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Table 3 The relationship between physical activity and psychosocial health

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 18.3 weeks-57.61 months; where mean age was not reported, baseline age ranged from 12 months-5 years. Data were collected by RCT, clustered RCT longitudinal with up to 8- to 10-year follow-up, and cross-sectional study designs. Psychosocial health was assessed by social competence (proxy-report; Social Competence Behavior Evaluation: Preschool Education Questionnaire); internalizing behaviour problems (proxy-report; Social Competence Behavior Evaluation: Preschool Education Questionnaire); externalizing behaviour problems (proxy-report; Social Competence Behavior Evaluation: Preschool Education Questionnaire); quality of life (self-reported; Dartmouth Primary Care Cooperative Project charts); health-related quality of life (proxy-report; PedsQL 4.0); temper frequency (proxy-report interview); sociability, emotionality, and soothability (proxy-report; Child Temperament Questionnaire); conduct problems (proxy-report; Strengths and Difficulties Questionnaire); anxiety symptoms (proxy-report; Preschool Anxiety Scale – Revised); classroom peer acceptance (proxy-report; sociometric interviews); and personal-social behaviour (objectively measured; Gessell Development Schedules – Development Quotient).
2 RCTa Serious risk of biasb No serious inconsistency No serious indirectness No serious imprecision None 170 The PA interventions (planned passive cycling or dance) were favourably associated with improved psychosocial health in 2 studies [90, 102]. MODERATEc
1 Clustered RCTd Serious risk of biase No serious inconsistency Very serious indirectnessf No serious imprecision None 1467 The PA intervention (government-led PA program) was not associated with psychosocial health [41]. VERY LOWg
2 Longitudinalh Serious risk of biasi No serious inconsistency No serious indirectness No serious imprecision Dose-response gradientj 9989 TPA was favourably associated with psychosocial health (active vs. less active but not active vs. average) in 1 study [104] and not associated with psychosocial health in 1 study [103]. Sport participation was favourably associated with psychosocial health (high risk and recovery trajectories but not the rebound trajectory) in 1 study [103]. VERY LOWk
6 Cross-sectionall Serious risk of biasm Serious inconsistencyn No serious indirectness No serious imprecision None 5517 TPA was unfavourably associated with psychosocial health in 1 study [101] and not associated with psychosocial health in 1 study [109]. MVPA was unfavourably associated with psychosocial health in 1 study [107] and not associated with psychosocial health in 1 study [109]. Bike riding was unfavourably associated with psychosocial health (for boys only on weekdays only in 1 study) in 2 studies [106, 107]. Exercise play was favourably associated with psychosocial health (mixed gender [not non-mediated] and same gender but not other gender groups) in 1 study [105], unfavourably associated with psychosocial health (boys only, weekend only, and only for > 2 and ≤ 24 h group) in 1 study [106], and not associated with psychosocial health in 1 study [107]. Routh-and-tumble play was not associated with psychosocial health in 2 studies [105, 108]. Walking was not associated with psychosocial health in 2 studies [106, 107]. VERY LOWo
  1. MVPA: moderate- to vigorous-intensity physical activity; PA: physical activity; RCT: randomized controlled trial; TPA: total physical activity
  2. aIncludes 2 RCTs [90, 102]
  3. bNo intention-to-treat analysis; parent-child dyads were excluded if they did not carry out the management plan or if they became sick during the study and the physical activity program was interrupted in 1 study [90]. Physical activity was not measured, so it is unknown if the intervention significantly changed physical activity in 2 studies [90, 102]
  4. cQuality of evidence was downgraded from “high” to “moderate” because of serious risk of bias
  5. dIncludes 1 clustered RCT [41]
  6. eLarge amount of missing data primarily because mean attendance at child care was 48%, and it is unknown if hte reason for poor attendance was related to psychosocial health
  7. fThe intervention did not result in a significant change in physical activity
  8. gQuality of evidence was downgraded from “high” to “very low” because of serious risk of bias and very serious indirectness
  9. hIncludes 2 longitudinal studies [103, 104]
  10. iNo psychometric properties reported for the subjective physical activity measures in 2 studies [103, 104]
  11. jA significant trend was observed for poor quality of life when moving from the active to less active groups in 1 study [104]
  12. kQuality 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
  13. lIncludes 6 cross-sectional studies [101, 105,106,107,108,109]
  14. mConvenience sample was used in 5 studies [101, 105,106,107,108]. Physical activity was measured only during child care in 1 study [109]. Potential confounders were not adjusted for in 3 adjusted studies [101, 107, 109]. No psychometric properties reported for the subjective physical activity measures in 1 study [101]. No psychometric properties reported for the outcome measure in 2 studies [101, 105]. Large amount of missing data in 1 study [106]
  15. nFavourable and unfavourable associations between physical activity and psychosocial health observed across studies
  16. oQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias and serious inconsistency