Interventions to increase physical activity in children 0–5 years old: a systematic review, meta-analysis and realist synthesis

Abstract

Objective: The objective of the study is to evaluate the effectiveness of interventions to increase physical activity (PA) in 0–5 year olds and to determine what works, for whom, in what circumstances. Design: Systematic review, meta-analysis and realist synthesis. Data sources: Embase and EBSCOhost (Academic Search Complete, CINAHL Complete, Global Health, MEDLINE Complete, PsycINFO, SPORTDiscus with full text), up to and including April 2017. Eligibility criteria: Published in a peer-reviewed English language journal; randomized or controlled trial design; aimed to increase children's PA levels; reported on objectively assessed PA in children between 0 and 5.9 years at baseline and post-intervention. Results: Thirty-four studies were included in the review, mostly conducted in the preschool/childcare setting. Meta-analyses showed an overall non-significant (Z = 0.04, p = 0.97) mean difference of 0.03 (95% CI = −1.57, 1.63) minutes/day for light-intensity PA (n = 11). The overall mean difference for moderate-intensity to vigorous-intensity PA (n = 21) was 2.88 (95% CI = 1.54, 4.23) minutes/day, indicating a small but significant overall positive effect (Z = 4.20, p < 0.001). The realist synthesis provided insights into the key contexts and mechanisms that appeared to be effective at changing children's PA. Conclusion: Based on a quantitative and qualitative examination of the evidence, this review provides specific recommendations for effective early childhood PA interventions for practitioners and policymakers.