Given the many overwhelming and often competing demands families are challenged to face, it is easy to imagine why simple formulas for navigating exercise and nutrition (e.g., particular diets and walking 10,000 steps each day) may be appealing. However, research continues to indicate that there are many available routes to improved health and well-being when it comes to physical health.
In one recent study based in Australia, Emily Ng and colleagues investigated lifestyle features associated with healthy outcomes within a large sample of children. Their findings, published in Pediatrics, suggest that trade-offs can be made according to unique family makeup and needs to improve overall health, health-related quality of life (HRQoL), and academic achievement for children.
There is no simple solution, but rather, there are many options to promote health in childhood. However, of a variety of lifestyle characteristics included in the models compared, moderate-to-vigorous physical activity was the most efficient means to facilitating health among participants.
“There are many lifestyle recommendations for children (e.g., sleep more, exercise more, sit less), but families are busy. There are only 24 hours in a day, and any behavioral adjustment will have ripple effects across other activities,” Ng and colleagues write.
“Although children with different durations of activities may have the same health status, clinicians may recommend increasing [moderate-to-vigorous physical activity] MVPA because this seems to require less time to bring about the same beneficial associations as increasing sleep or decreasing sitting.”
Naturally, if young people were afforded the necessary resources to sleep more, eat nutritiously, and engage in more vigorous physical exercise over time, research indicates many would enjoy physiological, emotional, and cognitive benefits.
Despite the widespread acknowledgment of sleep needs of adolescents, including by major institutions such as the Centers for Disease Control and Prevention and the American Academy of Pediatrics, most middle and high school students in the US begin school before 8:30 am and lack the support required to sleep the recommended eight to 12 hours.
The benefits of physical activity are perhaps more actively encouraged by institutions of learning than sleep–through the gym and other recreational programming–but despite time-tested and empirically supported advantages, exercise programs are among the first to be cut in schools under financial stress.
Even though research continues to link mental health and cognitive gains to increased physical activity, related programming is not expanding in such a way that it is likely to benefit young people on a large scale, particularly those in school communities with limited resources.
Additionally, nutrition is known to influence psychosocial and physiological wellbeing in childhood. There are competing philosophies for what constitutes a healthy diet (e.g., the Mediterranean versus paleo-style eating). These competing diets can obscure how food insecurity and socioeconomic variables substantially influence nutrition and, in turn, mental health.
Some research has connected increased screen time (more than two hours every day), reduced sleep, and limited exercise with poor health in childhood and adolescence. However, these very conditions are often fueled by expectations imposed by schools and perpetuated by busy family schedules. Disease containment measures necessitated by the spread of COVID-19 have led to increases in required screen time for students and a more sedentary lifestyle for some.
We’re aware of many of the lifestyle features tied to health among young people. Yet, awareness of how much of what is necessary to lead to meaningful gains represents a gap in the available research. If it is not possible for young people to consistently eat well, exercise regularly and vigorously, sleep well and disengage from technology for at least some portion of every day, what should be prioritized in public health messaging and associated interventions?
Ng and colleagues’ project was conducted using cross-sectional data from the Australian Child Health CheckPoint Study involving a large sample of 11- and 12-year-old participants (N = 1,179). The researchers investigated relationships between participants’ self-reported 24-hour time use including sleep, sedentary behavior, light physical activity, and MVPA in relation to three indicators of health: “adiposity (bioelectrical impedance analysis, BMI and waist girth), self-reported health-related quality of life (HRQoL; Pediatric Quality of Life Inventory), and academic achievement (standardized national tests).”
Equivalence curves were generated to represent “trade-offs” representing lifestyle variables and health outcomes. Food and nutrition were not included in this particular study.
Their results revealed that increasing MVPA, increasing sleep, and decreasing sitting all impacted health. According to the authors:
“On a minute-for-minute basis, MVPA was 2 to 6 times as potent as sleep or sedentary time.”
Interestingly, young people with better academic achievement reported less light physical activity. In relation to adiposity, nearly an hour of added sleep and reduced sedentary time was required to achieve benefits equivalent to only 20 minutes invested in MVPA. MVPA appeared to be similarly efficient in promoting HRQoL compared to added sleep and reduced sedentary time necessary to enjoy benefits.
“Our findings have important clinical and policy implications: children with the same health status may have different time use. This suggests that the same improvement (or decrement) in health might be achievable by selecting from a menu of several different activity-change strategies.”
The authors highlight that additional research may help establish implications for recommendations and policy. However, the data indicate that there are no one-size-fits-all formulas in promoting child health. Different strategies may work for different families depending on their schedules and resources.
“Focusing on activity compositions rather than individual activities opens up new intervention possibilities. Rather than addressing just one domain (‘increase MVPA’), one could look at how to change activity patterns (‘trade-off screen time against sleep and MVPA’).”
Ng, E., Wake, M., Olds, T., Lycett, K., Edwards, B., Le, H., & Dumuid, D. (2021). Equivalence curves for healthy lifestyle choices. Pediatrics, 147(4). https://doi.org/10.1542/peds.2020-025395 (Link)