Accelerometer measured levels of moderate-to-vigorous intensity physical activity and sedentary time in children and adolescents with chronic disease: A systematic review and meta-analysis

Abstract

Context: Moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) are important for child and adolescent health.

Objective: To examine habitual levels of accelerometer measured MVPA and ST in children and adolescents with chronic disease, and how these levels compare with healthy peers.

Methods: Data sources: An extensive search was carried out in Medline, Cochrane library, EMBASE, SPORTDiscus and CINAHL from 2000-2017. Study selection: Studies with accelerometer-measured MVPA and/or ST (at least 3 days and 6 hours/day to provide estimates of habitual levels) in children 0-19 years of age with chronic diseases but without co-morbidities that would present major impediments to physical activity. In all cases patients were studied while well and clinically stable.

Results: Out of 1592 records, 25 studies were eligible, in four chronic disease categories: cardiovascular disease (7 studies), respiratory disease (7 studies), diabetes (8 studies), and malignancy (3 studies). Patient MVPA was generally below the recommended 60 min/day and ST generally high regardless of the disease condition. Comparison with healthy controls suggested no marked differences in MVPA between controls and patients with cardiovascular disease (1 study, n = 42) and type 1 diabetes (5 studies, n = 400; SMD -0.70, 95% CI -1.89 to 0.48, p = 0.25). In patients with respiratory disease, MVPA was lower in patients than controls (4 studies, n = 470; SMD -0.39, 95% CI -0.80, 0.02, p = 0.06). Meta-analysis indicated significantly lower MVPA in patients with malignancies than in the controls (2 studies, n = 90; SMD -2.2, 95% CI -4.08 to -0.26, p = 0.03). Time spent sedentary was significantly higher in patients in 4/10 studies compared with healthy control groups, significantly lower in 1 study, while 5 studies showed no significant group difference.

Conclusions: MVPA in children/adolescents with chronic disease appear to be well below guideline recommendations, although comparable with activity levels of their healthy peers except for children with malignancies. Tailored and disease appropriate intervention strategies may be needed to increase MVPA and reduce ST in children and adolescents with chronic disease.

Fig 1. The PRISMA flow diagram with numbers of included and excluded articles at each step of the review process.

Fig 2. Forest plot of the comparison of moderate-to-vigorous intensity physical activity between children and adolescents with chronic respiratory diseases and healthy participants.

SD: standard deviation; Std mean difference: Standardised mean difference; IV: Inverse variance; Random: random effect model; CI: 95% Confidence interval.

Fig 3. Forest plot of the comparison of daily moderate-to-vigorous intensity physical activity between children and adolescents with type 1 diabetes mellitus and healthy participants.

SD: standard deviation; Std mean difference: Standardised mean difference; IV: Inverse variance; Random: random effect model; CI: 95% Confidence interval.

Fig 4. Forest plot of the comparison of daily moderate-to-vigorous intensity physical activity between children and adolescents with malignancies and healthy participants.

SD: standard deviation; Std mean difference: Standardised mean difference; IV: Inverse variance; Random: random effect model; CI: 95% Confidence interval.