Lifestyle interventions and 24-hour movement behaviors in preschool children: a systematic review and meta-analysis

Abstract

Abstract

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; I 2 = 91%) and sleep duration (MD 0.18 h/day, 95% CI 0.01 to 0.35; I 2 = 68%), and with reductions in sedentary behavior (MD − 7.62 min/day, 95% CI − 15.08 to −0.17; I 2 = 63%) and screen time (MD − 0.33 h/day, 95% CI − 0.53 to −0.13; I 2 = 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.