During the 24 hours of the day people spend our time sleeping, in a sedentary behavior, standing or performing physical activity. Decreasing or increasing any of the above behaviors will mean, unequivocally, alterations in the distribution of time available for the rest, since 24 hours of one day are finite. Increasing the level of physical activity, limiting sedentary behaviors and optimizing the duration of our dream will improve our health and well -being in general. Some of these benefits include the reduction of chronic diseases such as obesity, type II diabetes and cardiovascular diseases, as well as the improvement of mental and emotional health. However, in a traditional way, these behaviors have been investigated in isolation and have been considered independent health factors. For example, the association between sleep and health hours was studied, but without attending how these hours modified the time spent in other activities such as sedentary. In this sense, a change in the research paradigm towards an integrated approach to the three domains (physical activity, sedentary behavior and sleep) has recently proposed ( Figure 1 ).

Let's put a practical example. Let's imagine a male patient, 45 years, with a slight overweight and that indicates that he performs a daily hour of physical activity of moderate/vigorous intensity three times a week (Monday, Wednesday and Friday). A priori , we can think that we are facing a patient with an active and healthy lifestyle, since it computes a total of 180 minutes of physical activity (therefore fulfilling the recommendations of the World Health Organization). However, when deepening the rest of the patient's day, we discover that he works as an administrative in an office and spends eight hours a day in front of a computer. In addition, outside of work, much of his time passes it in sedentary activities such as seeing series lying on the couch, playing video games and watching social networks on the mobile in a motionless position. In addition, he has problems reconciling the dream and usually sleeps about six hours a day with quite irregular schedules. As we can see, despite performing sufficient weekly physical activity according to international recommendations, our patient should optimize both their sedentary behavior and the duration of sleep in order to improve their health.

The 24 -hour movement recommendations have changed the traditional approach of focusing on individual components of physical activity, to consider all behaviors related to movement during the day as an integral part of our health. The first 24 -hour movement recommendations were published in Canada in 2016, by the global alliance for a healthy childhood, (Ahkga) and were allocated to children and adolescents between 5 and 17 years old (2). From here and depending on the age range, numerous 24 -hour movement recommendations have been proposed, trying to cover the entire general population, both by the Ahkga ( https://csepguidelines.ca ) and by of the World Health Organization (in children under five years (3)). Similarly, from a more inclusive perspective, specific recommendations have been proposed for people with different health conditions (pregnancy, people with spinal injury, or multiple sclerosis). Figure 2 collects a summary the different 24 -hour movement recommendations throughout life.

What does scientific evidence say about it?

For previous studies, we know that physical activity, sleep duration and sedentary behavior (including time in front of a screen) have been related in isolation with a wide range of health effects. This has allowed an exponential growth of studies in recent years by examining the association between complying with the 24 -hour movement recommendations and numerous health -related variables. Thus, associations have been reported between complying with these recommendations with less adiposity, lower behavioral problems or less mortality (4). In addition, they have also associated with greater bone health, quality of life in relation to health, socio-cognitive development, cardiometabolic health, psychosocial health, mental health, global cognition, physical condition, and even with healthy eating habits (4, 4, 5).
However, it is important to keep in mind that the majority of the benefits attributed to the fulfillment of 24 -hour recommendations are based on cross -cutting studies, which implies that the results must be interpreted with caution. A cross -sectional study is like taking a picture of a situation at a given time. For example, if we want to know how many people in a group have black hair, we can take a picture of that group and tell how many people have black hair. But we don't know if those people have always had black hair or if they painted it recently. Therefore, an association has been found between the fulfillment of the recommendations and a lower adiposity in people, although due to the design of these studies, a cause-effect relationship between the fulfillment of the recommendations and lower levels cannot be established of adiposity. In addition, complying with the long -term 24 -hour movement recommendations in adolescence and adult life has been associated with a lower risk of obesity (6), type 2 diabetes (7), suicidal depression and ideation (8).

Does the population meet the movement?

In spite of the health benefits attributed to comply with the activity recommendations, a recent meta -analysis has reported a global compliance rate of the 24 -hour movement recommendations of only 7% in preschool, children and adolescents of between 3 and 18 years (9). This meta -analysis underlines the need to implement effective and sustainable programs to promote physical activity in childhood and adolescence, and to investigate more in depth the barriers and facilitators for the fulfillment of these recommendations in this vulnerable population.

Since the first 24 -hour movement recommendations for adults and older adults were published at the end of 2020, no meta -analysis has yet been carried out that determines the prevalence of compliance with these recommendations in these populations. However, studies conducted to date in adults and older adults, as well as preschool, children and adolescents, show the need for initiatives to optimize the distribution of time during the 24 hours of the day.

As we can see, there is no doubt of the importance of having an adequate balance of these behaviors to maintain good long -term health. We have at our disposal a certain level of evidence (mainly observational) of what to comply with the 24 -hour movement recommendations is associated with benefits for our health. And then what now? What are the next steps that we should follow scientists and health professionals? Next, we present some proposals that could be useful for the future.

1. Locate factors associated with compliance.

Knowing the factors for which people (in their different age groups) meet the 24 -hour movement recommendations will develop more effective interventions when optimizing these behaviors. Here, from a point of view of socioecological model, both individual factors (age, sex), interpersonal type (socioeconomic level, family type), community (air quality, type of neighborhood), and even politician, and even political (hours of physical education in educational centers, transport policies). Falling into dogmatisms and reductionism considering that the person who does not meet the 24 -hour recommendations is only because he does not want to take us to a limited and stereotyped vision of reality . For example, it has been found to have a low socioeconomic level (10), live in urban areas (11), and even a lower air quality (12) (among other factors) is associated with less compliance with the recommendations of 24 -hour movement. The crucial role of the family has also been revealed regarding the fulfillment of these recommendations in children and adolescents (13). This fact is because children and adolescents also spend a lot of time with their brothers and/or the care of their parents or legal guardians, which, through certain practices, can provide stimuli that favor the capacity of response (for example, encouraging the practice of physical activity, co -participating with them), social and physical environments that allow to lead a more active lifestyle (for example, take them to parks, clubs sports), as well as requirement in restrictive practices according to the requirements for their age (for example, limit the time of screens, sleeping routines). As we see, not all factors depend exclusively on the individual, so we must expand the approach and perspective on the barriers and facilitators associated with this compliance.

2. Integrate muscle strengthening activities into the physical activity domain.

The first 24 -hour movement recommendations indicate that, within the domain of physical activity, children and adolescents between 5 and 17 years they should, in addition to accumulating at least 60 minutes a day of physical activity from moderate to vigorous intensity (including a great variety of aerobic activities), carry out muscle and bone strengthening activities at least three times a week (2). Bone and muscular strengthening activities have also been included in recommendations for adults (18-64 years) and older adults (≥ 65 years). However, a recent meta-analysis made by García-Hermoso et al. (14) He has reported that less than 2 out of 10 people meet the recommendations for aerobic physical activity and muscle and bone strengthening. A large amount of studies do not evaluate both recommendations within the physical activity domain, remaining only in the most focused recommendation on the aerobic character. This fact could offer a prevalence of breach of the smallest force training recommendations than we actually consider. Given the numerous intrinsic benefits to strength training in the young population, and after having exceeded an era of endless myths infused on it (especially in the young population), studies that also evaluate the distribution of the time spent in the Exercise of force.

3. More robust evidence through longitudinal studies and interventions.

To grant due visibility and recognition of compliance with these recommendations, it is necessary to advance in obtaining scientific evidence through research. As we have said, transverse studies are a form of research in which data is collected at a specific time, which offers us a "photo" of the characteristics of a population and allows us to identify possible risk factors or determinants Health However, as mentioned above, it is important to keep in mind that cross -sectional studies cannot establish causality between an exposure or risk factor (for example, comply with 24 -hour recommendations) and a health condition. In this sense, we have seen how, in numerous studies with this type of design, these recommendations are associated with numerous health benefits, but what happens in the long term? Only some studies have examined these associations over the years, finding favorable associations with health -related variables (for example, obesity, type II diabetes, depression, suicidal ideation. This fact shows the need to carry out more longitudinal studies . (Especially randomized clinical trials) To determine whether, increase compliance with 24 -hour recommendations, necessarily leads to better health results in the general population.

4. Bring scientific knowledge closer to the general population more efficiently.

Do we know what 24 -hour movement recommendations do we need to comply based on our age range? Do fathers, mothers, legal tutors know the 24 -hour movement recommendations? One of the basic needs of public health recommendations is that they can be attainable by the population. How are people going to fulfill something they do not know? It is likely that scientists and health professionals have notions about what is, for example, the physical activity of moderate to vigorous intensity. However, what happens to the general population? Do you know what is moderate or what is vigorous? Do you know if all the screen time counts regardless of the purpose of use? Do you know how to increase their sleep hours? Without a doubt, we have to be able to improve our ability to transmit knowledge, providing practical examples as a "recipe" to facilitate adhesion to these behaviors by the general population. Some ways to try to achieve this purpose may include: use clear and accessible language (trying to avoid scientific technicalities or jargon), use accessible media for most of the population (blogs, social networks, popular magazines), knowledge In talks and conferences (schools, universities), make use of daily examples (upload stairs, transport the purchase, walk the dog), use attractive educational resources (videos, tutorials, infographics), or collaborate with other scientists and disseminators (television programs, radio, podcast ). It is important to highlight that the promotion of physical activity and the reduction of sedentary lifestyle not only depend on individual effort, but also require an approach at community level and public policies. Public institutions, due to their greater scope, coordination and resources, have a fundamental role in promoting physical activity and the reduction of sedentary lifestyle at the general population level. For example, they could carry out awareness campaigns, facilitate access to sports and recreational facilities, promote physical activity in the workplace and education, or even develop policies for the creation of active and healthy environments in cities.

Conclusions

It is important to keep in mind that every day has a limit of hours, so it is necessary to maximize the distribution of our time in the three areas that make up our 24 hours: sleep, sedentary behavior and physical activity. In this sense, the new approach in favor of 24 -hour movement recommendations can have a significant impact on people's health, since it will contribute to a better management of their time and a more active and healthy life.

References:

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