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

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

RESUMO

Objetivo:

Sumarizar indicadores e descrever detalhadamente os métodos utilizados na avaliação da atividade física e do comportamento sedentário em pré-escolares sul-americanos.

Fontes de dados:

Em 2017, buscas foram realizadas, nos idiomas espanhol, inglês e português, em quatro bases de dados eletrônicas (LILACS, PubMed, SciELO e Web of Science), no Google Acadêmico e em listas de referências. Foram procurados artigos sobre pesquisas realizadas em países da América do Sul, que apresentaram indicadores de atividade física e/ou de comportamento sedentário em crianças entre dois e seis anos de idade.

Síntese dos dados:

De 416 artigos inicialmente avaliados, 13 compuseram a síntese descritiva. Foram envolvidas amostras da Argentina, Brasil e Chile. Três artigos ofereceram estimativas médias de atividade física moderada, por meio de acelerômetros: 32; 70,1 e 71,3 minutos por dia. Sobre o comportamento sedentário total, foram observadas as médias de 468,3 e 562,9 minutos por dia e, considerando-se o ponto de corte de 2 horas por dia em comportamentos de tela, as seguintes prevalências foram encontradas: 39,4; 40,3 e 100%. Observou-se grande variação no número de instrumentos e estratégias utilizadas para a avaliação dos comportamentos.

Conclusões:

Mesmo que a síntese tenha apontado para elevadas exposições ao comportamento sedentário em pré-escolares, com particular enfoque nas exposições ao tempo de tela, é importante um maior debate e aproximação dos métodos empregados na avaliação da atividade física e do comportamento sedentário, o que tornaria suas evidências mais comparáveis e fortalecidas para a formulação de estratégias e ações preventivas.

Palavras-chave:
Atividade física; Estilo de vida sedentário; Indicadores; Criança; Revisão

INTRODUCTION

The preschool period is marked by the potential growth and development of a person. The introduction of healthy behaviors in this life stage is critical, as it increases the chance of these behaviors persisting throughout life.11. Jones RA, Hinkley T, Okely AD, Salmon J. Tracking physical activity and sedentary behavior in childhood: a systematic review. Am J Prev Med. 2013;44:651-8. https://doi.org/10.1016/j.amepre.2013.03.001
https://doi.org/https://doi.org/10.1016/...
,22. Telama R. Tracking of physical activity from childhood to adulthood: a review. Obes Facts. 2009;2:187-95. https://doi.org/10.1159/000222244
https://doi.org/https://doi.org/10.1159/...

Nonetheless, recent evidence points to low levels of moderate and vigorous physical activity33. Bornstein DB, Beets MW, Byun W, McIver K. Accelerometer-derived physical activity levels of preschoolers: a meta-analysis. J Sci Med Sport. 2011;14:504-11. https://doi.org/10.1016/j.jsams.2011.05.007
https://doi.org/https://doi.org/10.1016/...
and excessive exposure to screen time, considering recommendations that suggest the cut-off point of less than two hours of daily recreational (or non-educational) screen time.44. Tremblay MS, Carson V, Chaput JP, Connor Gorber S, Dinh T, Duggan M, et al. Canadian 24-Hour Movement Guidelines for Children and Youth: an integration of physical activity, sedentary behaviour, and sleep. Appl Physiol Nutr Metab. 2016;41 Suppl 3:S311-27. https://doi.org/10.1139/apnm-2016-0151
https://doi.org/https://doi.org/10.1139/...
,55. Council on Communications and Media, Strasburger VC . Children, adolescents, obesity, and the media. Pediatrics. 2011;128:201-8. https://doi.org/10.1542/peds.2011-1066
https://doi.org/https://doi.org/10.1542/...
We emphasize that recreational screen time is one of the most common indicators of sedentary behavior in studies conducted with children and adolescents.66. Tremblay MS , LeBlanc AG, Kho ME, Saunders TJ, Larouche R, Colley RC, et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth. Int J Behav Nutr Phys Act. 2011;8:98. https://doi.org/10.1186/1479-5868-8-98
https://doi.org/https://doi.org/10.1186/...
,77. Guerra PH, Farias Júnior JC, Florindo AA. Sedentary behavior in Brazilian children and adolescents: a systematic review. Rev Saude Publica. 2016;50:9. https://doi.org/10.1590/S1518-8787.2016050006307
https://doi.org/https://doi.org/10.1590/...

Besides the recognized physical, psychological, social, and cognitive benefits associated with the practice of regular physical activity in childhood,88. Poitras VJ, Gray CE, Borghese MM, Carson V , Chaput JP , Janssen I, et al. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41 Suppl 3:S197-239. https://doi.org/10.1139/apnm-2015-0663
https://doi.org/https://doi.org/10.1139/...
,99. Carson V , Lee EY, Hewitt L, Jennings C, Hunter S, Kuzik N, et al. Systematic review of the relationships between physical activity and health indicators in the early years (0-4 years). BMC Public Health. 2017;17 Suppl 5:854. https://doi.org/10.1186/s12889-017-4860-0
https://doi.org/https://doi.org/10.1186/...
it is noteworthy that the topic of sedentary behavior is becoming more prominent, particularly due to the awareness of its risk associations with body composition, psychosocial health, and cognitive development1010. LeBlanc AG , Spence JC, Carson V , Connor Gorber S , Dillman C, Janssen I , et al. Systematic review of sedentary behaviour and health indicators in the early years (aged 0-4 years). Appl Physiol Nutr Metab. 2012;37:753-72. https://doi.org/10.1139/h2012-063
https://doi.org/https://doi.org/10.1139/...
,1111. Carson V , Hunter S , Kuzik N , Gray CE , Poitras VJ , Chaput JP , et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update. Appl Physiol Nutr Metab. 2016;41 Suppl 3:S240-65. https://doi.org/10.1139/apnm-2015-0630
https://doi.org/https://doi.org/10.1139/...
in preschool children, with the latter two variables presenting potential dose-response relationships.1010. LeBlanc AG , Spence JC, Carson V , Connor Gorber S , Dillman C, Janssen I , et al. Systematic review of sedentary behaviour and health indicators in the early years (aged 0-4 years). Appl Physiol Nutr Metab. 2012;37:753-72. https://doi.org/10.1139/h2012-063
https://doi.org/https://doi.org/10.1139/...

Considering that most researches that substantiate the knowledge available were conducted in North American and European countries and Australia and that socioeconomic status is an important determinant of development in preschool age,1212. Lu C, Black MM, Richter LM. Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country level. Lancet Glob Health. 2016;4:e916-22. https://doi.org/10.1016/S2214-109X(16)30266-2
https://doi.org/https://doi.org/10.1016/...
the gathering and discussion of indicators of physical activity and sedentary behavior from other locations worldwide become valuable. In this regard, South America stands out as a place of interest, both for the increased prevalence of inactive adolescents and their high exposure to recreational screen time in various parts of the continent1313. Guthold R, Cowan MJ, Autenrieth CS, Kann L, Riley LM. Physical activity and sedentary behavior among schoolchildren: a 34-country comparison. J Pediatr. 2010;157:43-9. https://doi.org/10.1016/j.jpeds.2010.01.019
https://doi.org/https://doi.org/10.1016/...
,1414. Hallal PC, Andersen LB, Bull FC, Guthold R , Haskell W, Ekelund U. Global physical activity levels: surveillance progress, pitfalls, and prospects. Lancet. 2012;380:247-57. https://doi.org/10.1016/S0140-6736(12)60646-1
https://doi.org/https://doi.org/10.1016/...
and for being an important research development center on the topic.1515. Varela AR, Pratt M, Powell K, Lee IM, Bauman A, Heath G, et al. Worldwide surveillance, policy, and research on physical activity and health: the global observatory for physical activity. J Phys Act Health. 2017;14:701-9. https://doi.org/10.1123/jpah.2016-0626
https://doi.org/https://doi.org/10.1123/...

Thus, the present study aimed to identify and compare indicators of physical activity and sedentary behavior in South American preschool children, as well as describe in detail the methods adopted to measure these behaviors.

METHOD

This study is a systematic review, designed, conducted, and reported based on items from the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist (PRISMA).1616. Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ. 2009;339:b2535. https://doi.org/10.1136/bmj.b2535
https://doi.org/https://doi.org/10.1136/...
This systematic review was not registered.

As inclusion criteria, we searched for original articles, with observational design, conducted in South American countries, without requiring a representative sample, and presenting indicators of physical activity and/or sedentary behavior in preschool children, classified, for this study, as those aged two to six years. On the other hand, we excluded articles involving samples of children with disabilities and/or clinical conditions in common (e.g., diabetes), except for those comprising overweight and/or obese children.

In 2017, we conducted systematic searches in Spanish, English, and Portuguese in four electronic databases - Latin American and Caribbean Health Sciences Literature (LILACS), PubMed, Scientific Electronic Library Online (SciELO), and Web of Science -, following the strategies designed by PubMed (searching for terms in the body of the text), both for physical activity: Argentina or Bolivia or Brazil or Chile or Colombia or Ecuador or Guyana or Paraguay or Suriname or Uruguay or Venezuela and “physical activity” and toddler or infant or preschool; and sedentary behavior: Argentina or Bolivia or Brazil or Chile or Colombia or Ecuador or Guyana or Paraguay or Suriname or Uruguay or Venezuela and “sedentary behavior” or “sitting time” or “screen time” or “television time” or “computer time” or “video game time” and toddler or infant or preschool. The corresponding author can provide a complete description of the searches. As an additional strategy, we searched Google Scholar and the reference lists of the articles submitted to data extraction.

Next, four previously trained researchers independently evaluated the headings and abstracts, full-texts, and data extracted, with the aid of a senior researcher, to solve potential doubts and establish consensus throughout the process. All references retrieved from the databases were evaluated (by their headings, abstracts, and full texts) simultaneously. The assessment of headings and abstracts was based on four inclusion criteria (objective of the research, study location, age group, and sample characteristics) and conducted in a sensitive manner to avoid potential losses, keeping in the evaluation process not only potentially relevant articles but all studies that could be eligible for subsequent checking of their full texts.

We extracted the original data and included them in an electronic spreadsheet, organized into three domains:

  • Descriptive information (research location, year of collection, sampling procedures, sample size, percentage of girls in the sample, age group, mean age, and objective of the study).

  • Methodological information (instruments used to assess physical activity and sedentary behavior, domains and types evaluated, and criteria and cut-off points adopted to classify the level of physical activity and sedentary behavior).

  • Measurements and indicators of physical activity and/or sedentary behavior (prevalence, time per day) and additional results (data from subgroup analyses and associations among variables). At the end of data extraction, we elaborated a descriptive summary, separating the results by physical activity and sedentary behavior topics.

The risk of bias of the original articles was assessed using an adapted version of the instrument Quality Assessment Tool for Quantitative Studies of the Effective Public Health Practice Project (EPHPP),1717. Thomas BH, Ciliska D, Dobbins M, Micucci S. A process for systematically reviewing the literature: providing the research evidence for public health nursing interventions. Worldviews Evid Based Nurs. 2004;1:176-84. https://doi.org/10.1111/j.1524-475X.2004.04006.x
https://doi.org/https://doi.org/10.1111/...
which covers the domains:

  • Selection bias (sample information, whether heterogeneous or specific for a clinical condition).

  • Study design (sample representativeness and sampling methods used).

  • Instruments to assess physical activity and/or sedentary behavior (prior validation of the instrument and information enabling the replication of the measurement).

  • Losses and withdrawals (information about losses and withdrawals, as well as the percentage of children who had their data analyzed).

  • Analysis (suitability of statistical methods used in the research).

RESULTS

We retrieved a total of 582 articles in electronic searches (Figure 1). After identifying and excluding the duplicates (n=166), 416 potential articles had their headings and abstracts evaluated. At the end of this stage, we excluded 345 articles, due mainly to discrepancies regarding the objectives (n=230) and age group (n=82). Among the 71 remaining articles that had their full texts assessed, 60 were excluded, mainly for inconsistencies related to age group (n=28) and objectives (n=19). Thus, 11 articles were submitted to data extraction. After the inclusion of two articles retrieved in manual searches, the descriptive summary consisted of a total of 13 original articles.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/...
,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...
,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.,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/...
,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/...
,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/...
,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...
,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...
,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...
,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.,2828. 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...
,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/...
,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...

Figure 1
Flowchart of the systematic review.

The study design determined that all included articles had a cross-sectional nature. In all, the summary gathered data from 11 different samples: five from Chile, five from Brazil, and one from Argentina. Studies by 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...
and 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...
used the same sample from Recife (Brazil), assessed in 2010, similarly to 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 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/...
who analyzed the same sample from Santiago (Chile). Five samples adopted randomized techniques for their composition, and the study by 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. involved children from all child development centers in the city of Merlo (Argentina). The sample size ranged from 242828. 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...
,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/...
to 1,020 children2626. 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...
(Table 1).

Table 1
Descriptive characteristics of the articles included (n=13).

Eight of the 13 articles included used accelerometers to measure physical activity and/or sedentary behavior levels (66.7%). However, we noted a high number of devices (n=6) and protocols adopted for their use. Among them, we can mention the significant variation in the number of days used for the measurements (two to seven days), measurements done on weekends (which occurred in three out of five articles with reports available), and different cut-off points to determine sufficient physical activity and sedentary behavior (Table 2).

Table 2
Description of the instruments used to measure physical activity and sedentary behavior (n=13).

The other five articles used questionnaires to evaluate physical activity and/or sedentary behavior, with three of them developing their own instruments,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...
,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...
,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. in addition to the use of the Children and Youth Physical Activity questionnaire and the adapted version of the questionnaire from the Childhood Obesity Study in Florianópolis. A common characteristic among the questionnaires is that they were all administered to parents/guardians. On the other hand, we found high variability among the questions, as well as in the approach of physical activity regarding the coverage of weekdays/weekends, places, and intensity of the activities performed (Table 2).

Since the articles by Vásquez et al.2828. 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...
,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/...
used the same sample and techniques to evaluate physical activity, 12 articles were assessed for risk of bias (Figure 2). With respect to selection bias, only the evaluation of the articles by Vásquez resulted in a high risk of bias, as their sample was specifically composed of obese children.2828. 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...
,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/...
Given the study design, the most common weaknesses were the lack of information about sample representativeness1818. 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/...
,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/...
,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/...
,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...
,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...
,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.,2828. 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...
,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/...
and the use of convenience samples.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/...
,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...
Two articles did not report prior validation of the instrument used to evaluate physical activity2727. 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. and sedentary behavior.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...
,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. Four articles showed a high percentage of losses, considering the difference between the children who had their informed consent form signed and those who were referred to analyses of physical activity and/or sedentary behavior.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.,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/...
,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/...
,2828. 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...
,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/...
One article did not present information about losses and withdrawals throughout the research.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/...

Figure 2
Risk of bias analysis of the articles included.

Three articles estimated the daily volume of moderate physical activity as 32, 70.1, and 71.3 minutes per day.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.,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...
,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/...
As to the volume of vigorous physical activity, two articles presented the following estimates: 15 and 21.7 minutes per day.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.,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...
The mean daily time spent practicing moderate and vigorous physical activity was 92 and 97.1 minutes per day1818. 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/...
,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/...
(Table 3).

Table 3
Indicators of physical activity in South American preschool children.

Considering accelerometer-based measurements, the summary identified the following prevalence rates: 12.7, 81.8, and 100% of preschool children who practice at least 60 minutes per day of moderate and vigorous physical activity2121. 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/...
,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/...
,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...
(Table 3). In articles that used the questionnaires, we found prevalence rates of 34.7 and 58% of children who practice at least 60 minutes per day of outdoor3030. 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...
and moderate2727. 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. physical activities, respectively.

Seven articles presented measurements of sedentary behavior based on screen time (n=3), sitting time during school hours (n=2), and the total period of sedentary behavior (n=2) (Table 4). Table 4 shows two accelerometer-based means of daily time of sedentary behavior: 468.3 minutes per day (7.8 hours)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/...
and 562.9 minutes per day (9.4 hours).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. Based on questionnaires answered by parents, three articles indicated prevalence of children exposed to at least two hours per day of screen time: 39.4, 40.3, and 100%.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/...
,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...
,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. Two of these articles also analyzed the prevalence of children exposed to, at least, five hours per day of screen time, with results of 7.2 and 15.5%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...
,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. (Table 4).

Table 4
Indicators of sedentary behavior in South American preschool children.

DISCUSSION

This review aimed at identifying and summarizing indicators of physical activity and sedentary behavior in South American preschool children, as well as the methods used to measure them. Among the evidence found, we underline:

  • That most of the articles included presented moderate physical activity levels exceeding 60 minutes per day.

  • The high exposure to screen time, considering the cut-off point of two hours per day.

  • The high variability of instruments and strategies used to measure physical activity and/or sedentary behavior.

Researches that investigate the lifestyle of preschool children are very important, as their outcomes might not only provide state of the art on the topic but also support the planning and execution of strategies for prevention and/or health promotion, particularly in local communities and social protection networks,3131. Britto PR, Lye SJ, Proulx K, Yousafzai AK, Matthews SG, Vaivada T, et al. Nurturing care: promoting early childhood development. Lancet. 2017;389:91-102. http://dx.doi.org/10.5007/1980-0037.2012v14n4p390
https://doi.org/http://dx.doi.org/10.500...
that could control the risk of interference in the development, which, in turn, is also associated with low socioeconomic status.1212. Lu C, Black MM, Richter LM. Risk of poor development in young children in low-income and middle-income countries: an estimation and analysis at the global, regional, and country level. Lancet Glob Health. 2016;4:e916-22. https://doi.org/10.1016/S2214-109X(16)30266-2
https://doi.org/https://doi.org/10.1016/...

Physical activity indicators

Contrary to the present finding, three previous reviews, whose conclusions are mostly based on data from studies conducted in high-income countries, suggest low levels of moderate and vigorous physical activities in preschool children.3232. Hnatiuk JA, Salmon J , Hinkley T , Okely AD , Trost S. A review of preschool children’s physical activity and sedentary time using objective measures. Am J Prev Med. 2014;47:487-97. https://doi.org/10.1016/j.amepre.2014.05.042
https://doi.org/https://doi.org/10.1016/...
,3333. Reilly JJ. Low levels of objectively measured physical activity in preschoolers in child care. Med Sci Sports Exerc. 2010;42:502-7. https://doi.org/10.1249/MSS.0b013e3181cea100
https://doi.org/https://doi.org/10.1249/...
,3434. Tucker P. The physical activity levels of preschool-aged children: a systematic review. Early Child Res Q. 2008;23:547-58. https://doi.org/10.1016/j.ecresq.2008.08.005
https://doi.org/https://doi.org/10.1016/...
However, any direct comparison between the findings of this review and the references cited should be weighted, acknowledging the issues related to the representativeness of the samples involved, in addition to the reduced number of South American researches.

Both the tendency of maintaining moderate physical activity between early childhood and pre-adolescence11. Jones RA, Hinkley T, Okely AD, Salmon J. Tracking physical activity and sedentary behavior in childhood: a systematic review. Am J Prev Med. 2013;44:651-8. https://doi.org/10.1016/j.amepre.2013.03.001
https://doi.org/https://doi.org/10.1016/...
,3232. Hnatiuk JA, Salmon J , Hinkley T , Okely AD , Trost S. A review of preschool children’s physical activity and sedentary time using objective measures. Am J Prev Med. 2014;47:487-97. https://doi.org/10.1016/j.amepre.2014.05.042
https://doi.org/https://doi.org/10.1016/...
and the gradual reduction in physical activity over the years3535. Hinkley T , Salmon J , Okely AD , Hesketh K, Crawford D. Correlates of preschool children’s physical activity. Am J Prev Med. 2012;43:159-67. https://doi.org/10.1016/j.amepre.2012.04.020
https://doi.org/https://doi.org/10.1016/...
reinforce the recommendation that strategies and incentives for this practice should be fostered since the first years of life. Thus, further tracking studies should be developed in South America, so this evidence can provide a better understanding of this behavior and deepen the discussion on the specificities of the continent.

In face of the evidence of two previous reviews,3535. Hinkley T , Salmon J , Okely AD , Hesketh K, Crawford D. Correlates of preschool children’s physical activity. Am J Prev Med. 2012;43:159-67. https://doi.org/10.1016/j.amepre.2012.04.020
https://doi.org/https://doi.org/10.1016/...
,3636. Bingham DD, Costa S, Hinkley T , Shire KA, Clemes SA, Barber SE. Physical activity during the early years: a systematic review of correlates and determinants. Am J Prev Med. 2016;51:384-402. https://doi.org/10.1016/j.amepre.2016.04.022
https://doi.org/https://doi.org/10.1016/...
which suggest gender and the support of parents/guardians as determinants of physical activity, future studies on the theme should intensify their investigations, developing, for instance, stratified analyses that could allow the discussion and comparison of their findings with those based on research conducted in the countries previously mentioned. We also believe that this is an important point, as this expansion in the debate can support the decision making and formulation of public policies that promote physical activity in this population and are suitable to the particularities of a given group, or even a territory.

Sedentary behavior indicators

In the summary, the lowest prevalence rates of preschool children exposed to at least 2 hours of screen time per day were 392222. 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/...
and 40%.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. Given the increase in exposure to sedentary behavior in the transition between childhood and adolescence3737. Pearson N, Haycraft E, Johnston J, Atkin AJ. Sedentary behaviour across the primary-secondary school transition: a systematic review. Prev Med. 2017;94:40-7. https://doi.org/10.1016/j.ypmed.2016.11.010
https://doi.org/https://doi.org/10.1016/...
and the different negative health indicators associated with high exposure,1111. Carson V , Hunter S , Kuzik N , Gray CE , Poitras VJ , Chaput JP , et al. Systematic review of sedentary behaviour and health indicators in school-aged children and youth: an update. Appl Physiol Nutr Metab. 2016;41 Suppl 3:S240-65. https://doi.org/10.1139/apnm-2015-0630
https://doi.org/https://doi.org/10.1139/...
previous interventions are important and have significant effects on its control, especially when they involve strategies that monitor screen time, counseling, and participation of parents/guardians.3838. Biddle SJ, Petrolini I, Pearson N . Interventions designed to reduce sedentary behaviours in young people: a review of reviews. Br J Sports Med. 2014;48:182-6. https://doi.org/10.1136/bjsports-2013-093078
https://doi.org/https://doi.org/10.1136/...

Considering the socioeconomic characteristics of the South American continent, it is also essential to understand that various socioeconomic aspects are associated with the persistence of sedentary behavior in childhood, and take these aspects into account while formulating preventive strategies.3939. Mielke GI, Brown WJ, Nunes BP, Silva IC, Hallal PC . Socioeconomic correlates of sedentary behavior in adolescents: systematic review and meta-analysis. Sports Med. 2017;47:61-75. https://doi.org/10.1007/s40279-016-0555-4
https://doi.org/https://doi.org/10.1007/...
Therefore, further research on the topic in different scenarios is necessary, so that the evidence can strengthen action plans and strategies on a larger scale.

One of the articles included in this summary presents data collected in the school environment.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...
Besides the high prevalence of sedentary behavior throughout the school day, the study also shows that children enrolled in schools with recreation room and playgrounds have reduced levels of sedentary behavior when compared to those who attend schools that do not have these facilities. In this scenario, we can suggest the development of new studies in the school environment, introducing knowledge, involving parents/guardians, and with the possibility of changing the surroundings to avoid excessive sedentary behavior. The school has a great potential for interventions related to this theme, given that educational4040. Friedrich RR, Polet JP, Schuch I, Wagner MB. Effect of intervention programs in schools to reduce screen time: a meta-analysis. J Pediatr (Rio J). 2014;90:232-41. https://doi.org/10.1016/j.jped.2014.01.003
https://doi.org/https://doi.org/10.1016/...
and environmental strategies, such as the introduction height-adjustable chairs,4141. Hinckson E, Salmon J , Benden M, Clemes SA , Sudholz B, Barber SE , et al. Standing classrooms: research and lessons learned from around the world. Sports Med. 2016;46:977-87. https://doi.org/10.1007/s40279-015-0436-2
https://doi.org/https://doi.org/10.1007/...
have promising results in schoolchildren and adolescents.

Methodological aspects

In regard to measurement instruments, considering the difficulty of preschool children in answering questionnaires,4242. Oliver M, Schofield GM, Kolt GS. Physical activity in preschoolers: understanding prevalence and measurement issues. Sports Med. 2007;37:1045-70. https://doi.org/10.2165/00007256-200737120-00004
https://doi.org/https://doi.org/10.2165/...
confirmed by the information that all questionnaires adopted in the summary were administered to parents, we underline that good part of the articles used accelerometers to measure physical activity and/or sedentary behavior in the populations of interest, providing a more accurate estimate of these behaviors.

However, the differences among the devices used, as well as the criteria and strategies adopted for the measurements, limits more direct comparisons among the results. This fact corroborates the need to deepen the knowledge about the tools (validation and calibration aspects) and the most appropriate criteria to evaluate physical activity and sedentary behavior objectively,4343. Kim Y, Beets MW , Welk GJ. Everything you wanted to know about selecting the “right” Actigraph accelerometer cut-points for youth, but…: a systematic review. J Sci Med Sport. 2012;15:311-21. https://doi.org/10.1016/j.jsams.2011.12.001
https://doi.org/https://doi.org/10.1016/...
so that the measurements can be more comparable, as other investigations indicate.33. Bornstein DB, Beets MW, Byun W, McIver K. Accelerometer-derived physical activity levels of preschoolers: a meta-analysis. J Sci Med Sport. 2011;14:504-11. https://doi.org/10.1016/j.jsams.2011.05.007
https://doi.org/https://doi.org/10.1016/...
,3434. Tucker P. The physical activity levels of preschool-aged children: a systematic review. Early Child Res Q. 2008;23:547-58. https://doi.org/10.1016/j.ecresq.2008.08.005
https://doi.org/https://doi.org/10.1016/...

In this regard, we highlight the evidence produced by the article by Lima et al., which suggests that the most appropriate criterion is monitoring for three days a week with measurements of ten hours per day, in order not to underestimate the data and avoid sample loss.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...
In addition to objective measurements, the use of questionnaires should not be ruled out, as they can help identify the activities (for instance, which physical activities or sedentary behaviors), as well as the respective places where they happen.

Notes for future studies

Besides the notes made in previous topics, we recommend that future researches involve larger samples, aiming at a better representation of the evidence, as one of the main weakness of the assessment for risk of bias was the lack of reports on sample representativeness. Investigations on the theme in countries other than Argentina, Brazil, and Chile are also essential to allow the development of a future summary with data from different locations and populations. Considering the data of this summary, we can also recommend the development of strategies and technologies to monitor and survey levels of physical activity and sedentary behavior in this age group in the continent.4444. Kohl HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al. The pandemic of physical inactivity: global action for public health. Lancet. 2012;380:294-305. https://doi.org/10.1016/S0140-6736(12)60898-8
https://doi.org/https://doi.org/10.1016/...

Limitations

The main limitation of this review was not performing a preliminary survey of all South American scientific journals not indexed in the researched databases, which might have resulted in the non-evaluation of potential articles. Nevertheless, additional searches on the site Google Scholar were performed in Spanish, English, and Portuguese to avoid further effects of this limitation. We also emphasize that investigations from only three countries provided data for the summary, as well as the presence of a large number of studies that did not report their sample representativeness.

Lastly, 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

REFERENCES

Funding

  • This study did not receive funding.

Publication Dates

  • Publication in this collection
    25 Nov 2019
  • Date of issue
    2020

History

  • Received
    17 Apr 2018
  • Accepted
    11 July 2018
  • Published
    08 Nov 2019
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