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Lifestyle interventions and 24-hour movement behaviors in preschool children: a systematic review and meta-analysis
Yu Wu1,2, Marcin Białas2, Yintao Niu2,3
1Department of Exercise and Health, Guiyang Preschool Education College, Guiyang, Guizhou, China.
Insights
Lifestyle interventions modestly improved physical activity, sleep, and reduced sedentary behavior and screen time in preschoolers. However, evidence certainty is low, requiring cautious interpretation and further research with standardized methods.
Area of Science:
- Pediatric Health
- Behavioral Science
- Public Health Interventions
Background:
- Unhealthy 24-hour movement behaviors (physical inactivity, sedentary time, screen time, inadequate sleep) are prevalent in preschoolers.
- Evidence on the effectiveness of lifestyle interventions targeting these behaviors is limited and inconsistent.
- This study evaluates lifestyle interventions' impact on preschool children's 24-hour movement behaviors.
Purpose of the Study:
- To systematically evaluate the effects of lifestyle interventions on 24-hour movement behaviors in preschool children.
- To synthesize evidence from randomized controlled trials (RCTs) on preschooler movement behaviors.
Main Methods:
- Searched major databases (PubMed, SPORTDiscus, Scopus, Web of Science, CENTRAL) up to December 31, 2025.
- Included RCTs involving children aged 2-6 years targeting movement behavior domains.
- Utilized random-effects meta-analyses, assessed risk of bias (Cochrane RoB 2), and certainty of evidence (GRADE).
Main Results:
- Forty-three trials (13,659 children) showed interventions increased moderate-to-vigorous physical activity and sleep duration.
- Interventions decreased sedentary behavior and screen time, though with substantial heterogeneity (I² > 60% for all).
- Certainty of evidence was low for primary outcomes; risk of bias was high in 9 trials and moderate in 32.
Conclusions:
- Lifestyle interventions show modest, yet uncertain, benefits for preschooler 24-hour movement behaviors.
- Substantial heterogeneity and low certainty of evidence necessitate cautious interpretation.
- Future research requires standardized methods, longer follow-up, and analysis of time reallocation within movement composition.
Background:
Unhealthy 24-h movement behaviors, including insufficient physical activity, excessive sedentary behavior, excessive screen time, and inadequate sleep, are common among preschool children. However, evidence for the effectiveness of lifestyle interventions across these behavioral domains remains limited and inconsistent. This study aimed to evaluate the effects of lifestyle interventions on 24-h movement behaviors in preschool children.
Methods:
PubMed, SPORTDiscus, Scopus, Web of Science Core Collection, and CENTRAL were searched from inception to December 31, 2025. Randomized controlled trials involving children aged 2-6 years that evaluated structured lifestyle interventions targeting movement behavior domains were included. Random-effects meta-analyses were performed to estimate pooled mean differences (MDs) and 95% confidence intervals (CIs). Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool, and certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.
Results:
Forty-three trials from 16 countries were included, comprising 13,659 preschool children. Lifestyle interventions were associated with increases in moderate-to-vigorous physical activity (MD 5.77 min/day, 95% CI 2.27 to 9.28; I2 = 91%) and sleep duration (MD 0.18 h/day, 95% CI 0.01 to 0.35; I2 = 68%), and with reductions in sedentary behavior (MD - 7.62 min/day, 95% CI - 15.08 to -0.17; I2 = 63%) and screen time (MD - 0.33 h/day, 95% CI - 0.53 to -0.13; I2 = 95%). Effects on total physical activity and other intensity-specific physical activity outcomes remained uncertain. The overall risk of bias was rated as low in 2 trials, as having some concerns in 32 trials, and as high in 9 trials. The certainty of evidence was low for the primary outcomes, and small-study effects could not be ruled out for screen time.
Conclusion:
Lifestyle interventions were associated with modest improvements in several 24-h movement behaviors in preschool children. However, heterogeneity was substantial across outcomes, and the certainty of evidence was low. These findings should therefore be interpreted as favorable but uncertain directions of effect rather than precise estimates of intervention efficacy. Future trials should adopt more standardized measurement and reporting methods, include longer follow-up, and examine time reallocation within the 24-h movement composition.
Systematic Review Registration:
https://www.crd.york.ac.uk/PROSPERO/view/CRD420261332463, Identifier CRD420261332463.
