Early childhood movement habits predict a more physically active lifestyle in early adolescence, according to a longitudinal study.

Following the publication of the World Health Organization (WHO)’s 2019 movement behavior guidelines for children under age 5, “it became clear that these standards are vital for immediate health and motor skill development, with the potential for lasting benefits,” Kianoush Harandian, doctoral researcher at the University of Montreal, told Medscape News Canada. “However, the long-term impact of these early behaviors on lifelong activity trajectories remained a critical, unaddressed gap that we decided to explore.”

The results were “eye-opening,” she said. “We found that less than 10% of toddlers met all three movement guidelines within a 24-hour day, and only a third met specific targets for active leisure or screen time. Active parent-child time — playing, moving, being physically engaged together — appears to be the single most powerful lever for establishing healthy long-term habits,” she added. “Those shared experiences help children associate movement with enjoyment, motivation, and routine.”

The study was published on April 8 in the Journal of Developmental & Behavioral Pediatrics.

More Outdoor Play and Leisure Physical Activity

Researchers analyzed data from 849 boys and 819 girls who were born between 1997 and 1998 and participated in the Quebec Longitudinal Study of Child Development. They used linear regression analysis to examine associations between parent-reported daily movement behaviors (ie, active leisure, screen time, and sleep) at age 2.5 and self-reported indicators of an active lifestyle (ie, outdoor play and leisure physical activity level) at age 12, while adjusting for individual and family factors.

At age 2.5, roughly one third of boys and girls participated in active leisure activities at least once a day with a parent, and one third spent less than 1 hour a day in front of a screen. Roughly 75% of boys and girls slept 11 hours or more on an average day.

This meant that most children attained 1 or 2 of the WHO-recommended movement guidelines. But 11.8% of boys and 12.9% of girls did not meet any guidelines, and only 8.7% of boys and 9.3% of girls effectively participated in all three movement behaviors daily. 

At age 12, boys played outside for an average of 1 hour and 20 minutes per day, and girls did so for 1 hour and 12 minutes per day. About half of boys and girls reported little or no activity in their leisure time, and only 24.5% of boys and 14.9% of girls were considered active.

“What surprised us was how the early habits uniquely influenced boys and girls as they grew up,” Harandian said. “For girls, early active leisure with parents and limited screen time were linked to higher frequency, intensity, and energy expenditure during leisure-time physical activity a decade later.

“For boys, however, only adequate sleep in toddlerhood contributed to greater leisure-time physical activity in adolescence,” she said. “Because boys are more often socially encouraged toward physical activities and sports, it seems that developing healthy sleep behaviors provides a foundation they need to rest and recharge, allowing them to remain invested in physically demanding activities as they grow.”

Individual and family factors influenced the findings. For example, being a more agitated, irritable, fussy, and reactive child and having a mother with greater feelings of restlessness, loneliness, and depression; a BMI higher than the median; and no high school diploma reduced the likelihood that boys participated in adequate amounts of combined movement behaviors in toddlerhood. For girls, the likelihood of participation was affected only by greater depressive symptoms in mothers and belonging to nonintact families.

The study had limitations, however. The measure of active leisure in toddlerhood did not assess the duration or intensity of physical activity, and the participants were children born between spring 1997 and spring 1998, making these historical data. In addition, as a nonexperimental population-based longitudinal study, the study could not establish causality.

Nevertheless, the authors called for broader dissemination of WHO guidelines for children under age 5 — at least 180 minutes of physical activity per day, no more than 1 hour of sedentary screen time, and 11-14 hours of sleep — and made the case for hospitals, schools, and public health organizations to target family lifestyle habits from the start.

‘Proactively Promote Physical Activity’

Commenting on the study for Medscape News Canada, Christine Voss, PhD, assistant professor of pediatrics at the University of British Columbia’s Faculty of Medicine, Kelowna, British Columbia, said the findings “add to a well-established body of evidence linking parental attitudes and actions to their children’s physical activity habits. What is yet again being highlighted is that being active together with the child is so important. It makes sense in the context of very young children, who still heavily rely on their parents as facilitators.” 

That said, the observational nature of the study could not prove causation, she noted, and the key physical activity outcomes were assessed by self-report. “Physical activity — unlike structured exercise — is very difficult to remember and report accurately, as it encompasses all types of movement, including unplanned and unstructured activities,” she noted.

In addition, the baseline assessments make the data “old,” said Voss, who was not involved in the study. “We live in a different time now, certainly as far as screens are concerned.

“There is also the potential for bias in longitudinal samples, with people who are doing better regarding the outcomes being more likely to stay in the study for the long term, while others who experience challenges are more likely to drop out. This can skew the results.

“Our environments — both physical and cultural — favor sedentary choices,” said Voss. “In this context, we just can’t seem to figure out how to effectively shift physical activity participation at the population level.”

But clinicians may be able to help. “Clinicians often practice reactively, treating illness once it has already emerged. By the time the harms of insufficient physical activity become apparent, it is exceedingly difficult to meaningfully counsel individuals on healthy lifestyle change,” said Voss.

“When it comes to physical activity promotion, I would like to see a shift from reactive to proactive care beginning at well-child visits in infancy and toddlerhood, with clinicians assigning physical activity the same level of urgency and importance as growth and development monitoring and immunizations.”

This study was supported by the Social Sciences and Humanities Research Council and Sport Canada Research Initiative. Harandian and Voss declared no relevant financial relationships.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDEdge, The Lancet (where she was a contributing editor), and Reuters Health.