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Table 3 Results of the included reviews

From: Behavioral determinants of physical activity across the life course: a “DEterminants of DIet and Physical ACtivity” (DEDIPAC) umbrella systematic literature review

Author, Date (Type of review) [Ref] Outcome(s) Determinant(s) Review aim Overall qualitative results of the review Overall quantitative results of the review Overall limitations of the study Overall Recommendations
Babakus WS, 2012 (SLR) [24] Overall PA Language difficulties; lack of time To assess what is known about the levels of PA and sedentary time and to contextualize these behaviors among South Asian women with an immigrant background. South Asian women are less active than the other ethnic groups as well as compared to South Asian males; knowledge of PA and its benefits was found to be lacking among south Asian. N.A. No standardized method for quality evaluation; lack of details from some of the included papers; measurement and definition of PA varied widely; publication and researcher bias possibility; significant heterogeneity among studies. More research should be dedicated to standardize objective PA measurement and to understand how to utilize the resources of the individuals and communities to increase PA levels and overall health of South Asian women; future research is needed to assess levels of sedentary time and contextualize sedentary behaviors.
Barnett I, 2012 (SLR)[25] Overall PA Work after retirement from main occupation; retirement from strenuous occupation; being retired for <5 years; lifelong participation in PA; being married To examine changes and predictors of changes in PA across the transition to retirement; whether these changes vary by SES; what is known about predictors of changes in PA across the retirement transition. Exercise and leisure-time PA increased after the transition to retirement, whereas the findings regarding changes in total PA were inconclusive; men increase their PA more than women; lower SES is associated with a decrease and high SES with an increase in PA. Evidence on other predictors was scarce, often inconsistent, and methodologically weak. N.A. Evidence on predictors of change was scarce and methodologically weak; no language or country restrictions; published peer-reviewed journal articles as well as gray research literature were included; multidisciplinary approach contributed to the heterogeneity of the results and to the unfeasibility of meta-analysis. Further studies should include other measures of SES, appropriate and valid PA measures, apply clear and relevant defınitions of retirement, and study predictors of PA change across the transition to retirement; qualitative studies and longitudinal studies with longer follow-up are needed.
Craggs C, 2011 (SLR) [34] Overall PA Vigorous PA; participation in sport teams outside school; previous PA; alcohol consumption; dietary habits; smoking status; sedentary behavior To collate the current evidence base, highlight research trends and limitations in physical activity determinants research, and synthesize the existing evidence. Inconclusive associations were reported for large proportion of the determinants examined; girls consistently reported larger declines in PA than boys in younger children; parental marital status was consistently shown not to be associated with change in activity; higher levels of self-efficacy were associated with smaller declines compared to lower levels of self efficacy in older children and adolescents. N.A. Possibility of publication bias (included published studies only); heterogeneity in study samples, exposure and outcome measures included in this review; some studies draw data from the same cohorts; semi-quantitative reporting used in the review that limits the classification of the associations. Further research should include objective measures of PA and use previously validated questionnaires to assess the investigated determinants; more high quality research is needed in all age groups, especially in younger children; investigation into determinants of change should take into account of specifıc physical intensities such as minutes spent in moderate or vigorous physical activity.
De Craemer M, 2012 (SLR) [26] Overall PA, MVPA, active transport Participation in organized sports; television viewing/sedentary; enjoy television viewing; child has no energy to use active transport To systematically review the correlates of PA, sedentary and eating behavior in preschool children 4-6 years old. Attending a rural preschool was positively associated with physical activity; gender, age and socioeconomic status were not associated with physical activity, while an indeterminate result was found for ethnicity; gender and ethnicity were not associated with sedentary behavior and indeterminate results were found for age and socioeconomic status; preschoolers were more physically active as well as sedentary on weekdays; watching television was associated with a higher consumption of snacks and sweet beverages. N.A. Some limitations regarding the coding of the association of the variables; new categories for each behavior were made. Future research should focus on identifying the common correlates of physical activity, sedentary behavior and eating behavior in preschool-aged children so that better tailored interventions could be developed. Furthermore, more longitudinal studies could contribute in drawing stronger conclusions on determinants of these EBRBs.
Engberg E, 2012 (SLR) [12] Overall PA Transition to university; change in employment status; marital transitions and changes in relationships; pregnancy/having a child; experiencing harassment at work, violence or disaster; moving into an institution To examine literature concerning the effects of life events on changes in PA. Most of the studies reviewed showed statistically significant changes in PA associated with certain life events; transition to university, having a child, remarriage and mass urban disaster were associated with decreased PA levels, while retirement was associated with increased PA; experiencing multiple simultaneous life events were associated with decreased PA in men and women; PA is often used as part of a rehabilitation programme for diseases. N.A. Self-reported PA data are likely to be somewhat limited; another limitation is the possible cross contamination of responses when PA levels before and after a life event were assessed at the same time; the generalization of study findings to lower socioeconomic status and ethnic minority populations, as well as to other countries, may be limited because PA and life events vary; limitations of the studies include that PA data were not always reported in detail; some studies did not analyze, statistically, the magnitude of change in PA; another important limitation is that life events tend to overlap. Future studies should examine gender differences in the effects of life events and use validated methods in assessing leisure PA. Longitudinal cohort studies and clinical trials from different countries and cultures are needed. Studies with longer follow-ups are necessary to examine how long the effects of life events on PA persist.
Kaczynski AT, 2008 (SLR) [13] Overall PA Smoking To better understand the co-occurrence of smoking and physical inactivity in both adults and youth. In approximately 61% of the studies of adult populations, the association between smoking and PA was negative, less pronounced for youth and adolescents, and among males than females. N.A. Some authors defined a smoker as someone who smoked at least once in the past 30 days whereas other studies used the criterion of at least one cigarette per day over the past month. Further complicating interpretations is the fact that controlling for or including different variables changes the impact of the "predictor" variables on the "outcome" measures. Almost all of the aforementioned studies were cross-sectional, and so inferring causality or the direction of relationships is near impossible. Researchers hoping to improve understanding of the joint relation between PA and smoking need to collect data at both the individual and organization (i.e., environment) levels. Understanding the mechanisms by which depression, lung function, school setting, or other factors mediate or moderate the smoking and PA relationship requires measurement of these variables at multiple (preferably three or more) points in time. By expanding the array of investigative methods employed, researchers will be better equipped to understand linkages between smoking and PA and to design effective interventions.
Koeneman MA, 2011 (SLR) [27] Overall PA, Overall Ex, Overall PA/Ex Baseline activity level; smoking To systematically review determinants of PA and exercise among healthy older adults. Insufficient evidence for most associations between possible determinants and PA or Ex. N.A. There may be possibility of publication bias; a wide age range is applied that might have masked some of the differences between subsamples inside that population; they excluded some specific subsamples of the older population; overall low quality of the studies included The determinants of PA need further study that include the use of objective measures of PA and exercise and valid and reliable measures of determinants.
Larouche R, 2014 (SLR) [15] Overall PA Active school transport To systematically assess the quality of evidence with respect to the relationship between active school transport and daily PA, cardiovascular fitness, and body composition. Overall, 81.6% of the studies showed positive associations between active school transport and PA levels with moderate quality of evidence. N.A. Meta-analyses were precluded due to the wide heterogeneity in study methodologies and analyses. Further, the funnel plot and related statistical methods for detecting publication bias could not be used because a consistent measure of effect across studies was not available. Future active school transport studies should analyze walking and cycling separately. Future studies could evaluate the impact of existing programs that promote active school transport on PA levels and health related outcomes. Future studies should consider assessing active school transport as a continuous variable (i.e., frequency × distance).
Lee MC, 2008 (SLR) [28] Overall PA Active commuting to school This article presents a systematic review of the literature on active commuting (walking or bicycling) and the outcomes of physical activity and weight/obesity in school-age children. In multiple studies in a number of countries, a significant association between physical activity and walking or cycling to school has been noted across many age groups of school children. The strength of the association is mixed and a summary estimate is not possible because of the heterogeneity in study design. Regardless of this association, it remains unclear as to whether the commute trip itself is a significant component of total physical activity. N.A. The definition of active commuting and the potential for misclassification bias; the methodology of measuring physical activity; the majority of cross-sectional studies. Future research should focus on measuring the impact of interventions that succeed in changing commuting behavior and quantifying the contribution of the commute to children’s daily activity.
Marshall SJ, 2004 (MA) [14] Overall PA TV viewing; video/computer game use To examine the evidence that sedentary behaviors displace physical activity. Possible mechanisms lack supporting evidence and claims that TV viewing, playing video games or using computers displace physical activity receive very limited empirical support. −0.096 (95% CI = -0.080,-0.112)
-0.104 (95% CI = -0.080,-0.128)
Only studies written in English. More experimental research is needed to replicate these findings and explore possible mechanisms.
Pearson N, 2014 (MA) [29] Overall PA Total sedentary behavior; computer; homework; internet; reading; screen time; television; video games; composite sedentary behavior The aim of the current study was to systematically review and meta-analysis peer-reviewed research describing the association between sedentary behavior and PA in children and adolescents. A significant, but small, negative association was found between sedentary behaviors and physical activity in children and adolescents; in moderator analyses, studies that recruited smaller samples, employed objective methods of measurement or were assessed to be of higher methodological quality reported stronger associations, although the magnitude of effect remained small or small to moderate; small inverse associations were observed between specific sedentary behaviours, including Internet use, screen time and TV viewing, and physical activity. −0.108 (95% CI = -0.128,-0.087)
-0.018 (95% CI = -0.038,0.001)
0.014 (95% CI = -0.043,0.095)
-0.051 (95% CI = -0.097,-0.006)
-0.009 (95% CI = -0.039,0.021)
-0.080 (95% CI = -0.101,-0.060)
-0.064 (95% CI = -0.084,-0.045)
-0.002 (95% CI = -0.043,0.040)
-0.265 (95% CI = -0.364,-0.165)
Dichotomization of a continuous construct; searches were confined to studies published in peer-reviewed journals and those written in English; evaluation of associations between sedentary behavior and all PA outcomes combined, instead of different PA domains. Further research is required to clarify the relative and interacting impact of PA and sedentary behavior on weight status in this population.
Ridgers ND, 2012 (SLR) [33] Recess PA Sport activities; physical conflict frequency; day-to-day variability; play ball games; sedentary activities To examine the correlates of children’s and adolescent’s PA during school recess periods. Higher perceived encouragement from parents, peers, and the school as a whole was associated with higher self-reported physical activity levels during recess periods, particularly in adolescents; overall facility provision (i.e., sum of facilities available) was positively associated with physical activity; a positive association was found between unfıxed equipment and recess physical activity in children; boys are more physically active during recess. N.A. The majority are small-sized and cross-sectional studies; meta-analysis is difficult to obtain given the limited number of studies and the lack of consistency in correlates assessed; a range of physical activity measures have been used; different cut-points and observation systems may have influenced the strength of associations observed. Further research should investigate correlates of children’s and adolescents’ recess physical activity for variables that were not investigated frequently but indicated positive associations with physical activity; further research using objective measures is needed to determine adolescents’ recess physical activity levels; future research should examine whether increasing access to school facilities during recess periods increases physical activity levels in children and adolescents; further research is needed to determine whether specifıc types of equipment, or the overall availability of unfıxed equipment, are associated with higher levels of physical activity; future research should examine the correlates of boys and girls physical activity separately; More research is needed concerning correlates of PA in recess period, particularly in adolescents.
Schoeppe S, 2013 (SLR) [16] Overall PA Independent mobility without adult supervision (Active travel to and/or from school and active travel to leisure time related places); independent mobility without adult supervision (outdoor play); active travel with or without adult supervision (Active travel to and/or from school); active travel with or without adult supervision (Active travel to leisure time related places) To synthesize the evidence for associations of children’s independent mobility and active travel to various destinations with physical activity, sedentary behavior and weight status. Children’s active travel to and/or from school was consistently positively associated with physical activity; positive relationships were found between active travel to leisure-related destinations and physical activity; travel to various places including school, shops, cinemas and friend’s homes were positive associated with moderate-to-vigorous and overall physical activity; children were more likely to increase physical activity levels when their outdoor play occurred independently; associations between active school travel and weight status were inconsistent across the studies. N.A Few studies measuring active travel to places other than school; use of different thresholds for defining objectively measured sedentary behavior in children; the measurement of sedentary activities in children still lacks standardization and validation; Social and physical environments conducive to children’s independent mobility and active travel were not explored but certainly play a role as correlates of children’s physical activity, sedentary behavior and weight status. Future studies should seek to investigate associations of independent mobility and active travel with light intensity physical activity; children’s daily active travel to various destinations beyond the school setting requires further attention, as well as investigating diverse sedentary behaviors beyond simply screen-based activities and defining appropriate thresholds for objectively measured sedentary behavior in children; the potential of independent mobility to prevent sedentary behavior and excessive weight should be explored in future observational studies; studies should measure independent mobility and active travel more thoroughly by considering frequency and duration of independent mobility and active travel, as well as whether children are travelling alone or with peers, or to proximal versus distant destinations, and whether the observed associations differ by age and gender.
Stanley RM, 2012 (SLR) [30] Time-specific PA (i.e., school break time PA and after-school PA) TV viewing/playing video games; use of facilities; member of organized activities To identify the correlates of childrens' PA (8-14years) occurring during the school break-time and after school periods. Boys and younger children tend to be more active during break-time and after-school; BMI in females negatively associated with after-school PA, age was negatively associated in school-break and after school; family affluence, access to a gym, access to four or more PA programs and the condition of a playing field were all associated with school break time PA in one study; access to loose and fixed equipment, playground markings, size of and access to play space and the length of school break time were all positively associated with changes in school break time PA in intervention studies; in the after-school period, gender (with boys again more active), younger age, lower body mass index (for females), lower TV viewing/playing video games and greater access to facilities were associated with higher levels of after-school PA in two or more studies, while parent supervision was negatively associated with females’ after-school PA in one study. N.A. Small number of studies that vary in methodological aspects; possibility that some studies are missed during the search process; majority of cross-sectional studies; some studies stratified analyses by salient variables such as age, gender and intensity of PA, resulting in an over-representation of these studies in the review; the relatively narrow age range specified in the current review is a limitation. Future studies using a context specific approach should identify and report specific facilities relevant to the context in question, which will contribute to a clearer understanding of context-specific PA; future studies should choose measurement tools with appropriate psychometric properties; Need of high quality evidence upon which PA promotion in young people can be tailored to specific settings and contexts.
Tzormpatzakis N, 2007 (SLR) [31] Overall PA/Ex Lack of time; time constraints; marital status To evaluate the evidence from research relevant to participation in PA and exercise in Greece. Participation in physical activity and exercise in Greece was generally low; men exercise more vigorously and more actively than women; the main reasons for participation were health, weight control, fitness, and stress management. Lack of leisure time was the main perceived barrier to increasing levels of physical activity and exercise; men seemed to exercise more frequently and more vigorously than women; single people were more likely to be physically active compared to those who were married or divorced/widowed; people living in rural areas were more likely to be physically active than those living in urban areas. N.A. None of the studies used objective measurements and also they used different self-reported estimates of PA; lack of appropriate use of the terms 'exercise' and 'PA'; none of the instruments were validated in Greece; seasonality effect, since seasonal variation exists in physical activity participation. PA promotion should be organized in a systematic way; a clear definition of variables is needed; intervention studies should be employed in order to test the efficiency of policies, strategies and campaigns; longitudinal studies should be utilized in order to evaluate trends in physical activity participation and the long-term effects of campaigns; a clear pattern of who is considered physically active and inactive should be determined according to internationally established criteria in order to have more valid and reliable data; studies should not concentrate only on leisure time physical activities but on the total physical activity profile of each participant.
Uijtdewillingen L, 2014 (SLR) [35] Overall PA Past physical activity; screen time To summarize and update the existing literature on determinants of PA and sedentary behavior in young people. Moderate evidence for intention as a determinant of children’s physical activity, and age (i.e., older children were more active), ethnicity (i.e., being of African–American descent determined being less physically active) and planning as determinant of adolescent physical activity. N.A. Included studies assessed overall PA only; used two databases only; the selected language of publication was English only. Future researches should be focused on determinants of child and adolescent sedentary behavior and on environmental determinants of physical activity in both children and adolescents, should use reliable and valid measures of both determinants as well as the actual behaviors and should conduct prospective studies of high methodological quality.
van der Horst K, 2007 (SLR) [32] Overall PA PE/school sports; watching TV; smoking; television/sedentary time To summarize and update the literature on correlates of PA, insufficient PA, and sedentary behavior in young people. The results from our review suggest that correlates of physical activity for children are gender, self-efficacy, parental physical activity for boys, and parental support. Correlates for adolescents' physical activity were gender, parental education, attitude, self-efficacy, goal orientation/motivation, physical education/school sports participation, family influences, and friend support. Gender, self-efficacy, and family/parental support were associated with physical activity, both in children and adolescents. N.A. Publication bias may be present; possibility of missed studies as a result of the search strategy; the main outcome was overall PA without other classifications; mostly cross-sectional studies included; because of the variability, it was not possible to assess the overall strength of the associations. More prospective studies are needed and more research including children.
  1. Notes: MA meta-analysis, SLR systematic literature review, PA physical activity, PE physical education, MVPA moderate-to-vigorous physical activity, Ex exercise, SES socio-economic status, EBRB energy balance-related behavior