24-Hour movement behaviours research during the COVID-19 pandemic: a systematic scoping review

The study addresses how the COVID-19 pandemic, associated restrictions (e.g., school/work closures, quarantine, social distancing), and resulting lifestyle changes affected integrated 24-hour movement behaviours—physical activity (PA), sedentary behaviour (SB), and sleep—considered together under the 24-Hour Movement Guidelines (24HMG). Prior research shows declines in PA, increases in SB, and mixed changes in sleep during the pandemic, all with implications for health. Given that PA, SB, and sleep are interdependent and influence health synergistically, the authors argue for evaluating them collectively via 24HMG. While pre-pandemic 24HMG studies examined prevalence, trends, correlates, and health associations, there was no synthesized review of 24HMG evidence during COVID-19. The research question: What does the existing literature report about prevalence, changes, correlates/determinants, and outcomes related to meeting 24HMG during the COVID-19 pandemic? The purpose is to map and synthesize evidence to inform public health and future research.

The paper summarizes evidence that COVID-19 restrictions led to decreased PA and increased SB, with altered sleep patterns (often longer duration with poorer quality). It reviews the emergence and rationale of the Canadian 24HMG across the life course and notes pre-pandemic studies on prevalence, secular trends, correlates, and health outcomes related to meeting 24HMG. Using the VIRTUE framework, prior work clusters into time-use compositions, determinants, and health outcomes. Early pandemic studies reported reduced adherence to 24HMG compared to pre-COVID-19, but a comprehensive synthesis of such findings and correlates had been lacking.

Design: Systematic scoping review. Framework: PRISMA for study selection and reporting; categorization via the Viable Integrative Research in Time-Use Epidemiology (VIRTUE) framework. Data sources: Web of Science, EBSCO, PubMed. Search window: January 1, 2020 to November 30, 2022. Search terms combined three concept sets: (24-h*, 24 h, 24-hour, Movement Behavio*, Sleep*, Screen, Physical Activity) AND (Guideline*, recommendation*) AND (COVID-19, Coronavirus Disease, Coronavirus, SARS-CoV-2, nCoV). Screening: 1339 records identified; 461 duplicates removed; 878 screened by title/abstract; 25 full texts assessed; 16 studies met inclusion criteria after independent dual screening with third-party adjudication for disagreements. Inclusion criteria: human studies; English; reported combined 24-hour movement behaviours using 24HMG (PA/SB and sleep) during the pandemic; publication between Jan 1, 2020 and Nov 30, 2022. Exclusion criteria: duplicates; case studies, theses/dissertations, conference papers/abstracts, reviews, brief reports, letters, protocols, commentaries, qualitative studies; studies not reporting percentage adherence to 24HMG during the pandemic. Data extraction: study characteristics (authors, year, journal, country/organization), design, population/age, sample size, measurement/assessment methods, outcomes (prevalence, trends), correlates/determinants, and health outcomes. Coding: Trends coded as D-* (significant decrease), D- (nonsignificant/unspecified p-value decrease), I+ (nonsignificant increase), NC (no change). Studies were also mapped to VIRTUE domains (time-use composition, correlates/determinants, outcomes).

- Corpus: 16 studies included from 19 countries; substantial representation from Canada (n=5), Spain (n=3), China (n=3); several multi-country studies. Predominant populations: children and adolescents; one adult sample. - Designs: 62.5% cross-sectional (10/16), 25.0% repeated cross-sectional (4/16), 12.5% longitudinal (2/16). - Measurement: Predominantly subjective methods (proxy or self-report); some studies used device-based measures (accelerometers) and mixed-method approaches. - Prevalence levels during COVID-19: Across 17 outcomes from 16 studies, 76.5% (13 outcomes) reported prevalence of meeting 24HMG under 5%; two studies reported <1%. Four studies reported >10% adherence (examples ~13.4%, 15.1%, 19.4%, up to ~27%); the highest observed prevalence was about 27%, and the lowest was 0%. - Changes relative to pre-COVID-19: Eight outcomes from seven studies showed decreased adherence during the pandemic; about half reported statistically significant declines. Some decreases exceeded 3 percentage points. One study reported 0% with no change; some nonsignificant increases were observed in specific subgroups (e.g., girls). - Correlates/determinants: Most studies examined sociodemographic factors (sex/gender, age, region, urban/rural, country income). Fewer assessed behavioural/lifestyle (e.g., outdoor activity), disability status, environmental (e.g., presence of outdoor space), and social/cultural factors (e.g., parental concerns/support, parental stress/exhaustion). Two studies linked adherence to psychological outcomes (depression, anxiety, stress) in Chinese preschoolers and university students. - Overall synthesis: During COVID-19, adherence to 24HMG among children/adolescents was very low and typically declined from pre-pandemic levels. Research emphasis was on time-use composition and sociodemographic correlates, with limited exploration of broader determinants and health outcomes.

The review shows that COVID-19-related restrictions likely reduced opportunities for physical activity, increased sedentary time (especially recreational screen use), and disrupted sleep routines, collectively resulting in very low adherence to 24HMG in youth and significant declines from pre-pandemic baselines. These findings address the research question by quantifying the extent of nonadherence and highlighting predominant determinants investigated to date. The predominance of cross-sectional, Western-based, and subjectively measured studies reflects feasibility constraints during lockdowns. The limited focus beyond sociodemographic correlates suggests gaps in understanding environmental, social, and cultural influences on integrated movement behaviours. Public health implications include the need to restore and enhance access to PA opportunities (e.g., safe outdoor spaces, school-based PE, organized activities), reduce sedentary time, and support healthy sleep routines, particularly during future public health crises. The review underscores the importance of integrating device-based monitoring and more robust designs to inform interventions and policy.

This scoping review synthesized studies applying 24HMG during the COVID-19 pandemic and found that adherence, particularly among children and adolescents, was very low and generally declined compared with pre-pandemic levels. There remains considerable scope for improvement in study design (e.g., longitudinal/interventional approaches), measurement (greater use of device-based tools), and expansion of research domains (broader correlates and health outcomes). Findings provide a knowledge base to guide future research and policy aimed at mitigating adverse impacts on 24-hour movement behaviours during and after public health emergencies.

- Most included studies were cross-sectional, limiting inference about changes and causality. - Search limited to English-language articles in three databases; studies in other languages or databases may have been missed. - COVID-19 policy contexts were not incorporated; future analyses should consider policy effects on adherence to 24HMG. - No stratified review by gender, socioeconomic status, country income level, or detailed age groups, which may limit generalizability and specificity. - The review summarized topics within the VIRTUE framework but did not meta-analyze associations between determinants and 24-hour movement behaviours; future systematic reviews and meta-analyses are warranted.