Abstract
BackgroundLow levels of physical activity (PA) and high levels of sedentary behaviour (SB) have been observed in young people. Both behaviours are detrimental for health with patterns tending to continue into adulthood. There is sustained value in establishing health habits in early years. Even though levels of SB and participation in PA differ among boys and girls, and the effectiveness of interventions to promote PA and/or prevent sedentary behaviours varies by sex/gender to date, sex/gender in systematic reviews is not yet widely considered. Additionally, while tools have been proposed, there is no consensus on the criteria to assess sex/gender in systematic reviews in the context of health promotion. The main objectives of this systematic review are to evaluate the effects of interventions on girls’ and boys’ PA and SB and to appraise the extent to which the studies have taken sex/gender into account.MethodsEleven electronic databases will be searched to identify all relevant (randomized) controlled trials. Two independent reviewers will screen studies, extract data and appraise the quality of studies. The main outcome of the studies will be a quantified measure of PA and/or SB. Risk of bias of individual studies will be assessed using the Cochrane Risk of Bias Tool for RCTs. Meta-analyses will be conducted when possible among studies with sufficient homogeneity. To evaluate sex/gender considerations in primary studies, we will use a sex/gender checklist that builds on existing tools and was developed during a 2-day, iterative process among a multidisciplinary panel of 16 experts. The GRADE framework will be used to evaluate evidence across studies for each main efficacy outcome.DiscussionTo our knowledge, our systematic review will be the first to analyse how sex/gender is considered in interventions promoting PA and/or reducing SB in children and adolescents in detail. The review will provide information on how sex/gender aspects have been considered in recent research and the extent to which sex/gender might impact study outcomes. Our findings will be of interest to stakeholders, health promoters, researchers and policy makers who wish to support more equal outcomes from interventions promoting PA and/or reducing SB.Trial registrationPROSPERO CRD42018109528.
Highlights
Low levels of physical activity (PA) and high levels of sedentary behaviour (SB) have been observed in young people
The subject strategies for databases will be based on the MEDLINE search strategy (Appendix), which will combine Medical Subject Heading (MeSH) terms and keywords related to physical activity and sedentary behaviour
To our knowledge our systematic review will be the first to systematically assess how sex/gender is considered in interventions promoting PA and/or reducing SB in children and adolescents
Summary
This systematic review protocol is registered in the PROSPERO international prospective register of systematic reviews (registration number: CRD42018109528). The current version of the sex/gender checklist consists of 16 items in the following categories: background and concepts, study design, intervention planning and delivery, statistical accounting and presentation and interpretation of findings These items are rated using three categories by item-specific definitions and provide information on the extent to which the primary study took sex/gender into account regarding the respective item. We will address the possible effect of publication bias using a fail-safe number, e.g. the number of non-published studies that would reverse the significant meta-analysis result into a non-significant one If this fail-safe number is reasonable, that is, not too large, the Copas selection model may be used for a sensitivity analysis along with the Henmi-Copas confidence interval approach [44].
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