Advertisement

Effects of Exercise Intervention on Health-Related Physical Fitness and Blood Pressure in Preschool Children: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

  • Antonio García-HermosoEmail author
  • Alicia M. Alonso-Martinez
  • Robinson Ramírez-Vélez
  • Mikel Izquierdo
Systematic Review

Abstract

Background

No previous systematic review has quantitatively examined the effect of physical exercise interventions on health-related physical fitness and blood pressure in children younger than 6 years old.

Objective

To evaluate the effects of exercise interventions on health-related physical fitness (i.e., physical fitness components and body composition) and blood pressure in preschoolers.

Methods

We searched four databases. Only randomized controlled trials (RCTs), evaluating the effectiveness of exercise intervention on weight-related outcomes, blood pressure, and physical fitness components in preschoolers (1–5.99 years old) were included. The effect sizes were reported as Hedges’ g using random-effects models.

Results

A total of 19 RCTs were included. Exercise interventions favored reductions in body mass index (g = − 0.17; 95% confidence interval [CI], − 0.31 to − 0.03), waist circumference (g = − 0.25; 95% CI − 0.47 to − 0.03), and body fat percentage (g = − 0.31; 95% CI − 0.60 to − 0.23); as well as improvement in cardiorespiratory fitness (g = 0.25; 95% CI 0.08–0.42), muscular strength (g = 0.25; 95% CI 0.09–0.40), and speed–agility (g = − 0.51; 95% CI − 0.78 to − 0.24). Blood pressure was not reduced. The subgroup analysis revealed that physical exercise alone favored larger reductions in body mass index and waist circumference compared with physical exercise combined with another intervention. Also, changes in cardiorespiratory fitness, lower-body muscular strength and speed–agility were associated with larger decreases in body composition.

Conclusion

Physical exercise whether combined or not with additional intervention has a small effect on both body weight and physical fitness in preschoolers. Also, it seems that interventions to prevent obesity should be directed towards improving physical fitness of preschoolers.

Notes

Acknowledgements

The authors wish to thank C. A. C. Coloma, for revision of the English text.

Compliance with Ethical Standards

Funding

No sources of funding were used to assist in the preparation of this article. Antonio Garcia-Hermoso is a Miguel Servet Fellow (Instituto de Salud Carlos III-CP18/0150).

Conflicts of interest

Antonio Garcia-Hermoso, Alicia M. Alonso-Martinez, Robinson Ramírez-Vélez and Mikel Izquierdo declare that they have no conflicts of interest relevant to the content of this review.

References

  1. 1.
    Berk L. Development through the lifespan. 2nd ed. Boston: Allyn & Bacon; 2002.Google Scholar
  2. 2.
    Jones RA, Hinkley T, Okely AD, Salmon J. Tracking physical activity and sedentary behavior in childhood. Am J Prev Med. 2013;44(6):651–8.  https://doi.org/10.1016/j.amepre.2013.03.001.CrossRefPubMedGoogle Scholar
  3. 3.
    Telama R, Yang X, Leskinen E, et al. Tracking of physical activity from early childhood through youth into adulthood. Med Sci Sport Exerc. 2014;46(5):955–62.  https://doi.org/10.1249/MSS.0000000000000181.CrossRefGoogle Scholar
  4. 4.
    Department of Health and Social Care. Start active, stay active: report on physical activity in the UK - GOV.UK. 2011. https://www.gov.uk/government/publications/start-active-stay-active-a-report-on-physical-activity-from-the-four-home-countries-chief-medical-officers. Accessed 4 Apr 2019.
  5. 5.
    WHO. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. Geneva: World Health Organization; 2019.Google Scholar
  6. 6.
    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(4):487–97.  https://doi.org/10.1016/j.amepre.2014.05.042.CrossRefPubMedGoogle Scholar
  7. 7.
    Timmons BW, LeBlanc AG, Carson V, et al. Systematic review of physical activity and health in the early years (aged 0–4 years). Appl Physiol Nutr Metab. 2012;37(4):773–92.  https://doi.org/10.1139/h2012-070.CrossRefPubMedGoogle Scholar
  8. 8.
    Carson V, Lee E-Y, Hewitt L, 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(S5):854.  https://doi.org/10.1186/s12889-017-4860-0.CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Ling J, Robbins LB, Wen F. Interventions to prevent and manage overweight or obesity in preschool children: a systematic review. Int J Nurs Stud. 2016;53:270–89.  https://doi.org/10.1016/j.ijnurstu.2015.10.017.CrossRefPubMedGoogle Scholar
  10. 10.
    Van Capelle A, Broderick CR, van Doorn N, Ward ER, Parmenter BJ. Interventions to improve fundamental motor skills in pre-school aged children: a systematic review and meta-analysis. J Sci Med Sport. 2017;20(7):658–66.  https://doi.org/10.1016/j.jsams.2016.11.008.CrossRefPubMedGoogle Scholar
  11. 11.
    Pate RR, Hillman CH, Janz KF, et al. Physical activity and health in children younger than 6 years. Med Sci Sport Exerc. 2019;51:1282–91.CrossRefGoogle Scholar
  12. 12.
    Liberati A, Altman DG, Tetzlaff J, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Med. 2009;6(7):e1000100.  https://doi.org/10.1371/journal.pmed.1000100.CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Maher C, Sherrington C, Herbert RD, et al. Reliability of the PEDro scale for rating quality of randomized controlled trials. academic.oup.com. https://academic.oup.com/ptj/article-abstract/83/8/713/2805287. Accessed 29 Mar 2019.
  14. 14.
    Higgins JP, Green S (eds). Cochrane Handbook for systematic reviews of interventions. Chichester: Wiley; 2008.  https://doi.org/10.1002/9780470712184 Google Scholar
  15. 15.
    Morris S-18th annual conference of the S, 2003 U. Estimating effect size from the pretest-posttest-control design. 2019. faculty.cas.usf.edu. http://faculty.cas.usf.edu/mbrannick/papers/conf/esppc_siop03.pdf. Accessed 29 Mar 2019.
  16. 16.
    Cohen J. Statistical power analysis for the behavioral sciences. 2013. https://content.taylorfrancis.com/books/download?dac=C2010-0-30830-5&isbn=9781134742707&format=googlePreviewPdf. Accessed 1 Apr 2019.
  17. 17.
    Higgins JPT, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med. 2002;21(11):1539–58.  https://doi.org/10.1002/sim.1186.CrossRefPubMedGoogle Scholar
  18. 18.
    Higgins J, Thompson S, Deeks J, Altman DG. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.  https://doi.org/10.1136/bmj.327.7414.557.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Egger M, Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315:629–34.CrossRefGoogle Scholar
  20. 20.
    Annesi JJ, Smith AE, Tennant GA. Effects of a cognitive-behaviorally based physical activity treatment for 4- and 5-year-old children attending US preschools. Int J Behav Med. 2013;20(4):562–6.  https://doi.org/10.1007/s12529-013-9361-7.CrossRefPubMedGoogle Scholar
  21. 21.
    Bellows LL, Davies PL, Anderson J, Kennedy C. Effectiveness of a physical activity intervention for Head Start preschoolers: a randomized intervention study. Am J Occup Ther. 2013;67(1):28–36.  https://doi.org/10.5014/ajot.2013.005777.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Martínez-Vizcaíno V, Pozuelo-Carrascosa DP, García-Prieto JC, et al. Effectiveness of a school-based physical activity intervention on adiposity, fitness and blood pressure: MOVI-KIDS study. Br J Sports Med.  https://doi.org/10.1136/bjsports-2018-099655
  23. 23.
    Mo-suwan L, Pongprapai S, Junjana C, Puetpaiboon A. Effects of a controlled trial of a school-based exercise program on the obesity indexes of preschool children. Am J Clin Nutr. 1998;68(5):1006–11.  https://doi.org/10.1093/ajcn/68.5.1006.CrossRefPubMedGoogle Scholar
  24. 24.
    Puder JJ, Marques-Vidal P, Schindler C, et al. Effect of multidimensional lifestyle intervention on fitness and adiposity in predominantly migrant preschool children (Ballabeina): cluster randomised controlled trial. BMJ. 2011;343(oct13 2):d6195.  https://doi.org/10.1136/bmj.d6195 CrossRefGoogle Scholar
  25. 25.
    Reilly JJ, Kelly L, Montgomery C, et al. Physical activity to prevent obesity in young children: cluster randomised controlled trial. BMJ. 2006;333(7577):1041.  https://doi.org/10.1136/bmj.38979.623773.55.CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Roth K, Kriemler S, Lehmacher W, Ruf KC, Graf C, Hebestreit H. Effects of a physical activity intervention in preschool children. Med Sci Sport Exerc. 2015;47(12):2542–51.  https://doi.org/10.1249/MSS.0000000000000703.CrossRefGoogle Scholar
  27. 27.
    Nemet D, Geva D, Eliakim A. Health promotion intervention in low socioeconomic kindergarten children. J Pediatr. 2011;158(5):796–801.e1.  https://doi.org/10.1016/j.jpeds.2010.10.040.CrossRefPubMedGoogle Scholar
  28. 28.
    Tan S, Chen C, Sui M, Xue L, Wang J. Exercise training improved body composition, cardiovascular function, and physical fitness of 5-year-old children with obesity or normal body mass. Pediatr Exerc Sci. 2017;29(2):245–53.  https://doi.org/10.1123/pes.2016-0107.CrossRefPubMedGoogle Scholar
  29. 29.
    Zask A, Adams JK, Brooks LO, Hughes DF. Tooty Fruity Vegie: an obesity prevention intervention evaluation in Australian preschools. Health Promot J Austr. 2019;23(1):10–15.  https://doi.org/10.1071/he12010 CrossRefGoogle Scholar
  30. 30.
    Latorre-Román PA, Mora-López D, García-Pinillos F. Effects of a physical activity programme in the school setting on physical fitness in preschool children. Child Care Health Dev. 2018;44:427–32.CrossRefGoogle Scholar
  31. 31.
    Birnbaum J, Geyer C, Kirchberg F, Manios Y, Koletzko B, ToyBox-study Group. Effects of a kindergarten-based, family-involved intervention on motor performance ability in 3- to 6-year-old children: the ToyBox-study. J Sports Sci. 2017;35(4):377-384.  https://doi.org/10.1080/02640414.2016.1166390 CrossRefGoogle Scholar
  32. 32.
    Bocca G, Corpeleijn E, Stolk RP, Sauer PJJ. Results of a multidisciplinary treatment program in 3-year-old to 5-year-old overweight or obese children: a randomized controlled clinical trial. Arch Pediatr Adolesc Med. 2012;166(12):1109.  https://doi.org/10.1001/archpediatrics.2012.1638.CrossRefPubMedGoogle Scholar
  33. 33.
    Donath L, Faude O, Hagmann S, Roth R, Zahner L. Fundamental movement skills in preschoolers: a randomized controlled trial targeting object control proficiency. Child Care Health Dev. 2015;41(6):1179–87.  https://doi.org/10.1111/cch.12232.CrossRefPubMedGoogle Scholar
  34. 34.
    Eliakim A, Nemet D, Balakirski Y, Epstein Y. The effects of nutritional-physical activity school-based intervention on fatness and fitness in preschool children. J Pediatr Endocrinol Metab. 2007;20(6):711–8.CrossRefGoogle Scholar
  35. 35.
    Fitzgibbon ML, Stolley MR, Schiffer L, et al. Family-based hip-hop to health: outcome results. Obesity (Silver Spring). 2013;21(2):274–83.  https://doi.org/10.1002/oby.20269.CrossRefPubMedCentralGoogle Scholar
  36. 36.
    Hacke C, Ketelhut S, Wendt U, Müller G, Schlesner C, Ketelhut K. Effectiveness of a physical activity intervention in preschoolers: a cluster-randomized controlled trial. Scand J Med Sci Sports. 2019;29(5):742–52.  https://doi.org/10.1111/sms.13390.CrossRefPubMedGoogle Scholar
  37. 37.
    Jones RA, Riethmuller A, Hesketh K, Trezise J, Batterham M, Okely AD. Promoting fundamental movement skill development and physical activity in early childhood settings: a cluster randomized controlled trial. Pediatr Exerc Sci. 2011;23(4):600–15.CrossRefGoogle Scholar
  38. 38.
    Ketelhut K, Mohasseb I, Ketelhut RG. Two years of regular exercise decreases blood pressure and improves motor skills in early childhood. Sport Sci Health. 2018;14(3):571–8.  https://doi.org/10.1007/s11332-018-0463-0.CrossRefGoogle Scholar
  39. 39.
    WHO. Childhood overweight and obesity. WHO. 2017. https://www.who.int/dietphysicalactivity/childhood/en/. Accessed 31 Mar 2019.
  40. 40.
    Foster BA, Farragher J, Parker P, Sosa ET. Treatment interventions for early childhood obesity: a systematic review. Acad Pediatr. 2015;15(4):353–61.  https://doi.org/10.1016/j.acap.2015.04.037.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Towner EK, Clifford LM, McCullough MB, Stough CO, Stark LJ. Treating obesity in preschoolers: a review and recommendations for addressing critical gaps. Pediatr Clin North Am. 2016;63(3):481–510.  https://doi.org/10.1016/j.pcl.2016.02.005.CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Bleich SN, Vercammen KA, Zatz LY, Frelier JM, Ebbeling CB, Peeters A. Interventions to prevent global childhood overweight and obesity: a systematic review. Lancet Diabetes Endocrinol. 2018;6(4):332–46.  https://doi.org/10.1016/S2213-8587(17)30358-3.CrossRefPubMedGoogle Scholar
  43. 43.
    Slentz CA, Houmard JA, Kraus WE. Exercise, abdominal obesity, skeletal muscle, and metabolic risk: evidence for a dose response. Obesity (Silver Spring). 2009;17(Suppl. 3):27–33.CrossRefGoogle Scholar
  44. 44.
    Lavoie J-M, Gauthier M-S. Regulation of fat metabolism in the liver: link to non-alcoholic hepatic steatosis and impact of physical exercise. Cell Mol Life Sci. 2006;63(12):1393–409.CrossRefGoogle Scholar
  45. 45.
    González-Ruiz K, Ramírez-Vélez R, Correa-Bautista JE, Peterson MD, García-Hermoso A. The effects of exercise on abdominal fat and liver enzymes in pediatric obesity: a systematic review and meta-analysis. Child Obes. 2017;13(4):272–82.CrossRefGoogle Scholar
  46. 46.
    García-Hermoso A, Ceballos-Ceballos RJM, Poblete-Aro CE, Hackney AC, Mota J, Ramírez-Vélez R. Exercise, adipokines and pediatric obesity: a meta-analysis of randomized controlled trials. Int J Obes. 2017;41(4):475–82.CrossRefGoogle Scholar
  47. 47.
    Wang Y, Cai L, Wu Y, et al. What childhood obesity prevention programmes work? A systematic review and meta-analysis. Obes Rev. 2015;16(7):547–65.  https://doi.org/10.1111/obr.12277.CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Waters E, de Silva-Sanigorski A, Burford BJ, et al. Interventions for preventing obesity in children. Cochrane Datab Syst Rev. 2011;(12):CD001871.  https://doi.org/10.1002/14651858.cd001871.pub3
  49. 49.
    Oosterhoff M, Joore M, Ferreira I. The effects of school-based lifestyle interventions on body mass index and blood pressure: a multivariate multilevel meta-analysis of randomized controlled trials. Obes Rev. 2016;17(11):1131–53.  https://doi.org/10.1111/obr.12446.CrossRefPubMedGoogle Scholar
  50. 50.
    Leppänen MH, Henriksson P, Delisle Nyström C, et al. Longitudinal physical activity, body composition, and physical fitness in preschoolers. Med Sci Sport Exerc. 2017;49(10):2078–85.  https://doi.org/10.1249/MSS.0000000000001313.CrossRefGoogle Scholar
  51. 51.
    Camhi SM, Katzmarzyk PT. Tracking of cardiometabolic risk factor clustering from childhood to adulthood. Int J Pediatr Obes. 2010;5(2):122–9.  https://doi.org/10.3109/17477160903111763.CrossRefPubMedGoogle Scholar
  52. 52.
    Ekelund U, Anderssen SA, Froberg K, et al. Independent associations of physical activity and cardiorespiratory fitness with metabolic risk factors in children: the European youth heart study. Diabetologia. 2007;50(9):1832–40.  https://doi.org/10.1007/s00125-007-0762-5.CrossRefPubMedGoogle Scholar
  53. 53.
    Pozuelo-Carrascosa DP, Cavero-Redondo I, Herráiz-Adillo Á, Díez-Fernández A, Sánchez-López M, Martínez-Vizcaíno V. School-based exercise programs and cardiometabolic risk factors: a meta-analysis. Pediatrics. 2018;142(5):e20181033.  https://doi.org/10.1542/peds.2018-1033.CrossRefPubMedGoogle Scholar
  54. 54.
    Dobbins M, Husson H, DeCorby K, LaRocca RL. School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18. Cochrane Datab Syst Rev. 2013;(2):CD007651.  https://doi.org/10.1002/14651858.cd007651.pub2
  55. 55.
    Stabouli S, Papakatsika S, Kotsis V. The role of obesity, salt and exercise on blood pressure in children and adolescents. Expert Rev Cardiovasc Ther. 2011;9(6):753–61.CrossRefGoogle Scholar
  56. 56.
    García-Hermoso A, Saavedra JM, Escalante Y. Effects of exercise on resting blood pressure in obese children: a meta-analysis of randomized controlled trials. Obes Rev. 2013;14(11):919–28.CrossRefGoogle Scholar
  57. 57.
    Pozuelo-Carrascosa DP, García-Hermoso A, Álvarez-Bueno C, Sánchez-López M, Martinez-Vizcaino V. Effectiveness of school-based physical activity programmes on cardiorespiratory fitness in children: a meta-analysis of randomised controlled trials. Br J Sports Med. 2018;52(19):1234–40.  https://doi.org/10.1136/bjsports-2017-097600.CrossRefPubMedGoogle Scholar
  58. 58.
    Smith JJ, Eather N, Weaver RG, Riley N, Beets MW, Lubans DR. Behavioral correlates of muscular fitness in children and adolescents: a systematic review. Sports Med. 2019.  https://doi.org/10.1007/s40279-019-01089-7.CrossRefGoogle Scholar
  59. 59.
    Cliff DP, Okely AD, Smith LM, McKeen K. Relationships between fundamental movement skills and objectively measured physical activity in preschool children. Pediatr Exerc Sci. 2009;21(4):436–49.  https://doi.org/10.1123/pes.21.4.436.CrossRefPubMedGoogle Scholar
  60. 60.
    Mintjens S, Menting MD, Daams JG, van Poppel MNM, Roseboom TJ, Gemke RJBJ. Cardiorespiratory fitness in childhood and adolescence affects future cardiovascular risk factors: a systematic review of longitudinal studies. Sports Med. 2018;48(11):2577–605.  https://doi.org/10.1007/s40279-018-0974-5.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    García-Hermoso A, Ramírez-Campillo R, Izquierdo M. Is muscular fitness associated with future health benefits in children and adolescents? A systematic review and meta-analysis of longitudinal studies. Sports Med. 2019;49(7):1079–94.  https://doi.org/10.1007/s40279-019-01098-6.CrossRefPubMedGoogle Scholar
  62. 62.
    Henriksson P, Leppänen MH, Henriksson H, et al. Physical fitness in relation to later body composition in pre-school children. J Sci Med Sport. 2019;22(5):574–9.  https://doi.org/10.1016/j.jsams.2018.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Navarrabiomed, Complejo Hospitalario de Navarra (CHN)Universidad Pública de Navarra (UPNA), IdiSNAPamplonaSpain
  2. 2.Laboratorio de Ciencias de la Actividad Física, el Deporte y la SaludUniversidad de Santiago de Chile, USACHSantiagoChile
  3. 3.Department of Health Sciences, Public University of Navarra, CIBER of Frailty and Healthy Aging (CIBERFES)Instituto de Salud Carlos IIIPamplonaSpain

Personalised recommendations