Abstract
Accumulating evidence suggests that, independent of physical activity levels, sedentary behaviours are associated with increased risk of cardio-metabolic disease, all-cause mortality, and a variety of physiological and psychological problems. Therefore, the purpose of this systematic review is to determine the relationship between sedentary behaviour and health indicators in school-aged children and youth aged 5-17 years. Online databases (MEDLINE, EMBASE and PsycINFO), personal libraries and government documents were searched for relevant studies examining time spent engaging in sedentary behaviours and six specific health indicators (body composition, fitness, metabolic syndrome and cardiovascular disease, self-esteem, pro-social behaviour and academic achievement). 232 studies including 983,840 participants met inclusion criteria and were included in the review. Television (TV) watching was the most common measure of sedentary behaviour and body composition was the most common outcome measure. Qualitative analysis of all studies revealed a dose-response relation between increased sedentary behaviour and unfavourable health outcomes. Watching TV for more than 2 hours per day was associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement. Meta-analysis was completed for randomized controlled studies that aimed to reduce sedentary time and reported change in body mass index (BMI) as their primary outcome. In this regard, a meta-analysis revealed an overall significant effect of -0.81 (95% CI of -1.44 to -0.17, p = 0.01) indicating an overall decrease in mean BMI associated with the interventions. There is a large body of evidence from all study designs which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5-17 years. In particular, the evidence suggests that daily TV viewing in excess of 2 hours is associated with reduced physical and psychosocial health, and that lowering sedentary time leads to reductions in BMI.
Highlights
Engaging in regular physical activity is widely accepted as an effective preventative measure for a variety of health risk factors across all age, gender, ethnic and socioeconomic subgroups [1,2,3,4,5,6]
Reasons for excluding studies included: ineligible population (n = 161), ineligible exposure (n = 145), ineligible measure of sedentary behaviour (n = 19), ineligible outcome (n = 60), ineligible analysis (n = 60), and ‘other’ (n = 216)
This review demonstrates that there is a need to advocate for increases in physical activity AND decreases in sedentary behaviour
Summary
Engaging in regular physical activity is widely accepted as an effective preventative measure for a variety of health risk factors across all age, gender, ethnic and socioeconomic subgroups [1,2,3,4,5,6]. Across all age groups, levels of physical activity remain low [7,8,9,10,11,12] and obesity rates continue to rise [10,11,13,14]; collectively threatening the persistent increase in life expectancy This inactivity crisis is especially important in the pediatric population as recent data from the Canadian Health Measures Survey [8] suggest that only 7% of children and youth aged 6-19 years participate in at least 60 minutes of moderate- to vigorous-intensity physical activity per day, meeting the current physical activity guidelines from Canada [16], the U.S [6], the U.K [17], Australia [18] and the World Health Organization (WHO) [5]. To date, public health efforts have focused primarily on physical activity and have paid little attention to the mounting evidence to support sedentary behaviour as a distinct behaviour related to poor health
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