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With an ongoing childhood obesity epidemic it's good to see that new physical activity guidelines for the under-fives have been published this week.

A report, detailing activity advice for all ages groups, has been produced by the four Chief Medicals Officers of England, Scotland, Wales and Northern Ireland.

The last decade has seen an expansion in the evidence base on the health and developmental impact of variation in time spent in physical activity in the under-fives.

This shows the importance of time spent in physical activity of any intensity for infants, toddlers, and pre-schoolers; time spent in moderate to vigorous physical activity (MVPA) for pre-schoolers; and time spent in various specific types of physical activity for infants, toddlers, pre-schoolers.

The new guidelines, an update on those published in 2011, reflect these different exposures.

There is now a large body of evidence that the amount of physical activity in the under-five period influences a wide range of both short-term and long-term health and developmental outcomes.

Perhaps unsurprisingly, low levels of physical activity have been recognised as a contributor to increasing rates of child obesity in this age group.

In both boys and girls the average level of physical activity reaches a lifetime peak around the age of school-entry and then declines.

Achieving higher levels of physical activity in the early years, the Chief Medical Officers have concluded, should help maintain higher levels later in childhood and adolescence.

New recommendations for 2019 include time spent in physical activity - 'tummy time' - in infants, MVPA in pre-schoolers, and new specific guidance on time spent in physical activity and outdoor play in pre-schoolers.

Higher levels of time spent in physical activity are associated consistently with improved health and developmental outcomes including motor development, wellbeing, cognitive development, cardiovascular and musculoskeletal fitness. The new guidelines for the under-fives consider three distinct developmental stages and age groups: infants (less than 12 months); toddlers (1-2 years); and pre-schoolers (3-4 years).


The guidelines are:

Infants (less than 12 months):

  • Infants should be physically active several times every day in a variety of ways, including interactive floor-based activity such as crawling
  • For infants not yet mobile, this includes at least 30 minutes of tummy time spread throughout the day while awake and other movements such as reaching and grasping, pushing and pulling themselves independently, or rolling over


Toddlers (1-2 years):

  • Toddlers should spend at least three hours per day in a variety of physical activities at any intensity, including active and outdoor play, spread throughout the day.


Pre-schoolers (3-4 years):

  • Pre-schoolers should spend at least three hours per day in a variety of physical activities spread throughout the day, including active and outdoor play. The three hours should include at least 60 minutes of MVPA.


For all under-fives the message is that these timings are guidelines and 'more is better'.