“Establishing Reference Values: Daily Steps in Preschoolers Insights from 33 Countries with different income level

Background: The World Health Organization (WHO) has underscored the significance of monitoring behaviours in children beneath the age of five years. Considering this, global studies such as the SUNRISE initiative have been conducted. Wearable technology is capable of tracking daily step counts; however, research predominantly from high-income countries highlights the need for global reference values.
Purpose: This study aimed to provide age-group reference percentile values for daily step counts in young children, and to investigate factors that contribute to variations, such as income level.

Methods: The study utilized the International SUNRISE Study protocol to collect data from 2815 children across 33 countries. Quantile regression techniques were then applied to examine how daily step counts varied with age.
Results: The results of the study showed that age significantly influenced step count, with varying effects observed at different percentiles. Income differences also significantly affected the daily step count, particularly at the 75th percentile, indicating a pronounced effect.

Conclusions: The findings of this study emphasize the need for reference values to optimize behaviors, as socioeconomic level influences movement in children under five. These results offer insight into the relationship between step count, age, and income, which can inform public health initiatives for young children.
Practical implications: The study provides a foundation for future research and policy decisions regarding general movement and serves as a reference guide for this purpose.
Funding: The study was supported by the Sunrise Global project, the government of Andalucia (P20\_01181), and the European Union through the requalification of university teaching staff – Ministry of Universities (22330, 22334).