Peer-reviewed article

Global reference values for daily steps in preschool children (SUNRISE): a cross-sectional analysis from 44 countries.

Jesús Del Pozo-Cruz, Rosa María Alfonso-Rosa, Zhiguang Zhang, Chalchisa Abdeta, Eva Brita Roos et al. · 28 Sept 2026

Abstract

BACKGROUND: Physical activity during early childhood is essential for optimal growth and development. Daily step counts provide a practical proxy measure of ambulatory physical activity; however, international reference percentile values for step-based physical activity metrics in preschool-aged children remain limited. This study aimed to establish age-specific reference values for daily steps and cadence-based metrics in children aged 3 and 4 years across 44 countries participating in the SUNRISE study. METHODS: We included a cross-sectional sample of typically developing children aged 3 and 4 years affiliated with childhood care and education centres in 44 countries spanning six world regions and all World Bank income classifications. Daily step counts and cadence-based metrics (peak 1 min, peak 30 min, and peak 60 min cadence) were derived from accelerometer data for participants with at least 1 day of data (≥10 h per day of wear time). Weighted percentile distributions were estimated overall and according to child-level and country-level factors, including sex, residential setting, country income level, geographical region, and Human Development Index. FINDINGS: We included 3570 children (1755 boys and 1815 girls, mean age 4·22 years, SD 0·53) with data collected between March, 2018, and March, 2025. Overall, the weighted median daily step count was 18 542 steps (95% CI 18 318-18 812); with 17 502 steps (16 904-17 992) for participants aged 3 years, and 18 928 steps (18 682-19 221) for those aged 4 years. Boys accumulated more daily steps than girls across most percentiles. For participants aged 3 years, the median step count was 18 064 steps (17 404-19 011) for boys and 16 426 steps (15 590-17 835) for girls; for participants aged 4 years, the median step count was 19 477 steps (19 187-19 938) for boys and 18 321 steps (17 939-18 815) for girls. Participants living in low-income and middle-income countries and rural settings recorded higher daily step counts than those in high-income countries and urban areas. Similar patterns were observed for cadence-based metrics, although between-group differences were smaller than for total daily steps. INTERPRETATION: To our knowledge, we provide the first international reference percentile values for step-based physical activity metrics in preschool-aged children across diverse global settings. The findings highlight substantial variation in step accumulation according to sex, residential setting, and country-level socioeconomic indicators, underscoring the importance of contextual differences when interpreting step-based physical activity metrics in early childhood. Step counts could provide a practical and scalable approach for global movement behaviour surveillance, particularly in low-resource settings. FUNDING: University of Wollongong and other national partners involved in the SUNRISE study.