Position Statement on Active Outdoor Play

How young children's play is shaped through common iPad applications: a study of 2 and 4-5 year-olds

Digital devices such as iPads are prevalent in children's play from an early age. How this shapes young children's play is an area of considerable debate without any clear consensus on how different forms of play are brought into the iPad interaction. In this study, we examined 98 play activities of children in two preschool settings, featuring 2 and 4-5-year-olds, their play with iPads and non-digital artefacts. Three analytical approaches were used: an index built on a digital play framework [Bird, Jo, and Susan Edwards. 2015. "Children Learning to Use Technologies Through Play: A Digital Play Framework." British Journal of Educational Technology 46 (6): 1149-1160. doi:10.1111/bjet.12191 ], a quantitative description of the index, and a qualitative interaction analysis of children's play. Results show how play with iPads is characterised as less ludic than play with other artefacts, and diverges from the age-typical norms of play. We discuss what these results might mean for children's play in contemporary early childhood settings and for children's learning.

A Tale of Two Cities: Unpacking the Success and Failure of School Street Interventions in Two Canadian Cities

One innovative strategy to support child-friendly cities is street-based interventions that provide safe, vehicle-free spaces for children to play and move about freely. School streets are one such innovation involving closing streets around elementary schools to vehicular traffic to improve children's safety as they come and go from school while providing opportunities for children to play and socialize on the street. Launching these initiatives in communities dominated by automobiles is enormously challenging and little is known about why these interventions are successfully launched in some places but not others. As part of a larger research project called Levelling the Playing Fields, two School Street initiatives were planned for the 2021-2022 school year; one initiative was successfully launched in Kingston, ON, while the second initiative failed to launch in Montreal, QC. Using a critical realist evaluation methodology, this paper documents the contextual elements and key mechanisms that enabled and constrained the launch of these School Streets in these cities, through document analysis and key informant interviews. Our results suggest that municipal and school support for the initiative are both imperative to establishing legitimacy and collaborative governance, both of which were necessary for a successful launch.

"Children are precious cargo; we don't let them take any risks!": Hearing from adults on safety and risk in children's active play in schools: a systematic review

Background

Understanding determinants of children’s outdoor play is important for improving low physical activity levels, and schools are a key setting for both. Safety concerns shape children’s opportunity to play actively outdoors, therefore, this qualitative evidence synthesis aimed to i) examine adult (e.g., parent, teacher, yard supervisor, principal) perspectives on safety and risk in children’s active play during recess in elementary and/or middle schools, and ii) identify how safety and risk influence playground supervision and decision making in this setting.

Methods

Six electronic databases were systematically searched in March 2021, with an updated search in June 2022. Records were screened against eligibility criteria using Covidence software, and data extraction and synthesis were performed using predesigned coding forms in Microsoft Excel and NVivo. Framework synthesis methodology was employed, guided by a conceptual framework structured on the socio-ecological model (SEM) and affordance theory.

Results

From 10,370 records, 25 studies were included that represented 608 adults across 89 schools from nine countries. The synthesis identified 10 constraining and four affording factors that influenced whether school staff were risk-averse or risk tolerant during recess, and, in turn, the degree to which children’s play was managed. Constraining factors stemmed from fears for children’s physical safety, and fear of blame and liability in the event of playground injury, which shaped parent, school staff and institutional responses to risk. Interrelated factors across SEM levels combined to drive risk-averse decision making and constraining supervision. Emerging evidence suggests children’s active play in schools can be promoted by fostering a risk tolerant and play friendly culture in schools through play facilitation training (e.g., risk-reframing, conflict resolution) and engaging stakeholders in the development of school policies and rules that balance benefits of play against potential risks.

Conclusions

Findings show several socio-cultural factors limited the ability of school staff to genuinely promote active play. Future work should seek to foster risk tolerance in schools, challenge the cultural norms that shape parent attitudes and institutional responses to risk in children’s play, and explore novel methods for overcoming policy barriers and fear of liability in schools.

Trial registration

PROSPERO registration: CRD42021238719.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01344-7.

Playground Inclusivity for Children With a Disability: Protocol for a Scoping Review

BACKGROUND

Although playgrounds are designed to promote outdoor play, children with disabilities may be unable to engage in these spaces due to intrinsic and extrinsic factors. Previous research has examined inclusive/accessible playground design when developing new playgrounds; however, it is unclear if there is a best-practice tool for evaluating the inclusivity of existing playground structures.

OBJECTIVE

A scoping review of both peer-reviewed and grey literature will be employed to explore evaluation tools for playground inclusivity, to enable the participation of children with disabilities.

METHODS

The conduct of this study will adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. A search for peer-reviewed research studies will be conducted in the following electronic databases: MEDLINE, Scopus, CINAHL, and Embase. Grey literature will be examined via a three-step process: (1) a search in the Canadian Health Research Collection Database; (2) a targeted Google search; and (3) reference list searching. Titles, abstracts, keywords, and full texts of identified studies will be independently screened for inclusion by two reviewers. A synthesis of included articles will describe the publication and auditing tool details. A summary of the findings will highlight the types of playgrounds measured, types of disability considered, measures of inclusion used, and psychometric properties.

RESULTS

Database searches for peer-reviewed articles were completed in December 2021. A total of 1471 unique records were returned after the removal of 559 duplicate records. Full texts of 167 studies meeting eligibility criteria will be reviewed. The peer-reviewed research search will guide the grey literature search. The scoping review is planned for completion in 2022.

CONCLUSIONS

A rigorous search of the literature will determine the availability of tools for evaluating existing playground structures for the inclusivity of children with disabilities. The results will inform recommendations on tool applications, and applicable knowledge translation activities.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/37312.

Changes in the continuous leaping performance of Finnish adolescents between 1979 and 2020

The aims of this secular trend design study were: 1) to investigate whether the continuous leaping performance of Finnish adolescents (mean age 14.99 ± .61 years) changed between 6 data sets collected between 1979 and 2020, and 2) to analyse if variation in leaping performance increased from 1979 to 2020. The data for this secular trend study of 6 cohorts were collected in 1979 (n = 599), 1995 (n = 498), 1998 (n = 796), 2003 (n = 2383), 2010 (n = 1383), and 2020 (n = 719). All cohorts performed the 5-leaps test, following the same protocol. Between-cohort differences in scores were analysed using a General Linear Contrast Model. Between-cohort differences in variance were tested using Chi-square-based between-group tests. Sex, age, and BMI were used as covariates in the secular trend analyses. Continuous leaping performance demonstrated a decreasing trend in both girls and boys. Specifically, girls' scores were stable between 1979 and 1995, decreased from 1995 to 2010 and remained stable thereafter. Boys leaping performance improved from 1979 to 1995, was stable until 2003, and had declined by 2020. Within-group variation in continuous leaping was greater in girls and boys during the first decades of the 21st century than previously.

"All the fun stuff, the teachers say, 'that's dangerous!'" Hearing from children on safety and risk in active play in schools: a systematic review

Background

Active play is vital for healthy child development, and schools are a valuable setting to promote this behaviour. Understanding the determinants of children’s physical activity behaviour during recess, particularly the role of risk-taking and the influence safety concerns have on active play, is required. This systematic review aimed to 1) synthesise qualitative research with children that explored their perceptions of safety and risk in active play during recess in elementary and/or middle school, and 2) develop a model from the findings to guide efforts in schools to optimise children’s active play opportunities during recess.

Methods

Six online databases were systematically searched for articles published between January 2000 and March 2021. Following PRISMA guidelines, records were screened against eligibility criteria using Covidence software, and data extraction and synthesis was conducted using customised forms in Excel and NVivo software. Framework synthesis methodology was employed, conceptually guided by Bronfenbrenner’s socio-ecological model and Gibson’s affordance theory.

Results

Of 9664 records, 31 studies met inclusion criteria, representing 1408 children across 140 schools from 11 countries. An emergent conceptual framework was developed encompassing 23 risk and safety themes and 10 risky play types that children desired in schools. Individual characteristics (age, gender, physical literacy) influenced children’s engagement with risk and how they kept themselves safe. Across outer SEM levels, factors interacted to constrain or afford children’s active play. Socio-cultural factors (supervision practices, rules, equipment restrictions) constrained active play, which children perceived were driven by adults’ concern with physical safety. These factors contributed to a cycle of risk-averse decision making and diminished play affordances, which could inadvertently exacerbate safety issues. A model for risk tolerance in children’s active play has been proposed.

Conclusions

The findings show a disparity between the active play children want in schools and what they are able to do. Future work should balance the concerns of adults against the active play children want, involve children in decisions about playground policy, and foster a risk-tolerant culture in schools.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01305-0.

A Low-Cost Method for Understanding How Nature-Based Early Learning and Childcare Impacts Children's Health and Wellbeing

Nature-based play and learning provision is becoming increasingly popular across the early learning and childcare (ELC) sector in Scotland. However, there remains a lack of understanding of how the program is expected to function. This has implications for program learning and may affect wider rollout of the program. Secondary data analysis of parent interviews (n = 22) and observations (n = 7) in Scottish ELC settings, and review of internationally published studies (n = 33) were triangulated to develop a program theory using the Theory of Change approach. This approach makes a program's underlying assumptions explicit by systematically demonstrating the relationship between each component: inputs, activities, outcomes, impact, and the contexts of the program. Findings suggested that location of outdoor nature space, affordances, availability of trained practitioners, and transport to location lead to activities such as free play, educator-led activities, and interactions with nature, resulting in longer durations of physical activity, interactions with peers and educators, and increased engagement with the natural environment. These activities are vital for supporting children's physical, cognitive, social, and emotional development. Our results demonstrate the value of using secondary data analysis to improve our understanding of the underlying theory of nature-based ELC which can support future evaluation designs. These findings will be of interest to program evaluators, researchers, practitioners, and funders, who find themselves with limited resources and want to better understand their program before investing in an evaluation. We encourage researchers and evaluators in the field of early years and outdoor play in other countries to refine this logic model in their own context-specific setting.

Evaluating Outdoor Nature-Based Early Learning and Childcare Provision for Children Aged 3 Years: Protocol of a Feasibility and Pilot Quasi-Experimental Design

Systematic reviews have demonstrated the scarcity of well-designed evaluations investigating outdoor nature-based play and learning provision for children in the early learning and childcare (ELC) sector among global Western countries. This study will examine the feasibility and acceptability of the programme and the evaluation design of outdoor nature-based play and learning provision across urban ELC settings in a Scottish metropolitan city. Six ELC settings with different outdoor nature-based play delivery models will be recruited. One trial design will be tested: a quasi-experimental comparison of children attending three different models of outdoor play and learning provision. Measures will be assessed at baseline and five weeks later. Key feasibility questions include: recruitment and retention of ELC settings and children; suitability of statistical matching based on propensity score; completeness of outcome measures. Process evaluation will assess the acceptability of trial design methods and provision of outdoor nature-based play among ELC educators. These questions will be assessed against pre-defined progression criteria. This feasibility study will inform a powered effectiveness evaluation and support policy making and service delivery in the Scottish ELC sector.

Play, Learn, and Teach Outdoors-Network (PLaTO-Net): terminology, taxonomy, and ontology

BACKGROUND

A recent dialogue in the field of play, learn, and teach outdoors (referred to as "PLaTO" hereafter) demonstrated the need for developing harmonized and consensus-based terminology, taxonomy, and ontology for PLaTO. This is important as the field evolves and diversifies in its approaches, contents, and contexts over time and in different countries, cultures, and settings. Within this paper, we report the systematic and iterative processes undertaken to achieve this objective, which has built on the creation of the global PLaTO-Network (PLaTO-Net).

METHODS

This project comprised of four major methodological phases. First, a systematic scoping review was conducted to identify common terms and definitions used pertaining to PLaTO. Second, based on the results of the scoping review, a draft set of key terms, taxonomy, and ontology were developed, and shared with PLaTO members, who provided feedback via four rounds of consultation. Third, PLaTO terminology, taxonomy, and ontology were then finalized based on the feedback received from 50 international PLaTO member participants who responded to ≥ 3 rounds of the consultation survey and dialogue. Finally, efforts to share and disseminate project outcomes were made through different online platforms.

RESULTS

This paper presents the final definitions and taxonomy of 31 PLaTO terms along with the PLaTO-Net ontology model. The model incorporates other relevant concepts in recognition that all the aspects of the model are interrelated and interconnected. The final terminology, taxonomy, and ontology are intended to be applicable to, and relevant for, all people encompassing various identities (e.g., age, gender, culture, ethnicity, ability).

CONCLUSIONS

This project contributes to advancing PLaTO-based research and facilitating intersectoral and interdisciplinary collaboration, with the long-term goal of fostering and strengthening PLaTO's synergistic linkages with healthy living, environmental stewardship, climate action, and planetary health agendas. Notably, PLaTO terminology, taxonomy and ontology will continue to evolve, and PLaTO-Net is committed to advancing and periodically updating harmonized knowledge and understanding in the vast and interrelated areas of PLaTO.

Physical Activity Opportunities in US Early Child Care Programs

BACKGROUND AND OBJECTIVES

Physical activity provides health and developmental benefits to young children. The Study of Nutrition and Activity in Child Care Settings describes physical activity opportunities and sedentary occasions for children aged 1 to 5 years at programs participating in the US Department of Agriculture Child and Adult Care Food Program.

METHODS

The Study of Nutrition and Activity in Child Care Settings obtained a nationally representative sample of classrooms within Child and Adult Care Food Program-participating Head Start and child care centers via multistage cluster sampling. For 1 observation day, an observer in each classroom tallied designated outdoor and indoor playspaces; minutes children spent in playspaces; barriers and facilitators to physical activity; and classroom time when most children were physically active (eg, walking, dancing), sedentary (seated, lying down), or neither. Weighted descriptive tabulations by program type compared outdoor physical activity opportunity counts and total physical activity opportunity durations to national guidelines. Multivariate regression analysis investigated association of barriers with physical activity opportunity duration.

RESULTS

The sample included 227 classrooms, 96 in child care centers and 131 in Head Start programs. All had sedentary occasions outside meals, snacks, and naps; virtually all offered opportunities for physical activity. Seventy-four percent of programs met national guidance on sufficient number of outdoor opportunities, weather permitting. Just 50% met guidance of ≥60 to 90 minutes of physical activity, whereas only 43% met both sets of guidance. Weather and staff not joining in outdoor play were associated with 74 and 31 fewer minutes devoted to physical activity, respectively.

CONCLUSIONS

Findings suggest ample room for improvement in provision of physical activity opportunities during child care.

A GoPro Look on How Children Aged 17–25 Months Assess and Manage Risk during Free Exploration in a Varied Natural Environment

Research indicates that risky play has positive effects on children’s development, learning and health, and ability to assess and manage risk, but there is a lack of knowledge on how toddlers engage in risky play. This study aims to investigate how toddlers assess and manage risk in free exploration in a varied natural environment and was conducted within an explorative qualitative approach. Observations were collected through head-mounted GoPro cameras while seven toddlers freely explored a natural environment. The results show that toddlers are able to assess and manage risks in challenging natural environments. They develop their own risk management skills and assess risks directly and indirectly. The results also show that practitioners sometimes perform risk assessment/management on behalf of the child and thus override the child’s own actions. The findings suggest implications for an early childhood education and care (ECEC) practice where children even as young as 17–25 months should be allowed to explore challenging environments and learn how to assess and manage risks.

Consensus statement on Singapore integrated 24-hour activity guide for children and adolescents

INTRODUCTION

Lifestyle activities, such as regular physical activity, are important for good metabolic health and the prevention of non-communicable diseases. Epidemiological studies highlight an increase in the proportion of overweight children in Singapore. A workgroup was formed to develop recommendations to encourage children and adolescents (aged 7-17 years) to adopt a holistic approach towards integrating beneficial activities within a daily 24-hour period for good metabolic and general health.

METHODS

The Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework was employed to formulate the public health question, assess the evidence and draw conclusions for the guide. The evidence for international 24-hour movement guidelines, and guidelines for physical activity, sedentary behaviour, and sleep and eating habits were reviewed. An update of the literature review from August 2018 to end of September 2020 was conducted through an electronic search of Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases.

RESULTS

Ten consensus statements were developed. The statements focused on the overall aim of achieving good metabolic health through integration of these activities and initiatives: light and moderate- to vigorous-intensity physical activity on a regular basis; muscle- and bone-strengthening activities; limiting sedentary behaviour; regular and adequate sleep; good eating habits and choosing nutritionally balanced foods and drinks; practise safety in exercise; and aiming to achieve more or all aforementioned recommendations for the best results.

CONCLUSION

This set of recommendations provides guidance to encourage Singapore children and adolescents to adopt health-beneficial activities within a 24-hour period.

Cross-sectional association of light sensor-measured time outdoors with physical activity and gross motor competency among U.S. preschool-aged children: the 2012 NHANES National Youth Fitness Survey

Background

Time spent outdoors (outdoor time) has been suggested to be beneficial for physical activity (PA) and healthy development among preschool-aged children. The aim of this study was to quantify PA level and gross motor competency associated with light sensor-measured daily outdoor time in a representative sample of U.S. children aged 3 to 5 years.

Methods

The study sample included 301 participants (149 girls) aged 3 to 5 years from the 2012 U.S. National Health and Examination Survey National Youth Fitness Survey. ActiGraph GT3X+ accelerometers with a built-in ambient light sensor were used to measure PA (expressed in monitor-independent movement summary [MIMS]) and outdoor time. The Test of Gross Motor Development-Second Edition (TGMD-2) was used to assess gross motor skills. Multivariable linear regression models were fit to predict daily and gross motor scores by daily outdoor time.

Results

Average daily outdoor time was 95 min (median of 84 min; interquartile range of 52 to 123 min). Means of daily outdoor time and daily MIMS were not significantly different between boys and girls. Among girls, every additional 10 min of daily outdoor time was associated with an additional 540 daily total MIMS (95% CI = 372, 708). Among boys, every additional 10 min of daily outdoor time was associated with an additional 296 daily total MIMS (95% CI = 131, 460). Every additional 10 min of daily outdoor time was associated with a 0.1-point (95% CI = 0.001, 0.130) higher object control standard score. Daily outdoor time was not associated with a locomotor standard score.

Conclusions

In a representative sample of U.S. preschool-aged children, daily outdoor time was positively associated with daily PA. The contribution of outdoor time to PA was greater among girls than boys, suggesting that providing outdoor opportunities is critical for promoting PA, particularly among girls.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13239-0.

Affordances of School Ground Environments for Physical Activity: A Case Study on 10- and 12-Year-Old Children in a Norwegian Primary School

Several studies have focused on how different school ground environments can stimulate physical activity (PA) in children. This study aimed to investigate the contributions of two school ground environments (a constructed schoolyard and a natural forest) in moderate to vigorous physical activity (MVPA) of Norwegian school children in the 5th and 7th grades. This study described two school ground environments that provided large and multifunctional spaces, giving the children several affordances for being physically active during the school day. The constructed schoolyard afforded a space of 44 m2 per child and had an access to sports and game courts and various types of equipment for PA. The natural forest provided a space of 50.6 m2 per child and had a varied landscape for activities that afforded a wide range of PA. On average, the children engaged in 50% of the 60-min period of MVPA when playing in the natural and constructed play settings. The two different environments, thus, contributed equally to the daily MVPA of the school children. The findings can inform policies and programs aiming at promoting recommended levels of PA among children using school outdoor environments that may eventually have implications for the physical and mental health of school children during the current pandemic.

The Management of Safety Situations and Assumable Risk during Transitions and Recesses in Different Types of Schools

The present study aims to analyze the situations of safety and risk perceived during the school transitions and recesses at different types of schools and to determine the level of empowerment of the students to manage situations of risk. The novelty of the study lies in analyzing the best strategy for dealing with risk situations during school transitions and recess. For this purpose, different situations in different types of schools are analyzed. An observational methodology was utilized. The sample was composed of a total of 23 schools, with 69 different observations conducted at different times of the day (morning recess and noon recess, on sunny days and rainy days). The results show that the morning recesses were the safest, and that the schools that serve a great number of at-risk students offered the greatest safety during recess and its transitions. With respect to the level of empowerment of the students, it was observed that they managed the possible risks when the safety guidelines were clear. The study provides evidence showing that when students are clearly aware of recess rules and guidelines, the management of risk situations improves.

A randomised controlled trial of an implementation strategy delivered at scale to increase outdoor free play opportunities in early childhood education and care (ECEC) services: a study protocol for the get outside get active (GOGA) trial

BACKGROUND

Increased outdoor play time in young children is associated with many health and developmental benefits. This study aims to evaluate the impact of a multi-strategy implementation strategy delivered at scale, to increase opportunities for outdoor free play in Early Childhood Education and Care (ECEC) services.

METHODS

The study will employ a parallel-group randomised controlled trial design. One hundred ECEC services in the Hunter New England region of New South Wales, Australia, will be recruited and randomised to receive either a 6-month implementation strategy or usual care. The trial will seek to increase the implementation of an indoor-outdoor routine (whereby children are allowed to move freely between indoor and outdoor spaces during periods of free play), to increase their opportunity to engage in outdoor free play. Development of the strategy was informed by the Behaviour Change Wheel to address determinants identified in the Theoretical Domains Framework. ECEC services allocated to the control group will receive 'usual' implementation support delivered as part of state-wide obesity prevention programs. The primary trial outcome is the mean minutes/day (calculated across 5 consecutive days) of outdoor free play opportunities provided in ECEC services measured at baseline, 6-months (primary end point) and 18-months post baseline. Analyses will be performed using an intention-to-treat approach with ECEC services as the unit of analysis, using a linear mixed effects regression model to assess between-group differences. A sensitivity analysis will be undertaken, adjusting for service characteristics that appear imbalanced between groups at baseline, and a subgroup analysis examining potential intervention effect among services with the lowest baseline outdoor free play opportunities.

DISCUSSION

Identifying effective strategies to support the implementation of indoor-outdoor routines in the ECEC setting at scale is essential to improve child population health.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ( ACTRN12621000987864 ). Prospectively registered 27th July 2021, ANZCTR - Registration.

Play-Friendly Communities in Nova Scotia, Canada: A Content Analysis of Physical Activity and Active Transportation Strategies

The Play-Friendly Cities framework describes key municipal actions and indicators which support a community’s playability and can positively influence children’s health behaviors and quality of life. The purpose of this study was to conduct a content analysis of Nova Scotia physical activity (PA) and active transportation (AT) strategies by applying the playability criteria in the Play-Friendly Cities framework. Methods: PA and AT strategies from communities across Nova Scotia were assessed using the Play-Friendly Cities framework. Strategy content was analyzed based on indicators across four themes: participation of children in decision making, safe and active routes around the community, safe and accessible informal play environments, and evidence-informed design of formal play spaces. Results: Forty-two (28 PA,14 AT) strategies were reviewed and all included statements reflective of at least one indicator (8 ± 4; range: 1–14). Content about safe and active routes around the community was most prevalent (41 plans, 812 mentions), while participation of children in decision making was least frequently presented (18 plans, 39 mentions). Content about safe and accessible informal play environments (31 plans, 119 mentions) and evidence-informed design of formal play spaces (28 plans, 199 mentions) was also present. Conclusions: All PA and AT strategies included some content reflective of a Play-Friendly City; however, there was great variability in the number of included indicators. This summary provides key information on opportunities, such as increasing meaningful involvement of children in decision making, that can inform future municipal actions and policies to improve a community’s playability.

I Play, You Play, We Play: Concurrent Activity at Play Streets

Purpose: Despite multiple health benefits, many children and teens do not achieve recommended amounts of physical activity (PA). Temporary changes to the built environment like Play Streets, temporarily closing streets to create safe places to play, are one solution to encourage PA in summer months. Play Streets can promote social cohesion by creating opportunities for concurrent activity, being active in the same area simultaneously. This study assesses concurrent activity at Chicago PlayStreets. Methods: During summer 2018, the System for Observing Play and Recreation in Communities (SOPARC) and iSOPARC mobile application were used to measure PA at PlayStreets (n = 11) organized by eight community partners. Odds ratios were used to determine odds of observing an individual as active when in the same target area as another individual, and when in the same target area as an active individual, separated by sex and age categories. Results: Presence of an active individual significantly increased odds of observing an individual as active for several sex and age stratifications. Specifically, presence of active children or an active male adult significantly increased odds of observing children and teens as active. In contrast, presence of another person alone was not shown to significantly increase odds of observing an individual as active, except in two instances when stratified by sex and age. Conclusions: Active male adults have a significant positive impact on activity levels at PlayStreets underlining the importance of engaged male figures. Additionally, findings suggest that active children can promote PA among other children at PlayStreets.

The Results of the OutsidePlay-ECE Study: Randomized Controlled Trial to Evaluate a Web-Based Intervention to Influence Early Childhood Educators’ Attitudes and Supportive Behaviors Toward Outdoor Play (Preprint)

Background

Outdoor play is critical to children’s healthy development and well-being. Early learning and childcare centers (ELCCs) are important venues for increasing children’s outdoor play opportunities, and early childhood educators’ (ECE) perception of outdoor play can be a major barrier to outdoor play. The OutsidePlay-ECE risk-reframing intervention is a fully automated and open access web-based intervention to reframe ECEs’ perceptions of the importance of outdoor play and risk in play and to promote a change in their practice in supporting it in ELCC settings. We grounded the intervention in social cognitive theory and behavior change techniques.

Objective

The aim of this study is to evaluate the effectiveness of the OutsidePlay-ECE web-based risk-reframing intervention.

Methods

We conducted a single-blind randomized controlled trial in Canada between December 2020 and June 2021 to test the OutsidePlay-ECE risk-reframing intervention for ECEs. We recruited participants using social media and mass emails through our partner and professional networks. We invited ECEs and administrators working in an ELCC, who can speak, read, and understand English. We randomized consented participants to the intervention or control condition. The participants allocated to the intervention condition received a link to the OutsidePlay-ECE intervention. Participants allocated to the control condition read the Position Statement on Active Outdoor Play, a 4-page document on research and recommendations for action in addressing barriers to outdoor play. The primary outcome was a change in tolerance of risk in play. The secondary outcome was goal attainment. We collected data on the web via REDCap (Vanderbilt University) at baseline and 1 week and 3 months after intervention.

Results

A total of 563 participants completed the baseline survey, which assessed their demographics and tolerance of risk in play. They were then randomized: 281 (49.9%) to the intervention and 282 (50.1%) to the control condition. Of these, 136 (48.4%) and 220 (78%) participants completed the baseline requirements for the intervention and control conditions, respectively. At 1 week after intervention, 126 (44.8%) and 209 (74.1%) participants completed follow-up assessments, respectively, and at 3 months after intervention, 119 (42.3%) and 195 (69.1%) participants completed the assessments, respectively. Compared with participants in the control condition, participants in the intervention group had significantly higher tolerance of risk in play at 1 week (β=.320; P=.001) and 3 months after intervention (β=.251; P=.009). Intention-to-treat analyses replicated these findings (β=.335; P<.001 and β=.271; P=.004, respectively). No significant intervention effect was found for goal attainment outcomes (odds ratio 1.124, 95% CI 0.335-3.774; P=.85).

Conclusions

The results of this randomized controlled trial demonstrated that the OutsidePlay-ECE intervention was effective and had a sustained effect in increasing ECEs’ and administrators’ tolerance of risk in play. It was not effective in increasing goal attainment.

Trial Registration

ClinicalTrials.gov NCT04624932; https://clinicaltrials.gov/ct2/show/NCT04624932

International Registered Report Identifier (IRRID)

RR2-10.2196/31041

A Framework for Pediatric Health Care Providers to Promote Active Play in Nature for Children

Aim:

Time outdoors and contact with nature are positively associated with a broad range of children’s health outcomes. Pediatricians are uniquely positioned to promote active play in nature (APN) but may face challenges to do so during well child visits. The objective of this study was to understand barriers to children’s APN, before and during the COVID-19 pandemic, and how health care providers could promote APN.

Methods:

Focus groups were conducted with 14 pediatric providers and interviews with 14 parents (7 in English, 7 in Spanish) of children ages 3 to 10 on public insurance. Dedoose was used for coding and content analysis. We contextualized this work within the WHO’s Commission on Social Determinants of Health conceptual framework.

Results:

Parents mentioned a range of material circumstances (time, finances, family circumstances, access to safe outdoor play spaces and age-appropriate activities) and behavioral/psychosocial factors (previous experiences in nature, safety, and weather concerns), many of which were exacerbated by the pandemic, that serve as barriers to children’s APN. Providers said they were motivated to talk to families about children’s APN but mentioned barriers to this conversation such as time, other pressing priorities for the visit, and lack of resources to give families.

Conclusions:

Many pre-pandemic barriers to APN were exacerbated by the COVID-19 pandemic. Well-child visits may be an effective setting to discuss the benefits of APN during and beyond the pandemic, and there is a need for contextually appropriate resources for pediatric providers and families.

Impact of an outdoor loose parts intervention on Nova Scotia preschoolers' fundamental movement skills: a multi-methods randomized controlled trial

Development of fundamental movement skills in early childhood supports lifelong health. The potential for outdoor play with loose parts to enhance fundamental movement skills has not been investigated. A multi-methods randomized controlled design was used to determine the efficacy of integrating outdoor loose parts play into Nova Scotia childcare centers (19 sites: 11 interventions, 8 control). Movement skills (n = 209, age 3-5 years) were assessed over a 6-month period to investigate changes in fundamental movement skills over time and between groups. Qualitative data was also collected on the educators' perceptions of outdoor loose parts play. Quantitative data (fundamental movement skills) revealed a non-intervention effect, however, educators spoke of outdoor loose parts play providing opportunities to combine/ repeat movements and take risks; supporting physical, cognitive and socio-emotional (holistic) development; and increasing awareness of children's physical development and how to support it. Our findings demonstrate value in outdoor loose parts play for the development of fundamental movement skills in childcare settings.

Children and parents' perspectives of the impact of the COVID-19 pandemic on Ontario children's physical activity, play, and sport behaviours

Background

The COVID-19 pandemic and associated public health measures have resulted in the closure of many physical activity-supporting facilities. This study examined Ontario parents’ and children’s perspectives of COVID-19’s impact on children’s physical activity behaviours, return to play/sport during COVID-19, as well as barriers/facilitators to getting active amid extended closures of physical activity venues.

Methods

Parents/guardians of children aged 12 years and under living in Ontario, Canada were invited to participate in an interview. 12 parent/guardian and 9 child interviews were conducted via Zoom between December 2020 – January 2021, were audio-recorded, and transcribed verbatim. Thematic content analysis was undertaken to identify pronounced themes.

Results

Themes for both parent and child interviews fell into one of three categories: 1) barriers and facilitators for getting children active amid COVID-19 closures of physical activity-supporting facilities; 2) changes in children’s activity levels; and, 3) perspectives on return to play/sport during and post-pandemic. Various subthemes were identified and varied between parents and children. The most common facilitator for dealing with children’s inactivity voiced by parents/guardians was getting active outdoors. Parents/guardians noted their willingness to have their children return to play/sport in the community once deemed safe by public health guidelines, and children’s willingness to return stemmed primarily from missing their friends and other important authority figures (e.g., coaches) and sporting events (e.g., tournaments).

Conclusions

Findings from this study could inform families of feasible and realistic strategies for increasing children’s physical activity during community closures, while also providing public health experts with information regarding what supports, or infrastructure might be needed during future lockdown periods and/or pandemics.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12344-w.

A Web-Based Risk-Reframing Intervention to Influence Early Childhood Educators' Attitudes and Supportive Behaviors Toward Outdoor Play: Protocol for the OutsidePlay Study Randomized Controlled Trial

Background

Early learning and childcare centers (ELCCs) can offer young children critical opportunities for quality outdoor play. There are multiple actual and perceived barriers to outdoor play at ELCCs, ranging from safety fears and lack of familiarity with supporting play outdoors to challenges around diverse perspectives on outdoor play among early childhood educators (ECEs), administrators, licensing officers, and parents.

Objective

Our study objective is to develop and evaluate a web-based intervention that influences ECEs’ and ELCC administrators’ perceptions and practices in support of children’s outdoor play at ELCCs.

Methods

The development of the fully automated, open-access, web-based intervention was guided by the intervention mapping process. We first completed a needs assessment through focus groups of ECEs, ELCC administrators, and licensing officers. We identified key issues, needs, and challenges; opportunities to influence behavior change; and intervention outcomes and objectives. This enabled us to develop design objectives and identify features of the OutsidePlay web-based intervention that are central to addressing the issues, needs, and challenges of ECEs and ELCC administrators. We used social cognitive theory and behavior change techniques to select methods, applications, and technology to deliver the intervention. We will use a two-parallel-group randomized controlled trial (RCT) design to evaluate the efficacy of the intervention. We will recruit 324 ECEs and ELCC administrators through a variety of web-based means, including Facebook advertisements and mass emails through our partner networks. The RCT study will be a purely web-based trial where outcomes will be self-assessed through questionnaires. The RCT participants will be randomized into the intervention group or the control group. The control group participants will read the Position Statement on Active Outdoor Play.

Results

The primary outcome is increased tolerance of risk in children’s play, as measured by the Teacher Tolerance of Risk in Play Scale. The secondary outcome is self-reported attainment of a self-developed behavior change goal. We will use mixed effects models to test the hypothesis that there will be a difference between the intervention and control groups with respect to tolerance of risk in children’s play. Differences in goal attainment will be tested using logistic regression analysis.

Conclusions

The OutsidePlay web-based intervention guides users through a personalized journey that is split into 3 chapters. An effective intervention that addresses the barriers to outdoor play in ELCC settings has the potential to improve children’s access to outdoor play and support high-quality early childhood education.

Trial Registration

ClinicalTrials.gov NCT04624932; https://clinicaltrials.gov/ct2/show/NCT04624932

International Registered Report Identifier (IRRID)

DERR1-10.2196/31041

Asia-Pacific Consensus Statement on integrated 24-hour activity guidelines for children and adolescents

Non-communicable diseases (NCDs) constitute a significant public health challenge and pose a great burden on health and social systems throughout the world. The Asia-Pacific region is in a vulnerable position as the prevalence of NCDs will inevitably increase with rapid socioeconomic transitions; yet it is ill prepared for this public health challenge as Asian children are among the most physically inactive in the world. Aligned with the WHO's global strategy to control NCDs via preventive measures and health promotion policies, representatives from the Asia-Pacific region came together to develop consensus statement on integrated 24-hour activity guidelines for children and adolescents. These guidelines apply to children and adolescents, aged 5-18 years, in the Asia-Pacific region, regardless of gender, cultural background or socioeconomic status. These guidelines aim to provide the latest evidence-based recommendations, taking a holistic approach to lifestyle activities and adopting a practical perspective by framing these activities within a 24-hour period. Eating and dietary elements were incorporated as they closely influence the energy balance of the movement behaviours and vice versa. By investing in the younger generations through advocacy for healthier lifestyles, we aim to reduce the burden of NCDs in the Asia-Pacific region.

Schoolyard Affordances for Physical Activity: A Pilot Study in 6 Nordic–Baltic Countries

Environmental settings influence children’s and adolescents’ physical activity (PA) in neighborhoods and schoolyards. This study aimed to explore the main characteristics of schoolyards in six Nordic–Baltic countries, to document how those facilities provide affordances for PA in 7–18 year–old schoolchildren, and how the schoolyard meets children’s preferences. One schoolyard was studied in each included country: Iceland, Norway, Finland, Lithuania, Latvia, and Estonia. The affordances, facilities, and equipment for PA in schoolyards were identified through orthophoto maps and standard registration forms. Children’s preferences were collected through group interviews at each participating school. A common design of schoolyards across countries indicated mostly flat topography with sparse vegetation and green areas dominated by large traditional sport arenas such as a football field, areas suitable for ball games, and track and field activities. Green spaces and varied topography were more prominent in Nordic countries. Across nationalities, the responses from pupils regarding the schoolyard were similar: they liked it though they wished for more variety of activities to do during recess. National regulations/recommendations for schoolyard design differed across the countries, being more restricted to sport fields and sport-related activities in Latvia and Lithuania, while in Nordic countries, the recommendations focused more on versatile schoolyard design.

Nature and Children's Health: A Systematic Review

CONTEXT

Daily outdoor play is encouraged by the American Academy of Pediatrics. Existing evidence is unclear on the independent effect of nature exposures on child health.

OBJECTIVE

We systematically evaluated evidence regarding the relationship between nature contact and children's health.

DATA SOURCES

The database search was conducted by using PubMed, Cumulative Index to Nursing and Allied Health Literature, PsychInfo, ERIC, Scopus, and Web of Science in February 2021.

STUDY SELECTION

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. In all searches, the first element included nature terms; the second included child health outcome terms.

DATA EXTRACTION

Of the 10 940 studies identified, 296 were included. Study quality and risk of bias were assessed.

RESULTS

The strongest evidence for type of nature exposure was residential green space studies (n = 147, 50%). The strongest evidence for the beneficial health effects of nature was for physical activity (n = 108, 32%) and cognitive, behavioral, or mental health (n = 85, 25%). Physical activity was objectively measured in 55% of studies, and 41% of the cognitive, behavioral, or mental health studies were experimental in design.

LIMITATIONS

Types of nature exposures and health outcomes and behaviors were heterogenous. Risk of selection bias was moderate to high for all studies. Most studies were cross-sectional (n = 204, 69%), limiting our ability to assess causality.

CONCLUSIONS

Current literature supports a positive relationship between nature contact and children's health, especially for physical activity and mental health, both public health priorities. The evidence supports pediatricians in advocating for equitable nature contact for children in places where they live, play, and learn.

"A 15% Reduction in Physical Inactivity Will Be Achieved in Australasia by 2030"-Audience Votes Negative in Online Debate

The Australasian Society for Physical Activity aims to advance the science and practice of physical activity in Australia, New Zealand, the Pacific Islands, East Asia, South Asia, Southeast Asia, and Oceania. Fun, enjoyment, and cross-disciplinary discourse are important to ensure the network of physical activity professionals and our collective voice continues to grow. In May 2021, Australasian Society for Physical Activity's Early Career Network curated an engaging online Physical Activity Debate attended by 206 professionals. This commentary provides a synopsis of the debate and the central arguments presented by the affirmative and negatives teams. The authors describe the debate format and interactive design of the online Physical Activity Debate to provide insights for future online events that aim to boost interaction among physical activity professionals from various disciplines.

Relating outdoor play to sedentary behavior and physical activity in youth - results from a cohort study

BACKGROUND

Outdoor play, sedentary behavior (SB), and moderate-to-vigorous physical activity (MVPA) are related to youth's health, however, there are research gaps regarding 1) associations between outdoor play, SB, and MVPA across a broad pediatric age range (6-17 years), and 2) longitudinal associations between outdoor play, SB, and MVPA across childhood and adolescence. Two studies were conducted to address those research gaps: Study 1 aimed to investigate relationships between outdoor play and accelerometer-assessed SB and MVPA in a cross-sectional nationwide sample of children and adolescents in Germany. Study 2 aimed to investigate prospective associations between outdoor play and self-reported screen-time SB and MVPA and in a sample of children with three measurement timepoints across 11 years.

METHODS

Data were obtained of the German national representative Motorik-Modul (MoMo) Study and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). In Study 1, N = 2278 participants (6-17 years) were included with self-reported outdoor play and accelerometer-assessed SB and MVPA. Associations were examined via multiple linear regressions. In Study 2, N = 570 participants (baseline: 4-7 years) were included in the longitudinal analysis with follow-ups six and 11 years later. Screen-time SB (TV watching and PC/Gaming), MVPA, and outdoor play were self-reported. Associations were investigated through a path prediction model.

RESULTS

Study 1 showed that compared to <1 h outdoor play, higher engagement in daily outdoor play was related to lower SB (1-2 h: - 9.75 min/day, P = 0.017; ≥2 h: - 17.78 min/day, P < 0.001) and higher MVPA (≥2 h: + 3.87 min/day, P = 0.001). The cross-sectional relationship between MVPA and outdoor play was moderated by sex (in favor of males) and age (in favor of younger children). Study 2 showed that outdoor play in early childhood negatively predicted PC use/Gaming in later childhood, but was unrelated to MVPA.

CONCLUSION

In Study 1, outdoor play was negatively related to SB cross-sectionally. In Study 2, outdoor play in early childhood was negatively related to PC and Gaming time in later childhood. Thus, providing outdoor play opportunities, especially during early childhood, has potential to prevent SB. Future research should investigate longitudinal relationships using device-based assessments for SB and MVPA.

The role of weather conditions on time spent outdoors and in moderate-to-vigorous physical activity among Norwegian preschoolers

The aim of this study was to determine associations between weather and playground surface conditions and time spent outdoors and in moderate-to-vigorous PA (MVPA) in preschool children aged 3-6 years. We included 1201 children (mean age 4.8 years, 51% boys) from 68 preschools in Norway who provided 12,030 days of observation during 2015-2016. Preschool MVPA was measured by accelerometry (ActiGraph GT3X+) for 10 consecutive weekdays. During this period, outdoor time and playground surface conditions were logged by staff and weather conditions were obtained from the Norwegian Meteorological Institute. Associations were determined using linear mixed models. Associations for MVPA depended on whether the analyses were adjusted for outdoor time or not. In unadjusted analyses, rainfall, wind, and wet, icy, and mixed playground conditions were negatively associated with MVPA, while temperature, snowfall, and dry playground conditions were positively associated with MVPA. In adjusted analyses, temperature and wet and mixed playground conditions were negatively associated with MVPA, while snowfall and dry and snowy playground conditions were positively associated with MVPA. Outdoor time and MVPA should be addressed simultaneously to inform interpretation of associations with weather characteristics and intervention development in early childhood education settings.

The effect of the use of a physical-activity mobile application on body composition and sleep quality of overweight children

OBJECTIVE

To analyze the use of a mobile physical activity application and its influence on body composition and sleep quality in overweight children.

METHODS

Prospective study with 37 patients from the Child and Adolescent Obesity Clinic at Unicamp Hospital das Clínicas, between 2018 and 2019. Anamnesis and anthropometry were performed. We oriented the use of the application for six weeks, five days/week for ten minutes.

RESULTS

Among 37 patients, 28 (mean age 10.7±2.0 years, 50% boys) used the application. The average use of the application ranged from 1.93±2.18 to 3.25±1.84 times/week, with a peak in the second week and a progressive decrease during follow-up. The paired t-test showed, on average, lean mass (t (27)=-2.91), weight (t (27)=-3.11) and height (t (27)=-3.79). After using the application, these were higher than before (all p<0.05). There was a significant difference in the proportion of children who presented difficulty sleeping (χ2 (1)=5.143) and insomnia (χ2 (1)=4.167).

CONCLUSIONS

There was an improvement in sleep quality and an increase in lean mass, but no significant changes in BMI z-score, waist circumference, and body fat percentage.

Play Behaviors in Children during the COVID-19 Pandemic: A Review of the Literature

Play is a key factor for children's healthy psychological, emotional, social, and cognitive development. During the COVID-19 pandemic, it has been postulated that children's play was affected, not only regarding the time children spent playing but also in terms of the qualitative characteristics of play. The aim of this review was to investigate how children's play has changed during the COVID-19 pandemic. A review was conducted in the PubMed, Google Scholar, EMBASE, SCOPUS, ERIC, PsycInfo, and JSTOR databases up to 6 December 2020. Furthermore, references of eligible studies as well as of relevant articles were searched using a snowballing technique. The search retrieved 17 eligible studies, conducted in Europe and North America. In general, outdoor play was reduced during the pandemic; on the other hand, there was an increase in indoor play and in videogames-screen time. COVID-19 was present in children's pretend play. Children's play was a key contributor to children's mood and wellbeing. Furthermore, teachers were especially concerned about how children's play was affected during the lockdown measures. There is evidence that children's play habits were affected during the COVID-19 pandemic; further research is required, especially cross-culturally oriented.

Few Canadian children and youth were meeting the 24-hour movement behaviour guidelines 6-months into the COVID-19 pandemic: Follow-up from a national study

Daily life has changed for families due to the COVID-19 pandemic. The aim of this repeated cross-sectional study was to describe movement behaviours in Canadian children and youth six months into the pandemic (T2; October 2020) compared with the start of the pandemic (T1, April 2020). An online survey was distributed to parents (N=1568) of children and/or youth (5-17 years; 58% girls) in October 2020. The survey assessed changes in movement behaviours [physical activity (PA) and play, sedentary behaviours (SB), and sleep] from before the pandemic to October 2020 (T2). We compared these data to spring data (T1; April 2020; Moore et al., 2020) collected using identical methodology (N=1472; 54% girls). We report correlations between movement behaviours and relevant parental factors and provide word frequency distributions for open-ended responses. During the second wave, 4.5% of children (4.6% girls; 4.3% boys) and 1.9% of youth (1.3% girls, 2.4% boys) met the movement guidelines (3.1% overall). Whereas, during the first wave, 4.8% (2.8% girls, 6.5% boys) of children and 0.6% (0.8% girls, 0.5% boys) of youth were meeting combined guidelines (2.6% overall). Parental support was correlated with their child's movement behaviours (T1 and T2). Our study demonstrates the ongoing challenges for children and youth to engage in healthy movement during the pandemic. Novelty bullets: • Our large-scale national study demonstrates that children and youth were not meeting the 24-hour movement guidelines during the second wave of the pandemic. • Our findings illustrate the need to protect children and youth from the collateral consequences of the pandemic.

Perceived Barriers and Facilitators of Adventurous Play in Schools: A Qualitative Systematic Review

Adventurous play, defined as exciting, thrilling play where children are able to take age-appropriate risks, has been associated with a wide range of positive outcomes. Despite this, it remains unclear what factors might aid or hinder schools in offering adventurous play opportunities. The purpose of this systematic review is to synthesise findings from qualitative studies on the perceived barriers and facilitators of adventurous play in schools. A total of nine studies were included in the final synthesis. The review used two synthesis strategies: a meta-aggregative synthesis and narrative synthesis. Findings were similar across the two syntheses, highlighting that key barriers and facilitators were: adults’ perceptions of children; adults’ attitudes and beliefs about adventurous play and concerns pertaining to health and safety, and concerns about legislation. Based on the findings of the review, recommendations for policy and practice are provided to support adventurous play in schools.

Backyard benefits? A cross-sectional study of yard size and greenness and children's physical activity and outdoor play

BACKGROUND

The home environment is the most important location in young children's lives, yet few studies have examined the relationship between the outdoor home environment and child physical activity levels, and even fewer have used objectively measured exposures and outcomes. This study examined relationships between objectively assessed home yard size and greenness, and child physical activity and outdoor play.

METHODS

Data were drawn from the HealthNuts study, a longitudinal study of 5276 children in Melbourne, Australia. We used cross-sectional data from a sample at Wave 3 (2013-2016) when participants were aged 6 years (n = 1648). A sub-sample of 391 children had valid accelerometer data collected from Tri-axial GENEActive accelerometers worn on their non-dominant wrist for 8 consecutive days. Yard area and greenness were calculated using geographic information systems. Objective outcome measures were minutes/day in sedentary, light, and moderate-vigorous physical activity (weekday and weekend separately). Parent-reported outcome measures were minutes/day playing outdoors (weekend and weekday combined). Multi-level regression models (adjusted for child's sex, mother's age at the birth of child, neighbourhood socioeconomic index, maternal education, and maternal ethnicity) estimated effects of yard size and greenness on physical activity.

RESULTS

Data were available on outdoor play for 1648 children and usable accelerometer data for 391. Associations between yard size/greenness and components of physical activity were minimal. For example, during weekdays, yard size was not associated with daily minutes in sedentary behaviour (β: 2.4, 95% CI: - 6.2, 11.0), light physical activity (β: 1.4, 95% CI: - 5.7, 8.5) or MVPA (β: -2.4, 95% CI: - 6.5, 1.7), with similar patterns at weekends. There was no relationship between median annual yard greenness and physical activity or play.

CONCLUSION

In our study of young children residing in higher socio-economic areas of Melbourne yard characteristics did not appear to have a major impact on children's physical activity. Larger studies with greater variation in yard characteristics and identification of activity location are needed to better understand the importance of home outdoor spaces and guide sustainable city planning.

Measuring Early Childhood Educators' Physical Activity and Sedentary Behavior-Related Self-Efficacy: A Systematic Review of Tools

Early childhood educators’ (ECEs) self-efficacy is often predictive of their ability and likelihood of promoting healthy activity behaviors in childcare settings. To date, ECEs’ physical activity and sedentary behavior–related self-efficacy has been measured in a variety of ways in childcare-based research, creating difficulty when comparing across studies. To identify the different approaches ECEs’ self-efficacy is assessed, the current study aimed to compare all existing tools that quantitatively measure physical activity and sedentary behavior–related self-efficacy of pre- and in-service ECEs. Seven online databases were searched for original, peer-reviewed, English-written journal articles. Articles were deemed eligible if they employed a tool which measured physical activity and/or sedentary behavior–related self-efficacy of pre- or in-service ECEs. A total of 16 studies were included in this review, and 13 unique tools were identified. All tools measured task self-efficacy (n = 13), while only 1 tool measured barrier self-efficacy, and approximately half of the tools (n = 7; 54%) reported on the validity and reliability. Great variability existed among the self-efficacy items included in the tools; however, common constructs included: teaching/leading physical activity, fundamental movement skill development, and physical activity programming. Very few tools mentioned sedentary behavior (n = 2) and outdoor/risky play (n = 2). Given the low number of studies that tested validity and reliability of their self-efficacy tools, the lack of consideration for barrier self-efficacy, and the paucity of tools that fully encompassed physical activity, sedentary behavior, and outdoor play considerations for ECEs, future research is needed to validate a new, reliable tool.

Active Play Network Influences on Physical Activity Among Children Living in Texas Colonias

Physical activity (PA) is beneficial for child health; however, few children meet PA guidelines. Social relationships impact child PA behaviors; however, little is known about this effect in Mexican-heritage populations. This study aims to understand associations between self-reported play networks and PA among Mexican-heritage children. Mexican-heritage children from colonias along the Texas-Mexico border (n = 44; 54.5% girls; mean age = 9.89 years, SD = 0.97) reported information on up to 5 people they played with most often. Linear regression was used to analyze the relationship between composition of children's social network and minutes of moderate- to vigorous-intensity PA (MVPA) and sedentary minutes per day measured by accelerometers. Children who reported a higher percentage of friends as opposed to family members attained significantly more minutes of MVPA per day (β = .27, P = .04). Children who reported playing with individuals in their network more often (β = ‒.28, P = .03) were sedentary for fewer minutes per day. Increasing the connections between children in the neighborhood or community, as well as increasing a child's frequency of active play, may be promising approaches to increasing MVPA and decreasing sedentary behaviors among Mexican-heritage children.

Exploring Preschoolers' Physical Activity and Sedentary Time During Outdoor Play at Childcare: A Cross-Sectional Analysis of the Supporting Physical Activity in the Childcare Environment Study

BACKGROUND

Moderate-to-vigorous physical activity (MVPA) offers many health benefits for preschoolers (2.5-5 y). In childcare, MVPA is predominantly accumulated outdoors, with higher rates purported among children within the first few minutes outside. The Supporting Physical Activity in the Childcare Environment intervention included shorter, more frequent outdoor play sessions; this study sought to explore children's activity levels during various outdoor play schedules.

METHODS

During the final week of the Supporting Physical Activity in the Childcare Environment intervention, preschoolers wore an Actical™ accelerometer for 5 days during childcare and staff logged outdoor times. Separate linear mixed effects models were run to explore the effect of the intervention on preschoolers' physical activity (total and MVPA) and sedentary time during outdoor play. Sex was entered as an interaction effect.

RESULTS

Preschoolers (n = 292) were significantly more active in the first 10 minutes outdoors compared with remaining time (P < .0083). For total outdoor time, children in the experimental group engaged in significantly less sedentary time than those in the control group (P < .017), and experimental group boys and girls engaged in higher MVPA than boys and girls in the control group (P < .017).

CONCLUSIONS

Findings support scheduling more frequent outdoor play sessions in childcare to increase physical activity participation among young children.

Development and evaluation of a new measure of children's play: the Children's Play Scale (CPS)

Background

There is increasing recognition of the importance of children’s play from a public health perspective, given the links between play and children’s physical and mental health. The present research aimed to develop and evaluate a new parent-report questionnaire that measures the time children spend playing across a range of places and includes a supplement to evaluate how adventurously children play.

Methods

The questionnaire was developed with input from a diverse group of parents and experts in children’s play. It was designed to yield a range of metrics including time spent playing per year, time spent playing outside, time spent playing in nature and level of adventurous play. The reliability of the questionnaire was then evaluated with 245 parents (149 mothers, 96 fathers) of 154 children aged 5–11 years. All participants completed the measure at time 1. At time 2, an average of 20 days later, 184 parents (111 mothers and 73 fathers) of 99 children completed the measure again.

Results

Cross-informant agreement, evaluated using Concordance Correlation Coefficients (CCCs), ranged from 0.36 to 0.51. These fall in the poor to moderate range and are largely comparable to cross-informant agreement on other measures. Test-retest reliability for mothers was good (range 0.67–0.76) for time spent playing metrics. For fathers, test-retest reliability was lower (range 0.39–0.63). For both parents the average level of adventurous play variable had relatively poor test retest reliability (mothers = 0.49, fathers = 0.42). This variable also showed a significant increase from time 1 to time 2. This instability over time may be due to the timing of the research in relation to the Covid-19 lockdown and associated shifts in risk perception.

Conclusions

The measure will be of value in future research focusing on the public health benefits and correlates of children’s play as well as researchers interested in children’s outdoor play and play in nature specifically. The development of the measure in collaboration with parents and experts in children’s play is a significant strength. It will be of value for future research to further validate the measure against play diaries or activity monitors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-10812-x.

Children's Physical Activity and Screen Time during COVID-19 Pandemic: A Qualitative Exploration of Parent Perceptions

OBJECTIVE

In this study, we explore parent perception of children's physical activity and screen time during COVID-19 stay-at-home orders.

METHODS

We interviewed 16 parents of children ages 5-12 years in the St. Louis, Missouri region using snowball sampling. We sampled from rural, urban, and suburban areas. The interviews were recorded, transcribed, and analyzed using a priori and emergent codes.

RESULTS

The transition to virtual school and work transformed daily activities. Physical education requirements varied, generally perceived as not contributing to overall physical activity. Parents perceived the amount of physical activity as the same or increased but reported an increase in screen time. The physical environment of the home, yard, and neighborhood emerged as a theme as did the social environment for physical activity.

CONCLUSIONS

COVID-19 stay-at-home orders created challenges for children's physical activity. Results can be used to inform more generalizable studies and serve as a basis for creating better parent resources to support their children's physical activity outside of ordinary school, sport, and community activity opportunities.

A Web-Based and In-Person Risk Reframing Intervention to Influence Mothers' Tolerance for, and Parenting Practices Associated With, Children's Outdoor Risky Play: Randomized Controlled Trial

BACKGROUND

Outdoor risky play, such as climbing, racing, and independent exploration, is an important part of childhood and is associated with various positive physical, mental, and developmental outcomes for children. Parental attitudes and fears, particularly mothers', are a major deterrent to children's opportunities for outdoor risky play.

OBJECTIVE

The aim of this study was to evaluate the efficacy of 2 versions of an intervention to reframe mothers' perceptions of risk and change parenting behaviors: a web-based intervention or an in-person workshop, compared with the control condition.

METHODS

The Go Play Outside! randomized controlled trial was conducted in Canada from 2017 to 2018. Participants were recruited through social media, snowball sampling, and community notices. Mothers of children aged 6-12 years were self-assessed through eligibility questions, and those eligible and consented to participate in the study were randomized into a fully automated web-based intervention, the in-person workshop, or the control condition. The intervention was underpinned by social cognitive theory, incorporating behavior change techniques. Participants progressed through a series of self-reflection exercises and developed a goal for change. Control participants received the Position Statement on Active Outdoor Play. The primary outcome was increase in tolerance of risky play and the secondary outcome was goal attainment. Data were collected online via REDCap at baseline, 1 week, and 3 months after the intervention. Randomization was conducted using sealed envelope. Allocations were concealed to researchers at assignment and data analysis. We conducted mediation analyses to examine whether the intervention influenced elements of social cognitive theory, as hypothesized.

RESULTS

A total of 451 mothers were randomized and completed baseline sociodemographic assessments: 150 in the web-based intervention, 153 in the in-person workshop, and 148 in the control condition. Among these, a total of 351 mothers completed the intervention. At 1 week after the intervention, 113, 85, and 135 mothers completed assessments for each condition, respectively, and at 3 months after the intervention, 105, 84, and 123 completed the assessments, respectively. Compared with mothers in the control condition, mothers in the web-based intervention had significantly higher tolerance of risky play at 1 week (P=.004) and 3 months after the intervention (P=.007); and mothers in the in-person workshop had significantly higher tolerance of risky play at 1 week after the intervention (P=.02). No other significant outcomes were found. None of the potential mediators were found to significantly mediate the outcomes.

CONCLUSIONS

The trial demonstrates that the web-based intervention was effective in increasing mothers' tolerance for risk in play.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03374683; https://clinicaltrials.gov/ct2/show/NCT03374683.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-018-2552-4.

Nowhere to Go: Parents' Descriptions of Children's Physical Activity During a Global Pandemic

Background: Schools and outdoor public spaces play a substantial role in children's physical activity. Yet, the COVID-19 shelter-in-place mandates bound many children to their available home spaces for learning, movement, and development. The exact effect this mandate had on children's physical activity may vary among families.

Objective: To understand, from the perspective of parents, how the COVID-19 shelter-in-place mandates affected children's physical activity, while also considering families' socioeconomic status.

Design: Open-ended survey.

Setting: Online.

Method: Data were collected from 321 parents living in the United States of America. Parents answered an open-ended prompt to describe their children's physical activity during COVID-19 shelter-in-place mandates. Following data collection, inductive and deductive content analysis examined patterns in the data.

Results: Analyses indicated that shelter-in-place mandates restricted children's opportunities for physical activity. However, if families had access to outdoor spaces or equipment, they could encourage and support more physical activity opportunities than those without. Families in the lower-income bracket had less access to outdoor space and subsequently those children had fewer opportunities to be physically active. Parents supported their children's physical activity through their involvement and encouragement.

Conclusion: These findings underscore the importance of access to outdoor spaces and equipment for increasing children's physical activity. Findings can be used by educators and policymakers to equitably support families of lower socioeconomic status who reported less access to outdoor spaces.

Impact of COVID-19 on Early Childhood Educator's Perspectives and Practices in Nutrition and Physical Activity: A Qualitative Study

Government guidelines for relaunching early childhood education and care (ECEC) programs during the COVID-19 pandemic have required the implementation of various practices to minimize the risk of infection transmission. These directives include recommendations regarding serving and handling food, shared spaces, and physical distancing which have a direct impact on the health and development of children in care. The purpose of this study was to explore early childhood educators' perspectives on how COVID-19 guidelines have impacted the nutrition and physical activity practices within their ECEC environment. A qualitative description approach was used to explore a purposive sample of 17 educators working full time in ECEC centres during the pandemic between July and August 2020. Semi-structured, individual interviews were conducted, audio-recorded, transcribed verbatim, and analysed using a thematic analysis. Educators identified environmental changes in their environments noting a reduction in the quality food available for children juxtaposed with increased outdoor opportunities and a perceived increase in physical activity time. Teaching practices were also identified as being impacted by the COVID-19 guidelines. Curriculum, life skills, and social connectedness around healthy eating education was disrupted. Promoting physical activity education was challenged due to equipment, space, and curriculum enrichment opportunities losses. These findings demonstrate pronounced negative effects of COVID guidelines on nutrition and physical activity best practices within the ECEC environment. There is a need to support educators in maintaining healthy and active environments for preschoolers while following guidelines to minimize the risk of COVID infection transmission.

Children's Independent Mobility and Physical Activity during the COVID-19 Pandemic: A Qualitative Study with Families

Children's independent mobility (CIM) is the freedom of children to move around their neighbourhood without adult supervision and is closely related to overall physical activity participation. The COVID-19 pandemic has impacted movement behaviours for children, with evidence indicating a decrease in physical activity. The aim of this study was to explore experiences of CIM and physical activity during the COVID-19 pandemic from the perspectives of children and their parents. We completed 21 family (at least one parent and one child aged 7-12) semi-structured interviews with 45 participants living in small urban and rural areas of British Columbia, Canada. Three themes were identified through a reflexive thematic analysis: (1) keeping everyone safe from COVID-19; (2) change in pattern and types of activity; (3) social impacts with family, friends, and community. Participants expressed a perceived increase in unstructured activity and a decrease in structured physical activity during the pandemic, which many parents viewed as a positive change. Parents and children indicated negative feelings due to spending less time with peers and reflected positively about spending more time with family. Parents and children expressed fear and anxiety in trying to keep their families safe from virus spread and creativity in adapting play behaviours. Findings highlight the impact of the pandemic on social friendship networks for families and a shift in activity patterns for children toward unstructured play.

A case study exploring the 'real world' process of 'naturalizing' school playgrounds

Background: The aim of this study was to examine the lived experiences of teachers and administrators at two schools (one elementary Kindergarten-Grade 5 and one middle school, grades 6-8) following the 'naturalizing' of a portion of their schoolyard. Methods: A qualitative case study design was used. Focus groups and interviews allowed participants to express their rationale, identify implementation facilitators and barriers and critical processes/steps for realizing their naturalization goals. Researcher questions explored (1) factors which led to naturalizing the schoolyard, (2) key planning and process steps (3) challenges and successes experienced, and, (4) lessons learned. Findings: Six themes were identified as rationale for naturalizing including: re-integration of outdoor play into children's daily lives, pro-active mental health, opportunity for inclusion, nature as a positive space for learning, it fit with our values and principles, we had a need. Implementation was facilitated by having champions and support from multiple levels, adopting a phased approach, resources and having the buy-in to persevere over time. Significant challenges and 'how to' steps were also identified. Conclusions: Naturalizing schoolyards does not happen without a supportive context, significant time and effort. Implementation steps and issues were those commonly found in other school-based health promotion efforts.

Paving the Way for Outdoor Play: Examining Socio-Environmental Barriers to Community-Based Outdoor Play

Outdoor play and independent, neighborhood activity, both linked with healthy childhood development, have declined dramatically among Western children in recent decades. This study examines how social, cultural and environmental factors may be hindering children’s outdoor and community-based play. A comprehensive survey was completed by 826 children (aged 10–13 years) and their parents from 12 schools (four each urban, suburban and rural) from a large county in Ontario, Canada. Five multilevel regression models, controlling for any school clustering effect, examined associations between outdoor play time per week and variable sets representing five prevalent factors cited in the literature as influencing children’s outdoor play (OP). Models predicted that younger children and boys were more likely to spend time playing outdoors; involvement in organized physical activities, other children nearby to play with, higher perception of benefits of outdoor play, and higher parental perceptions of neighborhood social cohesion also predicted more time in outdoor play. Time outdoors was less likely among children not allowed to play beyond home without supervision, felt they were ‘too busy’ with screen-based activities, and who reported higher fears related to playing outdoors. Study findings have important implications for targeting environmental, cultural and policy changes to foster child-friendly communities which effectively support healthy outdoor play.

Systematic review of the correlates of outdoor play and time among children aged 3-12 years

BACKGROUND

Due to the myriad of benefits of children's outdoor play and time, there is increasing concern over its decline. This systematic review synthesized evidence on the correlates of outdoor play and outdoor time among children aged 3-12 years.

METHODS

A total of 12 electronic databases in five different languages (Chinese, English, Korean, Spanish, Portuguese) were searched between October 28, 2019 and July 27, 2020. Covidence software was used for screening and Microsoft Excel with a predesigned coding form was used for data extraction. Evidence was synthesized and correlates were categorized using the socioecological model framework.

RESULTS

Based on 107 studies representing 188,498 participants and 422 childcare centers from 29 countries, 85 studies examined potential correlates of outdoor play while 23 studies examined that of outdoor time (one examined both). The duration of outdoor play and outdoor time ranged between 60 and 165 min/d and 42-240 min/d, respectively. Out of 287 (outdoor play) and 61 (outdoor time) potential correlates examined, 111 correlates for outdoor play and 33 correlates for outdoor time were identified as significant correlates. Thirty-three variables were identified as key/common correlates of outdoor play/time, including eight correlates at the individual level (e.g., sex/gender, race/ethnicity, physical activity), 10 correlates at the parental level (e.g., parental attitude/support/behavior, parenting practice), nine at the microsystem level (e.g., proximal home/social environment such as residence type, peer influence), three at the macrosystem/community level (e.g., availability of space children can play), and three at the physical ecology/pressure for macrosystem change level (e.g., seasonality, rurality). No key correlates were found at the institutional level.

CONCLUSIONS

Individual, parental, and proximal physical (home) and social environments appear to play a role in children's outdoor play and time. Ecological factors (i.e., seasonality, rurality) also appear to be related to outdoor play/time. Evidence was either inconsistent or lacking at institutional and macrosystem/community levels. Standardizing terminology and measures of outdoor play/time is warranted. Future work should investigate the interactions and processes of multiple variables across different levels of socioecological modelling to better understand the mechanisms through which outdoor play/time opportunities can be optimized for children while paying special attention to varying conditions in which children are born, live, and play.

Early childhood educator perceptions of risky play in an outdoor loose parts intervention

Free play is important in early childhood and offers physical and mental health benefits. Outdoor play offers opportunity for children to use natural elements and promotes physical activity, among other health benefits, including exploring their environment and taking risks. Risky outdoor play may involve challenges, heights, speed, and the potential for injury, but has been associated with increased physical activity levels, decreased sedentary behaviour, improved mental health, and social benefits. The integration of loose parts, or open-ended, unstructured materials, into play environments, has been associated with positive social behaviours, creativity, and improved problem-solving, confidence, and resilience. As opportunities for risky play in early childhood are determined by adults, including early childhood educators, it is important to understand their perspectives on these types of play. The purpose of this study was to explore early childhood educators' perspectives of risky play, in the context of the Physical Literacy in the Early Years (PLEY) intervention. PLEY was a mixed methods study that aimed to evaluate a loose parts intervention in early childcare settings. This paper used Qualitative Description to explore educators' perspectives. Data were collected from 15 focus groups with early childhood educators. Four themes were identified through thematic analysis. The first explains how risky play with loose parts contributes to evolution in educator perceptions; the second describes how educators' perceptions of risk are connected to institutions and systems; the third illustrates how educators developed strategies to facilitate risky play with loose parts; and the fourth demonstrates how educators perceive risky play as beneficial for children's healthy development. This project highlights societal shifts in play and how loose parts and risky play fit into the ongoing evolution in play, from the perspectives of early childhood educators.