KKH-led survey reveals unhealthy lifestyle habits in children and adolescents

Singapore, 8 January 2021 – To promote healthy lifestyle habits during their formative years, a structured and comprehensive approach is needed. This approach has been outlined in The Singapore Integrated 24-Hour Activity Guidelines for Children and Adolescents (“Guidelines”), and was launched today.

A first for Singapore, the Guidelines are based on locally and globally established studies and best practices, and have been developed with our local population in mind. It aims to standardise advice on physical activities, screen time, eating habits and sleep for children and adolescents aged seven to 18 years of age within a 24-hour period, to improve health and promote adoption of healthy lifestyle habits. These guidelines are aligned with the national goals of the Health Promotion Board to promote healthier lifestyles.

Dr Janil Puthucheary, Senior Minister of State, Ministry of Health and Ministry of Communications and Information, was the Guest of Honour at the Asia Pacific Maternal and Child Metabolic Health Conference (APMCMHC) and Integrated Platform for Research in Advancing Metabolic Health Outcomes of Women and Children (IPRAMHO*) International Meeting 2021 held at KK Women’s and Children’s Hospital (KKH) earlier today. The Guidelines were launched at the event.

According to Statistics from the Ministry of Education, the incidence of overweight children has increased from 11 per cent in 2013 to 13 per cent in 2017. Studies also showed that children and adolescents in Singapore could only meet up to 40 per cent of the recommended physical activity level and above 70 per cent of adolescents exceeded more than two hours of electronic screen time daily1-3. A recently-concluded KKH-led survey involving 100 parents of children aged five to 14 years of age gave further insights to their children’s lifestyle habits:

- 43 per cent do not engage in any vigorous physical activity while 32 per cent do not engage in any moderate physical activity
- 25 per cent spend more than 10 waking hours per day in sedentary behaviour
- 20 per cent spend more than four hours on screen viewing daily, exceeding the recommendation of two hours per day
- 20 per cent are not meeting the recommended sleep requirement on weekdays

Parents surveyed also showed inadequate awareness of the recommended amount of physical activities, screen time and sleep for children, with:

  • 30 per cent of parents believed that their child does not receive sufficient exercise or sleep
  • 70 per cent were concerned with their child’s screen time. Yet 41 per cent were unaware of existing screen time viewing guidelines, 49 per cent of parents were unaware of existing physical activity guidelines, and 20 per cent were unaware of existing sleep guidelines.

Taking a longer-term, holistic approach

These developments have prompted healthcare professionals to develop a set of guidelines to provide structured and comprehensive health advice to children and adolescents, and their caregivers living in Singapore.

The Workgroup that has developed the Guidelines is formed by KKH-led IPRAMHO, and College of Paediatrics and Child Health in Academy of Medicine Singapore, in partnership with Exercise is Medicine Singapore, Sports Medicine Association, Singapore, Perinatal Society of Singapore, Singapore Paediatric Society and College of Family Physicians Singapore, and Singapore Medical Association.

Professor Tan Kok Hian, Head and Senior Consultant, Perinatal Audit and Epidemiology Unit, KKH, and Lead Principal Investigator of IPRAMHO, said, "Globally and locally, there is increasing evidence to show that children and adolescents reap more health benefits when they adopt healthy lifestyle habits such as exercising regularly, having adequate sleep and reducing screen time.4-8 In Singapore, our children and adolescents are not moving and sleeping enough, made worse by having more screen time than recommended. With interests in preventing and reducing risks for metabolic diseases in women and children, it is timely for KKH and IPRAMHO to support in making the new guidelines relevant and reflect the current lifestyle patterns of our youths."

The set of Guidelines complements the 2013 national guidelines on physical and sedentary behaviour for children and adolescents. The 2013 guidelines focus largely on moderate and vigorous intensity physical activities, sedentary behaviours and safety in sports. The new Guidelines includes the most recent researches on the effectiveness of adopting light physical activities, sleep and eating habits for children and adolescents in a 24-Hour period.

The Guidelines elaborates on the following 10 summary statements:

  1. For physical, mental and social health, children and adolescents should acquire a lifestyle that integrates regular physical activity, limited sedentary behaviour, adequate sleep and good eating habits within each 24-hour period.
  2. Accumulate at least an average of 60 minutes per day of moderate-to-vigorous intensity physical activity in a week, where more is better.
  3. Engage in muscle and bone strengthening exercises at least three times a week. This could be part of the daily minimum accumulation of 60 minutes of moderate-to-vigorous intensity physical activity.
  4. Engage regularly in a variety of light physical activities throughout the day.
  5. Limit recreational screen time as much as possible.
  6. Build in regular breaks to move around during times of prolonged sitting or inactivity.
  7. Have regular sleep of at least 9 hours (for 7-13 years old), at least 8 hours (for 14-17 years old) and at least 7 hours (for 18 years old).
  8. Take the necessary precautions before, during and after exercise and see a doctor if you feel unwell during the exercise.
  9. Have regular meals consisting of nutritionally-balanced foods and drinks to support daily activities, to optimise growth, maturation and development.
  10. Aim to achieve most or all recommendations on physical activity, sedentary behaviour, sleep and diet for the best results.

For more details on the guidelines, please visit https://www.ams.edu.sg/colleges/CPCHS/home

Coupled with being the only paediatric sports medicine facility, KKH as the only children’s hospital in Singapore is taking the lead to counsel parents and caregivers of patients to adopt these guidelines. KKH will also work hand-in-hand with other paediatricians, family medicine physicians to equip them in reinforcing the Guidelines.

Dr Benny Loo, Consultant, General Paediatrics Service and Sports Medicine Service, KKH, who is also the Chairperson of the Workgroup for the Guidelines said, "Research shows that adopting healthy lifestyle habits at a young age sets the stage for becoming healthy adults, reducing risks for metabolic diseases.9, 10 Singapore’s children and adolescents today are time-poor as they lead very hectic lives. This set of guidelines helps to promote a structured and comprehensive approach in organising a child’s 24-hour day of physical activities, sedentary time, and sleep, to optimise his/her health outcomes in the long run."

The Guidelines is part of a series of guidelines to improve metabolic health in women and children. It was launched at the fourth APMCMHC and IPRAMHO International Meeting 2021, focusing on Asia-Pacific perspectives in the management of metabolic diseases such as diabetes and obesity in pregnant women and children. In previous years, other guidelines released were for the management of gestational diabetes, perinatal nutrition, as well as physical activity and exercise in pregnancy.

The annual event, held during 8 and 9 January this year, was attended by key opinion leaders such as Senior Professor Anthony Okely, University of Wollongong, Australia, and Professor Satoshi Kusuda, President of the Federation of Asia and Oceania and Perinatal Societies. Experts from Australia, China, Hong Kong, India, Indonesia, Japan, Malaysia, Myanmar, Philippines, Singapore, Sri Lanka, Vietnam and Thailand also attended the event.

*IPRAMHO is a research platform that seeks to develop a seamless integrated model of care through optimal implementation of effective population prevention strategies and diabetes and weight reduction programmes for women and children. IPRAMHO is led by KKH in partnership with SingHealth Polyclinics and National Healthcare Group Polyclinics; and is a collaborative centre grant funded by the National Medical Research Council.


  1. Chia M. Physical inactivity among children and adolescents in Singapore: A paradoxical issue. Acta Kinesiol. 2008;2:7-15

  2. Ting JL, Mukherjee S, Hwa MC. Physical activity and sedentary behavior patterns of Singaporean adolescents. Journal of Physical Activity and Health. 2015 Sep 1;12(9):1213-20.

  3. Lee KS, Trost SG. Physical activity patterns of Singaporean adolescents. Pediatric Exercise Science. 2006 Nov 1;18(4):400-14.

  4. Poitras VJ, Gray CE, Borghese MM, Carson V, Chaput JP, Janssen I, Katzmarzyk PT, Pate RR, Connor Gorber S, Kho ME, Sampson M. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Applied Physiology, Nutrition, and Metabolism. 2016;41(6):S197-239.

  5. Janssen I, LeBlanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. International journal of behavioral nutrition and physical activity. 2010 Dec 1;7(1):40.

  6. Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B, Hergenroeder AC, Must A, Nixon PA, Pivarnik JM, Rowland T. Evidence based physical activity for school-age youth. The Journal of pediatrics. 2005 Jun 1;146(6):732-7.

  7. Saunders TJ, Gray CE, Poitras VJ, Chaput JP, Janssen I, Katzmarzyk PT, Olds T, Connor Gorber S, Kho ME, Sampson M, Tremblay MS. Combinations of physical activity, sedentary behaviour and sleep: relationships with health indicators in schoolaged children and youth. Applied Physiology, Nutrition, and Metabolism. 2016;41(6):S283-93.

  8. Hjorth MF, Chaput JP, Damsgaard CT, Dalskov SM, Andersen R, Astrup A, Michaelsen KF, Tetens I, Ritz C, Sjödin A. Low physical activity level and short sleep duration are associated with an increased cardio-metabolic risk profile: a longitudinal study in 8-11 year old Danish children. PloS one. 2014 Aug 7;9(8):e104677.

  9. Chen, B., Bernard, J.Y., Padmapriya, N. et al. Socio-demographic and maternal predictors of adherence to 24-hour movement guidelines in Singaporean children. Int J Behav Nutr Phys Act 16, 70 (2019). https://doi.org/10.1186/s12966-019-0834-1

  10. Ames ME, Leadbeater BJ, MacDonald SW. Health behavior changes in adolescence and young adulthood: Implications for cardiometabolic risk. Health Psychology. 2018 Feb;37(2):103.