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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
Risk of bias Inconsistency Indirectness Imprecision Other
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-overa Serious risk of biasb 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]. LOWc
1 Longitudinald Serious risk of biase No serious inconsistency Serious indirectnessf No serious imprecision Dose-response evidenceg 2692 Outdoor time was favourably associated with fracture incidence in the winter but unfavourably associated with fracture incidence in the summer [129]. VERY LOWh
1 Case-controli Serious risk of biasj 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 LOWk
1 Cross-sectionall Serious risk of biasm No serious inconsistency No serious indirectness No serious imprecision None 380 Prone position was not associated with plagiocephaly [131]. VERY LOWn
  1. min: minutes; TPA: total physical activity
  2. aIncludes 1 case cross-over study [128]
  3. bConvenience sample
  4. cQuality of evidence remained at “low”
  5. dIncludes 1 longitudinal study [129]
  6. eNo psychometric properties were reported for outdoor time and fracture incidence, and there was a large unexplained loss to follow-up
  7. fOutdoor time was the measure of physical activity
  8. gDose-response evidence was observed for higher outdoor time with lower fracture incidence
  9. 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
  10. iIncludes 1 case-control study [130]
  11. jNo psychometric properties were reported for the subjective physical activity measures
  12. kQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias
  13. lIncludes 1 cross-sectional study [131]
  14. mConvenience sample and no psychometric properties were reported for the subjective physical activity measure
  15. nQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias