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A systematic review of compositional analysis studies examining the associations between sleep, sedentary behaviour, and physical activity with health indicators in early childhood

A systematic review of compositional analysis studies examining the associations between sleep,... Background: This systematic review examined if the composition of time spent in sleep, sedentary behaviour, and physical activity of different intensities is associated with health and developmental indicators in children aged 0–5 years. Methods: Four electronic databases (MEDLINE, EMBASE, PsycINFO, and SPORTDiscus) were searched in January 2022. Studies were eligible for inclusion if they were peer‑reviewed, the average age of participants was < 6 years, and com‑ positional data analysis was used to examine the associations between the composition of time spent in movement behaviours and health and developmental indicators. Results: Eight studies (7 cross‑sectional, 1 prospective cohort) of < 2070 unique participants were included. Only a single study included children < 3 years old and 37% of the associations examined in the literature were based on indicators of body composition. The 24‑h movement behaviour composition was associated with mental health indicators (3 of 4 associations examined in the literature), motor skills and development (6 of 7 associations), and physical fitness (3 of 3 associations). Reallocating time from light physical activity into moderate ‑to ‑ vigorous physical activity was favourable for motor skills and development. Reallocating time from light physical activity into sleep was unfavourable for mental health. Reallocating time from light physical activity into sedentary behaviour or sleep was favourable for motor skills and development. Conclusions: This review provides some evidence that the composition of movement behaviours is important for the health of young children. Future research should consider including infants and toddlers, larger sample size, and measures of health and development other than body composition. (PROSPERO registration no.: CRD42022298370.) Keywords: Physical activity, Sedentary behaviour, Sleep, Young children, Time‑use data Background Early childhood is a critical period for physical, emo- tional, and social development [1], as well as adopting *Correspondence: ian.janssen@queensu.ca healthy movement behaviours including sleep, seden- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON, tary behaviour (SED), and physical activity (PA) [1–3]. Canada Systematic reviews examining movement behaviours Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Zahran et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 2 of 11 in isolation concluded that adequate levels of sleep, Methods high levels of PA, and low levels of SED benefit several Protocol and registration aspects of physical, cognitive, and social-emotional This systematic review is registered with the Inter - health and development in children 5  years old or national Prospective Register of Systematic Reviews younger [3–5]. Furthermore, some evidence indicates (PROSPERO registration no. CRD42022298370). It that combinations of movement behaviours influence was conducted per the Preferred Reporting Items for health and developmental indicators in young children Systematic Reviews and Meta-Analyses (PRISMA) [6]. Specifically, a combination of adequate sleep, high statement for reporting systematic reviews and meta- PA, and low SED is favourably associated with motor analyses [14]. development and physical fitness [6]. Most previous studies examining the health effects Eligibility criteria of combinations of movement behaviours used non- To assist the search process and identify key study con- compositional movement behaviour exposure vari- cepts a priori, the Participants, Intervention/Exposure, ables, such as the absolute time spend in sleep, PA, and Comparisons, Outcomes, Study design (PICOS) frame- SED [6]. Movement behaviours should not be treated work was used [15]. as non-compositional variables because they are co- dependent variables that form a composition that makes a finite 24-h day [8]. Therefore, changing time Population in any movement behaviour must result in an equal The population of interest was children of the early but opposite change in time spent in one or more of years including infants, toddlers, and preschoolers. the remaining movement behaviours [8]. For example, Studies were only included if the average age of partici- increasing sleep by 30 min per day will lead to a 30 min pants was < 6 years . decrease in some combination of SED and PA. Compositional data analysis (CoDA) statistical tech- Intervention/exposure niques are suitable for data that are codependent and The exposure of interest was the composition of time compositional, such as the combined time spent in spent in sleep, SED, and PA of different intensities (e.g., sleep, SED, and PA across the 24-h day [8, 9]. Recent light physical activity (LPA) and moderate-to-vigorous research that used CoDA suggests that the composi- physical activity (MVPA)). These movement behaviours tion of movement behaviours may influence health were based on the measures and definitions used by the at all ages [10–13]. A systematic review published in authors of the different studies. In general, a cut-point 2020 that examined the association between 24-h of < 1.5 metabolic equivalents (METs) during waking movement behaviours and health indicators across hours defined SED, a range of 1.5–2.99 METs defined the lifespan only included two studies that examined LPA, and a cut-point of ≥ 3.0 METs defined MVPA [16]. children of the early years [13]. CoDA is a new form Only studies that used a CoDA statistical approach and of statistical analysis within the movement behaviour had at least one measure of sleep, one measure of SED, literature, with an exponential increase in the number and one measure of PA were included. No limits were of published studies in recent years [13]. Therefore, an placed on the methods used to assess the movement updated and focused comprehensive review of CoDA behaviours (e.g., device-based or parental-report), the studies examining the association between movement follow-up length in longitudinal studies, or the inter- behaviours and health indicators in young children is vention length in intervention studies. warranted. The purpose of this paper was to conduct a system- atic review that considered whether the composition Comparator/control of time spent in sleep, SED, and PA of different intensi- The comparator was different levels and compositions ties is associated with health and developmental indi- of time spent in sleep, SED, and PA of different intensi - cators in children of the early years. The review also ties. In addition, changes to the composition of move- considered whether changes in the movement behav- ment behaviours were considered, including changes iour composition (e.g., compositional isotemporal observed in an intervention setting and changes esti- substitutions) is associated with changes in health and mated from observational data (i.e., compositional developmental indicators. isotemporal substitutions). Zahr an et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 3 of 11 Outcome(s) Findings were considered statistically significant at All health and developmental indicators were included p < 0.05. in this review. Risk of bias assessment A modified version of the Downs and Black checklist was Study designs used to assess the risk of bias [17]. This checklist has 27 All quantitative study designs were eligible except for items that assess the strength of reporting, external valid- reviews, meta-analyses, and case studies. ity, internal validity (bias and confounding), and power. Since none of the eligible studies for our review were interventions, we removed 10 checklist items that are Information sources and search strategy not relevant for observational studies (items 8, 13, 14, 16, A research librarian with expertise in systematic 19, 21–24, and 26). We also modified 6 items (items 4, 5, review searching created the electronic search strat- 9, 10, 12, and 15) and added 1 item to better align with egy. The following databases were searched: MEDLINE, observational studies designs. The added item assessed EMBASE, PsycINFO (all using the Ovid platform), and the methods used to measure the movement behaviours SPORTDiscus  (EbscoHost). Searches were conducted (e.g., device-based or parental-report). Each item was on January 1, 2022, and dated back to 2015, as that is assigned a score of 1 if the article met the quality crite- when the first study on the relationship between the ria, or a score of 0 if it did not. A maximum of 18 points 24-h movement-behaviour composition and health was for prospective studies and 17 points for cross-sectional published [10]. Studies were eligible for inclusion if studies could be achieved. In addition, overall study they were published in English and peer reviewed. Grey quality levels were assigned based on the total number literature (e.g., book chapters, dissertations, conference of points as follows: excellent (16–18), good (13–15), abstracts) was excluded. An example search strategy fair (10–12), or poor (≤ 9) [13, 18, 19]. For more details based on Ovid MEDLINE is in the Additional file 1 . on these modifications and the scoring system, see the Additional file  1: Table S1. Risk of bias assessments were duplicated by 2 reviewers and any disagreements were Study selection resolved by a third. To remove duplicate records and facilitate screening, bibliographic records were imported into Covidence Synthesis of results software (Veritas Health Innovation, Melbourne, Aus- When CoDA is used to analyze the association between tralia). In level 1 screening, titles and abstracts were movement behaviours with health indicators, up to screened by two reviewers. Records that were not 17 parameters are generated for each indicator exam- screened out by both reviewers proceeded to level 2 ined. These parameters include: (1) a result that reflects screening. In level 2, full-text articles were obtained and whether the 24-h movement behaviour composition examined by two 2 reviewers. Any discrepancies about as a whole is associated with the health indicator; (2) 4 final inclusion were resolved by discussion between results that reflect whether the relative time spent in each the two reviewers. In some cases, a third reviewer was of MVPA, LPA, SED, and sleep are associated with the included to resolve disputes or address uncertainties. health indicator; and (3) 12 results that reflect whether different time reallocations are associated with changes in the health indicator (e.g., reallocating time from Data extraction MVPA to LPA, reallocating time from MVPA to SED, A customized Microsoft Excel spreadsheet was used reallocating time from MVPA to sleep, etc.). during data extraction. Data extraction was completed To simplify and standardize the presentation of find - by one reviewer and checked for accuracy by another. ings for all health and developmental indicators across Information was extracted about the study and sam- all studies, we used the approach previously described in ple characteristics, intervention/exposure, health and a systematic review of CoDA studies examining move- developmental indicator(s), results (including whether ment behaviours and health indicators in adults [20]. these differed by sex/gender, race/ethnicity, and socio - Specifically, the results of each of the up to 17 individual economic status), and confounding variables controlled parameters of interest for each health and developmen- for in statistical models. Reviewers were not blinded to tal indicator for each study were presented as an upward the authors or journals when extracting data. Results arrow (↑), a sideways arrow (↔), or a downward arrow were extracted from the most fully adjusted models for (↓) in a summary table. For results based on the 24-h studies that reported findings from multiple models. movement behaviour composition, ↑ denoted a result Zahran et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 4 of 11 that was statistically significant while ↔ denoted a result that was not statistically significant. For results based on the relative contributions of each movement inten- sity, and results for the time substitutions, ↑ denoted the presence of a result that was statistically significant and favourable for health (e.g., relative time spent in MVPA was associated with a lower BMI), ↔ denoted the pres- ence of a result that was not statistically significant (e.g., relative time spent in sleep was not associated with BMI), and ↓ denoted the presence of a result that was statisti- cally significant and unfavourable for health (e.g., relative time spent in SED was associated with a higher BMI). The ↑/ ↔ /↓ rating system was also used to summarize the overall pattern of results for each health and devel- opmental indicator across all 8 studies. This process started by applying scores of 1, 0, and − 1 to the ↑, ↔, and ↓ ratings from the individual studies. These scores were summed and divided by the total number of ratings. For Fig. 1 PRISMA flow diagram results based on the 24-h movement behaviour compo- sition, the potential range for the final calculated value was 0 to 1. The overall pattern was rated ↑ when the final convenience sample of 95 participants [24] to a nationally value was ≥ 0.66 or  ↔ when the final value was ≤ 0.65. representative sample of 552 [28]. All but one study was For the results based on the relative contributions of each limited to participants aged 3 or older. Data across stud- movement behaviour and the time substitutions, the ies involved a total of < 2070 unique participants; there potential range for the final calculated value was − 1 to 1. was an overlap of participants in two studies [21, 23]. The overall pattern was rated ↑ when the final value was All studies used an observational design; 7 were cross- 0.33 or higher, ↔ when the final value was between − 0.32 sectional studies [21–25, 27, 28] and one was a prospec- and 0.32, or ↓ when the final value was − 0.33 or lower. tive cohort study that included both cross-sectional and Meta-analyses were planned for the time substitution longitudinal analyses [26]. SED, LPA, and MVPA were findings if enough studies used comparable time real - measured using either an Actical or ActiGraph accel- location estimation approaches on the same indicators. erometer. Six studies used a parental-report measure However, there were too few studies for any given health to estimate sleep duration [21–23, 25, 27, 28] while two indicators and considerable heterogeneity in time real- used a device-based measure [24, 26]. location approaches that deterred us from conducting Of the 8 studies, four examined the movement behav- meta-analysis. iour composition in relation to body composition meas- ures including the body mass index, waist circumference, Results skinfold thickness, fat mass or % fat, and fat-free mass. Description of studies One study assessed associations between the movement The PRISMA diagram is in Fig.  1. A total of 717 studies behaviour composition and measures of physical fit - were identified through the database searches (MED - ness including cardiorespiratory fitness, speed-agility, LINE, n = 243; EMBASE, n = 229; CINAHL, n = 194; and lower-body muscular strength. One study examined SPORTDiscus, n = 51). After duplicates were removed, measures of bone health. Two studies examined men- there were 469 unique studies. After titles and abstracts tal health (e.g., executive function, response inhibition, were screened in level 1, 22 full-text articles were working memory, and vocabulary). Finally, motor devel- obtained for level 2 screening. Eight studies passed level opment and sleep health were each assessed in a single 2 screening and were included in the systematic review study. [21–28]. The top two reasons for excluding studies dur - Results were not presented for all of the parameters of ing level 2 screening were that studies did not examine interest in many of the studies. Five studies did not report the association between the movement composition with whether relative time spent in each movement behaviour a health and/or developmental indicator (n = 4), and an was associated with health and developmental indicators average age > 5 years (n = 4). [21–23, 25, 27], 1 study did not report findings for any The characteristics of the 8 studies included in the time substitutions [28], and 2 studies reported the results review are in Table  1. The samples ranged from a small Zahr an et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 5 of 11 Table 1 Description of studies included in the systematic review Authors Participant characteristics Study MVPA LPA SED Sleep Health and (year) design developmental Country Sample size Age (y) indicators Carson et al. Canada 552 3–4 Cross‑sec‑ 5 d Actical 5 d Actical 5 d Actical Parent‑ waist circumfer‑ (2017) tional reported ence, BMI Taylor et al. New Zealand 380 1–5 Cross‑ 5–7 d Actical 5–7 d Actical 5–7 d Actical 5–7 d Actical BMI, bone (2018) sectional and and parent‑ mineral content, prospective reported bone mineral density Bezerra et al. Brazil 123 3–5 Cross‑sec‑ 7 d Actigraph 7 d Actigraph 7 d Actigraph Parent‑ executive func‑ (2020) tional reported tion Kuzik et al. Canada 95 3–5 Cross‑sec‑ 7 d Actigraph 7 d Actigraph 7 d Actigraph 7 d Actigraph BMI, motor (2020) tional skills, response inhibition, work‑ ing memory, vocabulary, self‑regulation, prosocial behav‑ iour Lemos et al. Brazil 270 3–5 Cross‑sec‑ 7 d Actigraph 7 d Actigraph 7 d Actigraph Parent‑ cardiorespiratory (2021) tional reported fitness, speed‑ agility, lower‑ body strength McGee et al. Canada 158 5.5 Cross‑sec‑ 7 d Actical 7 d Actical 7 d Actical Parent‑ BMI, obesity (2019) tional reported skinfold thick‑ ness, body fat, fat‑free mass Mota et al. Brazil 204 3–5 Cross‑sec‑ 7 d Actigraph 7 d Actigraph 7 d Actigraph Parent‑ motor skills and (2020) tional reported development St.Laurent United States 288 2.8–5.9 Cross‑sec‑ 7 d Actigraph Actigraph 7 d 7 d Actigraph Parent‑ sleep efficiency, et al. (2020) tional reported nap frequency, sleep distur‑ bances, bedtime resistance BMI body mass index, LPA light physical activity, MVPA moderate-to-vigorous physical activity, SED sedentary time for some time substitutions but not others [22, 24]. Of Table S4 contain the results for each of the time substitu- the 7 studies that showed results for time substitutions, 3 tions, which reflect the estimated changes in the health used the method explained by Dumuid et al. in 2019 [24, indicators that would occur if equivalent time was reallo- 26, 27, 29], 2 used the method explained by Chastin et al. cated from one intensity of movement into another (e.g., in 2015 [10, 21, 22], and 2 used both of these methods decreasing SED by 30 min per day while increasing sleep [23, 25]. by 30 min per day). Risk of bias and quality assessment Movement behaviour composition The risk of bias assessment scores for each Downs and A summary of the associations between the 24-h move- Black checklist item and an overall quality score for each ment behaviour composition and health and develop- study are presented in Additional file  1: Table  S1. The mental indicators is provided in Tables 2 and 3. The 24-h total checklist score of the prospective cohort study was movement behaviour composition was significantly asso - 13.5/18 and it was rated as good quality. The total check - ciated with body composition in only 1 of 20 associations list scores of the 7 cross-sectional studies ranged from examined in the literature. None of the associations for 11.5/17 to 12.5/17 and they were all rated as fair quality. indicators of social-emotional development (0 of 7) or bone health (0 of 8) were significant. For sleep health, 2 of Data synthesis 4 associations were significant. Most of or all associations The associations between the 24-h movement behav - for the 24-h movement behaviour composition were sig- iour composition with specific health and developmen - nificant for indicators of mental health (3 of 4), motor tal indicators from the 8 individual studies are shown in skills and development (6 of 7), and physical fitness (3 of Additional file  1: Table S2. Additional file  1: Table S3 and 3). Zahran et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 6 of 11 Table 2 Summary of results for each health and developmental indicator Movement behaviour component Health and development indicator Body composition Mental health Motor skills and Social‑ Fitness Sleep development emotional development Composition 24‑h composition ↑(1) ↔ (19) ↑(3) ↔ (1) ↑(6) ↔ (1) ↑(0) ↔ (7) ↑(3) ↔ (0) ↑(2) ↔ (2) Relative time in MVPA ↑(0) ↔ (19) ↑(0) ↔ (3) ↑(3) ↔ (1) ↑(1) ↔ (6) Relative time in LPA ↑(2) ↔ (16) ↓(1) ↑(0) ↔ (3) ↑(0) ↔ (2) ↓(2) ↑(0) ↔ (7) Relative time in SED ↑(2) ↔ (17) ↑(2) ↔ (1) ↑(0) ↔ (4) ↑(0) ↔ (7) Relative time in sleep ↑(1) ↔ (17) ↓(1) ↑(0) ↔ (3) ↑(0) ↔ (4) ↑(0) ↔ (7) Time reallocation MVPA to LPA ↑(0) ↔ (7) ↓(0) ↑(1) ↔ (1) ↓(0) ↑(0) ↔ (3) ↓(3) ↑(0) ↔ (1) ↓(2) ↑(0) ↔ (9) ↓(0) ↑(0) ↔ (4) ↓(0) LPA to MVPA ↑(0) ↔ (7) ↓(0) ↑(0) ↔ (2) ↓(0) ↑(3) ↔ (3) ↓(0) ↑(1) ↔ (2) ↓(0) ↑(0) ↔ (9) ↓(0) ↑(0) ↔ (4) ↓(0) MVPA to SED ↑(0) ↔ (6) ↓(1) ↑(0) ↔ (2) ↓(0) ↑(0) ↔ (5) ↓(1) ↑(0) ↔ (2) ↓(1) ↑(1) ↔ (2) ↓(1) SED to MVPA ↑(1) ↔ (6) ↓(0) ↑(0) ↔ (2) ↓(0) ↑(0) ↔ (6) ↓(0) ↑(1) ↔ (2) ↓(0) ↑(3) ↔ (6) ↓(0) ↑(1) ↔ (2) ↓(1) MVPA to sleep ↑(0) ↔ (7) ↓(0) ↑(1) ↔ (1) ↓(0) ↑(0) ↔ (6) ↓(0) ↑(0) ↔ (2) ↓(1) ↑(0) ↔ (4) ↓(0) Sleep to MVPA ↑(0) ↔ (7) ↓(0) ↑(0) ↔ (1) ↓(1) ↑(0) ↔ (6) ↓(0) ↑(1) ↔ (2) ↓(0) ↑(3) ↔ (6) ↓(0) ↑(0) ↔ (4) ↓(0) LPA to SED ↑(0) ↔ (6) ↓(1) ↑(0) ↔ (2) ↓(0) ↑(4) ↔ (2) ↓(0) ↑(0) ↔ (3) ↓(0) ↑(0) ↔ (4) ↓(0) SED to LPA ↑(1) ↔ (6) ↓(0) ↑(0) ↔ (1) ↓(1) ↑(0) ↔ (2) ↓(4) ↑(0) ↔ (3) ↓(0) ↑(0) ↔ (9) ↓(0) ↑(0) ↔ (4) ↓(0) LPA to sleep ↑(1) ↔ (7) ↓(1) ↑(0) ↔ (0) ↓(1) ↑(4) ↔ (2) ↓(0) ↑(1) ↔ (1) ↓(2) Sleep to LPA ↑(0) ↔ (7) ↓(0) ↑(0) ↔ (1) ↓(0) ↑(0) ↔ (2) ↓(4) ↑(2) ↔ (4) ↓(3) ↑(2) ↔ (1) ↓(1) SED to sleep ↑(0) ↔ (7) ↓(0) ↑(0) ↔ (1) ↓(1) ↑(0) ↔ (2) ↓(4) ↑(0) ↔ (3) ↓(0) ↑(1) ↔ (1) ↓(2) Sleep to SED ↑(0) ↔ (7) ↓(0) ↑(1) ↔ (1) ↓(0) ↑(4) ↔ (2) ↓(0) ↑(0) ↔ (3) ↓(0) ↑(2) ↔ (1) ↓(1) LPA light physical activity, MVPA modertate-to-vigorous physical activity, SED sedentary time ↑ For the 24-h movement behaviour composition, this symbol indicates a statistically significant association. For the co-dependent associations for relative time spent in MVPA, LPA, SED, and sleep this symbol indicates a favourable association that was statistically significant. ↓ For the co-dependent associations for relative time spent in MVPA, LPA, SED, and sleep this symbol indicates an unfavourable association that was statistically significant. ↔ For the 24-h movement behaviour composition, this symbol indicates a null (non-significant) association. For the co-dependent associations for relative time spent in MVPA, LPA, SED, and sleep this symbol indicates a null (non-significant) association Moderate‑tovigor ‑ ous physical activity Table 3 Summary of results of each health and developmental indicator Relative time spent in MVPA was favourably associ- ated with indicators of motor skills and development (3 Component Health and developmental indicator of 4 associations) and bone health (6 of 8 associations) Body composition Bone health (Tables  2 and 3). However, relative time in MVPA was rarely or never significantly associated with indicators of Composition ↑(1) ↔ (19) ↑(0) ↔ (8) body composition (0 of 19 associations), mental health (0 MVPA ↑(0) ↔ (19) ↑(6) ↔ (2) of 3 associations), and social-emotional development (1 LPA ↑(2) ↔ (16) ↓(1) ↑(2) ↔ (6) of 7 associations) (Table 2). Associations between relative SED ↑(2) ↔ (17) ↑(1) ↔ (5) ↓(2) time spent in MVPA with indicators of physical fitness Sleep ↑(1) ↔ (17) ↓(1) ↑(0) ↔ (7) ↓(1) and sleep health were not reported. 10% increase in component Time substitution estimates show that increasing Others to MVPA ↑(0) ↔ (15) ↓(0) ↑(6) ↔ (2) ↓(0) time spent in MVPA at the expense of LPA was favour- Others to LPA ↑(2) ↔ (12) ↓(1) ↑(2) ↔ (6) ↓(0) ably associated with motor skills and development for Others to SED ↑(2) ↔ (13) ↓(0) ↑(1) ↔ (5) ↓(2) half (i.e., 3 of 6) of the associations examined in the lit- Others to sleep ↑(2) ↔ (13) ↓(0) ↑(0) ↔ (7) ↓(1) erature (Table 2). In contrast, removing time from MVPA 10% decrease in component and adding it into LPA was unfavourably associated with MVPA to others ↑(0) ↔ (15) ↓(0) ↑(0) ↔ (2) ↓(6) motor skills (3 of 6 associations) and social-emotional LPA to others ↑(1) ↔ (12) ↓(2) ↑(0) ↔ (2) ↓(6) development (2 of 3 associations). For the other health SED to others ↑(0) ↔ (13) ↓(2) ↑(2) ↔ (5) ↓(1) and developmental indicators, the majority of time sub- Sleep to others ↑(2) ↔ (13) ↓(0) ↑(1) ↔ (7) ↓(0) stitutions that involved MVPA were rated as ↔ as there LPA light physical activity, MVPA moderate-to-vigorous physical activity, SED were no consistent associations (Tables 4 and 5). sedentary time Zahr an et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 7 of 11 Table 4 Summary of results for the movement behavior composition and each of its components Movement behaviour Health and development indicator component Body composition Mental health Motor skills and Social‑ emotional Fitness Sleep development development Composition ↔ ↑ ↑ ↔ ↑ ↔ MVPA ↔ ↔ ↑ ↔ LPA ↔ ↔ ↔ ↔ SED ↔ ↑ ↔ ↔ Sleep ↔ ↔ ↔ ↔ Time substitutions MVPA to LPA ↔ ↔ ↓ ↓ ↔ ↔ LPA to MVPA ↔ ↔ ↑ ↔ ↔ ↔ MVPA to SED ↔ ↔ ↔ ↓ ↔ SED to MVPA ↔ ↔ ↔ ↑ ↔ ↔ MVPA to sleep ↔ ↔ ↔ ↓ ↔ Sleep to MVPA ↔ ↔ ↔ ↑ ↔ ↔ LPA to SED ↔ ↔ ↑ ↔ ↔ SED to LPA ↔ ↔ ↓ ↔ ↔ ↔ LPA to sleep ↔ ↓ ↑ ↔ Sleep to LPA ↔ ↔ ↓ ↔ ↔ SED to sleep ↔ ↔ ↓ ↔ ↔ Sleep to SED ↔ ↔ ↑ ↔ ↔ LPA light physical activity, MVPA moderate-to-vigorous physical activity, SED sedentary time ↑ Substituting time from the first movement behaviour to the second was associated with a favourable change in the health or developmental indicator. ↓ Substituting time from the first movement behaviour to the second was associated with an unfavourable change in the health or developmental indicator. ↔Substituting time from the first movement behaviour to the second was associated with a null (non-significant) change in the health or developmental indicator Light physical activity Table 5 Summary of results for the movement behavior The summary presented in Table  4 indicates that rela- composition and each of its components tive time spent in LPA is not consistently associated Movement behaviour component Health and developmental with any of the health and developmental indicators indicator examined in the literature as > 85% of the reported Body Bone health associations were not significant. composition Results for time substitutions indicate that increasing time spent in LPA by taking it from MVPA was unfa- Composition ↔ ↔ vourably associated with motor skills and development MVPA ↔ ↑ (3 of 6 associations) and indicators of socio-emotional LPA ↔ ↔ development (2 of 3 associations). Also, increasing SED ↔ ↔ time spent in LPA by taking it from SED or sleep was Sleep ↔ ↔ unfavourably associated with motor skills and develop- 10% increase in component ment (4 of 6 associations). However, taking time from Others to MVPA ↔ ↑ LPA and reallocating it into MVPA (3 of 6 associa- Others to LPA ↔ ↔ tions), SED (4 of 6 associations), or sleep (4 of 6 asso- Others to SED ↔ ↔ ciations) was favourably associated with motor skills Others to sleep ↔ ↔ and development. Taking time from LPA and reallocat- 10% decrease in component ing it to sleep was unfavourably associated with men- MVPA to others ↔ ↓ tal health (1 of 1 association). For the other health and LPA to others ↔ ↓ developmental indicators, most time substitutions that SED to others ↔ ↔ involved LPA were rated as ↔ and there were no con- Sleep to others ↔ ↔ sistent associations. LPA light physical activity, MVPA moderate-to-vigorous physical activity, SED sedentary time Zahran et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 8 of 11 Sedentary time health and developmental indicators to reallocate more Relative time spent in SED was mostly favourably associ- time into MVPA by taking it from LPA while it is unfa- ated with indicators of mental health (2 of 3 associations) vourable to take time out of MVPA. Taking time out of but not indicators of body composition (2 of 19 associa- LPA and reallocating it into SED or sleep was favourable tions), motor skills and development (0 of 4 associations), for motor skills and development while adding more time or social-emotional development (0 of 7 associations) into LPA by taking it from SED or sleep was unfavourable (Tables  3 and 4). Associations between relative time for motor skills and development. Finally, reallocating spent in SED and indicators of physical fitness and sleep more time into sleep by taking it from LPA was unfavour- health were not reported. ably associated with mental health. There were no con - The time substitution estimates indicate that reallocat - sistent patterns for the other time substitutions. ing more time into SED by taking it from LPA or sleep We noticed a different pattern of findings in this sys - was favourably associated with motor skills and develop- tematic review of children of the early years than what ment (4 of 6 associations) while taking time from SED has been observed in previous systematic reviews of and moving it into LPA or sleep was unfavourably associ- school-aged children and youth and adults [13, 20]. In ated with motor skills and development (4 of 6 associa- school-aged children and youth and adults, there is con- tions). For the other health and developmental indicators, sistent evidence that the 24-h movement behaviour com- the majority of time substitutions that involved SED were position is associated with a variety of health indicators rated as ↔ (no consistent associations). [13, 20]. Conversely, in our systematic review, the 24-h movement behaviour composition was associated with Sleep some health indicators (e.g., mental health, motor skills Relative time spent in sleep was not consistently associ- and development, physical fitness) but not others (e.g., ated with any of the health and developmental indicators body composition, bone health, social-emotional devel- examined in the literature as > 90% of the associations opment). Furthermore, in school-aged children and reported were not significant (Table 2). youth and adults, there is consistent evidence that rela- Increasing time spent in sleep by taking it from LPA tive time spent in MVPA and reallocating more time into was favourably associated with motor skills and develop- MVPA by taking time out of the other movement behav- ment (4 of 6 associations) but unfavourably associated iours benefits a variety of health indicators [13, 20]. For with mental health (1 of 1 associations). Also, adding example, two systematic reviews of adults published in more time into sleep by removing it from SED was unfa- 2020 concluded that the 24-h composition was associ- vourably associated with motor skills and develop- ated with all of the examined health indicators and that ment (4 of 6 associations) while taking time out of sleep relative time spent in MVPA was favourably associated and adding it into SED was favourably associated with with all examined health indicators [20]. In this review motor skills and development (4 of 6 associations). In of young children, relative time spent in MVPA was only contrast, removing time from sleep and adding it into favourably associated with indicators of motor skills and LPA was unfavourably associated with motor skills and development and bone health. development (4 of 6 associations). For the other health Several factors could explain the aforementioned age- and developmental indicators, most time substitu- related differences. Although body composition has tions that involved sleep were rated as ↔ (no consistent been a focus of movement behaviour CoDA research associations). in all age groups, many of the other health indicators studied in children of the early years (e.g., bone health, Discussion motor skills and development) are different from the This systematic review comprehensively examined the health indicators studied in school-aged children and associations between the composition of 24-h movement youth and adults (e.g., cardiometabolic risk factors). behaviours and health and developmental indicators in Second, the movement behaviours levels and patterns children of the early years. The 24-h movement behav - are different in children of early years than they are in iour composition was consistently associated with indica- older children, youth, and adults. For example, 3–5 year tors of mental health, motor skills and development, and old Canadians accumulate 5.9 h/day of physical activity physical fitness. Relative time spent in MVPA and SED of which 19% is MVPA [30], 6–17  year old Canadians were consistently associated with mental health, motor accumulate 5.3  h/day of physical activity of which 17% skills and development, and physical fitness. Relative time is MVPA [31], and Canadian adults accumulate 4.4  h/ spent in LPA and sleep showed inconsistent association day of physical activity of which 9% is MVPA [32]. Also, with the health and developmental indicators. Results for unlike young children who spent a high proportion of time substitutions suggest that it is favourable for some their physical activity time in unorganized activities Zahr an et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 9 of 11 (i.e., unstructured free play), school-aged children recent study reported that excluding non-English pub- youth accumulate a lot of their PA through organized lications from evidence syntheses did not change the and structured activities such as physical education, conclusions [37]. organized sports and programs, exercising, and active transportation [30, 33]. A few of the findings for the compositional isotem - Conclusion poral substitution models were counter intuitive. Spe- In conclusion, the 24-h movement behaviour compo- cifically, increasing time spent in LPA by taking it from sition was associated with indicators of mental health, SED or sleep was unfavourably associated with motor motor skills and development, physical fitness but skills and development (4 of 6 associations), adding more not with body composition, bone health, and social- time into sleep by removing it from SED was unfavour- emotional development. Future research should study ably associated with motor skills and development (4 of 0–3  year olds, include larger sample size, consider 6 associations), and increasing time spent in sleep by tak- health and development indicators other than body ing it from LPA was unfavourably associated with mental composition, and adopt new CoDA strategies that health (1 of 1 associations). It is possible that these coun- aim to determine the best combination of movement ter intuitive findings reflect some of the limitations of the behaviours. studies included in this review such as spurious findings that occurred because some important confounding vari- Abbreviations ables were not controlled for, the use of cross-sectional CoDA: Compositional data analysis; PA: Physical activity; BMI: Body mass index; study designs that do not provide evidence of causal asso- LPA: Light physical activity; MVPA: Moderate‑to ‑ vigorous physical activity; SED: Sedentary time; METs: Metabolic equivalents. ciations, and small sample sizes that may have increased the likelihood of type II error. Supplementary Information Our systematic review highlights that there are impor- The online version contains supplementary material available at https:// doi. tant limitations and gaps in the movement behaviour org/ 10. 1186/ s44167‑ 022‑ 00012‑2. CoDA literature in young children. In addition to the small number of studies, most of the existing studies Additional file 1. Supplemental materials. had small sample sizes with 6 of 8 having < 300 partici- pants. This may in part explain why many of the observed Acknowledgements associations were not significant (i.e., these studies may Not applicable. have been underpowered to detect modest or small effect Author contributions sizes). Furthermore, only one study included infants and IJ and SZ came up with the idea for the systematic review. SZ designed the toddlers and more research is needed in children < 3 years systematic review with input from IJ. AW created the electronic search strat‑ egy and performed the searches. SZ and CV screened articles, abstracted data, old. Also, 19 of 51 (37%) of the associations examined in and completed the risk of bias assessments under the supervision of IJ. SZ the literature are based on indicators of body composi- wrote the manuscript; this was edited for important intellectual content by all tion, and more research is warranted for other measures remaining co‑authors. All authors read and approved the final manuscript. of health and development. Finally, none of the studies Funding used new CoDA strategies that aim to determine the best Not applicable. combinations of movement behaviours [34, 35]. In 2022, Availability of data and materials Dumuid et  al. explained the concept of the “Goldilocks Group‑level data were obtained from the published results of the studies day” and reported that the best overall composition for included in the systematic review and are provided in the additional file. health among adolescents was 10.4  h of sleep, 9.7  h of SED, 2.4 h of LIPA, and 1.5 h of MVPA [34]. Similar anal- Declarations yses are needed in studies of young children. Ethics approval and consent to participate Our review is not void of limitations. It is a narra- Not applicable. tive synthesis; a meta-analysis could not be performed because there were too few studies with some parame- Consent for publication Not applicable. ters of interest not being reported and heterogeneity in indicator measures and time substitution approaches. Competing interests Also, our systematic review was limited to papers pub- The authors declare that they have no conflict of interest. lished in the peer-reviewed literature, which might Author details result in publication bias as studies with null findings School of Kinesiology and Health Studies, Queen’s University, Kingston, ON, are less likely to be published [36]. Finally, this review Canada. Health Sciences Library, Queen’s University, Kingston, ON, Canada. was limited to papers published in English. However, a Zahran et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 10 of 11 Department of Public Health Sciences, Queen’s University, Kingston, ON, non‑randomised studies of health care interventions. J Epidemiol Canada. Community Health. 1998;52(6):377–84. 18. Korakakis V, Whiteley R, Tzavara A, Malliaropoulos N. The effectiveness Received: 5 October 2022 Accepted: 21 November 2022 of extracorporeal shockwave therapy in common lower limb condi‑ tions: a systematic review including quantification of patient ‑rated pain reduction. Br J Sports Med. 2018;52(6):387–407. 19. Hooper P, Jutai JW, Strong G, Russell‑Minda E. Age ‑related macular degeneration and low‑ vision rehabilitation: a systematic review. Can J Ophthalmol. 2008;43(2):180–7. References 20. Janssen I, Clarke AE, Carson V, Chaput J‑P, Giangregorio LM, Kho ME, 1. Tickell C. The Early Years: Foundations for life, health and learning: an et al. A systematic review of compositional data analysis studies exam‑ independent report on the early years foundation stage to Her Maj‑ ining associations between sleep, sedentary behaviour, and physical esty’s government. 2011. activity with health outcomes in adults. Appl Physiol Nutr Metab. 2. Timmons BW, LeBlanc AG, Carson V, Connor Gorber S, Dillman C, Jans‑ 2020;45(10):S248–57. sen I, et al. Systematic review of physical activity and health in the early 21. Bezerra TA, Clark CCT, Souza Filho AND, Fortes LDS, Mota JAPS, Duncan years (aged 0–4 years). Appl Physiol Nutr Metab. 2012;37(4):773–92. MJ, et al. 24‑hour movement behaviour and executive function in 3. Poitras VJ, Gray CE, Janssen X, Aubert S, Carson V, Faulkner G, et al. preschoolers: a compositional and isotemporal reallocation analysis. Systematic review of the relationships between sedentary behaviour Eur J Sport Sci. 2021;21(7):1064–72. and health indicators in the early years (0–4 years). BMC Public Health. 22. Lemos L, Clark C, Brand C, Pessoa ML, Gaya A, Mota J, et al. 24‑hour 2017;17(5):65–89. movement behaviors and fitness in preschoolers: a compositional 4. Carson V, Lee E‑ Y, Hewitt L, Jennings C, Hunter S, Kuzik N, et al. and isotemporal reallocation analysis. Scand J Med Sci Sports. Systematic review of the relationships between physical activity and 2021;31(6):1371–9. health indicators in the early years (0–4 years). BMC Public Health. 23. Mota JG, Clark CCT, Bezerra TA, Lemos L, Reuter CP, Mota JAPS, et al. 2017;17(5):33–63. Twenty‑four ‑hour movement behaviours and fundamental movement 5. Chaput J‑P, Gray CE, Poitras VJ, Carson V, Gruber R, Birken CS, et al. skills in preschool children: a compositional and isotemporal substitu‑ Systematic review of the relationships between sleep duration and tion analysis. J Sports Sci. 2020;38(18):2071–9. health indicators in the early years (0–4 years). BMC Public Health. 24. Kuzik N, Naylor P‑ J, Spence JC, Carson V. Movement behaviours and 2017;17:91–107. physical, cognitive, and social‑ emotional development in preschool‑ 6. Kuzik N, Poitras VJ, Tremblay MS, Lee E‑ Y, Hunter S, Carson V. System‑ aged children: cross‑sectional associations using compositional atic review of the relationships between combinations of movement analyses. PLoS ONE. 2020;15(8): e0237945. behaviours and health indicators in the early years (0–4 years). BMC 25. McGee M, Unger S, Hamilton J, Birken CS, Pausova Z, Vanderloo LM, Public Health. 2017;17(5):109–22. et al. Lean mass accretion in children born very low birth weight is 7. Kuzik N, Carson V. The association between physical activity, sedentary significantly associated with estimated changes from sedentary time behavior, sleep, and body mass index z‑scores in different settings to light physical activity. Pediatr Obes. 2020;15(5):1–9. among toddlers and preschoolers. BMC Pediatr. 2016;16(1):1–8. 26. Taylor RW, Haszard JJ, Meredith‑ Jones KA, Galland BC, Heath A‑LM, 8. Pedišić Ž, Dumuid D, Olds ST. Integrating sleep, sedentary behav‑ Lawrence J, et al. 24‑h movement behaviors from infancy to preschool: iour, and physical activity research in the emerging field of time ‑use cross‑sectional and longitudinal relationships with body composition epidemiology: definitions, concepts, statistical methods, theoretical and bone health. Int J Behav Nutr Phys Activity. 2018;15(1):N.PAG‑N. framework, and future directions. Kinesiology. 2017;49(2):252–69. PAG. 9. Dumuid D, Stanford TE, Martin‑Fernández J‑A, Pedišić Ž, Maher 27. St Laurent CW, Burkart S, Rodheim K, Marcotte R, Spencer R. Cross‑ CA, Lewis LK, et al. Compositional data analysis for physical activ‑ sectional associations of 24‑hour sedentary time, physical activity, ity, sedentary time and sleep research. Stat Methods Med Res. and sleep duration compositions with sleep quality and habits in 2018;27(12):3726–38. preschoolers. Int J Environ Res Public Health. 2020;17(19):7148. 10. Chastin SF, Palarea‑Albaladejo J, Dontje ML, Skelton DA. Combined 28. Carson V, Tremblay MS, Chastin SFM. Cross‑sectional associations effects of time spent in physical activity, sedentary behaviors and sleep between sleep duration, sedentary time, physical activity, and adipos‑ on obesity and cardio‑metabolic health markers: a novel composi‑ ity indicators among Canadian preschool‑aged children using compo ‑ tional data analysis approach. PLoS ONE. 2015;10(10): e0139984. sitional analyses. BMC Public Health. 2017;17:123–31. 11. Carson V, Tremblay MS, Chaput J‑P, Chastin SFM. Associations between 29. Dumuid D, Pedišić Ž, Stanford TE, Martín‑Fernández J‑A, Hron K, Maher sleep duration, sedentary time, physical activity, and health indicators CA, et al. The compositional isotemporal substitution model: a method among Canadian children and youth using compositional analyses. for estimating changes in a health outcome for reallocation of time Appl Physiol Nutr Metab. 2016;41:S294–302. between sleep, physical activity and sedentary behaviour. Stat Meth‑ 12. McGregor DE, Carson V, Palarea‑Albaladejo J, Dall PM, Tremblay MS, ods Med Res. 2019;28(3):846–57. Chastin SF. Compositional analysis of the associations between 24‑h 30. Colley RC, Garriguet D, Adamo KB, Carson V, Janssen I, Timmons movement behaviours and health indicators among adults and older BW, et al. Physical activity and sedentary behavior during the early adults from the Canadian health measure survey. Int J Environ Res years in Canada: a cross‑sectional study. Int J Behav Nutr Phys Act. Public Health. 2018;15(8):1779. 2013;10(1):1–9. 13. Rollo S, Antsygina O, Tremblay MS. The whole day matters: under‑ 31. Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. standing 24‑hour movement guideline adherence and relation‑ Physical activity of Canadian children and youth: accelerometer results ships with health indicators across the lifespan. J Sport Health Sci. from the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 2020;9(6):493–510. 2011;22(1):15. 14. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items 32. Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. Physi‑ for systematic reviews and meta‑analyses: the PRISMA statement. Ann cal activity of Canadian adults: accelerometer results from the 2007 to Internal Med. 2009;151(4):264–9. 2009 Canadian Health Measures Survey. Health Rep. 2011;22(1):7. 15. Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the 33. Freeman J, King M, Pickett W. Health Behaviour in School‑aged PICO framework to improve searching PubMed for clinical questions. Children in Canada: Focus on Relationships Ottawa, ON: Public Health BMC Med Inform Decis Mak. 2007;7:16. Agency of Canada 2016 Available from: https:// healt hycan adians. gc. 16. Fridolfsson J, Börjesson M, Buck C, Ekblom Ö, Ekblom‑Bak E, Huns‑ ca/ publi catio ns/ scien ce‑ resea rch‑ scien ces‑ reche rches/ health‑ behav berger M, et al. Eec ff ts of frequency filtering on intensity and noise in iour‑ child ren‑ canada‑ 2015‑ compo rteme nts‑ sante‑ jeunes/ index‑ eng. accelerometer‑based physical activity measurements. Sensors (Basel). php# c15a3. 2019;19(9):2186. 17. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and Zahr an et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 11 of 11 34. Dumuid D, Olds T, Lange K, Edwards B, Lycett K, Burgner DP, et al. Goldilocks Days: optimising children’s time use for health and well‑ being. J Epidemiol Community Health. 2022;76(3):301–8. 35. Chastin SF, McGregor DE, Biddle SJ, Cardon G, Chaput J‑P, Dall PM, et al. Striking the right balance: evidence to inform combined physical activity and sedentary behavior recommendations. J Phys Act Health. 2021;18(6):631–7. 36. Sterne J, Egger M, Smith G. Systematic reviews in health care: investi‑ gating and dealing with publication and other biases in meta‑analysis. BMJ [Internet]. 2001;323(7304):101–5. 37. Nussbaumer‑Streit B, Klerings I, Dobrescu A, Persad E, Stevens A, Garritty C, et al. Excluding non‑English publications from evidence ‑ syntheses did not change conclusions: a meta‑ epidemiological study. J Clin Epidemiol. 2020;118:42–54. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in pub‑ lished maps and institutional affiliations. Re Read ady y to to submit y submit your our re researc search h ? Choose BMC and benefit fr ? 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A systematic review of compositional analysis studies examining the associations between sleep, sedentary behaviour, and physical activity with health indicators in early childhood

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Abstract

Background: This systematic review examined if the composition of time spent in sleep, sedentary behaviour, and physical activity of different intensities is associated with health and developmental indicators in children aged 0–5 years. Methods: Four electronic databases (MEDLINE, EMBASE, PsycINFO, and SPORTDiscus) were searched in January 2022. Studies were eligible for inclusion if they were peer‑reviewed, the average age of participants was < 6 years, and com‑ positional data analysis was used to examine the associations between the composition of time spent in movement behaviours and health and developmental indicators. Results: Eight studies (7 cross‑sectional, 1 prospective cohort) of < 2070 unique participants were included. Only a single study included children < 3 years old and 37% of the associations examined in the literature were based on indicators of body composition. The 24‑h movement behaviour composition was associated with mental health indicators (3 of 4 associations examined in the literature), motor skills and development (6 of 7 associations), and physical fitness (3 of 3 associations). Reallocating time from light physical activity into moderate ‑to ‑ vigorous physical activity was favourable for motor skills and development. Reallocating time from light physical activity into sleep was unfavourable for mental health. Reallocating time from light physical activity into sedentary behaviour or sleep was favourable for motor skills and development. Conclusions: This review provides some evidence that the composition of movement behaviours is important for the health of young children. Future research should consider including infants and toddlers, larger sample size, and measures of health and development other than body composition. (PROSPERO registration no.: CRD42022298370.) Keywords: Physical activity, Sedentary behaviour, Sleep, Young children, Time‑use data Background Early childhood is a critical period for physical, emo- tional, and social development [1], as well as adopting *Correspondence: ian.janssen@queensu.ca healthy movement behaviours including sleep, seden- School of Kinesiology and Health Studies, Queen’s University, Kingston, ON, tary behaviour (SED), and physical activity (PA) [1–3]. Canada Systematic reviews examining movement behaviours Full list of author information is available at the end of the article © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Zahran et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 2 of 11 in isolation concluded that adequate levels of sleep, Methods high levels of PA, and low levels of SED benefit several Protocol and registration aspects of physical, cognitive, and social-emotional This systematic review is registered with the Inter - health and development in children 5  years old or national Prospective Register of Systematic Reviews younger [3–5]. Furthermore, some evidence indicates (PROSPERO registration no. CRD42022298370). It that combinations of movement behaviours influence was conducted per the Preferred Reporting Items for health and developmental indicators in young children Systematic Reviews and Meta-Analyses (PRISMA) [6]. Specifically, a combination of adequate sleep, high statement for reporting systematic reviews and meta- PA, and low SED is favourably associated with motor analyses [14]. development and physical fitness [6]. Most previous studies examining the health effects Eligibility criteria of combinations of movement behaviours used non- To assist the search process and identify key study con- compositional movement behaviour exposure vari- cepts a priori, the Participants, Intervention/Exposure, ables, such as the absolute time spend in sleep, PA, and Comparisons, Outcomes, Study design (PICOS) frame- SED [6]. Movement behaviours should not be treated work was used [15]. as non-compositional variables because they are co- dependent variables that form a composition that makes a finite 24-h day [8]. Therefore, changing time Population in any movement behaviour must result in an equal The population of interest was children of the early but opposite change in time spent in one or more of years including infants, toddlers, and preschoolers. the remaining movement behaviours [8]. For example, Studies were only included if the average age of partici- increasing sleep by 30 min per day will lead to a 30 min pants was < 6 years . decrease in some combination of SED and PA. Compositional data analysis (CoDA) statistical tech- Intervention/exposure niques are suitable for data that are codependent and The exposure of interest was the composition of time compositional, such as the combined time spent in spent in sleep, SED, and PA of different intensities (e.g., sleep, SED, and PA across the 24-h day [8, 9]. Recent light physical activity (LPA) and moderate-to-vigorous research that used CoDA suggests that the composi- physical activity (MVPA)). These movement behaviours tion of movement behaviours may influence health were based on the measures and definitions used by the at all ages [10–13]. A systematic review published in authors of the different studies. In general, a cut-point 2020 that examined the association between 24-h of < 1.5 metabolic equivalents (METs) during waking movement behaviours and health indicators across hours defined SED, a range of 1.5–2.99 METs defined the lifespan only included two studies that examined LPA, and a cut-point of ≥ 3.0 METs defined MVPA [16]. children of the early years [13]. CoDA is a new form Only studies that used a CoDA statistical approach and of statistical analysis within the movement behaviour had at least one measure of sleep, one measure of SED, literature, with an exponential increase in the number and one measure of PA were included. No limits were of published studies in recent years [13]. Therefore, an placed on the methods used to assess the movement updated and focused comprehensive review of CoDA behaviours (e.g., device-based or parental-report), the studies examining the association between movement follow-up length in longitudinal studies, or the inter- behaviours and health indicators in young children is vention length in intervention studies. warranted. The purpose of this paper was to conduct a system- atic review that considered whether the composition Comparator/control of time spent in sleep, SED, and PA of different intensi- The comparator was different levels and compositions ties is associated with health and developmental indi- of time spent in sleep, SED, and PA of different intensi - cators in children of the early years. The review also ties. In addition, changes to the composition of move- considered whether changes in the movement behav- ment behaviours were considered, including changes iour composition (e.g., compositional isotemporal observed in an intervention setting and changes esti- substitutions) is associated with changes in health and mated from observational data (i.e., compositional developmental indicators. isotemporal substitutions). Zahr an et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 3 of 11 Outcome(s) Findings were considered statistically significant at All health and developmental indicators were included p < 0.05. in this review. Risk of bias assessment A modified version of the Downs and Black checklist was Study designs used to assess the risk of bias [17]. This checklist has 27 All quantitative study designs were eligible except for items that assess the strength of reporting, external valid- reviews, meta-analyses, and case studies. ity, internal validity (bias and confounding), and power. Since none of the eligible studies for our review were interventions, we removed 10 checklist items that are Information sources and search strategy not relevant for observational studies (items 8, 13, 14, 16, A research librarian with expertise in systematic 19, 21–24, and 26). We also modified 6 items (items 4, 5, review searching created the electronic search strat- 9, 10, 12, and 15) and added 1 item to better align with egy. The following databases were searched: MEDLINE, observational studies designs. The added item assessed EMBASE, PsycINFO (all using the Ovid platform), and the methods used to measure the movement behaviours SPORTDiscus  (EbscoHost). Searches were conducted (e.g., device-based or parental-report). Each item was on January 1, 2022, and dated back to 2015, as that is assigned a score of 1 if the article met the quality crite- when the first study on the relationship between the ria, or a score of 0 if it did not. A maximum of 18 points 24-h movement-behaviour composition and health was for prospective studies and 17 points for cross-sectional published [10]. Studies were eligible for inclusion if studies could be achieved. In addition, overall study they were published in English and peer reviewed. Grey quality levels were assigned based on the total number literature (e.g., book chapters, dissertations, conference of points as follows: excellent (16–18), good (13–15), abstracts) was excluded. An example search strategy fair (10–12), or poor (≤ 9) [13, 18, 19]. For more details based on Ovid MEDLINE is in the Additional file 1 . on these modifications and the scoring system, see the Additional file  1: Table S1. Risk of bias assessments were duplicated by 2 reviewers and any disagreements were Study selection resolved by a third. To remove duplicate records and facilitate screening, bibliographic records were imported into Covidence Synthesis of results software (Veritas Health Innovation, Melbourne, Aus- When CoDA is used to analyze the association between tralia). In level 1 screening, titles and abstracts were movement behaviours with health indicators, up to screened by two reviewers. Records that were not 17 parameters are generated for each indicator exam- screened out by both reviewers proceeded to level 2 ined. These parameters include: (1) a result that reflects screening. In level 2, full-text articles were obtained and whether the 24-h movement behaviour composition examined by two 2 reviewers. Any discrepancies about as a whole is associated with the health indicator; (2) 4 final inclusion were resolved by discussion between results that reflect whether the relative time spent in each the two reviewers. In some cases, a third reviewer was of MVPA, LPA, SED, and sleep are associated with the included to resolve disputes or address uncertainties. health indicator; and (3) 12 results that reflect whether different time reallocations are associated with changes in the health indicator (e.g., reallocating time from Data extraction MVPA to LPA, reallocating time from MVPA to SED, A customized Microsoft Excel spreadsheet was used reallocating time from MVPA to sleep, etc.). during data extraction. Data extraction was completed To simplify and standardize the presentation of find - by one reviewer and checked for accuracy by another. ings for all health and developmental indicators across Information was extracted about the study and sam- all studies, we used the approach previously described in ple characteristics, intervention/exposure, health and a systematic review of CoDA studies examining move- developmental indicator(s), results (including whether ment behaviours and health indicators in adults [20]. these differed by sex/gender, race/ethnicity, and socio - Specifically, the results of each of the up to 17 individual economic status), and confounding variables controlled parameters of interest for each health and developmen- for in statistical models. Reviewers were not blinded to tal indicator for each study were presented as an upward the authors or journals when extracting data. Results arrow (↑), a sideways arrow (↔), or a downward arrow were extracted from the most fully adjusted models for (↓) in a summary table. For results based on the 24-h studies that reported findings from multiple models. movement behaviour composition, ↑ denoted a result Zahran et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 4 of 11 that was statistically significant while ↔ denoted a result that was not statistically significant. For results based on the relative contributions of each movement inten- sity, and results for the time substitutions, ↑ denoted the presence of a result that was statistically significant and favourable for health (e.g., relative time spent in MVPA was associated with a lower BMI), ↔ denoted the pres- ence of a result that was not statistically significant (e.g., relative time spent in sleep was not associated with BMI), and ↓ denoted the presence of a result that was statisti- cally significant and unfavourable for health (e.g., relative time spent in SED was associated with a higher BMI). The ↑/ ↔ /↓ rating system was also used to summarize the overall pattern of results for each health and devel- opmental indicator across all 8 studies. This process started by applying scores of 1, 0, and − 1 to the ↑, ↔, and ↓ ratings from the individual studies. These scores were summed and divided by the total number of ratings. For Fig. 1 PRISMA flow diagram results based on the 24-h movement behaviour compo- sition, the potential range for the final calculated value was 0 to 1. The overall pattern was rated ↑ when the final convenience sample of 95 participants [24] to a nationally value was ≥ 0.66 or  ↔ when the final value was ≤ 0.65. representative sample of 552 [28]. All but one study was For the results based on the relative contributions of each limited to participants aged 3 or older. Data across stud- movement behaviour and the time substitutions, the ies involved a total of < 2070 unique participants; there potential range for the final calculated value was − 1 to 1. was an overlap of participants in two studies [21, 23]. The overall pattern was rated ↑ when the final value was All studies used an observational design; 7 were cross- 0.33 or higher, ↔ when the final value was between − 0.32 sectional studies [21–25, 27, 28] and one was a prospec- and 0.32, or ↓ when the final value was − 0.33 or lower. tive cohort study that included both cross-sectional and Meta-analyses were planned for the time substitution longitudinal analyses [26]. SED, LPA, and MVPA were findings if enough studies used comparable time real - measured using either an Actical or ActiGraph accel- location estimation approaches on the same indicators. erometer. Six studies used a parental-report measure However, there were too few studies for any given health to estimate sleep duration [21–23, 25, 27, 28] while two indicators and considerable heterogeneity in time real- used a device-based measure [24, 26]. location approaches that deterred us from conducting Of the 8 studies, four examined the movement behav- meta-analysis. iour composition in relation to body composition meas- ures including the body mass index, waist circumference, Results skinfold thickness, fat mass or % fat, and fat-free mass. Description of studies One study assessed associations between the movement The PRISMA diagram is in Fig.  1. A total of 717 studies behaviour composition and measures of physical fit - were identified through the database searches (MED - ness including cardiorespiratory fitness, speed-agility, LINE, n = 243; EMBASE, n = 229; CINAHL, n = 194; and lower-body muscular strength. One study examined SPORTDiscus, n = 51). After duplicates were removed, measures of bone health. Two studies examined men- there were 469 unique studies. After titles and abstracts tal health (e.g., executive function, response inhibition, were screened in level 1, 22 full-text articles were working memory, and vocabulary). Finally, motor devel- obtained for level 2 screening. Eight studies passed level opment and sleep health were each assessed in a single 2 screening and were included in the systematic review study. [21–28]. The top two reasons for excluding studies dur - Results were not presented for all of the parameters of ing level 2 screening were that studies did not examine interest in many of the studies. Five studies did not report the association between the movement composition with whether relative time spent in each movement behaviour a health and/or developmental indicator (n = 4), and an was associated with health and developmental indicators average age > 5 years (n = 4). [21–23, 25, 27], 1 study did not report findings for any The characteristics of the 8 studies included in the time substitutions [28], and 2 studies reported the results review are in Table  1. The samples ranged from a small Zahr an et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 5 of 11 Table 1 Description of studies included in the systematic review Authors Participant characteristics Study MVPA LPA SED Sleep Health and (year) design developmental Country Sample size Age (y) indicators Carson et al. Canada 552 3–4 Cross‑sec‑ 5 d Actical 5 d Actical 5 d Actical Parent‑ waist circumfer‑ (2017) tional reported ence, BMI Taylor et al. New Zealand 380 1–5 Cross‑ 5–7 d Actical 5–7 d Actical 5–7 d Actical 5–7 d Actical BMI, bone (2018) sectional and and parent‑ mineral content, prospective reported bone mineral density Bezerra et al. Brazil 123 3–5 Cross‑sec‑ 7 d Actigraph 7 d Actigraph 7 d Actigraph Parent‑ executive func‑ (2020) tional reported tion Kuzik et al. Canada 95 3–5 Cross‑sec‑ 7 d Actigraph 7 d Actigraph 7 d Actigraph 7 d Actigraph BMI, motor (2020) tional skills, response inhibition, work‑ ing memory, vocabulary, self‑regulation, prosocial behav‑ iour Lemos et al. Brazil 270 3–5 Cross‑sec‑ 7 d Actigraph 7 d Actigraph 7 d Actigraph Parent‑ cardiorespiratory (2021) tional reported fitness, speed‑ agility, lower‑ body strength McGee et al. Canada 158 5.5 Cross‑sec‑ 7 d Actical 7 d Actical 7 d Actical Parent‑ BMI, obesity (2019) tional reported skinfold thick‑ ness, body fat, fat‑free mass Mota et al. Brazil 204 3–5 Cross‑sec‑ 7 d Actigraph 7 d Actigraph 7 d Actigraph Parent‑ motor skills and (2020) tional reported development St.Laurent United States 288 2.8–5.9 Cross‑sec‑ 7 d Actigraph Actigraph 7 d 7 d Actigraph Parent‑ sleep efficiency, et al. (2020) tional reported nap frequency, sleep distur‑ bances, bedtime resistance BMI body mass index, LPA light physical activity, MVPA moderate-to-vigorous physical activity, SED sedentary time for some time substitutions but not others [22, 24]. Of Table S4 contain the results for each of the time substitu- the 7 studies that showed results for time substitutions, 3 tions, which reflect the estimated changes in the health used the method explained by Dumuid et al. in 2019 [24, indicators that would occur if equivalent time was reallo- 26, 27, 29], 2 used the method explained by Chastin et al. cated from one intensity of movement into another (e.g., in 2015 [10, 21, 22], and 2 used both of these methods decreasing SED by 30 min per day while increasing sleep [23, 25]. by 30 min per day). Risk of bias and quality assessment Movement behaviour composition The risk of bias assessment scores for each Downs and A summary of the associations between the 24-h move- Black checklist item and an overall quality score for each ment behaviour composition and health and develop- study are presented in Additional file  1: Table  S1. The mental indicators is provided in Tables 2 and 3. The 24-h total checklist score of the prospective cohort study was movement behaviour composition was significantly asso - 13.5/18 and it was rated as good quality. The total check - ciated with body composition in only 1 of 20 associations list scores of the 7 cross-sectional studies ranged from examined in the literature. None of the associations for 11.5/17 to 12.5/17 and they were all rated as fair quality. indicators of social-emotional development (0 of 7) or bone health (0 of 8) were significant. For sleep health, 2 of Data synthesis 4 associations were significant. Most of or all associations The associations between the 24-h movement behav - for the 24-h movement behaviour composition were sig- iour composition with specific health and developmen - nificant for indicators of mental health (3 of 4), motor tal indicators from the 8 individual studies are shown in skills and development (6 of 7), and physical fitness (3 of Additional file  1: Table S2. Additional file  1: Table S3 and 3). Zahran et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 6 of 11 Table 2 Summary of results for each health and developmental indicator Movement behaviour component Health and development indicator Body composition Mental health Motor skills and Social‑ Fitness Sleep development emotional development Composition 24‑h composition ↑(1) ↔ (19) ↑(3) ↔ (1) ↑(6) ↔ (1) ↑(0) ↔ (7) ↑(3) ↔ (0) ↑(2) ↔ (2) Relative time in MVPA ↑(0) ↔ (19) ↑(0) ↔ (3) ↑(3) ↔ (1) ↑(1) ↔ (6) Relative time in LPA ↑(2) ↔ (16) ↓(1) ↑(0) ↔ (3) ↑(0) ↔ (2) ↓(2) ↑(0) ↔ (7) Relative time in SED ↑(2) ↔ (17) ↑(2) ↔ (1) ↑(0) ↔ (4) ↑(0) ↔ (7) Relative time in sleep ↑(1) ↔ (17) ↓(1) ↑(0) ↔ (3) ↑(0) ↔ (4) ↑(0) ↔ (7) Time reallocation MVPA to LPA ↑(0) ↔ (7) ↓(0) ↑(1) ↔ (1) ↓(0) ↑(0) ↔ (3) ↓(3) ↑(0) ↔ (1) ↓(2) ↑(0) ↔ (9) ↓(0) ↑(0) ↔ (4) ↓(0) LPA to MVPA ↑(0) ↔ (7) ↓(0) ↑(0) ↔ (2) ↓(0) ↑(3) ↔ (3) ↓(0) ↑(1) ↔ (2) ↓(0) ↑(0) ↔ (9) ↓(0) ↑(0) ↔ (4) ↓(0) MVPA to SED ↑(0) ↔ (6) ↓(1) ↑(0) ↔ (2) ↓(0) ↑(0) ↔ (5) ↓(1) ↑(0) ↔ (2) ↓(1) ↑(1) ↔ (2) ↓(1) SED to MVPA ↑(1) ↔ (6) ↓(0) ↑(0) ↔ (2) ↓(0) ↑(0) ↔ (6) ↓(0) ↑(1) ↔ (2) ↓(0) ↑(3) ↔ (6) ↓(0) ↑(1) ↔ (2) ↓(1) MVPA to sleep ↑(0) ↔ (7) ↓(0) ↑(1) ↔ (1) ↓(0) ↑(0) ↔ (6) ↓(0) ↑(0) ↔ (2) ↓(1) ↑(0) ↔ (4) ↓(0) Sleep to MVPA ↑(0) ↔ (7) ↓(0) ↑(0) ↔ (1) ↓(1) ↑(0) ↔ (6) ↓(0) ↑(1) ↔ (2) ↓(0) ↑(3) ↔ (6) ↓(0) ↑(0) ↔ (4) ↓(0) LPA to SED ↑(0) ↔ (6) ↓(1) ↑(0) ↔ (2) ↓(0) ↑(4) ↔ (2) ↓(0) ↑(0) ↔ (3) ↓(0) ↑(0) ↔ (4) ↓(0) SED to LPA ↑(1) ↔ (6) ↓(0) ↑(0) ↔ (1) ↓(1) ↑(0) ↔ (2) ↓(4) ↑(0) ↔ (3) ↓(0) ↑(0) ↔ (9) ↓(0) ↑(0) ↔ (4) ↓(0) LPA to sleep ↑(1) ↔ (7) ↓(1) ↑(0) ↔ (0) ↓(1) ↑(4) ↔ (2) ↓(0) ↑(1) ↔ (1) ↓(2) Sleep to LPA ↑(0) ↔ (7) ↓(0) ↑(0) ↔ (1) ↓(0) ↑(0) ↔ (2) ↓(4) ↑(2) ↔ (4) ↓(3) ↑(2) ↔ (1) ↓(1) SED to sleep ↑(0) ↔ (7) ↓(0) ↑(0) ↔ (1) ↓(1) ↑(0) ↔ (2) ↓(4) ↑(0) ↔ (3) ↓(0) ↑(1) ↔ (1) ↓(2) Sleep to SED ↑(0) ↔ (7) ↓(0) ↑(1) ↔ (1) ↓(0) ↑(4) ↔ (2) ↓(0) ↑(0) ↔ (3) ↓(0) ↑(2) ↔ (1) ↓(1) LPA light physical activity, MVPA modertate-to-vigorous physical activity, SED sedentary time ↑ For the 24-h movement behaviour composition, this symbol indicates a statistically significant association. For the co-dependent associations for relative time spent in MVPA, LPA, SED, and sleep this symbol indicates a favourable association that was statistically significant. ↓ For the co-dependent associations for relative time spent in MVPA, LPA, SED, and sleep this symbol indicates an unfavourable association that was statistically significant. ↔ For the 24-h movement behaviour composition, this symbol indicates a null (non-significant) association. For the co-dependent associations for relative time spent in MVPA, LPA, SED, and sleep this symbol indicates a null (non-significant) association Moderate‑tovigor ‑ ous physical activity Table 3 Summary of results of each health and developmental indicator Relative time spent in MVPA was favourably associ- ated with indicators of motor skills and development (3 Component Health and developmental indicator of 4 associations) and bone health (6 of 8 associations) Body composition Bone health (Tables  2 and 3). However, relative time in MVPA was rarely or never significantly associated with indicators of Composition ↑(1) ↔ (19) ↑(0) ↔ (8) body composition (0 of 19 associations), mental health (0 MVPA ↑(0) ↔ (19) ↑(6) ↔ (2) of 3 associations), and social-emotional development (1 LPA ↑(2) ↔ (16) ↓(1) ↑(2) ↔ (6) of 7 associations) (Table 2). Associations between relative SED ↑(2) ↔ (17) ↑(1) ↔ (5) ↓(2) time spent in MVPA with indicators of physical fitness Sleep ↑(1) ↔ (17) ↓(1) ↑(0) ↔ (7) ↓(1) and sleep health were not reported. 10% increase in component Time substitution estimates show that increasing Others to MVPA ↑(0) ↔ (15) ↓(0) ↑(6) ↔ (2) ↓(0) time spent in MVPA at the expense of LPA was favour- Others to LPA ↑(2) ↔ (12) ↓(1) ↑(2) ↔ (6) ↓(0) ably associated with motor skills and development for Others to SED ↑(2) ↔ (13) ↓(0) ↑(1) ↔ (5) ↓(2) half (i.e., 3 of 6) of the associations examined in the lit- Others to sleep ↑(2) ↔ (13) ↓(0) ↑(0) ↔ (7) ↓(1) erature (Table 2). In contrast, removing time from MVPA 10% decrease in component and adding it into LPA was unfavourably associated with MVPA to others ↑(0) ↔ (15) ↓(0) ↑(0) ↔ (2) ↓(6) motor skills (3 of 6 associations) and social-emotional LPA to others ↑(1) ↔ (12) ↓(2) ↑(0) ↔ (2) ↓(6) development (2 of 3 associations). For the other health SED to others ↑(0) ↔ (13) ↓(2) ↑(2) ↔ (5) ↓(1) and developmental indicators, the majority of time sub- Sleep to others ↑(2) ↔ (13) ↓(0) ↑(1) ↔ (7) ↓(0) stitutions that involved MVPA were rated as ↔ as there LPA light physical activity, MVPA moderate-to-vigorous physical activity, SED were no consistent associations (Tables 4 and 5). sedentary time Zahr an et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 7 of 11 Table 4 Summary of results for the movement behavior composition and each of its components Movement behaviour Health and development indicator component Body composition Mental health Motor skills and Social‑ emotional Fitness Sleep development development Composition ↔ ↑ ↑ ↔ ↑ ↔ MVPA ↔ ↔ ↑ ↔ LPA ↔ ↔ ↔ ↔ SED ↔ ↑ ↔ ↔ Sleep ↔ ↔ ↔ ↔ Time substitutions MVPA to LPA ↔ ↔ ↓ ↓ ↔ ↔ LPA to MVPA ↔ ↔ ↑ ↔ ↔ ↔ MVPA to SED ↔ ↔ ↔ ↓ ↔ SED to MVPA ↔ ↔ ↔ ↑ ↔ ↔ MVPA to sleep ↔ ↔ ↔ ↓ ↔ Sleep to MVPA ↔ ↔ ↔ ↑ ↔ ↔ LPA to SED ↔ ↔ ↑ ↔ ↔ SED to LPA ↔ ↔ ↓ ↔ ↔ ↔ LPA to sleep ↔ ↓ ↑ ↔ Sleep to LPA ↔ ↔ ↓ ↔ ↔ SED to sleep ↔ ↔ ↓ ↔ ↔ Sleep to SED ↔ ↔ ↑ ↔ ↔ LPA light physical activity, MVPA moderate-to-vigorous physical activity, SED sedentary time ↑ Substituting time from the first movement behaviour to the second was associated with a favourable change in the health or developmental indicator. ↓ Substituting time from the first movement behaviour to the second was associated with an unfavourable change in the health or developmental indicator. ↔Substituting time from the first movement behaviour to the second was associated with a null (non-significant) change in the health or developmental indicator Light physical activity Table 5 Summary of results for the movement behavior The summary presented in Table  4 indicates that rela- composition and each of its components tive time spent in LPA is not consistently associated Movement behaviour component Health and developmental with any of the health and developmental indicators indicator examined in the literature as > 85% of the reported Body Bone health associations were not significant. composition Results for time substitutions indicate that increasing time spent in LPA by taking it from MVPA was unfa- Composition ↔ ↔ vourably associated with motor skills and development MVPA ↔ ↑ (3 of 6 associations) and indicators of socio-emotional LPA ↔ ↔ development (2 of 3 associations). Also, increasing SED ↔ ↔ time spent in LPA by taking it from SED or sleep was Sleep ↔ ↔ unfavourably associated with motor skills and develop- 10% increase in component ment (4 of 6 associations). However, taking time from Others to MVPA ↔ ↑ LPA and reallocating it into MVPA (3 of 6 associa- Others to LPA ↔ ↔ tions), SED (4 of 6 associations), or sleep (4 of 6 asso- Others to SED ↔ ↔ ciations) was favourably associated with motor skills Others to sleep ↔ ↔ and development. Taking time from LPA and reallocat- 10% decrease in component ing it to sleep was unfavourably associated with men- MVPA to others ↔ ↓ tal health (1 of 1 association). For the other health and LPA to others ↔ ↓ developmental indicators, most time substitutions that SED to others ↔ ↔ involved LPA were rated as ↔ and there were no con- Sleep to others ↔ ↔ sistent associations. LPA light physical activity, MVPA moderate-to-vigorous physical activity, SED sedentary time Zahran et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 8 of 11 Sedentary time health and developmental indicators to reallocate more Relative time spent in SED was mostly favourably associ- time into MVPA by taking it from LPA while it is unfa- ated with indicators of mental health (2 of 3 associations) vourable to take time out of MVPA. Taking time out of but not indicators of body composition (2 of 19 associa- LPA and reallocating it into SED or sleep was favourable tions), motor skills and development (0 of 4 associations), for motor skills and development while adding more time or social-emotional development (0 of 7 associations) into LPA by taking it from SED or sleep was unfavourable (Tables  3 and 4). Associations between relative time for motor skills and development. Finally, reallocating spent in SED and indicators of physical fitness and sleep more time into sleep by taking it from LPA was unfavour- health were not reported. ably associated with mental health. There were no con - The time substitution estimates indicate that reallocat - sistent patterns for the other time substitutions. ing more time into SED by taking it from LPA or sleep We noticed a different pattern of findings in this sys - was favourably associated with motor skills and develop- tematic review of children of the early years than what ment (4 of 6 associations) while taking time from SED has been observed in previous systematic reviews of and moving it into LPA or sleep was unfavourably associ- school-aged children and youth and adults [13, 20]. In ated with motor skills and development (4 of 6 associa- school-aged children and youth and adults, there is con- tions). For the other health and developmental indicators, sistent evidence that the 24-h movement behaviour com- the majority of time substitutions that involved SED were position is associated with a variety of health indicators rated as ↔ (no consistent associations). [13, 20]. Conversely, in our systematic review, the 24-h movement behaviour composition was associated with Sleep some health indicators (e.g., mental health, motor skills Relative time spent in sleep was not consistently associ- and development, physical fitness) but not others (e.g., ated with any of the health and developmental indicators body composition, bone health, social-emotional devel- examined in the literature as > 90% of the associations opment). Furthermore, in school-aged children and reported were not significant (Table 2). youth and adults, there is consistent evidence that rela- Increasing time spent in sleep by taking it from LPA tive time spent in MVPA and reallocating more time into was favourably associated with motor skills and develop- MVPA by taking time out of the other movement behav- ment (4 of 6 associations) but unfavourably associated iours benefits a variety of health indicators [13, 20]. For with mental health (1 of 1 associations). Also, adding example, two systematic reviews of adults published in more time into sleep by removing it from SED was unfa- 2020 concluded that the 24-h composition was associ- vourably associated with motor skills and develop- ated with all of the examined health indicators and that ment (4 of 6 associations) while taking time out of sleep relative time spent in MVPA was favourably associated and adding it into SED was favourably associated with with all examined health indicators [20]. In this review motor skills and development (4 of 6 associations). In of young children, relative time spent in MVPA was only contrast, removing time from sleep and adding it into favourably associated with indicators of motor skills and LPA was unfavourably associated with motor skills and development and bone health. development (4 of 6 associations). For the other health Several factors could explain the aforementioned age- and developmental indicators, most time substitu- related differences. Although body composition has tions that involved sleep were rated as ↔ (no consistent been a focus of movement behaviour CoDA research associations). in all age groups, many of the other health indicators studied in children of the early years (e.g., bone health, Discussion motor skills and development) are different from the This systematic review comprehensively examined the health indicators studied in school-aged children and associations between the composition of 24-h movement youth and adults (e.g., cardiometabolic risk factors). behaviours and health and developmental indicators in Second, the movement behaviours levels and patterns children of the early years. The 24-h movement behav - are different in children of early years than they are in iour composition was consistently associated with indica- older children, youth, and adults. For example, 3–5 year tors of mental health, motor skills and development, and old Canadians accumulate 5.9 h/day of physical activity physical fitness. Relative time spent in MVPA and SED of which 19% is MVPA [30], 6–17  year old Canadians were consistently associated with mental health, motor accumulate 5.3  h/day of physical activity of which 17% skills and development, and physical fitness. Relative time is MVPA [31], and Canadian adults accumulate 4.4  h/ spent in LPA and sleep showed inconsistent association day of physical activity of which 9% is MVPA [32]. Also, with the health and developmental indicators. Results for unlike young children who spent a high proportion of time substitutions suggest that it is favourable for some their physical activity time in unorganized activities Zahr an et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 9 of 11 (i.e., unstructured free play), school-aged children recent study reported that excluding non-English pub- youth accumulate a lot of their PA through organized lications from evidence syntheses did not change the and structured activities such as physical education, conclusions [37]. organized sports and programs, exercising, and active transportation [30, 33]. A few of the findings for the compositional isotem - Conclusion poral substitution models were counter intuitive. Spe- In conclusion, the 24-h movement behaviour compo- cifically, increasing time spent in LPA by taking it from sition was associated with indicators of mental health, SED or sleep was unfavourably associated with motor motor skills and development, physical fitness but skills and development (4 of 6 associations), adding more not with body composition, bone health, and social- time into sleep by removing it from SED was unfavour- emotional development. Future research should study ably associated with motor skills and development (4 of 0–3  year olds, include larger sample size, consider 6 associations), and increasing time spent in sleep by tak- health and development indicators other than body ing it from LPA was unfavourably associated with mental composition, and adopt new CoDA strategies that health (1 of 1 associations). It is possible that these coun- aim to determine the best combination of movement ter intuitive findings reflect some of the limitations of the behaviours. studies included in this review such as spurious findings that occurred because some important confounding vari- Abbreviations ables were not controlled for, the use of cross-sectional CoDA: Compositional data analysis; PA: Physical activity; BMI: Body mass index; study designs that do not provide evidence of causal asso- LPA: Light physical activity; MVPA: Moderate‑to ‑ vigorous physical activity; SED: Sedentary time; METs: Metabolic equivalents. ciations, and small sample sizes that may have increased the likelihood of type II error. Supplementary Information Our systematic review highlights that there are impor- The online version contains supplementary material available at https:// doi. tant limitations and gaps in the movement behaviour org/ 10. 1186/ s44167‑ 022‑ 00012‑2. CoDA literature in young children. In addition to the small number of studies, most of the existing studies Additional file 1. Supplemental materials. had small sample sizes with 6 of 8 having < 300 partici- pants. This may in part explain why many of the observed Acknowledgements associations were not significant (i.e., these studies may Not applicable. have been underpowered to detect modest or small effect Author contributions sizes). Furthermore, only one study included infants and IJ and SZ came up with the idea for the systematic review. SZ designed the toddlers and more research is needed in children < 3 years systematic review with input from IJ. AW created the electronic search strat‑ egy and performed the searches. SZ and CV screened articles, abstracted data, old. Also, 19 of 51 (37%) of the associations examined in and completed the risk of bias assessments under the supervision of IJ. SZ the literature are based on indicators of body composi- wrote the manuscript; this was edited for important intellectual content by all tion, and more research is warranted for other measures remaining co‑authors. All authors read and approved the final manuscript. of health and development. Finally, none of the studies Funding used new CoDA strategies that aim to determine the best Not applicable. combinations of movement behaviours [34, 35]. In 2022, Availability of data and materials Dumuid et  al. explained the concept of the “Goldilocks Group‑level data were obtained from the published results of the studies day” and reported that the best overall composition for included in the systematic review and are provided in the additional file. health among adolescents was 10.4  h of sleep, 9.7  h of SED, 2.4 h of LIPA, and 1.5 h of MVPA [34]. Similar anal- Declarations yses are needed in studies of young children. Ethics approval and consent to participate Our review is not void of limitations. It is a narra- Not applicable. tive synthesis; a meta-analysis could not be performed because there were too few studies with some parame- Consent for publication Not applicable. ters of interest not being reported and heterogeneity in indicator measures and time substitution approaches. Competing interests Also, our systematic review was limited to papers pub- The authors declare that they have no conflict of interest. lished in the peer-reviewed literature, which might Author details result in publication bias as studies with null findings School of Kinesiology and Health Studies, Queen’s University, Kingston, ON, are less likely to be published [36]. Finally, this review Canada. Health Sciences Library, Queen’s University, Kingston, ON, Canada. was limited to papers published in English. However, a Zahran et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 10 of 11 Department of Public Health Sciences, Queen’s University, Kingston, ON, non‑randomised studies of health care interventions. J Epidemiol Canada. Community Health. 1998;52(6):377–84. 18. Korakakis V, Whiteley R, Tzavara A, Malliaropoulos N. The effectiveness Received: 5 October 2022 Accepted: 21 November 2022 of extracorporeal shockwave therapy in common lower limb condi‑ tions: a systematic review including quantification of patient ‑rated pain reduction. Br J Sports Med. 2018;52(6):387–407. 19. Hooper P, Jutai JW, Strong G, Russell‑Minda E. Age ‑related macular degeneration and low‑ vision rehabilitation: a systematic review. Can J Ophthalmol. 2008;43(2):180–7. References 20. Janssen I, Clarke AE, Carson V, Chaput J‑P, Giangregorio LM, Kho ME, 1. Tickell C. The Early Years: Foundations for life, health and learning: an et al. A systematic review of compositional data analysis studies exam‑ independent report on the early years foundation stage to Her Maj‑ ining associations between sleep, sedentary behaviour, and physical esty’s government. 2011. activity with health outcomes in adults. Appl Physiol Nutr Metab. 2. Timmons BW, LeBlanc AG, Carson V, Connor Gorber S, Dillman C, Jans‑ 2020;45(10):S248–57. sen I, et al. Systematic review of physical activity and health in the early 21. Bezerra TA, Clark CCT, Souza Filho AND, Fortes LDS, Mota JAPS, Duncan years (aged 0–4 years). Appl Physiol Nutr Metab. 2012;37(4):773–92. MJ, et al. 24‑hour movement behaviour and executive function in 3. Poitras VJ, Gray CE, Janssen X, Aubert S, Carson V, Faulkner G, et al. preschoolers: a compositional and isotemporal reallocation analysis. Systematic review of the relationships between sedentary behaviour Eur J Sport Sci. 2021;21(7):1064–72. and health indicators in the early years (0–4 years). BMC Public Health. 22. Lemos L, Clark C, Brand C, Pessoa ML, Gaya A, Mota J, et al. 24‑hour 2017;17(5):65–89. movement behaviors and fitness in preschoolers: a compositional 4. Carson V, Lee E‑ Y, Hewitt L, Jennings C, Hunter S, Kuzik N, et al. and isotemporal reallocation analysis. Scand J Med Sci Sports. Systematic review of the relationships between physical activity and 2021;31(6):1371–9. health indicators in the early years (0–4 years). BMC Public Health. 23. Mota JG, Clark CCT, Bezerra TA, Lemos L, Reuter CP, Mota JAPS, et al. 2017;17(5):33–63. Twenty‑four ‑hour movement behaviours and fundamental movement 5. Chaput J‑P, Gray CE, Poitras VJ, Carson V, Gruber R, Birken CS, et al. skills in preschool children: a compositional and isotemporal substitu‑ Systematic review of the relationships between sleep duration and tion analysis. J Sports Sci. 2020;38(18):2071–9. health indicators in the early years (0–4 years). BMC Public Health. 24. Kuzik N, Naylor P‑ J, Spence JC, Carson V. Movement behaviours and 2017;17:91–107. physical, cognitive, and social‑ emotional development in preschool‑ 6. Kuzik N, Poitras VJ, Tremblay MS, Lee E‑ Y, Hunter S, Carson V. System‑ aged children: cross‑sectional associations using compositional atic review of the relationships between combinations of movement analyses. PLoS ONE. 2020;15(8): e0237945. behaviours and health indicators in the early years (0–4 years). BMC 25. McGee M, Unger S, Hamilton J, Birken CS, Pausova Z, Vanderloo LM, Public Health. 2017;17(5):109–22. et al. Lean mass accretion in children born very low birth weight is 7. Kuzik N, Carson V. The association between physical activity, sedentary significantly associated with estimated changes from sedentary time behavior, sleep, and body mass index z‑scores in different settings to light physical activity. Pediatr Obes. 2020;15(5):1–9. among toddlers and preschoolers. BMC Pediatr. 2016;16(1):1–8. 26. Taylor RW, Haszard JJ, Meredith‑ Jones KA, Galland BC, Heath A‑LM, 8. Pedišić Ž, Dumuid D, Olds ST. Integrating sleep, sedentary behav‑ Lawrence J, et al. 24‑h movement behaviors from infancy to preschool: iour, and physical activity research in the emerging field of time ‑use cross‑sectional and longitudinal relationships with body composition epidemiology: definitions, concepts, statistical methods, theoretical and bone health. Int J Behav Nutr Phys Activity. 2018;15(1):N.PAG‑N. framework, and future directions. Kinesiology. 2017;49(2):252–69. PAG. 9. Dumuid D, Stanford TE, Martin‑Fernández J‑A, Pedišić Ž, Maher 27. St Laurent CW, Burkart S, Rodheim K, Marcotte R, Spencer R. Cross‑ CA, Lewis LK, et al. Compositional data analysis for physical activ‑ sectional associations of 24‑hour sedentary time, physical activity, ity, sedentary time and sleep research. Stat Methods Med Res. and sleep duration compositions with sleep quality and habits in 2018;27(12):3726–38. preschoolers. Int J Environ Res Public Health. 2020;17(19):7148. 10. Chastin SF, Palarea‑Albaladejo J, Dontje ML, Skelton DA. Combined 28. Carson V, Tremblay MS, Chastin SFM. Cross‑sectional associations effects of time spent in physical activity, sedentary behaviors and sleep between sleep duration, sedentary time, physical activity, and adipos‑ on obesity and cardio‑metabolic health markers: a novel composi‑ ity indicators among Canadian preschool‑aged children using compo ‑ tional data analysis approach. PLoS ONE. 2015;10(10): e0139984. sitional analyses. BMC Public Health. 2017;17:123–31. 11. Carson V, Tremblay MS, Chaput J‑P, Chastin SFM. Associations between 29. Dumuid D, Pedišić Ž, Stanford TE, Martín‑Fernández J‑A, Hron K, Maher sleep duration, sedentary time, physical activity, and health indicators CA, et al. The compositional isotemporal substitution model: a method among Canadian children and youth using compositional analyses. for estimating changes in a health outcome for reallocation of time Appl Physiol Nutr Metab. 2016;41:S294–302. between sleep, physical activity and sedentary behaviour. Stat Meth‑ 12. McGregor DE, Carson V, Palarea‑Albaladejo J, Dall PM, Tremblay MS, ods Med Res. 2019;28(3):846–57. Chastin SF. Compositional analysis of the associations between 24‑h 30. Colley RC, Garriguet D, Adamo KB, Carson V, Janssen I, Timmons movement behaviours and health indicators among adults and older BW, et al. Physical activity and sedentary behavior during the early adults from the Canadian health measure survey. Int J Environ Res years in Canada: a cross‑sectional study. Int J Behav Nutr Phys Act. Public Health. 2018;15(8):1779. 2013;10(1):1–9. 13. Rollo S, Antsygina O, Tremblay MS. The whole day matters: under‑ 31. Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. standing 24‑hour movement guideline adherence and relation‑ Physical activity of Canadian children and youth: accelerometer results ships with health indicators across the lifespan. J Sport Health Sci. from the 2007 to 2009 Canadian Health Measures Survey. Health Rep. 2020;9(6):493–510. 2011;22(1):15. 14. Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items 32. Colley RC, Garriguet D, Janssen I, Craig CL, Clarke J, Tremblay MS. Physi‑ for systematic reviews and meta‑analyses: the PRISMA statement. Ann cal activity of Canadian adults: accelerometer results from the 2007 to Internal Med. 2009;151(4):264–9. 2009 Canadian Health Measures Survey. Health Rep. 2011;22(1):7. 15. Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the 33. Freeman J, King M, Pickett W. Health Behaviour in School‑aged PICO framework to improve searching PubMed for clinical questions. Children in Canada: Focus on Relationships Ottawa, ON: Public Health BMC Med Inform Decis Mak. 2007;7:16. Agency of Canada 2016 Available from: https:// healt hycan adians. gc. 16. Fridolfsson J, Börjesson M, Buck C, Ekblom Ö, Ekblom‑Bak E, Huns‑ ca/ publi catio ns/ scien ce‑ resea rch‑ scien ces‑ reche rches/ health‑ behav berger M, et al. Eec ff ts of frequency filtering on intensity and noise in iour‑ child ren‑ canada‑ 2015‑ compo rteme nts‑ sante‑ jeunes/ index‑ eng. accelerometer‑based physical activity measurements. Sensors (Basel). php# c15a3. 2019;19(9):2186. 17. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and Zahr an et al. Journal of Activity, Sedentary and Sleep Behaviors (2023) 2:1 Page 11 of 11 34. Dumuid D, Olds T, Lange K, Edwards B, Lycett K, Burgner DP, et al. Goldilocks Days: optimising children’s time use for health and well‑ being. J Epidemiol Community Health. 2022;76(3):301–8. 35. Chastin SF, McGregor DE, Biddle SJ, Cardon G, Chaput J‑P, Dall PM, et al. Striking the right balance: evidence to inform combined physical activity and sedentary behavior recommendations. J Phys Act Health. 2021;18(6):631–7. 36. Sterne J, Egger M, Smith G. Systematic reviews in health care: investi‑ gating and dealing with publication and other biases in meta‑analysis. BMJ [Internet]. 2001;323(7304):101–5. 37. Nussbaumer‑Streit B, Klerings I, Dobrescu A, Persad E, Stevens A, Garritty C, et al. Excluding non‑English publications from evidence ‑ syntheses did not change conclusions: a meta‑ epidemiological study. J Clin Epidemiol. 2020;118:42–54. Publisher’s Note Springer Nature remains neutral with regard to jurisdictional claims in pub‑ lished maps and institutional affiliations. Re Read ady y to to submit y submit your our re researc search h ? Choose BMC and benefit fr ? 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Journal

Journal of Activity Sedentary and Sleep Behaviors – Springer Journals

Published: Feb 1, 2023

Keywords: Physical activity; Sedentary behaviour; Sleep; Young children; Time-use data

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