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There is strong and consistent evidence based on experimental studies for several health outcomes that participating in as little as 2 or 3 hours of moderate-to-vigorously intense physical activity per week is associated with health benefits. Evidence from observational studies also demonstrates dose-response relations between physical activity and health, with differences in health risk between the least active (or fit) and the second least active (of fit) groups. Thus, it would seem appropriate to set minimal physical activity targets that reflect a low level of physical activity (see Recommendation #1). Furthermore, the current recommendation of 90 minutes more per day (Canadian) or 60 minutes per day (US, UK, Australian) may be quite intimidating, particularly for children and youth who are very inactive. From a behaviour modification perspective, having a target that seems out of reach may actually undermine physical activity participation [115].
That being said, with the exception of injuries, the dose-response evidence from observational studies for several health outcomes suggests that more physical activity will be better, and that additional health benefits can still be achieved at the higher end of the physical activity spectrum. Therefore, it would also seem appropriate to set higher physical activity targets (60 minutes and up to several hours) that would elicit more pronounced health benefits for those children and youth who are already somewhat active (see Recommendation #1). This approach is consistent with recommendations made by the U.S. National Association for Sports and Physical Education[116] and the Australia Department of Health and Ageing [117], both of whom have recommended that children and youth participate in at least 60 minutes, and up to several hours, of moderate to vigorous intensity physical activity every day.
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Previous physical activity recommendations and guidelines for school-aged children and youth indicate that a high volume of physical activity needs to be performed everyday. The need for children and youth to engage in physical activity on a daily basis to maintain good health was not supported by the evidence reviewed here. In other words, it is unknown as to whether a child who accumulates 7 hours of activity over the week, with one hour being performed on each day, would have any greater health benefits than a child who accumulates 7 hours of activity over the week, with different amounts of activity being performed each day (including some days with no activity). Thus, the recommendation made in this systematic review calls for an "average" of at least 60 minutes per day instead of at least 60 minutes everyday. Future studies need to address whether a "days per week" recommendation is warranted. In addition, future studies within children and youth should consider whether the daily physical activity needs to be accumulated in bouts of at least a few minutes in duration (eg, 5 or 10 minutes). Most children accumulate the majority of their physical activity in a very sporadic manner (eg, a couple of minutes here and there), and new evidence suggests that this sporadic pattern of activity may not be as beneficial as bouts of activity that last at least 5 minutes in length [118].
The proportion of children meeting the physical activity recommendation was comparable to that reported for urban Brazilian preschool children, while adherence to the screen time and sleep recommendations was substantially higher [11]. These findings are consistent with the results of a recent study comparing the physical activity and screen time behaviors of rural and urban preschool children in Brazil [33]. In that study, rural and urban preschoolers exhibited similar levels of device-measured total physical activity and energetic play, but rural preschool children had almost 1-hour less parent reported daily screen time than their urban counterparts [33]. The higher adherence to the sleep recommendation observed among rural preschool children is consistent with the results of Rae et al. [34] who reported 24-hour sleep duration to be significantly longer among low-income South African rural preschool children than urban preschool children. The authors hypothesized that children living in rural areas may have fewer environmental constraints on their sleep, e.g., lower housing density, more room and/or less bed sharing, less noise and less light pollution. Alternatively, the lower adherence rates reported for urban preschool children may be attributable to subtle methodological differences in the assessment of nighttime sleep duration. In the de Lucena Martins study [11], parents reported the total number of hours their child slept on weekdays and weekends during the night. In the current study, parents reported the time their child usually went to bed at night and the time the child woke up in the morning to start the day on weekdays and weekend days, respectively.
Workers exposed to mercury usually represent a group whose mercury-exposure starts only with adulthood (for about 8 hours a day, 5 days a week), while amalgam bearers can be exposed to mercury in the womb through maternal amalgam fillings during their childhood and until death at a rate of 24 hours per day, 7 days per week.
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