Developing international consensus on key indicators for a 24-hour movement behaviour report card in early childhood: a twin-panel delphi study

Wendy Y. Huang; Danqing  Zhang; Mark S. Tremblay; Martin C. S.  Wong; Cindy H. P. Sit; Sam W. S.  Wong; Derwin K. C.  Chan; Stephen H. S. Wong; The Collaborative Author Group

doi:10.1186/s40798-025-00905-x

Developing international consensus on key indicators for a 24-hour movement behaviour report card in early childhood: a twin-panel delphi study

Wendy Y. Huang^*, Danqing Zhang, Mark S. Tremblay, Martin C. S. Wong, Cindy H. P. Sit, Sam W. S. Wong, Derwin K. C. Chan, Stephen H. S. Wong, The Collaborative Author Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background

The World Health Organization has established recommendations for 24-h movement behaviours in children under 5 years. Building on the successful knowledge translation model of Active Healthy Kids Global Alliance Report Cards, this study aimed to develop a similar framework for the early years.

Methods

Using a three-round twin-panel Delphi survey (conducted via an online survey between 28 November 2024 and 11 March 2025), expert consensus was sought on indicators and benchmarks for the first dedicated report card on 24-h movement behaviours for the early years. The experts were identified through a three-step selection process, which included recognised international projects and networks as well as literature search. In Round 1, participants evaluated the applicability of 15 initial indicators. In Rounds 2 and 3, they rated the importance of each indicator, with results from their own panel (Round 2) and the other panel (Round 3) provided to inform their decisions. Qualitative feedback on definitions and benchmarks was systematically reviewed and incorporated. Consensus was predefined as ≥ 75% agreement, with stability across rounds considered.

Results

Of 175 invited experts, 72 (41.1% recruitment rate) from 15 regions participated in Round 1, with 61 (84.7% response rate) and 56 (77.8% response rate) completing Rounds 2 and 3, respectively. Consensus was achieved for 12 indicators, with definitions and benchmarks refined based on expert inputs. Notably, Weight Status and Motor Proficiency were excluded due to lower agreement.

Conclusions

The finalised set of indicators, definitions, and benchmarks provides a robust foundation for creating a standardised report card for early childhood. The finalised results serve as a critical advocacy instrument to raise awareness, improve surveillance, facilitate cross-jurisdictional comparisons, and inform policy and public health initiatives, ultimately supporting the health and well-being of young children globally.

Original language	English
Article number	92
Number of pages	12
Journal	Sports Medicine - Open
Volume	11
Issue number	1
Early online date	7 Aug 2025
DOIs	https://doi.org/10.1186/s40798-025-00905-x
Publication status	Published - Dec 2025

Funding

WYH was supported by the Research Grants Council Research Fellow Scheme (RFS) from the Government of the Hong Kong Special Administrative Region (# RFS2324-2H01).

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

physical activity
sedentary behaviour
sleep
consensus
children

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10.1186/s40798-025-00905-xLicence: CC BY-NC-ND 4.0

Bardid-Sports-Medicine-Open_Developing-International-ConsensusFinal published version, 1.09 MBLicence: CC BY-NC-ND 4.0

Cite this

Huang, W. Y., Zhang, D., Tremblay, M. S., Wong, M. C. S., Sit, C. H. P., Wong, S. W. S., Chan, D. K. C., Wong, S. H. S., & The Collaborative Author Group (2025). Developing international consensus on key indicators for a 24-hour movement behaviour report card in early childhood: a twin-panel delphi study. Sports Medicine - Open, 11(1), Article 92. https://doi.org/10.1186/s40798-025-00905-x

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title = "Developing international consensus on key indicators for a 24-hour movement behaviour report card in early childhood: a twin-panel delphi study",

abstract = "BackgroundThe World Health Organization has established recommendations for 24-h movement behaviours in children under 5 years. Building on the successful knowledge translation model of Active Healthy Kids Global Alliance Report Cards, this study aimed to develop a similar framework for the early years. MethodsUsing a three-round twin-panel Delphi survey (conducted via an online survey between 28 November 2024 and 11 March 2025), expert consensus was sought on indicators and benchmarks for the first dedicated report card on 24-h movement behaviours for the early years. The experts were identified through a three-step selection process, which included recognised international projects and networks as well as literature search. In Round 1, participants evaluated the applicability of 15 initial indicators. In Rounds 2 and 3, they rated the importance of each indicator, with results from their own panel (Round 2) and the other panel (Round 3) provided to inform their decisions. Qualitative feedback on definitions and benchmarks was systematically reviewed and incorporated. Consensus was predefined as ≥ 75\% agreement, with stability across rounds considered. ResultsOf 175 invited experts, 72 (41.1\% recruitment rate) from 15 regions participated in Round 1, with 61 (84.7\% response rate) and 56 (77.8\% response rate) completing Rounds 2 and 3, respectively. Consensus was achieved for 12 indicators, with definitions and benchmarks refined based on expert inputs. Notably, Weight Status and Motor Proficiency were excluded due to lower agreement. ConclusionsThe finalised set of indicators, definitions, and benchmarks provides a robust foundation for creating a standardised report card for early childhood. The finalised results serve as a critical advocacy instrument to raise awareness, improve surveillance, facilitate cross-jurisdictional comparisons, and inform policy and public health initiatives, ultimately supporting the health and well-being of young children globally.",

keywords = "physical activity, sedentary behaviour, sleep, consensus, children",

author = "Huang, \{Wendy Y.\} and Danqing Zhang and Tremblay, \{Mark S.\} and Wong, \{Martin C. S.\} and Sit, \{Cindy H. P.\} and Wong, \{Sam W. S.\} and Chan, \{Derwin K. C.\} and Wong, \{Stephen H. S.\} and Farid Bardid and John Reilly and \{The Collaborative Author Group\}",

year = "2025",

month = dec,

doi = "10.1186/s40798-025-00905-x",

language = "English",

volume = "11",

number = "1",

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T1 - Developing international consensus on key indicators for a 24-hour movement behaviour report card in early childhood

T2 - a twin-panel delphi study

AU - Huang, Wendy Y.

AU - Zhang, Danqing

AU - Tremblay, Mark S.

AU - Wong, Martin C. S.

AU - Sit, Cindy H. P.

AU - Wong, Sam W. S.

AU - Chan, Derwin K. C.

AU - Wong, Stephen H. S.

AU - Bardid, Farid

AU - Reilly, John

AU - The Collaborative Author Group

PY - 2025/12

Y1 - 2025/12

N2 - BackgroundThe World Health Organization has established recommendations for 24-h movement behaviours in children under 5 years. Building on the successful knowledge translation model of Active Healthy Kids Global Alliance Report Cards, this study aimed to develop a similar framework for the early years. MethodsUsing a three-round twin-panel Delphi survey (conducted via an online survey between 28 November 2024 and 11 March 2025), expert consensus was sought on indicators and benchmarks for the first dedicated report card on 24-h movement behaviours for the early years. The experts were identified through a three-step selection process, which included recognised international projects and networks as well as literature search. In Round 1, participants evaluated the applicability of 15 initial indicators. In Rounds 2 and 3, they rated the importance of each indicator, with results from their own panel (Round 2) and the other panel (Round 3) provided to inform their decisions. Qualitative feedback on definitions and benchmarks was systematically reviewed and incorporated. Consensus was predefined as ≥ 75% agreement, with stability across rounds considered. ResultsOf 175 invited experts, 72 (41.1% recruitment rate) from 15 regions participated in Round 1, with 61 (84.7% response rate) and 56 (77.8% response rate) completing Rounds 2 and 3, respectively. Consensus was achieved for 12 indicators, with definitions and benchmarks refined based on expert inputs. Notably, Weight Status and Motor Proficiency were excluded due to lower agreement. ConclusionsThe finalised set of indicators, definitions, and benchmarks provides a robust foundation for creating a standardised report card for early childhood. The finalised results serve as a critical advocacy instrument to raise awareness, improve surveillance, facilitate cross-jurisdictional comparisons, and inform policy and public health initiatives, ultimately supporting the health and well-being of young children globally.

AB - BackgroundThe World Health Organization has established recommendations for 24-h movement behaviours in children under 5 years. Building on the successful knowledge translation model of Active Healthy Kids Global Alliance Report Cards, this study aimed to develop a similar framework for the early years. MethodsUsing a three-round twin-panel Delphi survey (conducted via an online survey between 28 November 2024 and 11 March 2025), expert consensus was sought on indicators and benchmarks for the first dedicated report card on 24-h movement behaviours for the early years. The experts were identified through a three-step selection process, which included recognised international projects and networks as well as literature search. In Round 1, participants evaluated the applicability of 15 initial indicators. In Rounds 2 and 3, they rated the importance of each indicator, with results from their own panel (Round 2) and the other panel (Round 3) provided to inform their decisions. Qualitative feedback on definitions and benchmarks was systematically reviewed and incorporated. Consensus was predefined as ≥ 75% agreement, with stability across rounds considered. ResultsOf 175 invited experts, 72 (41.1% recruitment rate) from 15 regions participated in Round 1, with 61 (84.7% response rate) and 56 (77.8% response rate) completing Rounds 2 and 3, respectively. Consensus was achieved for 12 indicators, with definitions and benchmarks refined based on expert inputs. Notably, Weight Status and Motor Proficiency were excluded due to lower agreement. ConclusionsThe finalised set of indicators, definitions, and benchmarks provides a robust foundation for creating a standardised report card for early childhood. The finalised results serve as a critical advocacy instrument to raise awareness, improve surveillance, facilitate cross-jurisdictional comparisons, and inform policy and public health initiatives, ultimately supporting the health and well-being of young children globally.

KW - physical activity

KW - sedentary behaviour

KW - sleep

KW - consensus

KW - children

U2 - 10.1186/s40798-025-00905-x

DO - 10.1186/s40798-025-00905-x

M3 - Article

VL - 11

JO - Sports Medicine - Open

JF - Sports Medicine - Open

IS - 1

M1 - 92

ER -

Developing international consensus on key indicators for a 24-hour movement behaviour report card in early childhood: a twin-panel delphi study

Abstract

Funding

UN SDGs

Keywords

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