International study of 24-hour movement behaviours among preschool children (SUNRISE): A pilot study from Nepal

BACKGROUND: This study aimed to determine the proportion of Nepali preschool children (3-4 years of age) meeting the World Health Organization (WHO) 24- hour movement guidelines for physical activity (PA), sedentary behaviour and sleep by sex (male vs. female) and place of residence (urban vs. rural) and evaluate their executive functions and motor skills. Furthermore, it evaluated the feasibility and acceptability of methods proposed for the main SUNRISE study in diverse settings. METHODS: In this pilot study, a total of 99 preschool children, balancing sex and place of residence, each with one parent/caregiver, from Syangja District were recruited. Physical activity, sedentary behaviour and sleep were assessed using waist-worn ActiGraph accelerometers (ActiGraph wGT3x-BT) with ≥ 1 valid 24-hour period of data, motor skills (gross and fine) were evaluated using the NIH Toolbox motor battery, and executive functions were assessed using the Early Years Toolbox. Eight focus group discussions (FGDs) were carried out with parents/caregivers, and a short interview was conducted with eight Early Childhood Development (ECD) centre teachers to explore the feasibility and acceptability of implementing the SUNRISE protocol. RESULTS: Only 10% of children met all components of the WHO 24-hour movement guidelines (≥ 180 min total PA, of which ≥ 60 min were MVPA, ≤ 1 h of screen time, and 10-13 h of sleep). Proportions of those meeting the guidelines were higher for sleep (81%) and physical activity (79%) than for screen time (56%). Altogether, 96 children wore the accelerometer, of which 78 had at least ≥ 1 valid 24-hour period of data. Males and rural children accumulated more daily moderate-to-vigorous and vigorous physical activity than females and urban children, respectively. In contrast, females were more likely to meet screen time guidelines than males (66% vs. 42%, p = 0.018). Additionally, females had better inhibition control than males, and rural children had better working memory than urban children. Parent/caregivers and ECD teachers reported that the study procedures, including accelerometer use, were acceptable and feasible. CONCLUSIONS: Adherence to the full set of WHO movement guidelines was very low among preschool children in this study, with screen time emerging as the most challenging component. Targeted strategies are needed to promote healthier movement behaviours, particularly to reduce screen time. The findings support the feasibility and acceptability of conducting the main SUNRISE study in Nepal.