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 8 The relationship between physical activity and risks/harm

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 7.4 weeks-24 months; where mean age was not reported, baseline age ranged from 2 months-4.5 years. Data were collected by case cross-over and longitudinal with 4.5-6.5 years follow-up, case control, and cross-sectional study designs. Risks/harm was assessed as injury risk (proxy-report; Participant Event Monitoring method), injury severity (proxy-report; minor injury severity scale), fracture incidence (proxy-report), and plagiocephaly (objectively measured).
1	Case cross-over^a	Serious risk of bias^b	No serious inconsistency	No serious indirectness	No serious imprecision	None	170	TPA was unfavourably associated with injury risk but was not associated with injury severity [128].	LOW^c
1	Longitudinal^d	Serious risk of bias^e	No serious inconsistency	Serious indirectness^f	No serious imprecision	Dose-response evidence^g	2692	Outdoor time was favourably associated with fracture incidence in the winter but unfavourably associated with fracture incidence in the summer [129].	VERY LOW^h
1	Case-controlⁱ	Serious risk of bias^j	No serious inconsistency	No serious indirectness	No serious imprecision	None	194	TPA was favourably associated with plagiocephaly (at present but not at 6 weeks of age) [130]. Prone position was favourably associated with plagiocephaly (for ≥ 5 min/day but not whether it was provided or not) at 6 weeks of age [130].	VERY LOW^k
1	Cross-sectional^l	Serious risk of bias^m	No serious inconsistency	No serious indirectness	No serious imprecision	None	380	Prone position was not associated with plagiocephaly [131].	VERY LOWⁿ

min: minutes; TPA: total physical activity
^aIncludes 1 case cross-over study [128]
^bConvenience sample
^cQuality of evidence remained at “low”
^dIncludes 1 longitudinal study [129]
^eNo psychometric properties were reported for outdoor time and fracture incidence, and there was a large unexplained loss to follow-up
^fOutdoor time was the measure of physical activity
^gDose-response evidence was observed for higher outdoor time with lower fracture incidence
^hQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias and serious indirectness; because of these limitations, was not upgraded for dose-response evidence
ⁱIncludes 1 case-control study [130]
^jNo psychometric properties were reported for the subjective physical activity measures
^kQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias
^lIncludes 1 cross-sectional study [131]
^mConvenience sample and no psychometric properties were reported for the subjective physical activity measure
ⁿQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias

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ISSN: 1471-2458

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