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 4 The relationship between physical activity and cognitive 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-4.94聽years; where mean age was not reported, baseline age ranged from 12聽months-5聽years. Data were collected by RCT, clustered RCT, non-randomized intervention, cross-over trial, and cross-sectional study designs. Cognitive development was assessed by psychomotor skills (objectively measured), time on task (direct observation), early literacy and language skills (objectively measured), creativity (direct observation; Thinking Creatively in Action and Movement test), attention (direct observation), attention span (proxy-report interview; proxy-report Child Temperament Questionnaire), literacy skills (self-report; Woodcock Johnson, Peabody Picture Vocabulary Test), math skills (self-report; Woodcock Johnson Applied Problems subscale), language development (objectively measured; Gessell Developmental Schedules 鈥� Development Quotient), free and cued word recall (objectively measured), cognitive function (objectively measured; Herbst Test), and sustained attention and response inhibition (objectively measured; Picture Deletion Task for Preschoolers).
2	RCT^a	Serious risk of bias^b	No serious inconsistency	No serious indirectness	No serious imprecision	None	454	The PA interventions (planned passive cycling or structured/organized PA) were favourably associated with improved cognitive development in 2 studies [90, 91].	MODERATE^c
1	Clustered RCT^d	No serious risk of bias	No serious inconsistency	No serious indirectness	No serious imprecision	None	125	The PA intervention (physical exercises to enact meanings of words) was favourably associated with improved cognitive development [110]. The PA intervention (physical exercises unrelated to words) was favourably associated with improved cognitive development (cued recall of words but not free recall of words) [110].	HIGH
4	Non-randomized intervention^e	Serious risk of bias^f	No serious inconsistency	No serious indirectness	No serious imprecision	None	460	The PA interventions (structured/organized PA, free play and structured PA, or academic MVPA lessons) were favourably associated with improved cognitive development (only in intervention sites that actively participated in the intervention in 1 study; for alliteration in 2/2 studies; and for rhyming and picture naming in 1/2 studies) in 4 studies [93, 111,112,113].	VERY LOW^g
3	Cross-over trial^h	Serious risk of biasⁱ	No serious inconsistency	No serious indirectness	No serious imprecision	None	182	The PA condition (structured/organized PA or MVPA breaks) was favourably associated with improved cognitive development (sustained attention but not response inhibition in 1 study) in 2 studies [114, 115]. Recess conditions were favourably associated with cognitive development in 1 study [116].	VERY LOW^j
3	Cross-sectional^k	Serious risk of bias^l	No serious inconsistency	No serious indirectness	No serious imprecision	None	3138	TPA was unfavourably associated with cognitive development in 1 study [101] and not associated with cognitive development in 1 study [109]. MVPA was not associated with cognitive development in 1 study [109]. Outdoor PA (at child care) was not associated with cognitive development in 1 study [58].	VERY LOW^m

MVPA: moderate- to vigorous-intensity physical activity; PA: physical activity; RCT: randomized controlled trial; TPA: total physical activity
^aIncludes 2 RCTs [90, 91]
^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 significantly changed physical activity in 2 studies [90, 91]
^cQuality of evidence was downgraded from 鈥渉igh鈥� to 鈥渕oderate鈥� because of serious risk of bias
^dIncludes 1 clustered RCT [110]
^eIncludes 4 non-randomized interventions [93, 111,112,113]
^fPhysical activity was not measured, so it is unknown if the intervention significantly changed physical activity in in 2 studies [93, 113]
^gQuality of evidence was downgraded from 鈥渓ow鈥� to 鈥渧ery low鈥� because of serious risk of bias
^hIncludes 3 cross-over trials [114,115,116]
ⁱCondition was not randomly assigned in 1 study [116]. Physical activity was not measured, so it is unknown if there were significant differences in physical activity between conditions in 2 studies [114, 116]. Unclear what conditions had significant differences in the outcome measure in 1 study [116]
^jQuality of evidence was downgraded from 鈥渓ow鈥� to 鈥渧ery low鈥� because of serious risk of bias
^kIncludes 3 cross-sectional studies [58, 101, 109]
^lConvenience sample was used in 1 study [101]. Physical activity was measured only during child care in 2 studies [58, 109]. No potential confounders were adjusted for in 2 adjusted studies [101, 109]. No psychometric properties reported for the subjective physical activity measure or the outcome measure in 1 study [101]
^mQuality of evidence was downgraded from 鈥渓ow鈥� to 鈥渧ery low鈥� because of serious risk of bias

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