The relationship between youth sport participation, physical activity levels, and cardiovascular disease risk factors in 5- to 14-year-old children: a systematic review

Background Cardiovascular disease (CVD) causes approximately 18 million deaths annually, disproportionately affecting underrepresented racial and ethnic groups. Participation in youth sports has been suggested as a potential strategy to improve CVD-related risk factors, but studies on the topic have produced mixed results. The primary objective of this systematic review was to evaluate the relationship between youth sport participation, physical activity levels, and CVD risk factors, in children aged 5 to 14 years. A secondary objective was to investigate whether relationships differed across racial and ethnic groups. Methods The search encompassed studies published in English, Spanish, or Portuguese between January 1995 and April 2024, utilizing five databases: PubMed, Medline, EMBASE, Cochrane Library, and SPORTDiscus. Eligible studies included experimental, quasi-experimental, or observational studies conducted on youth (5–14 years of age) from any health background. To be included, studies needed to report on the relationship of youth sport participation to at least one of the following outcomes: (a) physical activity levels, (b) blood pressure, (c) lipid fractions, (d) body mass index, (e) central adiposity, (f) systemic inflammation, or (g) glucose levels/insulin resistance. Primarily quantitative descriptive analyses were used to synthesize studies by outcome. Results We screened 12,286 studies; 379 underwent full text review, and 186 studies included in the final sample. The five most commonly reported CVD-risk related outcomes were: physical activity (119 studies), body mass index (117 studies), waist circumference (28 studies), blood pressure (27 studies), and lipid profiles (18 studies). 23 studies (12.4%) reported a definition of sport. Physical activity was measured primarily using MVPA (n = 65), sport participation (n = 30), or step counts (n = 8). Twenty-eight out of 65 studies (43.1%) that had a measure of MVPA demonstrated significant differences in MVPA. Out of 117 studies that assessed BMI, 75 studies (64.1%) assessed the significance of BMI-related relationships, and 41 studies (35.0%) reported statistically significant BMI-related relationships. 62 studies (33.3%) reported effect size estimates. Conclusions The present review indicated a need for more consistent and transparent methodology in youth sport research related to physical activity and CVD risk factors. Studies clearly stating the operationalized definition of youth sport and diverse and generalizable samples were lacking. Systematic Review Registration: PROSPERO CRD42023427219