GRADE ADOLOPMENT Process to Develop 24-Hour Movement Behavior Recommendations and Physical Activity Guidelines for the Under 5s in the UK, 2019

Background: Physical activity guideline developers are faced with demands to produce guidelines quickly and at low cost. This paper summarises a new, efficient, approach taken to develop UK Chief Medical Officers’ (CMOs) Guidelines for the Under 5s, 2019.

Methods: The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Adaptation, Adoption, De Novo Development (ADOLOPMENT) approach was used, based on 24-hour movement behavior guidelines from Canada and Australia in 2017, with a systematic review update in 2018. Draft recommendations were based on (a) the influence of time spent asleep, sedentary, and in physically activity on 10 health outcomes and (b) the influence of PA and sedentary behaviour (including screen time) on sleep outcomes (e.g. duration, latency).

Results: There was consistent evidence of links between the 24-hour movement behaviors and all outcomes, and a high degree of UK stakeholder support for all draft recommendations. UK Guidelines for the Under 5s will be published in 2019 with new guidance on infant tummy time and moderate-to vigorous-intensity physical activity in pre-schoolers, but draft recommendations on sleep and screen time were not accepted by the CMOs.

Conclusions: This was the first time that the GRADE ADOLOPMENT process has been used in Europe to develop physical activity guidelines. It permitted a rapid and inexpensive production of the UK Physical Activity Guidelines for the Under 5s.