Urban-Rural Differences in Preschoolers’ Compliance with WHO Guidelines on physical activity, sedentary behaviour and sleep

Background: China’s urbanization resulted significant challenges for the physical activity (PA) of children from both from urban and rural areas.
Purpose: Investigating the disparities in WHO guideline adherence among urban and rural Chinese preschoolers.
Method: The study recruited 1,304 children aged 3.0–4.9 across urban and rural regions in China ( rural children: 47.7%). PA was assessed using 24-hour accelerometry over three consecutive days. Demographic information, child sedentary screen time (SST), outdoor time (OT), and sleep duration (SD) were reported by parents. Descriptive and logistic regression analyses were conducted using SPSS 26.
Results: Urban children (UC) adherence to WHO guidelines for PA (≥ 3 h daily PA, including ≥1 h daily moderate- to vigorous-intensity PA), SST (< 1 h/day), OT (＞ 2 h/day), and SD (10-13 h/day) are at 47.7%, 69.2%, 57.5%, and 66.6% respectively, while rural children (RC) show compliance rates of 56.4%, 52.4%, 60.6%, and 64.7%. The urban-rural differences were particularly notable in PA and SST. RC had higher adherence to PA guidelines compared to UC overall and across ages and genders (OR = 1.4 ~ 2.3, 95% CI= 1.0–3.0),. This difference in PA was pronounced among families with higher education, rather than the families with lower education. On the contrary, RC were less likely to meet SST guidelines compared to UC, both overall and across ages and genders (OR = 0.4–0.6, 95% CI: 0.3–0.8). This urban-rural gap in SST is more apparent in higher educated families.
Conclusions: Overall and across age and gender categories, RC outperformed UC PA and RC consistently show excessive SST. These disparities are more evident among families with higher education.
Practical implications: Disparities in physical activity between urban and rural children, influenced by urbanization and digital access, necessitate tailored public health interventions, particularly for families with lower education levels.