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This study compared physical activity, sedentary behaviour, sleep and rest\u2013activity rhythms in paediatric DS with those of peers with normal weight and obesity. This cross-sectional study included 51 participants aged 8\u201318\u00a0years: 17 with DS, 17 with normal weight and 17 with obesity. Seven-day accelerometry assessed activity, sedentary behaviour, sleep and rest\u2013activity rhythms. Group differences were analysed using adjusted ANCOVA, PERMANOVA and principal component analysis. Compared with normal-weight peers, participants with DS had significantly greater sedentary time and lower light, moderate and moderate-to-vigorous physical activity (all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). They also exhibited longer sedentary bouts (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001), shorter physical-activity bouts (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.037), a lower probability of transitioning from sedentary time to physical activity (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and a higher probability of transitioning back to sedentary time (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.027). Rest\u2013activity rhythms were less stable, with lower interdaily stability (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.030), greater intradaily variability (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.008), lower M5 activity (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001) and later M5 timing (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.015) and cosinor acrotime (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Most activity and rhythmicity outcomes were similar in the DS and obesity groups. Participants with DS slept longer but had poorer sleep continuity. Overall 24-h behavioural profiles differed significantly among groups (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:italic>Conclusion<\/jats:italic>\n                    :\u00a0Children and adolescents with DS display a sedentary, low-movement and less stable 24-h behavioural profile resembling that observed in obesity. Integrated assessment of activity, sedentary accumulation, sleep continuity and rhythmicity may support early identification of modifiable risk and guide individualized, family-centred interventions.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:table-wrap>\n                      <jats:table>\n                        <jats:tbody>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is Known:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Youth with Down syndrome are generally less active and more sedentary than typically developing peers and frequently experience disrupted sleep.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Objective studies integrating activity, sedentary accumulation, sleep and rest\u2013activity rhythms across 24 h remain limited.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                          <jats:tr>\n                            <jats:td colspan=\"2\">\n                              <jats:bold>What is New:<\/jats:bold>\n                              \u2022\n                              <jats:italic>Youth with Down syndrome showed a sedentary, low-movement, fragmented and less stable 24-h profile resembling that of peers with obesity.<\/jats:italic>\n                              \u2022\n                              <jats:italic>Longer sleep did not indicate better sleep, as nocturnal wakefulness remained high and sleep efficiency was low.<\/jats:italic>\n                            <\/jats:td>\n                          <\/jats:tr>\n                        <\/jats:tbody>\n                      <\/jats:table>\n                    <\/jats:table-wrap>\n                  <\/jats:p>","DOI":"10.1007\/s00431-026-07507-z","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T23:20:34Z","timestamp":1791847234000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Accelerometer-based 24-h movement behaviours in children and adolescents with Down syndrome"],"prefix":"10.1007","volume":"185","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2137-5974","authenticated-orcid":false,"given":"Valeria","family":"Calcaterra","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Vandoni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Gatti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paolo","family":"Maugeri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Gazzarri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonabel","family":"Dolor","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Odone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maddalena","family":"Gaeta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianvincenzo","family":"Zuccotti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"issue":"5","key":"7507_CR1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-057010","volume":"149","author":"MJ Bull","year":"2022","unstructured":"Bull MJ, Trotter T, Santoro SL, Christensen C, Grout RW, THE COUNCIL ON GENETICS (2022) Health supervision for children and adolescents with Down syndrome. 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