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      Systematic review of the relationships between sedentary behaviour and health indicators in the early years (0–4 years)

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          Abstract

          Background

          The purpose of this systematic review was to examine the relationships between sedentary behaviour (SB) and health indicators in children aged 0 to 4 years, and to determine what doses of SB (i.e., duration, patterns [frequency, interruptions], and type) were associated with health indicators.

          Methods

          Online databases were searched for peer-reviewed studies that met the a priori inclusion criteria: population (apparently healthy, 1 month to 4.99 years), intervention/exposure and comparator (durations, patterns, and types of SB), and outcome/health indicator (critical: adiposity, motor development, psychosocial health, cognitive development; important: bone and skeletal health, cardiometabolic health, fitness, risks/harm). The quality of the evidence was assessed by study design and outcome using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

          Results

          Due to heterogeneity, meta-analyses were not possible; instead, narrative syntheses were conducted, structured around the health indicator and type of SB. A total of 96 studies were included (195,430 participants from 33 countries). Study designs were: randomized controlled trial ( n = 1), case-control ( n = 3), longitudinal ( n = 25), longitudinal with additional cross-sectional analyses ( n = 5), and cross-sectional ( n = 62). Evidence quality ranged from “very low” to “moderate”. Associations between objectively measured total sedentary time and indicators of adiposity and motor development were predominantly null. Associations between screen time and indicators of adiposity, motor or cognitive development, and psychosocial health were primarily unfavourable or null. Associations between reading/storytelling and indicators of cognitive development were favourable or null. Associations between time spent seated (e.g., in car seats or strollers) or in the supine position, and indicators of adiposity and motor development, were primarily unfavourable or null. Data were scarce for other outcomes.

          Conclusions

          These findings continue to support the importance of minimizing screen time for disease prevention and health promotion in the early years, but also highlight the potential cognitive benefits of interactive non-screen-based sedentary behaviours such as reading and storytelling. Additional high-quality research using valid and reliable measures is needed to more definitively establish the relationships between durations, patterns, and types of SB and health indicators, and to provide insight into the appropriate dose of SB for optimal health in the early years.

          Electronic supplementary material

          The online version of this article (10.1186/s12889-017-4849-8) contains supplementary material, which is available to authorized users.

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          Most cited references104

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          Sedentary behaviors and subsequent health outcomes in adults a systematic review of longitudinal studies, 1996-2011.

          To systematically review and provide an informative synthesis of findings from longitudinal studies published since 1996 reporting on relationships between self-reported sedentary behavior and device-based measures of sedentary time with health-related outcomes in adults. Studies published between 1996 and January 2011 were identified by examining existing literature reviews and by systematic searches in Web of Science, MEDLINE, PubMed, and PsycINFO. English-written articles were selected according to study design, targeted behavior, and health outcome. Forty-eight articles met the inclusion criteria; of these, 46 incorporated self-reported measures including total sitting time; TV viewing time only; TV viewing time and other screen-time behaviors; and TV viewing time plus other sedentary behaviors. Findings indicate a consistent relationship of self-reported sedentary behavior with mortality and with weight gain from childhood to the adult years. However, findings were mixed for associations with disease incidence, weight gain during adulthood, and cardiometabolic risk. Of the three studies that used device-based measures of sedentary time, one showed that markers of obesity predicted sedentary time, whereas inconclusive findings have been observed for markers of insulin resistance. There is a growing body of evidence that sedentary behavior may be a distinct risk factor, independent of physical activity, for multiple adverse health outcomes in adults. Prospective studies using device-based measures are required to provide a clearer understanding of the impact of sedentary time on health outcomes. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.
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            Early life risk factors for obesity in childhood: cohort study.

            To identify risk factors in early life (up to 3 years of age) for obesity in children in the United Kingdom. Prospective cohort study. Avon longitudinal study of parents and children, United Kingdom. 8234 children in cohort aged 7 years and a subsample of 909 children (children in focus) with data on additional early growth related risk factors for obesity. Obesity at age 7 years, defined as a body mass index (3) 95th centile relative to reference data for the UK population in 1990. Eight of 25 putative risk factors were associated with a risk of obesity in the final models: parental obesity (both parents: adjusted odds ratio, 10.44, 95% confidence interval 5.11 to 21.32), very early (by 43 months) body mass index or adiposity rebound (15.00, 5.32 to 42.30), more than eight hours spent watching television per week at age 3 years (1.55, 1.13 to 2.12), catch-up growth (2.60, 1.09 to 6.16), standard deviation score for weight at age 8 months (3.13, 1.43 to 6.85) and 18 months (2.65, 1.25 to 5.59); weight gain in first year (1.06, 1.02 to 1.10 per 100 g increase); birth weight, per 100 g (1.05, 1.03 to 1.07); and short (< 10.5 hours) sleep duration at age 3 years (1.45, 1.10 to 1.89). Eight factors in early life are associated with an increased risk of obesity in childhood.
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              Canadian sedentary behaviour guidelines for children and youth.

              The Canadian Society for Exercise Physiology (CSEP), in partnership with the Healthy Active Living and Obesity Research Group (HALO) at the Children's Hospital of Eastern Ontario Research Institute, and in collaboration with ParticipACTION, and others, has developed the Canadian Sedentary Behaviour Guidelines for Children (aged 5-11 years) and Youth (aged 12-17 years). The guidelines include a preamble to provide context, followed by the specific recommendations for sedentary behaviour. The entire development process was guided by the Appraisal of Guidelines for Research Evaluation (AGREE) II instrument, which is the international standard for clinical practice guideline development. Thus, the guidelines have gone through a rigorous and transparent developmental process and the recommendations are based on evidence from a systematic review and interpretation of the research evidence. The final guidelines benefitted from an extensive online consultation process with 230 domestic and international stakeholders and key informants. The final guideline recommendations state that for health benefits, children (aged 5-11 years) and youth (aged 12-17 years) should minimize the time that they spend being sedentary each day. This may be achieved by (i) limiting recreational screen time to no more than 2 h per day - lower levels are associated with additional health benefits; and (ii) limiting sedentary (motorized) transport, extended sitting time, and time spent indoors throughout the day. These are the first evidence-based Canadian Sedentary Behaviour Guidelines for Children and Youth and provide important and timely recommendations for the advancement of public health based on a systematic synthesis, interpretation, and application of the current scientific evidence.
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                Author and article information

                Contributors
                (613) 737-7600 , veronicapoitras@gmail.com
                casgray@cheo.on.ca
                xanne.janssen@strath.ac.uk
                SAubert@cheo.on.ca
                vlcarson@ualberta.ca
                guy.faulkner@ubc.ca
                ggoldfield@cheo.on.ca
                john.j.reilly@strath.ac.uk
                msampson@cheo.on.ca
                mtremblay@cheo.on.ca
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                20 November 2017
                20 November 2017
                2017
                : 17
                Issue : Suppl 5 Issue sponsor : Publication of this supplement has not been supported by sponsorship. Information about the source of funding for publication charges can be found in the individual articles. The articles have undergone the journal's standard peer review process for supplements. The supplement editor declares the following: I publish and serve as a co-investigator on research grants with Dr. Brian Timmons. I have previously published one paper with Dr. Catherine Birken. Drs. Valerie Carson and Kristi Adamo are my co-applicants on a grant submission currently under review as of the publication date of this supplement. I have no financial competing interests to declare.
                : 868
                Affiliations
                [1 ]ISNI 0000 0000 9402 6172, GRID grid.414148.c, Healthy Active Living and Obesity Research Group, RI #1, Children’s Hospital of Eastern Ontario Research Institute, ; 401 Smyth Road, Ottawa, ON K1H 8L1 Canada
                [2 ]ISNI 0000000121138138, GRID grid.11984.35, University of Strathclyde, School of Psychological Science and Health, ; G1 1QE, Glasgow, Scotland UK
                [3 ]GRID grid.17089.37, Faculty of Physical Education and Recreation, University of Alberta, ; Edmonton, AB T6G 2H9 Canada
                [4 ]ISNI 0000 0001 2288 9830, GRID grid.17091.3e, School of Kinesiology, University of British Columbia, ; Vancouver, BC V6T 1Z3 Canada
                [5 ]ISNI 0000 0000 9402 6172, GRID grid.414148.c, Library and Media Services, Children’s Hospital of Eastern Ontario, ; Ottawa, ON K1H 8L1 Canada
                Article
                4849
                10.1186/s12889-017-4849-8
                5773886
                29219092
                d706d38d-382f-4df7-a81c-416d367e920d
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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                © The Author(s) 2017

                Public health
                sedentary behaviour,infants,toddlers,preschoolers,early years,screen time,sitting,reading,adiposity,motor development,cognitive development,bone and skeletal health,cardiometabolic health,fitness,risks

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