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Table 6 Summary of results for social-emotional indicators organized by study design

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

No. of participants (No. of studies)

Design

Risk of bias

Inconsistency

Indirectness

Imprecision

Other

Absolute effect

Quality

6095 (4)

[49, 111,112,113]

Clustered RCT

No serious risk of bias

No serious risk of inconsistency

Very serious risk of indirectnessa

No serious risk of imprecision

None

Overall:

 • 1/4 studies reported null findings

 • 2/4 studies reported unfavourable findings

 • 1/4 studies reported mixed findings

  • 1: null and unfavourable

 • 1/4 studies also compared types of sedentary behaviours

Active Lessons:

 • 2/4 studies reported unfavourable findings [111, 112]

 • 1/4 studies reported mixed findingsb

  • 1: Null and unfavourable [113]

 • 1/4 studies compared types of sedentary

  • 1: Sedentary game was favourable compared to sedentary lesson [113]

Additional PA:

 • 1/1 studies reported null findings [49]

Low

49 (1)

[85]

Non-Randomised Intervention

No serious risk of bias

No serious risk of inconsistency

No serious risk of indirectness

Very serious risk of imprecisionc

None

Standing Desks:

 • 1/1 study reported favourable findings [85]

Very Low

4656 (4)

[57, 114,115,116]

Longitudinal

Serious risk of biasd

No serious risk of inconsistency

No serious risk of indirectness

No serious risk of imprecision

None

Overall:

 • 1/4 studies reported null findings

 • 3/4 studies reported mixed findings

  • 2: Null and unfavourable

  • 1: Null and favourable

Active Breaks:

 • 1/1 studies reported mixed findingse

  • 1: Null and unfavourable [115]

Homework:

 • 1/3 studies reported null findings [114]

 • 2/3 studies reported mixed findingsf

  • 1: Null and unfavourable [57]

  • 1: Null and favourable [116]

  • 1: Mixed findings included dose response relationships with favourable associations for up to 2 h, but null associations for ≥2 h [116]

Very Low

83,252 (12)

[39, 63, 65, 68, 71, 117,118,119,120,121,122,123]

Cross-sectional

Serious risk of biasg

No serious risk of inconsistency

No serious risk of indirectness

No serious risk of imprecision

None

Overall:

 • 2/12 studies reported null findings

 • 1/12 studies reported favourable findings

 • 1/12 studies reported unfavourable findings

 • 8/12 studies reported mixed findings

  • 2: Favourable and unfavourable

  • 2: Null and unfavourable

  • 3: Favourable and null

  • 1: Favourable, null, and unfavourable

Homework:

 • 1/10 studies reported null findings [117]

 • 1/10 studies reported favourable findings [118]

 • 1/10 studies reported unfavourable findings [119]

 • 7/10 studies reported mixed findingsh

  • 3: Favourable and null [63, 65, 120]

  • 2: Favourable and unfavourable [39, 121]

  • 1: Null and unfavourable [122]

  • 1: Favourable, null, and unfavourable findings [123]

  • 1: Mixed findings included dose response relationships with favourable associations for 1–2 h/day and null associations for > 2 h/day [65]

Sedentary time:

 • 1/2 studies reported null findings [71]

 • 1/2 studies reported mixed findingsi

  • 1: Null and unfavourable [68]

Very Low

  1. Mean age at baseline ranged from 8.8 to 17.0 years; when mean age was not reported age or grade range minimums were 10.0 years and grade 1 and range maximums were 15.0 years and grade 12. Study designs included clustered RCT, non-randomized interventions, and longitudinal with up to 3 years follow-up, and cross-sectional. Social-emotional indicators were assessed objectively for time on task (direct observation momentary time sampling) and subjectively for anxiety (Brief Symptom Inventory, and Generalised Anxiety Disorder 7-item Scale), body dissatisfaction (Eating Disorders Inventory-3), classroom amotivation (Classroom Behavior and Assets Scale), classroom attentiveness (Classroom Behavior and Assets Scale), classroom behavioural assets (Classroom Behavior and Assets Scale), classroom cheerfulness (Classroom Behavior and Assets Scale), classroom cooperation (Classroom Behavior and Assets Scale), classroom defiance (Classroom Behavior and Assets Scale), classroom effort (Classroom Behavior and Assets Scale), classroom inattention (Classroom Behavior and Assets Scale), classroom mood problems (Classroom Behavior and Assets Scale), classroom problematic behavior (Classroom Behavior and Assets Scale), classroom restlessness (Classroom Behavior and Assets Scale), conduct problems (Strengths and Difficulties Questionnaire), coping (Brief Resilient Coping Scale), covid-19 stress (Swine Flu Anxiety Scale), depression (Brief Symptom Inventory, Child Depression Inventory, and Center for Epidemiologic Studies Depression Scale Revised 10), depressive mood (Depressive Mood Scale), difficulties with classroom transitions (Classroom Behavior and Assets Scale), emotional problems (Strengths and Difficulties Questionnaire), flourishing (Flourishing Scale), health-related quality of life (Child Health Utility 9D-Chinese version, Kidscreen-10, PedsQL 4.0 Spanish version), hostility (Brief Symptom Inventory), hyperactivity (Strengths and Difficulties Questionnaire), loneliness (UCLA Loneliness Scale), negative self-esteem (Brief Symptom Inventory), peer problems (Strengths and Difficulties Questionnaire), persistence (School-Age Temperament Inventory), physical quality of life (Child Health Questionnaire), physical self-concept (Marsh’s Physical Self-Description Questionnaire), positive mental wellbeing (Warwick-Edinburgh Mental Well-being Scale), prosociality (Strengths and Difficulties Questionnaire), psychological distress (Malaise Inventory), psychological well-being (Flourishing Scale), psychological quality of life (Child Health Questionnaire), reactivity (School-Age Temperament Inventory), school subjective social status (Subjective Social Status Scale), social quality of life (Paediatric Quality of Life Inventory), society subjective social status (Subjective Social Status Scale), somatization (Brief Symptom Inventory), study and interpersonal stress (Student-life Stress Inventory), suicidal attempt (Kiddie Schedule for Affective Disorders and Schizophrenia), suicidal ideation (Kiddie Schedule for Affective Disorders and Schizophrenia), total difficulties (Strength and Difficulties questionnaire)
  2. a Only 1/4 studies reported intervention effect of decreasing school-related sedentary behaviours
  3. b 1: Null & unfavourable [Null when comparing the low/moderate physical activity game to the sedentary game conditions, but unfavourable when comparing sedentary lesson to low/moderate physical activity game, or MVPA game to either sedentary condition [113]]
  4. c Only one study, and small sample size
  5. d 3/4 studies used subjective exposure measures with no evidence of psychometric testing
  6. e 1: Null and unfavourable [1: Unfavourable for lack of effort or motivation, but null for all other outcomes (12/13 null associations) [115]]
  7. f 1: Null and unfavourable [1: unfavourable for change in homework, but null for baseline homework [57]]; 1: Null and favourable [favourable for psychological distress trend and up to 2 h (Dose response), but null for > = 2 h, and all other outcomes [116]]
  8. g 8/12 studies reported subjective exposures without evidence of psychometric testing
  9. h 3: Favourable and null [1: favourable for weekday homework in girls, but null for all other comparisons [120]; 1: Favourable for persistence and screen-based homework, but null for all other outcomes [63]; 1: Dose response-1-2 h favourable, > 2 h null [65]]; 2: Favourable and unfavourable [1: Favourable for loneliness and depression, unfavourable for COVID stress [121]; 1: Adding 15 min/day of homework unfavourable for anxiety, favourable for depression (except subtracting sleep unfavourable for those with < 8 h of sleep), and favourable for flourishing (except unfavourable when subtracting MVPA) [39]] 1: Null and unfavourable [1: Unfavourable for suicidal ideation, but null for suicide attempts [122]]; 1: favourable and null and unfavourable findings [1: Null for Asian-Australians, for Caucasian-Australians null for depressive mood, favourable for coping, and unfavourable for study and interpersonal stress [123]]
  10. i 1: Null and unfavourable [1: Null for society subjective social status, unfavourable for school subjective social status [68]]