The influence of physical activity, sedentary behavior on health-related quality of life among the general population of children and adolescents: A systematic review

Abstract

Background: The association between physical activity, sedentary behavior and health-related quality of life in children and adolescents has been mostly investigated in those young people with chronic disease conditions. No systematic review to date has synthesized the relationship between physical activity, sedentary behavior and health-related quality of life in the general healthy population of children and adolescents. The purpose of this study was to review systematically the existing literature that evaluated the relations between physical activity, sedentary behavior and health-related quality of life in the general population of children and adolescents.

Methods: We conducted a computer search for English language literature from databases of MEDLINE, EMBASE, PSYCINFO and PubMed-related articles as well as the reference lists of existing literature between 1946 and the second week of January 2017 to retrieve eligible studies. We included the studies that assessed associations between physical activity and/or sedentary behavior and health-related quality of life among the general population of children and adolescents aged between 3-18 years. The study design included cross-sectional, longitudinal and health intervention studies. We excluded the studies that examined associations between physical activity, sedentary behavior and health-related quality of life among children and adolescents with specific chronic diseases, and other studies and reports including reviews, meta-analyses, study protocols, comments, letters, case reports and guidelines. We followed up the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement in the reporting of this review. The risk of bias of the primary studies was assessed by the Newcastle-Ottawa Scale. We synthesized the difference in health-related quality of life scores between different levels of physical activity and sedentary time.

Results: In total, 31 studies met the inclusion criteria and were synthesized in the review. Most of the included studies used a cross-sectional design (n = 21). There were six longitudinal studies and three school-based physical activity intervention studies. One study used both cross-sectional and longitudinal designs. We found that higher levels of physical activity were associated with better health-related quality of life and increased time of sedentary behavior was linked to lower health-related quality of life among children and adolescents. A dose-response relation between physical activity, sedentary behavior and health-related quality of life was observed in several studies suggesting that the higher frequency of physical activity or the less time being sedentary, the better the health-related quality of life.

Conclusions: The findings in this study suggest that school health programs promoting active lifestyles among children and adolescents may contribute to the improvement of health-related quality of life. Future research is needed to extend studies on longitudinal relationships between physical activity, sedentary behavior and health-related quality of life, and on effects of physical activity interventions on health-related quality of life among children and youth.

Fig 1. PRISMA flow diagram for selection and inclusion of the eligible studies.

Fig 2. Forest plot of the mean difference in PedsQL total scores between physically active and inactive children and adolescents.

Study by Lacy et al. 2011 has two groups: adolescents <15 years (Lacy et al. 2011); adolescents ≥15 years (Lacy2 et al. 2011).

Fig 3. Forest plot of the mean difference in PedsQL total scores between screen time of sedentary behavior.

Study by Gopinath et al. has two groups by screen time: the first group (Gopinath, et al. 2012) indicates 2nd tertile of screen time 2.57–3.86 hours relative to the non-sedentary group (≤2.5 hours/day); the second group (Gopinath2, et al. 2012) indicates 3rd tertile of screen time ≥3.93 hours relative to the non-sedentary group. Study by Lacy et al. has two groups by age of the adolescents: <15 years in the first group (Lacy et al., 2011); and ≥15 years in the second group (Lacy2 et al., 2011); the non-sedentary (reference) group is defined as total daily screen time≤2.0 hours/day.