Much of the current research on movement behaviors has focused on moderate-to-vigorous physical activity, which accounts for only a small proportion (< 5%) of human activity throughout the 24-h day cycle.1 In contrast, sleep and sedentary behavior account for approximately 80% of the 24-h day.1 Within a 24-h period, an increase of time in one of these 24-h movement behaviors (i.e., physical activity, sedentary behavior, sleep) will inevitably reduce the time of the other two behaviors to varying degrees. Additionally, previous studies have shown that each of the 24-h movement behaviors is strongly associated with various health indicators, but these studies have explored single movement behavior instead of using an integrative approach/perspective.2, 3, 4 In recent years, researchers have started to pay great attention to the interdependence of the 24-h movement behaviors.5,6 In 2016, the first 24-h movement guidelines for children and adolescents aged 5–17 years were published in Canada,7 and subsequently the guidelines for other age groups such as the early childhood (0–4 years) and adults (18–64 years and over 65 years) were published.8,9

Currently, adherence rates with the 24-h movement guidelines in nondisabled people is concerning. That is, a survey based in 12 countries found that only 7.2% of children met all three 24-h movement guidelines, while 18.9% met none, and adherence to physical activity, screen time, and sleep guidelines was 44.1%, 39.3% and 41.9%, respectively.10 Similarly, a meta-analysis of 387,437 participants from 23 countries found that only 7.12% of children and adolescents met all three guidelines, 19.21% did not meet any of the guidelines, and there were age and gender differences in prevalence of meeting the guidelines.11 Meanwhile, researchers have also explored the health benefits of meeting the 24-h movement behaviors.12,13 For example, several studies employing correlational analyses have found that people who met more than two guidelines had higher cognitive function, better mental health, and lower all-cause mortality than those who did not meet any of the guidelines.14, 15, 16 Employing compositional data analysis, researchers found that substituting sedentary behavior with physical activity was favorably associated with lower body mass index (BMI) as well as better motor competence and cardiometabolic health.17, 18, 19 These findings speak the importance of adhering to the 24-h movement guidelines among nondisabled people.

A number of sociodemographic groups have been identified as being at particular risk for low adherence with the 24-h movement guidelines. For example, people with disabilities tend to engage in inadequate physical activity20,21 and sleep,22, 23, 24 and excessive sedentary time,21,25 which may lead to adverse physical and psychological health, such as obesity26 and mental health problems.27 While most research, to date, has explored these three movement behaviors separately among people with disabilities, increased attention has been paid to examine them simultaneously through the 24-h movement behaviors framework to understand adherence levels and potential multiplicative benefits of meeting more than one guideline.28,29 For example, Li and colleagues30 investigated adherence to the 24-h movement guidelines and its relationship with health indicators among 1165 adolescents with autism spectrum disorders (ASD) in seven countries/regions, and found that only 2% of the participants met all three guidelines and 21.5% of them met none of the guidelines. Within this study, participants who met all three guidelines had lower BMI, higher quality of life and better general health than those met none of the guidelines.30 Haegele and colleagues found similar results in adults with visual impairments, where only 18.6% of the participants met all three 24-h movement guidelines, and this group of participants had higher levels of health-related quality of life compared to those who met none.28 These findings highlight the concept of “the whole day matters”, and that the three 24-h movement behaviors seem to be as important for health promotion among people with disabilities as they are for nondisabled peers.

To date, there has been no systematic review or meta-analysis that, to our best knowledge, has comprehensively examined the prevalence of meeting the 24-h movement guidelines and its relationships with health indicators in people with disabilities. Synthesizing related findings across individual studies may help researchers, policymakers and health practitioners to understand the current evidence base, which can have significant implications for future research, health surveillance and early intervention for people with disabilities. Therefore, the present systematic review and meta-analysis was conducted to (a) assess the prevalence of meeting the overall and individual 24-h movement guidelines, and (b) examine the associations between meeting 24-h movement guidelines and health indicators in people with disabilities.