Cross-sectional examination of 24-hour movement behaviours among 3- and 4-year-old children in urban and rural settings in low-income, middle-income and high-income countries: the SUNRISE study protocol

Tony Okely, John J Reilly, Mark S Tremblay, Katharina E Kariippanon, Catherine E Draper, Asmaa El Hamdouchi, Alex A Florindo, Janette P Green, Hongyan Guan, Peter T Katzmarzyk, Himangi Lubree, Bang Nguyen Pham, Thomas Suesse, Juana Willumsen, Mohamed Basheer, Rebecca Calleia, Kar Hau Chong, Penny L Cross, Maria Nacher, Laura SmeetsEllie Taylor, Chalchisa Abdeta, Nicolas Aguilar-Farias, Aqsa Baig, Jambaldori Bayasgalan, Cecilia H S Chan, P W Prasad Chathurangana, Michael Chia, Fazlollah Ghofranipour, Amy S Ha, Mohammad Sorowar Hossain, Xanne Janssen, Alejandra Jáuregui, Piyawat Katewongsa, Dong Hoon Kim, Thanh Van Kim, Denise Koh, Anna Kontsevaya, Germana H Leyna, M Löf, Nyaradzai Munambah, Tawonga Mwase-Vuma, Jackline Nusurupia, Aoko Oluwayomi, Borja Del Pozo-Cruz, Jesus Del Pozo-Cruz, Eva Roos, Asima Shirazi, Pragya Singh, Amanda Staiano, Adang Suherman, Chiaki Tanaka, Hong Kim Tang, Wei-Peng Teo, Marites M Tiongco, Dawn Tladi, Ali Turab, Sanne L C Veldman, E Kipling Webster, Pujitha Wickramasinghe, Dyah Anantalia Widyastari

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Introduction 24-hour movement behaviours (physical activity, sedentary behaviour and sleep) during the early years are associated with health and developmental outcomes, prompting the WHO to develop Global guidelines for physical activity, sedentary behaviour and sleep for children under 5 years of age. Prevalence data on 24-hour movement behaviours is lacking, particularly in low-income and middle-income countries (LMICs). This paper describes the development of the SUNRISE International Study of Movement Behaviours in the Early Years protocol, designed to address this gap. Methods and analysis SUNRISE is the first international cross-sectional study that aims to determine the proportion of 3- and 4-year-old children who meet the WHO Global guidelines. The study will assess if proportions differ by gender, urban/rural location and/or socioeconomic status. Executive function, motor skills and adiposity will be assessed and potential correlates of 24-hour movement behaviours examined. Pilot research from 24 countries (14 LMICs) informed the study design and protocol. Data are collected locally by research staff from partnering institutions who are trained throughout the research process. Piloting of all measures to determine protocol acceptability and feasibility was interrupted by COVID-19 but is nearing completion. At the time of publication 41 countries are participating in the SUNRISE study. Ethics and dissemination The SUNRISE protocol has received ethics approved from the University of Wollongong, Australia, and in each country by the applicable ethics committees. Approval is also sought from any relevant government departments or organisations. The results will inform global efforts to prevent childhood obesity and ensure young children reach their health and developmental potential. Findings on the correlates of movement behaviours can guide future interventions to improve the movement behaviours in culturally specific ways. Study findings will be disseminated via publications, conference presentations and may contribute to the development of local guidelines and public health interventions.

Original languageEnglish
Article numbere049267
Number of pages17
JournalBMJ open
Issue number10
Early online date25 Oct 2021
Publication statusPublished - 25 Oct 2021


  • public health
  • child
  • SARS-CoV-2
  • Child, Preschool
  • Pediatric Obesity - prevention & control
  • COVID-19
  • developed countries
  • community child health
  • statistics & research methods
  • Cross-Sectional Studies


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