types of physical activities at any intensity, including moderate-to-vigorous-intensity physical activity, spread throughout the day; more is better.

* Not be restrained for more than one hour at a time (example, prams/strollers, high chairs, or strapped on a caregiver’s back) or sit for extended periods of time. For one-year-olds, sedentary screen time (such as watching TV or videos, playing computer games) is not recommended. For those aged two years, sedentary screen time should be no more than one hour; less is better. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.

* Have 11-14 hours of good quality sleep, including naps, with regular sleep and wake-up times.

Children three-four years of age should:

*Spend at least 180 minutes in a variety of types of physical activities at any intensity, of which at least 60 minutes is moderate- to vigorous intensity physical activity, spread throughout the day; more is better.

* Not be restrained for more than one hour at a time (example, prams/strollers) or sit for extended periods of time. Sedentary screen time should be no more than one hour; less is better. When sedentary, engaging in reading and storytelling with a caregiver is encouraged.

* Have 10–13 hour of good quality sleep, which may include a nap, with regular sleep and wake-up times.