Associations between physical activity, sedentary behaviour and self-rated health among the general population of children and adolescents: a systematic review and meta-analysis

Abstract

Background: Self-rated health (SRH) is an indicator that captures a person's perception of their overall health status. The relationship between physical activity (PA), sedentary behaviour (SB) and SRH has been investigated in systematic reviews among adult and elderly populations. No systematic review to date has synthesized the relationship between PA, SB and SRH among children and adolescents. The purpose of this systematic review and meta-analysis was to synthesize the associations between PA, SB and SRH in the general population of children and adolescents and to investigate the dose-response relationship between PA, SB and SRH.

Methods: We conducted a computer search for English language studies in the databases of MEDLINE, EMBASE and PSYCINFO that were published between 1946 and 2019. We searched PubMed, Google Scholar, and the references of the identified publications for additional studies. A meta-analysis was employed to synthesize the associations between PA, SB respectively and SRH. The dose-response association was tested using a random effects meta-regression model. The review was reported following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines.

Results: Sixty-eight published articles were included in the final review, including 59 cross-sectional and nine longitudinal studies. We found evidence that PA was associated with better SRH, and SB was associated with lower SRH among children and adolescents. A dose-response relationship between PA and SRH was observed, where a higher level of PA was associated with better SRH than a lower level of PA. The relationship between PA, SB and SRH was observed in both boys and girls, and did not show a significant gender difference.

Conclusions: The findings in the systematic review suggest that health intervention programmes targeting promoting PA and reducing SB among children and adolescents may enhance their overall health status. Future research is needed to expand prospective cohort and intervention studies to address directionality and causality in the relationships between PA, SB and SRH among children and youth.

Trial registration: PROSPERO - CRD42019142244 . Registered on October 18, 2019.

Keywords: Adolescents; Children; Meta-analysis; Physical activity; Sedentary behaviour; Self-rated health; Systematic review.

Fig. 1

PRISMA flow diagram for selection of the included studies

Fig. 2

Forest plot for the association between physical activity and self-rated health in children and adolescents (total sample): OR (95% CI) for poor health comparing a lower level with a higher level of physical activity. Legend: Matin (g1-g2): g1-Low PA vs. Moderate PA, g2-Low PA vs. High PA; Herman (g1-g2): g1-Inactive vs. Moderate active, g2-Inactive vs. High active; Meireles (g1-g2): g1-Insufficiently active vs. Active, g2-Inactive vs. Active; Dyremyhr (g1-g3): g1-No PA vs. Small PA, g2-No PA vs. Moderate PA, g3- No PA vs. High PA; Kahlin (g1-g2): g1-Low PA vs. Moderate PA, g2-Low PA vs. High PA; Piko (g1-g2) (2007a): g1-PA Sometimes vs. Regularly, g2-No or occasionally PA vs. Regularly. Kantomaa (g1-g2): g1-Poor/Moderate health vs. Good health, g2-Poor/Moderate health vs. Very good health

Fig. 3

Forest plot for the association between physical activity and self-rated health in children and adolescents (by gender): OR (95% CI) for poor health comparing low level with higher level of physical activity. Piko (g1-g2) (2007a): g1-PA Sometimes vs. Regularly, g2-No or occasionally PA vs. Regularly. Other study groups compared PA Low level vs. Moderate or High level

Fig. 4

Forest plot for the association between sedentary behaviour and self-rated health in children and adolescents (total sample): OR (95% CI) for poor health comparing higher sedentary time with lower sedentary time. Sedentary time levels: Granger (2017): ≥4 h/day vs. < 4 h/day; Foti (2010): ≥3 h/day vs. < 3 h/day; All other studies’ comparisons: ≥2 h/day vs. < 2 h/day

Fig. 5

Forest plot for the association between sedentary behaviour and self-rated health in children and adolescents (by gender): OR (95% CI) for poor health comparing higher sedentary time with lower sedentary time. Sedentary time levels: Richter (2009): ≥4 h/day vs. < 4 h/day; All other study comparisons: ≥2 h/day vs. < 2 h/day