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Cited by 589Physical Activity and HealthObesity, Physical Activity, DietSleep and related disorders

Combinations of physical activity, sedentary behaviour and sleep: relationships with health indicators in school-aged children and youth

Open access
Saunders, Travis John, Gray, Casey Ellen, Poitras, Veronica Joan, Chaput, Jean-Philippe, Janssen, Ian, Katzmarzyk, Peter T., Olds, Timothy, Connor Gorber, Sarah +4 more·2016·Applied Physiology, Nutrition, and Metabolism
DOI 10.1139/apnm-2015-0626
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Abstract

The purpose of this systematic review was to determine how combinations of physical activity (PA), sedentary behaviour (SB), and sleep were associated with important health indicators in children and youth aged 5–17 years. Online databases (MEDLINE, EMBASE, SPORTdiscus, CINAHL, and PsycINFO) were searched for relevant studies examining the relationship between time spent engaging in different combinations of PA, SB, and sleep with the following health indicators: adiposity, cardiometabolic biomarkers, physical fitness, emotional regulation/psychological distress, behavioural conduct/pro-social behaviour, cognition, quality of life/well-being, injuries, bone density, motor skill development, and self-esteem. PA had to be objectively measured, while sleep and SB could be objectively or subjectively measured. The quality of research evidence and risk of bias for each health indicator and for each individual study was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework. A total of 13 cross-sectional studies and a single prospective cohort study reporting data from 36 560 individual participants met the inclusion criteria. Children and youth with a combination of high PA/high sleep/low SB had more desirable measures of adiposity and cardiometabolic health compared with those with a combination of low PA/low sleep/high SB. Health benefits were also observed for those with a combination of high PA/high sleep (cardiometabolic health and adiposity) or high PA/low SB (cardiometabolic health, adiposity and fitness), compared with low PA/low sleep or low PA/high SB. Of the 3 movement behaviours, PA (especially moderate- to vigorous-intensity PA) was most consistently associated with desirable health indicators. Given the lack of randomized trials, the overall quality of the available evidence was low.

Integrity signals

Registry

Crossref · 10.1139/apnm-2015-0626

Cites

30 of 30 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 23 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    After screening, 14 studies reporting data from 9 different datasets met all inclusion criteria.

    “After screening, 14 studies reporting data from 9 different datasets met all inclusion criteria (See Table 1).”
    Quote in the paperSubstantial claim
  • Findingcitation

    All 3 studies assessing combinations of all 3 movement behaviours reported that individuals with high PA/low SB/high sleep had lower adiposity and/or risk of overweight than those with low PA/high SB/low sleep.

    “All 3 of these studies reported that individuals with a combination of high PA/low SB/high sleep had lower adiposity and/or risk of overweight than those with a combination of low PA/high SB/low sleep.”
    Quote in the paperSubstantial claim
  • Findingown data

    No papers were identified reporting the relationship between combinations of movement behaviours and emotional regulation/psychological distress, behavioural conduct/pro-social behaviour, cognition, quality of life/well-being, or injuries.

    “We did not identify any papers reporting the relationship between combinations of movement behaviours and emotional regulation/psychological distress, behavioural conduct/pro-social behaviour, cognition, quality of life/ well-being, or injuries.”
    Quote in the paperSubstantial claim
  • Findingown data

    The included studies presented results from 36,560 individual participants from 20 countries.

    “These papers presented results from 36 560 individual participants from 20 countries.”
    Quote in the paperNot a substantial claim
  • Findingown data

    Health benefits were observed for those with high PA/low SB (cardiometabolic health, adiposity and fitness) compared with low PA/high SB.

    “Health benefits were also observed for those with a combination of high PA/high sleep (cardiometabolic health and adiposity) or high PA/low SB (cardiometabolic health, adiposity and fitness), compared with low PA/low sleep or low PA/high SB.”
    Quote in the paperSubstantial claim
  • May combine two claims. 30
  • Classified as probably not a substantial claim. 32
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    Meta-analysis was not possible because of high heterogeneity across studies; a narrative synthesis was performed.

    “However, it was determined that a meta-analysis was not possible because of high levels of heterogeneity for the above characteristics across studies, and a narrative synthesis was performed for each health indicator instead.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Meta-analysis was not possible because of high levels of heterogeneity across studies.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Of the 14 included studies, 10 reported on adiposity, 3 on cardiometabolic risk factors, and 3 on cardiorespiratory or musculoskeletal fitness.

    “Of the 14 included studies, 10 reported on adiposity (Aggio et al. 2015;Chaput et al. 2014b;De Bourdeaudhuij et al. 2013;Ekelund et al. 2012;Herman et al. 2014;Hjorth et al. 2014b;Katzmarzyk et al. 2015;Laurson et al. 2008Laurson et al. , 2014;;Loprinzi et al. 2015), 3 on cardiometabolic risk factors (de Moraes et al. 2013;Ekelund et al. 2012;Hjorth et al. 2014a), and 3 on cardiorespiratory or mus”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    PA was measured with pedometers in 2 studies, while the rest used accelerometers.

    “PA was measured with pedometers in 2 studies (Laurson et al. 2008(Laurson et al. , 2014)), while the rest used accelerometers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    Sleep was objectively measured in 3 studies, and self-reported in 1 study.

    “Sleep was objectively measured in 3 studies (Chaput et al. 2014b;Hjorth et al. 2014aHjorth et al. , 2014b)), and self-reported in 1 study (Laurson et al. 2014).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    After title and abstract review, 71 papers remained and were retrieved for full-text review.

    “After title and abstract review, 71 papers remained and were retrieved for full-text review.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    All included studies were published in 2008 or later, with participants ranging from 4-18 years of age (mean age between 5.0 and 17.9 years).

    “All studies were published in 2008 or later, with participants ranging from 4-18 years of age (the mean age was between 5.0 and 17.9 years).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    SB was objectively measured using accelerometers in 12 studies, and self-reported in 4 studies.

    “SB was objectively measured using accelerometers in 12 studies (Aggio et al. 2015;Chaput et al. 2014b;De Bourdeaudhuij et al. 2013;de Moraes et al. 2013;Ekelund et al. 2012;Martinez-Gomez et al. 2011;Herman et al. 2014;Hjorth et al. 2014aHjorth et al. , 2014b;;Katzmarzyk et al. 2015;Loprinzi et al. 2015;Santos et al. 2014), and self-reported in 4 studies (Herman et al. 2014;Hjorth et al. 2014b;La”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingnone given

    Hjorth et al. (2014a) employed a longitudinal design with a 200-day follow-up, while all other studies employed cross-sectional designs.

    “Hjorth et al. (2014a) employed a longitudinal design with a 200-day follow-up, while all other studies employed cross-sectional designs.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Hjorth et al. 2014a

      Not checked in the free run.

  • May combine two claims.

    Findingown data

    The systematic review included 14 studies (13 cross-sectional and 1 prospective cohort) reporting data from 36,560 individual participants.

    “A total of 13 cross-sectional studies and a single prospective cohort study reporting data from 36 560 individual participants met the inclusion criteria.”
    • Also stated in: § Description of studies · plain
      “After screening, 14 studies reporting data from 9 different datasets met all inclusion criteria (See Table 1).These papers presented results from 36 560 individual participants from 20 countries.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    A total of 489 unique citations were eligible for inclusion.

    “A total of 489 unique citations were eligible for inclusion (134 from CINAHL, 352 identified during the screening process of the 3 parallel systematic reviews, and 3 nominated by the research team) (Fig. 1).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    There was no influence on grip strength when replacing SB or LPA with MVPA, or on any indicator when replacing SB with LPA.

    “There was no influence on grip strength when replacing SB or LPA with MVPA, or on any indicator when replacing SB with LPA.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Findingnone given

    The majority of studies compared only the best and worst combinations of behaviours, without directly comparing intermediate combinations.

    “Further, the majority of studies compared only the best and worst combinations of behaviours (e.g., high PA/high sleep/low SB vs low PA/low sleep/high SB), without directly comparing intermediate combinations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    Among the 3 movement behaviours, health benefits were most consistently associated with high levels of PA, and especially MVPA.

    “Our results also suggest that among the 3 movement behaviours, health benefits were most consistently associated with high levels of PA, and especially MVPA.”
    Quote in the paperSubstantial claim

  • The quote only partly states this claim.

    Findingcitation

    In 2 isotemporal substitution studies, replacing 60 min/day of SB or LPA with MVPA was associated with better musculoskeletal fitness in children.

    “and better musculoskeletal fitness in children (Aggio et al. 2015)”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Aggio et al. 2015

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Both studies examining cardiorespiratory fitness reported that participants in both the high MVPA/low SB and low MVPA/low SB groups had higher odds of having high cardiorespiratory fitness compared with those with low MVPA/high SB, although in 1 study this was observed in females only.

    “Both studies reported that participants in both the high MVPA/low SB and low MVPA/low SB groups had higher odds of having a high cardiorespiratory fitness compared with those with low MVPA/high SB, although in 1 study (Martinez-Gomez et al. 2011) this was observed in females only.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Martinez-Gomez et al. 2011

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Both studies also reported higher maximal oxygen uptake in the high MVPA/low SB group compared with the low MVPA/high SB group, although 1 study observed this in females only.

    “Both studies also reported higher maximal oxygen uptake in the high MVPA/low SB group, compared with the low MVPA/high SB group, although 1 study (Martinez-Gomez et al. 2011) observed this in females only.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Martinez-Gomez et al. 2011

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    In Ekelund et al. (2012), those in higher tertiles of MVPA had lower systolic blood pressure, fasting insulin and fasting triglycerides, and higher values of HDL cholesterol across tertiles of SB.

    “One study (Ekelund et al. 2012) found that those in higher tertiles of MVPA had lower systolic blood pressure, fasting insulin and fasting triglycerides, and higher values of HDL cholesterol across tertiles of SB.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ekelund et al. 2012

      Not checked in the free run.

  • May combine two claims.

    Findingnone given

    High sleep/low SB was associated with more favourable markers of cardiometabolic health, but not adiposity, compared with low sleep/high SB.

    “High sleep/low SB was associated with more favourable markers of cardiometabolic health, but not adiposity, compared with low sleep/high SB.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In Aggio et al. (2015), replacing 60 min/day of SB with MVPA was associated with a 16-cm longer horizontal jump distance and a 4.7-cm greater sit and reach flexibility score.

    “The estimates from the isotemporal substitution models suggested that replacing 60 min/day of SB with MVPA was associated with a 16-cm longer horizontal jump distance, and a 4.7-cm greater sit and reach flexibility score.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Aggio et al. 2015

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Findingreasoning

    The present review identified several important research gaps in the published literature.

    “The present review identified several important research gaps in the published literature.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingcitation

    In Laurson et al. (2014), the authors simply examined the benefits of meeting 1 or more guideline, with all guidelines being treated as equivalent.

    “However, in that study, the authors simply examined the benefits of meeting 1 or more guideline, with all guidelines being treated as equivalent.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Laurson et al. (2014)

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Findingreasoning

    To date, no one has examined whether meeting the guidelines for specific behaviours (e.g., sleep vs PA vs SB) have similar associations with health indicators in school-aged children and youth.

    “To date, no one has examined whether meeting the guidelines for specific behaviours (e.g., sleep vs PA vs SB) have similar associations with health indicators in school-aged children and youth.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingnone given

    Only 4 studies (representing 3 separate datasets) looked at combinations of all 3 movement behaviours, with the majority of included studies focusing on only 2 behaviours (typically PA and SB).

    “Finally, only 4 studies (representing 3 separate datasets) looked at combinations of all 3 movement behaviours, with the majority of included studies focusing on only 2 behaviours (typically PA and SB).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    The electronic search strategy was developed in consultation with a librarian and peer reviewed by a second librarian.

    “The electronic search strategy was developed in consultation with a librarian with expertise in systematic reviews (Margaret Sampson) and peer reviewed by a second librarian (Linda Slater).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Discrepancies between reviewers were decided by consensus or by a third reviewer.

    “Any discrepancies between reviewers were decided by consensus, or by a third reviewer if required.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Reviewers were not blinded to authors or journals when extracting data.

    “Reviewers were not blinded to the authors or journals when extracting data.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Titles and abstracts were screened by 2 independent reviewers.

    “Titles and abstracts of potentially relevant articles were screened by 2 independent reviewers using DistillerSR software (Evidence Partners, Ottawa, Ont., Canada).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The overall quality of the available evidence was low, given the lack of randomized trials.

    “Given the lack of randomized trials, the overall quality of the available evidence was low.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The quality of research evidence and risk of bias for each health indicator and each individual study was assessed using GRADE.

    “The quality of research evidence and risk of bias for each health indicator and for each individual study was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.”
    • Also stated in: § Quality assessment · plain
      “The overall quality of research evidence for each health indicator was assessed using the GRADE framework (Balshem et al. 2011).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Balshem et al. 2011

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    The systematic review was prospectively registered with PROSPERO and follows PRISMA guidelines.

    “This systematic review was prospectively registered with PROSPERO (www.crd.york.ac.uk/PROSPERO/;ID: CRD42015015493), and follows the PRISMA guidelines for the transparent reporting of systematic reviews (Moher et al. 2009).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Moher et al. 2009

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Full-text review was performed by 2 independent reviewers.

    “Potentially eligible articles were obtained for full-text review, which was performed by 2 independent reviewers.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Health indicators were identified by a 26-member expert group in accordance with GRADE.

    “Prior to the search process, health indicators of relevance to movement behaviour guidelines for school-aged children and youth were identified by a 26-member expert group, each with expertise in 1 or more of PA, SB, or sleep, in accordance with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework (Guyatt et al. 2011a).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Guyatt et al. 2011a

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Data extraction was completed by 1 reviewer and checked by another for accuracy.

    “Data extraction was completed by 1 reviewer and checked by another for accuracy.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Overall quality of evidence for each study design within each health indicator was evaluated by 1 reviewer and verified by the larger review team.

    “Overall quality of evidence for each study design within each health indicator was evaluated by 1 reviewer and verified by the larger review team.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S1 (asserted), S3 (load-bearing), S4 (based). May combine two claims.

    Study design and conductreasoning

    For cardiorespiratory and musculoskeletal fitness, the evidence was not downgraded from the initial low-quality rating because the papers showed no serious risk of bias, inconsistency, indirectness, or imprecision.

    “These papers showed no serious risk of bias, inconsistency, indirectness, or imprecision and were therefore not downgraded from the initial rating of low quality.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The quality of evidence was downgraded for any health indicator if there were limitations because of risk of bias, inconsistency, indirectness, imprecision, or other factors.

    “The quality of evidence was downgraded for any health indicator if there were limitations because of risk of bias, inconsistency, indirectness, imprecision, or other factors.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Following GRADE, quality of evidence ratings began as high for RCTs and low for all other study designs.

    “Following the GRADE framework, the quality of evidence ratings began as high when summarizing evidence from randomized controlled trials (RCTs) and low for all other study designs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Factors positively and negatively affecting quality of individual studies were recorded by 1 reviewer and reviewed by another.

    “Factors positively and negatively affecting the quality of individual studies were recorded by 1 reviewer, and reviewed by another.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Only objective measures of PA were included in the review.

    “Only objective measures of PA (e.g., accelerometry, heart rate monitors, pedometers, arm bands, etc.) were included in this review, while objective and subjective measures were included for both SB and sleep.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Subjective measures of PA typically focus exclusively on moderate-to-vigorous-intensity PA (MVPA).

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    At present it remains unclear how different combinations of PA, SB, and sleep relate to bone density, motor skill development, or psycho-social outcomes in the school-aged population.

    “Thus, at present it remains unclear how different combinations of PA, SB, and sleep relate to these important health indicators in the school-aged population.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    If no serious overall quality limitations, all studies could be upgraded based on large effect sizes; nonrandomized studies based on dose-response; cross-sectional based on gradient.

    “If there were no serious overall quality of evidence limitations identified, all studies could be upgraded based on large effect sizes, while nonrandomized studies could be upgraded based on dose-response evidence, and crosssectional studies could be upgraded based on a gradient of higher exposure with higher/lower outcome.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Observational studies were required to have a minimum sample size of 300 participants; randomized controlled trials and other intervention studies were required to have at least 30 participants in the intervention group.

    “Observational studies (e.g., cross-sectional, prospective or retrospective cohorts, and case-control studies) were required to have a minimum sample size of 300 participants; randomized controlled trials and other intervention studies were required to have at least 30 participants in the intervention group.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: The minimum sample size thresholds of 300 for observational studies and 30 for intervention studies are appropriate.

  • May combine two claims.

    Study design and conductcitation

    The present systematic review employed a rigorous and systematic methodology, which was prospectively registered using PROSPERO (CRD42015015493), and followed the PRISMA guidelines and GRADE methodology.

    “This review employed a rigorous and systematic methodology, which was prospectively registered using PROSPERO (CRD42015015493), and followed the PRISMA guidelines (Moher et al. 2009) and GRADE methodology (Higgins and Green 2011).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Moher et al. 2009

      Not checked in the free run.

    • cites Higgins and Green 2011

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationreasoning

    It is unclear how children with high PA/high sleep/low SB compare to children with low PA/high sleep/low SB, or other intermediate combinations.

    “it is unclear how they compare to children with low PA/high sleep/low SB, or other intermediate combinations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    The strength of the conclusions is limited by the small number of included studies and total lack of intervention studies assessing movement behaviours during the full 24-h period.

    “Finally, the strength of our conclusions is limited by the small number of included studies and total lack of intervention studies assessing movement behaviours during the full 24-h period.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    Only studies including objective measures of PA were included.

    “Consistent with the other reviews done in parallel with the present review, only studies including objective measures of PA were included.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The search strategy was developed in consultation with a research librarian with expertise in systematic review methodologies.

    “The search strategy was developed in consultation with a research librarian with expertise in systematic review methodologies (Margaret Sampson).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Those with high PA/high sleep, and high PA/low SB are also likely to experience health benefits, when compared with low PA/low sleep, or low PA/high SB.

    “Further, those with high PA/high sleep, and high PA/low SB are also likely to experience health benefits, when compared with low PA/low sleep, or low PA/high SB.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    The review did not investigate grey or other unpublished literature, which may have resulted in some relevant studies being left out.

    “Despite the comprehensive search process, we did not investigate grey or other unpublished literature, which may have resulted in some relevant studies being left out.”
    Quote in the paperNot a substantial claim
49 of 49

  • The paper relies on this without support.

    The evidence on combinations of movement behaviours has yet to be systematically reviewed or synthesized.

    “Researchers have recently begun to compare the health impacts of specific combinations of these movement behaviours, but this evidence has yet to be systematically reviewed or synthesized.”

  • The paper relies on this without support.

    Meta-analysis was not possible because of high levels of heterogeneity across studies.

    “However, it was determined that a meta-analysis was not possible because of high levels of heterogeneity for the above characteristics across studies, and a narrative synthesis was performed for each health indicator instead.”

  • The paper relies on this without support.

    Subjective measures of PA typically focus exclusively on moderate-to-vigorous-intensity PA (MVPA).

    “whereas subjective measures of PA typically focus exclusively on moderate-to vigorous-intensity PA (MVPA).”

  • The paper relies on this without support.

    The minimum sample size thresholds of 300 for observational studies and 30 for intervention studies are appropriate.

    “Observational studies (e.g., cross-sectional, prospective or retrospective cohorts, and case-control studies) were required to have a minimum sample size of 300 participants; randomized controlled trials and other intervention studies were required to have at least 30 participants in the intervention group.”

  • The paper relies on this without support.

    Combinations of physical activity, sedentary behaviour, and sleep can be meaningfully classified into high/low categories to examine associations with health indicators.

    “the majority of studies compared only the best and worst combinations of behaviours (e.g., high PA/high sleep/low SB vs low PA/low sleep/high SB)”
5 of 5

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Cites

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Research works printed but not linked: 1

  1. Guyatt G.H., 2011, Framing the question and deciding on important outcomes. J. Clin. Epidemiol., 64, 395

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Authors
Saunders, T. J., Gray, C. E., Poitras, V. J., Chaput, J.-P., Janssen, I., Katzmarzyk, P. T., Olds, T., Connor Gorber, S., Kho, M. E., Sampson, M., Tremblay, M. S., & Carson, V.
Affiliations
  • University of Prince Edward Island (CA)
  • Children's Hospital of Eastern Ontario (CA)
  • Queen's University (CA)
  • Pennington Biomedical Research Center (US)
  • Alliance for Research in Exercise, Nutrition and Activity (ARENA), Sansom Institute of Health Research, University of South Australia, Adelaide 5001, Australia.
  • Office of the Task Force on Preventive Health Care, Public Health Agency of Canada, Ottawa, ON, K1A 0K9, Canada.
  • McMaster University (CA)
  • University of Alberta (CA)
ORCID
Venue
Applied Physiology, Nutrition, and Metabolism
Publisher
Canadian Science Publishing
Published
2016-06
Volume
41
Issue
6 (Suppl. 3)
Pages
S283-S293
ISSN
  • 1715-5312 (ISSN-L)
  • 1715-5320
DOI
10.1139/apnm-2015-0626
OpenAlex
W2440319744
Cited by
589
References
29
Citations by year
2026: 37 · 2025: 55 · 2024: 77 · 2023: 81 · 2022: 72 · 2021: 85 · 2020: 68 · 2019: 34 · 2018: 40 · 2017: 29 · 2016: 10
FWCI
30.29
Type
journal article
Language
en
Open access
Licence
Locations
  • Applied Physiology, Nutrition, and Metabolism (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • UniSA Research Outputs Repository (University of South Australia) (acceptedVersion, cc-by)
  • Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion, cc-by)
  • IslandScholar (University of Prince Edward Island) (submittedVersion)
Funders
  • Public Health Agency of Canada
  • Public Health Agency
  • Canadian Institutes of Health Research
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
physical activity, sedentary behavior, sleep, children and young people, adiposity, cardiometabolic health, physical fitness, psychological distress, prosocial behavior, cognitive function, quality of life, injuries, bone mineral density, motor skill development, self-esteem, moderate-to-vigorous physical activity, health indicators
MeSH terms
Adolescent, Adolescent Behavior, Cardiovascular Diseases, Child, Child Behavior, Child, Preschool, Health Status, Humans, Physical Fitness, Quality of Life, Sleep, Exercise, Muscle, Skeletal, Metabolic Syndrome, Adiposity, Sedentary Behavior

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-10.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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