Association between 24-hour movement behaviors and health-related quality of life in children.

Purpose: To assess the associations between adherence to 24-hour movement behaviors guidelines and child general health and functional status measured by health-related quality of life.

Methods: The Longitudinal Study of Australian Children (2004-2016) a nationally representative sample with data available for children aged 2-15 years was used. Physical activity time, recreational screen time, and sleep time were calculated from time use diaries and classified as 'meeting guidelines' or 'not' based on the age-specific 24-h movement guidelines. Child general health and functional status were measured using the multidimensional Pediatric Quality of Life Inventory (PedsQL). Associations between meeting guidelines and PedsQL were assessed using linear mixed effects models.

Results: 8919 children were included. Each additional guideline met was associated with a 0.52 (95% confidence interval [CI] 0.39-0.65) increase in PedsQL total score. Compared with meeting no guidelines, the effect of meeting physical activity guidelines alone (β = 0.93, 95% CI 0.42-1.44) was larger compared to meeting screen (β = 0.66, 95% CI 0.06-1.27) or sleep time (β = 0.47, 95% CI 0.04-0.89) guidelines alone. The highest increment was observed in meeting both screen time and physical activity guidelines (β = 1.89, 95% CI 1.36-2.43). Associations were stronger in children from lower-income families (β for meeting all versus none = 2.88, 95% CI 1.77-3.99) and children aged 14-15 years (β = 4.44, 95% CI 2.49-6.40).

Conclusions: The integration of screen time and physical activity guidelines is associated with the highest PedsQL improvement. The association between guidelines adherence and PedsQL appears stronger for adolescents and those from low-income families.