Table 1.

Summaries of Studies Examining Associations between Physical Activity and Weight Status on Adiposity in Children <6 Years of Age

Study (title, citation)	Subjects	Sample Size	Study Design	Physical Activity Exposure	Adiposity Measures	Findings
Berkowitz RI, 1985 (12)	infants at baseline (first 3 days of life); 4–8 years old at follow up	52	Prospective Cohort	Neonatal physical activity measured by an electronic activity monitor inside a mattress	BMI and skinfolds	Neonatal PA was significantly correlated with measures of adiposity in childhood.
DuRant RH, 1993 (13)	3–4 year olds at baseline, 4–5 years old at follow up	123	Prospective Cohort	Physical activity assessed by heart rate monitoring	Waist-to-hip ratio, sum of skinfolds	Mean activity level was negatively correlated with waist/hip ratio. Temporal direction of the association is unclear.
Jago R, 2005 (14)	3–4 year old children at baseline; 6–7 years old at follow up	133	Prospective Cohort	Physical activity assessed by heart rate monitoring and direct observation of sedentary behavior and TV viewing (CARS)	BMI	PA and TV viewing were significant predictors of BMI with both PA (- associated) and TV viewing (+ associated) becoming stronger predictors as the children aged.
Janz KF, 2009 (15)	Ages 5, 8 and 11 years	333	Prospective Cohort	Moderate-to-vigorous physical activity measured by accelerometry	Body fat measured by DXA	MVPA at age 5 years was a predictor of adjusted fat mass at age 8 years and age 11 years, in both sexes.
Klesges RC, 1995 (16)	4 years old at baseline	146	Prospective Cohort	Physical activity (Parent-reported structured, leisure, and aerobic activity)	BMI	Baseline aerobic activity predicted change in BMI over 2 years.
Leppanen MH, 2017 (17)	4 years old at baseline	138	Prospective Cohort	Light-intensity, moderate-intensity, vigorous intensity, and moderate-to-vigorous intensity physical activity & sedentary behavior measured by accelerometry	BMI and Fat Mass Index, Fat-free Mass Index, and %FM (from air-displacement plethysmography)	Higher VPA at the age of 4.5 years was significantly associated with higher BMI and FFMI at 12-month follow-up. Higher baseline MVPA was also associated with higher FFMI at follow-up.
Li R, 1995 (18)	Ages 6, 9, and 12 months	31	Prospective Cohort	Physical activity from 6-hour direct observation (modifyied CARS)	Body fat measured by DXA	The percentage of body fat was inversely related to activity level. This association became stronger with increasing age and remained significant after adjustment for dietary energy intake.
Metcalf BS, 2008 (19)	5 years old at baseline, 6–8 years old at follow up	212	Prospective Cohort	Physical activity measured by accelerometry	BMI, skinfolds and waist circumference	PA above the government-recommended intensity of 3 METs was associated with a progressive improvement in metabolic health but not with a change in BMI or fatness.
Moore LL, 2003 (20)	4 years old at baseline (males and females)	103	Prospective Cohort	Physical Activity by Caltrac accelerometer	BMI, Skinfolds	Higher levels of PA during childhood may lead to less body fat by the time of early adolescence. A protective effect of activity was evident in both sexes.
Moore LL, 1995 (21)	3–5 years old	97	Prospective Cohort	Physical activity by Caltrac acclerometer	BMI, skinfolds	There was a protective effect of PA on body fat change in both sexes. Higher levels of PA during childhood lead to less body fat by the time of early adolescence.
Remmers T, 2014 (22)	4–7 years old at baseline, 6–9 years at follow-up	470	Prospective Cohort	Light PA, MVPA and sedentary behavior measured by accelerometry	BMI z-scores	Increments of MVPA were associated with decreases in BMI z-score in heavier children, in both sexes.
Roberts SB, 1988 (23)	0–12 months old (6 infants from lean and 12 infants from overweight mothers)	18	Prospective Cohort	Total energy expenditure from doubly labeled water	Weight gain (1st year of life), triceps and subscapular skinfolds	Total energy expenditure at 3 months of age was 20.7% lower in infants who became overweight compared to other infants.
Saakslahti A, 2004 (24)	4–7 years old at baseline	155	Prospective Cohort	Physical activity measured by parental report (observation diary)	BMI	In girls, low-activity playing was positively correlated with BMI at age 4–5 years and playing indoors was positively correlated with BMI at age 5–6 years. There were no significant associations in boys.
Sugimori H, 2004 (25)	3 years old at baseline; 6 years old at follow up	8170	Prospective Cohort	Physical activity measured by questionnaire (physical exercise/playing outdoor), physical club activities, duration of TV viewing)	BMI	Physical inactivity at age 6 years was associated with temporal changes in overweight status between 3–6 years in boys.
Wells JCK, 1996 (26)	12 weeks old at baseline; 2–3.5 years old at follow up	30	Prospective Cohort	Physical activity energy expenditure measured from total energy expenditure (doubly labeled water) and minimal metabolism (Deltatrac Metabolic monitor); mother’s diary of infant activity	Weight, BMI, skinfolds, and fat mass (from total body water)	PA energy expenditure at 12 weeks was not associated with measures of adiposity at follow-up.