School-related sedentary behaviours and indicators of health and well-being among children and youth: a systematic review

Kuzik, Nicholas; da Costa, Bruno G. G.; Hwang, Yeongho; Verswijveren, Simone J. J. M.; Rollo, Scott; Tremblay, Mark S.; Bélanger, Stacey; Carson, Valerie; Davis, Melanie; Hornby, Susan; Huang, Wendy Yajun; Law, Barbi; Salmon, Jo; Tomasone, Jennifer R.; Wachira, Lucy-Joy; Wijndaele, Katrien; Saunders, Travis J.

doi:10.1186/s12966-022-01258-4

International Journal of Behavioral Nutrition and Physical Activity

Table 5 Summary of results for risks (injury)/harm indicators organized by study design

No. of participants (No. of studies)	Design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other	Absolute effect	Quality
47 (1) [98]	Cross-Over Trial	Very serious risk of bias^a	No serious risk of inconsistency	No serious risk of indirectness	Very serious risk of imprecision^b	None	Standing desk: • 1/1 studies reported mixed findings^c • 1: More sedentary behaviour null and unfavourable for health [98]	Very Low
178 (3) [54, 55, 85]	Non-Randomised Intervention	Very serious risk of bias^d	No serious risk of inconsistency	No serious risk of indirectness	No serious risk of imprecision	None	Standing desk: • 3/3 studies reported null findings [54, 55, 85]	Very Low
1958 (1) [99]	Longitudinal	Serious risk of bias^e	No serious risk of inconsistency	No serious risk of indirectness	Serious risk of imprecision^f	Dose Response	Homework: • 1/1 studies reported mixed findings • 1: Mixed findings included dose response relationships with unfavourable associations for ≥2 h of cram school attendance, and null associations for 0.5–1.9 h/day [99].	Very Low
472,293 (14) [63, 94, 99,100,101,102,103,104,105,106,107,108,109,110]	Cross-sectional	Serious risk of bias^g	No serious risk of inconsistency	No serious risk of indirectness	No serious risk of imprecision	Dose Response	Overall: • 2/14 studies reported null findings, • 5/14 studies reported more sedentary behaviour unfavourable for health • 7/14 studies reported mixed findings • 5: More sedentary behaviour null and unfavourable for health • 2: More sedentary behaviour favourable, null, and unfavourable for health • 5: Mixed findings included dose response relationships Homework: • 2/12 studies reported null findings [63, 100] • 3/12 studies reported more sedentary behaviour unfavourable for health [94, 101, 102] • 7/12 studies reported mixed findings^h • 5: More sedentary behaviour null and unfavourable for health [99, 105,106,107,108] • 2: More sedentary behaviour favourable, null, and unfavourable for health [109, 110] • 5: Mixed findings included dose response relationships with unfavourable results for “too much”, ≥60 min/day, ≥ 2 h/day, 2–3 h/day, and > 3 h/day; null results for “not enough”, 1–30 min/day, 31–60 min/day, and 0.5–1.9 h/day homework, as well as 4–6 h/day and > 10 h/day of studying/sitting; and favourable results for 6–8 and 8–10 h of studying/sitting [99, 105,106,107, 110] Recess/PE: • 1/1 studies reported more sedentary behaviour unfavourable for health [103] Screen time: • 1/1 studies reported more sedentary behaviour unfavourable for health [104]	Very Low

Mean age at baseline ranged from 9.7 to 16.5 years; when mean age was not reported age or grade range minimums were 6.0 years and grade 1 and range maximums were 19.0 years and grade 12. Study designs included cross-over trial, non-randomized interventions, and longitudinal with up to 4 years follow-up, and cross-sectional. Risks (injury)/harms were assessed objectively through eye examinations for myopia, visual acuity, and visual impairment; and subjectively pain/discomfort (abdominal, ankles/feet, back, elbow, hip/thigh, knee, lower back, lower limbs, neck and shoulder, neck, shoulder, upper back, upper limbs, wrist/hands, and overall pain or discomfort using the Nordic Musculoskeletal Questionnaire, HBSC survey, or study-specific questionnaires), headaches (study-specific questionnaires), well-being (self-report HBSC), and global health (parent-report questionnaire)
^a Intervention first condition, and control group first condition were in the same classroom
^b Only one study, with a small sample size
^c Unfavourable for odds of elbow, low back, neck, and shoulder pain, as well as for less neck pain, but null for all other areas of pain [98]
^d 2/3 studies had intervention and control groups in the same school
^e Study did not demonstrate psychometric testing of subjectively measured exposure variables
^f Only one study, but did have large sample size
^g 9/15 studies did not demonstrate psychometric testing of subjectively measured exposure variables
^h 5: null and unfavourable [1: unfavourable for too much homework and shoulder pain, but null for not enough and shoulder pain, and all neck pain [105]; 1: unfavourable for too much, null for not enough [106]; 1: unfavourable for > = 60 min and myopia, null for all visual acuity and myopia 1–30 and 31–60 min homework [107]; 1: unfavourable overall and > = 2 h of homework, null for 0.5–1.9 h/day [99]; 1: unfavourable for boys weekday homework and odds of pain, but null for all other outcomes and sub-groups (11/12 associations) [108]; 2: favourable and null and unfavourable findings [1: dose response-generally favourable associations at 1–2 h of studying, unfavourable at > 3 h and 2–3 h [109]; 1: dose response-favourable associations at 6–8 and 8–10 h, but null for > 10 h and 4–6 h (compared to < 4 h), and unfavourable for extra learning tasks after class [110]]

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ISSN: 1479-5868

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