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      Systematic review of the relationships between physical activity and health indicators in the early years (0-4 years)

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          Abstract

          Background

          Given the rapid development during the early years (0-4 years), an understanding of the health implications of physical activity is needed. The purpose of this systematic review was to examine the relationships between objectively and subjectively measured physical activity and health indicators in the early years.

          Methods

          Electronic databases were originally searched in April, 2016. Included studies needed to be peer-reviewed, written in English or French, and meet a priori study criteria. The population was apparently healthy children aged 1 month to 59.99 months/4.99 years. The intervention/exposure was objectively and subjectively measured physical activity. The comparator was various volumes, durations, frequencies, patterns, types, and intensities of physical activity. The outcomes were health indicators ranked as critical (adiposity, motor development, psychosocial health, cognitive development, fitness) and important (bone and skeletal health, cardiometabolic health, and risks/harm). The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess the quality of evidence for each health indicator by each study design.

          Results

          Ninety-six studies representing 71,291 unique participants from 36 countries were included. Physical activity interventions were consistently (>60% of studies) associated with improved motor and cognitive development, and psychosocial and cardiometabolic health. Across observational studies, physical activity was consistently associated with favourable motor development, fitness, and bone and skeletal health. For intensity, light- and moderate-intensity physical activity were not consistently associated with any health indicators, whereas moderate- to vigorous-intensity, vigorous-intensity, and total physical activity were consistently favourably associated with multiple health indicators. Across study designs, consistent favourable associations with health indicators were observed for a variety of types of physical activity, including active play, aerobic, dance, prone position (infants; ≤1 year), and structured/organized. Apart from ≥30 min/day of the prone position for infants, the most favourable frequency and duration of physical activity was unclear. However, more physical activity appeared better for health. Evidence ranged from “very low” to “high” quality.

          Conclusions

          Specific types of physical activity, total physical activity, and physical activity of at least moderate- to vigorous-intensity were consistently favourably associated with multiple health indicators. The majority of evidence was in preschool-aged children (3-4 years). Findings will inform evidence-based guidelines.

          Electronic supplementary material

          The online version of this article (10.1186/s12889-017-4860-0) contains supplementary material, which is available to authorized users.

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          Most cited references 107

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          Early-life determinants of overweight and obesity: a review of systematic reviews.

          The aim of this paper was to review the evidence for early-life (from conception to 5 years of age) determinants of obesity. The design is review of published systematic reviews. Data sources included Medline, Embase, Web of Science, Cochrane Library, CINAHL, PsycINFO. Identification of 22 eligible reviews from a database of 12,021 independent publications. Quality of selected reviews assessed using the Assessment of Multiple Systematic Reviews score. Articles published after the reviews were used to confirm results. No review was classified as high quality, 11 as moderate and 11 as low. Factors associated with later overweight and obesity: maternal diabetes, maternal smoking, rapid infant growth, no or short breastfeeding, obesity in infancy, short sleep duration, <30 min of daily physical activity, consumption of sugar-sweetened beverages. Other factors were identified as potentially relevant, although the size of their effect is difficult to estimate. Maternal smoking, breastfeeding, infant size and growth, short sleep duration and television viewing are supported by better-quality reviews. It is difficult to establish a causal association between possible determinants and obesity, and the relative importance of each determinant. Future research should focus on early-life interventions to confirm the role of protective and risk factors and to tackle the high burden obesity represents for present and future generations. © 2010 The Authors. obesity reviews © 2010 International Association for the Study of Obesity.
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            Methodological considerations in using accelerometers to assess habitual physical activity in children aged 0-5 years.

            This paper reviews the evidence behind the methodological decisions accelerometer users make when assessing habitual physical activity in children aged 0-5 years. The purpose of the review is to outline an evidence-guided protocol for using accelerometry in young children and to identify gaps in the evidence base where further investigation is required. Studies evaluating accelerometry methodologies in young children were reviewed in two age groups (0-2 years and 3-5 years) to examine: (i) which accelerometer should be used, (ii) where the accelerometer should be placed, (iii) which epoch should be used, (iv) how many days of monitoring are required, (v) how many minutes of monitoring per day are required, (vi) how data should be reduced, (vii) which cut-point definitions for identifying activity intensity should be used, and (viii) which physical activity outcomes should be reported and how. Critique of the available evidence provided a basis for the development of a recommended users protocol in 3-5-year olds, although several issues require further research. Because of the absence of methodological studies in children under 3 years, a protocol for the use of accelerometers in this age range could not be specified. Formative studies examining the utility, feasibility and validity of accelerometer-based physical activity assessments are required in children under 3 years of age. Recommendations for further research are outlined, based on the above findings, which, if undertaken, will enhance the accuracy of accelerometer-based assessments of habitual physical activity in young children.
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              Motor skill performance and physical activity in preschool children.

              Children with better-developed motor skills may find it easier to be active and engage in more physical activity (PA) than those with less-developed motor skills. The purpose of this study was to examine the relationship between motor skill performance and PA in preschool children. Participants were 80 three- and 118 four-year-old children. The Children's Activity and Movement in Preschool Study (CHAMPS) Motor Skill Protocol was used to assess process characteristics of six locomotor and six object control skills; scores were categorized as locomotor, object control, and total. The actigraph accelerometer was used to measure PA; data were expressed as percent of time spent in sedentary, light, moderate-to-vigorous PA (MVPA), and vigorous PA (VPA). Children in the highest tertile for total score spent significantly more time in MVPA (13.4% vs. 12.8% vs. 11.4%) and VPA (5% vs. 4.6% vs. 3.8%) than children in middle and lowest tertiles. Children in the highest tertile of locomotor scores spent significantly less time in sedentary activity than children in other tertiles and significantly more time in MVPA (13.4% vs. 11.6%) and VPA (4.9% vs. 3.8%) than children in the lowest tertile. There were no differences among tertiles for object control scores. Children with poorer motor skill performance were less active than children with better-developed motor skills. This relationship between motor skill performance and PA could be important to the health of children, particularly in obesity prevention. Clinicians should work with parents to monitor motor skills and to encourage children to engage in activities that promote motor skill performance.
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                Author and article information

                Contributors
                +780-492-1004 , vlcarson@ualberta.ca
                eunyoung.lee@ualberta.ca
                llh966@uowmail.edu.au
                cally1@ualberta.ca
                stephen1@ualberta.ca
                nkuzik@ualberta.ca
                jodie.stearns@ualberta.ca
                sunrau@ualberta.ca
                veronicap@cadth.ca
                casgray@cheo.on.ca
                Kristi.Adamo@uottawa.ca
                ian.janssen@queensu.ca
                tokely@uow.edu.au
                jc.spence@ualberta.ca
                timmonbw@mcmaster.ca
                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.
                Affiliations
                [1 ]GRID grid.17089.37, Faculty of Physical Education and Recreation, , University of Alberta, ; Edmonton, AB T6G 2H9 Canada
                [2 ]ISNI 0000 0004 0486 528X, GRID grid.1007.6, Early Start Research Institute, Faculty of Social Sciences, , University of Wollongong, ; Wollongong, NSW 2522 Australia
                [3 ]ISNI 0000 0000 9402 6172, GRID grid.414148.c, Healthy Active Living and Obesity Research Group, , Children’s Hospital of Eastern Ontario Research Institute, ; Ottawa, ON K1H 8L1 Canada
                [4 ]ISNI 0000 0001 2182 2255, GRID grid.28046.38, School of Human Kinetics, Faculty of Health Sciences, , University of Ottawa, ; Ottawa, ON K1N 1A2 Canada
                [5 ]ISNI 0000 0004 1936 8331, GRID grid.410356.5, School of Kinesiology and Health Studies, and Department of Public Health Sciences, , Queen’s University, ; Kingston, ON K7L 3N6 Canada
                [6 ]ISNI 0000 0004 1936 8227, GRID grid.25073.33, Child Health & Exercise Medicine Program, Department of Pediatrics, , McMaster University, ; Hamilton, ON L8S 4K1 Canada
                [7 ]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
                4860
                10.1186/s12889-017-4860-0
                5753397
                29219090
                © 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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