Comparison of recommendations or updated guidelines: A systematic review

Background. Guidelines are important tools for disseminating evidence-based dose-response recommendations.

Purpose. To perform a literature review to identify physical activity, sedentary, and sleep recommendations worldwide and to compare the World Health Organization (WHO) with those reported worldwide.

Methods. A systematic literature review for all age groups was carried out using the systematic steps of the Cochrane Handbook for Systematic Reviews. Medline, Embase, and CINHAL databases were used for scientific literature and Google, GoPA and WHO webpages were reviewed for grey literature documents. In addition, we emailed local physical activity and/or health researchers or authorities to verify if the guidelines posted within these web pages were the most current and officials within the country. All documents published in all languages between January 1st, 2015, and March 1st, 2023. were included. The quality of articles and documents was evaluated using the Appraisal of Guidelines for Research & Evaluation II (AGREE II).

Results. Sixty-nine scientific articles, and information from 59 countries coming from either Google, GoPA, or WHO web pages were identified and verified by local researchers or authorities. A higher percentage of high-income countries had three behavior recommendations compared to middle and low-income countries. In total, more than half of countries adopted WHO recommendations. Pregnant and postpartum women and children under 5 years were the groups with fewer recommendations among countries. Of those countries that do not adopt guidelines from WHO, fourteen countries developed their own guides. Several discrepancies were observed among guides including wording (minimum, average), and age groups (3-4 years or 3-5 years).

Conclusions. More than 50 countries have guidelines, however, countries with lower incomes and vulnerable populations do not have complete recommendations or guides for their population.

Practical implications Efforts are needed to help these countries to generate or adapt current guidelines.

Funding. Bloomberg Philanthropies