Effectiveness of early care and education center-based interventions for improving cardiovascular fitness in early childhood: A systematic review and meta-analysis

Jacob Szeszulski, Elizabeth Lorenzo, Gabriel Q. Shaibi, Matthew P. Buman, Sonia Vega-López, Steven P. Hooker, Rebecca E. Lee

Research output: Contribution to journalReview article


This systematic review and meta-analysis examined the literature on early care and education center (ECEC)-based physical activity interventions to identify ecologic environmental factors that improve cardiovascular fitness (CVF) in preschool-aged children. Data sources included PubMed, Web of Science, Cochrane Library Trials, CINHAL, Science Direct, PsychINFO and SPORTDiscus. Peer-reviewed publications of studies that met the following criteria were eligible for inclusion: (1) mean age of participants between two and a half and five and a half years old enrolled in a pre-primary school; (2) randomized controlled trials or quasi-experimental interventions with a control group; (3) interventions occurring before, during, or immediately after school; (4) use of an objective measure or field-based estimate of CVF; (5) enrolled apparently healthy children. In June of 2018, titles (n = 1197) were reviewed for inclusion into the study and 74 abstracts/full texts were assessed for eligibility. Ten articles met all eligibility criteria and were included in the final review. A random effects meta-analysis suggested a moderate-to-large effect size for ECEC-based interventions to increase CVF (g = 0.75; 95%CI [0.40–1.11]). Interventions that included three or more ecologic environments (g = 0.79 [0.34–1.25]) were more effective than interventions occurring at the individual level (g = 0.67 [0.12–1.22]). Study quality was moderate, and (mean ± SD) 17.9 ± 4.3 (63.9%) of 28 checklist items were reported. Preliminary evidence suggests that ECEC-based interventions to increase CVF are highly effective at improving preschool children's exercise test scores. Although ECEC-based interventions show promise, the small number of studies included in this review limits confidence in these findings. Review registered at PROSPERO CRD42018099115.

Original languageEnglish (US)
Article number100915
JournalPreventive Medicine Reports
StatePublished - Sep 1 2019



  • Cardiorespiratory fitness
  • Child
  • Physical activity
  • Preschool
  • Social ecology
  • Systematic review

ASJC Scopus subject areas

  • Health Informatics
  • Public Health, Environmental and Occupational Health

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