SYSTEMATIC REVIEW OF PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOR INDICATORS IN SOUTH-AMERICAN PRESCHOOL CHILDREN

Guerra, Paulo Henrique; Barbosa Filho, Valter Cordeiro; Almeida, Angélica; Silva, Letícia de Souza; Pinto, Marcelo Tedesco Vidal; Leonel, Renan Martinelli; Ribeiro, Evelyn Helena Corgosinho; Florindo, Alex Antonio

doi:10.1590/1984-0462/2020/38/2018112

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Brasil

Revista Paulista de Pediatria

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Brasil

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Sumário

REVIEW ARTICLE • Rev. paul. pediatr. 38 • 2020 • https://doi.org/10.1590/1984-0462/2020/38/2018112 copy

SYSTEMATIC REVIEW OF PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOR INDICATORS IN SOUTH-AMERICAN PRESCHOOL CHILDREN

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To summarize indicators and describe in detail the methods used to physical activity and sedentary behavior measurement in South American preschool children.

Data source:

In 2017, we searched for articles on researches carried out in South American countries, which presented physical activity and/or sedentary behavior indicators in children aged two to six years. These searches were conducted in Spanish, English, and Portuguese in four electronic databases (LILACS, PubMed, SciELO, and Web of Science), Google Scholar, and in reference lists.

Data summary:

Out of 416 articles initially assessed, 13 composed the descriptive summary. Samples from Argentina, Brazil, and Chile were included. Three articles provided accelerometer-based estimates of moderate physical activity: 32, 70.1, and 71.3 minutes per day. The mean total sedentary behavior was 468.3 and 562.9 minutes per day and, considering the cut-off point of 2 hours per day of screen time, we found the following prevalence rates: 39.4, 40.3, and 100%. The studies adopted a wide number of instruments and strategies to evaluate those behaviors.

Conclusions:

Although the summary has pointed to high exposure to sedentary behavior in preschool children, with particular focus on screen time, it is essential to broaden the discussion and approximate the methods used to assess physical activity and sedentary behavior, making the evidence more comparable and strong, so as to elaborate preventive strategies and actions.

Keywords:
Physical activity; Sedentary lifestyle; Indicators (Statistics); Child; Review

References	Local (year of collection)	Sampling technique	Sample size (% of girls)	Age group (years)
Aguilar-Farías et al.¹⁸18. Aguilar-Farias N, Martino-Fuentealba P, Espinoza-Silva M. Objectively measured physical activity and sedentary behaviour patterns in Chilean pre-school children. Nutr Hosp. 2015;32:2606-12. https://doi.org/10.3305/nh.2015.32.6.9489 https://doi.org/https://doi.org/10.3305/...	Temuco, Chile (nd)	Randomized	25 (52)	4-5
Barbosa et al.¹⁹19. Barbosa SC, Coledam DH, Stabelini Neto A, Elias RG, Oliveira AR. School environment, sedentary behavior and physical activity in preschool children. Rev Paul Pediatr. 2016;34:301-8. http://dx.doi.org/10.1016/j.rppede.2016.02.003 https://doi.org/http://dx.doi.org/10.101...	Londrina, Brazil (2015)	Randomized	370 (50)	4-6
Barro et al.³⁰30. Barros SS , Lopes AS, Barros MV . Prevalence of low physical activity level among preschool children. Rev Bras Cineantropom Desempenho Hum. 2012;14:390-400. http://dx.doi.org/10.5007/1980-0037.2012v14n4p390 https://doi.org/http://dx.doi.org/10.500...	Olinda, Brazil (2004)	Randomized	265 (54)	4-6
Bielemann et al.²⁰20. Bielemann RM, Cascaes AM, Reichert FF, Domingues MR, Gigante DP. Objectively measured physical activity in children from a southern Brazilian city: a population-based study. J Phys Act Health. 2013;10:1145-52.	Pelotas, Brazil (2015)	Randomized	59 (nd)	4-5
Cano Cappelacci et al.²¹21. Cappelacci MC, Alfaro TO, Artigas FL, Muñoz CS. Relationship between nutritional status, level of physical activity and psychomotor development in preschoolers. Nutr Hosp. 2014;30:1313-8. https://doi.org/10.3305/nh.2014.30.6.7781 https://doi.org/https://doi.org/10.3305/...	Metropolitan Area of Chile (nd)	nd	29 (57)	5
Cremm et al.²²22. Cremm EC, Leite FH, Abreu DS, Oliveira MA, Scagliusi FB, Martins PA. Factors associated with overweight in children living in the neighbourhoods of an urban area of Brazil. Public Health Nutr. 2012;15:1056-64. https://doi.org/10.1017/S1368980011002771 https://doi.org/https://doi.org/10.1017/...	Santos, Brazil (nd)	Randomized	302 (48)	<6
Godard et al.²³23. Godard C, Román M, Rodríguez MP, Leyton B, Salazar G. Variability of physical activity in 4 to 10-year-old children: a study by accelerometry. Arch Argent Pediatr. 2012;110:388-93. https://doi.org/10.5546/aap.2012.388 https://doi.org/https://doi.org/10.5546/...	Santiago, Chile (2006)	Convenience	109 (nd)	4-10
Lima et. al.²⁴24. Lima RA, Barros SS, Cardoso Júnior CG, Silva G, Farias Júnior JC , Andersen LB , et al. Influence of number of days and valid hours using accelerometry on the estimates of physical activity level in preschool children from Recife, Pernambuco, Brazil. Rev Bras Cineantropom Desempenho Hum. 2014;16:171-81. http://dx.doi.org/10.5007/1980-0037.2014v16n2p171 https://doi.org/http://dx.doi.org/10.500... ^a	Recife, Brazil (2010)	Randomized	176 (nd)	3-5
Melo et al.²⁶26. Mélo EN, Barros MV, Hardman CM, Siqueira ML, Wanderley Jr RS, Oliveira ES. Association between the preschool environment and physical activity level among preschoolers. Braz J Phys Act and Health. 2013;18:53-62. http://dx.doi.org/10.12820/2317-1634.2013v18n1p53 https://doi.org/http://dx.doi.org/10.128... ^a	Recife, Brazil (2010)	Randomized	1,020 (49)	3-5
Lopez and Llanos; Diaz²⁵25. López MA, Llanos IP, Díaz JM. Television watching and its relationship with food frequency and nutritional status in children from a community of Talca, Chile. Rev Chil Nutr. 2012;39:129-34. http://dx.doi.org/10.4067/S0717-75182012000400004 https://doi.org/http://dx.doi.org/10.406...	Talca, Chile (nd)	Convenience	45 (44)	3-6
Roda et al.²⁷27. Roda G, Salvador CS, Campisi M, Amato D. Poll results of dietary habits and family history in Child Development Centers, Municipality of Merlo. Diaeta. 2016;34:41-7.	Merlo, Argentina (2014)	All child development centers of the city	183 parents (nd)	1-5
Vásquez and Salazar²⁸28. Vásquez F, Salazar G . Physical activity pattern a group of obese preschool children, attending daycare centers (JUNJI), evaluated by a movement sensor. Rev Chil Nutr. 2005;32:110-7. http://dx.doi.org/10.4067/S0717-75182005000200005 https://doi.org/http://dx.doi.org/10.406... ^b	Santiago, Chile (nd)	Convenience	24 (50)^c	3-5
Vásquez et al.²⁹29. Vásquez F , Salazar G , Andrade M, Vásquez L, Díaz E. Energy balance and physical activity in obese children attending day-care centres. Eur J Clin Nutr. 2006;60:1115-21. https://doi.org/10.1038/sj.ejcn.1602426 https://doi.org/https://doi.org/10.1038/... ^b	Santiago, Chile (nd)	Convenience	24 (50)^c	3-5

Assessment instrument and description of its use
Accelerometers
Aguilar-Farías et al.:¹⁸18. Aguilar-Farias N, Martino-Fuentealba P, Espinoza-Silva M. Objectively measured physical activity and sedentary behaviour patterns in Chilean pre-school children. Nutr Hosp. 2015;32:2606-12. https://doi.org/10.3305/nh.2015.32.6.9489 https://doi.org/https://doi.org/10.3305/... ActivPAL micro: four full days (weekdays and weekend). The study evaluated periods of at least 5 or 10 minutes of PA. Estimates of PA and SB for an average day were retrieved from previous studies: mean steps per day=(5 steps per weekday+2 steps per day of the weekend)/7.
Barbosa et al.:¹⁹19. Barbosa SC, Coledam DH, Stabelini Neto A, Elias RG, Oliveira AR. School environment, sedentary behavior and physical activity in preschool children. Rev Paul Pediatr. 2016;34:301-8. http://dx.doi.org/10.1016/j.rppede.2016.02.003 https://doi.org/http://dx.doi.org/10.101... Actigraph GT3X: five consecutive school days. The 75th percentile for PA and SB were adopted as cut-off points. The average number of minutes per day considered valid for the use of accelerometers was at least 360 minutes for children aged 4 to 5 years and 120 minutes for children aged 6 years. Two cut-off points were adopted to classify physical activity and sedentary behavior ^a,b.
Bielemann et al.:²⁰20. Bielemann RM, Cascaes AM, Reichert FF, Domingues MR, Gigante DP. Objectively measured physical activity in children from a southern Brazilian city: a population-based study. J Phys Act Health. 2013;10:1145-52. Actigraph GT1M: full days. The participants were instructed to report on a diary when they did not wear the device for more than an hour. The epoch was adjusted for five seconds, and the accelerometers were delivered in the households on Saturdays and collected on Wednesdays.
Cano Cappelacci et al.:²¹21. Cappelacci MC, Alfaro TO, Artigas FL, Muñoz CS. Relationship between nutritional status, level of physical activity and psychomotor development in preschoolers. Nutr Hosp. 2014;30:1313-8. https://doi.org/10.3305/nh.2014.30.6.7781 https://doi.org/https://doi.org/10.3305/... Actigraph GT3X: the measurements occurred in two weekdays (time: 6 continuous hours).
Godard et al.:²³23. Godard C, Román M, Rodríguez MP, Leyton B, Salazar G. Variability of physical activity in 4 to 10-year-old children: a study by accelerometry. Arch Argent Pediatr. 2012;110:388-93. https://doi.org/10.5546/aap.2012.388 https://doi.org/https://doi.org/10.5546/... Actiwatch AW64: Sufficient MVPA: number of minutes per day with cpm>900, according to the classification of Puyau et al.^c For nighttime PA, all records showing activity (cpm>25) were selected for more than 60 minutes.
Lima et al.:²⁴24. Lima RA, Barros SS, Cardoso Júnior CG, Silva G, Farias Júnior JC , Andersen LB , et al. Influence of number of days and valid hours using accelerometry on the estimates of physical activity level in preschool children from Recife, Pernambuco, Brazil. Rev Bras Cineantropom Desempenho Hum. 2014;16:171-81. http://dx.doi.org/10.5007/1980-0037.2014v16n2p171 https://doi.org/http://dx.doi.org/10.500... ^d Actigraph GT1M: seven full days (weekdays and weekend). The accelerometer monitoring used epochs of 15 seconds. The cut-off points adopted to set the intensity of the activities performed followed a prior reference^e. Non-monitoring was determined after 30 consecutive minutes without any count record.
Vásquez and Salazar²⁸28. Vásquez F, Salazar G . Physical activity pattern a group of obese preschool children, attending daycare centers (JUNJI), evaluated by a movement sensor. Rev Chil Nutr. 2005;32:110-7. http://dx.doi.org/10.4067/S0717-75182005000200005 https://doi.org/http://dx.doi.org/10.406... and Vásquez.²⁹29. Vásquez F , Salazar G , Andrade M, Vásquez L, Díaz E. Energy balance and physical activity in obese children attending day-care centres. Eur J Clin Nutr. 2006;60:1115-21. https://doi.org/10.1038/sj.ejcn.1602426 https://doi.org/https://doi.org/10.1038/... ^f Tritrac R3D: three consecutive days (weekdays and weekend).
Questionnaires
Barros et al.:³⁰30. Barros SS , Lopes AS, Barros MV . Prevalence of low physical activity level among preschool children. Rev Bras Cineantropom Desempenho Hum. 2012;14:390-400. http://dx.doi.org/10.5007/1980-0037.2012v14n4p390 https://doi.org/http://dx.doi.org/10.500... adapted version of the questionnaire from the Childhood Obesity Study in Florianópolis.
Cremm et al.:²²22. Cremm EC, Leite FH, Abreu DS, Oliveira MA, Scagliusi FB, Martins PA. Factors associated with overweight in children living in the neighbourhoods of an urban area of Brazil. Public Health Nutr. 2012;15:1056-64. https://doi.org/10.1017/S1368980011002771 https://doi.org/https://doi.org/10.1017/... Children and youth physical activity questionnaire: adapted for the Brazilian population, taking into account the number of daily hours that the child spends on screen behavior, the type of transport the child uses to go to school, and sports practiced.
López et al.:²⁵25. López MA, Llanos IP, Díaz JM. Television watching and its relationship with food frequency and nutritional status in children from a community of Talca, Chile. Rev Chil Nutr. 2012;39:129-34. http://dx.doi.org/10.4067/S0717-75182012000400004 https://doi.org/http://dx.doi.org/10.406... QDS: parents reported the amount of PA practiced in a week.
Melo et al.²⁶26. Mélo EN, Barros MV, Hardman CM, Siqueira ML, Wanderley Jr RS, Oliveira ES. Association between the preschool environment and physical activity level among preschoolers. Braz J Phys Act and Health. 2013;18:53-62. http://dx.doi.org/10.12820/2317-1634.2013v18n1p53 https://doi.org/http://dx.doi.org/10.128... ^d: QDS: question directed to parents: on a weekday (Monday to Friday), how much time does your child spend playing outdoors, in the garden, the yard, or on the streets near home?
Roda et al.:²⁷27. Roda G, Salvador CS, Campisi M, Amato D. Poll results of dietary habits and family history in Child Development Centers, Municipality of Merlo. Diaeta. 2016;34:41-7. QDS: open question directed to parents about the number of hours that their children spend on screen activities. Also, PA was classified as “unstructured”/moderate or “structured”/vigorous.

Mean PA time
Aguilar-Farías et al.¹⁸18. Aguilar-Farias N, Martino-Fuentealba P, Espinoza-Silva M. Objectively measured physical activity and sedentary behaviour patterns in Chilean pre-school children. Nutr Hosp. 2015;32:2606-12. https://doi.org/10.3305/nh.2015.32.6.9489 https://doi.org/https://doi.org/10.3305/...
Walking	147.2 minutes/day (SD=52)
PA (at least 10 minutes)	97.1 minutes/day (SD=53)
Barbosa et al.¹⁹19. Barbosa SC, Coledam DH, Stabelini Neto A, Elias RG, Oliveira AR. School environment, sedentary behavior and physical activity in preschool children. Rev Paul Pediatr. 2016;34:301-8. http://dx.doi.org/10.1016/j.rppede.2016.02.003 https://doi.org/http://dx.doi.org/10.101...
Light to vigorous PA during school hours	275.2 minutes/day (SD=78)
Bielemann et al.²⁰20. Bielemann RM, Cascaes AM, Reichert FF, Domingues MR, Gigante DP. Objectively measured physical activity in children from a southern Brazilian city: a population-based study. J Phys Act Health. 2013;10:1145-52.
Light PA	261.9 minutes/day (SD=37)
Moderate PA	71.3 minutes/day (SD=19)
Vigorous PA	15 minutes/day (SD=8)
Cano Cappelacci et al.²¹21. Cappelacci MC, Alfaro TO, Artigas FL, Muñoz CS. Relationship between nutritional status, level of physical activity and psychomotor development in preschoolers. Nutr Hosp. 2014;30:1313-8. https://doi.org/10.3305/nh.2014.30.6.7781 https://doi.org/https://doi.org/10.3305/...
Eutrophic children	141.6 minutes/day
Overweight children	126.2 minutes/day
Obese children	130.9 minutes/day
Godard et al.²³23. Godard C, Román M, Rodríguez MP, Leyton B, Salazar G. Variability of physical activity in 4 to 10-year-old children: a study by accelerometry. Arch Argent Pediatr. 2012;110:388-93. https://doi.org/10.5546/aap.2012.388 https://doi.org/https://doi.org/10.5546/...
Moderate and vigorous PA	92 minutes/day (SD=41)
Lima et al.²⁴24. Lima RA, Barros SS, Cardoso Júnior CG, Silva G, Farias Júnior JC , Andersen LB , et al. Influence of number of days and valid hours using accelerometry on the estimates of physical activity level in preschool children from Recife, Pernambuco, Brazil. Rev Bras Cineantropom Desempenho Hum. 2014;16:171-81. http://dx.doi.org/10.5007/1980-0037.2014v16n2p171 https://doi.org/http://dx.doi.org/10.500... ^a
Moderate PA	70.1 (95%CI 66.2-74.0)^b
Vigorous PA	24.7 (95%CI 22.3-23.1)^b
Vásquez and Salazar²⁸28. Vásquez F, Salazar G . Physical activity pattern a group of obese preschool children, attending daycare centers (JUNJI), evaluated by a movement sensor. Rev Chil Nutr. 2005;32:110-7. http://dx.doi.org/10.4067/S0717-75182005000200005 https://doi.org/http://dx.doi.org/10.406... and Vásquez²⁹29. Vásquez F , Salazar G , Andrade M, Vásquez L, Díaz E. Energy balance and physical activity in obese children attending day-care centres. Eur J Clin Nutr. 2006;60:1115-21. https://doi.org/10.1038/sj.ejcn.1602426 https://doi.org/https://doi.org/10.1038/... ^c
Moderate PA (weekdays)	32 minutes/day
Moderate and vigorous PA (weekends)	22 minutes/day
Prevalence of PA by cut-off point
Barros et al.³⁰30. Barros SS , Lopes AS, Barros MV . Prevalence of low physical activity level among preschool children. Rev Bras Cineantropom Desempenho Hum. 2012;14:390-400. http://dx.doi.org/10.5007/1980-0037.2012v14n4p390 https://doi.org/http://dx.doi.org/10.500... ^q
>60 minutes/day of outdoor PA	34.7%
Cano Cappelacci et al.²¹21. Cappelacci MC, Alfaro TO, Artigas FL, Muñoz CS. Relationship between nutritional status, level of physical activity and psychomotor development in preschoolers. Nutr Hosp. 2014;30:1313-8. https://doi.org/10.3305/nh.2014.30.6.7781 https://doi.org/https://doi.org/10.3305/...
>60 minutes/day of moderate and vigorous PA	100%
Cremm et al.²²22. Cremm EC, Leite FH, Abreu DS, Oliveira MA, Scagliusi FB, Martins PA. Factors associated with overweight in children living in the neighbourhoods of an urban area of Brazil. Public Health Nutr. 2012;15:1056-64. https://doi.org/10.1017/S1368980011002771 https://doi.org/https://doi.org/10.1017/... ^q	18.9%
Godard et al.²³23. Godard C, Román M, Rodríguez MP, Leyton B, Salazar G. Variability of physical activity in 4 to 10-year-old children: a study by accelerometry. Arch Argent Pediatr. 2012;110:388-93. https://doi.org/10.5546/aap.2012.388 https://doi.org/https://doi.org/10.5546/...
≥60 minutes/day of moderate and vigorous PA	81.8%
Lima et al.²⁴24. Lima RA, Barros SS, Cardoso Júnior CG, Silva G, Farias Júnior JC , Andersen LB , et al. Influence of number of days and valid hours using accelerometry on the estimates of physical activity level in preschool children from Recife, Pernambuco, Brazil. Rev Bras Cineantropom Desempenho Hum. 2014;16:171-81. http://dx.doi.org/10.5007/1980-0037.2014v16n2p171 https://doi.org/http://dx.doi.org/10.500... ^a
≥60 minutes/day of moderate and vigorous PA	12.7 (95%CI 7.6-19.7)^c
Melo et al.²⁶26. Mélo EN, Barros MV, Hardman CM, Siqueira ML, Wanderley Jr RS, Oliveira ES. Association between the preschool environment and physical activity level among preschoolers. Braz J Phys Act and Health. 2013;18:53-62. http://dx.doi.org/10.12820/2317-1634.2013v18n1p53 https://doi.org/http://dx.doi.org/10.128... ^q
>60 minutes/day of moderate and vigorous PA	36.4 (95%CI 33.6-39.2)^d
Roda et al.²⁷27. Roda G, Salvador CS, Campisi M, Amato D. Poll results of dietary habits and family history in Child Development Centers, Municipality of Merlo. Diaeta. 2016;34:41-7.^q
Moderate PA	8%
Vigorous PA	58%

Period of sedentary behavior
Aguilar-Farías et al.¹⁸18. Aguilar-Farias N, Martino-Fuentealba P, Espinoza-Silva M. Objectively measured physical activity and sedentary behaviour patterns in Chilean pre-school children. Nutr Hosp. 2015;32:2606-12. https://doi.org/10.3305/nh.2015.32.6.9489 https://doi.org/https://doi.org/10.3305/...
Total sedentary behavior	468.3 minutes/day (SD=92)
Barbosa et al.¹⁹19. Barbosa SC, Coledam DH, Stabelini Neto A, Elias RG, Oliveira AR. School environment, sedentary behavior and physical activity in preschool children. Rev Paul Pediatr. 2016;34:301-8. http://dx.doi.org/10.1016/j.rppede.2016.02.003 https://doi.org/http://dx.doi.org/10.101...
Sedentary behavior at school	2,234.5 minutes/week (SD=353)
Bielemann et al.²⁰20. Bielemann RM, Cascaes AM, Reichert FF, Domingues MR, Gigante DP. Objectively measured physical activity in children from a southern Brazilian city: a population-based study. J Phys Act Health. 2013;10:1145-52.	562.9 minutes/day (SD=102)
Prevalence of sedentary behavior by cut-off point
Barbosa et al.¹⁹19. Barbosa SC, Coledam DH, Stabelini Neto A, Elias RG, Oliveira AR. School environment, sedentary behavior and physical activity in preschool children. Rev Paul Pediatr. 2016;34:301-8. http://dx.doi.org/10.1016/j.rppede.2016.02.003 https://doi.org/http://dx.doi.org/10.101...
School day	89.6-90.9%
Cremm et al.²²22. Cremm EC, Leite FH, Abreu DS, Oliveira MA, Scagliusi FB, Martins PA. Factors associated with overweight in children living in the neighbourhoods of an urban area of Brazil. Public Health Nutr. 2012;15:1056-64. https://doi.org/10.1017/S1368980011002771 https://doi.org/https://doi.org/10.1017/... ^q
>2 hours/day of television	39.4%
>1 hour/day of computer and games	27.5%
Lopez et al.²⁵25. López MA, Llanos IP, Díaz JM. Television watching and its relationship with food frequency and nutritional status in children from a community of Talca, Chile. Rev Chil Nutr. 2012;39:129-34. http://dx.doi.org/10.4067/S0717-75182012000400004 https://doi.org/http://dx.doi.org/10.406... ^q
≥2 hours/day of television	100%
≥5 hours/day of television	15.5%
Roda et al.²⁷27. Roda G, Salvador CS, Campisi M, Amato D. Poll results of dietary habits and family history in Child Development Centers, Municipality of Merlo. Diaeta. 2016;34:41-7.^q
>2 hours/day of screen time	40.3%
≥5 hours/day of screen time	7.2%

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[1] *Corresponding author. E-mail: paulo.guerra@uffs.edu.br(P. H. Guerra)