Background

To combat the high prevalence of physical inactivity among children, there is an urgent need to develop and implement real-world interventions and policies that promote physical activity (PA) and reduce sedentary behaviour (SB). To inform policy makers, the current body of evidence for children’s PA/SB interventions needs to be translated.

Objectives

The current systematic review and meta-analysis aimed to identify modifiable determinants of device-measured PA and SB targeted in available intervention studies with randomized controlled trial (RCT) and controlled trial (CT) designs in children and early adolescents (5–12 years) and to quantify the effects of the interventions within their respective settings on the determinants of PA/SB and the outcomes PA and SB.

Methods

A systematic search was conducted in MEDLINE, PsycINFO, Web of Science, SPORTDiscus and CENTRAL. Studies were considered if they were randomized controlled trials (RCTs) or controlled trials (CTs), included children and/or early adolescents (5–12 years; henceforth termed children), measured PA and/or SB using device-based methods and measured PA and/or SB and determinants of PA/SB at least at two timepoints. Risk of bias was assessed using the Cochrane Risk of Bias Tool for Randomised Trials (RoB2) for RCTs and Risk of Bias in Non-randomised Studies of Interventions (ROBINS-I) for CTs. The quality of the generated evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE). Robust Bayesian meta-analysis was conducted to quantify the effects of the interventions on the determinants of PA/SB, and the outcomes PA and SB, stratifying by study design, duration of PA/SB measurement, intervention setting and duration of follow-up measurement. Study characteristics and interventions were summarized.

Results

Thirty-eight studies were included with a total sample size of n = 14,258 (67% girls). Settings identified were school, family/home, community and combinations of these. The review identified 38 modifiable determinants, spanning seven categories on individual, interpersonal and physical environmental levels, with 66% of determinants on the individual level. Overall, the results indicated trivial-to-moderate effects of the interventions on the determinants of PA and SB, with mostly trivial level of evidence for the presence of an effect (as indicated by a small Bayes factor; BF₁₀ < 3.00). The exceptions were moderate effects on parental PA modelling in the family/home setting and SB measured during specific parts of the school day. Higher quality of evidence was found in the family/home setting compared with other settings.

Discussion

Overall, the results indicated that interventions have neither been effective in modifying the determinants of PA/SB, nor changing the PA/SB outcomes in children. In general, the approach in the current review revealed the breadth of methodological variability in children’s PA interventions. Research is needed to address novel approaches to children’s PA research and to identify potential determinants to inform policy and future interventions.

Registration

International prospective register of systematic reviews (PROSPERO): CRD42021282874.

中文翻译：

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DE-PASS 最佳证据声明 （BESt）：关于设备测量的身体活动和久坐行为及其决定因素试验对 5-12 岁儿童的有效性的系统评价和荟萃分析

 背景

为了应对儿童身体活动不足的高普遍性，迫切需要制定和实施促进身体活动 （PA） 和减少久坐行为 （SB） 的现实世界干预措施和政策。为了告知政策制定者，需要翻译当前儿童 PA/SB 干预的证据体系。

 目标

目前的系统评价和荟萃分析旨在确定针对儿童和早期青少年 （5-12 岁） 的随机对照试验 （RCT） 和对照试验 （CT） 设计的可用干预研究中针对设备测量的 PA 和 SB 的可改变决定因素，并量化各自环境中干预措施对 PA/SB 决定因素和 PA 和 SB 结果的影响。

 方法

在 MEDLINE 、 PsycINFO 、 Web of Science 、 SPORTDiscus 和 CENTRAL 中进行了系统检索。如果研究是随机对照试验 （RCT） 或对照试验 （CT），包括儿童和/或早期青少年（5-12 岁，以下简称儿童），使用基于设备的方法测量 PA 和/或 SB，并测量 PA 和/或 SB 以及 PA/SB 的决定因素，则至少在两个时间点。使用 Cochrane 随机试验偏倚风险工具 （RoB2） 评估 RCT 的偏倚风险，使用 CT 的非随机干预研究偏倚风险 （ROBINS-I） 评估偏倚风险。使用建议分级评估、开发和评价 （GRADE） 评估所生成证据的质量。进行稳健的贝叶斯荟萃分析，以量化干预措施对 PA/SB 决定因素以及 PA 和 SB 结局的影响，按研究设计、PA/SB 测量持续时间、干预设置和随访测量持续时间进行分层。总结了研究特征和干预措施。

 结果

纳入 38 项研究，总样本量为 n = 14,258 （67% 为女孩）。确定的设置是学校、家庭/家庭、社区和这些的组合。该审查确定了 38 个可修改的决定因素，涵盖个人、人际关系和物理环境水平的七个类别，其中 66% 的决定因素在个人层面。总体而言，结果表明干预措施对 PA 和 SB 的决定因素的影响微乎其微，存在效果的证据大多微乎其微（如小贝叶斯因子所示;BF₁₀ < 3.00）.例外情况是对家庭/家庭环境中父母 PA 建模的中等影响，以及在上学日的特定时段测量的 SB。与其他环境相比，在家庭/家庭环境中发现的证据质量更高。

 讨论

总体而言，结果表明，干预措施既不能有效改变 PA/SB 的决定因素，也不能改变儿童 PA/SB 的结局。总的来说，本综述中的方法揭示了儿童 PA 干预方法学差异的广度。需要进行研究以解决儿童 PA 研究的新方法，并确定潜在的决定因素，以便为政策和未来的干预措施提供信息。

 注册

国际前瞻性系统评价注册库 （PROSPERO）：CRD42021282874。