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

Carson, Valerie; Lee, Eun-Young; Hewitt, Lyndel; Jennings, Cally; Hunter, Stephen; Kuzik, Nicholas; Stearns, Jodie A.; Unrau, Stephanie Powley; Poitras, Veronica J.; Gray, Casey; Adamo, Kristi B.; Janssen, Ian; Okely, Anthony D.; Spence, John C.; Timmons, Brian W.; Sampson, Margaret; Tremblay, Mark S.

doi:10.1186/s12889-017-4860-0

Table 2 The relationship between physical activity and motor development

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

# of studies	Design	Quality assessment					# of participants	Absolute effect	Quality
# of studies	Design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other	# of participants	Absolute effect	Quality
Mean baseline age ranged from 18.3聽weeks-59.79聽months; where mean age was not reported, baseline age ranged from 0聽months-5聽years. Data were collected by RCT, clustered RCT, non-randomized intervention, longitudinal with up to 20-month follow-up, and cross-sectional study designs. Motor development was assessed by fundamental movement skills/motor ability/motor performance/motor development/motor skills/gross-motor development/psychomotor skills (objectively measured; Test of Gross Motor Development 鈥� 2, movement assessment battery, Movement Assessment Battery for Children 鈥� 2, APM-Inventory, Dutch Second Edition of the Bayley Scales of Infant and Toddler 鈥� 3, Motoriktestf眉rvier-bissechsj盲hrige Kinder 4-6; 12-m run, standing long jump, Motor Test Battery 3-7, Alberta Infant Motor Scales, neurological examination technique for toddler-age, Children鈥檚 Activity and Movement in Preschool Study Motor Skill Protocol, Comprehensive Developmental Inventory for Infants and Toddlers, Gessel Development Schedules 鈥� Development Quotient, adapted measures from the Zurich Neuromotor Assessment test), achievement of developmental milestones (proxy-report questionnaire), coordination (proxy-report questionnaire), and fine motor coordination/fine motor development (proxy-report interview; Comprehensive Developmental Inventory for Infants and Toddlers).
4	RCT^a	Serious risk of bias^b	No serious inconsistency	Serious indirectness^c	No serious imprecision	None	705	The PA interventions (planned passive cycling or structured/organized PA) were favourably associated with improved motor development in 3 studies [90,91,92]. The PA intervention (PA recommendations from nurse) was not associated with improved motor development in 1 study [40].	LOW^d
2	Clustered RCT^e	Serious risk of bias^f	No serious inconsistency	Serious indirectness^g	No serious imprecision	None	1564	The PA intervention (structured/organized PA) was favourably associated with improved motor development (total score and jumping individual score but not for running, hopping, catching, and kicking) in 1 study [33]. The PA intervention (government-led PA program) was not associated with motor development in 1 study [41].	LOW^h
6	Non-randomized interventionⁱ	Serious risk of bias^j	No serious inconsistency	No serious indirectness	No serious imprecision	None	946	The PA interventions (free play and structured activities, structured/organized PA, dance, or swimming) were favourably associated with improved motor development (boys only and running speed between time 2 and 3 only in 1 study; one-leg balance only in 1 study) in 6 studies [36, 42, 93,94,95,96].	VERY LOW^k
1	Longitudinal^l	Serious risk of bias^m	No serious inconsistency	No serious indirectness	No serious imprecision	None	197	Prone position was favourably associated with motor development (higher prone duration and gross motor development only at age 6 mo but not at age 24 mo and prone-specific milestones only) [97].	VERY LOWⁿ
10	Cross-sectional^o	Serious risk of bias^p	No serious inconsistency	No serious indirectness	No serious imprecision	Exposure/outcome gradient^q	1833	TPA was favourably associated with motor development (correlations but not when comparing quartiles of fundamental movement skills in 1 study) in 3 studies [56, 69, 100], unfavourably associated with motor development (running speed only in 1 study) in 2 studies [81, 101], and not associated with motor development in 1 study [86]. LPA was not associated with motor development in 3 studies [67, 86, 100]. LPA 5-min bouts were not associated with motor development in 1 study [86]. MVPA was favourably associated with motor development (total and locomotor [high vs. low only] but not for object control skills in 1 study) in 3 studies [67, 69, 100] and not associated with motor development in 1 study [86]. MVPA 5-min bouts were not associated with motor development in 1 study [86]. VPA was favourably associated with motor development (total and locomotor [high vs. low only] but not for object control skills) in 1 study [67]. Indoor PA was favourably associated with motor development (throwing at target only) in 1 study [81]. Outdoor PA was not associated with motor development in 1 study [81]. Prone position was favourably associated with motor development (gross motor development but not fine motor development in 1 study) in 3 studies [97,98,99].	VERY LOW^r

LPA: light-intensity physical activity; MVPA: moderate- to vigorous-intensity physical activity; PA: physical activity; RCT: randomized controlled trial; TPA: total physical activity; VPA: vigorous-intensity physical activity
^aIncludes 4 RCTs [40, 90,91,92]
^bNo intention-to-treat analysis; parent-child dyads were excluded if they did not carry out the management plan or if they became sick during the study; and the physical activity program was interrupted in 1 study [90]. Physical activity was not measured, so it is unknown if the intervention resulted in a significant change in physical activity in 3 studies [90,91,92]
^cThe intervention did not result in a significant change in physical activity in 1 study [40]
^dQuality of evidence was downgraded from 鈥渉igh鈥� to 鈥渓ow鈥� because of serious risk of bias and serious indirectness
^eIncludes 2 clustered RCTs [33, 41]
^fLarge amount of missing data primarily because mean attendance at child care was 48%, and it is unknown if the reason for poor attendance was related to the motor development in 1 study [41]
^gThe intervention did not result in a significant change in physical activity in 1 study [41]
^hQuality of evidence was downgraded from 鈥渉igh鈥� to 鈥渓ow鈥� because of serious risk of bias and serious indirectness
ⁱIncludes 6 non-randomized interventions [36, 42, 93,94,95,96]
^jThe outcome was measured post-intervention only in 2 studies [93, 96]. No control group in 1 study [42]. Physical activity was not measured so it is unknown if the intervention resulted in a significant change in physical activity in 6 studies [36, 42, 93,94,95,96]
^kQuality of evidence was downgraded from 鈥渓ow鈥� to 鈥渧ery low鈥� because of serious risk of bias
^lIncludes 1 longitudinal study [97]
^mPsychometric properties unknown for the subjective physical activity measures
ⁿQuality of evidence was downgraded from 鈥渓ow鈥� to 鈥渧ery low鈥� because of serious risk of bias
^oIncludes 10 cross-sectional studies [56, 67, 69, 81, 86, 97,98,99,100,101]
^pConvenience sample was used in 6 studies [56, 67, 69, 86, 99, 101]. Psychometric properties unknown for the subjective physical activity measure in 5 studies [56, 97,98,99, 101], and the outcome measure in 2 studies [69, 101]. Potential confounders were not adjusted for in 7 studies [67, 69, 81, 86, 98, 100, 101]. Large amount of missing motor development data in 1 study [67]
^qA gradient for higher MVPA and VPA with better motor development was observed in 2 studies [67, 100]
^rQuality of evidence was downgraded from 鈥渓ow鈥� to 鈥渧ery low鈥� because of serious risk of bias; because of this limitation, was not upgraded for an exposure/outcome gradient

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