Table 5.

The relationship between physical activity and fitness

# of studies	Design	Quality assessment					# of participants	Absolute effect	Quality
		Risk of bias	Inconsistency	Indirectness	Imprecision	Other
Mean baseline age ranged from 4.04-4.48 years. One study reported the sample was of preschool age but did not provide a mean or range. Data were collected by longitudinal with 1-year follow-up and cross-sectional study designs. Fitness was assessed as cardiorespiratory fitness (treadmill test, 20-m shuttle run from the PREFIT fitness test battery), muscular fitness including handgrip strength and standing long jump (PREFIT fitness test battery), speed-agility (4 × 10 shuttle run from the PREFIT fitness test battery), and physical working capacity (Ruffier’s test using Ruffier–Dickson index). All outcomes were objectively measured.
1	Longitudinala	Serious risk of biasb	No serious inconsistency	No serious indirectness	No serious imprecision	None	123	TPA was favourably associated with cardiorespiratory fitness [43].	VERY LOWc
2	Cross-sectionald	Serious risk of biase	No serious inconsistency	No serious indirectness	No serious imprecision	Exposure/outcome gradientf	594	Cardiorespiratory fitness TPA was favourably associated with fitness (only for 95th, 90th, 75th but not 50th and 25th percentiles of vector magnitude in 1 study) in 2 studies [55, 117]. LPA was not associated with fitness in 1 study [55]. MPA was not associated with fitness in 1 study [55]. MVPA was favourably associated with fitness in 1 study [55]. VPA was favourably associated with fitness in 1 study [55]. Other fitness measures TPA was favourably associated with muscular fitness and speed-agility (only for 95th, 90th, 75th but not 50th and 25th percentiles of vector magnitude and not for standing long jump at the 75th percentile) in 1 study [55]. LPA was not associated with muscular fitness and speed-agility in 1 study [55]. MPA was not associated with muscular fitness and speed-agility in 1 study [55]. MVPA was favourably associated with muscular fitness (standing long jump but not handgrip strength) and speed-agility in 1 study [55]. VPA was favourably associated with muscular fitness and speed-agility in 1 study [55].	VERY LOWg

LPA: light-intensity physical activity; MPA: moderate-intensity physical activity; MVPA: moderate- to vigorous-intensity physical activity; TPA: total physical activity; VPA: vigorous-intensity physical activity

^aIncludes 1 longitudinal study [43]

^bThe findings that were reported did not adjust for any potential confounders

^cQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias

^dIncludes 2 cross-sectional studies [55, 117]

^eNo potential confounders were adjusted for; a convenience sample was used and it is unclear if the fitness measure is suitable for this age group in 1 study [117]. Potentially inappropriate statistical analysis: other movement behaviours were mutually adjusted for in the fully adjusted models in 1 study [55]

^fA gradient for higher TPA, MVPA, VPA with higher fitness was observed in 1 study [55]

^gQuality of evidence was downgraded from “low” to “very low” because of serious risk of bias; because of this limitation, was not upgraded for an exposure/outcome gradient