Adherence to 24-hr Activity Guidelines and Quality of Life in Singapore Children: A Self-Reported Survey Study
Keywords:
recreational screen time, moderate-to-vigorous physical activity, sleep, health-related quality of life, children, 24-hr activity guidelines
Abstract
There are limited data on how the lifestyle behaviours of school-aged children in Singapore fare against the Singapore Integrated 24-hr Activity Guidelines. One hundred and thirty-eight children ages 9 to 13 years self-reported their recreational screen time, moderate-to-vigorous physical activity (MVPA), night-time sleep duration, and health-related Quality of Life (HRQoL) in a survey package. Their lifestyle behaviours were then benchmarked against the Singapore Integrated 24-hr Activity Guidelines recommendations, specifically, (i) at least 1 hr/day of MVPA, (ii) no more than 2 hr/day of recreational screen time, and 7-9 hr/day of sleep. Association between the number of guideline recommendations met and HRQoL z-scores were explored. Of the 138 children, 6.5% met all three guideline recommendations while 29.0% did not meet any guideline recommendations. MVPA guideline recommendation was least adhered to followed by recreational screen time and sleep. The number of guideline recommendations met was significantly associated with children’s HRQoL, with an increase of 0.289 in HRQoL z-score (5.9%) for every additional guideline met. The 24-hr activity behaviours of Singapore children was sub-optimal in which the proportion of children who did not meet any guideline recommendations is higher than those who met all guideline recommendations. Nonetheless, larger cohort studies are needed to establish its prevalence. Greater dissemination of the guidelines and ameliorative programs targeted at different groups of children should be made to help support children in adopting healthy lifestyle habits.
References
Academy of Medicine, College of Paediatrics and Child Health, Singapore. Consensus Statement of the Singapore Integrated 24-hour Activity Guidelines For Children & Adolescents (7 to 18 years). 2021. Retrieved on 8 June 2023, https://www.ams.edu.sg/view-pdf.aspx?file=media%5c6200_fi_777.pdf&ofile=CPCHS+
Blum, R. W., Astone, N. M., Decker, M. R., & Mouli, V. C. (2014). A conceptual framework for early adolescence: a platform for research. International Journal of Adolescent Medicine and Health, 26(3), 321-331. https://doi.org/doi:10.1515/ijamh-2013-0327
Carson, V., Chaput, J.-P., Janssen, I., & Tremblay, M. S. (2017). Health associations with meeting new 24-hour movement guidelines for Canadian children and youth. Preventive medicine, 95, 7-13. https://doi.org/https://doi.org/10.1016/j.ypmed.2016.12.005
Chia, M. (2008). Physical inactivity among children and adolescents in Singapore: A paradoxical issue. Acta Kinesiologica, 2(2), 7–15.
Chia, M. (2010). Pedometer-assessed physical activity of Singaporean youths. Preventive medicine, 50(5-6), 262-264.
Chia, M., Tay, L. Y., & Chua, T. B. K. (2019). The development of an online surveillance of digital media use in early childhood questionnaire-SMALLQ™-for Singapore.
Chia, M., Tay, L. Y., & Chua, T. B. K. (2020). Quality of Life and Meeting 24-h WHO Guidelines Among Preschool Children in Singapore. Early Childhood Education Journal, 48(3), 313-323. https://doi.org/10.1007/s10643-019-00987-9
Dans, A., Ng, N., Varghese, C., Tai, E. S., Firestone, R., & Bonita, R. (2011). The rise of chronic non-communicable diseases in southeast Asia: time for action. Lancet, 377(9766), 680-689. https://doi.org/10.1016/s0140-6736(10)61506-1
Dolezal, B. A., Neufeld, E. V., Boland, D. M., Martin, J. L., & Cooper, C. B. (2017). Interrelationship between Sleep and Exercise: A Systematic Review. Advances in Preventive Medicine, 2017, 1364387. https://doi.org/10.1155/2017/1364387
Hidayat, K., Zhou, H.-J., & Shi, B.-M. (2019). Influence of physical activity at a young age and lifetime physical activity on the risks of 3 obesity-related cancers: systematic review and meta-analysis of observational studies. Nutrition Reviews, 78(1), 1-18. https://doi.org/10.1093/nutrit/nuz024
Kim, Y., Umeda, M., Lochbaum, M., & Sloan, R. A. (2020). Examining the day-to-day bidirectional associations between physical activity, sedentary behavior, screen time, and sleep health during school days in adolescents. PloS one, 15(9), e0238721. https://doi.org/10.1371/journal.pone.0238721
Li, M., Tan, C.-S., Xu, L., Foo, L.-L., Yap, F., Sun, C.-H., . . . Sabanayagam, C. (2022). Sleep Patterns and Myopia Among School-Aged Children in Singapore [Original Research]. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.828298
Lim, M. T. C., Ramamurthy, M. B., Aishworiya, R., Rajgor, D. D., Tran, A. P., Hiriyur, P., . . . Goh, D. Y. T. (2021). School closure during the coronavirus disease 2019 (COVID-19) pandemic–Impact on children's sleep. Sleep Medicine, 78, 108-114.
Loh, R., Stamatakis, E., Folkerts, D., Allgrove, J. E., & Moir, H. J. (2020). Effects of Interrupting Prolonged Sitting with Physical Activity Breaks on Blood Glucose, Insulin and Triacylglycerol Measures: A Systematic Review and Meta-analysis. Sports Medicine, 50(2), 295-330. https://doi.org/10.1007/s40279-019-01183-w
Loo, B. K. G., Tan, B., Chia, M. Y. H., Chan, P. C., Sirisena, D., Zainuddin, M. A., . . . Ng, K. C. (2022). Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents. Ann Acad Med Singap, 51(5), 292-299. https://doi.org/10.47102/annals-acadmedsg.202141
Lye, J. C. T., Mukherjee, S., & Chia, M. Y. H. (2015). Physical activity and sedentary behavior patterns of Singaporean adolescents. Journal of Physical Activity and Health, 12(9), 1213-1220.
Magee, C. A., Caputi, P., & Iverson, D. C. (2013). Patterns of health behaviours predict obesity in Australian children. Journal of Paediatrics and Child Health, 49(4), 291-296. https://doi.org/https://doi.org/10.1111/jpc.12163
Ministry of Health, Singapore. Annual Prevalence Of Obesity For Children Aged Below 18 Over Past Five Years, Their Profile And Assessed Effectiveness Of Preventive Measures. Retrieved on 18 May 2023, https://www.moh.gov.sg/news-highlights/details/annual-prevalence-of-obesity-for-children-aged-below-18-over-past-five-years-their-profile-and-assessed-effectiveness-of-preventive-measures/
World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization; 2014. Retrieved on 8 June 2023, https://apps.who.int/iris/handle/10665/148114.
Padmapriya, N., Chen, B., Goh, C. M. J. L., Shek, L. P. C., Chong, Y. S., Tan, K. H., . . . Müller-Riemenschneider, F. (2021). 24-hour movement behaviour profiles and their transition in children aged 5.5 and 8 years – findings from a prospective cohort study. International Journal of Behavioral Nutrition and Physical Activity, 18(1), 145. https://doi.org/10.1186/s12966-021-01210-y
Quah, P. L., Loo, B. K. G., Razali, N. S., Razali, N. S., Teo, C. C., & Tan, K. H. (2021). Parental perception and guideline awareness of children's lifestyle behaviours at ages 5 to 14 in Singapore. Ann Acad Med Singap, 50(9), 695-702. https://doi.org/10.47102/annals-acadmedsg.2021134
Rangul, V., Bauman, A., Holmen, T. L., & Midthjell, K. (2012). Is physical activity maintenance from adolescence to young adulthood associated with reduced CVD risk factors, improved mental health and satisfaction with life: the HUNT Study, Norway. International Journal of Behavioral Nutrition and Physical Activity, 9(1), 144. https://doi.org/10.1186/1479-5868-9-144
Rollo, S., Antsygina, O., & Tremblay, M. S. (2020). The whole day matters: Understanding 24-hour movement guideline adherence and relationships with health indicators across the lifespan. Journal of Sport and Health Science, 9(6), 493-510. https://doi.org/https://doi.org/10.1016/j.jshs.2020.07.004
Roman-Viñas, B., Chaput, J.-P., Katzmarzyk, P. T., Fogelholm, M., Lambert, E. V., Maher, C., . . . Sarmiento, O. L. (2016). Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study. International Journal of Behavioral Nutrition and Physical Activity, 13(1), 1-10.
Sampasa-Kanyinga, H., Colman, I., Goldfield, G. S., Janssen, I., Wang, J., Tremblay, M. S., . . . Chaput, J. P. (2021). 24-Hour Movement Behaviors and Internalizing and Externalizing Behaviors Among Youth. J Adolesc Health, 68(5), 969-977. https://doi.org/10.1016/j.jadohealth.2020.09.003
Sampasa-Kanyinga, H., Standage, M., Tremblay, M. S., Katzmarzyk, P. T., Hu, G., Kuriyan, R., . . . Chaput, J. P. (2017). Associations between meeting combinations of 24-h movement guidelines and health-related quality of life in children from 12 countries. Public Health, 153, 16-24. https://doi.org/https://doi.org/10.1016/j.puhe.2017.07.010
Saunders, T. J., Gray, C. E., Poitras, V. J., Chaput, J.-P., Janssen, I., Katzmarzyk, P. T., . . . Carson, V. (2016). Combinations of physical activity, sedentary behaviour and sleep: relationships with health indicators in school-aged children and youth. Applied physiology, nutrition, and metabolism, 41(6 (Suppl. 3)), S283-S293. https://doi.org/10.1139/apnm-2015-0626 %M 27306434
Sawyer, S. M., Afifi, R. A., Bearinger, L. H., Blakemore, S. J., Dick, B., Ezeh, A. C., & Patton, G. C. (2012). Adolescence: a foundation for future health. Lancet, 379(9826), 1630-1640. https://doi.org/10.1016/s0140-6736(12)60072-5
Tapia-Serrano, M. A., García-Hermoso, A., Sevil-Serrano, J., Sánchez-Oliva, D., & Sánchez-Miguel, P. A. (2022). Is adherence to 24-Hour Movement Guidelines associated with a higher academic achievement among adolescent males and females? Journal of Science and Medicine in Sport, 25(2), 155-161. https://doi.org/https://doi.org/10.1016/j.jsams.2021.09.005
Topp, C. W., Østergaard, S. D., Søndergaard, S., & Bech, P. (2015). The WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom, 84(3), 167-176. https://doi.org/10.1159/000376585
Varni, J. W., Limbers, C. A., & Burwinkle, T. M. (2007). How young can children reliably and validly self-report their health-related quality of life?: An analysis of 8,591 children across age subgroups with the PedsQL™ 4.0 Generic Core Scales. Health and Quality of Life Outcomes, 5(1), 1. https://doi.org/10.1186/1477-7525-5-1
Varni, J. W., Seid, M., & Kurtin, P. S. (2001). PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care, 39(8), 800-812. https://doi.org/10.1097/00005650-200108000-00006
Xiong, X., Dalziel, K., Carvalho, N., Xu, R., & Huang, L. (2022). Association between 24-hour movement behaviors and health-related quality of life in children. Quality of Life Research, 31(1), 231-240. https://doi.org/10.1007/s11136-021-02901-6
Blum, R. W., Astone, N. M., Decker, M. R., & Mouli, V. C. (2014). A conceptual framework for early adolescence: a platform for research. International Journal of Adolescent Medicine and Health, 26(3), 321-331. https://doi.org/doi:10.1515/ijamh-2013-0327
Carson, V., Chaput, J.-P., Janssen, I., & Tremblay, M. S. (2017). Health associations with meeting new 24-hour movement guidelines for Canadian children and youth. Preventive medicine, 95, 7-13. https://doi.org/https://doi.org/10.1016/j.ypmed.2016.12.005
Chia, M. (2008). Physical inactivity among children and adolescents in Singapore: A paradoxical issue. Acta Kinesiologica, 2(2), 7–15.
Chia, M. (2010). Pedometer-assessed physical activity of Singaporean youths. Preventive medicine, 50(5-6), 262-264.
Chia, M., Tay, L. Y., & Chua, T. B. K. (2019). The development of an online surveillance of digital media use in early childhood questionnaire-SMALLQ™-for Singapore.
Chia, M., Tay, L. Y., & Chua, T. B. K. (2020). Quality of Life and Meeting 24-h WHO Guidelines Among Preschool Children in Singapore. Early Childhood Education Journal, 48(3), 313-323. https://doi.org/10.1007/s10643-019-00987-9
Dans, A., Ng, N., Varghese, C., Tai, E. S., Firestone, R., & Bonita, R. (2011). The rise of chronic non-communicable diseases in southeast Asia: time for action. Lancet, 377(9766), 680-689. https://doi.org/10.1016/s0140-6736(10)61506-1
Dolezal, B. A., Neufeld, E. V., Boland, D. M., Martin, J. L., & Cooper, C. B. (2017). Interrelationship between Sleep and Exercise: A Systematic Review. Advances in Preventive Medicine, 2017, 1364387. https://doi.org/10.1155/2017/1364387
Hidayat, K., Zhou, H.-J., & Shi, B.-M. (2019). Influence of physical activity at a young age and lifetime physical activity on the risks of 3 obesity-related cancers: systematic review and meta-analysis of observational studies. Nutrition Reviews, 78(1), 1-18. https://doi.org/10.1093/nutrit/nuz024
Kim, Y., Umeda, M., Lochbaum, M., & Sloan, R. A. (2020). Examining the day-to-day bidirectional associations between physical activity, sedentary behavior, screen time, and sleep health during school days in adolescents. PloS one, 15(9), e0238721. https://doi.org/10.1371/journal.pone.0238721
Li, M., Tan, C.-S., Xu, L., Foo, L.-L., Yap, F., Sun, C.-H., . . . Sabanayagam, C. (2022). Sleep Patterns and Myopia Among School-Aged Children in Singapore [Original Research]. Frontiers in Public Health, 10. https://doi.org/10.3389/fpubh.2022.828298
Lim, M. T. C., Ramamurthy, M. B., Aishworiya, R., Rajgor, D. D., Tran, A. P., Hiriyur, P., . . . Goh, D. Y. T. (2021). School closure during the coronavirus disease 2019 (COVID-19) pandemic–Impact on children's sleep. Sleep Medicine, 78, 108-114.
Loh, R., Stamatakis, E., Folkerts, D., Allgrove, J. E., & Moir, H. J. (2020). Effects of Interrupting Prolonged Sitting with Physical Activity Breaks on Blood Glucose, Insulin and Triacylglycerol Measures: A Systematic Review and Meta-analysis. Sports Medicine, 50(2), 295-330. https://doi.org/10.1007/s40279-019-01183-w
Loo, B. K. G., Tan, B., Chia, M. Y. H., Chan, P. C., Sirisena, D., Zainuddin, M. A., . . . Ng, K. C. (2022). Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents. Ann Acad Med Singap, 51(5), 292-299. https://doi.org/10.47102/annals-acadmedsg.202141
Lye, J. C. T., Mukherjee, S., & Chia, M. Y. H. (2015). Physical activity and sedentary behavior patterns of Singaporean adolescents. Journal of Physical Activity and Health, 12(9), 1213-1220.
Magee, C. A., Caputi, P., & Iverson, D. C. (2013). Patterns of health behaviours predict obesity in Australian children. Journal of Paediatrics and Child Health, 49(4), 291-296. https://doi.org/https://doi.org/10.1111/jpc.12163
Ministry of Health, Singapore. Annual Prevalence Of Obesity For Children Aged Below 18 Over Past Five Years, Their Profile And Assessed Effectiveness Of Preventive Measures. Retrieved on 18 May 2023, https://www.moh.gov.sg/news-highlights/details/annual-prevalence-of-obesity-for-children-aged-below-18-over-past-five-years-their-profile-and-assessed-effectiveness-of-preventive-measures/
World Health Organization. Global status report on noncommunicable diseases 2014. Geneva: World Health Organization; 2014. Retrieved on 8 June 2023, https://apps.who.int/iris/handle/10665/148114.
Padmapriya, N., Chen, B., Goh, C. M. J. L., Shek, L. P. C., Chong, Y. S., Tan, K. H., . . . Müller-Riemenschneider, F. (2021). 24-hour movement behaviour profiles and their transition in children aged 5.5 and 8 years – findings from a prospective cohort study. International Journal of Behavioral Nutrition and Physical Activity, 18(1), 145. https://doi.org/10.1186/s12966-021-01210-y
Quah, P. L., Loo, B. K. G., Razali, N. S., Razali, N. S., Teo, C. C., & Tan, K. H. (2021). Parental perception and guideline awareness of children's lifestyle behaviours at ages 5 to 14 in Singapore. Ann Acad Med Singap, 50(9), 695-702. https://doi.org/10.47102/annals-acadmedsg.2021134
Rangul, V., Bauman, A., Holmen, T. L., & Midthjell, K. (2012). Is physical activity maintenance from adolescence to young adulthood associated with reduced CVD risk factors, improved mental health and satisfaction with life: the HUNT Study, Norway. International Journal of Behavioral Nutrition and Physical Activity, 9(1), 144. https://doi.org/10.1186/1479-5868-9-144
Rollo, S., Antsygina, O., & Tremblay, M. S. (2020). The whole day matters: Understanding 24-hour movement guideline adherence and relationships with health indicators across the lifespan. Journal of Sport and Health Science, 9(6), 493-510. https://doi.org/https://doi.org/10.1016/j.jshs.2020.07.004
Roman-Viñas, B., Chaput, J.-P., Katzmarzyk, P. T., Fogelholm, M., Lambert, E. V., Maher, C., . . . Sarmiento, O. L. (2016). Proportion of children meeting recommendations for 24-hour movement guidelines and associations with adiposity in a 12-country study. International Journal of Behavioral Nutrition and Physical Activity, 13(1), 1-10.
Sampasa-Kanyinga, H., Colman, I., Goldfield, G. S., Janssen, I., Wang, J., Tremblay, M. S., . . . Chaput, J. P. (2021). 24-Hour Movement Behaviors and Internalizing and Externalizing Behaviors Among Youth. J Adolesc Health, 68(5), 969-977. https://doi.org/10.1016/j.jadohealth.2020.09.003
Sampasa-Kanyinga, H., Standage, M., Tremblay, M. S., Katzmarzyk, P. T., Hu, G., Kuriyan, R., . . . Chaput, J. P. (2017). Associations between meeting combinations of 24-h movement guidelines and health-related quality of life in children from 12 countries. Public Health, 153, 16-24. https://doi.org/https://doi.org/10.1016/j.puhe.2017.07.010
Saunders, T. J., Gray, C. E., Poitras, V. J., Chaput, J.-P., Janssen, I., Katzmarzyk, P. T., . . . Carson, V. (2016). Combinations of physical activity, sedentary behaviour and sleep: relationships with health indicators in school-aged children and youth. Applied physiology, nutrition, and metabolism, 41(6 (Suppl. 3)), S283-S293. https://doi.org/10.1139/apnm-2015-0626 %M 27306434
Sawyer, S. M., Afifi, R. A., Bearinger, L. H., Blakemore, S. J., Dick, B., Ezeh, A. C., & Patton, G. C. (2012). Adolescence: a foundation for future health. Lancet, 379(9826), 1630-1640. https://doi.org/10.1016/s0140-6736(12)60072-5
Tapia-Serrano, M. A., García-Hermoso, A., Sevil-Serrano, J., Sánchez-Oliva, D., & Sánchez-Miguel, P. A. (2022). Is adherence to 24-Hour Movement Guidelines associated with a higher academic achievement among adolescent males and females? Journal of Science and Medicine in Sport, 25(2), 155-161. https://doi.org/https://doi.org/10.1016/j.jsams.2021.09.005
Topp, C. W., Østergaard, S. D., Søndergaard, S., & Bech, P. (2015). The WHO-5 Well-Being Index: a systematic review of the literature. Psychother Psychosom, 84(3), 167-176. https://doi.org/10.1159/000376585
Varni, J. W., Limbers, C. A., & Burwinkle, T. M. (2007). How young can children reliably and validly self-report their health-related quality of life?: An analysis of 8,591 children across age subgroups with the PedsQL™ 4.0 Generic Core Scales. Health and Quality of Life Outcomes, 5(1), 1. https://doi.org/10.1186/1477-7525-5-1
Varni, J. W., Seid, M., & Kurtin, P. S. (2001). PedsQL 4.0: reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Med Care, 39(8), 800-812. https://doi.org/10.1097/00005650-200108000-00006
Xiong, X., Dalziel, K., Carvalho, N., Xu, R., & Huang, L. (2022). Association between 24-hour movement behaviors and health-related quality of life in children. Quality of Life Research, 31(1), 231-240. https://doi.org/10.1007/s11136-021-02901-6
