Cited by 131Physical Activity and HealthObesity, Physical Activity, DietChildren's Physical and Motor Development

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Development of WHO Guidelines on Physical Activity, Sedentary Behavior, and Sleep for Children Less Than 5 Years of Age

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Willumsen, Juana, Bull, Fiona·2020·Journal of Physical Activity and Health

DOI 10.1123/jpah.2019-0457

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Abstract

Background: Physical inactivity is a leading risk factor for global mortality and a contributor to the increase in overweight and obesity. The Commission on Ending Childhood Obesity identified the need for guidance on physical activity, particularly for early childhood (<5 y), a period of rapid physical and cognitive development. Methods: The World Health Organization (WHO) has developed the first global guidelines on physical activity, sedentary, and sleep behaviors, building upon high-quality systematic reviews. The WHO guideline process is a rigorous, systematic, and transparent method for the development of recommendations, using the Grading of Recommendations Assessment, Development and Evaluation Evidence to Decision framework. It takes into consideration the strength of the evidence as well as values and preferences, benefits and harms, equity and human rights. Results: The authors summarize the first global guidelines on time spent in physical activity, sedentary behavior (including screen time and time spent restrained), and sleep patterns in infants (birth to 1 y of age), toddlers (1–2.9 y of age), and preschoolers (3–4.9 y of age). Conclusions: WHO is actively disseminating and supporting implementation of these guidelines by national adoption and adaptation, through links with early childhood development and the Global Action Plan on Physical Activity 2018–2030.

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Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based surveys with 1·9 million participants
Guthold, R., Stevens, G. A., Riley, L. M., & Bull, F. C. (2018) · The Lancet Global Health · doi:10.1016/s2214-109x(18)30357-7 · Cited by 4,819
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Systematic review of the relationships between combinations of movement behaviours and health indicators in the early years (0-4 years)
Kuzik, N., Poitras, V. J., Tremblay, M. S., Lee, E.-Y., Hunter, S., & Carson, V. (2017) · BMC Public Health · doi:10.1186/s12889-017-4851-1 · Cited by 246
Canadian 24-hour movement guidelines for the early years (0–4 years): exploring the perceptions of stakeholders and end users regarding their acceptability, barriers to uptake, and dissemination
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Show all 8 references

Research works printed but not linked: 8

Carson, 2017, Systematic review of the relationships between physical activity and health indicators in the early years (0–4 years), BMC Public Health, 17, 854, 10.1186/s12889-017-4860-0 · DOI
Poitras, 2017, Systematic review of the relationships between sedentary behaviour and health indicators in the early years (0–4 years), BMC Public Health, 17, 868, 10.1186/s12889-017-4849-8 · DOI
Kuzik, 2017, Systematic review of the relationships between combinations of movement behaviours and health indicators in the early years (0–4 years), BMC Public Health, 17, 849, 10.1186/s12889-017-4851-1 · DOI · Paper page
Riazi, 2017, Canadian 24-hour movement guidelines for the early years (0–4 years): exploring the perceptions of stakeholders and end users regarding their acceptability, barriers to uptake, and dissemination, BMC Public Health, 17, 841, 10.1186/s12889-017-4853-z · DOI
Okely, 2017, A collaborative approach to adopting/adapting guidelines—the Australian 24-hour movement guidelines for the early years (Birth to 5 years): an integration of physical activity, sedentary behavior, and sleep, BMC Public Health, 17, 869, 10.1186/s12889-017-4867-6 · DOI
Chaput, 2017, Systematic review of the relationships between sleep duration and health indicators in the early years (0–4 years), BMC Public Health, 17, 855, 10.1186/s12889-017-4850-2 · DOI
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Perspectives of infant active play: a qualitative comparison of working versus stay-at-home parents
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Unsupervised Screen Exposure and Poor Language Development: A Scoping Review to Assess Current Evidence and Suggest Priorities for Research
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BackgroundResult
Analysis of sleep problem in children aged 1–3 years with autism spectrum disorder in Zhejiang province, China
Yao, D., Wang, S., Li, F., Gao, M., & Shao, J. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.923757 · Cited by 10
“The guidelines issued by the WHO in 2019 define sleep duration <10 h a day is insufficient sleep duration for preschoolers (40).”
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Relationships between Physical Activity Level and Pain in the Spanish Population: A Cross-Sectional Study
Denche-Zamorano, Á. M., Franco-García, J. M., Pastor-Cisneros, R., Salas-Gómez, D., Collado‐Mateo, D., Olivares, P. R., & Adsuar, J. C. (2022) · Journal of Personalized Medicine · doi:10.3390/jpm12101591 · Cited by 10
“In addition, the way of quantifying the level of physical activity using indirect instruments could also be a limitation as several studies have reported that the IPAQ–SF overestimates PA level [41]; however, it has shown a good correlation with measurements in some populations [42].”
Result
Effects of Combined Movement and Storytelling Intervention on Fundamental Motor Skills, Language Development and Physical Activity Level in Children Aged 3 to 6 Years: Study Protocol for a Randomized Controlled Trial
Vargas-Vitoria, R., Faúndez-Casanova, C., Cruz-Flores, A., Hernández-Martínez, J., Jarpa-Preisler, S., Villar-Cavieres, N., Muzzio, M. T. G., González, L. G., Valderrama, J. F., & Valdés-Badilla, P. A. (2023) · Children · doi:10.3390/children10091530 · Cited by 10
“A physically active lifestyle should begin at an early age and continue throughout the life cycle [1,2], with a synergistic relationship between physical activity and motor competence [3].”
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Predictors for Screen Time Exposure among Children between 3 and 5 Years Old in Southern Brazil
Frata, B., de Souza, J. M., Montemezzo, D., Henning, E., Menegol, N. A., Okubo, R., Sonza, A., & Sanada, L. S. (2021) · Journal of Tropical Pediatrics · doi:10.1093/tropej/fmab092 · Cited by 8
Investigating young children’s physical activity through time and place
Remmers, T., Koolwijk, P., Fassaert, I., Nolles, J., de Groot, W., Vos, S. B., de Vries, S. I., Mombarg, R., & van Kann, D. (2024) · International Journal of Health Geographics · doi:10.1186/s12942-024-00373-8 · Cited by 8
“In 2020, the WHO formulated specific international guidelines for early childhood [18].”
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The effect of replacing sedentary behaviour with different intensities of physical activity on depression: A meta-analysis of isotemporal substitution studies
Liu, X., Du, Z., Wang, L., Tian, J., Zhang, L., & Li, Y. (2025) · Mental health and physical activity · doi:10.1016/j.mhpa.2025.100677 · Cited by 8
Evaluation of the Dissemination of the South African 24-Hour Movement Guidelines for Birth to 5 Years
Draper, C. E., Silubonde, T. M., Mukoma, G., & van Sluijs, E. M. F. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18063071 · Cited by 8
“This work can inform the dissemination of early years movement guidelines in other countries, including the WHO’s global guidelines [5].”
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Knowledge of Child Health and Affecting Factors Among Preschool Teachers: A Cross-Sectional Study in Chongqing, China
Hu, H., Wu, T., Fan, L., Zuo, K., Chen, L., Zhang, J., & Zhao, X. (2020) · Risk Management and Healthcare Policy · doi:10.2147/rmhp.s280214 · Cited by 8
Eating Habits and Lifestyle Factors Related to Childhood Obesity Among Children Aged 5-6 Years: Cluster Analysis of Panel Survey Data in Korea
Lim, H., & Lee, H. (2024) · JMIR Public Health and Surveillance · doi:10.2196/51581 · Cited by 7
“The importance of these early childhood lifestyle habits is highlighted by the World Health Organization’s guidelines for children’s health, which also discuss the importance of forming lifestyle habits in children before the age of 5 years [ 16].”
Background
Associations between sedentary types, sedentary patterns and cognitive ability in preschool children
Li, D., Chia, M., Low, S. T., Chua, T. B. K., Ma, J., Kim, H., Zhang, L., Tian, L., & Li, X. (2024) · European Journal of Pediatrics · doi:10.1007/s00431-024-05813-y · Cited by 7
“Quantitative SB recommendations based on evidence are crucial [87, 88], and current guidelines focus on reducing prolonged SB with thresholds for different age groups and contexts [89–91].”
An Environmental Scan of Existing Canadian Childcare Resources Targeting Improvements in Health Behaviours
Carson, V., Predy, M., Hunter, S., Storey, K., Farmer, A. P., McIsaac, J. D., & Flynn, J. (2021) · Early Childhood Education Journal · doi:10.1007/s10643-021-01266-2 · Cited by 7
“…Study, Faculty of Education, Mount Saint Vincent University, Halifax, NS, Canada 5 APPLE Schools, Edmonton, AB, Canada 1 3 health behaviour guidelines, including the WHO Guidelines on Physical Activity, Sedentary Behavior, and Sleep for Children Less Than 5 Years of Age (Juana & Fiona, 2020).”
Background
Perceptions of the South African 24-Hour Movement Guidelines for Birth to 5 Years: A Qualitative Study
Draper, C. E., Silubonde, T. M., Mukoma, G., & van Sluijs, E. M. F. (2021) · Journal of Physical Activity and Health · doi:10.1123/jpah.2021-0483 · Cited by 7
“12 The workshop discussion questions formed the basis of an initial thematic framework, and this was further developed to encompass the following main themes for the workshop discussions that are presented in this paper: (1) importance of the early years, (2) positive perceptions of the guidelines, and (3) importance…”
Background
The impact of different data handling strategies on the proportion of children classified as meeting 24-h movement guidelines and associations with overweight and obesity
Pfledderer, C. D., Burkart, S. A., Dugger, R., Parker, H., von Klinggraeff, L., Okely, A. D., Weaver, R. G., & Beets, M. W. (2024) · Journal of Activity Sedentary and Sleep Behaviors · doi:10.1186/s44167-023-00041-5 · Cited by 7
It’s Time to Put the Nap in Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC): A Systematic Review Demonstrating the Impact of Child Care on Sleep Outcomes in Early Childhood
von Ash, T., O’Hagan, B., Gupta, A., Deokule, N., Josephson, A., Chmielewski, S., & Chung, A. (2025) · Childhood Obesity · doi:10.1089/chi.2024.0384 · Cited by 5
COVID-19 and children’s screen time in Ceará, Brazil: a repeated cross-sectional survey
Rocha, H. A. L., Correia, L. L., Leite, Á. J. M., Machado, M. M. T., Lindsay, A. C., Rocha, S. G. M. O., Campos, J. S., Silva, A. C. E., & Sudfeld, C. R. (2022) · Journal of Children and Media · doi:10.1080/17482798.2021.2007967 · Cited by 5
“Based on AAP and WHO guidelines, an elevated level of screen exposure was defined as (Media Use in SchoolAged Children and Adolescents, 2016; Willumsen & Bull, 2020): Elevated levels are above one hour/day (for 3–4-year-olds) and above 2 hours (for 5–6-year-olds).”
BackgroundMethod
Effects of a physical activity-enhanced curriculum on increasing physical activity and improving physical fitness in preschoolers: Study protocol for a cluster randomized controlled trial (KID-FIT study)
Au, W. W., Leung, C. K., Lin, S. H., Yu, A. P., Fong, D., Wong, S. H., Chan, D. K. C., Capio, C. M., Yu, C. C.-W., Wong, S. W. S., et al. (2025) · Journal of Exercise Science & Fitness · doi:10.1016/j.jesf.2025.03.001 · Cited by 7
“…population, 61,66,67 and highly heterogenous study designs limited the certainty and implication of effect sizes pooled in reviews, 55,56,130 and 2) despite limited compa-rability to our intervention design, a review that conducted a subgroup analysis with interventions incorporating structured…”
A Food-Based Science, Technology, Engineering, Arts, and Mathematics Learning Program May Improve Preschool Children’s Science Knowledge and Language Skills in Rural North Carolina
Stage, V. C., Dixon, J. B., Grist, P., Wu, Q., Hegde, A. V., Lee, T., Lundquist, R., & Goodell, L. S. (2025) · Nutrients · doi:10.3390/nu17091523 · Cited by 4
Suboptimal movement behaviours among children under two years old in early childhood education institutions in urban China: A cross-sectional study
Wang, X., Huang, Y., Meng, N., Zhang, J., Wu, Q., & Zhang, Y. (2023) · Journal of Global Health · doi:10.7189/jogh.13.04110 · Cited by 4
Integrating Fundamental Movement Skills and Mathematics in Early Childhood: A Pilot Study
Capio, C. M., Cheung, S. K., Fung, S. S. W., & Hu, X. (2024) · Children · doi:10.3390/children11040457 · Cited by 11
“Despite such associated benefits, insufficient PA continues to be a global health problem contributing to obesity and overall mortality [4].”
Background
Clinician and Early Childhood Educator Knowledge and Advice Given to Parents Regarding Physical Activity, Screen Time and Sleep. An Observational Study
Hewitt, L., Frohmuller, C., Wall, J., & Okely, A. D. (2021) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2022.06.010 · Cited by 4
Employees’ perception of the impacts of global health crisis on work performance and sentiments about future career: the case of early childhood education
Akpan, I. J., Warner, T., Cardona, T. L. C., Schlosser, N., & Hennis, B. (2024) · European Early Childhood Education Research Journal · doi:10.1080/1350293x.2024.2305410 · Cited by 3
“The primary purpose is to improve children ’ s overall well-being and enhance development, encompassing social, cognitive, emotional, and physical growth (Dankiw et al. 2020; Pascal and Bertram 2001; Bartlett and Smith 2019; Willumsen and Bull 2020).”
“Instead of Being on a Screen You Can Be More Out There and Enjoy Your Life”: Young People’s Understandings of Physical Activity for Health
Wilson, N., Cale, L., & Casey, A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20105880 · Cited by 4
An Effective and Playful Way of Practicing Online Motor Proficiency in Preschool Children
Adamopoulou, E., Καρατράντου, Κ., Kaloudis, I., Κrommidas, C., & Gerodimos, V. (2024) · Children · doi:10.3390/children11010130 · Cited by 3
Pre-school-based behaviour change intervention to increase physical activity levels amongst young children: a feasibility cluster randomised controlled trial
Al-walah, M. A., Donnelly, M., Alhusaini, A. A., & Heron, N. (2024) · Frontiers in Public Health · doi:10.3389/fpubh.2024.1379582 · Cited by 4
24-Hour Movement Behaviours and Considerations of Disability: An Updated Review of Child Care Legislation in Canada
Vanderloo, L. M., Puchiele, A. A., Bruijns, B. A., Carsley, S., & Tucker, P. (2025) · International journal of child care and education policy/International journal of child care and education · doi:10.1186/s40723-025-00158-x · Cited by 3
“…these important documents resulted in a ripple effect, whereby other countries developed their own respective guidelines (New Zealand Ministry of Health, 2017; Okely et al., 2017; Tremblay et al., 2017), including the World Health Organization (WHO) (Trem-blay et al., 2017; Willumsen & Bull, 2020).”
24-hour movement behaviours are cross-sectionally associated with cognitive function in healthy adults aged 55 years and older
Marent, P.-J., Cardon, G., Dumuid, D., Albouy, G., & van Uffelen, J. G. Z. (2025) · Scientific Reports · doi:10.1038/s41598-025-22541-x · Cited by 7
“This approach has recently gained increasing attention in public health promotion 31 and has already been incorporated into 24-hour movement guidelines for general health 32,33 .”
Effect of Physical Activity Interventions on Brain Structure and Function Changes in Healthy Children: A Systematic Review
Zhou, W., Saiz-González, P., Aragon, R. R., Adams, K. T., & Gao, Z. (2023) · Quest · doi:10.1080/00336297.2023.2217361 · Cited by 3
“The World Health Organization (WHO) announced More Active People for a Healthier World to initiate a global action with a target of a 15% relative reduction in physical inactivity among adolescents and adults by 2030 (Bull et al., 2020).”
BackgroundMethod
A quality of body posture in early school-aged children after a pandemic and selected lifestyle components – preliminary report
Wysocka, R., Sołtys, J., Mikuś-Nowak, M., Klein, E. G., Jaunich, A., & Brzęk, A. (2024) · Annales Academiae Medicae Silesiensis · doi:10.18794/aams/190425 · Cited by 3
Disseminating the movement behaviour guidelines for young children in Hong Kong: process and outcome evaluations
Capio, C. M., Jones, R. A., Ng, C. S. M., Sit, C. H. P., & Chung, K. K. H. (2025) · International journal of child care and education policy/International journal of child care and education · doi:10.1186/s40723-025-00149-y · Cited by 2
Temporal Associations of Physical Activity Volume, Intensity, and Timing With Sleep in Preschool‐Aged Children
Huang, Y., Feng, J., Sit, C. H. P., Reilly, J. J., & Khan, A. (2025) · Journal of Sleep Research · doi:10.1111/jsr.70162 · Cited by 3
Cross-sectional and longitudinal associations between 24-hour movement behaviors and growth, motor, and social-emotional development in early childhood
Arts, J., Altenburg, T. M., Lettink, A., Verhoeff, A. P., Gubbels, J. S., & Chinapaw, M. J. M. (2025) · Journal of Activity Sedentary and Sleep Behaviors · doi:10.1186/s44167-025-00085-9 · Cited by 2
“To support the healthy growth and development of young children, the World Health Organization (WHO) has formulated 24-hour movement guidelines tailored to different age subgroups: infants (0–1 year), toddlers (1–3 years), and preschoolers (3–5 years) [14, 15].”
Translation, Cross-Cultural Adaptation, and Validation of the Persian Version of Thailand Physical Activity Children Survey Questionnaire
Khosravi, A., Kelishadi, R., Selk-Ghaffari, M., Hassanmirzaei, B., & Kordi, R. (2022) · International Journal of Preventive Medicine · doi:10.4103/ijpvm.ijpvm_705_20 · Cited by 2
“[1] Engaging in physical activity programs during childhood is a golden opportunity to achieved active lifestyle habits.[2] Based on the World Health Organization (WHO) guidelines, children and youth aged 5–17 years should engage in a minimum of 60 minutes of moderate to vigorous intensity daily physical activity.”
Background
The Relationship Between Screen Time, Social Network Usage, and Physical Activity with Depression in Students at Qazvin University
Ghaderi, D. (2024) · Asian Journal of Sports Medicine · doi:10.5812/asjsm-147095 · Cited by 2
Association between meeting the 24-hour movement guidelines and cardiometabolic risk factors in toddlers, preschoolers, children, and adolescents: A systematic review and meta-analysis
Ding, H., Jiang, L., Seo, H., & Chun, B. (2025) · Journal of Sports Sciences · doi:10.1080/02640414.2025.2547160 · Cited by 2
“Previous research has similarly high-lighted the limitations of single-behavior analyses (Julian et al., 2021; Rollo et al., 2020; Willumsen & Bull, 2020).”
Childhood obesity prevention: what can be achieved?
Gomahr, J., Julian, V., Thivel, D., Maruszczak, K., Schneider, A.-M., & Weghuber, D. (2022) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000831 · Cited by 4
“1), taking the formof supervised games promoting reaching, stretching, crawling, running, kicking, throwing and catching [38,39].”
Background
Nutzung von elektronischen Geräten und deren Einfluss auf Schlaf und Lernleistung bei Kindern und Jugendlichen
Stampfer, B., Weiss, E. M., & Canazei, M. (2023) · Lernen und Lernstörungen · doi:10.1024/2235-0977/a000403 · Cited by 2
The Effect of Using Anchored Wake Time to Derive 24‐h Device Measured Circadian Physical Behavior Patterns
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“Love, You Need to Give Your Child Love”: Mothers’ Perceptions of Nurturing Care for Young Children in South Africa
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Development and preliminary validation of a Chinese Physical Activity Parenting Practices Scale (3–6 years)
Na, R., Liang, Y., Zhang, H., Yang, Z., Li, N., Zhang, W., Tang, H., Ye, W., Zhang, L., Jiang, X., et al. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1560244 · Cited by 1
Developing International Consensus on Key Indicators for a 24-Hour Movement Behaviour Report Card in Early Childhood: A Twin-Panel Delphi Study
Huang, Y., Zhang, D., Tremblay, M. S., Wong, M. C. S., Sit, C. H. P., Wong, S. W. S., Chan, D. K. C., Wong, S. H., The Collaborative Author Group, Aadland, E., et al. (2025) · Sports Medicine - Open · doi:10.1186/s40798-025-00905-x · Cited by 1
“The World Health Organization (WHO) have provided age-specific recommendations on combinations of these movement behaviours in a 24-h day for children under 5 years [4].”
Influential
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“Understanding the impact of sleep and other daily behaviours on health outcomes requires analytic methods that reflect the co-dependent nature of time-use (Willumsen and Bull 2020; Pedišić et al. 2017).”
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“In support of this 24-h framework, the World Health Organization (WHO) published comprehensive movement guidelines in 2019 for children under five years of age, offering distinct recommendations specifically tailored for infants, toddlers, and preschool-aged children [8].”
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LATIHAN BOOTCAMP MEMBANTU MENINGKATKAN KEBUGARAN KARYAWAN INDOFOOD
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“lifestyle routines are open to changes and adaptations [8].”

Authors: Willumsen, J., & Bull, F.
Affiliations: World Health Organization (CH)
ORCID: Willumsen, Juana
Bull, Fiona
Venue: Journal of Physical Activity and Health
Publisher: Human Kinetics
Published: 2020-01-01
Volume: 17
Issue: 1
Pages: 96-100
ISSN: 1543-3080 (ISSN-L)
1543-5474
DOI: 10.1123/jpah.2019-0457
OpenAlex: W2996781162
Cited by: 131
References: 8
Citations by year: 2026: 14 · 2025: 22 · 2024: 17 · 2023: 17 · 2022: 22 · 2021: 22 · 2020: 17
FWCI: 10.49
Type: journal article
Language: en
Open access: bronze
doi.org
Locations: Journal of Physical Activity and Health (publishedVersion)
PubMed (publishedVersion)
Funders: Public Health Agency of Canada
Public Health Agency
Topics: Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
Social Sciences › Psychology › Developmental and Educational Psychology › Children's Physical and Motor Development
Keywords: physical activity guidelines, sedentary behavior, sleep duration, children under five, infants, toddlers, preschool children, screen time, childhood obesity, GRADE framework, early childhood development
MeSH terms: Child, Preschool, Female, Humans, Male, Risk Factors, Sleep, World Health Organization, Exercise, Sedentary Behavior

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Development of WHO Guidelines on Physical Activity, Sedentary Behavior, and Sleep for Children Less Than 5 Years of Age

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