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Table 3 Summary of included studies

From: The relationship between active travel to school and health-related fitness in children and adolescents: a systematic review

Study

Sample

Study design

ATS classification

HRF component(s) and method of assessment

Analyses

Results

Prevalence of ATS

Evenson et al [19]

4448 adolescents

Grades 6-12

United States

Cross-sectional

Walking or riding to/from school at least once/week

BC- Self report BMI z-score (>85th percentile considered overweight)

Logistic regression

Middle school students above the 85th percentile were less likely to use ATS

BMI categories not associated with ATS in high school students.

6th grade- 12.3%

7th grade- 7.5%

8th grade- 8.2%

9th grade- 6.0%

10th grade- 5.7%

11th grade- 4.0%

12th grade- 3.0%

Tudor-Locke et al [8]

1518 adolescents

14-16 years

Philippines

Cross-sectional

Usual travel to/from school (ATS, combination of ATS and PTS or PTS only)

BC- BMI

ANOVA

BMI not associated with ATS in girls.

Boys using ATS only had significantly lower BMI values than boys using PTS only.

Boys- 47% (323/691)

Girls- 37% (303/827)

Metcalf et al [26]

275 children

5 years

England

Cross-sectional

Usual travel to/from school (ATS or PTS)

BC- BMI and sum of 5 skinfolds

ANOVA

No relationship between ATS and BMI or skinfolds.

Boys- 63% (97/154)

Girls- 73% (88/121)

De Bourdeauhuij et al [30]

6078 children and adolescents

11-17 years Belgium

Cross-sectional

Usual travel to/from school (ATS or PTS)

BC- Self-report BMI z-score (>85th percentile considered overweight)

Independent samples t-test

Overweight youth less likely to use ATS.

Not available

Fulton et al [21]

1395 children and adolescents

Grades 4 to 6, 7 to 9 and 10 to 12

United States

Cross-sectional

Usual travel to/from school or work (ATS or PTS)

BC- Proxy and self-report BMI

Logistic regression

No association between BMI and ATS.

Boys- 17% (121/727)

Girls- 11% (74/668)

Gordon-Larsen et al [20]

10771 adolescents

Grades 7 to 12

United States

Cross-sectional

Usual travel to/from school or work (ATS or PTS)

BC- BMI

Independent samples t-test

Rates of ATS were higher among non-overweight adolescents.

 

Heelan et al [43]

320 children

10.2 years

United States

Cross-sectional

How they travelled to/from school in the past 24 hours (ATS or PTS) and amount of time taken

BC- BMI, average of 3 skinfolds

Multiple regression

Significant association between BMI and ATS in overweight children. No association between skinfolds and ATS.

Boys & girls- 33.3% (107/320)

Klein-Platat et al [31]

2714 adolescents

12 years

France

Cross-sectional

Walking or riding to/from school- none, 0-20 min/day and > 20 min/day

BC- BMI z-score (>90th percentile considered overweight) and WC

ANCOVA

ATS associated with weight status and WC.

Boys- 40% (543/1357)

Girls- 37% (503/1357)

Sirard et al [22]

219 children

10.3 years

United States

Cross-sectional

Walking or riding to/from school- regular active commuters (>5 times/week), irregular active commuters (1-4 times/week) or passive commuters (0 times/week)

BC- BMI z-score (>85th percentile considered overweight)

ANOVA

No association between weight status and ATS.

Boys- 3% (3/96)

Girls- 8% (8/123)

Cooper et al [32]

529 children and 390 adolescents

9.7 and 15.5 years Denmark

Cross-sectional

Usual travel to/from school [passive (car, motorcycle, train, bus), bicycle or walk] and duration of journey

CRF- Progressive cycle ergometer

ANOVA

Children and adolescents who cycled to school had higher CRF than those who used PTS.

No relationship between walking to school and CRF.

Boys (child)-66% (168/254)

Girls (child)- 62% (172/276)

Boys (adol)-87.5% (169/193)

Girls (adol)-85% (167/196)

Mota et al [35]

450 adolescents

14.6 years

Portugal

Cross-sectional

Usual travel to/from school (ATS or PTS) and duration of journey

BC- BMI z-score (>85th percentile considered overweight)

Bivariate correlation

No association between weight status and ATS.

Boys & girls- 23.1% (105/450)

Rosenberg et al [23]

1083 children

Grades 4 and 5

United States

Longitudinal

ATS- 2 or more days/week of ATS at each of the 4 assessment periods.

BC- BMI z-score (>85th percentile considered overweight), average of 3 skinfolds

ANOVA

Boys who used ATS at baseline had significantly lower BMI and skinfolds than passive commuters.

No association between ATS and weight status in girls.

No association between changes in BMI and skinfolds and ATS over 2-year period.

Boys- 36% (116/320)

Girls- 29% (79/274)

Timperio et al [36]

912 children

5 to 6 and 10 to 12 years

Australia

Cross-sectional

ATS at least once per week

BC- BMI z-scores (IOTF classification)

Logistic regression

No association between ATS and weight status.

Boys- 9% (29/316)

Girls- 4% (13/361)

Ford et al [27]

239 children

5 to 11 years

England

Cross-sectional

PST or ATS (walk) for > 10 mins, more than 3 times/week for at least 15 weeks

BC- Air displacement plethysmorgaphy (BodPed Self-Test)

Mann-Whitney U test

No significant difference in body fat between ATS a

Boys- 47% (59/125)

Girls- 43% (49/114)

Li et al [38]

6826 children and adolescents

7 to 17 years

China

Cross-sectional

Usual travel to/from school- walking or riding classified as ATS

BC- BMI z-score (>85th percentile considered overweight)

Cox regression analysis controlling for parental overweight and SES

Overweight youth less likely to use ATS.

Boys & girls- 93.6% (6386/6826)

Mota et al [34]

705 adolescent girls

14.7 years

Portugal

Cross-sectional

Usual travel to/from school- walking or riding classified as ATS

BC- BMI

Chi-square and bivariate correlation

No association between BMI and ATS.

Boys & girls- 52.6% (371/705)

Ortega et al [39]

2859 adolescents

13 to 18.5 years

Spain

Cross-sectional

ATS classified as riding/walking to/from school > 15 min/day

BC- BMI z-scores, WC adjusted for height

ANCOVA

Weights status not associated with ATS in boys or girls. Significant association between ATS and WC in girls.

Boys- 9.6% (130/1357)

Girls- 13% (189/1502)

Saksvig et al [24]

1721 adolescent girls

12.0 years

United States

Cross-sectional

Travel by walking on 1 or more weekdays before/after school.

BC- BMI

Linear mixed models

No difference in BMI among those who walked to school and those who did not.

Before school - 13.6% (232/1701)

After school 17.7% (301/1701)

Cooper et al [33]

384 children

9.7 years

Denmark

Longitudinal

Usual travel to/from school (cycle, walk or PTS).

CRF- Progressive cycle ergometer

ANOVA

CRF was significantly higher among children and adolescents who cycled to school at one or both time periods compared to those who used other forms of transport.

Boys- 66% (110/170)

Girls- 65% (137/214)

Landsberg et al [40]

626 adolescents

14 years

Germany

Cross-sectional

Usual travel to/from school (ATS or PTS) and duration of journey.

BC- BMI z-score (>85th percentile considered overweight), Sum of 4 skinfolds (triceps, biceps, suprailiacal and subscapular), bioelectrical impedance (fat mass) and WC.

General linear models

ATS associated with lower fat mass and skinfolds. ATS associated with BMI or WC.

Boys- 63% (206/328)

Girls- 50% (163/298)

Robertson-Wilson et al [41]

21345 adolescents

Grades 9 to 12

Canada

Cross-sectional

Usual travel to/from school (ATS or PTS).

BC- BMI z-score (>85th percentile considered overweight)

Binary logistic regression

No association between ATS and weight status.

Boys- 44% (4699/10747)

Girls- 41% (4378/10598)

Silva and Lopez [42]

1570 children

7 to 12 years

Brazil

Cross-sectional

Usual travel to/from school (ATS or PTS) and duration of journey.

BC- BMI z-scores (IOTF classification) and skinfolds (tri-cipital)

Regression

ATS was associated with a lower prevalence of excess weight and body fat.

Boys- 15% (117/785)

Girls- 18% (131/742)

Yeung et al [37]

107 children

4 to 12 years Australia

Cross-sectional

ATS at least once/week.

BC- Parental proxy BMI

Mann-Whitney U test

No association between BMI and mode of transportation to school.

Boys- 40% (59/149)

Girls- 27% (46/169)

Andersen et al [15]

1249 adolescents

15 to 19 years

Denmark

Cross-sectional

Usual travel to/from school (cycle, walk or PTS).

BC- BMI CRF- Progressive cycle ergometer

MF- sit-ups, static back strength, arm flexion dynamic test

FL- sit and reach

ANOVA

Cyclists had higher CRF, MF and FL than both walkers and those who use PTS.

No relationship between BMI and transportation mode.

Boys- 72% (391/545)

Girls- 79% (559/704)

Baig et al [28]

673 adolescents

12.6 years

England

Cross-sectional

Usual travel to/from school (cycle, walk, public transport or bus) and duration of journey calculated.

BC- BMI z-scores (IOTF classification)

Binary logistic regression

No association between ATS and weight status.

Girls 3.6 times more likely to walk to school than boys

Madsen et al [25]

5357 adolescents

Grades 7 and 9

United States

Cross-sectional

Travel to (day of survey) and from (day before survey) school.

BC- BMI z-scores (CDC >85th percentile considered overweight)

CRF- 1 mile run test

Linear regression

ATS was inversely associated with weight status

A non-significant (p = 0.07) trend between ATS and CRF was found.

To school - 29% (1554/5357)

From school - 46% (2464/5357)

Voss et al [29]

6085 children and adolescents

10 to 15.9 years England

Cross-sectional

Usual travel to/from school (cycle, walk, public transport or bus) and duration of journey calculated.

BC- BMI z-scores (IOTF classification)

CRF- 20 m shuttle run test

ANOVA

No association between travel mode and BMI. ATS associated with improved CRF.

Boys- 59% (1845/3135)

Girls- 57% (1587/2792)

  1. ATS = Active travel to school; BC = Body composition; BMI = Body mass index; CDC = Centers for Disease Control & Prevention; CRF = Cardiorespiratory fitness; FL = Flexibility HRF = Health-related fitness; IOTF = International Obesity Task Force; MF = Muscular fitness; NR = Not reported; PTS = Passive travel to school; WC = Waist circumference.