Accelerometer measured levels of moderate-to-vigorous intensity physical activity and sedentary time in children and adolescents with chronic disease: A systematic review and meta-analysis

Context
Moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) are important for child and adolescent health.
Objective
To examine habitual levels of accelerometer measured MVPA and ST in children and adolescents with chronic disease, and how these levels compare with healthy peers.
Methods
Data sources: An extensive search was carried out in Medline, Cochrane library, EMBASE, SPORTDiscus and CINAHL from 2000–2017.
Study selection: Studies with accelerometer-measured MVPA and/or ST (at least 3 days and 6 hours/day to provide estimates of habitual levels) in children 0–19 years of age with chronic diseases but without co-morbidities that would present major impediments to physical activity. In all cases patients were studied while well and clinically stable.
Results
Out of 1592 records, 25 studies were eligible, in four chronic disease categories: cardiovascular disease (7 studies), respiratory disease (7 studies), diabetes (8 studies), and malignancy (3 studies). Patient MVPA was generally below the recommended 60 min/day and ST generally high regardless of the disease condition. Comparison with healthy controls suggested no marked differences in MVPA between controls and patients with cardiovascular disease (1 study, n = 42) and type 1 diabetes (5 studies, n = 400; SMD -0.70, 95% CI -1.89 to 0.48, p = 0.25). In patients with respiratory disease, MVPA was lower in patients than controls (4 studies, n = 470; SMD -0.39, 95% CI -0.80, 0.02, p = 0.06). Meta-analysis indicated significantly lower MVPA in patients with malignancies than in the controls (2 studies, n = 90; SMD -2.2, 95% CI -4.08 to -0.26, p = 0.03). Time spent sedentary was significantly higher in patients in 4/10 studies compared with healthy control groups, significantly lower in 1 study, while 5 studies showed no significant group difference.
Conclusions
MVPA in children/adolescents with chronic disease appear to be well below guideline recommendations, although comparable with activity levels of their healthy peers except for children with malignancies. Tailored and disease appropriate intervention strategies may be needed to increase MVPA and reduce ST in children and adolescents with chronic disease.

研究背景：中高强度身体活动（moderate-to-vigorous physical activity, MVPA）与久坐时长（sedentary time, ST）对儿童青少年的健康至关重要。
研究目的：本研究旨在探究慢性病儿童青少年群体中，加速度计（accelerometer）测得的日常中高强度身体活动与久坐时长水平，并分析该群体与健康同龄对照人群的水平差异。
研究方法：
数据来源：于2000年至2017年间，在Medline、Cochrane图书馆、EMBASE、SPORTDiscus及CINAHL数据库中开展了全面文献检索。
文献纳入标准：针对0至19岁慢性病儿童青少年，且需采用加速度计测量中高强度身体活动或久坐时长（需至少连续3天、每日有效测量时长≥6小时以估算日常活动水平）；受试儿童青少年需无会对身体活动造成显著阻碍的共病情况，且所有研究均在患者病情稳定、健康状态良好的前提下开展。
研究结果：在1592条文献记录中，最终有25篇符合纳入标准，涉及四大类慢性疾病：心血管疾病（7项研究）、呼吸系统疾病（7项研究）、糖尿病（8项研究）以及恶性肿瘤（3项研究）。
受试慢性病患者的中高强度身体活动时长普遍低于推荐的每日60分钟标准，且无论患何种慢性病，其久坐时长普遍偏高。
与健康对照人群对比结果显示，心血管疾病患者（1项研究，n=42）与1型糖尿病患者（5项研究，n=400；标准化均数差（standardized mean difference, SMD）=-0.70，95%置信区间（confidence interval, CI）：-1.89~0.48，p=0.25）的中高强度身体活动水平与健康对照无显著差异。
呼吸系统疾病患者的中高强度身体活动水平则低于健康对照（4项研究，n=470；SMD=-0.39，95%CI：-0.80~0.02，p=0.06）。
荟萃分析（meta-analysis）结果显示，恶性肿瘤患者的中高强度身体活动水平显著低于健康对照（2项研究，n=90；SMD=-2.2，95%CI：-4.08~-0.26，p=0.03）。
在10项对比久坐时长的研究中，有4项结果显示慢性病患者的久坐时长显著高于健康对照，1项显示患者久坐时长显著更低，其余5项未发现组间存在显著差异。
研究结论：慢性病儿童青少年的中高强度身体活动水平普遍远低于指南推荐标准，但除恶性肿瘤患者外，其身体活动水平与健康同龄人群基本相当。针对慢性病儿童青少年，或需制定个体化、适配疾病特点的干预策略，以提升其中高强度身体活动时长并减少久坐时长。