24-hour movement behavior adherence and associations with health outcomes: an umbrella review.

Background: Physical activity, sedentary behavior, and sleep, collectively known as the 24-hour movement behaviors, demonstrate individual and joint benefits on physical and mental health. Examination of these behaviors has expanded beyond guideline adherence to reviews of isotemporal substitution models (ISM) and compositional data analysis (CoDA). This umbrella review sought to review existing systematic reviews to (1) characterize the breadth and scope, (2) examine prevalence estimates for 24-hour movement guideline adherence, and (3) examine the relationship between these behaviors with health outcomes based on various approaches. Methods: Eight databases and multiple supplementary strategies were used to identify systematic reviews, meta-analyses and pooled analyses that included two or more of the three 24-hour movement behaviors and a multi-behavior assessment approach. Overall review characteristics, movement behavior definitions, approaches, and health outcomes assessed were extracted, and methodological quality was assessed using the AMSTAR2 tool. Review characteristics (Aim 1), guideline prevalence estimates (Aim 2), and associations with health outcomes (Aim 3) were examined. Findings: Thirty-two reviews (20 systematic reviews, 10 meta-analyses, and 2 pooled analyses) were included. Reviews captured the entire lifespan, global regions, and several physical and mental health outcomes. Individual and total guideline adherence waned from preschool to adolescence, but reviews reported similar prevalence estimates and ranges (i.e., within 10%). Common approaches included ISM and CoDA, evaluating 24-hour movement behavior's interactive associations with health outcomes, guideline adherence, and profile-based analysis. Despite heterogeneous approaches, reviews found consistent evidence for beneficial associations between meeting all three guidelines and high amount of physical activity on physical and mental health outcomes, but varied assessment of sedentary behavior or sleep. Most reviews were rated as low or critically low quality. Conclusions: The breadth and scope of current reviews on 24-hour movement behaviors was wide and varied in this umbrella review, including all ages and across the globe. Prevalence estimates among populations beyond children need to be synthesized. Amongst the variety of definitions and approaches, reviews found benefit from achieving healthy amounts of all three behaviors. Longitudinal multi-behavior original research studies with rigorous assessment of sleep and sedentary behavior may help improve future systematic reviews of these various approaches. Supplementary Information: The online version contains supplementary material available at 10.1186/s44167-024-00064-6.