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Compliance with the 24-hour movement behaviour guidelines among children and adolescents with disabilities: a systematic review and meta-analysis

樱花视频 volume听24, Article听number:听2357 (2024) Cite this article

Abstract

Background

Compliance with the 24-Hour Movement Guidelines (24-HMG: physical activity (PA), screen time (ST), and sleep) has been associated with numerous beneficial health outcomes among children and adolescents. However, there is a lack of consensus on the overall compliance with the 24-HMG specifically among children and adolescents with disabilities. Therefore, this systematic review and meta-analysis aimed to examine the extent to which children and adolescents with disabilities adhere to the 24-HMG globally.

Method

Quantitative studies published in English until May 2023 were sought by searching seven electronic databases: Web of Science, PubMed, SPORTDiscus, CINAHL, MEDLINE, Scopus, Psychology and Behavioural Sciences Collection. This review included studies that identified participants as individuals with disabilities and reported the overall (non) compliance with the 24-HMG among children and adolescents with disabilities.

Results

A total of 13 studies, involving 21,101 individuals (65.95% males), aged 6 to 21 years from 9 countries, were included in the analysis. In general, 7% (95%CI: 0.05鈥�0.09, p鈥�<鈥�0.01) of children and adolescents with disabilities met all three 24-HMG, while 16% (95%CI: 0.13-020, p鈥�<鈥�0.01) did not meet any of the three recommendations. Regarding adherence to individual 24-hour movement behaviour, the rates of compliance were 22% (95%CI: 0.18鈥�0.25, p鈥�<鈥�0.01) for PA, 49% (95%CI: 0.41鈥�0.56, p鈥�<鈥�0.01) for ST, and 59% (95%CI: 0.56鈥�0.61, p鈥�<鈥�0.01) sleep. In relation to numbers of those meeting the 24-HMG, 43% (95%CI: 0.41鈥�0.45, p鈥�<鈥�0.01) met one guideline, while 32% (95%CI: 0.28鈥�0.36, p鈥�<鈥�0.01) met two guidelines.

Conclusion

There is a notable percentage of children and adolescents with disabilities who do not meet the recommended the 24-HMG, which encompasses PA, ST, and sleep. This underscores the pressing requirement to create and execute evidence-based strategies that effectively encourage and assist these individuals with disabilities in adopting and maintaining these movement behaviours.

Peer Review reports

Introduction

Extensive studies have highlighted that regular physical activity (PA), minimizing sedentary behaviour (SB), and adequate sleep are independently associated with favourable health outcomes in children and adolescents [1,2,3], including lower risk of disease [4,5,6,7], better physical fitness [8], greater psychosocial health [9, 10] and improved motor skills [11]. Considering the dynamic interplay and interrelationships of the three behaviours, to maximize overall health, there was a need to introduce a novel movement paradigm that integrates PA, SB, and sleep over a whole day [12]. In 2016, the pioneering Canadian 24-Hour Movement Guidelines (24-HMG) for children and adolescents was released, which provided guidance on the amount of time spent in all intensities of PA, SB and sleep to optimize health benefits [13]. The 24-HMG offer evidence-based recommendations for children and adolescents to ensure a well-balanced 24-hour period, including an accumulation of at least 60听min of moderate-to-vigorous PA, no more than two hours of recreational ST, and uninterrupted 9 to 11听h of sleep for children (6鈥�12 years) and 8 to 10听h for adolescents (13鈥�18 years) [13]. Following this, United States [14], Australia [15], New Zealand [16] and the Asia-Pacific region [17] also gradually developed or adopted the 24-HMG for children and youth, alongside Canada. Sufficient PA, reduced SB and adequate sleep have been demonstrated as the optimal combination for promoting overall health in children and adolescents. Adherence to the 24-HMG is associated with higher multiple health indicators, including reduced adiposity [18], lower cardiometabolic risk [19], enhanced global cognition [14], better mental health [20], decreased risk of internalizing and externalizing behaviours [21], improved executive function [22], higher academic achievement [23], and better quality of life [24], compared to those who meet fewer or none of these guidelines.

Meeting the recommendations within the 24-HMG poses greater challenges for children and adolescents with disabilities compared to their peers without disabilities. This heightened difficulty arises from the nature of disability, which can encompass a wide range of conditions, including physical, sensory, intellectual, or mental health impairments [25, 26]. Meanwhile, disability is frequently viewed as a social construct because it is not solely determined by an individual鈥檚 physical or mental characteristics, but also by how society perceives and responds to those characteristics [27]. To put it differently, disability encompasses not only an individual鈥檚 impairment or condition but also the barriers and discrimination they encounter in society due to those impairments [28]. These barriers and discrimination can manifest as physical (such as lack of accessibility) [29], attitudinal (such as stereotypes and prejudice) [30], or systemic (such as policies that exclude or marginalize people with disabilities) [31]. Notably, research findings consistently indicate that children and adolescents with disabilities, particularly those with attention deficit hyperactivity disorder [32, 33], autism spectrum disorder [34, 35], and cognitive difficulties [36], exhibit lower rates of meeting the recommendations within the 24-HMG, which highlights that children and adolescents with disabilities are often at a greater risk for health issues. Supporting positive 24-hour behaviour changes in children and adolescents is one potential way to reduce these inequalities. Therefore, it is essential to examine adherence to the 24-HMG in children and adolescents with disabilities.

However, to date, no systematic review and meta-analysis has been conducted to specifically synthesize the adherence rate to the 24-HMG among children and adolescents with disabilities - despite the growing body of literature on adherence to the 24-HMG among typically developing children and adolescents [37, 38]. For example, a recent review that incorporated 63 studies, 387,437 participants and 23 countries revealed that 7.12% of youth met all three 24-HMG, and 19.21% meet none of the 3 recommendations [39]. These figures highlight the general difficulty of adherence in typically developing children and adolescents, this challenge is likely even more pronounced among peers with disabilities. With nearly 240听million children and adolescents with disabilities worldwide [40], there is a critical need to investigate the status of their compliance with the 24-HMG and possibly the need to prioritize it, since adherence to the overall 24-HMG was associated with better health related-outcomes in individuals with disabilities [35, 41,42,43,44]. Therefore, this systematic review and meta-analysis aimed to synthesize the existing literature on adherence to the 24-HMG among children and adolescents with disabilities, bridging a research gap and offering evidence-based insights for fostering optimal health and well-being in this underserved population.

Materials and methods

Registration and protocol

The present systematic review and meta-analysis was conducted following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines (PRISMA) [45]. And the protocol was registered at the International Prospective Register of Systematic Reviews (PROSPERO; registration no. CRD42023441111).

Information sources and search strategy

A thorough search was carried out using seven electronic databases: Web of Science, PubMed (NIBI), SPORTDiscus (EBSCO), CINAHL (EBSCO), MEDLINE (EBSCO), Scopus and Psychology and Behavioural Sciences Collection (EBSCO), for relevant publications up to May 2023. Furthermore, we manually reviewed the reference lists of the retrieved articles and systematic reviews to identify any potentially missed relevant studies. A list of key search terms and alternative key search terms were created, combined together using Boolean operators (鈥楢ND鈥�, 鈥極R鈥�), and included in the aforementioned databases for the search. Table听1 provides more details regarding the strategy employed for selecting key search terms. The initial step involved exporting all references to EndNote X9 software, where duplicates were identified and eliminated through a combination of software functionality and manual inspection of the citation list. Subsequently, articles were evaluated for eligibility based on their title and abstract, using the predefined inclusion criteria. Lastly, full-text articles were acquired for studies that met the criteria or could not be excluded solely based on title and abstract. Throughout the process, reasons for excluding articles were carefully documented. Two reviewers (HYR and ZXG) independently determined the studies to be included based on the predefined inclusion and exclusion criteria. Any disagreements between the reviewers were resolved through discussion, and a final decision was reached with the involvement of a third reviewer (RR). The entire search process was conducted on June 20th, 2023.

Table 1 Key search terms strategy in databases
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Selection procedure and eligibility criteria

PICOS provides a structured format to define the key components of the research question: Population, Intervention, Comparison, Outcomes, and Study Design [46]. This precision ensures that the research question is specific and well-defined, especially in systematic reviews and meta-analyses [39, 47]. Studies had to fulfil following criteria concerning PICOS criteria: (1) population: population of children and adolescents aged between 5 and 17 years, or with a mean/ median sample age between 5 and 17 years; participants with disabilities including physical, sensory, cognitive and developmental disabilities; without limit on the multiple disabilities; (2) outcomes: assessed PA, ST and sleep, meeting none of the guidelines, one of the guidelines, two of the guidelines and all three of the 24-HMG; (3) study design: observational, cross-sectional, and longitudinal studies, and intervention studies were included as long as they provided pertinent baseline data; (4) articles published in a peer-reviewed journal with full-text in English between June 16th, 2016 and June 1st, 2023.

The exclusion criteria were defined as follows: (1) studies focusing solely on overweight or obese children and adolescents with disabilities; (2) studies where the title, abstract, or main text explicitly indicated that data collection occurred during the COVID-19 lockdown periods, COVID-19-related lockdowns had a detrimental effect on the movement behaviours of children and adolescents, with stricter lockdowns having a more significant impact [48], which altered behaviours may not reflect typical patterns, introducing potential biases into the analysis; (3) studies based on data from the same surveys or studies to prevent duplication (4) systematic reviews and/or meta-analyses, qualitative and case studies, grey literature, master/ doctoral dissertation, conference articles, and abstracts, comments and press releases, unpublished articles; (5) articles not written in English and (6) articles published prior to June 16th, 2016 because the initial 24-HMG for children and youth were introduced in June 16th, 2016.

Data collection process and data items

Data were extracted and presented based on previous reviews [49,50,51], and the data were organized in Microsoft Excel 2016 (Microsoft Corp, Washington US). Data extraction involved the utilization of a standardized extraction form, and the full texts of the selected studies were independently reviewed by two reviewers (HYR and ZXG). One reviewer (HYR) performed the information extraction from the chosen articles, while another reviewer (ZXG) verified the data for accuracy. In the event of disagreements between the two reviewers, a third reviewer (RR) resolved the discrepancies. All relevant studies underwent meticulous scrutiny to extract various data points, including author(s) name, publication year, geographic location, study design, participant characteristics, sampling time points, main findings, and quality assessment score. Formal data extraction was conducted from June 21st, 2023, and data extraction ended on June 29th, 2023.

Risk of bias assessment

To prevent bias in the assessment of the methodological quality of the articles included in this review, information regarding the author(s), affiliations, date, and source of each study was concealed. Methodological quality was assessed using the Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields [52]. The quantitative checklist was selected as the most appropriate tool for assessing studies with various designs. This assessment tool comprises a 14-item checklist, as outlined in Table听2. Each item was assigned a score: yes鈥�=鈥�2, partial鈥�=鈥�1, no鈥�=鈥�0, or N/A where applicable. The final quality assessment score was determined as a percentage of the relevant items achieved, with any N/A scores excluded from this calculation. Therefore, the exclusion of 鈥淣/A鈥� scores from these calculations provides comparable quality scores between studies, regardless of design. Two reviewers (HYR and ZXG) independently evaluated the methodological quality of the included studies, classifying them as high quality, medium quality, or low quality. Discrepancies in quality assessment were resolved by a third reviewer (RR). Quality was scored as a percentage of the criteria met, enabling comparison of quality across all included studies. Score ranges were categorized into the following 3 categories for these cross-sectional studies: 鈥渉igh quality鈥� (>鈥�75%), 鈥渕edium quality鈥� (scores of 55鈥�75%), and 鈥渓ow quality鈥� (scores of <鈥�55%) [53].

Table 2 Quality assessment checklist of quantitative studies
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Synthesis methods

The meta-analysis was conducted using Stata version 17.0 (StataCorp, College Station, TX, USA). A random-effects meta-analysis was employed to estimate the pooled compliance rate of children and adolescents with disabilities in achieving the 24-hour movement behaviour recommendation. The primary outcome assessed in the meta-analysis was the proportion of individuals meeting all the 24-HMG. Additionally, a random-effects analysis of variance model, specifically designed for meta-analytic research, was used to compare adherence to the 24-HMG across different types of guideline adherence (none, one, two, or all guidelines). The assessment of guideline adherence (none, one, two, or all guidelines) was conducted by utilizing the raw numerators and denominators derived from data obtained in the included studies. Initially, we extracted the essential data directly from the included studies whenever accessible. In instances where the required data was not explicitly provided in the included studies, we employed mathematical calculations to derive the necessary results indirectly. This involved utilizing available data from the included studies, such as tables and figures. The adherence of the outcome and corresponding 95% confidence intervals were reported. The I2 statistic and its associated p-value were used to assess the consistency and heterogeneity of the pooled proportions [54]. It should be noted that qualitative assessment of publication bias is not recommended in proportional meta-analyses [55].

Results

Selection of studies

Initially, a total of 5401 potentially eligible articles were identified from six electronic databases (n鈥�=鈥�5391) and other sources (n鈥�=鈥�10). Following the removal of 1,591 duplicates, 3,800 articles remained. Subsequently, after screening the titles and abstracts, 3,743 articles were excluded, and an additional six articles were excluded as the full reports could not be retrieved. A further 51 articles were excluded after their full texts were screened. Four articles were included via citation searching. Finally, 13 published articles met the inclusion criteria and were included in this systematic review and meta-analysis. Figure听1 illustrates the PRISMA flow diagram of the search and screening process.

Fig. 1
figure 1

The PRISMA flow diagram of the search and screening process

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Quality assessment

Full-quality assessment scores are presented in Table听3. The maximum points that a study could receive was 1. Higher scores indicate better quality of the study. The quality scores of all studies ranged from 0.65 to 1. Specifically, eleven (81.62%) of the studies were considered 鈥榟igh quality; and two (15.38%) were considered 鈥榤edium quality鈥�. In general, the quality of all included studies was assessed as high. Because of these high ratings, it is assumed that study quality will not impact the results, and therefore, the results have not been stratified based on quality assessment scores. All studies (100%) sufficiently described the objectives and questions. They were designed to be easily identified and appropriate to address the research questions/objectives. Most studies met the reporting criteria regarding the method of subject selection (92.31%), demographic information, and descriptions of the participants鈥� characteristics (76.92%). Since all included studies had a cross-sectional design, Items 5, Item 6, and Item 7 were not applicable. In the outcome, most studies indicated defined outcome(s) and exposure measure(s). A small number of studies (38.46%) had larger sample sizes (n鈥�>鈥�1000), nevertheless, the sample sizes of a few studies (23.07%) were probably inadequate (n鈥�<鈥�100). Most studies described analytical methods and provided appropriate variances estimate(s). Few studies (15.38%) indicated information about controlled for confounding, such as BMI z-score, received higher scores, yet Item 12 does not apply to more than half of the studies (53.85%). Lastly, the results of most of the studies were reported in sufficient detail (61.54%), and the results supported the conclusions (92.31%).

Table 3 Quality assessment of included studies
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Characteristics of included studies

Table听4 shows the descriptive characteristics of the 13 included studies. The publication dates ranged from 2019 to 2023. In terms of geographical regions, nine different countries were identified, including four countries (Hongkong, Mainland China, Singapore, and South Korea) in Asia [35, 56, 57], two countries (Finland and Ireland) in Europe [35, 58], two countries (United States and Canada) in North America [32, 34, 35, 42, 59,60,61,62,63,64] and one country (Brazil) in South America [35]. One study included participants from seven distinct countries [35]. All 13 studies were cross-sectional quantitative studies.

A total of 21,101 participants (65.95% males and 30.05% females) aged 6 to 21 were included in this systematic review and meta-analysis. The most common type of disability was neurodevelopmental disorders, including autism spectrum disorder, cerebral palsy, down syndrome, developmental delay, intellectual disability, learning disability, attention deficit disorder/ attention deficit hyperactivity disorder, epilepsy, tourette syndrome and speech disorder, visual impairments, hearing loss, spinal cord injury, muscular dystrophy, neuromuscular disorder, and amputation.

In terms of measuring the three components of the 24-HMG, PA was assessed using ActiGraph accelerometer measures in 2 of the studies [56, 57], parental/caregiver proxy-reported measures in 10 studies [32, 34, 35, 42, 58, 59, 61,62,63,64], and self-reported measures in one study [60]. ST was evaluated through parental/caregiver proxy-report in all 13 studies [32, 34, 35, 42, 56,57,58,59,60,61,62,63,64]. Sleep duration (SD) was obtained by ActiGraph accelerometer measures in 2 studies [56, 57], parental/caregiver proxy-reported measures in 10 studies [32, 34, 35, 42, 58, 59, 61,62,63,64], and self-reported measures in one study [60].

Table 4 Descriptive characteristics of included studies(n鈥�=鈥�13)
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Results of syntheses

Level of compliance with the 24-HMG

From the entire sample, Fig.听2 shows that 16% of children and adolescents with disabilities did not meet any of the 24-HMG (95% CI: 0.13鈥�0.20, p鈥�&濒迟;鈥�0.01).

Fig. 2
figure 2

Forest plot of adherence to none of the three 24-HMG

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As shown in Fig.听3, nearly half (43%) of children and adolescents with disabilities followed to one of three 24-HMG (95% CI: 0.41鈥�0.45, p鈥�&濒迟;鈥�0.01).

Fig. 3
figure 3

Forest plot of adherence to one of three 24-HMG

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Approximately one-third (32%) of children and adolescents with disabilities met two out of the three 24-HMG. The specific percentage breakdown is depicted in Fig.听4 (95% CI: 0.28鈥�0.36, p鈥�&濒迟;鈥�0.01).

Fig. 4
figure 4

Forest plot of adherence to two of three 24-HMG

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Figure听5 illustrates that the overall compliance with the 24-HMG of children and adolescents with disabilities was 7% (95%CI: 0.05鈥�0.09, p鈥�&濒迟;鈥�0.01).

Fig. 5
figure 5

Forest plot of adherence to all the 24-HMG

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Compliance with individual PA, screen time, and sleep guidelines

Figure听6 shows that only 22% children and adolescents with disabilities attained the recommendations of the PA guidelines (95% CI: 0.18鈥�0.25, p鈥�&濒迟;鈥�0.01).

Fig. 6
figure 6

Forest plot of adherence to PA guidelines

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As shown in Fig.听7, close to half of the children and adolescents with disabilities in the whole sample did not meet the ST guidelines. Achievement of the individual guidelines for ST was 49% (95% CI: 0.41鈥�0.56, p鈥�&濒迟;鈥�0.01).

Fig. 7
figure 7

Forest plot of adherence to ST guidelines

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As depicted in Fig.听8, irrespective of meeting the other two guidelines, the proportion of the sample that adhered to the individual guidelines for sleep was 59% (95% CI: 0.56鈥�0.61, p鈥�&濒迟;鈥�0.01).

Fig. 8
figure 8

Forest plot of adherence to sleep guidelines

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Discussion

To the best of our knowledge, this systematic review and meta-analysis represents the first comprehensive examination of the overall (non) compliance with the 24-HMG among children and adolescents with disabilities, which yielded the following key findings: a total of 7% of 21,101 children and adolescents with disabilities from 9 countries adhered to the overall 24-HMG, while 16% met none of the three recommendations; the highest proportion among them is observed in meeting at least one component of the 24-HMG and nearly 32% met two of three movement guidelines; there are significant differences in adherence to individual movement guidelines, more children and adolescents with disabilities meet recommendations for sleep (59%) than for PA (22%) and ST (49%). Based on these findings, it is evident that children and adolescents with disabilities fall far short of the Canadian 24-HMG for Children and Youth. The data obtained from this systematic review and meta-analysis holds potential value in assisting researchers in related fields to customize interventions that effectively address the specific requirements of this special population.

(Non) compliance with the 24-HMG

Only a very small proportion of children and adolescents with disabilities met all three 24-HMG in the present review, which is consistent with the previous systematic review that reported the overall adherence to the 24-HMG was 7.2% in typically developing children and adolescents aged 6鈥�17 years [39]. Furthermore, our review revealed that approximately one-fifth of children and adolescents with disabilities failed to meet any of the three recommendations. This lack of adherence to all three recommendations is particularly concerning because no single behaviour can compensate for the negative effects of the others [65].

The low overall adherence to the 24-HMG can be attributed to a range of factors among this particular cohort, including physical limitations, cognitive impairments, sensory issues, and social barriers. For example, a study by Stanish et al. [66] suggested that difficulties with motor skills, social interactions, and sensory sensitivities in children with autism spectrum disorder; could contribute to their reduced PA levels. While another study by [67] explored SB in children with cerebral palsy, which revealed that factors such as muscle weakness, spasticity, and mobility limitations hindered their ability to engage in active play and led to increased sedentary time. For sleep quality, a study by Krakowiak et al. [68] investigated sleep difficulties in children with autism spectrum disorders and developmental delays; they found that these children experienced higher rates of sleep problems compared to their typically developing peers. Collectively, these studies demonstrate that children with disabilities encounter unique challenges that can impede their ability to meet the 24-HMG.

It is crucial to acknowledge that children and adolescents who meet the 24-HMG tend to report more favourable health indicators compared to those who do not adhere to the guidelines [69]; while achieving all three guidelines is the ultimate goal, meeting at least one or more is better than meeting none. It should also be noted that children who do not achieve guidelines might face increased risk for health as they transition into adolescence [70]. Multiple meta-analyses have emphasized the favourable relationship between meeting all three 24-HMG throughout the lifespan and psychosocial health indicators when compared with meeting fewer or none of these guidelines [69, 71]. Hence, it is vital to consider the combined influences of these 24-hour movement behaviours and the resulting health implications associated with the duration spent in each behaviour. Such considerations can provide valuable insights for the development of effective interventions and treatments for children and adolescents with disabilities.

Our meta-analysis results revealed that 43% of children and adolescents with disabilities met one guideline, while 32% met two guidelines. When comparing these rates with typically developing children and adolescents, some notable differences emerge. In terms of compliance with one guideline, the rates among the typically developing peers were relatively higher 鈭掆��51% in Canada [72], 57% in Austria [73], 47.2% in the Czech Republic [74], and 85.8% in China [75]. This indicates that individuals with disabilities generally exhibit lower rates of compliance compared to their counterparts without disabilities in these countries. With regards to compliance with two guidelines, the rates among typically developing peers were as follows: 25% in Canada [72], 23% in Austria [73], 14.2% in the Czech Republic [74], and 8.8% in China [75]. Surprisingly, these figures appear lower than estimates of proportions of children and adolescents with disabilities in our meta-analysis. This tendency can be attributed to their ability to excel in specific combinations that align with their unique abilities and disability type. For instance, individuals with visual impairments typically participate in fewer screen-based activities, leading to their higher compliance rates with the SB recommendation.

It is important to recognize that children and adolescents with disabilities may encounter distinct challenges compared to peers without disabilities, which could hinder their ability to comply with the overall 24-HMG recommendations. Addressing the low compliance rates among children and adolescents with disabilities requires the development of customized strategies and accommodations to overcome the barriers they face and promote adherence to the guidelines [76]. This may involve creating adaptive PA programs to ensure a variety of options that cater to different abilities and preferences of individuals with disabilities [77]. Equally crucial is parental and caregiver involvement, as providing resources, education, and practical tips fosters a supportive environment at home [47]. Improving the accessibility of recreational facilities contributes significantly to creating spaces that encourage and facilitate PA [67]. By implementing these measures collectively, we can create an inclusive and supportive ecosystem that empowers children and adolescents with disabilities to adhere to 24-HMG, thereby promoting improved overall well-being and positive health outcomes.

Compliance with the individual 24-HMG

Of the three components of the 24-HMG, emphasizing increased adherence to the PA guideline emerges as particularly crucial for children and adolescents with disabilities. This importance is underscored by the fact that only 22% of individuals engage in a sufficient amount of moderate-to-vigorous PA to meet the PA recommendations. Our findings agree with those of the previous study showing that children and adolescents aged 10鈥�17 years with chronic conditions in the United States have the lowest likelihood of meeting the PA guidelines compared to the other 24-HMG [78]. Likewise, existing studies indicate that typically developing children and adolescents are more likely to fall short of meeting PA guidelines when compared to the other components of the 24-HMG [79, 80]. Similar results have been reported in other studies conducted in different populations indicating that PA was identified as the most challenging component of the 24-HMG for all children and adolescents. Specific impairments or functional limitations associated with certain disabilities may directly affect an individual鈥檚 ability to participate in PA, reducing overall activity levels of children and adolescents with disabilities. Consequently, there is a need for additional research and interventions aimed at overcoming obstacles and promoting PA among children and adolescents with disabilities. This entails emphasizing the development of accommodating surroundings, providing inclusive avenues, and implementing educational initiatives to enhance awareness and motivation for consistent engagement in PA.

Within a 24-hour period, individuals typically engage in one activity behaviour at a time, which means that the allocation of time to one specific activity domain inevitably results in less available time for other activity domains [81]. Consequently, achieving a more active lifestyle involves not only emphasizing the promotion of PA but also addressing the need to reduce sedentary time. A longitudinal study by Garcia et al. [82] has shown that decreasing the amount of time spent being sedentary can potentially enhance the PA levels of children with autism spectrum disorder on the following day.

Also, exceedingly more than half of the children and adolescents with disabilities had ST that fell outside the recommended range. This figure appears lower than estimates of proportions previously reported in children without chronic conditions aged 10 to 17 years (60%) [78], as well as in typically developing children and adolescents aged 10 to 17 years (range from 62 to 92%) [72, 80, 83]. A possible explanation is that factors such as limited mobility, social isolation, and reduced opportunities of PA for children and adolescents with disabilities may contribute to increased reliance on screens for entertainment and communication [72, 84, 85]. Several studies have indicated that children and adolescents with disabilities tend to have higher ST usage [86, 87]. It is crucial to consider the unique needs and circumstances of each individual when addressing ST usage in this population. Further research and targeted interventions are necessary to promote healthy ST behaviours and find strategies to mitigate excessive screen use among children and adolescents with disabilities.

Furthermore, our findings indicated that children and adolescents with disabilities were more likely to fulfil the age-appropriate sleep recommendations; than meet the guidelines for PA and screen time. The discrepancy could be explained by supportive environment - the home and school environments may prioritize sleep routines and provide structures that facilitate adequate sleep for children with disabilities, since sleep habits may be more easily controlled and managed compared to PA or screen time. Another possible explanation is health related - some disabilities or medical conditions may require children to have sufficient rest and sleep for their overall well-being and management of their condition. Indeed, this is in line with the results of the previous studies in typically developing children and adolescents and children with chronic health conditions [72, 78, 83]. The impact of sleep on cognitive, behavioural, and emotional development in children with disabilities is crucial; therefore, ideally the child鈥檚 sleep environment is comfortable, calm, and conducive to sleep. Future research can focus on developing and evaluating effective interventions to improve sleep in children with disabilities. This may involve exploring non-pharmacological approaches such as behavioural interventions, sleep hygiene practices, cognitive-behavioural therapy for insomnia, and assistive technologies. Investigating the efficacy, feasibility, and long-term effects of these interventions is essential for evidence-based practice.

Limitations

When interpreting the findings of this systematic review and meta-analysis, it is important to consider several limitations. Firstly, causal relationships cannot be established due to the reliance on cross-sectional studies. Another limitation is the predominant use of proxy-report measures in the majority of the studies, which may introduce validity and reliability issues with the survey tools. Additionally, both proxy-report and device-based measurements exhibit high variability, which could introduce biasness in the results. Furthermore, the limited availability of data on age (children / adolescents), as well as different disability types hindered subgroup analysis to explore the sources of heterogeneity. This review also focused primarily on reporting the percentage of compliance with 24-hour movement behaviour as the effect size, which may be influenced by context-specific factors. Finally, the presence of high heterogeneity resulting from data limitations also restricted further exploration.

Conclusion

Compliance with the 24-HMG plays a pivotal role in preventing diseases and promoting overall health across all stages of life. The analysis of data from the 13 included studies revealed that children and adolescents with disabilities were less likely to meet the recommended guidelines for PA, screen time, and sleep duration. Furthermore, the majority of them did not fulfil the requirements of all three components outlined in the 24-HMG. These findings strongly emphasize the urgent need to tailor the 24-HMG for children and adolescents with disabilities. Future research should prioritize the development of integrative the 24-HMG specifically designed for the unique needs of this population. Meanwhile, the development of research and intervention programs to foster healthy movement behaviours within this population is crucial. The approach holds the potential to enhance their overall quality of life and promote long-term health outcomes for children and adolescents with disabilities. Given the current evidence, there is a clear need for more global-scaled, device-based data on PA and SD to gain a more comprehensive understanding of overall compliance with the 24-HMG.

Availability of data and materials

Data sharing is not applicable to this article as no new data were created or analysed in this study.

Data availability

No datasets were generated or analysed during the current study.

Abbreviations

24-HMG:

24-hour movement guidelines

PA:

Physical activity

SB:

Sedentary behaviour

ST:

Screen time

SD:

Sleep duration

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Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

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Author notes

  1. Yaru Hao and Xiaogang Zhou contributed equally to this work.

Authors and Affiliations

  1. School of Sports Science, Changsha Normal University, Changsha, China

    Yaru Hao

  2. School of Educational Studies, Universiti Sains Malaysia, Penang, Malaysia

    Xiaogang Zhou听&听Nor Shafrin Ahmad

  3. Faculty of Sports and Exercise Science, Universiti Malaya, Kuala Lumpur, 50603, Malaysia

    Rizal Razman

  4. Department of Physical Education, Hohai University, Nanjing, China

    Sanying Peng

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  1. Yaru Hao

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  2. Xiaogang Zhou

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  3. Rizal Razman

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  4. Sanying Peng

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  5. Nor Shafrin Ahmad

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Contributions

Conceptualization: Yaru Hao and Xiaogang Zhou; Data curation: Yaru Hao and Xiaogang Zhou; Formal analysis: Yaru Hao, Xiaogang Zhou and Sanying Peng; Investigation: Yaru Hao and Xiaogang Zhou; Methodology: Yaru Hao, Xiaogang Zhou and Rizal Razman; Project administration: Rizal Razman; Software: Yaru Hao and Xiaogang Zhou; Supervision: Rizal Razman and Nor Shafrin Ahmad; Validation: Yaru Hao and Xiaogang Zhou; Visualization: Yaru Hao; Writing 鈥� original draft: Yaru Hao and Xiaogang Zhou; Writing 鈥� review & editing: Yaru Hao, Xiaogang Zhou and Rizal Razman. All authors have critically reviewed its content and have approved the final version submitted for publication.

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Correspondence to Rizal Razman.

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Hao, Y., Zhou, X., Razman, R. et al. Compliance with the 24-hour movement behaviour guidelines among children and adolescents with disabilities: a systematic review and meta-analysis. 樱花视频 24, 2357 (2024). https://doi.org/10.1186/s12889-024-19842-7

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  • DOI: https://doi.org/10.1186/s12889-024-19842-7

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樱花视频

ISSN: 1471-2458

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