Anthony D. Okely, University of WollongongFollow
Davina Ghersi, National Health and Medical Research Council, Canberra, University of Sydney
Kylie Hesketh, Deakin UniversityFollow
Rute Santos, University of Wollongong, University of PortoFollow
Sarah P. Loughran, University of WollongongFollow
Dylan P. Cliff, University of WollongongFollow
Trevor Shilton, National Heart Foundation, Western Australia
David Grant, Australian Government Department of Health, CanberraFollow
Rachel A. Jones, University of WollongongFollow
Rebecca M. Stanley, University of WollongongFollow
Julie Sherring, University of Wollongong
Trina Hinkley, National Health and Medical Research Council, CanberraFollow
Stewart Trost, Queensland University of TechnologyFollow
Clare McHugh, Early Childhood Australia, Canberra
Simon Eckermann, University of WollongongFollow
Karen Thorpe, University of QueenslandFollow
Karen Waters, University of Sydney, Children’s Hospital Westmead
Timothy Olds, University of South AustraliaFollow
Tracy Mackey, NSW Department Of Education
Rhonda Livingstone, Australian Children's Education and Care Quality Authority
Hayley Christian, University of Western Australia
Harriette Carr, New Zealand Ministry of Health
Adam Verrender, University of WollongongFollow
Joao Rafael Rodrigues Pereira, University of WollongongFollow
Zhiguang Zhang, University of WollongongFollow
Katherine Downing, Deakin University
Mark S. Tremblay, Children's Hospital of Eastern Ontario Research InstituteFollow



Publication Details

Okely, A. D., Ghersi, D., Hesketh, K. D., Santos, R., Loughran, S. P., Cliff, D. P., Shilton, T., Grant, D., Jones, R. A., Stanley, R. M., Sherring, J., Hinkley, T., Trost, S. G., McHugh, C., Eckermann, S., Thorpe, K., Waters, K., Olds, T. S., Mackey, T., Livingstone, R., Christian, H., Carr, H., Verrender, A., Pereira, J. R., Zhang, Z., Downing, K. L. & Tremblay, M. S. (2017). A collaborative approach to adopting/adapting guidelines - The Australian 24-Hour Movement Guidelines for the early years (Birth to 5 years): An integration of physical activity, sedentary behavior, and sleep. BMC Public Health, 17 (Suppl 5), 167-190.


Background: In 2017, the Australian Government funded the update of the National Physical Activity Recommendations for Children 0-5 years, with the intention that they be an integration of movement behaviours across the 24-h period. The benefit for Australia was that it could leverage research in Canada in the development of their 24-h guidelines for the early years. Concurrently, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) working group published a model to produce guidelines based on adoption, adaption and/or de novo development using the GRADE evidence-to-decision framework. Referred to as the GRADE-ADOLOPMENT approach, it allows guideline developers to follow a structured and transparent process in a more efficient manner, potentially avoiding the need to unnecessarily repeat costly tasks such as conducting systematic reviews. The purpose of this paper is to outline the process and outcomes for adapting the Canadian 24-Hour Movement Guidelines for the Early Years to develop the Australian 24-Hour Movement Guidelines for the Early Years guided by the GRADE-ADOLOPMENT framework. Methods: The development process was guided by the GRADE-ADOLOPMENT approach. A Leadership Group and Consensus Panel were formed and existing credible guidelines identified. The draft Canadian 24-h integrated movement guidelines for the early years best met the criteria established by the Panel. These were evaluated based on the evidence in the GRADE tables, summaries of findings tables and draft recommendations from the Canadian Draft Guidelines. Updates to each of the Canadian systematic reviews were conducted and the Consensus Panel reviewed the evidence for each behaviour separately and made a decision to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. An online survey was then conducted (n = 302) along with five focus groups (n = 30) and five key informant interviews (n = 5) to obtain feedback from stakeholders on the draft guidelines. Results: Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Consensus Panel agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, keep the wording of the guidelines, preamble and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-h), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for infants ( < 1 year), toddlers (1-2 years) and preschoolers (3-5 years). Conclusions: To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used. Following this approach, the judgments of the Australian Consensus Panel did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian recommendations were adopted with very minor alterations. This allowed the Guidelines to be developed much faster and at lower cost. As such, we would recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines, with all supporting materials and developed using a transparent process, is available. Other countries may consider using this approach when developing and/or revising national movement guidelines.

Grant Number

ARC/DE140101588, ARC/DE150101921