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Table 7 The relationship between physical activity and cardiometabolic 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 3-4.9 years. One study reported only that the children were preschool age. Data were collected by non-randomized intervention, longitudinal with up to 2 years follow-up, and cross-sectional study designs. Cardiometabolic health was assessed by mean arterial pressure, DBP, SBP, total cholesterol, total serum cholesterol, HDL, triglycerides, HDL2, LDL, LDL/HDL, total serum cholesterol/HDL, HDL/total triglycerides, and clustered cardiovascular risk score (SBP, triglycerides, total cholesterol/HDL, HOMA-IR, sum of two skinfolds). All outcomes were objectively measured.
1 Non-randomized interventiona Serious risk of biasb No serious inconsistency No serious indirectness No serious imprecision None 264 BP The PA intervention (structured/organized PA) was favourably associated with DBP during rest and activity [125]. VERY LOWc
2 Longitudinald Serious risk of biase No serious inconsistency No serious indirectness No serious imprecision None 291 BP Aerobic PA was favourably associated with BP (SBP but not DBP, boys only, 2-year follow-up but not 1-year follow-up) in 1 study [126]. Leisure PA was unfavourably associated with BP (DBP but not SBP, boys only, 1-year follow-up but not 2-year follow-up) in 1 study [126]. Structured PA was not associated with BP (SBP or DBP) in 1 study [126]. Cholesterol TPA was not associated with cholesterol (total serum cholesterol, HDL, HDL 2 , LDL, LDL/HDL, or total serum cholesterol/HDL) in 1 study [43]. Triglycerides TPA was not associated with triglycerides in 1 study [43]. VERY LOWf
6 Cross-sectionalg Serious risk of biash Serious inconsistencyi No serious indirectness No serious imprecision Exposure/outcome gradientj 1882 Clustered risk score TPA was favourably associated with clustered risk score (boys only, Quartile 1 vs. Quartile 5 only) in 1 study [127]. MPA was not associated with clustered risk score in 1 study [127]. MVPA was not associated with clustered risk score in 1 study [127]. VPA was favourably associated with clustered risk score (boys only, Quartile 2 vs. Quartile 5 only) in 1 study [127]. BP TPA was unfavourably associated with BP (SBP and DBP) in 1 study [117] and not associated with BP (SBP, DBP, or mean arterial pressure) in 3 studies [66, 72, 81]. Aerobic PA was not associated with BP (SBP or DBP) in 1 study [126]. Indoor PA was not associated with BP (SBP or DBP) in 1 study [81]. Leisure PA was not associated with BP (SBP or DBP) in 1 study [126]. Outdoor PA was not associated with BP (SBP or DBP) in 1 study [81]. Structured PA was not associated with BP (SBP or DBP) in 1 study [126]. Cholesterol TPA was favourably associated with cholesterol (total cholesterol but not HDL) in 1 study [81] and not associated with cholesterol (total cholesterol, HDL, or HDL/total cholesterol) in 1 study [72]. Indoor PA was not associated with cholesterol (total cholesterol or HDL) in 1 study [81]. Outdoor PA was unfavourably associated with cholesterol (HDL but not total cholesterol) in 1 study [81]. Triglycerides TPA was not associated with cholesterol (total cholesterol, HDL, or HDL/total cholesterol) in 1 study [72]. VERY LOWk
  1. BP: blood pressure; DBP: diastolic blood pressure; HDL: high-density lipoprotein cholesterol; HOMA-IR: homeostatic model assessment – insulin resistance; LDL: low-density lipoprotein cholesterol; MPA: moderate-intensity physical activity; MVPA: moderate- to vigorous-intensity physical activity; PA: physical activity; SBP: systolic blood pressure; TPA: total physical activity; VPA: vigorous intensity physical activity
  2. aIncludes 1 non-randomized intervention [125]
  3. bNo intention-to-treat analysis; results are based on children who were measured at all 3 time points. Physical activity was not measured, so it is unknown if the intervention significantly changed physical activity
  4. cQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias
  5. dIncludes 2 longitudinal studies [43, 126]
  6. ePotential confounders were not adjusted for in 1 study [43]. No psychometric properties were reported for the subjective physical activity measure in 1 study [126]
  7. fQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias
  8. gIncludes 6 cross-sectional studies [66, 72, 81, 117, 126, 127]
  9. hNo potential confounders were adjusted for in 5 studies [66, 72, 81, 117, 127]. Convenience sample in 1 study [117]. No psychometric properties were reported for the subjective physical activity measure in 1 study [126]
  10. iFavourable and unfavourable associations between physical activity and cardiometabolic health observed across studies
  11. jA gradient for higher TPA with worse total cholesterol was observed in 1 study [81]
  12. kQuality 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