The Efficacy of Interventions Targeting 24-h Movement Behaviours in Children and Adolescents: A Systematic Review and Meta-analysis

Abstract

Background

While the concept of “24-h movement behaviours” has gained attention, and correlational studies have shown its importance for health outcomes among children and adolescents, there is still no comprehensive review summarising the efficacy of such interventions in changing specific behaviour. This systematic review, therefore, aimed to examine the efficacy of interventions targeting 24-h movement behaviours on physical activity, sedentary behaviour/screen time, and sleep duration.

Methods

A systematic search was conducted on February 1, 2024, across six databases (MEDLINE, PsycINFO, EMBASE, PubMed, Web of Science, and SPORTDiscus). Included articles were interventions targeting 24-h movement behaviours simultaneously (physical activity, sedentary behaviour/screen time, and sleep duration) in children and adolescents aged under 18 years. Data were analysed using random effects meta-analysis, and the risk of bias was assessed using the Cochrane risk-of-bias tool.

Results

The literature search identifed 1849 articles, and 20 studies met the inclusion criteria, with 9 of them included in the meta-analysis. A pooled 26-min decrease was observed in screen time (95% CI =  − 48.52, − 3.91, I² = 86%), and an 8-min increase was found in sleep duration (95% CI = 3.52, 12.33, I² = 27%), while no significant changes were observed in physical activity and total sedentary behaviour.

Conclusion

Interventions targeting a combination of 24-h movement behaviours have demonstrated efficacy in decreasing screen time and improving sleep duration, while the efficacy in physical activity and total sedentary behaviour warrants further exploration. The findings from this systematic review on 24-h movement behaviour interventions highlight the potential to leverage the interconnectedness of different movement behaviours, particularly in targeting screen time reduction and sleep duration enhancement. These insights can inform the development of more effective, holistic interventions and policies that promote comprehensive approaches to physical activity, sedentary behaviour, and sleep duration among children and adolescents.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-025-00961-3.

Key Points

• This review is the first attempt to synthesise evidence on efficacy of interventions targeting 24-h movement behaviours among children and adolescents.

• Interventions targeting all three 24-h movement behaviours were effective in decreasing screen time and improving sleep duration.

• The efficacy of 24-h behaviour interventions on physical activity and sedentary behaviour warrants further exploration.

Supplementary Information

The online version contains supplementary material available at 10.1186/s40798-025-00961-3.

Introduction

Physical activity (PA), sedentary behaviour (SB), and sleep are closely tied to health outcomes in children and adolescents [1–3]. Consistent evidence has demonstrated that higher PA levels and sufficient sleep were associated with a reduced risk of obesity, lower cardiometabolic and cardiovascular risks, and improved cardiorespiratory fitness [1, 3]. On the other hand, prolonged SB and screen time have been associated with an increased risk of developing mental health issues and behavioural problems [2, 4]. However, the time in a 24-h day is finite and fixed. An increase in time spent on one behaviour may inevitably lead to a decrease in time spent on other behaviours. Therefore, moving beyond the traditional focus on individual behaviours, the concept of considering all movement behaviours as a whole within a 24-h period has gained increasing attention. Research has shown that a combination of high PA, low SB, and sufficient sleep promotes optimal health [5, 6].

Grounded in this, several countries and the World Health Organisation (WHO) have released guidelines for different age groups. As suggested by WHO, infants younger than 1 year should have at least 30 min of PA, no screen time, and 14 to 17 h (0 to 3 months of age) or 12 to 16 h (4 to 11 months of age) of sleep; toddlers aged 1 to 2 years should have at least 180 min of PA, no screen time (1‑year‑olds) or no more than 1 h of screen time (2‑year‑olds), and 11 to 14 h of sleep; and preschoolers aged 3 to 4 years should have at least 180 min of PA and 60 min of moderate‑to‑vigorous PA (MVPA), no more than 1 h of screen time, and 10 to 13 h of sleep [7]. For children and adolescents aged 5 to 17 years, the Canadian 24-h movement guidelines recommend at least 60 min of MVPA, limiting screen time to no more than two hours, and having adequate sleep in a 24-h day: 9 to 11 h for children aged 5 to 13 years and 8 to 10 h for adolescents aged 14 to 17 years [8]. Importantly, SB is distinct from screen time; different sedentary activities carry different benefits and risks, and no quantitative threshold for total SB has been established. Despite the clear health benefits associated with adhering to these guidelines [9], studies indicate low adherence rates among children and adolescents aged under 18 years. A systematic review among young children found that only 13% met all three guidelines, mainly driven by low compliance with the SB guideline (28.3%), whereas 67.0% and 77.3% met the PA and sleep guidelines, respectively [10]. Another review reported even lower adherence rates, with only 10% of children and 3% of adolescents meeting all guidelines, with poor compliance with PA and SB guidelines as the main barriers [11]. These findings highlight the urgent need for interventions aimed at improving 24-h movement behaviours in children and adolescents.

However, single-behaviour interventions have been a dominant approach for more than 20 years, with their efficacy well-documented [12, 13]. Interestingly, these interventions have exhibited an “overflow effect”, i.e., the intervention had an impact on other non-targeted behaviours [14, 15]. A recent systematic review involving 102 papers from 21 countries among children and adolescents reported small but significant changes in interventions aimed at increasing PA or reducing SB [15]. For instance, interventions aimed at improving PA have been shown to decrease SB in children and adolescents [15]; interventions targeting SB reduction have resulted in increased standing time in children and adolescents [15]. The above evidence echoes the fixed nature of time within a 24-h day, suggesting that improving one behaviour could theoretically lead to the reallocation of time spent on other behaviours. This raises the question of whether studies targeting multiple behaviours could generate a larger overall effect. Yet, interventions encompassing all three behaviours are still in their infancy, showing inconsistent findings [16–18]. For example, a study involving school-aged children found no significant changes in movement behaviours in scores, time, or the percentage meeting the guidelines [16], whereas another study among adolescents reported improvement in the percentages meeting individual behaviour guidelines or their general combinations [18]. Recently, a three-arm intervention study focused on preschoolers yielded promising results, indicating the superiority of 24-h movement behaviour interventions [17]. It found that those in the integrated intervention group, which targeted PA, SB, and sleep duration simultaneously, exhibited favourable changes in overall movement behaviours; but preschoolers in the group that only targeted PA and SB, as well as those in the control group, showed no such improvements [17]. While empirical evidence is limited, statistical methods suggest that targeting multiple behaviours simultaneously could provide more flexible choices for achieving desired health outcomes: similar health outcomes could be achieved by different combinations of movement behaviours [19, 20]. This implies that adopting an integrated approach allows individuals to distribute effort more balanced across movement behaviours, potentially leading to greater overall change.

Given the interconnected nature of PA, SB, and sleep within a 24-h period, the efficacy of interventions targeting all three behaviours simultaneously warrants exploration. This study aimed to examine the efficacy of such interventions among children and adolescents. We hypothesise that interventions targeting 24-h movement behaviours would be effective in improving PA, decreasing SB and screen time, and improving sleep duration among children and adolescents.

Methods

Protocol and Registration

The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024505122). This study follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [21].

Information Sources and Search Strategy

Six databases were searched on February 1, 2024, including MEDLINE (Ovid), PsycINFO (ProQuest), EMBASE (Ovid), PubMed, Web of Science, and SPORTDiscus (EBSCO). Searching was limited to English language, and there were no date limits of publication. The complete search strategy is available in Supplementary Table S1.

Eligibility Criteria

Studies published, peer-reviewed, and written in English were included. The study design could be randomised controlled trial (RCT), non-RCT, crossover study, parallel study, or single-group pre- and post-intervention. To be included in this review, interventions had to target all three 24-h movement behaviours (i.e., PA, SB/screen time, sleep) and measure at least one of these behaviours. For studies with a control group, participants in the control group should either receive no intervention or receive an intervention that was unrelated to the content of the intervention group (e.g., healthy diet). Studies involving apparently healthy children aged under 18 were eligible.

Studies were excluded if they were: qualitative studies; case studies and case series; grey literature; comments/editorials; reviews; or studies focusing on children with a clinical diagnosis (e.g., sleep disorders), with the exception of overweight/obesity.

Study Selection and Data Extraction

Data selection and coding were conducted by two reviewers independently. Any disagreement was resolved by discussion or a third reviewer (JF). In step 1, titles and abstracts of potentially relevant articles were screened by two reviewers (YS, JJ), using EndNote. In step 2, full text articles were screened by two reviewers independently (YS, JJ). Some characteristics of articles were extracted by two reviewers (XY, YW) (e.g., author, publication year, country, population, study design, setting [e.g., home, school], control group condition [e.g., non-intervention, waitlist non-intervention], outcome measurement, main results [i.e., intervention effect], intervention duration), using Microsoft Excel. The corresponding authors of potentially relevant studies were contacted to provide supplementary data. A total of 13 emails were sent, and 3 replies were received within two weeks.

Risk of Bias and Publication Bias

The Cochrane risk-of-bias tool for randomised trials was used to assess the risk of bias of included studies, and it was conducted by two reviewers independently (JF, XY). Any difference was resolved by discussion or a third reviewer (YL).

Data Synthesis

Meta-analyses were conducted if there were at least three studies that reported the same behavioural outcomes (e.g., MVPA) for both intervention and control groups at the same time point (e.g., post-intervention). Sensitivity analyses were conducted to assess the effect of removing each study from the pooled results. Random effect models were utilised to estimate the pooled mean difference and 95% confidence interval (CI). Heterogeneity was assessed using I square (I²) statistic. The meta-analysis was performed using Review Manager software (RevMan V.5.4; Cochrane Collaboration, Oxford, UK).

Results

Study Selection

A total of 1,849 records were identified through database searches, with 1,043 articles remained after removing duplicates. After screening titles and abstracts, 83 records remained for full-text screening. Of these, 63 were excluded due to the following reasons: not targeting all three behaviours (n = 33), study protocol (n = 11), data unavailable (n = 6), participants older than 18 years (n = 5), observational design (n = 4), control group received intervention (n = 2), and conference abstract (n = 2). Finally, a total of 20 studies were included, with 9 of them included in the meta-analysis, with at least three studies for each meta-analysed outcome. The details of the study selection are shown in Fig. 1.

Fig. 1.

The PRISMA flow diagram

Descriptive Characteristics of Included Studies

The 20 studies included 32,441 participants from 11 countries. Most included studies were RCT (n = 6) or clustered RCT (n = 6), followed by quasi-experimental study design (n = 6), and 2 studies used single-group pre- and post- design. Most studies targeted school-aged children (n = 7) and preschoolers (n = 7), followed by adolescents (n = 4), both infants and toddlers (n = 1), and both preschoolers and school-aged children (n = 1). Of the 20 studies, 19 measured PA, using accelerometers (n = 8) and questionnaire/questions (n = 11); 8 studies measured SB using accelerometers (n = 6) and questionnaire/questions (n = 2); 16 studies measured screen time subjectively, using questionnaire/questions (n = 15) and log diary (n = 1); sleep duration was measured in 18 studies, using questionnaire/questions (n = 14), accelerometers (n = 3), and log diary (n = 1). The characteristics of included studies are presented in Table 1.

Table 1.

Characteristics of included studies

Author, year	Country	Study design	Population	Sample size	Control group condition	Physical activity		Sedentary behaviour		Screen time		Sleep		Intervention duration
						Measurement	Findings	Measurement	Findings	Measurement	Findings	Measurement	Findings
Bahreynian et al. [22]	Iran	Quasi-experimental	School-aged children 10.1 ± 1.5 yrs, 100.0% males	71	Nil	Questionnaire/ questions	/	Questionnaire/ questions	/	NA	NA	Questionnaire/ questions	–	3 months
Brown et al. [32]	The United States	RCT	School-aged children 8.0 yrs	23	Non-intervention	Accelerometer	+	NA	NA	Questionnaire/questions	/	Accelerometer	?	11 weeks
Brown et al. [31]	The United States	Quasi-experimental	Preschoolers 3–5 yrs	17	Nil	Questionnaire/ questions	+	NA	NA	Questionnaire/questions	NA	Questionnaire/ questions	+	5 weeks
Champion et al. [23]	Australia	Clustered RCT	Adolescents 12.7 ± 0.5 yrs, 49.9% males	6640	Non-intervention	Questionnaire/ questions	/	NA	NA	Questionnaire/questions	/	Questionnaire/ questions	/	6–8 weeks
Donnelly et al. [33]	The United Kingdom	RCT	School-aged children 9–12 yrs	68	Non-intervention	Accelerometer	+	Accelerometer	–	Questionnaire/questions	/	Accelerometer	/	8 weeks
Faghy et al. [38]	The United Kingdom	Single-group pre- and post	School-age children 8.9 ± 1.3 yrs, 50.3% males	147	Nil	Accelerometer	LPA: – MPA: +  VPA: –	Accelerometer	–	Questionnaire/questions	/	Questionnaire/ questions	/	12 weeks
Gago et al. [24]	The United States	Clustered RCT	Preschoolers 2–4 yrs, 49.0% males	4011	Non-intervention	Questionnaire/ questions	/	NA	NA	Questionnaire/questions	–	Questionnaire/ questions	/	10 weeks
Haines et al. [25]	Canada	RCT	Preschoolers 3.0 ± 1.2 yrs, 47.2% males	44	Non-intervention	Accelerometer	/	Accelerometer	/	NA	NA	Accelerometer	/	6 months
Hyman et al. [26]	Canada	Single-group pre- and post	School-aged children 11.0 ± 0.6 yrs, 42.9% males	126	Nil	Questionnaire/ questions	/	NA	NA	Questionnaire/questions	/	NA	NA	6 weeks
Jovanovic et al. [34]	Croatia	Quasi-experimental	School-aged children 11.0 ± 0.4 yrs, 49.9% males	2709	Non-intervention	Questionnaire/ questions	+	NA	NA	Questionnaire/questions	/	Questionnaire/ questions	/	3 weeks
Marsh et al. [39]	New Zealand	RCT	Preschoolers 2.6 ± 0.7 yrs	54	Wait-list control	NA	NA	NA	NA	Questionnaire/questions	/	Questionnaire/ questions	/	6 weeks
Novotny et al. [27]	The United States	RCT	Preschoolers & school-aged children 5.4 ± 1.8 yrs, 50.9% males	8371	Wait-list control	Accelerometer	/	Accelerometer	/	Questionnaire/questions	/	Questionnaire/ questions	/	26 months
O’Dean et al. [37]	Australia	Clustered RCT	Adolescents 13.0 yrs, 50.0% males	6639	Non-intervention	Questionnaire/ questions	–	NA	NA	Questionnaire/questions	/	Questionnaire/ questions	/	7 weeks
Peuters et al. [35]	Belgium	Quasi-RCT	Adolescents 12–15 yrs, 44.4% males	279	Non-intervention	Accelerometer	+	Accelerometer	–	NA	NA	Accelerometer	+	12 weeks
Puder et al. [28]	Switzerland	Clustered RCT	Preschoolers 5.1 ± 0.7 yrs, 50.0% males	652	Non-intervention	Accelerometer	/	NA	NA	Questionnaire/questions	–	Questionnaire/ questions	/	One academic year
Sevil et al. [18]	Spain	Quasi-experimental	Adolescents 13.1 yrs, 47.2% males	210	Non-intervention	Accelerometer	+	Accelerometer	–	Questionnaire/questions	–	Questionnaire/ questions	+	One academic year
Tapia-Serrano et al. [16]	Spain	Quasi-experimental	School-aged children 9.01 ± 0.09 yrs, 52.9% males	121	Non-intervention	Questionnaire/ questions	/	NA	NA	Questionnaire/questions	/	Questionnaire/ questions	/	2.5 months
Tomayko et al. [29]	The United States	RCT	Preschoolers 3.3 ± 1.1 yrs, 49.8% males	450	Non-intervention (child safety)	Questionnaire/ question	/	NA	NA	Questionnaire/questions	/	Questionnaire/ questions	/	12 months
Ullevig et al. [30]	The United States	Clustered RCT	Preschoolers 3.6 ± 0.3 yrs, 43.1% males	325	Non-intervention (nutrition)	Questionnaire/ questions	/	NA	NA	Log diary	–	Log diary	+	8 months
Wu et al. [36]	China	Clustered RCT	Infants & toddlers 6–20 months, 50.9% males	1610	Non-intervention (feeding)	Questionnaire/ questions	+	Questionnaire/ questions	/	Questionnaire/questions	–	Questionnaire/ questions	/	2 months

Abbreviation: LPA, light-intensity physical activity; MPA, moderate-intensity physical activity; NA, not applicable; RCT, randomised controlled trial; VPA, vigorous-intensity physical activity

 + significantly higher (intervention vs. control group for interventions with a control group; postintervention vs. baseline for interventions without a control group), – significantly lower (intervention vs. control group for interventions with a control group; postintervention vs. baseline for interventions without a control group), / no significance, ? Analysis not conducted to compare the difference

Effects of 24-h Interventions on Physical Activity

A total of 19 studies examining the efficacy of 24-h movement behaviour interventions on PA revealed mixed results. Ten studies exhibited no significant changes in PA [16, 22–30], while 7 of them observed increased PA [18, 31–36]. One study reported decreased PA [37], and another observed decreased light- and vigorous- intensity PA and increased moderate-intensity PA [38]. Of the total of 19 studies, 3 were included in the meta-analysis and used device-based measurement [18, 27, 33], with MVPA being the outcome, and no significant changes in MVPA were reported (mean difference [MD] = 8.03 min/day, 95% CI =  − 8.24, 24.30, I² = 93%) (Fig. 2a).

Fig. 2.

Pooled analysis of the effect of 24-h movement behaviour intervention on a moderate-to-vigorous intensity physical activity, b sedentary behaviour, c screen time, and d sleep

Effects of 24-h Interventions on Sedentary Behaviour/Screen Time

The efficacy of 24-h movement behaviour intervention on SB was measured in 8 studies. Four of them reported decreased SB [18, 33, 35, 38], and the remaining four studies found no significant changes [22, 25, 27, 36]. A total of 3 studies were included in the meta-analysis and used device-based measurement [18, 27, 33], and no significant decrease in SB was observed in the intervention group (MD =  − 5.17 min/day, 95% CI =  − 42.10, 31.76, I² = 83%), compared with the control group (Fig. 2b).

A total of 16 studies examined the efficacy of 24-h movement intervention on screen time. Five studies reported a decrease in screen time [18, 24, 28, 30, 36], while no significant changes were observed in 11 studies [16, 23, 26, 27, 29, 32–34, 37–39]. Among these 16 studies, 8 of them were included in the meta-analysis [16, 18, 23, 27, 28, 30, 33, 39], and a significant decrease in screen time was observed in the intervention group (MD =  − 26.22 min/day, 95% CI =  − 48.52, − 3.91, I² = 86%), compared with the control group (Fig. 2c). All studies used subjective measures, with 7 studies using questionnaires/questions [16, 18, 23, 27, 28, 33, 39] and one study using a log diary [30].

Effects of 24-h Interventions on Sleep Duration

A total of 18 studies examined the efficacy of 24-h movement intervention on sleep duration and yielded mixed findings. Increased sleep duration was reported in 4 studies [18, 28, 30, 31], no significant changes were observed in 13 studies [16, 23–25, 27–29, 33, 34, 36–39], and one study found decreased sleep duration [22]. Among these 18 studies, 9 of them were included in the meta-analysis [16, 18, 23, 25, 27, 28, 30, 33, 39], a significant increase in sleep duration was observed in the intervention group (MD = 7.92 min/day, 95% CI = 3.52, 12.33, I² = 27%), compared with the control group (Fig. 2d). All studies except two [25, 33] used subjective measurements.

Risk of Bias

Among the 20 included studies, 9 studies were rated as high risk of bias, 10 studies exhibited some concerns, and one was rated as low risk of bias. The details are presented in Supplementary Table S2. The high risk of bias was primarily attributed to issues with the randomisation process, lack of blinding, and the exclusion of a significant portion of participants from the final analysis.

Sensitivity Analysis

Sensitivity analyses were conducted by removing each study from the meta-analyses. The results showed that the pooled effect of 24-h movement interventions on screen time became non-significant when removing any of the three studies [28, 30], and no significant changes were observed for other outcomes.

Discussion

This systematic review and meta-analysis summarised the efficacy of 24-h movement behaviour interventions among children and adolescents. A total of 20 studies were included, with 9 meeting the criteria for meta-analysis. The efficacy of 24-h movement interventions on PA and SB showed mixed results, including favourable, unfavourable, and non-significant changes, and the overall meta-analysis did not show significant changes. Encouragingly, the meta-analysis revealed a consistent positive impact on reducing screen time and improving sleep duration.

While our meta-analysis reported a pooled increase of 8 min of MVPA per day, this change did not reach statistical significance. This increase aligns with a systematic review of PA interventions among children under 16 years old, which found a small effect on overall PA levels, resulting in an average increase of approximately 4 min of walking or running per day [40]. Other systematic reviews have also reported non-existent or small increases in PA in children and adolescents, with these findings being consistent across age groups and settings, including both school and family environments [41–43]. However, it is noteworthy that only 3 studies with high heterogeneity were included in the meta-analysis in the present study, restricting the generalisability and reliability of the findings, and making it difficult to draw definitive conclusions about the efficacy of 24-h movement interventions on PA. Additionally, sub-group analyses could not be conducted to explore which factors (e.g., setting, duration, approach) may have contributed to the efficacy of the intervention. Further studies are crucial to explore the impact of interventions targeting all three components of 24-h movement on PA levels.

The efficacy of 24-h movement interventions on SB was mixed, with some studies showing no effect and others reporting favourable changes. The meta-analysis reported decreased SB in the intervention group, but the changes were not statistically significant. This finding, while not aligning with our hypothesis, can be partially explained by previous research. A recent systematic review found that programs solely targeting SB reduction were more effective at decreasing SB than interventions focused solely on PA or those combining both PA and SB strategies [13]. While solely targeting SB may offer some advantages, this raises the question of how to translate decreased SB into increased PA levels. The benefits gained from a more substantial decrease in SB being replaced by standing or light-intensity PA could differ significantly from the case where a smaller reduction in SB is replaced by MVPA. The trade-offs and outcomes in interventions targeting individual and multiple behaviours would likely vary. In addition, the interpretation of these findings is limited by the fact that the majority of studies included in the meta-analysis focused on adults, with only 7 studies involving children and adolescents [13]. Notably, another systematic review focusing on young children (0–5 years old) suggested that interventions targeting PA were more effective than those directly targeting SB, showing that the time spent in SB was shifted to PA [14]. Due to the limited number of studies in the meta-analysis, subgroup analysis exploring differences across participant characteristics was not possible. Further research is needed to determine whether interventions focused solely on SB, those combining PA and SB, or those targeting all three behaviours simultaneously are most effective in reducing SB across different age groups.

The meta-analysis revealed a decrease in screen time in interventions targeting 24-h movement behaviours, aligning with our hypothesis and supporting previous research. This finding is echoed by a systematic review that observed a significant reduction of three to four hours per week in screen time among preschoolers participating in such interventions [44]. Furthermore, a study encompassing children from birth to 18 years old also reported a decrease in screen time among those involved in interventions specifically targeting screen time [45]. Our current review demonstrated a 26-min reduction in daily screen time among the intervention group compared to the control group. This finding underscores the potential of interventions that address all three components of 24-h movement behaviours to effectively reduce screen time.

Interventions targeting 24-h movement behaviours demonstrated a significant increase in sleep duration, supporting our hypothesis and aligning with previous research. The pooled 8-min improvement in sleep duration is consistent with prior studies among children aged 18 months to 19 years, which reported a 10.5-min increase in sleep duration following sleep interventions [46]. This finding underscores the potential of 24-h movement behaviour interventions to enhance sleep duration. In addition, it is noteworthy that the only study included in our meta-analysis that observed descriptively shorter sleep duration in the intervention group lasted for 2 years [27], falling into the category of “less effective” interventions (longer than 6 months) suggested by a review [46]. The lower sleep in the intervention group may be due to several factors, including lower baseline sleep duration compared with the control group (9.71 vs. 10.00 h/day) and the age range (2 to 8 years) of included participants, during which sleep duration often declines with age [27]. To optimise the efficacy of these interventions, future research could explore the specific impact of strategies such as introducing earlier bedtimes and adopting shorter intervention durations [46]. However, due to the limited number of studies included in our analysis, these findings should be interpreted with caution. Further research is needed to draw conclusive evidence regarding the efficacy of 24-h movement behaviour interventions for improving sleep duration.

To the best of our knowledge, this review is the first attempt to examine the efficacy of interventions targeting all three behaviours among children and adolescents aged under 18 years. A comprehensive search strategy and rigorous methodological approach were adopted to identify relevant studies. However, some limitations of the review should be acknowledged. Firstly, a limited number of studies were included, with a significant proportion of them demonstrating some concerns or rated as high concerns restricting the robustness of the findings. More studies adopting rigorous methodologies, including randomisation, double blinding, and intention-to-treat-principle analysis, are warranted to strengthen the evidence base. Secondly, the search was limited to English-language and peer-reviewed studies, which may have introduced publication bias. Thirdly, although participants spanning a wide age range were included in this study, the number of studies within each age stratum (e.g., preschoolers, school-aged children, adolescents) was insufficient to conduct subgroup analyses. Future studies, particularly those focusing on school-aged children and adolescents, are needed. Fourthly, most included studies relied on subjective measures of PA and sleep duration, and future research should prioritise the use of objective, device-based measures to continuously track 24-h movement behaviours. Lastly, it is noteworthy that all included interventions were multicomponent, targeting both movement behaviours and diet. Therefore, the observed effects on movement behaviours reflect the combined intervention package rather than isolated movement behaviour–focused strategies.

Conclusions

Interventions targeting all three movement behaviours demonstrated a decrease in screen time and an increase in sleep duration. Mixed findings were observed for the efficacy of 24-h movement interventions on PA and SB. Given the interdependence of these behaviours within a finite 24-h day, integrated approaches remain a promising direction; however, current evidence is insufficient to conclude their superiority over single-behaviour interventions. Future high-quality studies using device-based measures, compositional data analysis, or joint guideline outcomes are needed to explore the efficacy of integrated strategies for improving overall daily movement patterns among children and adolescents.

Abbreviations

CI

Confidence interval

I²

I Square

MD

Mean difference

MVPA

Moderate-to-vigorous physical activity

PA

Physical activity

PRISMA

Preferred reporting items for systematic reviews and meta-analyses

RCT

Randomised controlled trial

SB

Sedentary behaviour

Author contributions

JF and YL conceived the idea for the review. JF, YS, and JJ searched and screened the studies, XY and YW completed data extraction, JF and XY evaluated the risk of bias. JF performed data analysis and drafted the initial manuscript. All authors contributed to the editing of the paper and provided their final approval of the manuscript.

Funding

This study is supported by the National Key Research and Development Program of China (2023YFC3305801), the Program for Overseas High-level Talents at Shanghai Institutions of Higher Learning (TP2022102) and Shanghai Key Laboratory of Human Performance (Shanghai University of Sport, 11DZ2261100).

Data availability

All data have been included in the article or included as supplementary information.

Code availability

Not applicable.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors have no relevant financial or non-financial interests to disclose.