International Recommendations for School-Related Sedentary Behaviours

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Travis Saunders (trsaunders@upei.ca),

Nicholas Corey Kuzik (nkuzik@cheo.on.ca)

Scott Rollo (arollo@cheo.on.ca).

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www.sedentarybehaviour.org

What is sedentary �behaviour?

Sedentary behaviour: sitting or lying down with low energy expenditure

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School-related: occurring during school hours (e.g., classroom, recess) or outside of school hours but influenced by the school (e.g., homework, assigned studying)

Why did we create these recommendations?

School is largely sedentary

Meta analysis: Students in grades K-12 are sedentary for 63% of the school day

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Accounts for 37% of daily sedentary time

Harrington et al., 2011 (IJBNPA); Grau-Cruces et al., 2020 (J Sport Sci)

School-related SB is changing

School-related SB is changing

Purpose

To develop recommendations for school-related sedentary behaviours for school-aged children and youth.

Benefits

Harms

Recommendations Take Time

1

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Form Steering Committee: October 2020

2

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Convene Expert Panel to identify data needed to inform recommendations: November 2020

3

•

Perform reviews to summarize data needed to inform recommendations: December 2020-June 2021

4

•

Convene Expert Panel to provide data and draft recommendations: June 2021

5

•

Share draft recommendations with key stakeholders: July 2021

6

•

Update recommendations based on feedback: July-September 2021

7

•

Release Guidelines: Spring 2022

Recommendations Take Time

1

•

Form Steering Committee: October 2020

2

•

Convene Expert Panel to identify data needed to inform recommendations: November 2020

3

•

Perform reviews to summarize data needed to inform recommendations: December 2020-June 2021

4

•

Convene Expert Panel to provide data and draft recommendations: June 2021

5

•

Share draft recommendations with key stakeholders: July 2021

6

•

Update recommendations based on feedback: July-September 2021

7

•

Release Guidelines: Spring 2022

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School-Related Sedentary Behaviours and Indicators of Health and Well-Being Among Children and Youth: A Systematic Review

Presented by Nicholas Kuzik

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Nicholas Kuzik, Bruno da Costa, Yeongho Hwang, Simone Verswijveren, Iryna Demchenko, Scott Rollo, Mark Tremblay, Stacey Bélanger, Kara Brisson-Boivin, Valerie Carson, Marsha Costello, Susan Hornby, Wendy Yajun Huang, Barbi Law, Chris Markham, Michelle Ponti, Maribeth Rogers Neale, Jo Salmon, Tony van Rooij, Lucy Wachira, Katrien Wijndaele, Travis Saunders

Background

• Carson et al. (2016) completed a comprehensive examination of sedentary behaviours and health indicators in school-aged children
• 235 studies; 6 school-related sedentary behaviour exposures

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• No up-to-date and comprehensive review of sedentary behaviours or school-related sedentary behaviours and indicators of health and well-being

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Objectives

• To comprehensively examine the associations between school-related sedentary behaviours and indicators of health and well-being in children and youth (~5-18 years) attending school

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• To examine differences in associations across school-related sedentary behaviour exposures, age groups, and dose-response relationships

Results: PRISMA Flow Diagram

Results: Study Characteristics

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Active lessons beneficial when displacing sedentary behaviours

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Results: Age Group Differences

Results: Dose-Reponse Relationships

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Discussion: Limitations

• Studies
• Few studies conducted in South American, African, and low- middle-income countries
• Quality of evidence most frequently rated as very low
• Review
• Conceptualization of school-related sedentary behaviour included physical activity
• Broad scope of the review

Discussion: Conclusions

• More school-related sedentary behaviour…
• Unfavourable for other movement behaviours
• Favourable for cognitive and social-emotional indicators
• Mainly due to homework, in secondary school-aged children, and in moderation
• Active lessons most beneficial form of sedentary behaviour displacement

Existing Sedentary Behaviour Guidelines for Children and Youth

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Presented by Scott Rollo

What recommendations exist for recreational sedentary behaviour?

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What Recommendations �Exist?

Summary of Existing Recommendations

• Limit recreational screen time (World Health Organization, Uruguay)
• To ≤ 1 hour/day (Germany children, France children)
• To ≤ 2 hours/day (Australia, Canada, China, New Zealand, Spain, Singapore, Finland, Germany adolescents, Qatar, France adolescents)

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• Break up long periods of sitting (Australia, Canada, China, New Zealand, Spain, Netherlands, Switzerland, UK, Turkey)
• Break every 60 minutes (Finland, Qatar)
• Break every 90 mins (Singapore)
• Break every 120 mins (France adolescents)

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• Limit total sedentary time (World Health Organization)

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Summary of Existing Recommendations

• MANAGE screen use
• Encourage MEANINGFUL screen use
• MODEL healthy screen use
• MONITOR for signs of problematic screen use at any age

Conclusions

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• National/International guidelines suggest limiting/breaking up periods of prolonged sitting and minimizing recreational screen time
• Breaks every 60-120 mins
• Limit screen time to 60-120 mins

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• Recommendations for digital media use from pediatric physician groups also exist
• Focus on quality of screen-based media use

School-related sedentary behaviour and screen time recommendations for school-aged children and youth: An environmental scan of the literature

Research Question

What are the existing evidence-based school-related sedentary behaviour and screen time guidelines and/or recommendations for school-aged children and youth (aged 5-18 years)?

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Objectives:

• To identify, collate, and summarize the existing literature on evidence-based school-related sedentary behaviour or screen time guidelines and/or recommendations for children and youth
• Map the evidence and report the content of existing guidelines, recommendations, and/or policies
• Depending on availability, describe the evidence-base and processes used to develop these guidelines and/or recommendations, as well as dissemination and implementation strategies
• Outline key issues and discuss avenues for future research and guideline development

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Findings

• Of the 7 included records, guidelines/recommendations targeted:
• General recommendations for digital device use (n = 1)
• Screen time limits for online classes/digital education (n = 2)
• Limiting/reducing SB and breaking up long periods of sedentary time (n = 3)
• Digital device use in the classroom/at home learning, screen time/break frequency, and movement/activity (n = 1)

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Conclusions

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• Very few recommendations targeting school-related sedentary behaviour or screen time exist
• Focus largely on digital device use

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• Current guidelines suggest:
• Taking a break from screens/devices at least every 20 mins
• Daily screen time limits depending on age and grade level

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• No time-specific recommendations exist for total school-related sedentary time

Recommendations Take Time

1

•

Form Steering Committee: October 2020

2

•

Convene Expert Panel to identify data needed to inform recommendations: November 2020

3

•

Perform reviews to summarize data needed to inform recommendations: December 2020-June 2021

4

•

Convene Expert Panel to provide data and draft recommendations: June 2021

5

•

Share draft recommendations with key stakeholders: July 2021

6

•

Update recommendations based on feedback: July-September 2021

7

•

Release Guidelines: Spring 2022

Recommendations Take Time

1

•

Form Steering Committee: October 2020

2

•

Convene Expert Panel to identify data needed to inform recommendations: November 2020

3

•

Perform reviews to summarize data needed to inform recommendations: December 2020-June 2021

4

•

Convene Expert Panel to provide data and draft recommendations: June 2021

5

•

Share draft recommendations with key stakeholders: July 2021

6

•

Update recommendations based on feedback: July-September 2021

7

•

Release Guidelines: Spring 2022

Recommendations Take Time

1

•

Form Steering Committee: October 2020

2

•

Convene Expert Panel to identify data needed to inform recommendations: November 2020

3

•

Perform reviews to summarize data needed to inform recommendations: December 2020-June 2021

4

•

Convene Expert Panel to provide data and draft recommendations: June 2021

5

•

Share draft recommendations with key stakeholders: July 2021

6

•

Update recommendations based on feedback: July-September 2021

7

•

Release Guidelines: Spring 2022

Pre-Amble

These recommendations are for children and youth attending school (typically 5-18 years of age) inclusive of gender, culture, nationality and socio-economic status.

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These recommendations are based on the best available evidence, expert consensus, and stakeholder input, and support health promoting schools. They recognize that students benefit from a balance of learning activities each day that include time spent indoors and outdoors, and a variety of sedentary and movement-based activities.

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Educators, school administrators, policy makers, parents/guardians, caregivers, physicians and other healthcare providers should support students to meet these recommendations. The application of these recommendations should be tailored to accommodate the diverse strengths, needs and interests of individual students.

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The background research informing these recommendations, as well as future research directions, are available at www.sedentarybehaviour.org.

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Recommendations

A Healthy Day Includes:

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• Breaking up periods of extended sedentary behaviour with both scheduled and unscheduled movement breaks
• At least once every 30 minutes for ages 5-11 years.
• At least once every hour for ages 12-18 years.
• Consider a variety of intensities and durations (e.g., standing, stretching breaks, moving to another classroom, active lessons, active breaks).

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• Incorporating different types of movement (e.g. light activities that require movement of any body parts, and moderate to vigorous activities that require greater physical effort) into homework whenever possible, and limiting sedentary homework to no more than 10 minutes per day, per grade level. For example, in Canada this means typically no more than 10 minutes per day in grade 1, or 60 minutes per day in grade 6 ). 

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Recommendations

A Healthy Day Includes:

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• Regardless of the location, school-related screen time should be meaningful, mentally or physically active, and serve a specific pedagogical purpose that enhances learning compared to alternative methods. When school-related screen time is warranted:
• Limit time on devices, especially for students 5-11 years of age.
• Take a device break at least once every 30 minutes.
• Discourage media-multitasking in the classroom and while doing homework.
• Avoid screen-based homework within an hour of bedtime.

• Replacing sedentary learning activities with movement-based learning activities (including standing) and replacing screen-based learning activities with non-screen-based learning activities (e.g., outdoor lessons), can further support students’ health and wellbeing.

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Implementation Strategies*

Educators, school administrators, policy makers, parents/guardians, caregivers, physicians and healthcare providers can implement these recommendations using the four M’s approach:

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1. Manage sedentary behaviour.
• See recommendations above.

2. Encourage Meaningful screen use.
• Prioritize face-to-face interactions over screen use.
• Use screens when they are the best pedagogical tool for the job and likely to enhance learning.
• Prioritize screens for mental and physical engagement, rather than for passive viewing.
• Turn screens off when not in use, including background TV or videos while doing school or homework.
• Avoid screen use during meal and snack times.
• Avoid using screens as the default method for content delivery or classroom management.
• Encourage students to review and self-regulate their screen use, and plan time for outdoor play and physical activity.

Implementation Strategies*

Educators, school administrators, policy makers, parents/guardians, caregivers, physicians and healthcare providers can implement these recommendations using the four M’s approach:

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3. Educators, healthcare providers, parents and caregivers should Model healthy and meaningful screen use.

4. Monitor for signs of problematic screen use and follow-up with a physician or healthcare provider if concerns arise. Signs of problematic screen use can include:
• Complaints about being bored or unhappy without access to technology.
• Difficulty accepting screen time limits.
• Screen use that interferes with school, family activities, sleep, physical activity, offline play, or face-to-face interactions.
• Negative emotions following time spent playing video games, texting or using social media.

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^*Adapted with permission from the Canadian Paediatric Society (Canadian Paediatric Society, 2019).

Stakeholder feedback

148 responses from 23 countries

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• Researchers: 45%
• Educators: 36%
• Healthcare Workers: 16%
• Government 14%
• Parents: 10%
• Students: 7%

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Stakeholder feedback

% Somewhat/Strongly Agree

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The recommendations are clearly stated: 91%

I ____ with how the recommendations are stated: 84%

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The recommendations are realistic for teachers: 65%

The recommendations are realistic for students: 63%

The recommendations will be useful professionally: 66%

The recommendations will be useful personally: 66%

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The recommendations will benefit students regardless of gender, race, ethnicity, nationality or SES: 87%

How to implement within your school community

Maximize Benefits

• Break up prolonged sedentary behaviour with frequent bouts of activity

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• All activity = good activity

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• When using screens, ask yourself “Is this the best tool for the job?”

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• Reach out to healthcare providers when you have concerns

Are screens the best �tool for this job?

Optimal screen use:

• Does it enhance learning?
• Is there a specific pedagogical purpose?
• Are students mentally/physically active when using the screen?

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Less optimal screen use:

• Are students eating?
• Is the purpose entertainment/classroom management?
• Is it simply on in the background?

Acknowledgements

Steering Committee:

Iryna Demchenko

Corey Kuzik

Scott Rollo

Travis Saunders

Mark Tremblay

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Expert Panel:

Stacey Bélanger

Kara Brisson-Boivin

Val Carson

Marsha Costello

Bruno da Costa

Melanie Davis

Susan Hornby

Wendy Huang

Barbi Law

Chris Markham

Maribeth Rogers Neale

Jo Salmon

Jennifer Tomasone

Antonius van Rooij

Lucy-Joy Wachira

Katrien Wijndaele

Michelle Ponti

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Systematic Review Co-Authors:

Yeongho Hwang

Simone J J M Verswijveren

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Stakeholders who provided feedback

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PHE Canada