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

Abstract

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

Associations of TV Viewing Duration, Meals and Snacks Eaten When Watching TV, and a TV in the Bedroom with Child Adiposity

“…For example, 9 out of 10 longitudinal studies reported at least one significant association between TV viewing duration with adiposity outcomes, whereas results from only 11 out of 22 (generally much smaller) cross-sectional studies offered comparable results. The authors contend that there may have been insufficient time for the effects of TV viewing to manifest when data from such young children were analyzed cross-sectionally (8). While plausible, we found little evidence to support this assertion, as there was no strong indication that our associations differed by age (Model 1a).…”

“…Similar levels of TV viewing have been documented in young children internationally (12). An association (albeit small in magnitude) has consistently been reported between TV viewing duration and higher child adiposity (6)(7)(8). This would appear plausible as, by definition, sedentary behavior involves low energy expenditure.…”

“It's like you are in the jungle”: Using the draw‐and‐tell method to explore preschool children's play preferences and factors that shape their active play

“…Once established, learned sedentary habits in children tend to shape sedentary behaviour over time, particularly in boys . The frequent mention of screen‐based games as preferred activities supports the work of other studies in this area linking sedentary behaviour with screen‐based activities …”

“…39 The frequent mention of screen-based games as preferred activities supports the work of other studies in this area linking sedentary behaviour with screen-based activities. [39][40][41][42][43] One explanation for the high preference for screen-based activities at home might be the prohibition of screen-based activities at childcare. Rules at preschool restricted children's participation in screen-based activities (eg, iPad/computer), with children reporting that they were unable to bring such devices to their preschool centre as it was against the rules.…”

Association between breaks in sitting time and adiposity in Australian toddlers: Results from the GET‐UP! study

“…Nevertheless, this review also suggested that the way sedentary time is spent may be important, with screen‐based and seated sedentary behaviors being more likely to have negative health effects, whereas interactive non‐screen based sedentary activities, such as reading and storytelling, more likely to have positive health and developmental effects. The authors also stated that it remains difficult to make recommendations concerning “appropriate” amounts or patterning (eg, breaks) of total sedentary time …”