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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
Risk of bias Inconsistency Indirectness Imprecision Other
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 RCTa No serious risk of bias No serious inconsistency Very serious indirectnessb 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]. LOWc
4 Clustered RCTd Serious risk of biase No serious inconsistency Serious indirectnessf 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]. LOWg
2 Non-randomized interventionh 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 LOWj
7 Longitudinalk Serious risk of biasl No serious inconsistency No serious indirectness No serious imprecision Dose-response gradientm 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-contolo Serious risk of biasp 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 LOWq
40 Cross-sectionalr Serious risk of biass Serious inconsistencyt No serious indirectness No serious imprecision Exposure/outcome gradientu 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 LOWv
  1. 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
  2. aIncludes 1 RCT [40]
  3. bThe intervention did not result in a significant change in physical activity [40]
  4. cQuality of evidence was downgraded from “high” to “low” because of very serious indirectness
  5. dIncludes 4 clustered RCTs [33,34,35, 41]
  6. 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]
  7. fThe intervention did not result in a significant change in physical activity in 1 study [41]
  8. gQuality of evidence was downgraded from “high” to “low” because of serious risk of bias and serious indirectness
  9. hIncludes 2 non-randomized interventions [36, 42]
  10. 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]
  11. jQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias
  12. kIncludes 7 longitudinal studies [43,44,45,46,47,48,49]
  13. 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]
  14. 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]
  15. 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
  16. oIncludes 3 case-control studies [51,52,53]
  17. pPsychometric properties unknown for the subjective physical activity measures in 3 studies [51,52,53]
  18. qQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias
  19. 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]
  20. 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]
  21. tFavourable and unfavourable associations between physical activity and adiposity observed across studies
  22. 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]
  23. 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