A narrative review of global and national physical activity and sedentary behaviour guidelines development processes - The GUidelines Standards (GUS) project

Background: Clinical and public health guidelines serve to direct clinical practice and policy, based on the best available evidence. The World Health Organization (WHO) and national health bodies of many countries have released physical activity and sedentary behaviour guidelines. Despite significant overlap in the body of evidence reviewed, the guidelines differ across jurisdictions. This study aimed to review the processes used to develop global and national physical activity and sedentary behaviour guidelines and examine the extent to which they conform with a recommended methodological standard for the development of guidelines. Methods: We extracted data on nine sets of guidelines from seven jurisdictions (WHO, Australia, Canada, Japan, the Netherlands, United Kingdom, and United States). We rated each set of guidelines as high, medium, or low quality on criteria related to the rigour of the development process. Results: We observed variation in the quality of guidelines development processes across jurisdictions and across different criteria. Guidelines received the strongest overall ratings for criteria on clearly describing the evidence selected and stating an explicit link between the recommendations and the supporting evidence. Guidelines received the weakest overall ratings for criteria related to clearly describing the methods used to formulate the recommendations and reporting external review by experts prior to publication. Evaluated against the selected criteria, the strongest processes were undertaken by the WHO and Canada. Conclusions: Reaching agreement on acceptable guideline development processes, as well as the inclusion and appraisal procedures of different types of evidence, would help to strengthen and align future guidelines.