The Overflow Effects of Movement Behaviour Change Interventions for Children and Adolescents: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Abstract

Background: Considering the finite time within a 24-h day, the distribution of time spent on movement behaviours has been found to be associated with health outcomes.

Objectives: This systematic review and meta-analysis aimed to summarise and evaluate the overflow effects of interventions targeting a single behaviour (physical activity, sedentary behaviour/screen time, or sleep) on other non-targeted behaviours among children and adolescents.

Methods: Six databases (MEDLINE [Ovid], PsycINFO [ProQuest], EMBASE [Ovid], PubMed, Web of Science and SPORTDiscus [EBSCO]) were searched for relevant studies published before 13 May, 2024. Randomised controlled trials and clustered randomised controlled trials that targeted a single behaviour and also assessed the effects on non-targeted behaviours, comprised of healthy children under the age of 18 years, were included. Movement behaviours can be measured either objectively or subjectively. The revised Cochrane risk-of-bias tool for randomised trials was adopted to evaluate the risk of bias.

Results: A total of 102 studies with 45,998 participants from 21 countries were identified, and 60 of them with 26,183 participants were incorporated into the meta-analysis. The meta-analysis demonstrated that physical activity interventions led to a reduction in the proportion of each day spent in sedentary behaviour (mean difference = - 0.95% of wear time, 95% confidence interval - 1.44, - 0.45, I² = 39%). Sedentary behaviour interventions resulted in increased standing time (mean difference = 3.87%, 95% confidence interval 1.99, 5.75, I² = 0%). Interventions targeting screen time did not yield changes in physical activity or sleep. The findings on the effectiveness of sleep interventions on non-targeted behaviours and of physical activity interventions on sleep were inconclusive.

Conclusions: Overall, the findings suggested that interventions aimed at increasing physical activity or reducing sedentary behaviour had overflow effects on non-targeted behaviours, but the effect sizes were small. Additional evidence is needed to reach definitive conclusions regarding the impact of behaviour change interventions on sleep and of the overflow effects of sleep interventions.

Fig. 1

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. RCT randomised controlled trial

Fig. 2

Pooled analysis on the effect of physical activity intervention on sedentary behaviour (% of wear time). CI confidence interval, IV inverse variance, PE physical education, SD standard deviation, SMS text messages

Fig. 3

Pooled analysis on the effect of physical activity intervention on a sedentary behaviour (min/day), b screen time (min/day) and c sleep (min/day). CI confidence interval, IV inverse variance, SD standard deviation

Fig. 4

Pooled analysis on the effect of a sedentary behaviour intervention on standing (% of wear time), b sedentary behaviour intervention on stepping (% of wear time) and c screen time intervention on moderate-to-vigorous intensity physical activity (min/day). CI confidence interval, IV inverse variance, SD standard deviation