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REVIEW Open Access
Behavioral determinants of physical activityacross the life
course: a “DEterminants ofDIet and Physical ACtivity”
(DEDIPAC)umbrella systematic literature reviewGiancarlo Condello1*†
, Anna Puggina2†, Katina Aleksovska2†, Christoph Buck3, Con Burns4,
Greet Cardon5,Angela Carlin6, Chantal Simon7, Donatella Ciarapica8,
Tara Coppinger4, Cristina Cortis9, Sara D’Haese5,Marieke De
Craemer5, Andrea Di Blasio10, Sylvia Hansen11, Licia Iacoviello12,
Johann Issartel13, Pascal Izzicupo10,Lina Jaeschke14, Martina
Kanning11, Aileen Kennedy15, Fiona Chun Man Ling6,16, Agnes
Luzak17,Giorgio Napolitano10, Julie-Anne Nazare7, Camille
Perchoux7, Caterina Pesce1, Tobias Pischon14, Angela
Polito8,Alessandra Sannella9, Holger Schulz17, Rhoda Sohun6, Astrid
Steinbrecher14, Wolfgang Schlicht11,Walter Ricciardi18,19, Ciaran
MacDonncha6†, Laura Capranica1†, Stefania Boccia18†
and on behalf of the DEDIPAC consortium
Abstract
Background: Low levels of physical activity (PA) are a global
concern and increasing PA engagement is becominga priority in
current public health policies. Despite the large number of studies
and reviews available, the evidenceregarding the behavioral
determinants of PA is still inconclusive. Thus, the aim of this
umbrella systematic literaturereview (SLR) was to summarize the
evidence on the behavioral determinants of PA across the life
course.
Methods: A systematic online search was conducted on MEDLINE,
ISI Web of Science, Scopus, and SPORTDiscusdatabases. The search
was limited to studies published in English from January, 2004 to
April, 2016. SLRs andmeta-analyses (MAs) of observational studies
that investigated the behavioral determinants of PA were
consideredeligible. The extracted data were assessed based on the
importance of the determinants, the strength of evidence,and the
methodological quality. The full protocol is available from
PROSPERO (PROSPERO 2014:CRD42015010616).
Results: Seventeen reviews on 35 behavioral determinants of PA
were eligible for this umbrella SLR. Regardless ofage, the most
investigated determinants were those related with ‘screen use’ and
‘smoking’. For youth, probablepositive evidence emerged for
‘previous PA’ and ‘independent mobility and active transport’ among
children andadolescents. For the adult population, ‘transition to
university’ and ‘pregnancy/having a child’ showed probablenegative
associations.(Continued on next page)
* Correspondence: [email protected]†Equal
contributors1Department of Movement, Human and Health Sciences,
University of RomeForo Italico, P.za Lauro de Bosis, 15, 00135
Rome, ItalyFull list of author information is available at the end
of the article
© The Author(s). 2017 Open Access This article is distributed
under the terms of the Creative Commons Attribution
4.0International License
(http://creativecommons.org/licenses/by/4.0/), which permits
unrestricted use, distribution, andreproduction in any medium,
provided you give appropriate credit to the original author(s) and
the source, provide a link tothe Creative Commons license, and
indicate if changes were made. The Creative Commons Public Domain
Dedication
waiver(http://creativecommons.org/publicdomain/zero/1.0/) applies
to the data made available in this article, unless otherwise
stated.
Condello et al. International Journal of Behavioral Nutritionand
Physical Activity (2017) 14:58 DOI 10.1186/s12966-017-0510-2
http://crossmark.crossref.org/dialog/?doi=10.1186/s12966-017-0510-2&domain=pdfhttp://orcid.org/0000-0001-5092-3258mailto:[email protected]://creativecommons.org/licenses/by/4.0/http://creativecommons.org/publicdomain/zero/1.0/
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(Continued from previous page)
Conclusions: Although the majority of the evidence was limited
and most of the determinants were notassociated with PA, this
umbrella SLR provided a comprehensive overview of the associations
between behavioraldeterminants and PA. Youth should be physically
active in the early years and increase active transportation
to/fromschool, independent mobility, and ‘free-range activities’
without adult supervision, whilst adult PA behaviors aremostly
influenced by the life events. Finally, more research is needed
that incorporates prospective study designs,standardized
definitions of PA, objective measurement methods of PA assessment,
and the use of interactionist andmediational approaches for the
evaluation of different behavioral determinants influencing PA
behaviors.
Keywords: Physical activity, Behavioral determinants, Umbrella
systematic literature review, Health promotion
BackgroundPhysical activity (PA) is widely recognized, together
withappropriate nutritional and mental status, to be an im-portant
component of healthy lifestyle [1]. Since thebenefits of being
physically active for the prevention andthe management of the
non-communicable diseases arewell known [2], the European Union
(EU) is strongly en-gaged in promoting health-enhancing physical
activity[3] for all individuals independently from age and
socialstatus. However, in Europe, a large proportion of chil-dren,
adolescents, adults, and older adults still adoptssedentary
lifestyles [4] and, consequently, are more atrisk of
non-communicable diseases.Several ecological models for the
exploration of the
lifestyle choice have been proposed [5–8], including in-dividual
(e.g., biological, psychological, and behavioralaspects),
interpersonal (e.g., relationships with parents,relatives, peers,
and socio-cultural networks), environ-mental (e.g.,
access/availability of tools/services, andproximal/distal
built/natural surroundings), and policy(e.g., organizational and
governmental aspects) dimen-sions. Within those dimensions,
positive, negative, incon-clusive, or no associations might exist
between severaldeterminants and PA. However, both determinants
andPA present a great diversity in research designs, measure-ment
approaches, populations studied, types of measure-ment,
terminologies, which still make difficult to draw acomprehensive
understanding. In general, the term ‘deter-minant’ is used to
address causal variables also includingcorrelates (i.e., multiple
variables intervening in cause-effect relationships), whilst
mediators (i.e., variables influ-encing a cause-effect relationship
between variables),moderators (i.e., variables effecting the
strength of a rela-tionship between variables), and/or confounders
(i.e., vari-ables associated with the outcome that distort
theobserved relationships) are considered different variables[9,
10]. Furthermore, a lack of commonality exists in thePA terminology
applied in the studies and different formsof PA are considered,
ranging from unstructured daily ac-tivities, occupational PA,
leisure time PA to structured PA(e.g., exercise, grassroots sports,
and competitive sports)and considering the most relevant parameters
of PA, such
as frequency (e.g., daily, weekly, monthly), duration
(e.g.,total time of activity, rest intervals), and intensity (e.g.,
low,moderate, moderate-vigorous, vigorous, maximal efforts).Within
the individual dimension, the determinants re-
lated to behaviour are widely investigated. Commonly,behavioral
determinants have been already defined as“those that can be
eliminated or reduces through life-style or behavioral changes”
[11]. Thus, among all ages,investigations into the behavioral
determinants consid-ered those related with major life changing
events (e.g.,pregnancy and retirement) [12], habits (e.g.,
smokingand alcohol consumption) [13], sedentary behaviors (e.g.,TV
viewing and video/computer game use) [14], andavailable mobility
(e.g., active school transport and inde-pendent mobility) [15, 16].
They have been studied in anumber of primary epidemiological
studies, systematicliterature reviews (SLRs), and meta-analyses
(MAs).However, the diversity in research designs, theoreticaland
measurement approaches, population groups, deter-minants
investigated, and PA outcomes, across the lit-erature, makes it
difficult to understand the evidenceand to draw appropriate
conclusions on the importanceof these determinants in influencing
PA behaviors.Recently, the European Commission endorsed a Joint
Programming Initiative to increase research capacityacross
Member States to engage in a common researchagenda on a Healthy
Diet for a Healthy Life [17] and theDEterminants of DIet and
Physical ACtivity-KnowledgeHub (DEDIPAC-KH) project was created
[18]. In orderto expand knowledge and to develop new insights
andsolutions in PA, the Thematic Area 2 of the DEDIPAC-KH project
organized and carried out an umbrella system-atic literature review
(SLR) [19] on all the possible deter-minants of PA. Overall, seven
categories of determinantsof PA have been identified: biological,
psychological, be-havioral, physical, socio-cultural,
socio-economic, and pol-icy determinants. Due to the amount of
researchesavailable, the DEDIPAC-KH Management Team decidedto
organize the findings in seven separated umbrella SLRs,each focused
on a single category. The DEDIPAC-KHManagement Team is conscious
that splitting the categor-ies may cause a lost in the analysis of
the interactions
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 2 of 23
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between those categories of determinants which mayshare
commonalities. However, this strategy was consid-ered necessary for
a clear dissemination of insights on thedeterminants of PA.The aim
of this umbrella SLR was to provide a system-
atic overview of studies investigating behavioral determi-nants
of PA across the life course by evaluating existingSLRs and MAs.
The summary also captures the differentstudy designs and
definitions applied for behavioral de-terminants and PA.
Additionally, overall results of theretrieved SLRs and MAs have
been evaluated in terms ofthe importance of the determinants, the
strength of theevidence, and the methodological quality.
MaterialsThe manuscript has been drafted following the
PRISMAchecklist [20]. A common protocol of the seven um-brella SLRs
(biological, psychological, behavioral, phys-ical, socio-cultural,
socio-economic, and policy) wasregistered and is available on
PROSPERO (Record ID:CRD42015010616), the international prospective
registerof systematic reviews [21]. Review title, timescale,
teamdetails, methods, and general information were all re-corded in
the PROSPERO register prior completing dataextraction.
Search strategy and eligibility criteriaThe present study
applied the same search strategy as wasused for the other umbrella
SLRs of the DEDIPAC-KH.SLRs and MAs investigating the determinants
of PAacross the life course were systematically searched onMEDLINE,
ISI Web of Science, Scopus, and SPORTDis-cus. The search was
limited to SLRs and MAs publishedin English, between January 2004
and April 2016. To avoidduplications of the earliest individual
studies, reviews pub-lished before 2004 were not included. Table 1
shows theMEDLINE search strategy, and Fig. 1 summarizes the
process of the literature research, common to the subse-quent 7
umbrella SLRs. Thus, Table 1 provides the overalllist of searched
terms, whilst Fig. 1 shows the count of theoverall
excluded/included reviews, related and not-relatedwith behavioral
determinants. SLRs or MAs of observa-tional primary studies on the
association between any de-terminant and PA, exercise (Ex) or sport
as the mainoutcome, were included in the seven umbrella SLRs.
Thefollowing studies were excluded: i) SLRs and MAs ofintervention
studies; ii) SLRs and MAs that focused onspecific population groups
(e.g., chronic diseases); and iii)umbrella SLR’s on the same topic
(e.g., reviews of SLRs orMAs of epidemiological studies on
variables in associationwith PA). In line with Peel and colleagues
[10], behavioraldeterminants were defined as “those that can be
elimi-nated or reduced through lifestyle or behavioral
changes”.
Selection processRelevant articles were independently screened
and assessedby two reviewers belonging to the DEDIPAC-KH,
whoscreened the titles, the abstracts, and the full texts.
Beforethe final study inclusion or exclusion, a common decisionwas
reached for each study. Any uncertainty and disagree-ment was
resolved by consulting three further authors ofthe DEDIPAC-KH (BS,
CL, PA).
Data extractionFor each included review, data was extracted on a
prede-fined data extraction form, developed by the DEDIPAC-KH and
checked by two authors (AK, PA). In reportingdata, authors agreed
to use the terms “reviews” as thoseSLRs and MAs found eligible for
the umbrella SLR, and‘primary studies’ as those studies included in
the eligibleSLRs and MAs. Moreover, authors agreed to consider
allof the terminologies and forms of PA, including unstruc-tured
(i.e., PA linked with daily life) and structured (i.e.,
Table 1 Search strategy: key words used for the literature
research
Set Search terms
#1 “physical activit*” OR “physical exercise*” OR sport OR
“motor activit*” OR “locomotor activit*” OR athletic* OR fitness OR
“physical movement*”OR “physical performance*” OR “aerobic
exercise*” OR “physical effort*” OR “physical exertion*”
#2 determinant OR determinants OR correlate OR correlates OR
mediator OR mediators OR moderator OR moderators OR contributor
ORcontributors OR factor OR factors OR association OR modifier OR
modifiers OR confounder OR confounders OR pattern OR patterns
ORpredictor*
#3 demographic* OR motivation OR cognition OR emotion* OR
attitude* OR “self-perception” OR “self-confidence” OR
“self-efficacy” ORcompetence OR reward* OR success* OR challenge*
OR knowledge OR belief* OR “personal trait*” OR “body image” OR
satisfaction OR “timeavailability” OR “perceived environment” OR
family OR peer* OR school* OR leader* OR coach* OR group* OR
“climate” OR network* ORemployment OR retirement OR “educational
level” OR SES OR “socioeconomic status” OR “local identity” OR
“national identity” OR value* ORtradition* OR “social expectation*”
OR “social trend*” OR “social barriere*” OR “availability of tool*”
OR “availability of service*” OR “access to tool*”OR “access to
service*” OR neighborhood OR “community route*” OR “school
environment” OR “work environment” OR architecture ORurbanization
OR transport OR traffic OR “facilit* in public space*” OR
advertisement OR “availability of sport club*” OR “availability of
fitnesscenter*” OR advocacy OR lobbying OR “corporate social
responsibility” OR “physical activity promotion initiative*” OR
legislation OR health OReducation OR tourism OR environment OR
“urban planning” OR transport* OR sport OR sports OR culture OR
dance OR theater OR “gendermainstreaming” OR “social inclusion” OR
“fiscal measure*” OR program* OR plan OR plans OR communication OR
media OR guideline*
#4 “systematic literature review” OR “meta-analysis”
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 3 of 23
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exercise and sports) independently from their
frequency,duration, and intensity.The following information was
extracted from each in-
cluded review: year of publication, type of review (eitherSLR or
MA), number of eligible primary studies in-cluded in the behavioral
umbrella SLR over the totalnumber of primary studies included in
the review, con-tinent/s of the included primary studies, primary
studydesign, overall sample size, age range or mean age, gen-der
proportion, year of publication range of included pri-mary studies,
outcome details, type of determinant/s,aim of the review, overall
results (qualitative or quantita-tive), overall recommendations,
and limitations as pro-vided by the review itself.
Evaluation of importance of determinants andstrength of the
evidenceThe results retrieved from the eligible primary
studiesincluded in the reviews were summarized combining
twoslightly modified grading scales, previously used bySleddens et
al. [22]. The first scale, grades the importanceof the
determinants, referring only to the consistency anddirection of the
associations among the reviews, or the in-dividual primary studies.
The second scale, grades thestrength of evidence, referring to the
study design usedamong individual primary studies. For its
importance, a de-terminant scored a “–” if all reviews, without
exception, re-ported a negative association between the determinant
and
the outcome and a “-” if the negative association was foundin
more than 75% of the reviews or of the original primarystudies. The
importance of the determinant was scored a“0” if the results were
mixed, or more specifically, if thevariable was found to be a
determinant and/or reported anassociation (either positive or
negative) in 25 to 75% ofavailable reviews or of the primary
studies of these reviews,but not in others. Furthermore, the
importance of the de-terminant scored a “+” if a positive
association was foundin more than 75% of the reviews or of the
included primarystudies and a “++” if a positive association was
found in allreviews, without exception. Despite in the literature
thecodes “+” and “++” were used in presence of an associ-ation,
independently from its direction (e.g., positive ornegative) [22],
in the present SLR these codes denote boththe strength and positive
direction of the association.The strength of the evidence was
described as ‘convin-
cing’ (Ce) if it was based on a substantial (n > 10) numberof
longitudinal observational studies showing associationsbetween the
determinant and PA. The strength of the evi-dence was defined as
‘probable’ (Pe) if it was based on atleast two cohort studies or
five cross-control studiesshowing associations between the
determinant and PA.Furthermore, the strength of the evidence was
given as‘limited suggestive evidence’ (Ls) if it was based mainly
onfindings from cross-sectional studies showing associationsbetween
the determinant and PA. Evidence was labelled as‘limited, no
conclusive evidence’ (Lns) if the study findings
Fig. 1 Flowchart of the literature research by database
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 4 of 23
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were suggestive but insufficient to provide an
associationbetween the determinant and PA [and if no
longitudinaldata available].
Quality assessmentThe methodological quality of the included
reviews wasassessed using a modified version of the AMSTAR
Check-list [23]. After a consensus between the DEDIPAC-KHpartners,
the question (number 11) referring to the pres-ence of any conflict
of interest was modified to allow forany conflict of interest to be
evaluated in any of the in-cluded reviews but not in the primary
studies included ineach review.Two authors belonging to the
DEDIPAC-KH inde-
pendently evaluated the included reviews, using thesame
methodology of Sleddens et al. [22]. Any uncer-tainty and
disagreement was resolved by consultingthree further authors (SB,
LC, AP). The eleven criteriawere evaluated and scored with 1 when
the criterion wasapplicable to the analyzed review or with 0 when
the cri-terion was not fulfilled, not applicable to the analyzed
re-view, or could not be answered based on the informationprovided
by the review. As a consequence, the total qual-ity score for each
included review ranged from 0 to 11.The quality of the review was
labelled as weak (score ran-ging from 0 to 3), moderate (score
ranging from 4 to 7),or strong (score ranging from 8 to 11).
ResultsSLRs and MAs selection processAs summarized in Fig. 1,
the systematic literature searchidentified 17,941 reviews that were
potentially relevantfor inclusion in our umbrella SLR. After the
removal ofduplicates, 15,147 reviews remained for screening.
Afterreading title and abstract, 12,414 and 2,198 reviews,
re-spectively, were excluded because they did not meet theinclusion
criteria. Thus, a total of 535 full-text reviewswere assessed for
eligibility. From these, another 472 re-views were removed because
they did not meet the in-clusion criteria. Thus, after the
full-text reading phase,the number of reviews eligible for the
umbrella reviewwas 63. Of these, 46 reviews did not include
behavioraldeterminants of PA. Therefore, the final number of
re-views included in the present umbrella SLR on behav-ioral
determinants of PA was 17 (15 SLRs and 2 MAs).
Characteristics of the reviews and quality assessmentThe
characteristics of the 17 included reviews are summa-rized in Table
2. All the primary studies included in the in-dividual SLRs or MAs
referring to non-behavioraldeterminants and PA were not considered.
Most of the re-views included primary studies from multiple
continents,mostly from Europe, North America, and Australia.
Thepredominant study design used among the primary studies
was cross-sectional [12, 13, 15, 16, 24–33]. Nine
reviewsincluded prospective and cohort studies, either as the
onlyeligible study design [34, 35] or as part of the
includedstudies [12, 15, 16, 25, 26, 29, 32]. In six reviews, it
was notpossible to retrieve the total population sample size of
theincluded primary studies because it was either not reportedor
not complete [26, 27, 29, 30, 32, 33]. In the remainingstudies, the
total population sample size ranged from 26[12] to 82,918
[13].Eleven reviews referred to primary studies that in-
cluded young people only. Among these, preschool chil-dren aged
between 4 and 6 years old were assessed inone review [26], whilst
children and adolescents (8–18years) were included in ten of the
reviews [14–16, 28–30, 32–35]. Three reviews considered adults
older than40 years [24, 25, 27], while three other reviews
consid-ered the population as a whole [12, 13, 31]. Finally,
thepercentage of the female participants, when reported,ranged from
0 [25] to 100% [16, 25, 35], though thatdata was absent in the
majority of the studies [12–14,26–30, 32–34].
Measurements of PAFrom the 17 reviews included, 461 primary
studies werefound eligible. Among these, 218 studies from 15
re-views used non-objective measurement methods of PAassessment
(e.g., self-report, parental report, direct PAobservation) [12, 13,
15, 16, 24, 25, 27–35]. Objectivemeasurements of PA, either
assessed by accelerometeror pedometer, were used in 201 of the
eligible primarystudies and were included in nine of the included
re-views [15, 16, 28–30, 32–35]. Eleven primary studies in-cluded
in four reviews combined objective with non-objective measures of
PA [15, 28, 29, 34]. Finally, 31 pri-mary studies from two reviews
did not report the exactnumber of the studies that used objective
and non-objective measures [14, 26].As reported in Table 3, the
majority of the included re-
views evaluated overall PA as an outcome (n = 13) [12–16,24–26,
28, 29, 32, 34, 35]. One review also measuredmoderate-to-vigorous
physical activity (MVPA) and activetransport [26] next to overall
PA. Two reviews measuredoverall PA/Ex [27, 31], one review measured
time-specificPA (i.e., school break time PA and after-school PA)
[30]and one review measured recess PA [33].
Categorization of the included determinantsDuring the
preliminary phase, 52 behavioral determi-nants of PA were
identified. Among those, similar deter-minants were identified to
form a single determinant.For example, the determinants ‘TV
viewing’, ‘TV viewing/playing video games’, ‘television
viewing/sedentary’, ‘enjoytelevision viewing’, ‘video/computer game
use’, ‘computer’,‘screen time’, and ‘video games’ were merged into
the
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 5 of 23
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Table
2Characteristicsof
theinclud
edreview
s
Autho
r,Date
(Typeof
review
)[Ref]
Num
berof
eligiblestud
ies
includ
edin
theum
brella
review
/totalnu
mbe
rof
stud
iesinclud
edin
thereview
Con
tinen
t/sof
includ
edstud
ies
Stud
yde
sign
ofinclud
edstud
ies
Totalsam
plesize
ofinclud
edstud
y(Sam
plerang
e)
Age
rang
eor
mean(years)
ofeligiblestud
ies
Gen
der(female,%
rang
e)of
eligible
stud
ies
Year
rang
eof
includ
edstud
ies
BabakusWS,2012
(SLR)[24]
6/38
Europe
(n=6)
In-dep
thinterviews(n=2)
Focusgrou
p(n=1)
Semi-structuredinterviews
(n=1)
N.A.(n=2)
276(30–109)
N.A.(n=2)
40–83
N.A.(n=2)
39–53
N.A.(n=2)
1980–2012
BarnettI,2012
(SLR)[25]
19/19
North
America(n=11)
Europe
(n=6)
Australia(n=2)
Coh
ort(n=14)
Cross-sectio
nal(n=5)
62,455
(51–11,469)
45–99
0–100
1985–2010
Cragg
sC,2011
(SLR)[34]
13/46
North
America(n=11)
Europe
(n=2)
Prospe
ctive(n=13)
13,332
(40–3,878)
4–9(n=1)
10–13(n=8)
14–18(n=4)
N.A.
1986–2009
DeCraem
erM,
2012
(SLR)[26]
7/43
N.A.
Cross-sectio
nal(n=6)
Long
itudinal(n=1)
N.A.
4–6
N.A.
2003–2010
Engb
ergE,2012
(SLR)[12]
32/34
Europe
(n=7)
North
America(n=22)
Australia(n=3)
Cross-sectio
nalretrospective
(n=7)
Prospe
ctivelong
itudinal
(n=25)
276,558
(26–80,944)
17–70
N.A.
1992–2012
KaczynskiA
T,2008
(SLR)[13]
50/50
North
America(n=23)
Europe
(n=18)
Australia(n=3)
Asia(n=1)
Multip
leCon
tinen
ts(n=
1) N.A.(n=4)
Mostly
cross-sectional
381,807
(120–82,918)
6–89
N.A.
1970–2005
Koen
eman
MA,
2011
(SLR)[27]
2/34
Australia(n=1)
Asia(n=1)
Observatio
nal(n=2)
N.A.
40–80
N.A.
2007
Larouche
R,2014
(SLR)[15]
46/73
Europe
(n=25)
North
America(n=9)
SouthAmerica(n=1)
Asia(n=1)
Australia(n=9)
Russia(n=1)
Cross-sectio
nal(n=41)
Prospe
ctive(n=5)
66,489
(103–7,023)
5–17.9
532002–2012
LeeMC,2008
(SLR)[28]
24/32
North
America(n=9)
Europe
(n=10)
Australia(n=5)
Cross-sectio
nal(n=24)
33,756
(88–10,771)
5–18
N.A.
2002–2007
MarshallSJ,2004
(MA)[14]
24/54
N.A.
N.A.
1443,235
(36–20,766)
0–18
N.A.
1990–2002
PearsonN,2014
(MA)[29]
163/163
Multip
leCon
tinen
tsProspe
ctive(n=12)
Cross-sectio
nal(n=147)
N.A.
0–18
N.A.
1987–2013
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 6 of 23
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Table
2Characteristicsof
theinclud
edreview
s(Con
tinued)
Prospe
ctiveandCross-sectio
nal
(n=4)
Ridg
ersND,2012
(SLR)[33]
3/53
Europe
(n=2)
Australia(n=1)
Cross-sectio
nal(n=2)
N.A.(n=1)
N.A.
5–18
N.A.
2006–2010
Scho
eppe
S,2013
(SLR)[16]
42/52
Europe
(n=25)
North
America(n=9)
Asia(n=1)
Australia(n=6)
Russia(n=1)
Cross-sectio
nal(n=39)
Long
itudinal(n=3)
55,896
(103–6,085)
3–18
39–100
2002–2012
StanleyRM
,2012
(SLR)[30]
6/22
Europe
(n=1)
North
America(n=4)
Australia(n=1)
Cross-sectio
nal(n=6)
N.A.
8–14
N.A.
1997–2010
TzormpatzakisN,
2007
(SLR)[31]
3/36
Europe
(n=3)
Cross-sectio
nal(n=3)
4,213
(171–1,000)
15–89
50–54
2002–2004
Uijtde
willinge
nL,
2014
(SLR)[35]
11/30
Europe
(n=5)
North
America(n=5)
Asia(n=1)
Prospe
ctive(n=11)
11,259
(155–5,451)
4–18
51–100
(n=10)
N.A.(n=1)
2005–2010
vande
rHorstK,
2007
(SLR)[32]
10/57
N.A.
Cross-sectio
nal(n=8)
Prospe
ctive(n=2)
N.A.
4–12
(n=3)
13–18(n=7)
N.A.
1999–2004
Notes:M
A:M
eta-Ana
lysis;SLR:
System
aticLiterature
Review
;N.A.:Not
App
licab
le
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 7 of 23
-
Table
3Results
oftheinclud
edreview
s
Autho
r,Date(Type
ofreview
)[Ref]
Outcome(s)
Determinant(s)
Review
aim
Overallqu
alitativeresults
ofthereview
Overall
quantitative
results
ofthereview
Overalllim
itatio
nsof
the
stud
yOverallRecommen
datio
ns
BabakusWS,2012
(SLR)[24]
OverallPA
Lang
uage
difficulties;lackof
time
Toassess
whatisknow
nabou
tthelevelsof
PAand
sede
ntarytim
eandto
contextualizethese
behaviorsam
ongSouth
Asian
wom
enwith
anim
migrant
backgrou
nd.
SouthAsian
wom
enareless
activethan
theothe
rethn
icgrou
psas
wellascompared
toSouthAsian
males;
know
ledg
eof
PAandits
bene
fitswas
foun
dto
belackingam
ongsouthAsian.
N.A.
Nostandardized
metho
dfor
quality
evaluatio
n;lack
ofde
tails
from
someof
the
includ
edpape
rs;
measuremen
tandde
finition
ofPA
variedwidely;
publicationandresearcher
bias
possibility;significant
heteroge
neity
amon
gstud
ies.
Moreresearch
shou
ldbe
dedicatedto
standardize
objectivePA
measuremen
tandto
unde
rstand
how
toutilize
theresourcesof
the
individu
alsandcommun
ities
toincrease
PAlevelsand
overallh
ealth
ofSouthAsian
wom
en;futureresearch
isne
eded
toassess
levelsof
sede
ntarytim
eand
contextualizesede
ntary
behaviors.
BarnettI,2012
(SLR)[25]
OverallPA
Workafterretirem
entfro
mmainoccupatio
n;retirem
ent
from
strenu
ousoccupatio
n;be
ingretired
for<5years;
lifelon
gparticipationin
PA;
beingmarried
Toexam
inechange
sand
pred
ictorsof
change
sin
PAacross
thetransitio
nto
retirem
ent;whe
ther
these
change
svary
bySES;what
isknow
nabou
tpred
ictors
ofchange
sin
PAacross
the
retirem
enttransitio
n.
Exercise
andleisure-tim
ePA
increasedafterthetransitio
nto
retirem
ent,whe
reas
the
finding
sregardingchange
sin
totalP
Awere
inconclusive;m
enincrease
theirPA
morethan
wom
en;
lower
SESisassociated
with
ade
crease
andhigh
SES
with
anincrease
inPA
.Eviden
ceon
othe
rpred
ictors
was
scarce,o
ften
inconsistent,and
metho
dologically
weak.
N.A.
Eviden
ceon
pred
ictorsof
change
was
scarce
and
metho
dologically
weak;no
lang
uage
orcoun
try
restrictio
ns;p
ublishe
dpe
er-
review
edjournalarticlesas
wellasgray
research
literaturewereinclud
ed;
multid
isciplinaryapproach
contrib
uted
tothe
heteroge
neity
oftheresults
andto
theun
feasibility
ofmeta-analysis.
Furthe
rstud
iesshou
ldinclud
eothe
rmeasuresof
SES,approp
riate
andvalid
PAmeasures,applyclear
andrelevant
defın
ition
sof
retirem
ent,andstud
ypred
ictorsof
PAchange
across
thetransitio
nto
retirem
ent;qu
alitative
stud
iesandlong
itudinal
stud
ieswith
long
erfollow-
uparene
eded
.
Cragg
sC,2011
(SLR)[34]
OverallPA
Vigo
rous
PA;p
articipationin
sportteam
sou
tsidescho
ol;
previous
PA;alcoh
olconsum
ption;
dietaryhabits;
smokingstatus;sed
entary
behavior
Tocollate
thecurren
teviden
cebase,h
ighlight
research
tren
dsand
limitatio
nsin
physical
activity
determ
inants
research,and
synthe
size
the
existin
geviden
ce.
Inconclusive
associations
wererepo
rted
forlarge
prop
ortio
nof
the
determ
inantsexam
ined
;girls
consistentlyrepo
rted
larger
declines
inPA
than
boys
inyoun
gerchildren;
parental
maritalstatuswas
consistentlyshow
nno
tto
beassociated
with
change
inactivity;h
ighe
rlevelsof
self-efficacywereassociated
with
smallerde
clines
comparedto
lower
levelsof
selfefficacyin
olde
rchildren
andadolescents.
N.A.
Possibility
ofpu
blicationbias
(includ
edpu
blishe
dstud
ies
only);he
teroge
neity
instud
ysamples,exposureand
outcom
emeasuresinclud
edin
thisreview
;som
estud
ies
draw
data
from
thesame
coho
rts;semi-q
uantitative
repo
rtingused
inthereview
that
limits
theclassification
oftheassociations.
Furthe
rresearch
shou
ldinclud
eob
jectivemeasures
ofPA
andusepreviously
validated
questio
nnairesto
assess
theinvestigated
determ
inants;m
orehigh
quality
research
isne
eded
inallage
grou
ps,especially
inyoun
gerchildren;
investigationinto
determ
inantsof
change
shou
ldtake
into
accoun
tof
specifıcph
ysicalintensities
such
asminutes
spen
tin
mod
erateor
vigo
rous
physicalactivity.
DeCraem
erM,
2012
(SLR)[26]
OverallPA
,MVPA,
activetransport
Participationin
organized
sports;televisionview
ing/
sede
ntary;en
joytelevision
view
ing;
child
hasno
energy
touseactivetransport
Tosystem
aticallyreview
the
correlates
ofPA
,sed
entary
andeatin
gbe
havior
inpreschoo
lchildren4-6years
old.
Atten
ding
aruralp
rescho
olwas
positivelyassociated
with
physicalactivity;
gend
er,age
and
socioe
cono
micstatus
were
notassociated
with
physical
N.A.
Somelim
itatio
nsregarding
thecoding
ofthe
associationof
thevariables;
new
catego
riesforeach
behavior
weremade.
Future
research
shou
ldfocus
oniden
tifying
thecommon
correlates
ofph
ysicalactivity,
sede
ntarybe
havior
and
eatin
gbe
havior
inpreschoo
l-age
dchildrenso
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 8 of 23
-
Table
3Results
oftheinclud
edreview
s(Con
tinued)
activity,w
hilean
inde
term
inateresultwas
foun
dforethn
icity;g
ende
randethn
icity
wereno
tassociated
with
sede
ntary
behavior
andinde
term
inate
results
werefoun
dforage
andsocioe
cono
micstatus;
preschoo
lersweremore
physicallyactiveas
wellas
sede
ntaryon
weekdays;
watchingtelevision
was
associated
with
ahigh
erconsum
ptionof
snacks
and
sweetbe
verage
s.
that
better
tailored
interven
tions
couldbe
develope
d.Furthe
rmore,
morelong
itudinalstudies
couldcontrib
utein
draw
ing
strong
erconclusion
son
determ
inantsof
theseEBRBs.
Engb
ergE,2012
(SLR)[12]
OverallPA
Transitio
nto
university;
change
inem
ploymen
tstatus;m
aritaltransition
sandchange
sin
relatio
nships;p
regn
ancy/
having
achild;experiencing
harassmen
tat
work,
violen
ceor
disaster;m
oving
into
aninstitu
tion
Toexam
ineliterature
concerning
theeffectsof
lifeeven
tson
change
sin
PA.
Mostof
thestud
iesreview
edshow
edstatistically
sign
ificant
change
sin
PAassociated
with
certainlife
even
ts;transition
toun
iversity,havingachild,
remarriage
andmassurban
disaster
wereassociated
with
decreasedPA
levels,
whileretirem
entwas
associated
with
increased
PA;experiencingmultip
lesimultane
ouslifeeven
tswereassociated
with
decreasedPA
inmen
and
wom
en;PAisoftenused
aspartof
arehabilitation
prog
rammefordiseases.
N.A.
Self-repo
rted
PAdata
are
likelyto
besomew
hat
limited;
anothe
rlim
itatio
nis
thepo
ssiblecross
contam
inationof
respon
ses
whe
nPA
levelsbe
fore
and
afteralifeeven
twere
assessed
atthesametim
e;thege
neralizationof
stud
yfinding
sto
lower
socioe
cono
micstatus
and
ethn
icminority
popu
latio
ns,
aswellasto
othe
rcoun
tries,
may
belim
itedbe
causePA
andlifeeven
tsvary;
limitatio
nsof
thestud
ies
includ
ethat
PAdata
were
notalwaysrepo
rted
inde
tail;somestud
iesdidno
tanalyze,statistically,the
magnitude
ofchange
inPA
;anothe
rim
portantlim
itatio
nisthat
lifeeven
tstend
tooverlap.
Future
stud
iesshou
ldexam
inege
nder
differences
intheeffectsof
lifeeven
tsandusevalidated
metho
dsin
assessingleisurePA
.Long
itudinalcoh
ortstud
ies
andclinicaltrialsfro
mdifferent
coun
triesand
cultu
resarene
eded
.Studies
with
long
erfollow-ups
are
necessaryto
exam
ineho
wlong
theeffectsof
life
even
tson
PApe
rsist.
KaczynskiA
T,2008
(SLR)[13]
OverallPA
Smoking
Tobe
tter
unde
rstand
the
co-occurrenceof
smoking
andph
ysicalinactivity
inbo
thadultsandyouth.
Inapproxim
ately61%
ofthe
stud
iesof
adultpo
pulatio
ns,
theassociationbe
tween
smokingandPA
was
negative,less
pron
ounced
foryouthandadolescents,
andam
ongmales
than
females.
N.A.
Someauthorsde
fined
asm
oker
assomeo
newho
smoked
atleaston
cein
the
past30
days
whe
reas
othe
rstud
iesused
thecriterio
nof
atleaston
ecigarettepe
rdayover
thepastmon
th.
Furthe
rcomplicating
interpretatio
nsisthefact
that
controlling
foror
includ
ingdifferent
variables
change
stheim
pact
ofthe
"predictor"variables
onthe
"outcome"
measures.Alm
ost
allo
ftheaforem
entio
ned
Researchersho
ping
toim
proveun
derstand
ingof
thejointrelatio
nbe
tween
PAandsm
okingne
edto
collect
data
atbo
ththe
individu
alandorganizatio
n(i.e.,enviro
nmen
t)levels.
Und
erstanding
the
mechanism
sby
which
depression
,lun
gfunctio
n,scho
olsetting,
orothe
rfactorsmed
iate
ormod
erate
thesm
okingandPA
relatio
nshiprequ
ires
measuremen
tof
these
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 9 of 23
-
Table
3Results
oftheinclud
edreview
s(Con
tinued)
stud
ieswerecross-sectional,
andso
inferringcausality
orthedirectionof
relatio
nships
isne
arim
possible.
variables
atmultip
le(preferablythreeor
more)
pointsin
time.By
expand
ing
thearrayof
investigative
metho
dsem
ployed
,researcherswillbe
better
equipp
edto
unde
rstand
linkage
sbe
tweensm
oking
andPA
andto
design
effectiveinterven
tions.
Koen
eman
MA,
2011
(SLR)[27]
OverallPA
,OverallEx,
OverallPA
/Ex
Baselineactivity
level;
smoking
Tosystem
aticallyreview
determ
inantsof
PAand
exercise
amon
ghe
althy
olde
radults.
Insufficien
teviden
cefor
mostassociations
betw
een
possiblede
term
inantsand
PAor
Ex.
N.A.
Theremay
bepo
ssibility
ofpu
blicationbias;a
wideage
rang
eisappliedthat
might
have
maskedsomeof
the
differences
betw
een
subsam
ples
inside
that
popu
latio
n;they
exclud
edsomespecificsubsam
ples
oftheolde
rpo
pulatio
n;overall
low
quality
ofthestud
ies
includ
ed
Thede
term
inantsof
PAne
edfurthe
rstud
ythat
includ
etheuseof
objective
measuresof
PAandexercise
andvalid
andreliable
measuresof
determ
inants.
Larouche
R,2014
(SLR)[15]
OverallPA
Activescho
oltransport
Tosystem
aticallyassess
the
quality
ofeviden
cewith
respectto
therelatio
nship
betw
eenactivescho
oltransportanddaily
PA,
cardiovascular
fitne
ss,and
body
compo
sitio
n.
Overall,81.6%
ofthestud
ies
show
edpo
sitiveassociations
betw
eenactivescho
oltransportandPA
levelswith
mod
eratequ
ality
ofeviden
ce.
N.A.
Meta-analyses
were
preclude
ddu
eto
thewide
heteroge
neity
instud
ymetho
dologies
andanalyses.
Furthe
r,thefunn
elplot
and
relatedstatisticalmetho
dsforde
tectingpu
blication
bias
couldno
tbe
used
becauseaconsistent
measure
ofeffect
across
stud
ieswas
notavailable.
Future
activescho
oltransportstud
iesshou
ldanalyzewalking
andcycling
separately.Futurestud
ies
couldevaluate
theim
pact
ofexistin
gprog
ramsthat
prom
oteactivescho
oltransporton
PAlevelsand
health
relatedou
tcom
es.
Future
stud
iesshou
ldconsider
assessingactive
scho
oltransportas
acontinuo
usvariable(i.e.,
frequ
ency
×distance).
LeeMC,2008
(SLR)[28]
OverallPA
Activecommutingto
scho
olThisarticlepresen
tsa
system
aticreview
ofthe
literatureon
active
commuting(walking
orbicycling)
andthe
outcom
esof
physical
activity
andweigh
t/ob
esity
inscho
ol-age
children.
Inmultip
lestud
iesin
anu
mbe
rof
coun
tries,a
sign
ificant
association
betw
eenph
ysicalactivity
andwalking
orcyclingto
scho
olhasbe
enno
ted
across
manyagegrou
psof
scho
olchildren.
Thestreng
thof
theassociationismixed
andasummaryestim
ateis
notpo
ssiblebe
causeof
the
heteroge
neity
instud
yde
sign
.Reg
ardlessof
this
association,
itremains
unclearas
towhe
ther
the
commutetrip
itselfisa
sign
ificant
compo
nent
oftotalp
hysicalactivity.
N.A.
Thede
finition
ofactive
commutingandthe
potentialfor
misclassification
bias;the
metho
dology
ofmeasurin
gph
ysicalactivity;
themajority
ofcross-
sectionalstudies.
Future
research
shou
ldfocus
onmeasurin
gtheim
pact
ofinterven
tions
that
succeedin
changing
commuting
behavior
andqu
antifying
the
contrib
utionof
the
commuteto
children’sdaily
activity.
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 10 of 23
-
Table
3Results
oftheinclud
edreview
s(Con
tinued)
MarshallSJ,2004
(MA)[14]
OverallPA
TVview
ing;
vide
o/compu
ter
gameuse
Toexam
inetheeviden
cethat
sede
ntarybe
haviors
displace
physicalactivity.
Possiblemechanism
slack
supp
ortin
geviden
ceand
claimsthat
TVview
ing,
playingvide
ogames
orusingcompu
tersdisplace
physicalactivity
receivevery
limitedem
piricalsupp
ort.
−0.096(95%
CI=
-0.080,-0.112)
-0.104
(95%
CI=
-0.080,-0.128)
Onlystud
ieswrittenin
English.
Moreexpe
rimen
talresearch
isne
eded
toreplicatethese
finding
sandexplore
possiblemechanism
s.
PearsonN,2014
(MA)[29]
OverallPA
Totalsed
entary
behavior;
compu
ter;ho
mew
ork;
internet;reading
;screen
time;television
;video
games;com
posite
sede
ntary
behavior
Theaim
ofthecurren
tstud
ywas
tosystem
atically
review
andmeta-analysis
peer-reviewed
research
describ
ingtheassociation
betw
eensede
ntarybe
havior
andPA
inchildrenand
adolescents.
Asign
ificant,b
utsm
all,
negativeassociationwas
foun
dbe
tweensede
ntary
behaviorsandph
ysical
activity
inchildrenand
adolescents;in
mod
erator
analyses,studies
that
recruitedsm
allersamples,
employed
objective
metho
dsof
measuremen
tor
wereassessed
tobe
ofhigh
ermetho
dological
quality
repo
rted
strong
erassociations,alth
ough
the
magnitude
ofeffect
remaine
dsm
allo
rsm
allto
mod
erate;sm
allinverse
associations
wereob
served
betw
eenspecificsede
ntary
behaviou
rs,including
Internet
use,screen
time
andTV
view
ing,
andph
ysical
activity.
−0.108(95%
CI=
-0.128,-0.087)
-0.018
(95%
CI=-0.038,0.001)
0.014(95%
CI=-0.043,0.095)
-0.051
(95%
CI=
-0.097,-0.006)
-0.009
(95%
CI=-0.039,0.021)
-0.080
(95%
CI=
-0.101,-0.060)
-0.064
(95%
CI=
-0.084,-0.045)
-0.002
(95%
CI=-0.043,0.040)
-0.265
(95%
CI=
-0.364,-0.165)
Dicho
tomizationof
acontinuo
usconstruct;
searches
wereconfined
tostud
iespu
blishe
din
peer-
review
edjournalsandthose
writtenin
English;
evaluatio
nof
associations
betw
een
sede
ntarybe
havior
andall
PAou
tcom
escombine
d,insteadof
different
PAdo
mains.
Furthe
rresearch
isrequ
ired
toclarify
therelativeand
interactingim
pact
ofPA
and
sede
ntarybe
havior
onweigh
tstatus
inthis
popu
latio
n.
Ridg
ersND,2012
(SLR)[33]
Recess
PASportactivities;p
hysical
conflictfre
quen
cy;d
ay-to-
dayvariability;play
ball
games;sed
entary
activities
Toexam
inethecorrelates
ofchildren’sand
adolescent’sPA
durin
gscho
olrecess
perio
ds.
Highe
rpe
rceived
encouragem
entfro
mparents,pe
ers,andthe
scho
olas
awho
lewas
associated
with
high
erself-
repo
rted
physicalactivity
levelsdu
ringrecess
perio
ds,
particularlyin
adolescents;
overallfacility
provision(i.e.,
sum
offacilitiesavailable)
was
positivelyassociated
with
physicalactivity;a
positiveassociationwas
foun
dbe
tweenun
fıxed
equipm
entandrecess
physicalactivity
inchildren;
boys
aremoreph
ysically
activedu
ringrecess.
N.A.
Themajority
aresm
all-sized
andcross-sectionalstudies;
meta-analysisisdifficultto
obtain
giventhelim
ited
numbe
rof
stud
iesandthe
lack
ofconsistencyin
correlates
assessed
;arang
eof
physicalactivity
measures
have
been
used
;differen
tcut-po
intsandob
servation
system
smay
have
influen
cedthestreng
thof
associations
observed
.
Furthe
rresearch
shou
ldinvestigatecorrelates
ofchildren’sandadolescents’
recess
physicalactivity
for
variables
that
wereno
tinvestigated
frequ
ently
but
indicatedpo
sitive
associations
with
physical
activity;further
research
usingob
jectivemeasuresis
need
edto
determ
ine
adolescents’recess
physical
activity
levels;futureresearch
shou
ldexam
inewhe
ther
increasing
access
toscho
olfacilitiesdu
ringrecess
perio
dsincreasesph
ysical
activity
levelsin
childrenand
adolescents;furthe
rresearch
isne
eded
tode
term
ine
whe
ther
specifıctype
sof
equipm
ent,or
theoverall
availabilityof
unfıxed
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 11 of 23
-
Table
3Results
oftheinclud
edreview
s(Con
tinued)
equipm
ent,areassociated
with
high
erlevelsof
physical
activity;futureresearch
shou
ldexam
inethe
correlates
ofbo
ysandgirls
physicalactivity
separately;
Moreresearch
isne
eded
concerning
correlates
ofPA
inrecess
perio
d,particularly
inadolescents.
Scho
eppe
S,2013
(SLR)[16]
OverallPA
Inde
pend
entmob
ility
with
outadultsupe
rvision
(Activetravelto
and/or
from
scho
olandactivetravelto
leisuretim
erelatedplaces);
inde
pend
entmob
ility
with
outadultsupe
rvision
(outdo
orplay);activetravel
with
orwith
outadult
supe
rvision(Activetravelto
and/or
from
scho
ol);active
travelwith
orwith
outadult
supe
rvision(Activetravelto
leisuretim
erelatedplaces)
Tosynthe
size
theeviden
ceforassociations
ofchildren’s
inde
pend
entmob
ility
and
activetravelto
vario
usde
stinations
with
physical
activity,sed
entary
behavior
andweigh
tstatus.
Children’sactivetravelto
and/or
from
scho
olwas
consistentlypo
sitively
associated
with
physical
activity;p
ositive
relatio
nships
werefoun
dbe
tweenactive
travelto
leisure-related
destinations
andph
ysical
activity;traveltovario
usplaces
includ
ingscho
ol,
shop
s,cine
mas
andfrien
d’s
homes
werepo
sitive
associated
with
mod
erate-
to-vigorou
sandoverall
physicalactivity;children
weremorelikelyto
increase
physicalactivity
levelswhe
ntheirou
tdoo
rplay
occurred
inde
pend
ently;associatio
nsbe
tweenactivescho
oltravel
andweigh
tstatus
were
inconsistent
across
the
stud
ies.
N.A
Few
stud
iesmeasurin
gactivetravelto
places
othe
rthan
scho
ol;use
ofdifferent
thresholds
forde
fining
objectivelymeasured
sede
ntarybe
havior
inchildren;
themeasuremen
tof
sede
ntaryactivities
inchildrenstilllacks
standardizationand
validation;
Socialand
physicalen
vironm
ents
cond
uciveto
children’s
inde
pend
entmob
ility
and
activetravelwereno
texplored
butcertainlyplay
aroleas
correlates
ofchildren’sph
ysicalactivity,
sede
ntarybe
havior
and
weigh
tstatus.
Future
stud
iesshou
ldseek
toinvestigateassociations
ofinde
pend
entmob
ility
and
activetravelwith
light
intensity
physicalactivity;
children’sdaily
activetravel
tovario
usde
stinations
beyond
thescho
olsetting
requ
iresfurthe
rattention,
aswellasinvestigatingdiverse
sede
ntarybe
haviorsbe
yond
simplyscreen
-based
activities
andde
fining
approp
riate
thresholds
for
objectivelymeasured
sede
ntarybe
havior
inchildren;
thepo
tentialo
finde
pend
entmob
ility
topreven
tsede
ntarybe
havior
andexcessiveweigh
tshou
ldbe
explored
infuture
observationalstudies;studies
shou
ldmeasure
inde
pend
entmob
ility
and
activetravelmore
thorou
ghlyby
considering
frequ
ency
anddu
ratio
nof
inde
pend
entmob
ility
and
activetravel,aswellas
whe
ther
childrenare
travellingalon
eor
with
peers,or
toproxim
alversus
distantde
stinations,and
whe
ther
theob
served
associations
differby
age
andge
nder.
StanleyRM
,2012
(SLR)[30]
Time-specificPA
(i.e.,schoo
lbreak
timePA
and
after-scho
olPA
)
TVview
ing/playingvide
ogames;use
offacilities;
mem
berof
organized
activities
Toiden
tifythecorrelates
ofchildrens'PA(8-14years)
occurringdu
ringthescho
olbreak-tim
eandafterscho
olpe
riods.
Boys
andyoun
gerchildren
tend
tobe
moreactive
durin
gbreak-tim
eandafter-
scho
ol;BMIinfemales
negativelyassociated
with
after-scho
olPA
,age
was
negativelyassociated
in
N.A.
Smalln
umbe
rof
stud
iesthat
vary
inmetho
dological
aspe
cts;po
ssibility
that
some
stud
iesaremisseddu
ring
thesearch
process;majority
ofcross-sectionalstudies;
somestud
iesstratified
Future
stud
iesusinga
contextspecificapproach
shou
ldiden
tifyandrepo
rtspecificfacilitiesrelevant
tothecontextin
questio
n,which
willcontrib
uteto
aclearerun
derstand
ingof
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 12 of 23
-
Table
3Results
oftheinclud
edreview
s(Con
tinued)
scho
ol-break
andafter
scho
ol;fam
ilyaffluen
ce,
access
toagym,accessto
four
ormorePA
prog
rams
andthecond
ition
ofa
playingfield
wereall
associated
with
scho
olbreak
timePA
inon
estud
y;access
tolooseandfixed
equipm
ent,playgrou
ndmarking
s,size
ofandaccess
toplay
spaceandtheleng
thof
scho
olbreaktim
ewereall
positivelyassociated
with
change
sin
scho
olbreak
timePA
ininterven
tion
stud
ies;in
theafter-scho
olpe
riod,
gend
er(with
boys
againmoreactive),you
nger
age,lower
body
massinde
x(fo
rfemales),lower
TVview
ing/playingvide
ogames
andgreateraccess
tofacilitieswereassociated
with
high
erlevelsof
after-
scho
olPA
intw
oor
more
stud
ies,whileparent
supe
rvisionwas
negatively
associated
with
females’
after-scho
olPA
inon
estud
y.
analyses
bysalient
variables
such
asage,ge
nder
and
intensity
ofPA
,resultin
gin
anover-rep
resentationof
thesestud
iesin
thereview
;therelativelynarrow
age
rang
especified
inthe
curren
treview
isalim
itatio
n.
context-specificPA
;future
stud
iesshou
ldchoo
semeasuremen
ttoolswith
approp
riate
psycho
metric
prop
erties;Needof
high
quality
eviden
ceup
onwhich
PAprom
otionin
youn
gpe
oplecanbe
tailoredto
specificsettings
and
contexts.
TzormpatzakisN,
2007
(SLR)[31]
OverallPA
/Ex
Lack
oftim
e;tim
econstraints;maritalstatus
Toevaluate
theeviden
cefro
mresearch
relevant
toparticipationin
PAand
exercise
inGreece.
Participationin
physical
activity
andexercise
inGreecewas
gene
rally
low;
men
exercise
more
vigo
rouslyandmoreactively
than
wom
en;the
main
reason
sforparticipation
werehe
alth,w
eigh
tcontrol,
fitne
ss,and
stress
managem
ent.Lack
ofleisure
timewas
themainpe
rceived
barrierto
increasing
levelsof
physicalactivity
andexercise;
men
seem
edto
exercise
morefre
quen
tlyandmore
vigo
rouslythan
wom
en;
sing
lepe
opleweremore
likelyto
beph
ysicallyactive
comparedto
thosewho
weremarriedor
divorced
/widow
ed;p
eoplelivingin
ruralareas
weremorelikely
tobe
physicallyactivethan
thoselivingin
urbanareas.
N.A.
Non
eof
thestud
iesused
objectivemeasuremen
tsand
also
they
used
different
self-
repo
rted
estim
ates
ofPA
;lack
ofapprop
riate
useof
theterm
s'exercise'and'PA';
none
oftheinstrumen
tswerevalidated
inGreece;
season
ality
effect,since
season
alvariatio
nexistsin
physicalactivity
participation.
PAprom
otionshou
ldbe
organizedin
asystem
atic
way;a
clearde
finition
ofvariables
isne
eded
;interven
tionstud
iesshou
ldbe
employed
inorde
rto
test
theefficiencyof
policies,
strategies
andcampaigns;
long
itudinalstudies
shou
ldbe
utilizedin
orde
rto
evaluate
tren
dsin
physical
activity
participationandthe
long
-term
effectsof
campaigns;a
clearpatternof
who
isconsidered
physically
activeandinactiveshou
ldbe
determ
ined
accordingto
internationally
establishe
dcriteria
inorde
rto
have
morevalid
andreliabledata;
stud
iesshou
ldno
tconcen
trateon
lyon
leisure
timeph
ysicalactivities
but
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 13 of 23
-
Table
3Results
oftheinclud
edreview
s(Con
tinued)
onthetotalp
hysicalactivity
profile
ofeach
participant.
Uijtde
willinge
nL,
2014
(SLR)[35]
OverallPA
Pastph
ysicalactivity;screen
time
Tosummarizeandup
date
theexistin
gliteratureon
determ
inantsof
PAand
sede
ntarybe
havior
inyoun
gpe
ople.
Mod
erateeviden
cefor
intentionas
ade
term
inant
ofchildren’sph
ysicalactivity,
andage(i.e.,older
children
weremoreactive),ethnicity
(i.e.,b
eing
ofAfrican–
American
descen
tde
term
ined
beingless
physicallyactive)
and
planning
asde
term
inantof
adolescent
physicalactivity.
N.A.
Includ
edstud
iesassessed
overallP
Aon
ly;usedtw
odatabaseson
ly;the
selected
lang
uage
ofpu
blicationwas
Englishon
ly.
Future
researches
shou
ldbe
focusedon
determ
inantsof
child
andadolescent
sede
ntarybe
havior
andon
environm
entald
eterminants
ofph
ysicalactivity
inbo
thchildrenandadolescents,
shou
ldusereliableandvalid
measuresof
both
determ
inantsas
wellasthe
actualbe
haviorsandshou
ldcond
uctprospe
ctivestud
ies
ofhigh
metho
dological
quality.
vande
rHorstK,
2007
(SLR)[32]
OverallPA
PE/schoo
lspo
rts;watching
TV;smoking;
television
/sede
ntarytim
e
Tosummarizeandup
date
theliteratureon
correlates
ofPA
,insufficient
PA,and
sede
ntarybe
havior
inyoun
gpe
ople.
Theresults
from
ourreview
sugg
estthat
correlates
ofph
ysicalactivity
forchildren
arege
nder,self-e
fficacy,
parentalph
ysicalactivity
for
boys,and
parentalsupp
ort.
Correlatesforadolescents'
physicalactivity
were
gend
er,p
aren
taledu
catio
n,attitud
e,self-efficacy,go
alorientation/motivation,
physicaled
ucation/scho
olsportsparticipation,
family
influen
ces,andfrien
dsupp
ort.Gen
der,self-efficacy,
andfamily/paren
talsup
port
wereassociated
with
physicalactivity,b
othin
childrenandadolescents.
N.A.
Publicationbias
may
bepresen
t;po
ssibility
ofmissed
stud
iesas
aresultof
the
search
strategy;the
main
outcom
ewas
overallP
Awith
outothe
rclassifications;
mostly
cross-sectional
stud
iesinclud
ed;b
ecause
ofthevariability,itwas
not
possibleto
assess
theoverall
streng
thof
theassociations.
Moreprospe
ctivestud
iesare
need
edandmoreresearch
includ
ingchildren.
Notes:M
Ameta-an
alysis,SLR
system
aticliteraturereview
,PAph
ysical
activ
ity,P
Eph
ysical
education,
MVP
Amod
erate-to-vigorou
sph
ysical
activ
ity,Exexercise,SES
socio-econ
omicstatus,EBR
Ben
ergy
balance-relatedbe
havior
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 14 of 23
-
determinant ‘screen use’. Differently, other similar
deter-minants were identified to form a sub-group with a spe-cific
label. For example, the determinants ‘being retired’,‘change in
employment status’, and ‘moving into an insti-tution’ were part of
the sub-group ‘job-related’. Thus, afinal consensus between authors
had been achieved forthis categorization and the final number of
behavioraldeterminants was 35 (Table 4). Any uncertainty and
dis-agreement was resolved by consulting three further au-thors of
the DEDIPAC-KH (BS, CL, PA).
Findings of the reviewsThe findings of the included reviews on
the associationsbetween the behavioral determinants and PA,
consider-ing different age groups and different types of PA,
aresummarized in Table 4.
Preschool childrenOne review specifically assessed the
behavioral correlatesof PA in preschool children that were aged
between 4and 6 years old [26]. Among the correlates
investigated,only those related with ‘screen use’ were negatively
asso-ciated with MVPA in all the studies included in the re-view
with a limited suggestive level of evidence (−−, Ls).Inconclusive
findings were found regarding ‘participa-tion in organized sports’
(0, Lns) and ‘screen use’ (0,Lns) with respect to overall PA and no
association wasfound between ‘children have no energy to use
activetransport’ and active transport (0, Lns).
ChildrenFew determinants were investigated among childrenaged
between 10 and 13 years old in respect to overallPA [34]. ‘Previous
PA’ was the only determinant posi-tively associated with overall PA
in more than 75% ofthe studies included in the review with a
probable levelof evidence (+, Pe). Conversely, ‘participation in
sportteams outside school’ (0, Ls) and ‘alcohol consumption’(0, Ls)
were not associated with overall PA in children.Considering
after-school PA, one review investigated thebehavioral correlates
of PA in children between 8 and14 years old [30]. Among the
correlates investigated,only those related with ‘screen use’ were
negative associ-ated with after-school PA in more than 75% of the
stud-ies included in the review with a limited suggestive levelof
evidence (−, Ls). ‘Member of organized activities’ (0,Lns) was not
associated with after-school PA, whilst for‘use of facilities’ the
evidence was limited and inconclu-sive (0, Lns).
AdolescentsTwo reviews investigated the behavioral
determinants[34] and correlates [32] of PA in adolescents aged
be-tween 14 and 18 years [32, 34]. ‘PE/school sports’ [32]
and ‘previous PA’ [34] were both positively associatedwith
overall PA in all the studies included in the review,without
exception, both with a limited suggestive levelof evidence (++,
Ls). ‘Vigorous PA’ was negatively associ-ated with overall PA in
all the studies included in the re-view, without exception, with a
limited suggestive levelof evidence (−−, Ls) [34]. No association
was found be-tween ‘dietary habits’ and overall PA (0, Ls)
[34].
Children and adolescentsTen reviews examined the behavioral
determinants andcorrelates of PA for children and adolescents (≤18
yearsold) in relation to overall PA [13–16, 28, 29, 32, 34, 35]and
recess PA [33]. Independent mobility and active trans-port’ [15,
16, 28] was positively associated with overall PAin more than 75%
of the studies included in the reviews,with a probable level of
evidence (+, Pe). ‘Homework’ [29]was positively associated with
overall PA in all the studiesincluded in the review, without
exception, with a limitedsuggestive level of evidence (++, Ls). In
particular, a posi-tive effect size (r = 0.014, 95% CI = −0.043,
0.095) emergedfrom the results of the MA [29]. Conversely,
‘Internet use’,‘reading’, and ‘composite sedentary behavior’ were
nega-tively associated with overall PA in all the studies
includedin the review, without exception, with a limited
suggestivelevel of evidence (−−, Ls). The results of the MA
[29]showed small to moderate negative effect sizes for thethree
determinants (r = −0.051, 95% CI = −0.097, −0.006;r = −0.009, 95%
CI = −0.039, 0.021; r = −0.265, 95%CI = −0.364, −0.165,
respectively). Limited evidence wasfound regarding ‘smoking’ (0,
Ls) [13, 32, 34], ‘screen use’(0, Ls) [14, 29, 32, 35], ‘sedentary
behavior’ (0, Ls) [34], and‘past physical activity’ (0, Ls) [35].
‘Sports activities’, ‘playballgames’, and ‘physical conflict
frequency’ were positivelyassociated with recess PA in all the
studies included in thereview, without exception, with a limited
suggestive level ofevidence (++, Ls) [33]. ‘Sedentary activities’
was negativelyassociated with recess PA in all the studies included
in thereview, without exception, with a limited suggestive level
ofevidence (−−, Ls) [33]. No association was found
between‘day-to-day variability’ and recess PA (0, Lns) [33].
AdultsThree reviews assessed the behavioral determinants ofPA in
adults older than 40 years [24, 25, 27]. ‘Baselineactivity level’
was positively associated with overall PA/Ex in all the studies
included in the review, without ex-ception, with a limited
suggestive level of evidence (++,Ls) [27]. Conversely, a negatively
association was foundbetween ‘language difficulties’ [24] and
overall PA/Ex inall the studies included in the review, without
exception,with a limited suggestive level of evidence (−−, Ls).
For‘being retired’ (0, Lns) and ‘lifelong participation in PA’(0,
Ls), the evidence was limited and inconclusive [25].
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 15 of 23
-
Older adultsFor older adults (≥70 years), only one review [27]
inves-tigated the association between ‘smoking’ and overallPA/Ex
suggesting negative associations in all the studiesincluded in the
review, without exception, with a limitedsuggestive level of
evidence (−−, Ls).
All agesFive reviews examined the behavioral determinants of
PAacross all ages [12, 13, 24, 25, 31]. A negative associationwas
found between ‘moving into an institution’ and overallPA/Ex in all
the studies included in the review, without ex-ception, with a
limited suggestive level of evidence (−−, Ls)[12].
‘Pregnancy/having a child’ and ‘transition to univer-sity’ were
negatively associated with overall PA/Ex in morethan 75% of the
studies included in the review with a prob-able level of evidence
(−, Pe) [12], while ‘time limitation’was negatively associated with
overall PA/Ex in more than75% of the studies included in the
reviews with a limitedsuggestive level of evidence (−, Ls) [24,
31]. Finally, for‘marital status’ (0, Lns) [12, 25, 31], ‘smoking’
(0, Lns) [13],‘change in employment status’ (0, Ls), and
‘experiencingharassment at work, violence, and disaster’ (0, Ls)
[12] theevidence was limited and inconclusive.
Evaluation of the quality of the SLRs and MAsThe results of the
quality assessment using theAMSTAR checklist are reported in Table
5. Among the17 included reviews, the majority were of
moderatequality (n = 13) [12, 14–16, 24–28, 30, 33–35], threewere
weak [13, 31, 32], and only one was considered to
be of strong quality [29]. Among those reviews of mod-erate
quality, five were scored with 4 points [12, 26, 28,30, 33], one
with 5 points [16], four with 6 points [14,15, 24, 34], and three
with 7 points [25, 27, 35].Few reviews provided all the
characteristics of the pri-
mary studies [12, 13, 15, 16, 25, 28, 31, 34, 35] and noneof the
reviews provided a full list of included and ex-cluded studies.
DiscussionThis umbrella SLR aimed to provide a comprehensive
andsystematic overview of behavioral determinants of PAacross the
life course, evaluating importance, strength ofthe evidence, and
methodological quality. Through asystematic evaluation of the
existing SLRs and MAs, anoverview of the associations between the
considered be-havioral determinants and PA is presented to promote
ef-fective health enhancing policies and identify gaps forfuture
research strategies. To our knowledge, this is thefirst umbrella
SLR that examined various potential behav-ioral determinants of PA
across the life course.Whether or not individuals choose to engage
in PA
behaviors is affected by a number of inter-dependentand
multilevel factors. A relevant contribution of theDEDIPAC-KH
project was the development of a dynamicframework of determinants
of PA, which identified twomain themes related to the person and to
the society,respectively [36]. Behavioral determinants are part
ofthe individual theme, together with the biological
andpsychological determinants, whereas the other themecomprises
physical (e.g., environmental), socio-cultural,
Table 4 Summary of the results of the included reviews: the
importance of a determinant and its strength of evidence
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 16 of 23
-
socio-economic, and policy determinants. Through thesystematic
analysis of scientific evidence, the present find-ings expand the
knowledge and the understanding of be-havioral determinants of PA
to prepare the ground for acoherent approach towards PA behaviors
research and in-terventions to favor active lifestyle
choices.Overall, for the majority of determinants, the evidence
was limited and inconclusive or there was not an associ-ation
with the different forms of PA. Furthermore, forseveral potential
determinants it was not possible to as-certain definite conclusions
on their association with PA.These findings urge researchers to
consider new andinnovative approaches when investigating factors
influ-encing PA behaviors.In relation to the investigated
populations, more studies
(n = 11) focused on youth (e.g., ≤18 years) with respect tothose
on individuals older than 18 years (n = 5). The rea-son for a
greater focus on young populations might bedue to the fact that
being physically active at the youngeststages of age is crucial to
maintain high levels of PA at theadulthood [32, 37], decreasing the
risk factors for non-communicable diseases [2] and having a
favorable effecton public health [37]. Nonetheless, the
understanding ofthe relationships between behavioral determinants
and PAis also crucial among older adults as they are more
vulner-able and more likely to have decreasing level of PA and
in-creasing levels of sedentary behaviors.Among all the young
population groups, 7 determi-
nants were positively associated and 6 determinantswere
negatively associated with PA. A probable positiveassociation was
evident between ‘previous PA’ and over-all PA in children, with the
review showing a moderatequality [34], confirming the importance of
PA in child-hood. Moreover, a probable positive association
wasfound in three reviews [15, 16, 28] between ‘independentmobility
and active transport’ and overall PA in childrenand adolescents,
with the reviews showing a moderatequality. Larouche and colleagues
[15] argued that it islikely that an active traveler is also more
inclined to beactive throughout the day. However, other
determinants(e.g., low socioeconomic status and lower income
house-holds), which were not considered in their review,
mayinfluence the relationship between ‘independent mobilityand
active transport’ and PA. Furthermore, potentialbiases due to
classification, such as active school trans-port only once per week
and direction of active trans-port (e.g., only to school and not
from school) could alsoplay a role. Other relevant aspects proposed
bySchoeppe and colleagues [16] concern the positive asso-ciations
of active travel to destination other than school,the health
benefits for children of being involved in‘free-range’ activities,
like active travel or play outdoorwithout adult supervision, and
the higher frequency ofactive travel from school to home rather
than from
home to school. Other determinants related to ‘sport/PAin and
out of school’ [32, 33] and to ‘other daily activ-ities’ [29] were
positively associated with PA but with alimited suggestive level of
evidence. The present findingsare in line with the determinants
related to school phys-ical activity and youth sport participation
(e.g., “PA Pro-grams in School”, “Availability/Access/Proximity of
PAOrganized Sport Facilities/Tools”, “PA Education
(atSchool/Work)/Knowledge of Effects of PA”, “GroupActivities
(Outdoor/Indoor)”, “Involvement in OrganizedSport”, “Time Spent
Outdoor/Playing Spaces”) highlightedby the European PA determinants
(EU-PAD) frameworkas having a high priority for research [36]. To
improve thestrength of evidence, future research adopting
longitudinalresearch designs is strongly needed. Indeed, motor
skillsin early childhood, school physical education, and
youthsports are important aspects for a holistic development
ofchildren and adolescents, so an effective interaction be-tween
researchers and policy makers should be establishedto promote of
health-enhancing lifestyles in early years, inline with the
recommendations of the Expert Group onHealth-Enhancing Physical
Activity of the EuropeanCommission [38].The determinants ‘composite
sedentary behavior’,
‘internet use’, ‘reading’, ‘sedentary activities’, and
‘vigorousPA’ [26, 29, 33, 34] were negatively associated with
PAwith a limited suggestive level of evidence. Even thoughmainly
based on cross-sectional studies, the negative as-sociations of
‘composite sedentary behavior’, ‘internetuse’, and ‘reading’ are
corroborated by the results of theMA, showing small to moderate
negative effect sizes[29]. Regarding ‘vigorous PA’, Bruner and
colleagues [39]suggested that a decline in PA over the course of
theschool year, in adolescents, is mainly due to a decreasein level
of vigorous intensity activity rather than moder-ate intensity
activity. Despite a clear dose-response spe-cificity of low,
moderate, and vigorous PA intensities oncardiovascular risk,
metabolic health, osteoporosis, im-mune function, and mental health
[40], the relationshipbetween intensity (but also frequency,
duration, andmode of activity) and adherence of PA is
controversial[35, 41]. To deepen our understanding of the quality
ofthe PA and to provide sound guidelines for PA prescrip-tions,
further research on this area is recommended toconsider the
intensity of PA on both absolute (e.g., oxy-gen uptake, oxygen
uptake relative to body mass, kcal orkJ per minute, and METs) and
relative (e.g., percentagesof maximal oxygen uptake, oxygen uptake
reserve, heartrate reserve, maximal heart rate, Borg’s Rating
ofPerceived Exertion) terms [42].The investigation of determinants
in adults showed a
higher proportion of negative associations (n = 6) with re-spect
to positive associations (n = 1). Regarding the nega-tive
associations, a probable level of evidence was found
Condello et al. International Journal of Behavioral Nutrition
and Physical Activity (2017) 14:58 Page 17 of 23
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only for ‘transition to university’ and ‘pregnancy/having
achild’ with respect to overall PA/Ex in all ages >18 years,with
the review showing a moderate quality [12]. Further-more, ‘moving
into an institution’ [12], ‘time limitation’[24, 31], ‘language
difficulties’ [24], and ‘smoking’ [27] werenegatively associated
but with a limited suggestive level ofevidence. Conversely,
‘baseline activity level’ was positivelyassociated with overall
PA/Ex in adults ≥40 years but witha limited suggestive level of
evidence and the quality ofthe review was moderate [27]. Although
without a consist-ent convincing evidence among all the
determinants, thesefindings highlight the possible impact of
specific lifeevents (i.e., ‘transition to university’,
‘pregnancy/having achild’, and ‘moving into an institution’) on the
relationshipbetween behavioral determinants and PA and the need
foreffective interventions and planning to increase
health-enhancing PA.An interactionist approach may help further our
un-
derstanding of the role played by specific life events.
Dif-ferent life events with shorter-term (e.g., pregnancy)
orlonger-term effects (e.g., retirement) might exert theireffects
on PA behaviors separately, in different lifephases. Differently,
life events, whose shorter- andlonger-lasting effects partially
overlap in time (e.g.,pregnancy and marital status) might generate
inter-active effects. Moreover, the impact of life events on
PAbehaviors might be moderated by other behavioral factors.For
instance, the extent to which ‘retirement’ impacts ac-tual PA
behavior may be moderated by past PA habits.Moreover, the
relationship linking the influence of differ-ent behavioral
determinants of PA may be mediational innature, with ‘time
limitation’ probably mediating most ofthe life event effects on PA
behaviors.However, not only people older than 18 years should
represent a target group population for the investigationof
those life events and for considering health
promotioninterventions. Adequate attention should be placed also
tothose related to ‘job’, such as temporary or long-term
un-employment, retirement, change in employment status, aswell as
to those concerning the ‘marital status’, such asstarting a new
close personal relationship, starting to livewith someone,
marriage, separation, divorce, widowhood,interpersonal loss, which
are frequent during adulthoodand may interfere and influence PA
behaviors.This umbrella SLR demonstrated that some potential
determinants were found to be specific for each agegroup, whilst
other determinants can be consideredacross all ages. For the
latter, ‘screen use’ and ‘smoking’were the most often investigated
determinants, with sixand four reviews examining the associations
with severalforms of PA, respectively. Actually, ‘screen use’
comprisesseveral determinants, such as ‘TV viewing’, ‘TV
viewing/playing video games’, ‘television viewing/sedentary’,
‘enjoytelevision viewing’, ‘video/computer game use’,
‘computer’,
‘screen time’, ‘video games’, which have been investigatedfor
their potential associations with PA from preschoolchildren to
adolescents. The negative association be-tween ‘enjoy television
viewing’ and MVPA in preschoolchildren emphasized the need for
intervention programsto decrease screen related behaviors in the
early yearsage group [26]. A similar negative association was
alsofound in children with respect to after-school time pe-riods
(i.e., after-school PA) [30]. Particularly due to thefact that ‘TV
viewing’ may negatively influence PA dur-ing time spent at home
with high TV accessibility, inter-vention programs should be
encouraged for increasingafter-school PA [30]. Future research
should adopt longi-tudinal study designs to investigate the
effectiveness oflong-term PA promoting strategies in children
afterschool for several components, like fitness, health,cognitive
functioning