ABSTRACT

OBJECTIVE

To synthesize evidence from studies that analyzed the associations between sedentary behavior and motor competence in children and adolescents.

METHODS

Systematic review of original articles that analyzed possible associations between sedentary behavior and motor competence in children and adolescents (3–18 years of age), without restrictions on study design, instruments and analysis protocols. The articles were identified through searches in the PubMed, Web of Science, Academic Search Premier, Cinahl, Medline and SPORTDiscus databases, as well as in reference lists. The level of evidence was evaluated according to the amount of studies that reported statistical significance in the associations between the variables and the quality of the articles (risk of bias).

RESULTS

Of 2,462 initial studies, 22 composed the synthesis (two interventions, nine longitudinal and eleven cross-sectional studies). Of these, in 13, we observed negative associations between the variables, more often in the age group of seven to fourteen years. In the analysis of risk of bias, the main limitations of the studies were “convenience sampling” and “no description of sample sizing”.

CONCLUSIONS

The available evidence suggests that sedentary behavior is negatively associated with motor competence in elementary school children, although the evidence is uncertain in the preschool years; the synthesis of results from longitudinal studies suggests that sedentary behavior negatively affects the development of motor competence. It is important that future studies have greater control over sociocultural determinants and deepen knowledge regarding sex and age, as well as the methods and indicators used to evaluate the two variables.

Child; Adolescent; Sedentary Behavior; Motor Competence; Systematic Review

INTRODUCTION

High sedentary behavior (SB) index, defined by activities with energy expenditure ≤ 1.5 metabolic equivalents (MET) while sitting or lying down during the waking period¹1. 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/10.1186/1479-5868-8-98... , is currently a serious global public health problem²2. World Health Organization. Global status report on noncommunicable diseases 2010. Geneva (CH): WHO; 2011.,³3. Tremblay MS, Aubert S, Barnes JD, Saunders TJ, Carson V, Latimer-Cheung AE et al. Sedentary Behavior Research Network (SBRN) – Terminology Consensus Project process and outcome. Int J Behav Nutr Phys Act. 2017;14(1):75. https://doi.org/10.1186/s12966-017-0525-8
https://doi.org/10.1186/s12966-017-0525-... . SB during childhood and adolescence has been identified as a predictor of SB in adulthood⁴4. 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(6):651-8. https://doi.org/10.1016/j.amepre.2013.03.001
https://doi.org/10.1016/j.amepre.2013.03... ,⁵5. Gordon-Larsen P, Nelson MC, Popkin BC. Longitudinal physical activity and sedentary behavior trends: adolescence to adulthood. Am J Prev Med. 2004;27(4):277-83. https://doi.og/10.1089/chi.2013.0021
https://doi.og/10.1089/chi.2013.0021... and development of chronic diseases such as diabetes, hypertension and overweight or obesity⁶6. Kohl HW 3rd, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, et al. The pandemic of physical inactivity: global action for public health. Lancet. TV viewing and physical activity are independently associated with metabolic risk in children: The European Youth Heart Study. 2012;380(9838):294-305. https://doi.org/10.1016/s0140-6736(12)60898-8
https://doi.org/10.1016/s0140-6736(12)60... .

Several factors, such as access to technologies, the decrease in the supply of public space and rates of violence, have led children and adolescents to adopt a SB during much of their day¹⁰10. Pate RR, Mitchell JA, Byun W, Dowda M. Sedentary behaviour in youth. Br J Sports Med. 2011;45(11): 906-13. https://doi.org/10.1136/bjsports-2011-090192
https://doi.org/10.1136/bjsports-2011-09... , particularly in leisure options involving screen activities (tablets, smartphones, computers, video games, television)¹⁰10. Pate RR, Mitchell JA, Byun W, Dowda M. Sedentary behaviour in youth. Br J Sports Med. 2011;45(11): 906-13. https://doi.org/10.1136/bjsports-2011-090192
https://doi.org/10.1136/bjsports-2011-09... ,¹³13. Biddle SJH, Marshall SJ, Gorely T, Cameron N. Temporal and environmental patterns of sedentary and active behaviors during adolescents’ leisure time. Int J Behav Med. 2009;16(3):278-86. https://doi.org/10.1007/s12529-008-9028-y
https://doi.org/10.1007/s12529-008-9028-... ,¹⁴14. Mathers M, Canterford L, Olds T, Hesketh K, Ridley K, Wake M. Electronic media use and adolescent health and well-being: cross-sectional community study. Acad Pediatr. 2009;9(5):307-14. https://doi.org/10.1016/j.acap.2009.04.003
https://doi.org/10.1016/j.acap.2009.04.0... . Current guidelines suggest a daily limit of 1h in screen activities for the age group of 3 to 5 years and 2h daily from 5 to 17 years¹⁵15. World Health Organization. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. Geneva (CH): WHO; 2019.,¹⁶16. Tremblay MS, Carson V, Chaput JP, Gorber SC, 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(6 Suppl 3):S311-27. https://doi.org/10.1139/apnm-2016-0151
https://doi.org/10.1139/apnm-2016-0151... . Despite these recommendations, studies¹⁰10. Pate RR, Mitchell JA, Byun W, Dowda M. Sedentary behaviour in youth. Br J Sports Med. 2011;45(11): 906-13. https://doi.org/10.1136/bjsports-2011-090192
https://doi.org/10.1136/bjsports-2011-09... ,¹⁷17. Webster EK, Martin CK, Staiano AE. Fundamental motor skills, screen-time, and physical activity in preschoolers. J Sport Health Sci. 2019;8(2):114-21. https://doi.org/10.1016/j.jshs.2018.11.006
https://doi.org/10.1016/j.jshs.2018.11.0... ,¹⁸18. Andrade Neto F, Eto FN, Pereira TSS, Carletti L, Molina MCB. Active and sedentary behaviours in children aged 7 to 10 years old: the urban and rural contexts, Brazil. BMC Public Health. 2014;14:1174. https://doi.org/10.1186/1471-2458-14-1174
https://doi.org/10.1186/1471-2458-14-117... have reported high screen time values (more than 3 to 4 hours per day) in children and adolescents of different nationalities, a fact probably aggravated due to the covid-19 pandemic¹⁹19. Moore SA, Faulkner G, Rhodes RE, Brussoni M, Chulak-Bozzer T, Ferguson LJ, et al. Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth a national survey. Int J Behav Nutr Phys Act. 2020;17:85. https://doi.org/10.1186/s12966-020-00987-8
https://doi.org/10.1186/s12966-020-00987... .

Along with the high rates of SB, a decline in motor competence (MC) has also been reported²⁰20. Brian A, Pennell A, Taunton S, Starrett A, Howard-Shaughnessy C, Goodway JD, et al. Motor competence levels and developmental delay in early childhood: a multicenter cross-sectional study conducted in the USA. Sports Med. 2019;49(10):1609-18. https://doi.org/10.1007/s40279-019-01150-5
https://doi.org/10.1007/s40279-019-01150... , that is, competence in the execution of motor skills, with organization and movement control compatible with age²³23. Robinson LE, Stodden DF, Barnett LM, Lopes VP, Logan SW, Rodrigues LP, et al. Motor competence and its effect on positive developmental trajectories of health. Sports Med. 2015;45(9):1273-84. https://doi.org/10.1007/s40279-015-0351-6.3
https://doi.org/10.1007/s40279-015-0351-... ; this factor is potentially important to decrease SB indices and increase the practice of physical activity (PA)¹²12. Adank AM, Van Kann DHH, Hoeboer JJAA, Vries SI, Kremer SPJ, Vos SB. Investigating motor competence in association with sedentary behavior and physical activity in 7- to 11-year-old children. Int J Environ Res Public Health. 2018;15(11):2470. https://doi.org/10.3390/ijerph15112470
https://doi.org/10.3390/ijerph15112470... ,²⁴24. Stodden DF, Goodway JD, Langendorfer SJ, Roberton MA, Rudisill ME, Garcia C, et al. A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship. Quest. 2008;60(2):290-306. https://doi.org/10.1080/00336297.2008.10483582
https://doi.org/10.1080/00336297.2008.10... . A growing body of evidence has indicated that MC favors participation in physical and sports activities²⁵25. Henrique RS, Ré AHN, Stodden DF, Fransen J, Campos CMC, Queiroz DR, et al. Association between sports participation, motor competence and weight status: a longitudinal study. J Sci Med Sport. 2016;19(10):825-9. https://doi.org/10.1016/j.jsams.2015.12.512
https://doi.org/10.1016/j.jsams.2015.12.... and associates with better overall health outcomes, including adequate body weight and increased cardiorespiratory fitness²⁸28. Cattuzzo MT, Henrique RS, Ré AHN, Oliveira IS, Melo BM, Moura M, et al. Motor competence and health related physical fitness in youth: a systematic review. J Sci Med Sport. 2016;19(2):123-9. https://doi.org/10.1016/j.jsams.2014.12.004
https://doi.org/10.1016/j.jsams.2014.12.... . Children and adolescents with low MC tend to avoid physical activity¹²12. Adank AM, Van Kann DHH, Hoeboer JJAA, Vries SI, Kremer SPJ, Vos SB. Investigating motor competence in association with sedentary behavior and physical activity in 7- to 11-year-old children. Int J Environ Res Public Health. 2018;15(11):2470. https://doi.org/10.3390/ijerph15112470
https://doi.org/10.3390/ijerph15112470... ,¹⁷17. Webster EK, Martin CK, Staiano AE. Fundamental motor skills, screen-time, and physical activity in preschoolers. J Sport Health Sci. 2019;8(2):114-21. https://doi.org/10.1016/j.jshs.2018.11.006
https://doi.org/10.1016/j.jshs.2018.11.0... and adopt screen activities as leisure option¹⁷17. Webster EK, Martin CK, Staiano AE. Fundamental motor skills, screen-time, and physical activity in preschoolers. J Sport Health Sci. 2019;8(2):114-21. https://doi.org/10.1016/j.jshs.2018.11.006
https://doi.org/10.1016/j.jshs.2018.11.0... ,²⁹29. Hardy LL, Ding D, Peralta LR, Mihrshahi S, Merom D. Association between sitting, screen time, fitness domains, and fundamental motor skills in children aged 5-16 years: cross-sectional population study. J Phys Act Health. 2018;15(12):933-40. https://doi.org/10.1123/jpah.2017-0620
https://doi.org/10.1123/jpah.2017-0620... , which further restricts motor development and can generate a negative behavioral cycle, increasing the likelihood of physical inactivity and excessive SB throughout life. Recent research has found a negative association between SB and MC¹²12. Adank AM, Van Kann DHH, Hoeboer JJAA, Vries SI, Kremer SPJ, Vos SB. Investigating motor competence in association with sedentary behavior and physical activity in 7- to 11-year-old children. Int J Environ Res Public Health. 2018;15(11):2470. https://doi.org/10.3390/ijerph15112470
https://doi.org/10.3390/ijerph15112470... ,³⁰30. Drenowatz C, Greier K. Cross-sectional and longitudinal association of sports participation, media consumption and motor competence in youth. Scand J Med Sci Sports. 2019;29(6):854-61. https://doi.org/10.1111/sms.13400
https://doi.org/10.1111/sms.13400... which suggests a reciprocal relationship between these variables²⁴24. Stodden DF, Goodway JD, Langendorfer SJ, Roberton MA, Rudisill ME, Garcia C, et al. A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship. Quest. 2008;60(2):290-306. https://doi.org/10.1080/00336297.2008.10483582
https://doi.org/10.1080/00336297.2008.10... , with important application in health promotion policies.

However, in a meta-analysis article, the evidence of association between SB and MC was considered uncertain³¹31. Cliff DP, Hesketh KD, Vella SA, Hinkley T, Tsiros MD, Ridgers ND, et al. Objectively measured sedentary behaviour and health and development in children and adolescents: systematic review and meta-analysis. Obes Rev. 2016;17(4):330-44. https://doi.org/10.1111/obr.12371
https://doi.org/10.1111/obr.12371... because, in addition to identifying only three surveys with children and adolescents³²32. 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
https://doi.org/10.1123/pes.21.4.436... , they only found one³³33. Lopes L, Santos R, Pereira B, Lopes VP. Associations between sedentary behavior and motor coordination in children. Am J Hum Biol. 2012;24(6):746-52. https://doi.org/10.1002/ajhb.22310
https://doi.org/10.1002/ajhb.22310... , conducted with children from 9 to 10 years of age, with significant association. Therefore, depending on the possible impact of SB guidelines on health policies¹⁵15. World Health Organization. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. Geneva (CH): WHO; 2019. and considering the importance of MC development in youth²³23. Robinson LE, Stodden DF, Barnett LM, Lopes VP, Logan SW, Rodrigues LP, et al. Motor competence and its effect on positive developmental trajectories of health. Sports Med. 2015;45(9):1273-84. https://doi.org/10.1007/s40279-015-0351-6.3
https://doi.org/10.1007/s40279-015-0351-... ,²⁴24. Stodden DF, Goodway JD, Langendorfer SJ, Roberton MA, Rudisill ME, Garcia C, et al. A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship. Quest. 2008;60(2):290-306. https://doi.org/10.1080/00336297.2008.10483582
https://doi.org/10.1080/00336297.2008.10... ,²⁸28. Cattuzzo MT, Henrique RS, Ré AHN, Oliveira IS, Melo BM, Moura M, et al. Motor competence and health related physical fitness in youth: a systematic review. J Sci Med Sport. 2016;19(2):123-9. https://doi.org/10.1016/j.jsams.2014.12.004
https://doi.org/10.1016/j.jsams.2014.12.... , there is a need for a greater understanding of the association between MC and SB, considering a greater number of studies and the possible differences between age groups.

Thus, the objective of this systematic review was to synthesize the evidence of studies that analyzed the associations between SB and MC in children and adolescents.

METHODS

Protocol and Registration

This study is a systematic review, with its protocol registered in the International Prospective Register of Systematic Reviews (PROSPERO CRD42020161554). The full text was elaborated based on the items in the list Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISM)³⁵35. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. https://doi.org/10.1186/2046-4053-4-1
https://doi.org/10.1186/2046-4053-4-1... .

Eligibility Criteria

Based on the research question, original articles published in peer-reviewed scientific journals in English, Portuguese and Spanish were sought. More specifically, other items were established from the PICO strategy³⁶36. Richardson WS, Wilson MC, Nishikawa J, Hayward RS. The well-built clinical question: a key to evidence-based decisions. ACP J Club. 1995;123(3):A12-3., considering:

Population

Heterogeneous samples of children and adolescents (without specific deficiencies or clinical cases, except for samples specifically composed of overweight or obese children) aged 3 to 18 years. For our purposes, aiming to improve the degree of comparability and presentation of evidence, the subgroups were defined as follows, considering the Brazilian education system: preschoolers, from 3 to 6 years of age; elementary school, involving children and adolescents between 6 and 14 years; and high school, which covers adolescents between 15 and 18 years.

Intervention or Exposure

Intervention studies were included that implemented strategies for the control or reduction of SB, regardless of the context (for example, at school or in the community) and characteristics (whether by theoretical, practical activities or both).

Observational studies analyzed possible associations between SB and MC, based on SB as an exposure variable and MC as an outcome variable. For the record, no restrictions were imposed on the types (e.g. screen time, sitting time), domains (e.g. leisure, school and travel) and instruments (e.g. questionnaires and motion sensors) used to measure SB or MC. Considering the current understanding of the concept, studies that addressed “sedentary” as absence of physical activity were excluded.

Comparison

In the intervention studies, no restrictions were imposed on the existence or type of activities offered to the control groups, opting, when possible (as in studies with more than one control group), for comparators that received less activity load.

Outcomes (Health Indicators)

The outcome was motor competence. To evaluate it, the gross motor skills of locomotion, object control and balance were considered.

Study Design

Cross-sectional studies, cohorts and interventions were included that showed analyses on possible associations between SB and MC, regardless of the protocol used (e.g. univariate or multivariate analyses). Case studies, descriptive studies, reviews, meta-analyses, dissertations, theses and summaries of events were excluded.

Sources of Information and Search Strategy

To recover potential studies, in March 2020, systematic searches were applied in six electronic databases: PubMed, Web of Science, Academic Search Premier, Cinahl, Medline and SPORTDiscus from the strategy applied in PubMed: ((((((((((motor competence[Text Word]) OR motor development[Text Word]) OR gross motor skills[Text Word]) OR fundamental motor skills[Text Word]) OR fundamental movement skills[Text Word]) OR motor coordination[Text Word]) OR motor ability[Text Word]) OR locomotor skills[Text Word]) OR object control skills[Text Word]) OR motor skills[Text Word]) AND (((((((sedentary behavior[Text Word]) OR sitting time[Text Word]) OR television[Text Word]) OR computer[Text Word]) OR videogame[Text Word]) OR screen time[Text Word]) OR screen activity*[Text Word]) AND child*[Text Word]. To avoid loss of relevant information, manual searches were conducted in the reference lists of articles evaluated by their full texts. No restrictions were imposed on the year of publication.

An author performed the initial search and entered all the recovered articles in the Rayyan platform (https://rayyan.qcri.org), where identification and removal of inter-database duplicates was conducted. Two authors (GS and SAM) independently reviewed the articles available by titles and abstracts. The results were compared and inconsistencies were discussed until a consensus was reached. If consensus was not reached, a third author (AHNR) would define the eligibility of the study. After this phase, the same authors evaluated the full texts of the remaining articles.

Data Extraction

Data were extracted independently by two authors (GS and SAM), using an electronic spreadsheet, which was organized into two levels of information: (1) descriptive (location, design, sample and age) and (2) methodological (type and measurement of MC, type and measurement of SB, statistics and main results). In particular, the results related to the analysis between SB and MC were extracted, considering the positive, negative or null associations, according to magnitude and level of significance p < 0.05. Data were extracted independently by sex only if data from the total sample were unavailable. In the case of different results for each sex, the study was classified as uncertain association.

Risk of Bias and Evaluation of the Quality of Studies

All included studies had their risk of bias assessed by two authors (GS and SAM), independently, with the support of the senior researcher (AHNR). For this purpose, the instrument developed by Lubans et al.²⁷27. Lubans DR, Morgan PJ, Cliff DP, Barnett LM, Okely AD. Fundamental movement skills in children and adolescents: review of associated health benefits. Sports Med. 2010;40(12):1019-35. https://doi.org/10.2165/11536850-000000000-00000
https://doi.org/10.2165/11536850-0000000... was used, who, in turn, were based on the items of the STROBE and CONSORT guidelines. Scores of 0 (absent or inadequately described) or 1 (present and adequately described) were assigned in six questions, namely: (a) “Does the study describe the eligibility/selection criteria of participants?“; (b) “Were participants randomly selected?” ; (c) “Does the study mention sources and details of the MC assessment, and do these instruments have adequate reliability for this specific age group?”; (d) “Does the study mention sources and details of SB assessment, and do all methods have acceptable reliability?” ; (e) “Did the study report sample sizing and was it adequately sized to detect hypothetical relationships?”; (f) “Does the study mention the number of subjects who completed each of the different measurements, and did these participants complete at least 80% of the MC and SB measurements?”. It was previously established that studies with scores ≤ 2 would have high risk of bias; studies in the range between 3 and 4 points, medium risk of bias; and studies with scores between 5 and 6, low risk of bias.

Summary of Results

Considering the heterogeneity between the designs and the methods adopted, since the first treatments, the construction of a descriptive synthesis of the available results was stipulated. The judgment of scientific evidence was based on Lubans et al.²⁷27. Lubans DR, Morgan PJ, Cliff DP, Barnett LM, Okely AD. Fundamental movement skills in children and adolescents: review of associated health benefits. Sports Med. 2010;40(12):1019-35. https://doi.org/10.2165/11536850-000000000-00000
https://doi.org/10.2165/11536850-0000000... using the percentage of studies that reported a statistically significant association, while also considering the risk of bias: (a) lack of scientific evidence, if less than 33% of the studies indicate a significant association between the variables or none of the studies considered at low risk of bias find a significant association; (b) uncertain evidence, if 34 to 59% of the studies indicate a significant association between the variables; (c) positive (or negative) evidence, if 60 to 100% of the studies indicate a significant association between variables; (d) strong evidence, if 60 to 100% of the studies indicate a significant association between variables (in the same direction), there are no studies classified as uncertain association and more than 59% of the studies are considered to be at low risk of bias (score ≥ 5).

RESULTS

The flow chart shows the selection process (Figure 1). In summary, of the 2,462 references initially identified, we evaluated 1,336 by titles and abstracts. Of these, we referred 36 for screening by full reading of the texts and excluded 14 because they did not show SB indicators (n = 12) or did not include the age group that was the target of our study (n = 2). Finally, we included 22 studies in the systematic review¹²12. Adank AM, Van Kann DHH, Hoeboer JJAA, Vries SI, Kremer SPJ, Vos SB. Investigating motor competence in association with sedentary behavior and physical activity in 7- to 11-year-old children. Int J Environ Res Public Health. 2018;15(11):2470. https://doi.org/10.3390/ijerph15112470
https://doi.org/10.3390/ijerph15112470... ,¹⁷17. Webster EK, Martin CK, Staiano AE. Fundamental motor skills, screen-time, and physical activity in preschoolers. J Sport Health Sci. 2019;8(2):114-21. https://doi.org/10.1016/j.jshs.2018.11.006
https://doi.org/10.1016/j.jshs.2018.11.0... ,³⁰30. Drenowatz C, Greier K. Cross-sectional and longitudinal association of sports participation, media consumption and motor competence in youth. Scand J Med Sci Sports. 2019;29(6):854-61. https://doi.org/10.1111/sms.13400
https://doi.org/10.1111/sms.13400... ,³²32. 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
https://doi.org/10.1123/pes.21.4.436... ,³³33. Lopes L, Santos R, Pereira B, Lopes VP. Associations between sedentary behavior and motor coordination in children. Am J Hum Biol. 2012;24(6):746-52. https://doi.org/10.1002/ajhb.22310
https://doi.org/10.1002/ajhb.22310... ,³⁷37. Wrotniak BH, Epstein LH, Dorn JM, Jones KE, Kondilis VA. The relationship between motor proficiency and physical activity in children. Pediatrics. 2006;118(6):e1758-65. https://doi.org/10.1542/peds.2006-0742
https://doi.org/10.1542/peds.2006-0742... .

Half of the studies included had a cross-sectional design (n = 11); also, there were nine longitudinal and two experimental studies (Table 1). The samples investigated included people aged 3 to 14 years. The sample size ranged from 17⁴⁹49. Lloyd M, Saunders TJ, Bremer E, Tremblay MS. Long-term importance of fundamental motor skills: a 20-year follow-up study. Adapt Phys Act Q. 2014;31(1):67-78. https://doi.org/10.1123/apaq.2013-0048
https://doi.org/10.1123/apaq.2013-0048... to 10,831⁵²52. Smith L, Fisher A, Hamer M. Prospective association between objective measures of childhood motor coordination and sedentary behaviour in adolescence and adulthood. Int J Behav Nutr Phys Act. 2015;12:75. https://doi.org/10.1186/s12966-015-0236-y
https://doi.org/10.1186/s12966-015-0236-... participants. Most of the studies were conducted in North American countries (n = 9)¹⁷17. Webster EK, Martin CK, Staiano AE. Fundamental motor skills, screen-time, and physical activity in preschoolers. J Sport Health Sci. 2019;8(2):114-21. https://doi.org/10.1016/j.jshs.2018.11.006
https://doi.org/10.1016/j.jshs.2018.11.0... ,³³33. Lopes L, Santos R, Pereira B, Lopes VP. Associations between sedentary behavior and motor coordination in children. Am J Hum Biol. 2012;24(6):746-52. https://doi.org/10.1002/ajhb.22310
https://doi.org/10.1002/ajhb.22310... ,³⁷37. Wrotniak BH, Epstein LH, Dorn JM, Jones KE, Kondilis VA. The relationship between motor proficiency and physical activity in children. Pediatrics. 2006;118(6):e1758-65. https://doi.org/10.1542/peds.2006-0742
https://doi.org/10.1542/peds.2006-0742... ,³⁸38. Burns RD, Kim Y, Byun W, Brusseau TA. Associations of school day sedentary behavior and physical activity with gross motor skills: use of compositional data analysis. J Phys Act Health. 2019;16(10):811-17. https://doi.org/10.1123/jpah.2018-0549
https://doi.org/10.1123/jpah.2018-0549... ,⁴⁰40. Cadoret G, Bigras N, Lemay L, Lehrer J, Lemire J. Relationship between screen-time and motor proficiency in children: a longitudinal study. Early Child Dev Care. 2018;188(2):231-9. https://doi.org/10.1080/03004430.2016.1211123
https://doi.org/10.1080/03004430.2016.12... ,⁴³43. Gu X. Fundamental motor skill, physical activity, and sedentary behaviour in socioeconomically disadvantaged kindergarteners. Psychol Health Med. 2016;21(7):871-81. https://doi.org/10.1080/13548506.2015.1125007
https://doi.org/10.1080/13548506.2015.11... .

Regarding the measures, fourteen studies used product measures, such as Bruininks-Oseretsky Test of Motor Proficiency Second Edition (BOT-2), Körperkoordinationstest für Kinder (KTK) and Movement Assessment Battery for Children Second Edition (MABC-2); to evaluate the MC, seven used process measures such as Test of Gross Motor Development (TGMD) - and only one study¹⁷17. Webster EK, Martin CK, Staiano AE. Fundamental motor skills, screen-time, and physical activity in preschoolers. J Sport Health Sci. 2019;8(2):114-21. https://doi.org/10.1016/j.jshs.2018.11.006
https://doi.org/10.1016/j.jshs.2018.11.0... used both types. The TGMD (first, second or third version) was the most used motor test (n = 8)¹⁷17. Webster EK, Martin CK, Staiano AE. Fundamental motor skills, screen-time, and physical activity in preschoolers. J Sport Health Sci. 2019;8(2):114-21. https://doi.org/10.1016/j.jshs.2018.11.006
https://doi.org/10.1016/j.jshs.2018.11.0... ,³⁸38. Burns RD, Kim Y, Byun W, Brusseau TA. Associations of school day sedentary behavior and physical activity with gross motor skills: use of compositional data analysis. J Phys Act Health. 2019;16(10):811-17. https://doi.org/10.1123/jpah.2018-0549
https://doi.org/10.1123/jpah.2018-0549... . Three studies used the PE Metrics⁴³43. Gu X. Fundamental motor skill, physical activity, and sedentary behaviour in socioeconomically disadvantaged kindergarteners. Psychol Health Med. 2016;21(7):871-81. https://doi.org/10.1080/13548506.2015.1125007
https://doi.org/10.1080/13548506.2015.11... , three studies used the BOT-2³⁷37. Wrotniak BH, Epstein LH, Dorn JM, Jones KE, Kondilis VA. The relationship between motor proficiency and physical activity in children. Pediatrics. 2006;118(6):e1758-65. https://doi.org/10.1542/peds.2006-0742
https://doi.org/10.1542/peds.2006-0742... ,⁴⁰40. Cadoret G, Bigras N, Lemay L, Lehrer J, Lemire J. Relationship between screen-time and motor proficiency in children: a longitudinal study. Early Child Dev Care. 2018;188(2):231-9. https://doi.org/10.1080/03004430.2016.1211123
https://doi.org/10.1080/03004430.2016.12... ,⁵¹51. Matarma T, Tammelin T, Kulmala J, Koski P, Hurme S, Lagström H. Factors associated with objectively measured physical activity and sedentary time of 5–6 year old children in the STEPS Study. Early Child Dev Care. 2017;187(12):1863-73. https://doi.org/10.1080/03004430.2016.1193016
https://doi.org/10.1080/03004430.2016.11... , two studies used the KTK³³33. Lopes L, Santos R, Pereira B, Lopes VP. Associations between sedentary behavior and motor coordination in children. Am J Hum Biol. 2012;24(6):746-52. https://doi.org/10.1002/ajhb.22310
https://doi.org/10.1002/ajhb.22310... ,⁴⁸48. Laukkanen A, Pesola A, Havu M, Sääkslahti A, Finni T. Relationship between habitual physical activity and gross motor skills is multifaceted in 5- to 8-year-old children. Scand J Med Sci Sports. 2014;24(2):e102-10. https://doi.org/10.1111/sms.12116
https://doi.org/10.1111/sms.12116... and two studies used the MABC-2¹⁷17. Webster EK, Martin CK, Staiano AE. Fundamental motor skills, screen-time, and physical activity in preschoolers. J Sport Health Sci. 2019;8(2):114-21. https://doi.org/10.1016/j.jshs.2018.11.006
https://doi.org/10.1016/j.jshs.2018.11.0... ,⁵⁰50. Lopes V, Barnett L, Rodrigues L. Is there an association among actual motor competence, perceived motor competence, physical activity, and sedentary behavior in preschool children? J Mot Learn Dev. 2016;4(2):129-41. https://doi.org/10.1123/jmld.2015-0012
https://doi.org/10.1123/jmld.2015-0012... . Only one study used the Athletic Skills Track¹²12. Adank AM, Van Kann DHH, Hoeboer JJAA, Vries SI, Kremer SPJ, Vos SB. Investigating motor competence in association with sedentary behavior and physical activity in 7- to 11-year-old children. Int J Environ Res Public Health. 2018;15(11):2470. https://doi.org/10.3390/ijerph15112470
https://doi.org/10.3390/ijerph15112470... test and another used the Deutsche Motorik Test³⁰30. Drenowatz C, Greier K. Cross-sectional and longitudinal association of sports participation, media consumption and motor competence in youth. Scand J Med Sci Sports. 2019;29(6):854-61. https://doi.org/10.1111/sms.13400
https://doi.org/10.1111/sms.13400... . Three studies used specific motor tasks (e.g. walking backwards, balancing, throwing and grasping)⁴⁶46. Jaakkola T, Kalaja S, Liukkonen J, Jutila A, Virtanen P, Watt A. Relations among physical activity patterns, lifestyle activities, and fundamental movement skills for Finnish students in grade 7. Percept Mot Skills. 2009;108(1):97-111. https://doi.org/10.2466/pms.108.1.97-111
https://doi.org/10.2466/pms.108.1.97-111... ,⁴⁷47. Jaakkola T, Hakonen H, Kankaanpää A, Joensuu L, Kulmala J, Kallio J, et al. Longitudinal associations of fundamental movement skills with objectively measured physical activity and sedentariness during school transition from primary to lower secondary school. J Sci Med Sport. 2019;22(1):85-90. https://doi.org/10.1016/j.jsams.2018.07.012
https://doi.org/10.1016/j.jsams.2018.07.... ,⁵²52. Smith L, Fisher A, Hamer M. Prospective association between objective measures of childhood motor coordination and sedentary behaviour in adolescence and adulthood. Int J Behav Nutr Phys Act. 2015;12:75. https://doi.org/10.1186/s12966-015-0236-y
https://doi.org/10.1186/s12966-015-0236-... . Regarding SB measurement, sixteen studies used accelerometer as a direct measure and six studies used questionnaires. Regarding the questionnaires, five studies used them to evaluate recreational screen time and only one study used them to evaluate sitting time (Table 2).

As for the risk of bias, 18.2% (n = 4) of the studies obtained a low-risk score (≥ 5), 77.3% (n = 17) obtained a medium risk score, and only one study obtained a high risk score. All studies met the criteria: (a) “Does the study describe the eligibility/selection criteria of participants?“ and (d) “Does the study mention sources and details of the SB assessment?”. Finally, the most absent quality items were: (b) “Were participants randomly selected?” and (e) Did the study report sample sizing and was it properly sized to detect hypothetical relationships?” (Figure 2).

Of the total studies investigated (n = 22), thirteen indicated negative associations between SB and MC, six did not indicate association and three indicated uncertain associations.

In the stratum of studies evaluated with low risk of bias (n = 4), a negative association was found in three studies, highlighting as main results: SB and high MC in schoolchildren¹²12. Adank AM, Van Kann DHH, Hoeboer JJAA, Vries SI, Kremer SPJ, Vos SB. Investigating motor competence in association with sedentary behavior and physical activity in 7- to 11-year-old children. Int J Environ Res Public Health. 2018;15(11):2470. https://doi.org/10.3390/ijerph15112470
https://doi.org/10.3390/ijerph15112470... ; SB and MC in preschoolers⁴⁴44. Gu X, Keller MJ, Weiller-Abels KH, Zhang T. The roles of physical activity and sedentary behavior on Hispanic children’s mental health: a motor skill perspective. Qual Life Res. 2018;27(7):185-93. https://doi.org/10.1007/s11136-017-1687-1
https://doi.org/10.1007/s11136-017-1687-... ; MC in childhood and sitting time after 20 years⁴⁹49. Lloyd M, Saunders TJ, Bremer E, Tremblay MS. Long-term importance of fundamental motor skills: a 20-year follow-up study. Adapt Phys Act Q. 2014;31(1):67-78. https://doi.org/10.1123/apaq.2013-0048
https://doi.org/10.1123/apaq.2013-0048... . Studies with moderate risk of bias also showed negative association results³⁰30. Drenowatz C, Greier K. Cross-sectional and longitudinal association of sports participation, media consumption and motor competence in youth. Scand J Med Sci Sports. 2019;29(6):854-61. https://doi.org/10.1111/sms.13400
https://doi.org/10.1111/sms.13400... ,³³33. Lopes L, Santos R, Pereira B, Lopes VP. Associations between sedentary behavior and motor coordination in children. Am J Hum Biol. 2012;24(6):746-52. https://doi.org/10.1002/ajhb.22310
https://doi.org/10.1002/ajhb.22310... ,³⁷37. Wrotniak BH, Epstein LH, Dorn JM, Jones KE, Kondilis VA. The relationship between motor proficiency and physical activity in children. Pediatrics. 2006;118(6):e1758-65. https://doi.org/10.1542/peds.2006-0742
https://doi.org/10.1542/peds.2006-0742... ,⁴⁰40. Cadoret G, Bigras N, Lemay L, Lehrer J, Lemire J. Relationship between screen-time and motor proficiency in children: a longitudinal study. Early Child Dev Care. 2018;188(2):231-9. https://doi.org/10.1080/03004430.2016.1211123
https://doi.org/10.1080/03004430.2016.12... ,⁴¹41. Capio CM, Sit CHP, Eguia KF, Abernethy B, Masters RSW. Fundamental movement skills training to promote physical activity in children with and without disability: a pilot study. J Sport Health Sci. 2015;4(3):235-43. https://doi.org/10.1016/j.jshs.2014.08.001
https://doi.org/10.1016/j.jshs.2014.08.0... ,⁴³43. Gu X. Fundamental motor skill, physical activity, and sedentary behaviour in socioeconomically disadvantaged kindergarteners. Psychol Health Med. 2016;21(7):871-81. https://doi.org/10.1080/13548506.2015.1125007
https://doi.org/10.1080/13548506.2015.11... ,⁴⁵45. Gu X, Chen S, Zhang X. Young Hispanic and non-Hispanic children’s fundamental motor competence and physical activity behaviors. J Mot Learn Dev. 2019;7(2):180-93. https://doi.org/10.1123/jmld.2018-0003
https://doi.org/10.1123/jmld.2018-0003... ,⁴⁶46. Jaakkola T, Kalaja S, Liukkonen J, Jutila A, Virtanen P, Watt A. Relations among physical activity patterns, lifestyle activities, and fundamental movement skills for Finnish students in grade 7. Percept Mot Skills. 2009;108(1):97-111. https://doi.org/10.2466/pms.108.1.97-111
https://doi.org/10.2466/pms.108.1.97-111... ,⁵²52. Smith L, Fisher A, Hamer M. Prospective association between objective measures of childhood motor coordination and sedentary behaviour in adolescence and adulthood. Int J Behav Nutr Phys Act. 2015;12:75. https://doi.org/10.1186/s12966-015-0236-y
https://doi.org/10.1186/s12966-015-0236-... ,⁵³53. Tsuda E, Goodway JD, Famelia R, Brian A. Relationship between fundamental motor skill competence, perceived physical competence and free-play physical activity in children. Res Q Exerc Sport. 2020;91(1):55-63. https://doi.org/10.1080/02701367.2019.1646851
https://doi.org/10.1080/02701367.2019.16... .

Considering experimental studies (n = 2) of medium risk of bias, a study⁴¹41. Capio CM, Sit CHP, Eguia KF, Abernethy B, Masters RSW. Fundamental movement skills training to promote physical activity in children with and without disability: a pilot study. J Sport Health Sci. 2015;4(3):235-43. https://doi.org/10.1016/j.jshs.2014.08.001
https://doi.org/10.1016/j.jshs.2014.08.0... found a negative association between SB and MC in the ability to move and control objects, but the other⁴⁸48. Laukkanen A, Pesola A, Havu M, Sääkslahti A, Finni T. Relationship between habitual physical activity and gross motor skills is multifaceted in 5- to 8-year-old children. Scand J Med Sci Sports. 2014;24(2):e102-10. https://doi.org/10.1111/sms.12116
https://doi.org/10.1111/sms.12116... found uncertain association. Considering the longitudinal studies (n = 9), two studies with low risk of bias found a negative association between SB and MC⁴⁴44. Gu X, Keller MJ, Weiller-Abels KH, Zhang T. The roles of physical activity and sedentary behavior on Hispanic children’s mental health: a motor skill perspective. Qual Life Res. 2018;27(7):185-93. https://doi.org/10.1007/s11136-017-1687-1
https://doi.org/10.1007/s11136-017-1687-... ,⁴⁹49. Lloyd M, Saunders TJ, Bremer E, Tremblay MS. Long-term importance of fundamental motor skills: a 20-year follow-up study. Adapt Phys Act Q. 2014;31(1):67-78. https://doi.org/10.1123/apaq.2013-0048
https://doi.org/10.1123/apaq.2013-0048... , and five other studies with medium risk of bias³⁰30. Drenowatz C, Greier K. Cross-sectional and longitudinal association of sports participation, media consumption and motor competence in youth. Scand J Med Sci Sports. 2019;29(6):854-61. https://doi.org/10.1111/sms.13400
https://doi.org/10.1111/sms.13400... ,⁴⁰40. Cadoret G, Bigras N, Lemay L, Lehrer J, Lemire J. Relationship between screen-time and motor proficiency in children: a longitudinal study. Early Child Dev Care. 2018;188(2):231-9. https://doi.org/10.1080/03004430.2016.1211123
https://doi.org/10.1080/03004430.2016.12... ,⁴³43. Gu X. Fundamental motor skill, physical activity, and sedentary behaviour in socioeconomically disadvantaged kindergarteners. Psychol Health Med. 2016;21(7):871-81. https://doi.org/10.1080/13548506.2015.1125007
https://doi.org/10.1080/13548506.2015.11... ,⁴⁵45. Gu X, Chen S, Zhang X. Young Hispanic and non-Hispanic children’s fundamental motor competence and physical activity behaviors. J Mot Learn Dev. 2019;7(2):180-93. https://doi.org/10.1123/jmld.2018-0003
https://doi.org/10.1123/jmld.2018-0003... ,⁵²52. Smith L, Fisher A, Hamer M. Prospective association between objective measures of childhood motor coordination and sedentary behaviour in adolescence and adulthood. Int J Behav Nutr Phys Act. 2015;12:75. https://doi.org/10.1186/s12966-015-0236-y
https://doi.org/10.1186/s12966-015-0236-... also found a negative association between SB and MC. In contrast, a study of high risk of bias⁵¹51. Matarma T, Tammelin T, Kulmala J, Koski P, Hurme S, Lagström H. Factors associated with objectively measured physical activity and sedentary time of 5–6 year old children in the STEPS Study. Early Child Dev Care. 2017;187(12):1863-73. https://doi.org/10.1080/03004430.2016.1193016
https://doi.org/10.1080/03004430.2016.11... found no association and a study of moderate risk of bias⁴⁷47. Jaakkola T, Hakonen H, Kankaanpää A, Joensuu L, Kulmala J, Kallio J, et al. Longitudinal associations of fundamental movement skills with objectively measured physical activity and sedentariness during school transition from primary to lower secondary school. J Sci Med Sport. 2019;22(1):85-90. https://doi.org/10.1016/j.jsams.2018.07.012
https://doi.org/10.1016/j.jsams.2018.07.... found uncertain association. Considering the cross-sectional studies (n = 11) a study of low risk of bias found a negative association between SB and MC¹²12. Adank AM, Van Kann DHH, Hoeboer JJAA, Vries SI, Kremer SPJ, Vos SB. Investigating motor competence in association with sedentary behavior and physical activity in 7- to 11-year-old children. Int J Environ Res Public Health. 2018;15(11):2470. https://doi.org/10.3390/ijerph15112470
https://doi.org/10.3390/ijerph15112470... and four studies of medium risk of bias³³33. Lopes L, Santos R, Pereira B, Lopes VP. Associations between sedentary behavior and motor coordination in children. Am J Hum Biol. 2012;24(6):746-52. https://doi.org/10.1002/ajhb.22310
https://doi.org/10.1002/ajhb.22310... ,³⁷37. Wrotniak BH, Epstein LH, Dorn JM, Jones KE, Kondilis VA. The relationship between motor proficiency and physical activity in children. Pediatrics. 2006;118(6):e1758-65. https://doi.org/10.1542/peds.2006-0742
https://doi.org/10.1542/peds.2006-0742... ,⁴⁶46. Jaakkola T, Kalaja S, Liukkonen J, Jutila A, Virtanen P, Watt A. Relations among physical activity patterns, lifestyle activities, and fundamental movement skills for Finnish students in grade 7. Percept Mot Skills. 2009;108(1):97-111. https://doi.org/10.2466/pms.108.1.97-111
https://doi.org/10.2466/pms.108.1.97-111... ,⁵³53. Tsuda E, Goodway JD, Famelia R, Brian A. Relationship between fundamental motor skill competence, perceived physical competence and free-play physical activity in children. Res Q Exerc Sport. 2020;91(1):55-63. https://doi.org/10.1080/02701367.2019.1646851
https://doi.org/10.1080/02701367.2019.16... found a negative association between SB and MC. In contrast, a study of low risk of bias³⁹39. Barnett LM, Hinkley T, Okely AD, Hesketh K, Salmon J. Use of electronic games by young children and fundamental movement skills? Percept Mot Skills. 2012;114(3):1023-34. https://doi.org/10.2466/10.13.PMS.114.3.1023-1034
https://doi.org/10.2466/10.13.PMS.114.3.... and four studies of medium risk of bias¹⁷17. Webster EK, Martin CK, Staiano AE. Fundamental motor skills, screen-time, and physical activity in preschoolers. J Sport Health Sci. 2019;8(2):114-21. https://doi.org/10.1016/j.jshs.2018.11.006
https://doi.org/10.1016/j.jshs.2018.11.0... ,³²32. 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
https://doi.org/10.1123/pes.21.4.436... ,³⁸38. Burns RD, Kim Y, Byun W, Brusseau TA. Associations of school day sedentary behavior and physical activity with gross motor skills: use of compositional data analysis. J Phys Act Health. 2019;16(10):811-17. https://doi.org/10.1123/jpah.2018-0549
https://doi.org/10.1123/jpah.2018-0549... ,⁵⁰50. Lopes V, Barnett L, Rodrigues L. Is there an association among actual motor competence, perceived motor competence, physical activity, and sedentary behavior in preschool children? J Mot Learn Dev. 2016;4(2):129-41. https://doi.org/10.1123/jmld.2015-0012
https://doi.org/10.1123/jmld.2015-0012... found no association, and a study of medium risk of bias⁴²42. Famelia R, Tsuda E, Bakhtiar S, Goodway JD. Relationships among perceived and actual motor skill competence and physical activity in Indonesian preschoolers. J Mot Learn Dev. 2018;6 Suppl 2:S403-23. https://doi.org/10.1123/jmld.2016-0072
https://doi.org/10.1123/jmld.2016-0072... found uncertain association.

Analyzing the age group of preschoolers (n = 11), two studies of low risk of bias⁴⁴44. Gu X, Keller MJ, Weiller-Abels KH, Zhang T. The roles of physical activity and sedentary behavior on Hispanic children’s mental health: a motor skill perspective. Qual Life Res. 2018;27(7):185-93. https://doi.org/10.1007/s11136-017-1687-1
https://doi.org/10.1007/s11136-017-1687-... ,⁴⁹49. Lloyd M, Saunders TJ, Bremer E, Tremblay MS. Long-term importance of fundamental motor skills: a 20-year follow-up study. Adapt Phys Act Q. 2014;31(1):67-78. https://doi.org/10.1123/apaq.2013-0048
https://doi.org/10.1123/apaq.2013-0048... and three studies of medium risk of bias⁴⁰40. Cadoret G, Bigras N, Lemay L, Lehrer J, Lemire J. Relationship between screen-time and motor proficiency in children: a longitudinal study. Early Child Dev Care. 2018;188(2):231-9. https://doi.org/10.1080/03004430.2016.1211123
https://doi.org/10.1080/03004430.2016.12... ,⁴³43. Gu X. Fundamental motor skill, physical activity, and sedentary behaviour in socioeconomically disadvantaged kindergarteners. Psychol Health Med. 2016;21(7):871-81. https://doi.org/10.1080/13548506.2015.1125007
https://doi.org/10.1080/13548506.2015.11... ,⁵³53. Tsuda E, Goodway JD, Famelia R, Brian A. Relationship between fundamental motor skill competence, perceived physical competence and free-play physical activity in children. Res Q Exerc Sport. 2020;91(1):55-63. https://doi.org/10.1080/02701367.2019.1646851
https://doi.org/10.1080/02701367.2019.16... found a negative association between SB and MC. In contrast, a study of low risk of bias³⁹39. Barnett LM, Hinkley T, Okely AD, Hesketh K, Salmon J. Use of electronic games by young children and fundamental movement skills? Percept Mot Skills. 2012;114(3):1023-34. https://doi.org/10.2466/10.13.PMS.114.3.1023-1034
https://doi.org/10.2466/10.13.PMS.114.3.... , three studies of medium risk of bias¹⁷17. Webster EK, Martin CK, Staiano AE. Fundamental motor skills, screen-time, and physical activity in preschoolers. J Sport Health Sci. 2019;8(2):114-21. https://doi.org/10.1016/j.jshs.2018.11.006
https://doi.org/10.1016/j.jshs.2018.11.0... ,³²32. 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
https://doi.org/10.1123/pes.21.4.436... ,⁵⁰50. Lopes V, Barnett L, Rodrigues L. Is there an association among actual motor competence, perceived motor competence, physical activity, and sedentary behavior in preschool children? J Mot Learn Dev. 2016;4(2):129-41. https://doi.org/10.1123/jmld.2015-0012
https://doi.org/10.1123/jmld.2015-0012... and one study of high risk of bias⁵¹51. Matarma T, Tammelin T, Kulmala J, Koski P, Hurme S, Lagström H. Factors associated with objectively measured physical activity and sedentary time of 5–6 year old children in the STEPS Study. Early Child Dev Care. 2017;187(12):1863-73. https://doi.org/10.1080/03004430.2016.1193016
https://doi.org/10.1080/03004430.2016.11... found no association, while one study found uncertain association⁴²42. Famelia R, Tsuda E, Bakhtiar S, Goodway JD. Relationships among perceived and actual motor skill competence and physical activity in Indonesian preschoolers. J Mot Learn Dev. 2018;6 Suppl 2:S403-23. https://doi.org/10.1123/jmld.2016-0072
https://doi.org/10.1123/jmld.2016-0072... . Therefore, according to the established criteria, the results show uncertain evidence of association between SB and MC in this age group. Considering the age group of elementary school (n = 11), a study of low risk of bias¹²12. Adank AM, Van Kann DHH, Hoeboer JJAA, Vries SI, Kremer SPJ, Vos SB. Investigating motor competence in association with sedentary behavior and physical activity in 7- to 11-year-old children. Int J Environ Res Public Health. 2018;15(11):2470. https://doi.org/10.3390/ijerph15112470
https://doi.org/10.3390/ijerph15112470... and seven studies³⁰30. Drenowatz C, Greier K. Cross-sectional and longitudinal association of sports participation, media consumption and motor competence in youth. Scand J Med Sci Sports. 2019;29(6):854-61. https://doi.org/10.1111/sms.13400
https://doi.org/10.1111/sms.13400... ,³³33. Lopes L, Santos R, Pereira B, Lopes VP. Associations between sedentary behavior and motor coordination in children. Am J Hum Biol. 2012;24(6):746-52. https://doi.org/10.1002/ajhb.22310
https://doi.org/10.1002/ajhb.22310... ,³⁷37. Wrotniak BH, Epstein LH, Dorn JM, Jones KE, Kondilis VA. The relationship between motor proficiency and physical activity in children. Pediatrics. 2006;118(6):e1758-65. https://doi.org/10.1542/peds.2006-0742
https://doi.org/10.1542/peds.2006-0742... ,⁴¹41. Capio CM, Sit CHP, Eguia KF, Abernethy B, Masters RSW. Fundamental movement skills training to promote physical activity in children with and without disability: a pilot study. J Sport Health Sci. 2015;4(3):235-43. https://doi.org/10.1016/j.jshs.2014.08.001
https://doi.org/10.1016/j.jshs.2014.08.0... ,⁴⁵45. Gu X, Chen S, Zhang X. Young Hispanic and non-Hispanic children’s fundamental motor competence and physical activity behaviors. J Mot Learn Dev. 2019;7(2):180-93. https://doi.org/10.1123/jmld.2018-0003
https://doi.org/10.1123/jmld.2018-0003... ,⁴⁶46. Jaakkola T, Kalaja S, Liukkonen J, Jutila A, Virtanen P, Watt A. Relations among physical activity patterns, lifestyle activities, and fundamental movement skills for Finnish students in grade 7. Percept Mot Skills. 2009;108(1):97-111. https://doi.org/10.2466/pms.108.1.97-111
https://doi.org/10.2466/pms.108.1.97-111... ,⁵²52. Smith L, Fisher A, Hamer M. Prospective association between objective measures of childhood motor coordination and sedentary behaviour in adolescence and adulthood. Int J Behav Nutr Phys Act. 2015;12:75. https://doi.org/10.1186/s12966-015-0236-y
https://doi.org/10.1186/s12966-015-0236-... of medium risk of bias found negative association between SB and MC. In contrast, a study of medium risk of bias³⁸38. Burns RD, Kim Y, Byun W, Brusseau TA. Associations of school day sedentary behavior and physical activity with gross motor skills: use of compositional data analysis. J Phys Act Health. 2019;16(10):811-17. https://doi.org/10.1123/jpah.2018-0549
https://doi.org/10.1123/jpah.2018-0549... found no association and two studies found uncertain association. Therefore, the results indicate evidence of a negative association between SB and MC in this age group (Table 3).

In short, considering the result of the associations and the risk of bias, there was scientific evidence for the negative association between SB and MC of children and adolescents in elementary school and uncertain scientific evidence for association in preschool children.

DISCUSSION

This review synthesized the results of studies that evaluated associations between SB and MC in childhood and adolescence. According to the results, there is evidence for negative association between SB and MC in elementary school years. Even though most of the studies examined used a cross-sectional design, making inferences about causality difficult, seven longitudinal studies pointed to negative associations between SB and MC, suggesting that time in SB may impair the development of MC³⁰30. Drenowatz C, Greier K. Cross-sectional and longitudinal association of sports participation, media consumption and motor competence in youth. Scand J Med Sci Sports. 2019;29(6):854-61. https://doi.org/10.1111/sms.13400
https://doi.org/10.1111/sms.13400... ,⁴⁰40. Cadoret G, Bigras N, Lemay L, Lehrer J, Lemire J. Relationship between screen-time and motor proficiency in children: a longitudinal study. Early Child Dev Care. 2018;188(2):231-9. https://doi.org/10.1080/03004430.2016.1211123
https://doi.org/10.1080/03004430.2016.12... ,⁴³43. Gu X. Fundamental motor skill, physical activity, and sedentary behaviour in socioeconomically disadvantaged kindergarteners. Psychol Health Med. 2016;21(7):871-81. https://doi.org/10.1080/13548506.2015.1125007
https://doi.org/10.1080/13548506.2015.11... .

A meta-analysis by Engel et al.⁵⁴54. Engel AC, Broderick CR, Doorn N, Hardy LL, Parmenter BJ. Exploring the relationship between fundamental motor skill interventions and physical activity levels in children: a systematic review and meta-analysis. Sports Med. 2018;48(8):1845-57. https://doi.org/10.1007/s40279-018-0923-3
https://doi.org/10.1007/s40279-018-0923-... suggests that MC and PA levels may increase through interventions in childhood, corroborating the findings of a previous review⁵⁵55. Logan SW, Webster EK, Getchell N, Pfeiffer KA, Robinson LE. Relationship between fundamental motor skill competence and physical activity during childhood and adolescence: a systematic review. Kinesiol Rev. 2015;4(4):416-26. https://doi.org/10.1123/kr.2013-0012
https://doi.org/10.1123/kr.2013-0012... , in which object control skills were strongly associated with PA in boys, and locomotion skills were associated with PA in girls. A recent longitudinal study demonstrated decreased PA and increased SB between 6 and 11 years⁵⁶56. Schwarzfischer P, Gruszfeld D, Stolarczyk A, Ferre N, Escribano J, Rousseaux D, et al. Physical activity and sedentary behavior from 6 to 11 years. Pediatrics. 2019;143(1):e20180994. https://doi.org/10.1542/peds.2018-0994
https://doi.org/10.1542/peds.2018-0994... . A plausible hypothesis, based on the results found in this study and the conceptual model proposed by Stodden et al.²⁴24. Stodden DF, Goodway JD, Langendorfer SJ, Roberton MA, Rudisill ME, Garcia C, et al. A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship. Quest. 2008;60(2):290-306. https://doi.org/10.1080/00336297.2008.10483582
https://doi.org/10.1080/00336297.2008.10... , is that the adequate MC could influence the increase of PA and the decrease of SB. It is possible that children with excess SB have few opportunities for developing MC³⁰30. Drenowatz C, Greier K. Cross-sectional and longitudinal association of sports participation, media consumption and motor competence in youth. Scand J Med Sci Sports. 2019;29(6):854-61. https://doi.org/10.1111/sms.13400
https://doi.org/10.1111/sms.13400... , further increasing the likelihood of adoption of SB (screen activities) in leisure moments¹⁸18. Andrade Neto F, Eto FN, Pereira TSS, Carletti L, Molina MCB. Active and sedentary behaviours in children aged 7 to 10 years old: the urban and rural contexts, Brazil. BMC Public Health. 2014;14:1174. https://doi.org/10.1186/1471-2458-14-1174
https://doi.org/10.1186/1471-2458-14-117... ,²⁹29. Hardy LL, Ding D, Peralta LR, Mihrshahi S, Merom D. Association between sitting, screen time, fitness domains, and fundamental motor skills in children aged 5-16 years: cross-sectional population study. J Phys Act Health. 2018;15(12):933-40. https://doi.org/10.1123/jpah.2017-0620
https://doi.org/10.1123/jpah.2017-0620... and generating a vicious behavioral cycle with unhealthy lifestyle habits associated with the emergence of chronic-degenerative diseases²⁴24. Stodden DF, Goodway JD, Langendorfer SJ, Roberton MA, Rudisill ME, Garcia C, et al. A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship. Quest. 2008;60(2):290-306. https://doi.org/10.1080/00336297.2008.10483582
https://doi.org/10.1080/00336297.2008.10... . Thus, it is important that public health policies consider the reciprocal and dynamic relationship between SB and MC and promote, simultaneously, the improvement of MC and the decrease of SB, particularly leisure time in screen activities during childhood and adolescence.

As for environmental factors, the theoretical model by Hulteen et al.⁵⁷57. Hulteen RM, Morgan PJ, Barnett LM, Stodden DF, Lubans DR. Development of foundational movement skills: A conceptual model for physical activity across the lifespan. Sports Med. 2018;48(7):1533-40. https://doi.org/10.1007/s40279-018-0892-6
https://doi.org/10.1007/s40279-018-0892-... suggests that motor skills vary in importance and popularity according to the cultural and geographical context, with an important role for the maintenance of PA throughout life. Considering the role of physical activity as a form of intervention to decrease SB and contribute to the development of MC, it is possible to suggest that the higher the MC in different abilities (for example, kicking, throwing, bouncing and jumping), the greater the range of possibilities of PA practice that could replace SB. The development of MC in skills that predominate in the cultural and geographical context in question can be an effective strategy to replace SB with a PA that the child or adolescent has the competence to perform. Reinforcing this perspective, data from a Finnish study⁴¹41. Capio CM, Sit CHP, Eguia KF, Abernethy B, Masters RSW. Fundamental movement skills training to promote physical activity in children with and without disability: a pilot study. J Sport Health Sci. 2015;4(3):235-43. https://doi.org/10.1016/j.jshs.2014.08.001
https://doi.org/10.1016/j.jshs.2014.08.0... point out a negative association between kicking skills and SB, being soccer one of the predominant youth sports in the country⁵⁸58. Kokko S, Kannas L, Villberg J. Health promotion profile of youth sports clubs in Finland: club officials’ and coaches’ perceptions. Health Promot Int. 2009;24(1):26-35. https://doi.org/10.1093/heapro/dan040
https://doi.org/10.1093/heapro/dan040... .

Data from this review reinforce the importance of integrated public education and health policies focused simultaneously on improving MC and decreasing SB, particularly screen time at leisure. Interventions in children who spend excessive time in SB should include the development of MC continuously, that is, they should consider the quality of the practice of PA, not only the amount of time spent in this practice⁵⁹59. Ribeiro EHC, Guerra PH, Oliveira AC, Silva KS, Santos P, Santos R, et al. Latin American interventions in children and adolescents’ sedentary behavior: a systematic review. Rev Saude Publica. 2020;54:59. https://doi.org/10.11606/s1518-8787.2020054001977
https://doi.org/10.11606/s1518-8787.2020... ,⁶⁰60. Ré AHN, Okely AD, Logan SW, Silva MMLM, Cattuzzo MT, Stodden DF. Relationship between meeting physical activity guidelines and motor competence among low-income school youth. J Sci Med Sport. 2020;23(6):591-5. https://doi.org/10.1016/j.jsams.2019.12.014
https://doi.org/10.1016/j.jsams.2019.12.... . Improvement of MC may be a promising strategy to reduce SB and increase moderate to vigorous PA, especially for children with low MC¹²12. Adank AM, Van Kann DHH, Hoeboer JJAA, Vries SI, Kremer SPJ, Vos SB. Investigating motor competence in association with sedentary behavior and physical activity in 7- to 11-year-old children. Int J Environ Res Public Health. 2018;15(11):2470. https://doi.org/10.3390/ijerph15112470
https://doi.org/10.3390/ijerph15112470... . Longitudinal evaluations should strengthen future research to provide a better understanding of causality between SB and MC.

In addition, there is a wide scope to be explored, considering environmental factors, gender and assessment methods, as well as the gap in the transition between age groups (children, adolescents, young adults and older adults). It is plausible that the causal direction between the variables is influenced by the age group. We suggest that future studies use two or more motor tests²²22. Ré AHN, Logan SW, Cattuzzo MT, Henrique RS, Tudela MC, Stodden DF. Comparison of motor competence levels on two assessments across childhood. J Sports Sci. 2018;36(1):1-6. https://doi.org/10.1080/02640414.2016.1276294
https://doi.org/10.1080/02640414.2016.12... ,⁶¹61. Logan SW, Barnett LM, Goodway JD, Stodden DF. Comparison of performance on process- and product-oriented assessments of fundamental motor skills across childhood. J Sports Sci. 2017;35(7):634-41. https://doi.org/10.1080/02640414.2016.1183803
https://doi.org/10.1080/02640414.2016.11... and the use of the accelerometer in conjunction with the questionnaire for a better understanding of SB and environmental factors. We also suggest randomized selection of participants and description of the statistical power of the study. Finally, it is also important to highlight that the results found are limited to adolescents up to 14 years, providing a wide field of research among adolescents and young adults in this topic.

This study contains some limitations. Although the search was comprehensive, we could only include studies in the English language. The bias related to the selective reporting of associations in the studies may be a possibility, and adjustments in the associations between SB and MC were not considered as a function of the practice of PA. In addition, limitations in the evidence base influenced the results of this review. The practice of moderate to vigorous PA (MVPA) may partially offset the negative effects of SB³¹31. Cliff DP, Hesketh KD, Vella SA, Hinkley T, Tsiros MD, Ridgers ND, et al. Objectively measured sedentary behaviour and health and development in children and adolescents: systematic review and meta-analysis. Obes Rev. 2016;17(4):330-44. https://doi.org/10.1111/obr.12371
https://doi.org/10.1111/obr.12371... ,⁶²62. Ekelund U, Steene-Johannessen J, Brown WJ, Fagerland MW, Owen N, Powell KE, et al. Does physical activity attenuate, or even eliminate, the detrimental association of sitting time with mortality? A harmonised meta- analysis of data from more than 1 million men and women. Lancet. 2016;388(10051):1302-10. https://doi.org/10.1016/S0140-6736(16)30370-1
https://doi.org/10.1016/S0140-6736(16)30... , being independent behaviors, i.e. high levels of SB do not necessarily imply low levels of MVPA and vice versa; people who meet the recommendations of MVPA (≥ 1h daily) may still have SB at many hours of the day⁶³63. Verloigne M, Van Lippevelde W, Maes L, Yildirim M, Chinapaw M, Manios Y, et al. Levels of physical activity and sedentary time among 10- to 12-year-old boys and girls across 5 European countries using accelerometers: an observational study within the ENERGY-project. Int J Behav Nutr Phys Act. 2012;9:34. https://doi.org/10.1186/1479-5868-9-34
https://doi.org/10.1186/1479-5868-9-34... . In reality, to date, SB recommendations are restricted to screen time¹1. 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/10.1186/1479-5868-8-98... ,¹⁵15. World Health Organization. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. Geneva (CH): WHO; 2019.,⁶⁴64. Okely AD, Gersi D, Hesketh KD, Santos R, Loughran SP, Cliff DP, et al. A collaborative approach to adopting/adapting guidelines -The Australian 24-Hour Movement Guidelines for the early years (Birth to 5 years): an integration of physical activity, sedentary behavior, and sleep. BMC Public Health. 2017;17:869. https://doi.org/10.1186/s12889-017-4867-6
https://doi.org/10.1186/s12889-017-4867-... . From a mathematical point of view, if the recommendation of at least three hours a day of PA at any intensity (including 1h of MVPA) is applied¹1. 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/10.1186/1479-5868-8-98... ,¹⁵15. World Health Organization. Guidelines on physical activity, sedentary behaviour and sleep for children under 5 years of age. Geneva (CH): WHO; 2019., and considering a period of 12 hours of wakefulness, the time limit of SB would be 9 hours daily. Therefore, a greater understanding of the context in which SB manifests itself and its association with the overall development of the child or adolescent is necessary.

Another limitation is the heterogeneity in the forms used to evaluate SB⁶⁵65. Strain T, Milton K, Dall P, Standage M, Mutrie N. How are we measuring physical activity and sedentary behaviour in the four home nations of the UK? A narrative review of current surveillance measures and future directions. Br J Sports Med. 2019;54(21):1269-76. https://doi.org/10.1136/bjsports-2018-100355
https://doi.org/10.1136/bjsports-2018-10... (questionnaires with information about total screen time or only TV/computer time or sitting time and direct accelerometry measurements), making it impossible to differentiate SB in screen/leisure activities and SB in other domains, such as sitting time in displacement or studies. The use of different motor tests to measure MC is also an important limitation. In total, at least 10 different MC evaluations were used. In literature, measures oriented to the process or product of movement can evaluate MC, and this can influence the magnitude of the associations²²22. Ré AHN, Logan SW, Cattuzzo MT, Henrique RS, Tudela MC, Stodden DF. Comparison of motor competence levels on two assessments across childhood. J Sports Sci. 2018;36(1):1-6. https://doi.org/10.1080/02640414.2016.1276294
https://doi.org/10.1080/02640414.2016.12... .

Finally, the results of this systematic review demonstrate that there is evidence of a negative association between SB and MC in children and adolescents in the elementary school period, although the evidence is uncertain in the preschool years. Environmental factors, as well as the method of assessment and age group, can be determinants for a better understanding of the investigated phenomenon. To better understand the associations between SB and MC, we suggest the establishment of standardized criteria for conducting studies, highlighting the context in which SB manifests itself (for example, in leisure situations or school activities). Improving the predominant MC in the sociocultural context in which the person is inserted can contribute to the decrease of SB and promote engagement in an active lifestyle in the long term for children and adolescents.

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