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; Eivind Aadland; Nicolas Aguilar-Farias; Devan Antczak; Liane Azevedo; Farid Bardid; Catherine M. Capio; Angela Carlin; Valerie Carson; Zhenya Chang; Michael Yong Hwa Chia; Silvia Costa; Yolanda Demetriou; Marsha Dowda; Catherine E. Draper; Susan Edwards; Vladimir Essau Martínez-Bello; Hongyan Guan; Asmaa E. L. Hamdouchi; Sandra Hansmann; Elisabeth Straume Haugland; Jaroslaw Herbert; Marianella Herrera; Kylie Hesketh; Stephen Hunter; Justin Jeon; Fan Jiang; Jaak Jürimäe; Sebastian Kerzel; Hyunshik Kim; Susi Kriemler; Nicholas Kuzik; Eun-Young Lee; Cong Liu; Yang Liu; Marie Löf; Himangi Lubree; Marlene Rosager Lund Pedersen; Daga Makaza; Taru Manyanga; Clarice Martins; Shawnda A. Morrison; Jorge Mota; Rowena Naidoo; Nelson Nardo Junior; Paulina Nowicka; Christine Delisle Nyström; Timothy Olds; Line Grønholt Olesen; Vincent O. Onywera; Sabine Plancoulaine; Bee Koon Poh; Alessandra Prioreschi; John J. Reilly; Blanca Roman-Viñas; Rute Santos; Diego Augusto Santos Silva; Olga Lucia Sarmiento; John Scriven; Mohd Razif Shahril; Ann-Christin Sollerhed; Martyn Standage; Gareth Stratton; Tim Takken; Chiaki Tanaka; Brian W. Timmons; Simone Tomaz; Grant R. Tomkinson; Patricia Tucker; Leigh M. Vanderloo; Guanghai Wang; Sunyue Ye; Long Yin

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, Eivind Aadland, Nicolas Aguilar-Farias, Devan Antczak, Liane Azevedo, Farid Bardid, Catherine M. Capio, Angela Carlin, Valerie Carson, Zhenya Chang, Michael Yong Hwa Chia, Silvia Costa, Yolanda DemetriouMarsha Dowda, Catherine E. Draper, Susan Edwards, Vladimir Essau Martínez-Bello, Hongyan Guan, Asmaa E. L. Hamdouchi, Sandra Hansmann, Elisabeth Straume Haugland, Jaroslaw Herbert, Marianella Herrera, Kylie Hesketh, Stephen Hunter, Justin Jeon, Fan Jiang, Jaak Jürimäe, Sebastian Kerzel, Hyunshik Kim, Susi Kriemler, Nicholas Kuzik, Eun-Young Lee, Cong Liu, Yang Liu, Marie Löf, Himangi Lubree, Marlene Rosager Lund Pedersen, Daga Makaza, Taru Manyanga, Clarice Martins, Shawnda A. Morrison, Jorge Mota, Rowena Naidoo, Nelson Nardo Junior, Paulina Nowicka, Christine Delisle Nyström, Timothy Olds, Line Grønholt Olesen, Vincent O. Onywera, Sabine Plancoulaine, Bee Koon Poh, Alessandra Prioreschi, John J. Reilly, Blanca Roman-Viñas, Rute Santos, Diego Augusto Santos Silva, Olga Lucia Sarmiento, John Scriven, Mohd Razif Shahril, Ann-Christin Sollerhed, Martyn Standage, Gareth Stratton, Tim Takken, Chiaki Tanaka, Brian W. Timmons, Simone Tomaz, Grant R. Tomkinson, Patricia Tucker, Leigh M. Vanderloo, Guanghai Wang, Sunyue Ye, Long Yin

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

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
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	E-pub ahead of print - 7 Aug 2025

Data Availability Statement

The anonymised dataset from the three-round survey is available from the corresponding author on reasonable request.

Acknowledgements

The authors would like to thank all the experts (a full list of experts shown in the Additional File 1) for their participation and for the insightful feedback they provided. We are also thankful to the two scholars (Dr Jie Feng and Mr Sitong Chen) who helped in the piloting survey.

Eivind Aadland (Western Norway University of Applied Sciences, Norway), Nicolas Aguilar-Farias (Universidad de La Frontera, Chile), Devan Antczak (University of Wollongong, Australia), Liane Azevedo (Sheffield Hallam University, United Kingdom), Farid Bardid (University of Strathclyde, Scotland), Catherine M. Capio (Hong Kong Metropolitan University, China), Angela Carlin (Ulster University, Northern Ireland), Valerie Carson (University of Alberta, Canada), Zhenya Chang (Changsha Normal University, China), Michael Yong Hwa Chia (Nanyang Technological University, Singapore), Silvia Costa (Loughborough University, United Kingdom), Yolanda Demetriou (University of Tübingen, Germany), Marsha Dowda (University of South Carolina, United States), Catherine E Draper (University of the Witwatersrand, South Africa), Susan Edwards (Australian Catholic University, Australia), Vladimir Essau Martínez-Bello (University of Valencia, Spain), Hongyan Guan (Capital Institute of Pediatrics, China), Asmaa E.L. Hamdouchi (CNESTEN, Morocco), Sandra Hansmann (Universitätsklinikum Tübingen, Germany), Elisabeth Straume Haugland (Western Norway University of Applied Sciences, Norway), Jaroslaw Herbert (Rzeszów University, Poland), Marianella Herrera (Framingham State University, United States), Kylie Hesketh (Deakin University, Australia), Stephen Hunter (University of Alberta, Canada), Justin Jeon (Yonsei University, Korea), Fan Jiang (Shanghai Jiao Tong University, China), Jaak Jürimäe (University of Tartu, Estonia), Sebastian Kerzel (Universität Regensburg, Germany), Hyunshik Kim (Sendai University, Japan), Susi Kriemler (University of Zurich, Switzerland), Nicholas Kuzik (Children’s Hospital of Eastern Ontario Research Institute, Canada), Eun-Young Lee (Queen’s University, Canada; Yonsei University, South Korea), Cong Liu (The University of Hong Kong, China), Yang Liu (Shanghai University of Sport, China), Marie Löf (Karolinska Institute, Sweden), Himangi Lubree (KEM Hospital Research Centre, India), Marlene Rosager Lund Pedersen (University of Southern Denmark, Denmark), Daga Makaza (National University of Science and Technology, Zimbabwe), Taru Manyanga (University of Northern British Columbia, Canada), Clarice Martins (University of Porto, Portugal), Shawnda A. Morrison (University of Ljubljana, Slovenia), Jorge Mota (University of Porto, Portugal), Rowena Naidoo (University of KwaZulu-Natal, South Africa), Nelson Nardo Junior (State University of Maringa, Brazil), Paulina Nowicka (Uppsala University, Sweden), Christine Delisle Nyström (Karolinska Institute, Sweden), Timothy Olds (University of South Australia, Australia), Line Grønholt Olesen (Steno Diabetes Center Aarhus, Denmark), Vincent O. Onywera (KCA University, Kenya), Sabine Plancoulaine (French Institute of Health and Medical Research, France), Bee Koon Poh (Universiti Kebangsaan Malaysia, Malaysia), Alessandra Prioreschi (University of the Witwatersrand, South Africa), John J. Reilly (University of Strathclyde, Scotland), Blanca Roman-Viñas (Ramon Llull University, Spain), Rute Santos (University of Minho, Portugal), Diego Augusto Santos Silva (Federal University of Santa Catarina, Brazil), Olga Lucia Sarmiento (Universidad de los Andes, Colombia), John Scriven (Move Well, Jersey), Mohd Razif Shahril (Universiti Kebangsaan Malaysia, Malaysia), Ann-Christin Sollerhed (Kristianstad University, Sweden), Martyn Standage (University of Bath, United Kingdom), Gareth Stratton (Swansea University, United Kingdom), Tim Takken (University Medical Center Utrecht, Netherlands), Chiaki Tanaka (Tokyo Kasei Gakuin University, Japan), Brian W. Timmons (McMaster University, Canada), Simone Tomaz (University of Stirling, United Kingdom), Grant R. Tomkinson (University of South Australia, Australia), Patricia Tucker (Western University, Canada), Leigh M. Vanderloo (ParticipACTION, Canada), Guanghai Wang (Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, China), Sunyue Ye (Jiaxing University, China), Long Yin (Hengyang Normal University, China; Hunan Normal University, China).

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

Access to Document

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

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., Aadland, E., Aguilar-Farias, N., Antczak, D., Azevedo, L., Bardid, F., Capio, C. M., Carlin, A., Carson, V., Chang, Z., Chia, M. Y. H., Costa, S., ... Yin, L. (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. Advance online publication. https://doi.org/10.1186/s40798-025-00905-x

Huang, WY, Zhang, D, Tremblay, MS, Wong, MCS, Sit, CHP, Wong, SWS, Chan, DKC, Wong, SHS, Aadland, E, Aguilar-Farias, N, Antczak, D, Azevedo, L, Bardid, F, Capio, CM, Carlin, A, Carson, V, Chang, Z, Chia, MYH, Costa, S, Demetriou, Y, Dowda, M, Draper, CE, Edwards, S, Martínez-Bello, VE, Guan, H, Hamdouchi, AEL, Hansmann, S, Haugland, ES, Herbert, J, Herrera, M, Hesketh, K, Hunter, S, Jeon, J, Jiang, F, Jürimäe, J, Kerzel, S, Kim, H, Kriemler, S, Kuzik, N, Lee, E-Y, Liu, C, Liu, Y, Löf, M, Lubree, H, Pedersen, MRL, Makaza, D, Manyanga, T, Martins, C, Morrison, SA, Mota, J, Naidoo, R, Junior, NN, Nowicka, P, Nyström, CD, Olds, T, Olesen, LG, Onywera, VO, Plancoulaine, S, Poh, BK, Prioreschi, A, Reilly, JJ, Roman-Viñas, B, Santos, R, Silva, DAS, Sarmiento, OL, Scriven, J, Shahril, MR, Sollerhed, A-C, Standage, M, Stratton, G, Takken, T, Tanaka, C, Timmons, BW, Tomaz, S, Tomkinson, GR, Tucker, P, Vanderloo, LM, Wang, G, Ye, S & Yin, L 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, vol. 11, no. 1, 92. https://doi.org/10.1186/s40798-025-00905-x

@article{7316f798d1dc45ddb05e0112bff266b2,

title = "Developing International Consensus on Key Indicators for a 24-Hour Movement Behaviour Report Card in Early Childhood: A Twin-Panel Delphi Study",

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.",

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 Eivind Aadland and Nicolas Aguilar-Farias and Devan Antczak and Liane Azevedo and Farid Bardid and Capio, \{Catherine M.\} and Angela Carlin and Valerie Carson and Zhenya Chang and Chia, \{Michael Yong Hwa\} and Silvia Costa and Yolanda Demetriou and Marsha Dowda and Draper, \{Catherine E.\} and Susan Edwards and Mart{\'i}nez-Bello, \{Vladimir Essau\} and Hongyan Guan and Hamdouchi, \{Asmaa E. L.\} and Sandra Hansmann and Haugland, \{Elisabeth Straume\} and Jaroslaw Herbert and Marianella Herrera and Kylie Hesketh and Stephen Hunter and Justin Jeon and Fan Jiang and Jaak J{\"u}rim{\"a}e and Sebastian Kerzel and Hyunshik Kim and Susi Kriemler and Nicholas Kuzik and Eun-Young Lee and Cong Liu and Yang Liu and Marie L{\"o}f and Himangi Lubree and Pedersen, \{Marlene Rosager Lund\} and Daga Makaza and Taru Manyanga and Clarice Martins and Morrison, \{Shawnda A.\} and Jorge Mota and Rowena Naidoo and Junior, \{Nelson Nardo\} and Paulina Nowicka and Nystr{\"o}m, \{Christine Delisle\} and Timothy Olds and Olesen, \{Line Gr{\o}nholt\} and Onywera, \{Vincent O.\} and Sabine Plancoulaine and Poh, \{Bee Koon\} and Alessandra Prioreschi and Reilly, \{John J.\} and Blanca Roman-Vi{\~n}as and Rute Santos and Silva, \{Diego Augusto Santos\} and Sarmiento, \{Olga Lucia\} and John Scriven and Shahril, \{Mohd Razif\} and Ann-Christin Sollerhed and Martyn Standage and Gareth Stratton and Tim Takken and Chiaki Tanaka and Timmons, \{Brian W.\} and Simone Tomaz and Tomkinson, \{Grant R.\} and Patricia Tucker and Vanderloo, \{Leigh M.\} and Guanghai Wang and Sunyue Ye and Long Yin",

year = "2025",

month = aug,

day = "7",

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

language = "English",

volume = "11",

journal = "Sports Medicine - Open",

issn = "2199-1170",

publisher = "Springer",

number = "1",

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TY - JOUR

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 - Aadland, Eivind

AU - Aguilar-Farias, Nicolas

AU - Antczak, Devan

AU - Azevedo, Liane

AU - Bardid, Farid

AU - Capio, Catherine M.

AU - Carlin, Angela

AU - Carson, Valerie

AU - Chang, Zhenya

AU - Chia, Michael Yong Hwa

AU - Costa, Silvia

AU - Demetriou, Yolanda

AU - Dowda, Marsha

AU - Draper, Catherine E.

AU - Edwards, Susan

AU - Martínez-Bello, Vladimir Essau

AU - Guan, Hongyan

AU - Hamdouchi, Asmaa E. L.

AU - Hansmann, Sandra

AU - Haugland, Elisabeth Straume

AU - Herbert, Jaroslaw

AU - Herrera, Marianella

AU - Hesketh, Kylie

AU - Hunter, Stephen

AU - Jeon, Justin

AU - Jiang, Fan

AU - Jürimäe, Jaak

AU - Kerzel, Sebastian

AU - Kim, Hyunshik

AU - Kriemler, Susi

AU - Kuzik, Nicholas

AU - Lee, Eun-Young

AU - Liu, Cong

AU - Liu, Yang

AU - Löf, Marie

AU - Lubree, Himangi

AU - Pedersen, Marlene Rosager Lund

AU - Makaza, Daga

AU - Manyanga, Taru

AU - Martins, Clarice

AU - Morrison, Shawnda A.

AU - Mota, Jorge

AU - Naidoo, Rowena

AU - Junior, Nelson Nardo

AU - Nowicka, Paulina

AU - Nyström, Christine Delisle

AU - Olds, Timothy

AU - Olesen, Line Grønholt

AU - Onywera, Vincent O.

AU - Plancoulaine, Sabine

AU - Poh, Bee Koon

AU - Prioreschi, Alessandra

AU - Reilly, John J.

AU - Roman-Viñas, Blanca

AU - Santos, Rute

AU - Silva, Diego Augusto Santos

AU - Sarmiento, Olga Lucia

AU - Scriven, John

AU - Shahril, Mohd Razif

AU - Sollerhed, Ann-Christin

AU - Standage, Martyn

AU - Stratton, Gareth

AU - Takken, Tim

AU - Tanaka, Chiaki

AU - Timmons, Brian W.

AU - Tomaz, Simone

AU - Tomkinson, Grant R.

AU - Tucker, Patricia

AU - Vanderloo, Leigh M.

AU - Wang, Guanghai

AU - Ye, Sunyue

AU - Yin, Long

PY - 2025/8/7

Y1 - 2025/8/7

N2 - 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.

AB - 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.

UR - https://www.scopus.com/pages/publications/105016089877

U2 - 10.1186/s40798-025-00905-x

DO - 10.1186/s40798-025-00905-x

M3 - Article

SN - 2199-1170

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

Data Availability Statement

Acknowledgements

Funding

UN SDGs

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