Move – Sit – Sleep: A balancing act

Did you know new research is changing the way we think about exercise and health? Rather than just “exercise”, we now think about “movement” more broadly, as well as the importance of good quality sleep, and spending less time sitting each day. This concept comes from The Canadian Society for Exercise Physiology (CSEP) which has developed a new Canadian 24-Hour Movement Guideline based on extensive research.

The following post will review some key messages of CSEP’s new movement guideline and more specific details for infants, children/youth, adults, older adults, as well as children with disabilities and pregnant women. And, it is always a good idea to check with your Doctor before starting a new exercise program.

Key Messages

In a 24 hours period we should aim for an ideal combination of movement, sedentary time and good quality sleep.
Movement includes moderate to intense physical activity e.g. playing sports, bicycling, shoveling snow, but also light intensity physical activity e.g. brisk walking, gardening, and cleaning the house. All movement is beneficial!
Decreasing sedentary time is important, especially on days that we have difficulty fitting in more intense physical activity. Consider building movement into your sedentary time by e.g. working at a standing desk, taking breaks from sitting, going for a walk during lunch, taking the stairs instead of the elevator.
An appropriate amount of good quality sleep is very important. Sleep hygiene helps to this end, e.g. consistent bed and wake times, and reducing the use of phones/computers before bed.
Why increase your daily movement? Movement has many benefits including decreasing one’s risk of cardiovascular disease, type 2 diabetes, weight gain, cancers, and improving bone health, dementia, anxiety, depression and overall improvement in quality of life.
It can be challenging to reach your movement goals, but do not despair. Any progress towards these goals is great and will provide you with some health benefits.

Details For Your Age Group and Abilities

EARLY YEARS

Why is movement important for babies and toddlers? Movement is important for the growth and healthy development of children. Through movement, children play, explore their surroundings and interact with people, all of which impacts the development of their brains and physical abilities. The movement guidelines during the early years are as follows.

INFANTS (LESS THAN 1 YEAR OLD)

Minimum 30 minutes of tummy time over the course of the day during waking hours, and various floor play activities. For example, play with a doll, rattle, or pop up toys. The more the better!
14 – 17 hours of sleep/naps between 0 – 3 months old, and 12 – 16 hours of sleep/naps between 4 – 11 months old.
Try not to restrain the infant, e.g. in a stroller, carseat, for over 1 hour at a time.
Screen time is not recommended for infants.

TODDLERS (1 – 2 YEARS OLD)

Minimum 180 minutes of any kind of physical activity throughout the day. For example play with toy shopping carts, practice climbing on safe low surfaces, play with crayons, and have the toddler feed him/herself.
11 – 14 hours of sleep/naps on a consistent schedule.
Try not to restrain the toddler for over 1 hour at a time.
When the toddler is sedentary, it is recommended to try and have interactive time, e.g. storytelling.
Screen time is not recommended until age 2, and then for a maximum of 1 hour per day.

PRESCHOOLERS (3 – 4 YEARS OLD)

Minimum 180 minutes of any kind of physical activity throughout the day, including a minimum of 60 minutes energetic play, for example, dance to music, kick a ball and play follow the leader.
10 – 13 hours of sleep/naps on a consistent sleep schedule.
Try not to restrain the toddler for over 1 hour at a time.
Screen time should be for a maximum of 1 hour.
When the toddler is sedentary, it is recommended to try and have interactive time, e.g. storytelling.

Children and Youth (5 – 17 years old)

Does your child not want to go to sleep at night? Lack of movement throughout the day makes it harder for children to sleep because they do not develop a sleep drive. So to help with bedtime, here are the movement recommendations for children and youth.

Moderate to vigorous aerobic physical activity, 60 minutes per day, and muscle/bone strengthening, both of which should be done a minimum of 3 days per week. Examples of activities that incorporate aerobic and/or strength training are playing in a jungle gym, swimming, skateboarding, practicing martial arts, trampolining, playing tag and bike riding.
Several hours of light activity, especially outside, is also important each day. For example walking the dog, helping with chores, building a snowman, or having a pillow fight.
Children ages 5 – 13 should get 9 – 11 hours of sleep per night, youth ages 14 – 17 should get 8 – 10 hours per night and everyone should have a consistent sleep schedule.
Limit sedentary time and take breaks from sitting, and try to have no more than 2 hours of recreational screen time.
This website is a fun tool for children to explore what their favourite day would look and how that fits into a healthy day.

Older Adults (65+ years old)

As we retire, we may find that we have less activity built into our days and therefore become more sedentary. This is a great time to work on filling our days with meaningful activities that include movement. Movement is especially important for older adults in order to improve physical health, functional independence, and cognition and reduce the risk of falls.

Remember, physical activities can be modified to your needs so that you feel safe and capable of doing them effectively. Speak with your physiotherapist or physician if you have any questions. Here are the movement recommendations for older adults.

Minimum 150 minutes of moderate to vigorous aerobic physical activity broken up throughout the week. Examples include brisk walking, swimming and yard work.
Several hours of light activity per day, for example standing while cooking.
Strengthening of major muscle groups 2 times per week is especially important as we age, since strength training also improves our bone health. Strengthening can be done with hand-held weights, resistance bands and through exercises using your own bodyweight e.g. squats, lunges, modified push ups and some yoga poses.
Balance training should be included in your activities. Any activity that challenges your balance is a form of balance training. Depending on your current level of balance you will need to incorporate more or less challenging balance activities. For example, a yogi may practice tree pose on one leg, but someone else may practice squatting or lunging. When doing activities that challenge your balance, make sure to have a sturdy counter or chair to hold onto as needed.
Sedentary time should be 8 hours or less per day, with frequent breaks from sitting and no more than 3 hours of recreational screen time.
Older adults should get 7 – 8 hours of quality sleep, with a consistent sleep schedule i.e. bedtime, wake-up time.

Pregnancy

Physical activity is safe (see below for exceptions) and provides health benefits to the mom and baby during pregnancy, e.g. reduced risk of gestational diabetes, preeclampsia, depression, and fewer newborn complications. Physical activity is not associated with miscarriage and other pregnancy related complications. The movement recommendations for pregnant women include the following.

Minimum of 150 minutes of moderate intensity physical activity per week, over a minimum of 3 days.
A variety of kinds of physical activity e.g. aerobic, resistance training, as well as yoga/stretching and pelvic floor muscle training.
There are some cases when exercise is not recommended during pregnancy. Speak with your physician/obstetrician to confirm that it is safe for you to exercise. Some examples of when exercise may not be recommended are a history of premature labour, preeclampsia, pregnancy with triplets or more, recurrent pregnancy loss, eating disorder, an uncontrolled medical condition such as diabetes, hypertension, thyroid disease, cardiovascular disease, respiratory disease or other systemic disease.

Children with Disabilities

The above movement recommendations are based on research conducted with typically abled individuals. However, with some information on adapting physical activities, the above recommendations can still be a beneficial guide for individuals with disabilities.

Individuals living with disabilities have a wide range of differing abilities that will impact how they do their daily physical activity. The key to increasing physical activity is to incorporate movement that you enjoy in a way that is adapted for your unique needs.

Where the above guidelines recommend walking, you may move around however you typically do, e.g. with a walker, wheelchair, or other gait aid.
Various forms of physical activity and equipment can be adapted so that you can join in the fun, e.g. hand cycling, power soccer, sled hockey, adapted downhill skiing, wheelchair racing and more.
Physical activity does not have to be with your legs, upper body exercises are very important too
For a resource on enabling someone with a disability to reach their movement goals, see The Ability Toolkit

We hope you have enjoyed reading about these new guidelines and we hope you have found some further things to do to “keep you in motion”!

Your team at Pro Motion Physiotherapy

References
https://csepguidelines.ca
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5618974/

Resources
http://buildyourbestday.participaction.com/en-ca
https://csepguidelines.ca/children-and-youth-5-17/the-ability-toolkit-a-resource-for-parents-of-children-and-youth-with-a-disability/