A systematic review and meta-analyses of the relationships between active outdoor play and 24-hour movement behaviors

Maeghan E. James, Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada. Electronic address: mjames4@uottawa.ca.
Louise de Lannoy, Outdoor Play Canada, Ottawa, ON K2K 2Y1, Canada.
Olivia Lopes, Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada.
Avril Johnstone, MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow G12 8TB, UK.
Eun-Young Lee, School of Kinesiology & Health Studies, Queen's University, Kingston, ON K7L 3N6, Canada.
Peter Bakalár, Faculty of Sports, University of Prešov, Prešov 08001, Slovakia; Faculty of Physical Culture, Palacký University Olomouc, Olomouc 771 47, Czech Republic.
Javier Brazo-Sayavera, Department of Sports and Computer Science, Universidad Pablo de Olavide, Sevilla 41013, Spain.
Taru Manyanga, Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; Division of Medical Sciences, University of Northern British Columbia, Prince George, BC V2N 4Z9, Canada.
Leigh M. Vanderloo, Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; Research & Evaluation, ParticipACTION, Toronto, ON M5G 2C8, Canada; School of Occupational Therapy, University of Western Ontario, London, ON N6A 3K7, Canada.
Erin Wentzell, Department of Health, Human Function, and Rehabilitation Sciences, The George Washington University, Washington, DC 20037, USA.
Lisa M. Barnett, Institute for Physical Activity and Nutrition, School of Health and Social Development, Deakin University, Geelong, VIC 3220, Australia.
Peter Bentsen, Center for Clinical Research and Prevention, University Hospital Copenhagen - Bispebjerg and Frederiksberg, Capital Region 2400, Denmark; Department of Geosciences and Natural Resource Management, University of Copenhagen, Copenhagen 1958, Denmark.
Valerie Carson, Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB T6G 2H9, Canada.
Scott Duncan, School of Sport and Recreation, Auckland University of Technology, Auckland 1142, New Zealand.
Ryan Fahey, Physical and Health Education Canada, Ottawa, ON K1H 7X7, Canada.
Shawnda A. Morrison, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Singapore.
Lærke Mygind, Center for Clinical Research and Prevention, University Hospital Copenhagen - Bispebjerg and Frederiksberg, Capital Region 2400, Denmark.
Alessandra Prioreschi, SAMRC Developmental Pathways for Health Research Unit, Department of Pediatrics, Faculty of Health Science, School of Clinical Medicine, University of the Witwatersrand, Johannesburg 2050, South Africa.
Suryeon Ryu, Department of Kinesiology, Recreation, and Sport Studies, University of Tennessee, Knoxville, TN 37996, USA.
Lindsey Sikora, Health Sciences Library, University of Ottawa, Ottawa, ON K1H 8M5, Canada.
Patricia Tucker, School of Occupational Therapy, University of Western Ontario, London, ON N6A 3K7, Canada; Children's Health Research Institute, London, ON N6C 2V5, Canada.
Lucy-Joy Wachira, Department of Physical Education, Exercise and Sport Science, Kenyatta University, Nairobi 00100, Kenya.
Mark S. Tremblay, Healthy Active Living and Obesity Research Group, Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON K1H 8L1, Canada; Faculty of Medicine, University of Ottawa, Ottawa, ON K1H 8M5, Canada; Outdoor Play Canada, Ottawa, ON K2K 2Y1, Canada.

Document Type

Journal Article

Publication Date

12-29-2025

Journal

Journal of sport and health science

DOI

10.1016/j.jshs.2025.101115

Keywords

Children; Physical activity; Public health; Sedentary behavior; Sleep

Abstract

BACKGROUND: Few individuals meet the 24-h movement guidelines for physical activity (PA), sedentary behavior, and sleep. Active outdoor play (AOP) may support healthier movement patterns, though its role is not yet established. The objective of this study was to synthesize evidence on associations between AOP and movement behaviors. METHODS: A systematic review and meta-analyses were conducted using five databases from inception to September 2025. Studies examining AOP and movement behaviors were included with no restriction on age, ability, or geographic location. Screening and data extraction were completed in duplicate. Narrative syntheses, random-effects meta-analyses, and The Grading of Recommendations Assessment, Development, and Evaluation assessments were conducted. RESULTS: Of 28,092 records, 61 studies met inclusion criteria, spanning 25 countries with participants aged 1.6-15.5 years. Most were cross-sectional (n = 46), with some longitudinal (n = 8), quasi-experimental (n = 5), and randomized trials (n = 3). AOP was consistently associated with greater PA, especially moderate-to-vigorous PA; meta-analysis showed a moderate positive correlation with high heterogeneity (r = 0.60, 95% confidence interval (95%CI): 0.34-0.78, p = 0.0004; I = 99.2%). AOP was also linked to less sedentary behavior: children were sedentary 38% of the time outdoors vs. 67% indoors. Meta-analyses showed a small, significant negative correlation with sedentary time (r = -0.05, 95%CI: -0.07 to -0.02, p < 0.0043; I = 7.0%) and a small, non-significant correlation with screen time (r = -0.19, 95%CI: -0.38 to 0.02, p = 0.0638; I = 98.9%). Evidence on sleep was mixed, with no adverse associations found. Certainty of evidence was low to very low. CONCLUSION: AOP may support healthier movement behaviors in children and youth. More longitudinal and intervention research is needed to confirm causality and guide policy and practice.

Department

Health, Human Function, and Rehabilitation Sciences

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