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

The DOI matches its Crossref record; 66 of the 70 references it cites were found in a registry or an index; none of the 70 sources its claims cite is checked for support yet.

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., Sampson, Margaret, Chaput, Jean-Philippe·2020·International Journal of Behavioral Nutrition and Physical Activity

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.

Overview

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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.

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Integrity signals

Registry

Crossref · 10.1186/s12966-020-00976-x

Cites

66 of 66 references verified0 citation errors · 0 not checkable

Statistics

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Figures

Fig. 1 PRISMA flow diagram for the identification, screening, eligibility, and inclusion of studies
Fig. 1 PRISMA flow diagram for the identification, screening, eligibility, and inclusion of studiesCC BY · PubMed Central

Verification

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Metadata

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)
Venue
International Journal of Behavioral Nutrition and Physical Activity
Published
2020-06-05
Volume
17
Issue
1
Pages
72-72
ISSN
1479-5868 (ISSN-L)
OpenAlex
W3034038324
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
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 › Public Health, Environmental and Occupational Health › 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

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