Physical activity (PA) and sedentary behaviour (SB) of pre-school aged children are associated with important health and developmental outcomes. Accurate measurement of these behaviours in young children is critical for research and practice in this area. The aim of this review was to examine the validity, reliability, and feasibility of measurement tools used to assess PA and SB of pre-school aged children.Searches of electronic databases, and manual searching, were conducted to identify articles that examined the measurement properties (validity, reliability or feasibility) of measurement tools used to examine PA and/or SB of pre-school aged children (3–7 years old). Following screening, data were extracted and risk of bias assessment completed on all included articles.A total of 69 articles, describing 75 individual studies were included. Studies assessed measurement tools for PA (n = 27), SB (n = 5), and both PA and SB (n = 43). Outcome measures of PA and SB differed between studies (e.g. moderate to vigorous activity, step count, posture allocation). Most studies examined the measurement properties of one measurement tool only (n = 65). Measurement tools examined included: calorimetry, direct observation, combined heart rate and accelerometry, heart rate monitors, accelerometers, pedometers, and proxy report (parent, carer or teacher reported) measures (questionnaires or diaries). Studies most frequently assessed the validity (criterion and convergent) (n = 65), face and content validity (n = 2), test-retest reliability (n = 10) and intra-instrument reliability (n = 1) of the measurement tools. Feasibility data was abstracted from 41 studies.Multiple measurement tools used to measure PA and SB in pre-school aged children showed some degree of validity, reliability and feasibility, but often for different purposes. Accelerometers, including the Actigraph (in particular GT3X versions), Actical, ActivPAL and Fitbit (Flex and Zip), and proxy reported measurement tools used in combination may be useful for a range of outcome measures, to measure intensity alongside contextual information.

Background: Sleep of pre-school aged children is important for their health and development, but there are currently no standards for measuring sleep in this age group. We aimed to examine the validity, reliability and feasibility of tools used to assess sleep of pre-school aged children.Methods: Studies were eligible for inclusion if they examined the validity and/or reliability and/or feasibility of a measurement tool used to examine sleep of pre-school aged children (aged 3–7 years). We systematically searched six electronic databases, grey literature and trial registries. We manually searched topic specific journals, reference and citations of included studies, and reference lists of existing reviews. We extracted data and conducted a risk of bias assessment on the included studies using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) risk of bias checklist. We used a narrative synthesis to present the results.Results: Sixteen studies met the inclusion criteria: these explored accelerometers (n = 3) and parental reported tools (n = 13; nine questionnaires, six diaries). Studies assessed construct validity (n = 3), criterion validity (n = 1), convergent validity (n = 13), test-retest reliability (n = 2), internal consistency (n = 4) and feasibility (n = 12). Most studies assessed the convergent validity of questionnaires and diaries compared with accelerometers, but the validity of accelerometers for sleep in this age group is unknown. Of studies with a low risk of bias, one sleep diary was shown to be valid for measuring sleep duration. No measurement tools were appropriate for determining sleep quality. Reporting of reliability and feasibility was minimal.Discussion: The evidence base in this field is limited, and most studies had high risk of bias. Future research on sleep in pre-school aged children should focus on assessing the validity, reliability and feasibility of accelerometers, which in turn will improve the quality of studies that assess questionnaires and diaries against accelerometers.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021230900; PROSPERO: CRD42021230900.

This systematic review and meta‐analysis synthesized evidence of the association between 24‐h movement behaviors and social–emotional health and cognitive development in children and adolescents aged 3–18 years from studies using compositional data analysis. Systematic literature searches were conducted on five electronic databases from January 2015 to December 2024. Studies were eligible if they assessed sleep, moderate‐to‐vigorous intensity physical activity, light intensity physical activity, and sedentary time. Eligible studies also examined associations between movement behaviors and social–emotional health or cognitive development using compositional data analysis in children and adolescents aged 3–18 years. Pooled effect sizes were estimated using cluster robust variance meta‐analysis. A total of 19 studies (5 longitudinal, 14 cross‐sectional) encompassing 11 826 participants were included. Meta‐analysis showed that engaging in more moderate‐to‐vigorous intensity physical activity, getting more sleep, and spending less time sedentary relative to other movement behaviors was favorably associated with social–emotional health; albeit, the observed relationships were small in magnitude. The association for sleep was stronger among adolescents compared to children. No components of 24‐h movement behavior compositions were associated with cognitive development. These findings suggest that engaging in healthy movement behavior compositions may be beneficial for social–emotional health in young people, although the link between 24‐h movement behavior compositions and cognitive development is less clear.

Background: The UK government released Chapter 1 of the ‘Childhood Obesity: a plan for action’ (2016), followed by Chapter 2 (2018) and preliminary Chapter 3 was published for consultation in 2019 (hereon collectively ‘The Policy’). The stated policy aims were to reduce the prevalence of childhood obesity in England, addressing disparities in health by reducing the gap (approximately two-fold) in childhood obesity between those from the most and least deprived areas. Methods: Combining a realist approach with an analysis of policy discourses, we analysed the policies using a social determinants of health (SDH) perspective (focusing on socio-economic inequalities). This novel approach reveals how the framing of policy ‘problems’ leads to particular approaches and interventions. Results: While recognising a social gradient in relation to obesity measures, we critique obesity problem narratives. The Policy included some upstream, structural approaches (e.g. restrictions in food advertising and the soft-drinks industry levy). However, the focus on downstream individual-level behavioural approaches to reduce calorie intake and increase physical activity does not account for the SDH and the complexity and contestedness of ‘obesity’ and pays insufficient attention to how proposals will help to reduce inequalities. Our findings illustrate that individualising of responsibility to respond to what wider evidence shows is structural inequalities, can perpetuate damaging narratives and lead to ineffective interventions, providing caution to academics, practitioners and policy makers (local and national), of the power of problem representation. Our findings also show that the problem framing in The Policy risks reducing important public health aims to encourage healthy diets and increase opportunities for physical activity (and the physical and mental health benefits of both) for children to weight management with a focus on particular children. Conclusions: We propose an alternative conceptualisation of the policy ‘problem’, that obesity rates are illustrative of inequality, arguing there needs to be policy focus on the structural and factors that maintain health inequalities, including poverty and food insecurity. We hope that our findings can be used to challenge and strengthen future policy development, leading to more effective action against health inequalities and intervention-generated inequalities in health.

Rationale Early childhood presents an important opportunity for obesity prevention, an international public health priority. Interventions aiming to prevent obesity typically promote healthy diets or activity levels (physical activity, sedentary behaviour), or both. There is uncertainty over which approaches are more effective. This is one of a suite of three reviews addressing interventions for preventing obesity in children, each focusing on different age groups up to 18 years. These reviews replace and update a 2019 Cochrane review on interventions for preventing obesity in children from birth to 18 years. Objectives To assess the effects of interventions that aimed to prevent obesity in children aged two to four years by changing dietary intake or activity levels, or both, on body mass index (BMI), BMI z‐score (zBMI), BMI percentile, and serious adverse events. Search methods We searched CENTRAL, MEDLINE, Embase, six other databases, and two trial registers, together with reference checking, citation searching, and contact with study authors to identify eligible studies. The latest search date was 7 February 2023. Eligibility criteria We included randomised controlled trials (RCTs) in children aged two to four years, comparing dietary or activity interventions (or both combined) to prevent overweight or obesity versus no intervention, usual care, or another eligible intervention, in any setting. Studies had to measure outcomes at a minimum of 12 weeks post‐baseline. There were no language restrictions. Outcomes Our outcomes were BMI, zBMI, BMI percentile, and serious adverse events. Risk of bias We used version 2 of the Cochrane risk of bias tool (RoB 2) to assess included RCTs. Synthesis methods Working independently, two authors screened studies, extracted data, and conducted risk of bias and GRADE assessments. We conducted random‐effects meta‐analyses stratified by type of intervention and follow‐up duration. Included studies We included 67 studies (36,601 participants), with 56 studies (21,404 participants) pooled in the meta‐analyses. Sixty‐three studies were conducted in high‐income countries. Study settings were split between childcare (26 studies; 39%), home (23 studies; 34%), and home plus childcare settings (10 studies; 15%). Few studies were conducted in the community (three studies; 5%) or healthcare settings (five studies; 7%). Most studies compared a combined dietary/activity intervention with a control group. Synthesis of results Dietary interventions versus control Dietary interventions may have little to no effect on BMI at short‐term follow‐up (mean difference (MD) 0.00, 95% confidence interval (CI) ‐0.28 to 0.28; 1 study, 94 participants; low‐certainty evidence). At medium‐ and long‐term follow‐up, dietary interventions may result in little to no difference in BMI. One study (103 participants; low‐certainty evidence) reported no difference in BMI at medium‐term follow‐up, and one study (2238 participants; low‐certainty evidence) found lower rates of overweight and obesity in the intervention group at long‐term follow‐up. Dietary interventions likely result in little to no difference in zBMI at short‐term (MD 0.03, 95% CI ‐0.13 to 0.19; 2 studies, 145 participants) and medium‐term follow‐up (MD ‐0.17, 95% CI ‐0.44 to 0.10; 1 study, 389 participants), both with moderate‐certainty evidence. None of the included studies reported zBMI at long‐term follow‐up. None of the studies reported serious adverse events. Activity interventions versus control Activity interventions may have little to no effect on BMI at short‐term follow‐up, but the evidence is very uncertain (MD ‐0.10, 95% CI ‐0.28 to 0.08; 6 studies, 826 participants; very low‐certainty evidence). They likely reduce BMI at medium‐term follow‐up (MD ‐0.70, 95% CI ‐1.09 to ‐0.31; 1 study, 567 participants; moderate‐certainty evidence). None of the studies reported BMI at long‐term follow‐up. Activity interventions likely result in little to no difference in zBMI at short‐term follow‐up (MD ‐0.06, 95% CI ‐0.19 to 0.07; 3 studies, 635 participants; moderate‐certainty evidence). They may result in little to no difference in zBMI at medium‐term follow‐up, but the evidence is very uncertain (MD ‐0.00, 95% CI ‐0.12 to 0.11; 4 studies, 1083 participants; very low‐certainty evidence). None of the included studies reported zBMI at long‐term follow‐up. Activity interventions may have little to no effect on serious adverse events, but the evidence is very uncertain (2 studies, 773 participants; very low‐certainty evidence). One study found no harms related to the intervention, and one study reported no difference in accident and infection rates between groups. Combined dietary/activity interventions versus control Combined dietary/activity interventions may have little to no effect on BMI at short‐term follow‐up, but the evidence is very uncertain (MD ‐0.08, 95% CI ‐0.20 to 0.04; 13 studies, 3867 participants; very low‐certainty evidence). They may result in little to no difference in BMI at medium‐term follow‐up (MD ‐0.05, 95% CI ‐0.18 to 0.08; 9 studies, 7016 participants; low‐certainty evidence), and may result in a slight reduction in BMI at long‐term follow‐up (MD ‐0.20, 95% CI ‐0.39 to ‐0.01; 5 studies, 2074 participants; low‐certainty evidence). Combined interventions may have little to no effect on zBMI at short‐term follow‐up (MD ‐0.03, 95% CI ‐0.07 to 0.01; 14 studies, 5518 participants), and may result in a slight reduction in zBMI at medium‐term...

This systematic review and meta-analysis aimed to compare estimated levels of physical activity (PA) and sedentary time (ST) of preschool-aged children (3–5 years old) based on different published accelerometer cut-points used in this age group. Four electronic databases were searched to identify studies estimating levels of PA or ST (ST, light PA [LPA], and moderate to vigorous PA [MVPA]) using multiple accelerometer cut-points, in a sample of preschool-aged children. Data were extracted and risk of bias assessed for all included studies. Random-effects meta-analysis was used to estimate pooled effects for unique combinations of accelerometer cut-points for each outcome. Twenty-four studies, reporting on 18 unique samples, were included. Results demonstrated substantial variability in estimates of PA and ST across different cut-points, with significant differences in estimates of the behaviors between most cut-points. Few cut-points showed similarity; Evenson and Pate were some of the most similar for the assessment of PA and ST of young children. However, when calculating the differences in ST, LPA, and MVPA between the cut-points, the Evenson cut-point estimates approximately 60 min more LPA per day and the Pate 148CPM cut-points estimates 23 and 37 min more ST and MVPA each day, respectively. Given that these were the most similar estimates, this highlights the magnitude of differences between the accelerometer cut-points when estimating preschool-aged children’s movement behavior. This review provides an illustration on the limitations of accelerometer cut-points used to determine PA and ST of preschool-aged children; in that they often produce substantially different estimates. This review provides a compelling rationale as to why further research moving toward alternative data processing methodologies is required, including to identify an optimal approach to estimating movement behavior outcomes in young children that considers congruence with past and future research.