Background: This article summarizes the approach taken to develop UK Chief Medical Officers’ physical activity guidelines for the Under 5s, 2019. Methods: The Grading of Recommendations Assessment, Development and Evaluation (GRADE)-Adaptation, Adoption, De Novo Development (ADOLOPMENT) approach was used, based on the guidelines from Canada and Australia, with evidence updated to February 2018. Recommendations were based on the associations between (1) time spent in sleep, sedentary time, physical activity, and 10 health outcomes and (2) time spent in physical activity and sedentary behavior on sleep outcomes (duration and latency). Results: For many outcomes, more time spent in physical activity and sleep (up to a point) was beneficial, as was less time spent in sedentary behavior. The authors present, for the first time, evidence in GRADE format on behavior type–outcome associations for infants, toddlers, and preschoolers. Stakeholders supported all recommendations, but recommendations on sleep and screen time were not accepted by the Chief Medical Officers; UK guidelines will refer only to physical activity. Conclusions: This is the first European use of GRADE-ADOLOPMENT to develop physical activity guidelines. The process is robust, rapid, and inexpensive, but the UK experience illustrates a number of challenges that should help development of physical activity guidelines in future.
Reilly, Hughes, and Janssen are with Physical Activity and Health Group, School of Psychological Sciences and Health, University of Strathclyde, Glasgow, United Kingdom. Martin is with MRC/CSO Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom. Hesketh is with the Great Ormond Street Institute of Child Health, University College London, London, United Kingdom. Livingstone is with the Department of Media and Communications, The London School of Economics and Political Science, London, United Kingdom. Hill is with the Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, United Kingdom. Kipping is with Bristol Medical School, University of Bristol, Bristol, United Kingdom. Draper is with South African MRC Developmental Pathways for Health Research Unit, University of the Witwatersrand, Johannesburg, South Africa; and Johannesburg Division of Exercise Science and Sports Medicine, University of Cape Town, Cape Town, South Africa. Okely is with Early Start, Faculty of Social Sciences, University of Wollongong, Wollongong, NSW, Australia.