Systematic review of the relationships between physical activity and health indicators in the early years (0-4 years)

Carson, Valerie; Lee, Eun-Young; Hewitt, Lyndel; Jennings, Cally; Hunter, Stephen; Kuzik, Nicholas; Stearns, Jodie A.; Unrau, Stephanie Powley; Poitras, Veronica J.; Gray, Casey; Adamo, Kristi B.; Janssen, Ian; Okely, Anthony D.; Spence, John C.; Timmons, Brian W.; Sampson, Margaret; Tremblay, Mark S.

doi:10.1186/s12889-017-4860-0

Table 1 The relationship between physical activity and adiposity

From: Systematic review of the relationships between physical activity and health indicators in the early years (0-4 years)

# of studies	Design	Quality assessment					# of participants	Absolute effect	Quality
# of studies	Design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other	# of participants	Absolute effect	Quality
Mean baseline age ranged from 41 weeks-59.6 months; where mean age was not reported, baseline age ranged from 2 weeks- <6 years. Data were collected by RCT, clustered RCT, non-randomized intervention, longitudinal with up to 4-year follow-up, case-control, and cross-sectional study designs. Adiposity was assessed objectively by BMI, weight-for-height z-score, BMI z-score (CDC, WHO, other country-specific reference data), weight/height³, weight percentiles, weight status (CDC, WHO, IOTF, Kaup index, country-specific reference data, BMI > 18, BMI percentile ≥95, ≥85th and ≥95th percentiles), waist circumference (absolute, percentile), hip circumference, waist-to-hip ratio, waist circumference z-score (Netherlands reference data), waist circumference-for-age z-score, sum of skinfolds, triceps skinfold thickness, body fat % (bioelectrical impedance, dual-energy X-ray absorptiometry), fat mass index (dual energy X-ray absorptiometry, air-displacement plethysmography), fat free mass index (dual energy X-ray absorptiometry, air-displacement plethysmography), fat mass (dual energy X-ray absorptiometry, air-displacement plethysmography), fat free mass (dual energy X-ray absorptiometry), % fat mass, trunk fat mass index, lean mass index (dual-energy X-ray absorptiometry), and subjectively by weight status (CDC ≥85th percentile). In 2 studies, it was unclear whether weight status (CDC ≥85th percentile) or BMI was measured objectively or subjectively.
1	RCT^a	No serious risk of bias	No serious inconsistency	Very serious indirectness^b	No serious imprecision	None	161	The PA intervention (PA recommendations from nurse) was favourably associated with improved adiposity (sum of 4 skinfolds but not % overweight, waist circumference, hip circumference, or body fat %) in 1 study [40].	LOW^c
4	Clustered RCT^d	Serious risk of bias^e	No serious inconsistency	Serious indirectness^f	No serious imprecision	None	3028	The PA interventions (structured/organized PA) were favourably associated with adiposity in 1 study [34]. The PA interventions (structured/organized PA, aerobic PA, or government-led PA program) were not associated with adiposity in 3 studies [33, 35, 41].	LOW^g
2	Non-randomized intervention^h	Serious risk of biasⁱ	No serious inconsistency	No serious indirectness	No serious imprecision	None	640	The PA interventions (structured/organized PA) were not associated with adiposity in 2 studies [36, 42].	VERY LOW^j
7	Longitudinal^k	Serious risk of bias^l	No serious inconsistency	No serious indirectness	No serious imprecision	Dose-response gradient^m	2441	TPA was favourably associated with adiposity (change in weight-for-height z-score but not waist circumference-for-age z-score in 1 study) in 2 studies [43, 45] and not associated with adiposity in 2 studies [46, 49]. MVPA was favourably associated with adiposity (fat free mass but not BMI, fat mass, or % fat mass in 1 study) in 1 study [49]. VPA was not associated with adiposity in 1 study [48]. Activity energy expenditure was favourably (fat free mass), unfavourably (BMI, fat mass), and not (% fat mass) associated with adiposity in 1 study [49]. Aerobic PA was favourably associated with adiposity (baseline PA only not change in PA) in 1 study [44]. Home-based PA was not associated with adiposity in 1 study [47]. Leisure PA was not associated with adiposity in 1 study [44]. Structured/organized PA was not associated with adiposity in 2 studies [44, 47].	VERY LOWⁿ
3	Case-contol^o	Serious risk of bias^p	No serious inconsistency	No serious indirectness	No serious imprecision	None	2271	TPA was not associated with adiposity in 1 study [51]. MPA was not associated with adiposity in 1 study [52]. VPA was not associated with adiposity in 1 study [52]. Outdoor PA was favourably associated with adiposity in 1 study [51] and not associated with adiposity in 1 study [53].	VERY LOW^q
40	Cross-sectional^r	Serious risk of bias^s	Serious inconsistency^t	No serious indirectness	No serious imprecision	Exposure/outcome gradient^u	37,813	TPA was favourably associated with adiposity (age 6 months but not 1, 2, 3, and 4 years in 1 study; boys only in 1 study; 95th percentile of vector magnitude and fat free mass index but not BMI, fat mass, or waist circumference and 90th percentile of vector magnitude and % fat mass and fat free mass index but not BMI, fat mass index, or waist circumference in 1 study) in 6 studies [55, 56, 60, 61, 63, 64], unfavourably associated with adiposity (BMI z-score but not waist circumference z-score in 1 study and hip circumference but not relative weights, skinfold thicknesses, and waist circumference in 1 study) in 3 studies [50, 66, 69], and not associated with adiposity in 11 studies [45, 46, 49, 54, 65, 72, 73, 75, 81, 82, 86]. LPA was favourably associated with adiposity (waist circumference z-score but not BMI z-score) in 1 study [50], unfavourably associated with adiposity (% body fat and fat mass index but not trunk fat mass index and lean mass index) in 1 study [89], and not associated with adiposity in 6 studies [55, 67, 76, 84, 86, 87]. LPA 5-min bouts were not associated with adiposity in 1 study [86]. MPA was unfavourably associated with adiposity in 1 study [50] and not associated with adiposity in 2 studies [55, 89]. MVPA was favourably associated with adiposity (% fat mass but not BMI, fat free mass, fat mass in 1 study; boys only in 1 study; % body fat and fat mass index but not trunk fat mass index or lean mass index in 1 study; % fat mass and fat free mass index but not BMI, fat mass index, or waist circumference in 1 study; girls only and waist circumference at the 90th percentile but not the 10th, 25th, 75th percentiles or BMI z-score or waist circumference in 1 study) in 6 studies [49, 54, 55, 60, 88, 89], unfavourably associated with adiposity (boys only and BMI z-score but not waist circumference in 1 study) in 3 studies [67, 69, 88], and not associated with adiposity in 8 studies [65, 76, 77, 82, 84,85,86,87]. MVPA 5-min bouts were not associated with adiposity in 1 study [86]. VPA was favourably associated with adiposity (boys only in 1 study; % body fat, fat mass index, trunk fat mass index but not lean mass index in 1 study; fat free mass index but not BMI, fat mass, fat mass index, and waist circumference in 1 study) in 4 studies [54, 55, 60, 89], unfavourably associated with adiposity in 1 study [50], and not associated with adiposity in 3 studies [67, 74, 82]. Activity energy expenditure was favourably (fat free mass), unfavourably (BMI), and not (fat mass, % fat mass) associated with adiposity in 1 study [49]. Indoor PA was not associated with adiposity in 1 study [81]. Leisure PA was favourably associated with adiposity (intermediate vs. none but not high vs. none) in 1 study [59]. Outdoor PA was favourably associated with adiposity in 1 study [58] and not associated with adiposity in 8 studies [61, 73, 75, 78,79,80,81, 83] Organized Sport was unfavourably associated with adiposity (girls only) in 1 study [68]. Structured/organized PA was favourably associated with adiposity in 1 study [57]. Active play was favourably associated with adiposity (weekdays only in 1 study) in 2 studies [62, 65] and not associated with adiposity in 1 study [71]. Active transportation was not associated with adiposity in 1 study [70].	VERY LOW^v

BMI: body mass index; CDC: Centers for Disease Control and Prevention; IOTF: International Obesity Task Force; LPA: light-intensity physical activity MPA: moderate-intensity physical activity; MVPA: moderate- to vigorous-intensity physical activity; PA: physical activity; RCT: randomized controlled trial; TPA: total physical activity; VPA: vigorous-intensity physical activity; WHO: World Health Organization
^aIncludes 1 RCT [40]
^bThe intervention did not result in a significant change in physical activity [40]
^cQuality of evidence was downgraded from “high” to “low” because of very serious indirectness
^dIncludes 4 clustered RCTs [33,34,35, 41]
^eUnclear whether outcome assessors were blinded to group allocation and unclear if the outcome was objectively measured in 1 study [34]. Large amount of missing data primarily because mean attendance at child care was 48% and it is unknown if the reason for poor attendance was related to adiposity in 1 study [41]. Physical activity was not measured so it is unknown if the intervention resulted in a significant change in physical activity in 1 study [35]
^fThe intervention did not result in a significant change in physical activity in 1 study [41]
^gQuality of evidence was downgraded from “high” to “low” because of serious risk of bias and serious indirectness
^hIncludes 2 non-randomized interventions [36, 42]
ⁱNo control group in 1 study [42]. Physical activity was not measured so it is unknown if the intervention resulted in a significant change in physical activity in 2 studies [36, 42]
^jQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias
^kIncludes 7 longitudinal studies [43,44,45,46,47,48,49]
^lConvenience sample was used in 1 study [44]. Psychometric properties unknown for the subjective physical activity measures in 3 studies [44, 45, 47]. Large unexplained loss to follow-up and incomplete data in 1 study [45]. No potential confounders were adjusted for in 2 studies [43, 45]. Potentially inappropriate statistical analysis: one study mutually adjusted for other movement behaviours in the fully adjusted models [49]
^mA dose-response gradient of higher aerobic PA and MVPA with better adiposity was observed in 2 studies [44, 49]. A dose-response gradient of higher activity energy expenditure was associated with both better and worse adiposity depending on the adiposity measure in 1 study [49]
ⁿQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias; because of this limitation, was not upgraded for a dose-response gradient
^oIncludes 3 case-control studies [51,52,53]
^pPsychometric properties unknown for the subjective physical activity measures in 3 studies [51,52,53]
^qQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias
^rIncludes 40 cross-sectional studies [45, 46, 49, 50, 54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88,89]
^sConvenience sample was used in 11 studies [54, 56, 62, 63, 67, 69, 76, 77, 85, 86, 88]. Low participation rate in 3 studies [54, 68, 84]. Psychometric properties unknown for the subjective physical activity measure in 15 studies [45, 57, 59, 61,62,63,64,65, 68, 70, 71, 75, 79, 80, 84]. No potential confounders were adjusted for in 19 studies [45, 50, 56, 61, 64,65,66,67, 69, 71, 72, 76, 77, 80, 81, 83, 85,86,87]. Large amount of unexplained missing data or it was unclear if the large amount of missing data was related to adiposity in 9 studies [50, 57, 62, 65, 67, 68, 80, 82, 89]. Physical activity was measured only during child care in 3 studies [58, 60, 82]. Potentially inappropriate statistical analysis: other movement behaviours were mutually adjusted for in the fully adjusted models in 3 studies [49, 55, 89]
^tFavourable and unfavourable associations between physical activity and adiposity observed across studies
^uA gradient for higher TPA, MVPA, VPA activity energy expenditure, outdoor PA, and physical education with better adiposity was observed in 6 studies [49, 55, 57, 58, 88, 89]. A gradient for higher activity energy expenditure and LPA, MVPA with worse adiposity was observed in 3 studies [49, 88, 89]
^vQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias and serious inconsistency; because of this limitation, was not upgraded for an exposure/outcome gradient

Back to article page

ISSN: 1471-2458

Contact us

Submission enquiries: bmcpublichealth@biomedcentral.com
General enquiries: ORSupport@springernature.com

BMC Public Health

Contact us