CoChat
Sign Up
Cited by 431Physical Activity and HealthChild and Adolescent Psychosocial and Emotional DevelopmentSleep and related disorders

Combinations of physical activity, sedentary time, and sleep duration and their associations with depressive symptoms and other mental health problems in children and adolescents: a systematic review

Open access
Sampasa-Kanyinga, Hugues, Colman, Ian, Goldfield, Gary S., Janssen, Ian, Wang, JianLi, Podinic, Irina, Tremblay, Mark S., Saunders, Travis J. +2 more·2020·International Journal of Behavioral Nutrition and Physical Activity
DOI 10.1186/s12966-020-00976-xPMC PMC7273653
Open this paper in CoChat — free accountOpen PDF

Abstract

Background: For optimal health benefits, the Canadian 24-Hour Movement Guidelines for Children and Youth (aged 5–17 years) recommend an achievement of high levels of physical activity (≥60 min of moderate-to-vigorous physical activity), low levels of sedentary behaviour (≤2 h of recreational screen time), and sufficient sleep (9–11 h for children or 8–10 h for adolescents) each day. The objective of this systematic review was to examine how combinations of physical activity, sedentary time, and sleep duration relate to depressive symptoms and other mental health indicators among children and adolescents. Methods: Literature was obtained through searching Medline, EMBASE, PsycINFO, and SportDiscus up to September 30, 2019. Peer-reviewed studies published in English or French were included if they met the following criteria: population (apparently healthy children and adolescents with a mean age of 5–17 years), intervention/exposure (combinations of physical activity, sedentary time, and sleep duration), and outcomes (depressive symptoms and other mental health indicators). A risk of bias assessment was completed for all included studies using the methods described in the Cochrane Handbook. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess the quality of evidence for each health indicator. Narrative syntheses were employed to describe the results due to high levels of heterogeneity across studies. Results: A total of 13 cross-sectional studies comprised in 10 papers met inclusion criteria. Data across studies involved 115,540 children and adolescents from 12 countries. Overall, the findings indicated favourable associations between meeting all 3 recommendations and better mental health indicators among children and adolescents when compared with meeting none of the recommendations. There was evidence of a dose-response gradient between an increasing number of recommendations met and better mental health indicators. Meeting the screen time and sleep duration recommendations appeared to be associated with more mental health benefits than meeting the physical activity recommendation. The quality of evidence reviewed was “very low” according to GRADE. Conclusions: The findings indicate favourable associations between meeting all 3 movement behaviour recommendations in the 24-h guidelines and better mental health indicators among children and adolescents. There is a clear need for high-quality studies that use robust measures of all movement behaviours and validated measures of mental health to increase our understanding in this topic area.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review of 13 cross-sectional studies (10 papers; 115,540 children and adolescents from 12 countries) found that meeting all three Canadian 24-hour movement recommendations was associated with better mental health indicators, including lower odds of depressive symptoms, than meeting none. The quality of evidence was rated “very low” by GRADE, and the authors call for higher-quality longitudinal and experimental studies.

Key findings

  • Across 3 studies of depressive symptoms (84,004 participants aged 6–20 years), meeting all 3 recommendations versus none was associated with lower odds of depressive symptoms among male and female adolescents; among children aged 6–11 years, meeting screen time alone, screen time + sleep, or physical activity + sleep was associated with lower odds of depressive symptoms than meeting none or all three guidelines.
  • Across 10 studies of other mental health indicators (111,641 participants aged 6–20 years), all 10 found better outcomes when meeting all 3 recommendations versus none; 3/10 found screen time alone or screen time + sleep consistently associated with better cognitive function, impulsivity scores, and health-related quality of life, and 2/10 documented a dose-response gradient (3 > 2 > 1 > 0 recommendations met).
  • Meeting prevalence ranged from 4.1–40.5% for physical activity, 8–48.2% for screen time, and 41.9–89.3% for sleep; meeting all three recommendations ranged from 2.6–17.1%. Depressive symptom prevalence examples were 42.7% in >59,000 US adolescents, 14.4% in nearly 4,000 UK adolescents, and 10.3% in >35,000 US children and adolescents.
  • GRADE quality was “very low” for both depressive symptoms and other mental health indicators.

Methods

  • Systematic review registered with PROSPERO (registration pending) and reported per PRISMA; searched Medline, EMBASE, PsycINFO, and SportDiscus up to September 30, 2019, limited to English or French. Eligible studies included apparently healthy children and adolescents with mean age 5–17 years, reported all three movement behaviours, and assessed depressive symptoms or other mental health indicators.
  • Included 13 cross-sectional studies from 10 papers; risk of bias was assessed using Cochrane Handbook methods, evidence quality was assessed with GRADE, and narrative synthesis was used because meta-analysis was not possible due to heterogeneity.
  • Primary outcome was depressive symptoms; secondary outcomes included anxiety, social and emotional health, health-related quality of life, substance use, impulsivity, cognitive functions, life satisfaction, and prosocial behaviour.

Limitations

  • Stated in the paper: GRADE quality was “very low” mainly because all included studies were cross-sectional and most used subjective measures of physical activity, recreational sedentary time, and sleep duration with no psychometric properties reported; many studies used single-item mental health measures; cross-sectional designs preclude temporality and causal inference; only English/French articles were included; meta-analysis was not possible due to heterogeneous data; and conclusions are limited by the small number of included studies and lack of longitudinal or intervention studies.
  • Evident from the text: all included studies were cross-sectional, most movement behaviour measures were self- or parent-reported, and only one depressive-symptoms study used an objective physical activity measure and a validated depression instrument.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s12966-020-00976-x

Cites

66 of 66 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 70 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Data across included studies involved 115,540 children and adolescents from 12 countries.

    “Data across studies involved 115,540 children and adolescents from 12 countries.”
    • Also stated in: § Description of studies · plain
      “Data across studies involved 115,540 children and adolescents from 12 countries.”
    Quote in the paperNot a substantial claim
  • Findingcitation

    Among adolescents, meeting all three guidelines was associated with lower odds of anxiety compared to meeting none of the recommendations.

    “Among adolescents, meeting all three guidelines was associated with lower odds of anxiety compared to meeting none of the recommendations”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [39] Zhu X, Haegele JA, Healy S. Movement and mental health: Behavioral correlates of anxiety and depression among children of 6–17 years old in the U.S. Ment Health Phys Act. 2019;16:60–5. source

      Not checked in the free run.

  • Findingcitation

    Among children, meeting all three guidelines was associated with lower odds of anxiety compared to meeting the physical activity and screen time recommendations.

    “Among children, meeting all three guidelines was associated with lower odds of anxiety compared to meeting the physical activity, and the screen time recommendations.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [39] Zhu X, Haegele JA, Healy S. Movement and mental health: Behavioral correlates of anxiety and depression among children of 6–17 years old in the U.S. Ment Health Phys Act. 2019;16:60–5. source

      Not checked in the free run.

  • Findingcitation

    The composition of movement behaviours was associated with HRQoL.

    “2/10 studies used compositional data analyses and found that the composition of movement behaviours was associated with social and emotional health [34] and with HRQoL [35]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [35] Dumuid D, Maher C, Lewis LK, Stanford TE, Fernández JAM, Ratcliffe J, et al. Human development index, children’s health-related quality of life and movement behaviors: a compositional data analysis. Qual Life Res. 2018;27(6):1473–82. source

      Not checked in the free run.

  • Findingcitation

    Meeting all 3 recommendations was associated with better impulsivity scores compared with meeting none.

    “1/1 study found that meeting all 3 recommendations was associated with better impulsivity scores compared with meeting none.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [36] Guerrero MD, Barnes JD, Walsh JJ, Chaput JP, Tremblay MS, Goldfield GS. 24-Hour Movement Behaviors and Impulsivity. Pediatrics. 2019;144(3):e20190187. source

      Not checked in the free run.

  • May combine two claims. 26
  • Classified as probably not a substantial claim. 22
  • The quote only partly states this claim. 1

  • May combine two claims.

    Findingown data

    Among included studies, the prevalence of meeting the physical activity recommendation ranged from 4.1% to 40.5% (majority 33.3-40.5%), screen time from 8% to 48.2% (majority 36.5-48.2%), and sleep duration from 41.9% to 89.3% (majority 66.2-89.3%).

    “The prevalence of children and adolescents who met the physical activity recommendation in the included studies ranged from 4.1 to 40.5%, with the majority in the 33.3–40.5% bracket; those who met the screen time recommendation ranged from 8 to 48.2%, with the majority in the 36.5–48.2% bracket; and those who met the sleep duration recommendation ranged from 41.9 to 89.3%, with the majority in the”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All included studies were cross-sectional and published in 2016 or later, with participant age ranging from 6 to 20 years.

    “All studies were cross-sectional, and were published in 2016 or later, with participants’ age ranging from 6 to 20 years.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingcitation

    Meeting the screen time recommendation alone, and both the screen time and sleep duration recommendations, were consistently associated with better cognitive functions, impulsivity scores and HRQoL.

    “3/10 studies found that meeting the screen time recommendation alone, and both the screen time and sleep duration recommendations, were consistently associated with better cognitive functions, impulsivity scores and HRQoL [20, 36, 38].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [20] Walsh JJ, Barnes JD, Cameron JD, Goldfield GS, Chaput JP, Gunnell KE, et al. Associations between 24 hour movement behaviours and global cognition in US children: a cross-sectional observational study. Lancet Child Adolesc Health. 2018;2(11):783–91. source

      Not checked in the free run.

    • cites [36] Guerrero MD, Barnes JD, Walsh JJ, Chaput JP, Tremblay MS, Goldfield GS. 24-Hour Movement Behaviors and Impulsivity. Pediatrics. 2019;144(3):e20190187. source

      Not checked in the free run.

    • cites [38] Sampasa-Kanyinga H, Standage M, Tremblay MS, Katzmarzyk PT, Hu G, Kuriyan R, et al. Associations between meeting combinations of 24-h movement guidelines and health-related quality of life in children from 12 countries. Public Health. 2017;153:16–24. source

      Not checked in the free run.

  • May combine two claims.

    Findingcitation

    Depressive symptoms were reported in 3 studies representing 3 unique datasets and 84,004 participants aged 6 to 20 years.

    “Depressive symptoms were reported in 3 studies [18, 19, 39], representing 3 unique datasets, and 84,004 individual participants with age ranging from 6 to 20 years (Table 2).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [18] Knell G, Durand CP, Kohl HW 3rd, Wu IHC, Pettee GK. Prevalence and likelihood of meeting sleep, physical activity, and screen-time guidelines among US youth. JAMA Pediatr. 2019;173(4):387–9. source

      Not checked in the free run.

    • cites [19] Pearson N, Sherar LB, Hamer M. Prevalence and correlates of meeting sleep, screen-time, and physical activity guidelines among adolescents in the United Kingdom. JAMA Pediatr. 2019;173(10):993–4. source

      Not checked in the free run.

    • cites [39] Zhu X, Haegele JA, Healy S. Movement and mental health: Behavioral correlates of anxiety and depression among children of 6–17 years old in the U.S. Ment Health Phys Act. 2019;16:60–5. source

      Not checked in the free run.

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

    Findingown data

    The included studies reported on depressive symptoms, social and emotional health, health-related quality of life, anxiety, substance use, impulsivity, cognitive functions, and life satisfaction and prosocial behaviour.

    “Of those, 3 reported on depressive symptoms [18, 19, 39], 3 on social and emotional health [33, 34, 37], 2 on health-related quality of life [35, 38], 1 on anxiety [39], 1 on substance use (including cigarette smoking, alcohol consumption, and cannabis use) [18], 1 on impulsivity [36], 1 on cognitive functions [20], and 1 on life satisfaction and prosocial behaviour [37].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Among included studies, the proportion meeting any one recommendation ranged from 34.9% to 51.1%, any two from 18.4% to 37.0%, and all three from 2.6% to 17.1%.

    “The proportion of children and adolescents who met any one recommendation in the included studies ranged from 34.9 to 51.1%, those who met any two recommendations ranged from 18.4 to 37.0%, and those who met all three recommendations ranged from 2.6 to 17.1%.”
    Quote in the paperNot a substantial claim

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

    Findingcitation

    The prevalence of depressive symptoms in included samples was 42.7% in more than 59,000 US adolescents, 14.4% in nearly 4000 UK adolescents, and 10.3% in more than 35,000 US children and adolescents.

    “Overall, the prevalence of depressive symptoms was 42.7% (unweighted) in a sample of more than 59,000 adolescents in the United States [18], 14.4% in a sample of nearly 4000 adolescents in the United Kingdom [19], and 10.3% in a sample of more than 35,000 children and adolescents from the United States [39].”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [18] Knell G, Durand CP, Kohl HW 3rd, Wu IHC, Pettee GK. Prevalence and likelihood of meeting sleep, physical activity, and screen-time guidelines among US youth. JAMA Pediatr. 2019;173(4):387–9. source

      Not checked in the free run.

    • cites [19] Pearson N, Sherar LB, Hamer M. Prevalence and correlates of meeting sleep, screen-time, and physical activity guidelines among adolescents in the United Kingdom. JAMA Pediatr. 2019;173(10):993–4. source

      Not checked in the free run.

    • cites [39] Zhu X, Haegele JA, Healy S. Movement and mental health: Behavioral correlates of anxiety and depression among children of 6–17 years old in the U.S. Ment Health Phys Act. 2019;16:60–5. source

      Not checked in the free run.

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    The review included 10 articles comprising 13 cross-sectional studies from 7 unique samples.

    “A total of 13 cross-sectional studies comprised in 10 papers met inclusion criteria.”
    • Also stated in: § Description of studies · plain
      “After titles and abstracts were screened, 28 full-text articles were obtained for further review and 10 articles met the inclusion criteria (7 unique samples).”
    • Also stated in: § Description of studies · plain
      “The 10 articles comprised 13 studies because some papers had more than one mental health outcome.”
    Quote in the paperNot a substantial claim

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

    Study design and conductnone given

    The electronic search strategy was created by a research librarian with expertise in systematic review.

    “The electronic search strategy was created by a research librarian with expertise in systematic review.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    The systematic review by Saunders et al. on associations between combinations of physical activity, sedentary time, and sleep duration and health indicators in children and adolescents is 5 years old and only included studies with objectively-measured physical activity.

    “The systematic review by Saunders et al. [25] on the associations between different combinations of physical activity, sedentary time, and sleep duration with health indicators in children and adolescents is 5 years old and only included studies with objectively-measured physical activity.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [25] Saunders TJ, Gray CE, Poitras VJ, Chaput J-P, Janssen I, Katzmarzyk PT, et al. Combinations of physical activity, sedentary behaviour and sleep: relationships with health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6):S283–S93. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Risk of bias was assessed for each outcome within each study using Cochrane Handbook methods.

    “A risk of bias assessment was completed for each outcome within each study using the methods described in the Cochrane Handbook [31].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [31] Higgins J, Green S. Cochrane handbook for systematic reviews of interventions, version 5.1.0. The Cochrane Collaboration. 2010. http://www.cochrane-handbook.org. Accessed 21 Apr 2020.

      Not checked in the free run.

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

    Study design and conductown data

    One reviewer completed data extraction, a second reviewer independently extracted data, and discrepancies were resolved by consensus.

    “One reviewer completed the data extraction electronically in Microsoft Excel. A second reviewer independently extracted data from eligible articles and entered this information into the extraction form. Forms were compared afterwards, and discrepancies were resolved by consensus.”
    Quote in the paperNot a substantial claim

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

    Study design and conductcitation

    Risk of bias assessment covered selection bias, performance bias, selective reporting bias, detection bias, attrition bias, and potential confounding.

    “we assessed the risk of selection bias, performance bias, selective reporting bias, detection bias, attrition bias, and potential confounding [32].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [32] Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, et al. GRADE guidelines: 4. Rating the quality of evidence--study limitations (risk of bias). J Clin Epidemiol. 2011;64(4):407–15. source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Results were extracted from the most fully adjusted models for studies reporting multiple models.

    “Results were extracted from the most fully adjusted models for studies that reported findings from multiple models.”
    Quote in the paperSubstantial claim

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

    Premisecitation

    The Canadian 24-Hour Movement Guidelines for Children and Youth (aged 5-17 years) recommend ≥60 min/day of moderate-to-vigorous physical activity, ≤2 h/day of recreational screen time, and 9-11 h of sleep per day for 5- to 13-year-olds or 8-10 h of sleep per day for 14- to 17-year-olds.

    “the Canadian 24-Hour Movement Guidelines for Children and Youth (aged 5 to 17 years) have been released in 2016 and recommend ≥60 min/day of moderate-to-vigorous physical activity (MVPA), ≤2 h/day of recreational screen time, and 9 to 11 h of sleep per day for 5- to 13-year-olds or 8 to 10 h of sleep per day for 14- to 17-year-olds to support healthy development [17].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [17] Tremblay MS, Carson V, Chaput JP, Connor Gorber S, Dinh T, Duggan M, et al. Canadian 24-hour movement guidelines for children and youth: an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab. 2016;41(6 Suppl 3):S311–27. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Physical activity, sedentary behaviour, and sleep are individually associated with better mental health among children and adolescents.

    “Achieving high levels of physical activity, low levels of sedentary behaviour, and getting sufficient sleep have been individually associated with better mental health among children and adolescents [12–14].”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites [12] Poitras VJ, Gray CE, Borghese MM, Carson V, Chaput J-P, Janssen I, et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6):S197–239. source

      Not checked in the free run.

    • cites [13] Chaput JP, Gray CE, Poitras VJ, Carson V, Gruber R, Olds T, et al. Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6 Suppl 3):S266–82. source

      Not checked in the free run.

    • cites [14] Carson V, Hunter S, Kuzik N, Gray CE, Poitras VJ, Chaput J-P, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update. Appl Physiol Nutr Metab. 2016;41(6):S240–S65. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Physical activity, sedentary time, and sleep are codependent and should be considered simultaneously.

    “research has shown that these three behaviours are codependent and should be considered simultaneously [15, 16].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [15] Pedišić Ž. Measurement issues and poor adjustments for physical activity and sleep undermine sedentary behaviour research—the focus should shift to the balance between sleep, sedentary behaviour, standing and activity. Kinesiology. 2014;46(1):135–46.

      Not checked in the free run.

    • cites [16] Chastin SFM, Palarea-Albaladejo J, Dontje ML, Skelton DA. Combined effects of time spent in physical activity, sedentary behaviors and sleep on obesity and cardio-metabolic health markers: a novel compositional data analysis approach. PLoS One. 2015;10(10):e0139984. source

      Not checked in the free run.

  • 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 conductcitation

    The searches used previously developed and validated searches for sleep, sedentary time, and physical activity.

    “The searches looked for journal articles reporting on sleep, sedentary time and physical activity using previously developed and validated searches [12–14, 30].”
    Quote in the paperNot a substantial claim0 of 4 sources checked
    • cites [12] Poitras VJ, Gray CE, Borghese MM, Carson V, Chaput J-P, Janssen I, et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6):S197–239. source

      Not checked in the free run.

    • cites [13] Chaput JP, Gray CE, Poitras VJ, Carson V, Gruber R, Olds T, et al. Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6 Suppl 3):S266–82. source

      Not checked in the free run.

    • cites [14] Carson V, Hunter S, Kuzik N, Gray CE, Poitras VJ, Chaput J-P, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update. Appl Physiol Nutr Metab. 2016;41(6):S240–S65. source

      Not checked in the free run.

    • cites [30] Kuzik N, Poitras VJ, Tremblay MS, Lee EY, Hunter S, Carson V. Systematic review of the relationships between combinations of movement behaviours and health indicators in the early years (0-4 years). BMC Public Health. 2017;17(Suppl 5):849. source

      Not checked in the free run.

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

    Study design and conductown data

    Two independent reviewers performed full-text review, consensus was required for inclusion, and discrepancies were resolved by discussion or a third reviewer.

    “At level 2, two independent reviewers performed full-text review of potentially eligible articles. Consensus was required for articles to be included; discrepancies between reviewers were resolved by discussion between them or with a third reviewer, if needed.”
    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

    Two reviewers independently screened titles and abstracts, and exclusion by both reviewers was required for exclusion at level 1.

    “Titles and abstracts of potentially relevant articles were imported to Covidence (a secure, internet-based software; Evidence Partners, Ottawa, Ontario, Canada) where two reviewers screened them independently. Exclusion by both reviewers was required for a study to be excluded at level 1 (title and abstract) screening.”
    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 conductown data

    This review was registered a priori with PROSPERO and conducted following the PRISMA statement.

    “This review was registered a priori with the International Prospective Register of Ongoing Systematic Reviews (PROSPERO; submitted 25/11/2019, registration pending), and was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement for reporting systematic reviews and meta-analyses [26].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [26] Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9 w64. source

      Not checked in the free run.

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

    Study design and conductcitation

    The PICOS framework was followed a priori to identify key study concepts and facilitate the search process.

    “The population, interventions, comparisons, outcomes, and study design (PICOS) framework [27] was followed to identify key study concepts in the research question a priori, and to facilitate the search process.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [27] Schardt C, Adams MB, Owens T, Keitz S, Fontelo P. Utilization of the PICO framework to improve searching PubMed for clinical questions. BMC Med Inform Decis Mak. 2007;7:16 Epub 2007/06/19. source

      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 forms were created by study coordinators, reviewed by collaborators, and pilot tested by all reviewers.

    “Data extraction forms were created by the study coordinators, reviewed by study collaborators, and pilot tested by all reviewers.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The quality of evidence for the three studies examining the association between the 24-h movement guidelines and depressive symptoms began at low due to observational design and was downgraded to very low due to serious risk of bias.

    “Following the GRADE protocol, the quality of evidence for the three studies examining the association between the 24-h movement guidelines and depressive symptoms began with a low-quality rating due to their observational design. Given that only one study used an objective measure of physical activity and a reliable and valid measure of depression in children [19], the quality of evidence was”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [19] Pearson N, Sherar LB, Hamer M. Prevalence and correlates of meeting sleep, screen-time, and physical activity guidelines among adolescents in the United Kingdom. JAMA Pediatr. 2019;173(10):993–4. source

      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

    The GRADE quality of evidence assessment was evaluated by one reviewer and verified by the larger review team, with disagreements resolved by discussion.

    “The quality of evidence assessment was evaluated by one reviewer and verified by the larger review team. Disagreements were resolved by discussion among the team members, if needed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The quality of evidence for other mental health indicators was downgraded from low to very low because of serious risk of bias, as most studies used subjective assessment of physical activity, screen time, and sleep duration.

    “Therefore, the quality of evidence was downgraded from “low” to “very low” because of a serious risk of bias (i.e., most studies used a subjective assessment of physical activity, screen time, and sleep duration”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    The present systematic review included only articles published in English or French.

    “Fourth, the present systematic review included only articles published in English or French.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    The overall quality of evidence for mental health indicators was assessed using the GRADE framework.

    “The overall quality of research evidence for mental health indicators was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework [32].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [32] Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, et al. GRADE guidelines: 4. Rating the quality of evidence--study limitations (risk of bias). J Clin Epidemiol. 2011;64(4):407–15. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    The strength of the conclusions is limited by the small number of included studies and lack of longitudinal and intervention studies.

    “Finally, the strength of our conclusions is limited by the small number of included studies and lack of longitudinal and intervention studies examining the associations between 24-h movement guidelines and mental health indicators in children and adolescents.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    The review used a comprehensive electronic search process created by an experienced research librarian.

    “First, it uses a comprehensive electronic search process that was created by an experienced research librarian, with the inclusion of a broad range of mental health indicators, comprising emotional, psychosocial, and cognitive health.”
    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

    Risk of bias was assessed by one reviewer and verified by another reviewer.

    “Risk of bias was assessed by one reviewer for all included articles, and then verified by another reviewer.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The quality of evidence was downgraded from 'low' to 'very low' because of a serious risk of bias, mainly because most studies used a subjective assessment of physical activity, screen time, and sleep duration with no psychometric properties reported.

    “Therefore, the quality of evidence was downgraded from “low” to “very low” because of a serious risk of bias (i.e., most studies used a subjective assessment of physical activity, screen time, and sleep duration with no psychometric properties reported)”
    • Also stated in: § Strengths and limitations · hedged
      “mainly because of the cross-sectional nature of all included studies, and the use of subjective measures for physical activity, recreational sedentary time, and sleep duration with no psychometric properties reported, raising concerns about possibility of risk of bias.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductown data

    A meta-analysis was not possible due to heterogeneous data, so a narrative synthesis was used.

    “Meta-analyses were planned if data were sufficiently homogenous with regards to methodological, statistical, and clinical characteristics. However, a meta-analysis was not possible due to heterogeneous data for the above characteristics. Therefore, a narrative synthesis was used to describe each health indicator.”
    Quote in the paperSubstantial claim

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

    Study design and conductnone given

    The current review focussed on sedentary time, particularly total recreational screen time, and did not look at the time spent in specific types of sedentary behaviours.

    “Likewise, the current review focussed on sedentary time, particularly total recreational screen time, and did not look at the time spent in specific types of sedentary behaviours (e.g., watching television, using social media, playing games, reading, eating, travelling in a car).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductcitation

    The review used a rigorous methodology following the PRISMA statement and GRADE framework.

    “Second, the review used a rigorous methodology following the PRISMA statement for reporting systematic reviews and meta-analyses [26] and GRADE framework [32].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [26] Moher D, Liberati A, Tetzlaff J, Altman DG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9 w64. source

      Not checked in the free run.

    • cites [32] Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, et al. GRADE guidelines: 4. Rating the quality of evidence--study limitations (risk of bias). J Clin Epidemiol. 2011;64(4):407–15. source

      Not checked in the free run.

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

    Study design and conductcitation

    The possibility of reverse causation is not excluded, as excessive screen time may be a coping strategy for individuals who are already suffering from mental health problems.

    “However, the possibility of reverse causation is not excluded, as excessive screen time may be a coping strategy for individuals who are already suffering from mental health problems [43].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [43] Domingues-Montanari S. Clinical and psychological effects of excessive screen time on children. J Paediatr Child Health. 2017;53(4):333–8. source

      Not checked in the free run.

37 of 37

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Sleep problems lead to a series of adverse outcomes, including decreased immune function, obesity, traffic accidents, substance abuse, depression, and suicidal tendency.

    “Sleep problems lead to a series of adverse outcomes, including decreased immune function, obesity, traffic accidents, substance abuse, depression, and suicidal tendency [1–3].”

    From Adolescents’ short-form video addiction and sleep quality: the mediating role of social anxiety (2024) · cites this paper as [2]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Depression sample size conflicts with Table 1

    Minor

    The text describes study [39] as having more than 35,000 children and adolescents, whereas Table 1 gives its sample size as 20,708.

  • Health-related quality-of-life findings attributed to the wrong studies

    Minor

    Table 3 attributes the finding about meeting all three recommendations to [35], but Table 1 assigns that finding to [38]. Table 1 instead describes [35] as the study of movement composition and human development index.

  • Two different result series are both labeled emotional problems

    Minor

    The Table 1 row for Janssen et al. assigns two distinct sets of adjusted means to emotional problems, although it also lists prosocial behaviour as an outcome. The second series appears to have been given the wrong outcome label.

3 of 3

Cites

Flagged first, then by citations

4 of the 70 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
Sampasa-Kanyinga, H., Colman, I., Goldfield, G. S., Janssen, I., Wang, J., Podinic, I., Tremblay, M. S., Saunders, T. J., Sampson, M., & Chaput, J.-P.
Affiliations
  • Norwegian Institute of Public Health (NO)
  • University of Ottawa (CA)
  • Queen's University (CA)
  • University of Prince Edward Island (CA)
  • Children's Hospital of Eastern Ontario (CA)
ORCID
Venue
International Journal of Behavioral Nutrition and Physical Activity
Publisher
Springer Science and Business Media LLC
Published
2020-06-05
Volume
17
Issue
1
Pages
72-72
ISSN
1479-5868 (ISSN-L)
DOI
10.1186/s12966-020-00976-x
PMC
PMC7273653
OpenAlex
W3034038324
Semantic Scholar
bc1e95a028d1b38fe304ac599bf9aca35dd6c27e
Cited by
430
References
70
Citations by year
2026: 67 · 2025: 98 · 2024: 104 · 2023: 74 · 2022: 55 · 2021: 27 · 2020: 4
FWCI
5.10
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of Behavioral Nutrition and Physical Activity (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • uO Research (University of Ottawa) (submittedVersion, public-domain)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
Funders
Norges Forskningsråd (262700.)
Topics
  • Health Sciences › Medicine › Physiology › Physical Activity and Health
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Keywords
physical activity, sedentary behavior, sleep duration, depressive symptoms, mental health, children, adolescents, screen time, dose-response relationship
MeSH terms
Adolescent, Child, Child, Preschool, Depression, Humans, Mental Health, Sleep, Exercise, 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 ›

Are you an author, or do you see a problem with this page? Request a review