Objective: To evaluate the relationship between biologico-demographical, sociocultural, and environmental factors and the performance of physical activity in early childhood. Methodology: A systematic search was carried out of the databases MEDLINE, EMBASE, CENTRAL, and LILACS, as well as Google Scholar, Open Grey, ClinicalTrials.gov, DARE, PROSPERO, Health Technology Assessment, and the World Health Organization International Clinical Trials Registry Platform, from their first records to June 2018. The selection criteria were previously defined with respect to population age and article theme. No meta-analyses were carried out due to the heterogeneity of the studies. Results: The percentage of moderate to vigorous physical activity runs between 3% and 47%. Environmental and sociocultural factors were identified as exerting a greater influence on children’s physical activity in early childhood, with the environmental factors being, according to almost all the study authors, the greater of the two. Conclusions: According to the studies included in this research project, the factors identified as associated with moderate to vigorous physical activity are environmental (play in open spaces) and sociocultural (the role of the family and the physical activity of the mother). The evidence is not strong enough to conclude that biologico-demographic factors are significantly influential in the physical activity at this age.

Physical activity brings benefits to human health, reducing the risk of suffering from chronic noncommunicable diseases. Its performance depends on both internal and external factors, which has led researchers to emphasize social factors as decisive in human health. As the behaviors acquired in early childhood influence the behaviors of later stages of life, intervention is vital at these ages, as it is still possible to prevent the acquisition of a sedentary lifestyle with all the diseases this involves.1,2 At the same time, obesity has reached epidemic levels among preschool children, following an ascendant curve, which came sharply into focus from 1990 onward.3 In Colombia, according to the national poll on nutritional behavior (Encuesta nacional de situación nutricional), 6.3% of preschool children (3–4 y old)4 and 24.4% of school-age children (5–12 y old) are overweight, situation directly related to a lack of active play (25.6%) at this same age; at the same time, a difference in behavior has been reported between the genders (30.2% men and 20.6% women). In addition, 44% of children between the ages of 5 and 11 years old do not commit even 1 hour of their weekly schedule to physical activities.5 To control this transformation, society needs to change its behavior, but for this to happen, everyone, including the community itself, must commit to taking action in favor of early childhood activity.

This systematic review was carried out with the aim of evaluating the relationship between biologico-demographic/sociocultural/environmental factors and the performance of physical activity (PA) in early childhood.

Methods

This study follows the Cochrane collaboration recommendations and the PRISMA statement report. The protocol was registered in the international prospective register of systematic reviews (PROSPERO) CRD42018094690.

Eligibility Criteria

Studies

We included cross-sectional, cohort, and clinical experiment studies carried out on child populations; these studies researched PA and the factors involved in its performance.

Participants

Children in early childhood, between the ages of 1 and 6 years old, whose motor skills correspond to their age and who are not physically challenged in any way.

Factors

Environmental and sociocultural factors related to the performance of moderate to vigorous physical activity (MVPA) such as outdoor play, access to parks, the role of parents in encouraging PA, and the encouragement of PA by teachers or caregivers.

Outcomes

PA, intensity, sedentary lifestyle, and MVPA.

Exclusion Criteria

Studies which approached themes related to physically challenged children, bone health, or obesity.

Source Information and Search Strategy

A research strategy was designed for MEDLINE through OVID, EMBASE, CENTRAL (Cochrane Controlled Register for Trials), and LILACS (Latin American and Caribbean Literature on Health Sciences from its first records to June 2018). The search strategy was specific to each database; there were no restrictions set on language, state of publication, or publication time. All of these search strategies are to be found in Appendix 1.

Other electronic sources were used to find additional studies, such as Google Scholar, ClinicalTrials.gov, DARE, PROSPERO, Health Technology Assessment (HTA), World Health Organization International Clinical Trials Registry Platform, and Open Grey (from 1997 to the present). Manual searches were carried out on reference lists of systematic reviews which were considered pertinent and contact was made with authors of published and unpublished articles as well as unpublished literature such as the opinion of experts and conferences. The results of the searches were double checked with a view to eliminating duplication.

Study Selection

Two researchers identified and selected, in a blinded and independent process, the studies after searching the different databases. Each one produced a list of studies after analyzing the title and abstract of each article and was included if one of the two thought it should be included. The eligibility criteria were applied to the analysis of the complete text in the final selection. Any disagreements between the authors as to the eligibility, quality, and data recovered from the articles were resolved by communication between the two.

Data Collection Process

The data extraction was carried out independently using a standardized format, which included first author and year, research design, country, sample size, participant age, study objective, variables, tools or methods used for measuring PA, details of the final outcome, and the main factor and odds ratio (OR) reported. The reviewers confirmed all of the data, making sure that they were exact.

Risk of Bias

The researchers independently evaluated the methodological quality of each article, for which purpose they used the Cochrane quality standard format for the clinical trials. The format contains information on random sequence generation and allocation concealment (selection bias), blinding of participants and personnel (performance bias), blinding of outcome assessment (detection bias), loss to follow-up (attrition bias), and selective reporting (reporting bias). For the assessment of the quality of observational studies (cohorts and cross-sections), the MINORS scale was applied.6 This scale contains information on clearly stated aims and questions, the inclusion of consecutive patients, prospective collection of data, the appropriateness of endpoints and a method for measuring variable results, bias assessment, treatment of lost data, and the presence of later calculations.

Statistical Analysis

Due to the heterogeneous nature of the data, a meta-analysis was not performed.

Results

After generating and applying the search strategies, 59 articles were evidenced, of which 14 were included in the quality synthesis, after excluding duplicates or articles which did not comply with the inclusion criteria (Figure 1).

Figure 1
Figure 1

—Selection of the studies. TI indicates title, AB, abstract.

Citation: Journal of Physical Activity and Health 16, 10; 10.1123/jpah.2018-0715

Characteristics of the Studies Included

In the studies analyzed, there were an accumulated total of 6704 children in groups ranging from 32 to 2026. All participants were between 2 and 6 years old, in accordance with the selection criteria. All studies presented data on the intensity of PA (sedentary lifestyle, low physical activity, and MVPA). With regard to the type of factor involved, the studies of Alhassan et al,7 Bonvin et al,8 Cardon et al,9 Grønholt Olesen et al,10 Hannon and Brown,11 and Nicaise et al12 presented results on the relationship between environmental factors and PA. Cardon et al,9 Dowda et al,13 Gubbels et al,14 Grønholt Olesen et al,10 Nicaise et al,12 Spurrier et al,15 and Xu et al16 approached PA in relation to sociocultural factors. For Alhassan et al,7 Draper et al,17 Hannon et al11 Jackson et al,18 Nicaise et al12 Grønholt Olesen et al,10 and Schmutz et al19 demographic and biological factors were linked to the performance of PA (Table 1). For Schmutz et al,19 psychological factors such as active temperament were linked both to a sedentary lifestyle and to MVPA, negatively and positively.

Table 1

Characteristics of the Studies Included

Author (year), countryStudy designSamplePA measurementResult measurementMain findingsFactor associated with PA
Alhassan et al (2007),7 CA, USAClinical trial32 (CON: n = 15, INT: n = 17)

Average age: CON: 3.5 y

INT: 3.8 y
Accelerometer 10 h/d for 4 dAge, BMI, gender, and PASedentary 91%, LPA l6%, MVPA 3%. OR 0.86 (IC 0.05–13.60) outdoor playOutdoor play (environmental)
Bonvin et al (2013),8 SwitzerlandBlind randomized clinical trial648 (INT: n = 313, CON: n = 335)

Average age: 3.3 y
Accelerometer 6.1 h/dMotor abilities, BMI, PA, family history, parents, and quality of life52% sedentary, 21% VPA, 20% MVPA.

Access to play in outdoor areas as a predictor of MVPA (increases 48% cpm).

OR 1.02 (IC 0.75–1.40) outdoor play
PA in preschool schedule and free access to an outdoor play area (environmental)
Bürgi et al (2010),20 SwitzerlandCross-sectional542

Average age: 5.1 y
Accelerometer 6 h/dBMI, PA, motor abilities, and sociocultural factorsStatistically significant differences in the PA of children of working mothers vs those who do not (P ≤ .03)Mother’s workload (sociocultural)
Cardon et al (2008),9 BelgiumCross-sectional783

Average age: 5.2 y
Pedometer 1 h/dAge, gender, weight, PA, and characteristics of the recreation yardGirls vs boys, lower PA levels (P ≤ .05). Presence of a soccer field and teacher supervision = significant predictors (P ≤ .07; P ≤ .05).Ample outdoor play area (environmental)

Teacher supervision (sociocultural)

Gender (biological)
Dowda et al (2011),13 SC, USACross-sectional as part of the CHAMPS study369

Average age: 4.2 y
Accelerometer >5 h/d and OSRACBMI, quality of the preschool, and PAFamily support (P < .001), quality of the preschool (P < .001), access to equipment (P < .001), and the enjoyment of the children (P < .001), positively related to MVPA.Role of the family

Performance of PA on the part of the parents (sociocultural)
Draper et al (2017),17 South AfricaCross-sectional224

Average age: 5.1 y
Accelerometer 64 min/d and OSRACBMI, PA, motor abilities, and perception by parents and teachersDifferences between the time invested and PA (P = .01). 72% sedentary, 18% MVPA, and 10% LPA.

OR 1.28 (IC 0.73–2.27) housing location
Housing location (demographic and biological)
Grønholt Olesen et al (2015),10 DenmarkCross-sectional351

Average age: 5.8 y
Accelerometer 12 h/d for 7 d and questionnairePA, age, gender, motor abilities, and role of the parentsMotor coordination (P < .001), location (P < .001), and area of play (P < .004). MVPA 11.4%.Location and area of play (environmental)

Motor coordination (biological)
Gubbels et al (2011),14 HollandCohort2026

Average age: 5 y
QuestionnaireParent work schedule, level of education, diet, PA, and BMIChildren of parents who limit sedentarism are 13 times more likely to perform PA (P < .001) than of those who do not. And of those who encourage PA (P < .005)Role of the family (sociocultural)
Hannon and Brown (2008),11 UT, USACross-sectional64

Average age: 3–5 y
Accelerometer

15 s of PA/h and OSRAC
Age and PASedentarism 50%, MVPA 13%.

With equipment in the yard sedentarism decreased from 57.17% to 41.18% min/d. And LPA increased from 30.60% to 34.13%; MPA from 9.84% to 17.60%, and VPA from 2.31% to 6.97%. Interaction with the age group

moderate (P < .001); vigorous (P = .07)
Age (biological)

Location (environmental)
Jackson et al (2003),18 ScotlandCohort104

Average age: 3–4 y
Accelerometer 6 h/dAge, BMI, and PAThe difference in gender was statistically significant (P < .001).Gender (biological)
Nicaise et al (2011),12 CA, USACross-sectional51

Average age: 4.5 y
OSRACAge, PA, and BMIDifference by gender was found in the realization of MVPA (P  < .001), sedentary: 22 (larger park), 26 cp. MVPA: 11 mp, 10 cp. Light: 18 mp,15 cp. OR 3.2 (IC 2.48–4.17) outdoor playGender (biological)

Location and parks (environmental)
Schmutz et al (2018),19 SwitzerlandCohort555

Average age: 4.9 y
Accelerometer 24 h/d

Questionnaire
Age, gender, BMI, active temperament, motor abilities, and time playingActive temperament (P < .001); age and gender (P < .001)Age and gender (biological)

Active temperament (psychological)
Spurrier et al (2008),15 AustraliaCross-sectional280

Average age: 4.8 y
Parent reports, direct observation, and questionnairesAge, PA, diet, and characteristics of the homeMVPA positively associated with the PA of the mother (P = .008) and with the existence of large open spaces near the housing, which encourage sports activity of the mother (P = .04).PA of the mother (sociocultural)

Large open spaces for exercising (environmental)
Xu et al (2016),16 AustraliaCohort663

Average age: 2–5 y
QuestionnaireAge, mother–children, educational level of the mother, socioeconomic income, PA, and screen timeChildren of active mothers are 6 times more likely to play outdoors compared with those without. OR 6.5 (2.06–11.04)

At the final moment of the monitoring, out of 486 children, 181 were sedentary and 305 performed MVPA.
Active mother (sociocultural)

Abbreviations: BMI, body mass index; CON, control; INT, intervention; LPA, low physical activity; MVPA, moderate to vigorous physical activity; OR, odds ratio; OSRAC, observation system for recording physical activity in children; PA, physical activity; VPA, vigorous physical activity.

Characteristics of the Excluded Studies

The studies were excluded mainly because they did not approach the theme of PA and factors related to it or had a different theme; because they had an older child population or did not supply specific data on their age; because of the type of study involved (systematic reviews, theme reviews, meta-analyses, and a protocol for a clinical trial without results); and in one case because the text was incomplete2164 (Supplementary Table 1 [available online]).

Risk of Bias Assessment

An assessment of bias risk was performed on the 2 clinical trial papers, of which the study by Alhassan et al7 presented 3 to 7 items of low risk (detection bias, time lag bias, and reporting bias) and of high risk in performance bias. By contrast, the study by Bonvin et al8 presented a low bias risk in most of its items, and only an allocation concealment bias was unclear (Figure 2A).

Figure 2
Figure 2

—(A) Risk of bias for each of the clinical trials. (B) Risk of bias for each of the observational studies.

Citation: Journal of Physical Activity and Health 16, 10; 10.1123/jpah.2018-0715

With regard to the observational studies, none of them presented a high risk of bias; all of them presented a low risk of bias in all of their items except in the item of unbiased assessment of the study endpoint, where 8 of the 10 studies presented an unclear risk of bias. The study by Xu et al16 presented a low risk of bias in all of its items (Figure 2B).

In the clinical trials, there was evidence that a low risk of bias was present, except for the item of allotment concealment, which was unclear in both studies. With regard to high risk of bias, in the study by Alhassan et al7 a high risk bias was present in the blinding of participants and personnel (Figure 3A).

Figure 3
Figure 3

—(A) Risk of bias among the clinical trials. (B) Risk of bias among the observational studies.

Citation: Journal of Physical Activity and Health 16, 10; 10.1123/jpah.2018-0715

In the cross-sectional studies, most of the biases observed were assessed as low risk (more than 75%); the item of unbiased assessment of the study endpoint presented a 75% unclear risk (Figure 3B).

Results of the Individual Studies: Levels of PA Reported

Of the children who participated in the studies, the percentage who performed MVPA ranged from 47%16 to 3%.7 Sedentarism was what was most observed at high levels, ranging from 37%14 to 49.33%,10 with behaviors at a par with different reports at a world level. For each of the authors, the PA is related to or depends on some factor in particular, for Alhassan et al,7 Bonvin et al,8 Cardon et al,9 Nicaise et al,12 and Spurrier et al15 factors included outdoor play with a greater opportunity for performing PA, and the opportunity given to children to play outdoors, in parks, or playgrounds with ample green areas. Of all the studies, the only one which studied scheduling at the preschool level was Bonvin, who found a connection between a schedule set aside especially for motor activities in the class timetable and the performance of PA. For Bürgi et al,20 Dowda et al,13 Gubbels et al,14 Spurrier et al,15 and Xu et al,16 the fact that the mother did PA and that the family encouraged its performance contributed to the children doing PA. With regard to the preschool level, only 3 authors studied the connection between teacher supervision or the location of the preschool facility (area, games, and tools) as a determining factor in the intensity of the PA performed. Finally, for some authors,11,12,18,19 age and gender were connected to the PA of the children at that age.

According to the adaptation carried out on the model of determining social factors on health,65 the factors which are connected to PA in early childhood can be divided into 3 large groups.

Factors Linked to the Socioeconomic or Political Context

According to Draper et al,17 location was a factor in determining the different conditions among the care giving sites or kindergartens (differences in socioeconomic class and rural vs urban contexts), which indirectly affected the performance of MVPA. It was observed that city schools of a high-socioeconomic class have more space and better equipment than rural schools or those of a lower socioeconomic class; the children in these schools therefore have more space for exploring, more access to playgrounds designed for their age group, and more opportunities for performing MVPA. In the same way, Nicaise et al12 concludes that there is a relationship between the intensity of the PA and the size and equipment of the park where the children are playing.

Factors Related to Social Education

With regard to this theme, Bonvin et al8 treats education (teacher training) as a factor related to physical activity in children.

Biologico-Demographic Factors

According to Hannon and Brown11 and Schmutz et al,19 the interaction between moderate PA and age is statistically significant (P <. 001), and in their view, it becomes a risk factor. With regard to gender, Cardon et al9 (P ≤ .05), Jackson et al18 (P < .001), Nicaise et al12 (P < .001), and Schmutz et al19 (P < .001) found that being a girl reduced the opportunity for performing MVPA. For Gronholt et al10 motor coordination has an influence on the performance of MVPA (P < .001). Of all the authors, Draper et al17 was the only one to carry out an analysis which took into account living space (rural or urban), finding that the differences in the proportion of time invested in different intensities of PA were significant (P = .01). For this author, when children in rural areas played in outdoor spaces, they had less structured activities which allowed for more PA.

Sociocultural Factors

The authors’ findings allow us to conclude that sociocultural factors have an influence on performing PA. These factors include the role of the family (Gubbels et al14: more PA among children of parents who discourage sedentarism, P < .001); the workload of the mother (Bürgi et al20: statistically significant differences in PA among children whose mothers work compared with those who do not, P = .03); the performance of PA on the part of the parents (Dowda et al13: family support, P < .001); Spurrier et al15: a MVPA positively associated with the PA of the mother (P = .008); and Xu et al16: children of active mothers versus outdoor play (OR 6.5 [confidence interval 2.06–11.04]); and the supervision and encouragement by teachers (Cardon et al9, P ≤ .05).

Environmental Factors

According to Alhassan et al7 (OR 0.86 [IC 0.05–13.60]); Bonvin et al8 (OR 1.02 [IC 0.75–1.40]); Cardon et al9 (P ≤ .07); Hannon and Brown11 (a change in MPA upon changing spaces, from 9.84% in small spaces to 17.60% in larger spaces); Nicaise et al12 (22% MVPA in a larger size park and 19% in a smaller size park); Spurrier et al15 (P = .04); Xu et al16 (46% MVPA) playing outdoors, whether in a park, a courtyard, and having periods in the class scheduled for PA provided the children with more opportunities for performing MVPA compared with those without. In the same way, Grønholt Olesen et al10 found a statistically significant relationship between the space (P < .001), the play area (P < .004), and performing MVPA.

Psychological Factors

Of all the authors, the only one who took on this type of factor was Schmutz et al,19 who found a relationship between active temperament and the performance of MVPA (P < .001).

Discussion

In the 14 studies analyzed, there were a total of 6704 participants; all assessed PA and the association with the factors mentioned (biologico-demographic, sociocultural, environmental, or psychological). With regard to the assessment of a final outcome, PA was assessed with tools validated for children. Of the studies, only one presented results for children of 2 years of age16 using questionnaires designed for the mothers.

The results of the review support the international data on sedentarism, finding that levels of sedentarism reach 49.33%11 and those of MVPA reach 3%.16 With regard to factors related to the performance of MVPA, it was observed that, though Hannon and Brown11 and Schmutz et al19 show a connection between age and PA, the evidence is not strong enough so as to come to a clear conclusion on this point. On the contrary, upon analyzing the other authors, it can be shown that the environmental and sociocultural factors are those with the strongest connection.

Comparison With the Literature

In the systematic review by Li et al,66 the influence of sociocultural factors was studied the finding evidence of the association between the family relationship and the PA result. However, the influence of environmental factors was not considered. On the other hand, for Bingham et al,67 the results are similar: environmental, behavioral, and sociocultural factors are the most relevant in the PA of children in their early infancy. However, the poor quality of these studies (only 6% of high quality) and the inclusion of studies related to obesity, seasonal change, mental health, and age differences allowed them to include behavioral factors, which have not been found to be relevant in the research carried out in this article.

Quality of the Evidence

With regard to the assessment of the sources of bias, from the beginning the selection by the 2 evaluators was carried out with a high rate of agreement, which ensured a control of the study selection process, in such a way that any difference in criteria was resolved through theoretical discussion so that it was not necessary to seek out a third evaluator. The studies evaluated in this review presented for the most part a low risk of bias,7,8 only one of the 2 presented a high risk of performance bias, but this study was not adequately described (without going so far as to say it was of poor quality), which may have generated underestimations.

To evaluate the heterogeneous nature of the studies, a critical analysis was carried out where it was observed that each study approached a different factor or presented it among diverse results. Though the variable for all the studies was PA, the difficulty involved in using a single language when analyzing the study results led to the decision not to realize a meta-analysis. Despite the heterogeneous nature of the studies, the results of this systematic review can be generalized, while considering various elements such as the number of participants in the studies, the low risk of bias found in the bias assessment, and the quality of the results reported.

Strengths and Limitations

This systematic review allowed for responding to the research question on the factors related to the performance of PA in early childhood, evidencing that the factors most related are environmental and sociocultural ones. In addition to this, it allowed for making clear that the analysis of PA at this stage of life requires a wide approach where government bodies should participate in decision-making processes to establish measures for designing future research projects.

A limitation was discovered in the search, though carried out thoroughly, including the most relevant databases in different languages and in accordance with international recommendations for the production of search sequences such as the MeSH terms. The research in the PROSPERO and HTA databases did not reveal any studies.

Importance in Public Health

Considering the results found in this review and the fact that chronic sickness is a problem of public health in our country, the evidence shown of the relationship which exists between environmental and sociocultural factors and the performance of MVPA is grounds for expressing concerns over the design of policies which deal with this sector of the population.

This systematic review complies with the rigor which should characterize a study of this kind. Though the results allow for answering, to a certain degree, the research question posed, further observational studies are required which would facilitate the analysis of children’s behavior in early infancy, that of their parents and environment to guarantee a more solid conclusion.

Conclusions

The factors identified as those related to MVPA are environmental and sociocultural factors and those concerning social education and the socioeconomic and political context of the children.

Of the environmental factors, the most striking one was play in open spaces which promote the performance of MVPA, seen as a protective factor. Among the sociocultural factors, the role of the family, the PA carried out by the parents, and the encouragement of PA on the part of the preschool teacher are the most significant.

With regard to those factors related to social education and the socioeconomic and political context, 3 studies examined the relationship between the teachers’ and caregivers’ education, the size of the play area, and the adaptation of the accessories for that age to the child’s PA.

The intensity of the PA of the children in early childhood was evaluated by all of the authors, finding that more than 50% of the children were sedentary and less than 20% performed MVPA.

Acknowledgments

PROSPERO REGISTER No. CRD42018094690.

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Search strategy

MEDLINE (OVID)

  • Exp motor activity
  • (physical adj2 activity).mp
  • (motor adj2 activity).mp
  • exp exercise
  • exercise.mp
  • physical exercise.mp
  • aerobic exercise.mp
  • exp physical fitness
  • (physical adj2 fitness).mp
  • sports.mp
  • (recreation* adj2 exercise).mp
  • (physical adj2 education).mp
  • (leisure adj2 activity).mp
  • (motor adj2 skill*).mp
  • or/
  • exp child
  • child*.mp
  • or/
  • (Psychosocial adj2 factors).mp
  • (social adj2 development).mp
  • (child adj2 development).mp
  • or/
  • randomized.ab
  • randomized controlled trial.pt
  • controlled clinical trial.pt
  • placebo.ab
  • randomly.ab
  • trial.ab
  • (clinical adj2 trial).mp
  • (randomi*ed adj2 controlled adj2 trial).mp
  • exp double-blind method
  • exp cohort studies
  • cohort*.mp
  • exp case-control studies
  • (case*control stud*).mp
  • (quasi-experimental stud*).mp
  • non-randomized controlled trials as topic

EMBASE

  • ‘Motor activity’/exp
  • (‘Physical activity’ next/2 childhood):ti,ab
  • (‘motor’ next/2 activity):ti,ab
  • ‘exercise’/exp
  • Exercise:ti,ab
  • physical exercise:ti,ab
  • aerobic exercise:ti,ab
  • ‘physical fitnes’/exp
  • (‘physical’ next/2 fitness):ti,ab
  • Sports:ti,ab
  • (‘recreation’ next/2 exercise):ti,ab
  • (‘physical’ next/2 education):ti,ab
  • (‘leisure’ next/2 activity):ti,ab
  • (‘motor’ next/2 skill):ti,ab
  • (‘motor’ next/2 skill $):ti,ab
  • ‘child’/exp
  • ‘child’:ti,ab
  • or/
  • (‘Psychosocial’ next/2 factors):ti,ab
  • (‘Social’ next/2 development):ti,ab
  • (‘Child’ next/2 development):ti,ab
  • Or
  • ‘randomized controlled trial’/exp
  • (randomi*ed NEXT/2 controlled NEXT/2 trial):ti,ab
  • ‘clinical trial’/exp
  • (clinical NEXT/2 trial):ti,ab
  • ‘double blind procedure’/exp
  • ‘cohort analysis’:ti,ab
  • ‘cohort analysis’/exp
  • ‘case control study’/exp
  • ‘case control study’:ti,ab
  • ‘quasi experimental study’/exp
  • ‘quasi experimental study’:ti,ab

CENTRAL (OVID)

  • Exp motor activity
  • (physical adj2 activity).mp
  • (motor adj2 activity).mp
  • exp exercise
  • exercise.mp
  • physical exercise.mp
  • aerobic exercise.mp
  • exp physical fitness
  • (physical adj2 fitness).mp
  • sports.mp
  • (recreation* adj2 exercise).mp
  • (physical adj2 education).mp
  • (leisure adj2 activity).mp
  • (motor adj2 skill*).mp
  • or/
  • exp child
  • child*.mp
  • or/
  • (Psychosocial adj2 factors).mp
  • (social adj2 development).mp
  • (child adj2 development).mp
  • or/
  • randomized.ab
  • randomized controlled trial.pt
  • controlled clinical trial.pt
  • placebo.ab
  • randomly.ab
  • trial.ab
  • (clinical adj2 trial).mp
  • (randomi*ed adj2 controlled adj2 trial).mp
  • exp double-blind method
  • exp cohort studies
  • cohort*.mp
  • exp case-control studies
  • (case*control stud*).mp
  • (quasi-experimental stud*).mp
  • non-randomized controlled trials as topic

If the inline PDF is not rendering correctly, you can download the PDF file here.

Hoyos-Quintero is with Universidad Santiago de Cali, Cali, Colombia. García-Perdomo is with the Department of Urology, Del Valle Universidad, Cali, Colombia; and UROGIV Research Group, Del Valle Universidad, Cali, Colombia.

Hoyos-Quintero (angela.hoyos@correounivalle.edu.co) is corresponding author.

Supplementary Materials

Journal of Physical Activity and Health
Article Sections
Figures
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    —Selection of the studies. TI indicates title, AB, abstract.

  • View in gallery

    —(A) Risk of bias for each of the clinical trials. (B) Risk of bias for each of the observational studies.

  • View in gallery

    —(A) Risk of bias among the clinical trials. (B) Risk of bias among the observational studies.

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