RESEARCH INSTITUTE
Thinking Outside the Gym: An Integrated
Perspective for Healthy Movement
Behaviours in Early Childhood
Mark Tremblay, Ph.D., D.Litt. (hons), FACSM, CSEP-CEP
Director, Healthy Active Living and Obesity Research Group
Children’s Hospital of Eastern Ontario Research Institute
Professor, Department of Pediatrics, University of Ottawa
Chair, Active Healthy Kids Global Alliance
RESEARCH INSTITUTE
I have received consulting, speaking, travel and/or research support from:
Canadian Institutes of Health Research
Canadian Population Health Initiative
Public Health Agency of Canada
Statistics Canada
Dairy Farmers of Canada
Laval University
University of British Columbia
University of Victoria
University of Alberta
University of Calgary
University of Saskatchewan
University of Manitoba
Lakehead University
Laurentian University
Nipissing University
University of Toronto
University of Western Ontario
University of Moncton
University of Guelph
York University
Queen’s University
University of Ottawa
McGill University
UPEI
University of New Brunswick
University of Guadalajara
University of South Australia
Conference Board of Canada
University of Maringa
Shanghai Sports University
The Moblees
West Texas A&M University
Dalhousie University
University of Jyvaskyla
The Lawson Foundation
Alberta Centre for Active Living
Heart and Stroke Foundation of Ontario
Ontario Ministry of Health Promotion
Active Healthy Kids Canada
ParticipACTION
Fundacion Mexicana para la Salud
Canadian Obesity Network
New Brunswick School District #2
City of London
Manitoba Institute of Child Health
Chronic Disease Prevention Alliance of Canada
Canadian Federation of Biological Societies
Heart and Stroke Foundation of Canada
Heart and Stroke Foundation of Ontario
StepsCount
Chatham-Kent Public Health Unit
Huron-Perth Public Health Unit
Ontario School Boards Association
Bruce-Grey Public Health Unit
Kellogg Canada
World Health Organization
Ontario Ministry of Health Promotion
Ontario Ministry of Health and Long-Term Care
Strathclyde University
American Society of Bariatric Physicians
Fuzhou Normal University
American College of Advanced Medicine
Ophea
Respironics, Inc.
Physical and Health Education Canada
Upper Canada District School Board
Ottawa Catholic School Board
Canadian Society for Exercise Physiology
Australian Council for Health, PE and Rec
Halton Health Region
Peel Health Region
Canadian Home Economics Foundation
Recreation and Parks Association of Yukon
Capital Health Authority
Newfoundland and Labrador Parks & Rec
Refreshments Canada
NB Power
New Brunswick Health and Wellness
Alberta Health and Wellness
Nova Scotia Recreation Commission
PEI Health
Canadian Fitness and Lifestyle Res Institute
CAHPERD
Health Canada
Statistics Canada
Macro International
CHEO Research Institute
Jalisco Ministry of Health
World Obesity Federation
Canada Foundation for Innovation
Thunder Bay Public Health
South West University (China)
Glasgow Caledoinan University
Champlain LHIN
Champlain Cardiovascular Disease Network
Medical Research Fund of New Brunswick
North American Soc for Ped Exercise Med
Interprovincial Sport and Recreation Council
Pennington Biomedical Research Center
Diabeaters Inc.
CAMBIO
Nanjing University
Shangdong University
Beijing Sport University
Ontario Society for Health and Fitness
World Health Organization
England Department of Health
Wellcome Trust
McMaster University
Cancer Prevention Alliance of Canada
C-CHANGE
TROPIC
Alberta School Boards Association
Canadian School Boards Association
Cardel Place
Coca-Cola Company
International Life Sciences Institute
Discovery Vitality (South Africa)
ActionSante (Switzerland)
Ontario College of Family Physicians
University of South Australia
Canada Foundation for Innovation
South Africa Nutrition Society
Da Lian Department of Education
Public Heath Ontario
RESEARCH INSTITUTE
RESEARCH INSTITUTE
Presentation Overview
• Status of healthy active living in the early years
• Canadian guidelines for the early years
• An integrated perspective on healthy moving
– International comparisons
– Evidence along the movement continuum
– More than just “be active”
• Some thoughts about doing things differently
RESEARCH INSTITUTE
THE HEALTH CONTINUUM
Optimum
Wellness
increased functional capacity
increased health contingency
Death
morbidity
detectable
illness
threshold
RESEARCH INSTITUTE
Are we mortgaging the health of our population?
increased functional capacity
increased health contingency
morbidity
detectable illness
threshold
Optimum
Wellness
increased functional capacity
increased health contingency
Role for you!
morbidity
Death
RESEARCH INSTITUTE
Designed to Move: A Physical Activity Action Agenda. 2012
RESEARCH INSTITUTE
Are we getting healthier?
Previous generation (1924-48) vs baby boomers (1948-1964)
Indicator
Previous
Boomers
excellent health
32.0%
13.2%
walking assistance
3.3%
6.9%
work limitations
10.1%
13.8%
functional limitations
8.8%
13.5%
obesity
29.4%
38.7%
regular exercise
49.9%
35.0%
no regular PA
17.4%
52.2%
hypertension
36.4%
43.0%
hypercholesterolemia
33.8%
73.5%
King et al. JAMA Int. Med. 173:385-6, 2013
RESEARCH INSTITUTE
Trends in drug expenditures in Canada
30
25
20
15
10
5
11
20
09
20
07
20
05
20
03
20
01
20
99
19
97
19
95
19
93
19
91
19
89
19
87
19
85
0
19
$ in billions
35
CIHI, 2013
RESEARCH INSTITUTE
19% overweight
15% obese
34% total
RESEARCH INSTITUTE
19% overweight
11% obese
30% total
RESEARCH INSTITUTE
Portrait of a typical Canadian 12 year old
Tremblay et al. Health Reports, 2010
RESEARCH INSTITUTE
CANADIAN PHYSICAL ACTIVITY
GUIDELINES FOR THE EARLY YEARS
Aged 0-4 years
RESEARCH INSTITUTE
RESEARCH INSTITUTE
Research question
What is the frequency, intensity, time and
type of physical activity, as measured by
direct and indirect methods, associated with
improved health indicators in preschool
aged children (0-4 years)?
RESEARCH INSTITUTE
Age groups
•
•
•
•
Infants: 0 - 1.0 years
Toddlers: 1.1 - 3.0 years
Preschoolers: 3.1 - 4.99 years
Defined collectively as “the early years”
Canadian Society for Exercise
Physiology, 2012
RESEARCH INSTITUTE
Health Indicators
Health Indicator
Infant
(<1 y)
Toddler
(1-2 y)
Preschool
(3-4 y)
Critical
Critical
Critical
Unimportant
Important
Critical
Motor development
Critical
Critical
Critical
Psychosocial health
Unimportant
Critical
Critical
Cognitive development
Important
Important
Critical
Cardiometabolic health
Unimportant
Unimportant
Important
Critical
Critical
Critical
Adiposity
Bone
Risks (injury)
RESEARCH INSTITUTE
11,222
18
12,742
participants
RESEARCH INSTITUTE
What did we find
•
•
•
•
•
5 studies in infants
2 studies in toddlers
11 studies in preschoolers
12,742 enrolled participants from 8 countries
Articles from 1972 to 2011
RESEARCH INSTITUTE
What is the evidence
“In infants, there was low- to moderate-quality evidence to suggest that
increased or higher physical activity is associated with improved measures of
adiposity, motor skill development, and cognitive development.”
“In toddlers, there was moderate-quality evidence to suggest increased or
higher physical activity was positively associated with bone and skeletal
health.”
“In preschoolers, there was low- to high-quality evidence on the relationship
between increased or higher physical activity and improved measures of
adiposity, motor skill development, psychosocial health, and cardiometabolic
health indicators.”
RESEARCH INSTITUTE
Physical Activity Guidelines
Guidelines: Agreement
527 responses – 94% agree
Guidelines: Clarity
524 responses – 92% agree
63.90%
63.2%
29.2%
29.54%
2.1%
2.12%
5.41%
5.3%
0.19%
0.2%
68.80%
67.4%
27.71%
27.1%
1.94%
1.9%
3.29%
3.2%
0.39%
0.4%
331
153
11
28
1
355
143
10
17
2
Completely Somewhat
agree
agree
Neither
agree nor
disagree
Somewhat Completely
disagree
disagree
Completely Somewhat
agree
agree
Neither
agree nor
disagree
Somewhat Completely
disagree
disagree
RESEARCH INSTITUTE
Knowledge Translation: Tools and Resources published
online: csep.ca/guidelines
RESEARCH INSTITUTE
Clinical Practice Guideline
Development Report (AGREE
Report)*
Scientific Statements for
professionals
Backgrounder
Q&A
*available in English only
Information Sheets for
professionals and the public
Glossary of Terms
Media Release
RESEARCH INSTITUTE
RESEARCH INSTITUTE
Messaging
RESEARCH INSTITUTE
Messaging
RESEARCH INSTITUTE
RESEARCH INSTITUTE
RESEARCH INSTITUTE
RESEARCH INSTITUTE
RESEARCH INSTITUTE
An Active Day?
6 hours
30 min
30 min
30 min
YES!
45 min
15 min
3 hours
4 hours
RESEARCH INSTITUTE
Sitting Time
Deaths per 10,000 person-years
180
Active
160
Inactive
p<0.001
140
120
p=0.008
100
80
60
40
20
0
<25%
25%
50%
75%
>75%
Katzmarzyk et al. MSSE. 41(5): 998-1005, 2009
RESEARCH INSTITUTE
Breaks In Sedentary Time
Dunstan et al, 2010 (Touch Briefings)
RESEARCH INSTITUTE
Benefits of Breaks in Sedentary Time
Independent of total sedentary time and moderateto-vigorous intensity activity time, increased breaks
in sedentary time were beneficially associated with
waist circumference, BMI, triglycerides, and 2-h
plasma glucose.
Healy et al. 2008 (Diabetes)
RESEARCH INSTITUTE
Katzmarzyk. Med Sci Sport Exerc. 46:940-946, 2014
RESEARCH INSTITUTE
Systematic review of the relationship between sedentary
behaviour and health indicators in school-aged children and youth
(232 studies, 983,840 participants)
This review found that being sedentary for more than 2
hours per day was associated with
• unfavourable body composition
• decreased fitness
• lowered scores for self esteem and pro-social behaviour
• decreased academic achievement
Tremblay et al. IJBNPA 8:98, 2011
RESEARCH INSTITUTE
RESEARCH INSTITUTE
Associations of sedentary behavior, sedentary bouts and
breaks in sedentary time with cardiometabolic risk in
children with a family history of obesity
Co-authors: Mark Tremblay, Marie-Ève Mathieu, Mélanie Henderson, Jennifer O’Loughlin,
Angelo Tremblay and JP Chaput
Acknowledgements: Participating families, Katherine Gray-Donald, Marie Lambert
Saunders et al. PLOS ONE, 2013
RESEARCH INSTITUTE
Physical Activity: 65 mins/day
Sedentary time: 8 hours/day
Sedentary Breaks: Frequent
Physical Activity: 65 mins/day
Sedentary time: 8 hours/day
Sedentary Breaks: Infrequent
RESEARCH INSTITUTE
Physical Activity: 65 mins/day
Sedentary time: 8 hours/day
Screen Time: 1 hour/day
Physical Activity: 65 mins/day
Sedentary time: 8 hours/day
Screen Time: 5 hours/day
RESEARCH INSTITUTE
Movement variability is associated with clustered
cardiometabolic disease risk in American youth
Co-authors: Val Carson and Mark Tremblay
Acknowledgements: Participating families
Saunders et al., in revision (IJBNPA)
RESEARCH INSTITUTE
Physical Activity: 65 mins/day
Sedentary time: 8 hours/day
High Movement Variability
Physical Activity: 65 mins/day
Sedentary time: 8 hours/day
Low Movement Variability
RESEARCH INSTITUTE
Optimal levels of cardiometabolic disease risk are
Thelikely
Take-Home
Message
most
to be seen
in children who:
1. Limit their time engaging in screen-based
sedentary behaviours.
2. Frequently interrupt their sedentary time.
3. Who have high levels of variability in their
movement behaviours.
RESEARCH INSTITUTE
Sedentary Behaviour Research Network
(SBRN)
• >900 members since Summer 2011
• Members from around the world
• Members include researchers, students,
clinicians, public health professionals and
private sector personnel
• >35,000 visitors/month to the website
www.sedentarybehaviour.org
RESEARCH INSTITUTE
CANADIAN SEDENTARY
BEHAVIOUR GUIDELINES
FOR THE EARLY YEARS
Aged 0-4 years
RESEARCH INSTITUTE
What is sedentary behaviour
RESEARCH INSTITUTE
RESEARCH INSTITUTE
Sleep is NOT a Sedentary Behaviour
RESEARCH INSTITUTE
Appl. Physiol. Nutr. Metab. 2012;37:753–772
RESEARCH INSTITUTE
6,365
22,417
21
participants
RESEARCH INSTITUTE
Conclusions of Systematic Review
1. Increased screen time is associated with unfavourable
measures of adiposity, psychosocial health, and cognitive
development.
2. Available research provides no specific information on the
amount of total sedentary behaviour associated with health.
3. No evidence that there are risks associated with
decreasing screen time and other sedentary behaviours.
RESEARCH INSTITUTE
Sedentary Behaviour Guidelines
Guideline: Agreement
601 responses – 92% agree
Guideline: Clarity
601 responses – 95% agree
76.38%
71.5%
24.87%
23.3%
2.49%
2.3%
2.66%
2.5%
0.36%
0.3%
73.23%
68.7%
25.18%
23.6%
3.19%
3.0%
4.26%
4.0%
0.71%
0.7%
430
140
14
15
2
413
142
18
24
4
Completely
disagree
Completely
agree
Completely
agree
Somewhat Neither agree Somewhat
agree
nor disagree disagree
Somewhat Neither agree Somewhat
agree
nor disagree disagree
Completely
disagree
RESEARCH INSTITUTE
Appl. Physiol. Nutr. Metab. 2012;37:370–380
Knowledge Translation: Tools and Resources published online:
csep.ca/guidelines
RESEARCH INSTITUTE
Clinical Practice Guideline
Development Report (AGREE
Report)*
Scientific Statements for
professionals
Backgrounder
Q&A
*available in English only
Information Sheets for
professionals and the public
Glossary of Terms
Media Release
RESEARCH INSTITUTE
RESEARCH INSTITUTE
Messaging
RESEARCH INSTITUTE
Should we Consider Strategies for…
•
•
•
•
•
•
Reducing auto-dependency – car time
Reducing nature-deficit disorder
Reducing indoor time
Reducing screen time
Reducing chair time
Other indices for reducing sedentary
behaviours
RESEARCH INSTITUTE
FITT vs SITT
•
•
•
•
Frequency
Intensity
Time
Type
•
•
•
•
Sedentary
Interruptions
Time
Type
RESEARCH INSTITUTE
M.S. Tremblay. Assessing the Level of Sedentarism. In C. Bouchard and P.T. Katzmarzyk (Eds.),
Advances in Physical Activity and Obesity. Human Kinetics Publishers, 2010.
RESEARCH INSTITUTE
RESEARCH INSTITUTE
RESEARCH INSTITUTE
RESEARCH INSTITUTE
RESEARCH INSTITUTE
RESEARCH INSTITUTE
RESEARCH INSTITUTE
Global Findings
•
•
•
•
•
Wide global variation exists for most indicators, allowing
potential for global learning transference
Most countries are BOTH leading and lagging in some
indicators
In developed countries it seems we have built it but they are
not coming
When children are given the opportunity/freedom, they like
to move
A mix of physical activity opportunities are needed to reach
desired levels: sport, play, chores, active transportation
RESEARCH INSTITUTE
Research and surveillance gaps
•
•
•
•
•
Global matrix is a start but many areas of the world not
represented - we need to expand this process
More global comparative research is needed on PA and
SB correlates and determinants
Better (especially more representative) and standardized
measures of all indicators are required
Data on young children (toddlers and preschoolers)
needed
Research on play and light activity particularly needed
RESEARCH INSTITUTE
Conclusion From Global Matrix 1.0
The global comparisons remind us of the importance of habitual
physical activity, pervasive throughout the day – not simply
planned and structured doses of movement. Physical activity is
not an item to check off your list of things to do – it is a way of life
– this is the message I glean from the global comparisons.
Together, with our domestic stakeholders and our global partners,
we have new and compelling evidence that can guide innovative
and novel solutions to power the movement to get kids moving –
and inform our work to improve the grades in the years ahead.
RESEARCH INSTITUTE
www.activehealthykids.org
RESEARCH INSTITUTE
RESEARCH INSTITUTE
Can’t See the Forest for the Trees?
• Recommendations for physical activity cluster around
30-60 min MVPA daily
• Surely the other 23.0 – 23.5 hours (96-98%) of the day
matter!
• Why focus on the 2% and not the 98%?
• Beware of behaviour compensation
RESEARCH INSTITUTE
The Movement Continuum
Sedentary
Physiology
sleep
sedentary behaviour
-
Exercise
Physiology
LPA
moderate physical activity
METS
intense exercise
+
RESEARCH INSTITUTE
RESEARCH INSTITUTE
RESEARCH INSTITUTE
RESEARCH INSTITUTE
Engelen et al. J Phys Act Health 12:8-12, 2015
RESEARCH INSTITUTE
RESEARCH INSTITUTE
Updating the Guidelines
We proposed a cyclical update of the guidelines as follows:
Year
Age group to be updated
2012
Young Children ages 0-4 (created)
2014
Children and Youth
2015
Adults
2016
Older Adults
2017
Young Children
2018
Children and Youth
2019
Adults
2020
Older Adults
RESEARCH INSTITUTE
Canadian Integrated 24-hour Movement Behaviour
Guidelines:
Guideline Development Meeting #1
Montebello, QC
December 8-10, 2014
RESEARCH INSTITUTE
RESEARCH INSTITUTE
RESEARCH INSTITUTE
RESEARCH INSTITUTE
Key concepts
•
•
•
•
Whole day thinking – compositional analyses
Habitual
Patterns may matter – movement variability
Multiple intervention entry points – can be
personalized
• Back to basics thinking
–
–
–
–
Eat well
Move well
Sleep well
Avoid toxins
RESEARCH INSTITUTE
RESEARCH INSTITUTE
“we spend the first two years of life
teaching kids to walk and talk – and
then the next 16 years telling them to
sit down and shut up”
anonymous
“they have listened – now we need
to fix it”
common sense
RESEARCH INSTITUTE
“Change will not come if we wait
for some other person or some
other time. We are the ones
we’ve been waiting for. We are
the change we seek.”
Barack Obama
RESEARCH INSTITUTE