Evaluation of movement behaviour in Malaysian children using a web-based application, MEDAL

Abstract

Movement behaviour encompasses physical activity (PA), sedentary behaviour (SB), and sleep. Meeting 24-hour movement behaviour guidelines can have a positive impact on long-term health and well-being. Self-reports are used to assess movement behaviour but have limited validity than objective measures. My E-Diary for Activities and Lifestyle (MEDAL), a web-based time-use diary, was developed and adapted to assess Malaysian schoolchildren’s diet and movement behaviours. This cross-sectional study consisted of Feasibility Study and Main Study, which evaluated schoolchildren’s movement behaviour using MEDAL. In the Feasibility Study, 57 Malaysian children (aged 10–11 years) self-reported daily activities in MEDAL to determine the feasibility and acceptability of customised MEDAL in Malaysia. 29 of them wore an Actigraph accelerometer for four days, including two weekends, to determine the feasibility and acceptability of wearing an accelerometer. As 66.7% completed MEDAL for four days with positive feedback, MEDAL was a feasible and acceptable tool for children aged 10–11 years. Children wore the accelerometer for four days, averaging 21 hours 36 minutes per day. Few children expressed discomfort with the strap, leading to mixed acceptability responses (48–96.6%). In the Main Study, 358 schoolchildren completed MEDAL to determine schoolchildren's adherence to 24-hour movement guidelines. 89 also wore an accelerometer for four days, including a weekend, to determine the reliability of self-reported movement behaviour in MEDAL against accelerometer. Overall, self-reported and accelerometer-measured sleep, SB, and LPA had weak to moderate correlations (r = 0.103–0.438) on average days, weekdays, and weekends. MVPA was constant (0 minute), thus Spearman correlation could not be computed. The agreement was poor for SB and LPA (ICC 0.19–0.42) but moderate for sleep (ICC 0.52). Children’s sleep, SB, screen time (ST), LPA, and MVPA averaged 9.9, 11.6, 2.5, 1.4, and 0.6 hours per day. One-third of children (31.8%) met PA and ST guidelines (19.1%), whereas 57.6% met sleep guidelines. Only 2.7% of children met all three guidelines, while 21.8% met none. In conclusion, MEDAL is a valuable tool for assessing urban children’s movement behaviour in Malaysia, but it requires careful interpretation. Increasing physical activity and reducing screen time should be prioritised among children aged 10-11 years.