Systematic review of sedentary behaviour and health indicators in the early years (aged 0-4 years)

The mediating role of the home environment in relation to parental educational level and preschool children's screen time: a cross-sectional study

Background

Previous studies suggest that preschoolers from low socioeconomic backgrounds engage in more screen time. Still, the factors in the social and physical home environment driving these differences in preschool children’s screen time are poorly understood. This study examines potential home environment mediators in the associations between parental educational level and preschoolers’ screen time.

Methods

A total of 864 children aged 3–6 years and their parents participated in a cross-sectional DAGIS study in 2015–2016. Parents recorded their children’s screen time in a diary (N = 823). For the analyses, the daily average screen time at home was calculated. Parental questionnaires (N = 808) assessed educational level and eight social and physical environment factors in the home (i.e., descriptive norm for children’s screen time, parental screen use in front of children, parental importance for limiting children’s screen time, parental attitude toward societal pressures for children’s screen time, access to screens at home, parental self-efficacy for limiting children’s screen time, satisfaction of children’s screen time, and rules for limiting children’s screen time). Parental education was grouped into low, middle, and high education. The associations were tested by conducting mediation analyses adjusted by season and children’s sex and age. The significant mediators in the single-mediator models were included in the final multiple-mediator models.

Results

Of the potential eight mediators, the following four had a significant indirect association: descriptive norm for children’s screen time, parental screen use in front of children, parental importance for limiting children’s screen time, and parental attitude toward societal pressures for children’s screen time. Parents with high education had lower descriptive norm and used fewer screens in front of children compared to parents with middle or low education, and in turn, these factors were associated with less screen time among children from parents with a higher education level. Parents with high education placed greater importance on limiting children’s screen time and felt less societal pressures about children’s screen time compared to parents with low education, and in turn, these factors were associated with less screen time among children from parents with a higher education level.

Conclusions

Our study recognized multiple modifiable mediators in the associations between parental education and preschool children’s screen time. When aiming to diminish socioeconomic status differences in preschool children’s screen time, the focus should be on parental role models, attitudes, and norm related to children’s screen time.

Barriers and facilitators to young children's physical activity and sedentary behaviour: a systematic review and synthesis of qualitative literature

Positive activity behaviours (i.e. higher physical activity [PA]/lower sedentary behaviour [SB]) are beneficial from infancy, yet evidence suggests that young children (0- to 6-year-olds) are relatively inactive. To better understand the perceived influences on these behaviours and to aid intervention development, this paper systematically synthesizes the extensive qualitative literature regarding perceived barriers and facilitators to PA and SB in young children (0-6 years old). A search of eight electronic databases (July 2016) identified 43 papers for inclusion. Data extraction and evidence synthesis were conducted using thematic content analysis, underpinned by the socio-ecological model (i.e. individual, interpersonal, community, organizational and policy levels). Parents, childcare providers and children perceived seven broad themes to be important for PA and SB, including the child; the home; out-of-home childcare; parent-childcare provider interactions; environmental factors; safety; and weather. Each theme mapped onto between one and five levels of the socio-ecological model; barriers and facilitators at the interpersonal level (e.g. parents, care providers and family) were most frequently cited, reflecting the important (perceived) role adults/peers play in shaping young children's behaviours. We provide an overarching framework to explain PA and SB in early childhood. We also highlight where gaps in the current literature exist (e.g. from male carers; in developing countries; and barriers and facilitators in the environmental and policy domains) and where future quantitative work may focus to provide novel insights about children's activity behaviours (e.g. safety and weather).

The effect of a movement-to-music video program on the objectively measured sedentary time and physical activity of preschool-aged children and their mothers: A randomized controlled trial

Regular physical activity (PA) and the avoidance of prolonged sitting are essential for children’s healthy growth, and for the physical and mental wellbeing of both children and adults. In the context of exercise, music may promote behavioral change through increased exercise adherence and participation. The purpose of this study was to determine whether a movement-to-music video program could reduce sedentary behavior (SB) and increase PA in mother-child pairs in the home environment. A randomized controlled trial was conducted in the Pirkanmaa region, Finland, in 2014–2016. The participants consisted of 228 mother-child pairs (child age 5–7 years). The primary outcomes of interest were tri-axial accelerometer-derived SB and PA, which were measured in weeks one (baseline), two, and eight in both the intervention and control groups. Further, the mothers and children in the intervention group used a movement-to-music video program from the beginning of week two to the end of week eight. Secondary outcomes included self-reported screen time. The statistical methods employed comprised an intention-to-treat and linear mixed effects model design. No statistically significant differences between groups were found in primary or secondary outcomes. Among the children in the control group, light PA decreased significantly over time and screen time increased from 89 (standard deviation, SD 37) to 99 (SD 41) min/d. Among mothers and children in the intervention group, no statistical differences were found. In supplementary analysis, the children who stayed at home instead of attending daycare/preschool had on average 25 (95% confidence interval, CI 19–30) min/d more sedentary time and 11 (95% CI 8–14) min/d less moderate-to-vigorous PA than those who were at daycare/preschool. The higher body mass index of mothers was related with 5 (95% CI 2–7) min/d more sedentary time and 1 (95% CI 0–2) min/d less moderate-to-vigorous PA. The movement-to-music video program did not change the objectively measured SB or PA of the mother-child pairs. However, mothers and children seemed to be more sedentary at home, and therefore interventions for decreasing SB and increasing PA should be targeted in the home environment.

Objectively measured physical activity patterns, sedentary time and parent-reported screen-time across the day in four-year-old Swedish children

Background

Physical activity (PA) improves health outcomes accumulating evidence suggests that sedentary time (ST), especially parent-reported screen-time, is associated with negative health outcomes in children. The aim of the present study is to describe levels and patterns of PA and ST across the day and week and activity pattern differences between the sexes, across all weekdays and time spent in and outside the preschool in four-year old children.

Methods

In total 899 four-year old Swedish children who had both complete questionnaire data on screen-time behaviors and objective activity variables and at least 4 days, including one weekend day, with more than 10 h of GT3X+ Actigraph accelerometer wear time data were included in the study. Patterns of PA and ST across the day and week and differences between sexes, weekdays vs. weekend days and time in preschool vs. time spent outside preschool were assessed.

Results

Children engaged in 150 min (SD 73) and 102 min (SD 60) of screen-time on weekend days and weekdays, with 97% and 86% of children exceeding the 1 h guideline for screen-time on weekend days and weekdays, respectively. Accelerometer data showed that boys are more active and less sedentary compared with girls and both sexes were more active and less sedentary on weekdays compared with weekend days, while parent-reported data showed that boys engage in more screen-time compared with girls. Children accumulated 24.8 min (SD. 19) MVPA during preschool time and 26.6 min (SD. 16) outside preschool hours on weekdays, compared with 22.4 min (SD. 18) MVPA during preschool time and 25.3 min (SD. 22) outside preschool hours on weekend days.

Conclusions

Four-year old Swedish children display different activity patterns across the day on weekdays compared to weekend days, with preschool hours during weekdays being the most active segments and preschool hours during weekend days being the least active segments of the day.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4600-5) contains supplementary material, which is available to authorized users.

Prevalence, trajectories, and determinants of television viewing time in an ethnically diverse sample of young children from the UK

Background

Excessive screen viewing in early childhood is associated with poor physical and psycho-social health and poor cognitive development. This study aimed to understand the prevalence, trajectory and determinants of television viewing time in early childhood to inform intervention development.

Methods

In this prospective longitudinal study, mothers of 1558 children (589 white British, 757 Pakistani heritage, 212 other ethnicities) completed questionnaires when their children were approximately 6, 12, 18, 24 and 36 months old. Mothers answered questions about their own and their child’s TV-time. TV-time trajectories were estimated by linear longitudinal multilevel modeling, potential determinants were considered in models.

Results

The modelled trajectory estimated that 75% of children aged 12 months exceeded guidelines of zero screen-time. At 12 months of age an accelerated increase in TV-time was observed (<1 h/day at 14 months, >2 h/day by 30 months old). For every hour of mothers’ TV-time and every hour the TV was on in the home, children’s TV-time was 8 min and 1 min higher respectively at 6 months old (P < 0.05), and 15 min and 3 min higher respectively at 36 months old (P < 0.05). Children whose mothers did not agree that it was important their child did not watch too much TV, had 17 min more TV-time than their counterparts (P < 0.05). Children of first time mothers had 6 min more TV-time (P < 0.05). At 12 months of age, children of mothers experiencing stress watched 8 min more TV (P < 0.05). By 36 months, children of Pakistani heritage mothers had 22 min more TV-time than those of white British mothers (P < 0.05), and an additional 35 min of TV-time if their mother was not born in the UK (P < 0.05).

Conclusions

High levels of TV-time were prevalent. Intervention developers should consider targeting interventions before 12 months of age. Modifiable determinants included mothers’ own TV-time, the time the television is on in the home and mothers’ attitude towards child TV-time. These behaviours may be key components to address in interventions for parents. Mothers experiencing stress, first time mothers, and Pakistani heritage mothers (particularly those born outside of the UK), may be priority groups for intervention.

Longitudinal study of the associations between change in sedentary behavior and change in adiposity during childhood and adolescence: Gateshead Millennium Study

BACKGROUND

Sedentary time (ST) has been reported to have a range of negative health effects in adults, however, the evidence for such effects among children and adolescents is sparse. The primary aim of the study was to examine associations between changes in sedentary behavior (time and fragmentation) and changes in adiposity across childhood and adolescence.

METHODS

Participants were recruited as part of the Gateshead Millennium Study. Measures were taken at age 7 (n=502), 9 (n=506), 12 (n=420) and 15 years (n=306). Participants wore an ActiGraph GT1M and accelerometer epochs were 'sedentary' when recorded counts were ⩽25 counts per 15 s. ST was calculated and fragmentation (SF) was assessed by calculating the number of sedentary bouts per sedentary hour. Associations of changes in ST and SF with changes in adiposity (body mass index (BMI), and fat mass index (FMI)) were examined using bivariate linear spline models.

RESULTS

Increasing ST by 1% per year was associated with an increase in BMI of 0.08 kg m-2 per year (95% CI: 0.06-0.10; P<0.001) and FMI of 0.15  kg m-2 per year (0.11-0.19; P<0.001). Change in SF was associated with BMI and FMI (P<0.001). An increase of 1 bout per sedentary hour per year (that is, sedentary time becoming more fragmented) was associated with an increase in BMI of 0.07  kg m-2 per year (0.06-0.09; P<0.001) and an increase in FMI of 0.14  kg m-2 per year (0.10-0.18; P<0.001) over the 8 years period. However, an increase in SF between 9-12 years was associated with a 0.09  kg m-2 per year decrease in BMI (-0.18-0.00; P=0.046) and 0.11  kg m-2 per year decrease in FMI (-0.22-0.00; P=0.049).

CONCLUSIONS

Increased ST and increased SF from 7-15 years were associated with increased adiposity. This is the first study to show age-specific associations between change in objectively measured sedentary behavior and adiposity after adjustment of moderate-to-vigorous-intensity physical activity in children and adolescents. The study suggests that, targeting sedentary behavior for obesity prevention may be most effective during periods in which we see large increases in ST.

Descriptive analysis of preschool physical activity and sedentary behaviors - a cross sectional study of 3-year-olds nested in the SKOT cohort

Background

Further collection of surveillance data is warranted, particularly in preschool populations, for optimizing future public health promotion strategies. This study aims to describe physical activity (PA) and sedentary behavior (SB) across different settings, including time in and out of daycare, and to determine the proportion of children complying with suggested PA recommendations in a high income country.

Methods

Valid PA was assessed in 231 children (36.4 ± 1.1 months) with the Actigraph GT3X accelerometer, and information regarding date and time of dropping-off/picking-up children in daycare was provided by parents. Mean total PA (i.e., counts per minute (CPM)), moderate-to-vigorous physical activity (MVPA), SB time, and non-SB time was generated and compared across settings. Post hoc, PA and SB were examined in subgroups of low-active (1st quartile) and high-active (4th quartile) children.

Results

Overall, boys and girls spent 1.4 ± 0.3 h/day and 1.2 ± 0.4 h/day in MVPA, respectively. Likewise, boys and girls accumulated 6.7 ± 0.8 h and 6.8 ± 0.9 h of SB time per day, respectively. Higher PA levels consistently co-occurred with lower SB time in the daycare setting. Girls accumulated less SB time in daycare than before and after daycare (β = −12.2%, p < 0.001 & β = −3.8%, p < 0.001, respectively). In boys, daycare-days contained more PA and less SB than non-daycare-days (CPM: β =29, p = 0.046, %MVPA: β = 0.83, p = 0.007, %SB: β = −2.3, p < 0.001, respectively). All children fulfilled recommendations of at least 3 h of daily non-SB. Eighty-nine percent of boys and 72% of girls met the daily 1-h MVPA recommendation for 5 year-olds. Lower proportions of children, especially boys, fulfilled MVPA recommendation on days with no daycare attendance. Generally, large mean differences in MVPA and SB were observed across all settings between the most active and the least active children, and only 7% of the low-active girls and 59% of the low-active boys fulfilled MVPA recommendations.

Conclusions

Overall, the majority of children fulfilled MVPA guidelines for 5 year-olds, and all children complied with suggested recommendations of 180 min of daily activity. Daycare time was found to represent an important setting for PA. Substantial and consistent differences observed in the amount of time spent physically active between high- and low-active children across all settings indicate substantial variations in young children’s PA levels irrespective of the context.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4521-3) contains supplementary material, which is available to authorized users.

Standing Classrooms: Research and Lessons Learned from Around the World

Children spend between 50 and 70 % of their time sitting while at school. Independent of physical activity levels, prolonged sitting is associated with poor health outcomes in adulthood. While there is mixed evidence of health associations among children and adolescents, public health guidelines in the USA, UK, Australia and Canada now recommend young people should break up long periods of sitting as frequently as possible. A potentially effective approach for reducing and breaking up sitting throughout the day is changing the classroom environment. This paper presents an overview of a relatively new area of research designed to reduce youth sitting time while at school by changing the classroom environment (n = 13 studies). Environmental changes included placement of height-adjustable or stand-biased standing desks/workstations with stools, chairs, exercise balls, bean bags or mats in the classroom. These 13 published studies suggest that irrespective of the approach, youth sitting time was reduced by between ~44 and 60 min/day and standing time was increased by between 18 and 55 min/day during classroom time at school. Other benefits include increased energy expenditure and the potential for improved management of students' behaviour in the classroom. However, few large trials have been conducted, and there remains little evidence regarding the impact on children's learning and academic achievement. Nevertheless, with an increasing demand placed on schools and teachers regarding students' learning outcomes, strategies that integrate moving throughout the school day and that potentially enhance the learning experience and future health outcomes for young people warrant further exploration.

Screen Time and Health Indicators Among Children and Youth: Current Evidence, Limitations and Future Directions

Despite accumulating evidence linking screen-based sedentary behaviours (i.e. screen time) with poorer health outcomes among children and youth <18 years of age, the prevalence of these behaviours continues to increase, with roughly half of children and youth exceeding the public health screen time recommendation of 2 h per day or less. The purpose of this article is to provide an overview of key research initiatives aimed at understanding the associations between screen time and health indicators including physical health, quality of life and psychosocial health. Available evidence suggests that screen time is deleteriously associated with numerous health indicators in child and youth populations, including adiposity, aerobic fitness, quality of life, self-esteem, pro-social behaviour, academic achievement, depression and anxiety. However, few longitudinal or intervention studies have been conducted, with most of these studies focusing on physical health indicators. While most studies have used self-reported assessments of screen time, the availability of more objective assessment methods presents important opportunities (e.g. more accurate and precise assessment of sedentary time and screen time) and challenges (e.g. privacy and participant burden). Novel statistical approaches such as isotemporal substitution modelling and compositional analysis, as well as studies using longitudinal and experimental methodologies, are needed to better understand the health impact of excessive screen time, and to develop strategies to minimise or reverse the negative impacts of these behaviours. The evidence to date suggests a clear need for policy aimed at minimising the hazardous health consequences associated with screen time among children and youth.

Association between objectively evaluated physical activity and sedentary behavior and screen time in primary school children

Background

Even when meeting guidelines for physical activity (PA), considerable sedentary time may be included. This study in primary school children investigated the relationships between objectively evaluated sedentary and PA times at different intensities using triaxial accelerometry that discriminated between ambulatory and non-ambulatory PA. The relationships between subjectively evaluated screen time (i.e. time spent viewing television and videos, playing electronic games, and using personal computers) and objectively evaluated sedentary and PA times were examined.

Methods

Objectively evaluated sedentary and PA times were assessed for 7 consecutive days using a triaxial accelerometer (Active style Pro: HJA-350IT) in 426 first to sixth grade girls and boys. Metabolic equivalents [METs] were used to categorize the minutes of sedentary time (≤1.5 METs), light PA (LPA, 1.6–2.9 METs), moderate-to-vigorous PA (MVPA,  ≥3.0 METs) and vigorous PA (VPA,  ≥6.0 METs). The physical activity level (PAL) was calculated using the mean MET value. Subjectively evaluated screen time behaviors were self-reported by participants and parents acting together. The associations between PA and sedentary and screen time variables were examined using partial correlation analyses.

Results

After adjustment for age, body weight and wearing time, objectively evaluated sedentary time correlated strongly with non-ambulatory and total LPA and PAL, moderately with ambulatory LPA, non-ambulatory or total MVPA, and weakly with ambulatory MVPA, ambulatory, non-ambulatory or total VPA. Subjectively evaluated screen time was not associated significantly with objectively evaluated sedentary and PA times or PAL. On average, each reduction of 30 min in daily sedentary time was associated with 6 or 23 min more of MVPA or LPA, respectively.

Conclusions

These findings show that higher daily sedentary time may be compensated mainly by lower LPA, while the association between sedentary time and MVPA was moderate. Therefore, improving MVPA and reducing sedentary time are important in primary school children.

The relationship between screen time, nighttime sleep duration, and behavioural problems in preschool children in China

The purpose of this study was to evaluate the relationships between screen time (ST), nighttime sleep duration, and behavioural problems in a sample of preschool children in China. A sample of 8900 children aged 3-6 years was enrolled from 35 kindergartens, in four cities, in two provinces, in China to evaluate the relationships between ST, nighttime sleep duration, and behavioural problems. Children's ST and nighttime sleep duration were assessed by questionnaires completed by parents or guardians. Behavioural problems were assessed using the Strengths and Difficulties Questionnaire (SDQ), and the Clancy Autism Behaviour Scale (CABS). Multivariate analysis was used to assess the associations between ST, nighttime sleep duration, and behavioural problems. The total SDQ and CABS scores were higher in children with ST ≥2 h/day and sleep duration <9.15 h/day (a P < 0.001 for all). After adjusting for potential confounders, children with ST ≥2 h/day had a significantly increased risk of having total difficulties, emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial problems, as well as behavioural symptoms of autism spectrum disorder. Similar results were found in children with sleep duration <9.15 h/day. No significantly increased risk of emotional symptoms was observed for short sleep duration. Preschool children with more ST and short nighttime sleep duration were significantly more likely to have behavioural problems. These results may contribute to a better understanding of prevention and intervention for psychosocial problems in children.

What mums think matters: A mediating model of maternal perceptions of the impact of screen time on preschoolers' actual screen time

Screen time during the preschool years is detrimental to wellbeing. The impact of parental perceptions on preschoolers' screen time is unknown. This paper explores the association between maternal perceptions of the impact of screen time on their preschoolers' wellbeing with their child's screen time and the potential mediating role of their perception of the appropriate amount of screen time. In 2013–2014, mothers of 575 preschoolers (2–5 years; metropolitan Melbourne and online sources) reported: their perceptions of the impact of screen time on 11 aspects of wellbeing, conceptually grouped to physical, social and cognitive well-being; their perceptions of the appropriate amount of screen time for preschoolers; and their child's actual screen time. Regression analyses investigated associations between perceptions and children's screen time. Mediation by perception of the appropriate amount of screen time was examined using indirect effects. Mothers' perceptions of the impact of screen time on social and cognitive wellbeing had a significant indirect effect on children's actual screen time through mothers' perception of the appropriate amount of screen time for their child. Findings illustrate the potential impact of parents' perceptions on their children's behaviors. Although a significant indirect effect was identified, direction of causality cannot be implied. Further exploration of the direction of association to determine causality, and interventions targeting parental perceptions, are warranted.

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Majority of mothers believe screen time is harmful to children's physical wellbeing.

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Perception of screen time volume associated with preschoolers' screen time

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Concern of poor cognitive, social wellbeing associated with screen time

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Interventions should target perceptions of impact of screen time.

The Preschool Activity, Technology, Health, Adiposity, Behaviour and Cognition (PATH-ABC) cohort study: rationale and design

BACKGROUND

Prevalence estimates internationally suggest that many preschool-aged children (3-5 years) are insufficiently physically active and engage in high levels of screen-based entertainment. Early childhood is the developmental period for which we know the least about the effects of physical activity on development and health. Likewise, rapid technological advancements in mobile electronic media have made screen-based forms of entertainment for young children ubiquitous, and research demonstrating the impacts on cognition, psychosocial well-being, and health has lagged behind the rate of adoption of these technologies. The purpose of the Preschool Activity, Technology, Health, Adiposity, Behaviour and Cognition (PATH-ABC) study is to investigate if physical activity and screen-based entertainment are independently associated with cognitive and psychosocial development, and health outcomes in young children, and if so, how much and which types of these behaviours might be most influential.

METHODS

The PATH-ABC study is a prospective cohort, aiming to recruit 430 3-5 year-old children. Children are recruited through and complete initial assessments at their Early Childhood Education and Care (ECEC) centre, and then 12-months later at their centre or school. Direct assessments are made of children's habitual physical activity using accelerometry, cognitive (executive function) and language development (expressive vocabulary), psychosocial development (emotional understanding, Theory of Mind, empathy, and heart rate variability), adiposity (body mass index and waist circumference), and cardiovascular health (blood pressure and retinal micro- vasculature). Educators report on children's psychological strengths and difficulties and self-regulation. Parents report on children's habitual use of electronic media and other child, parent and household characteristics.

DISCUSSION

The PATH-ABC study aims to provide evidence to enhance understanding of how much and which types of physical activity and screen-based media influence development and health in preschool-aged children. This information would benefit parents, educators, health professionals and governments seeking to develop strategies and policies to give young children the best start in life by promoting healthy levels of physical activity and electronic media use.

Increasing Canadian paediatricians' awareness and use of the new Canadian Physical Activity and Sedentary Behaviour Guidelines for ages 0 to 17 years

Objective

To examine changes in the awareness, use, feasibility, and barriers associated with the Canadian Physical Activity and Sedentary Behaviour Guidelines for Children and Youth ages 0-17 years in a sample of Canadian paediatricians, and to assess tools/resources developed by the Canadian Paediatric Society (CPS).

Methods

Practicing paediatricians who were members of the CPS were invited to complete an on-line survey in February 2013. In response to survey findings, the CPS developed and promoted tools/resources to increase and improve paediatricians' counselling of the guidelines. The CPS membership was surveyed again in September-October 2014. Findings are based on responses from 331 and 217 (23% and 16% participation rate) Canadian paediatricians who completed the survey in 2013 and 2014, respectively.

Results

No significant differences were observed for awareness, use, or feasibility associated with the physical activity or sedentary behaviour guidelines between 2013 and 2014. However, a lack of knowledge/training was reported as a barrier sometimes/often/always by paediatricians significantly less in 2014 (14%) compared to 2013 (32%). Insufficient motivation/lack of support from parents/caregivers/youth was also reported as a barrier less frequently in 2014 (64%) compared to 2013 (75%) but it was borderline non-significant (P=0.05). Only 9% of paediatricians were unaware of the new CPS tools/resources.

Conclusions

The new tools/resources developed by the CPS appeared to reduce some barriers experienced by paediatricians in counselling families about the guidelines. However, this did not appear to translate into greater awareness or use of the guidelines. Continued tool/resource development and training initiatives may be required.

Do the correlates of screen time and sedentary time differ in preschool children?

BACKGROUND

Preschool children can spend up to 12 h a day in sedentary time and few meet current recommendations for screen time. Little is known about ecological correlates that could be targeted to decrease specific versus total sedentary behaviour. This study examined whether the correlates of screen time and sedentary time differ in preschool boys and girls.

METHODS

Parents participating in the HAPPY Study in 2008/09 in Melbourne, Australia reported their child's usual screen time and potential individual, social and physical environment correlates. Children wore ActiGraph GT1M accelerometers for eight days to objectively assess sedentary time (<100 counts.min-1). Multivariable linear regression analyses were performed, stratified by sex and controlling for child age, preschool/childcare attendance and clustering by centre of recruitment. Correlates significantly associated with screen time or sedentary time in individual models (p < 0.05) were included in final combined models.

RESULTS

Children were sedentary for 301.1 (SD 34.1) minutes/day and spent 108.5 (SD 69.6) minutes/day in screen time. There were no sex differences in screen or sedentary time. In the final models, sleep duration was inversely associated with girls' sedentary time and boys' screen time. The only other consistent correlates for boys and girls were parental self-efficacy to limit screen time and screen time rules, which were inversely associated with screen time for both sexes. Parents reporting that they get bored watching their child play was inversely associated and maternal television viewing was positively associated with boys' screen time. Paternal age was positively associated with boys' sedentary time. Maternal ethnicity was inversely associated and paternal education, child preferences for sedentary behaviour, and parental concerns about child's physical activity and sedentary behaviour were positively associated with girls' screen time.

CONCLUSIONS

The modifiable correlates of total sedentary and screen time identified in this study could be targeted in interventions to reduce these behaviours. With correlates differing for screen and sedentary time, and between boys and girls, interventions may also benefit from including behaviour- and sex-specific strategies.

A mobile technology intervention to reduce sedentary behaviour in 2- to 4-year-old children (Mini Movers): study protocol for a randomised controlled trial

Background

Sedentary behaviour (e.g. television viewing, sitting time) tracks over time and is associated with adverse health and developmental outcomes across the lifespan. Young children (5 years or younger) spend up to 12 h/day sedentary, of which around 2 h is spent in screen time (e.g. watching television). Interventions to reduce sedentary behaviour in early childhood report mixed results and many have limited potential for scalability. Mobile phones offer a wide-reaching, low-cost avenue for the delivery of health behaviour programmes to parents but their potential to reduce young children’s sedentary behaviour has not been widely tested. This study aims to test the feasibility and efficacy of a parent-focused, predominantly mobile telephone-delivered intervention to support parents to minimise the amount of time their child spends using screens and in overall sitting time.

Methods/design

Mini Movers is a pilot randomised controlled trial recruiting 100 parents and children. Inclusion criteria include having a child aged between 2 and 4 years, being able to speak, read and write English, and smartphone ownership. Participants will be randomised to the intervention or a wait-list control group at a 1:1 ratio. Intervention group parents will receive printed materials including a content booklet and goal-checking magnet and will participate in a one-on-one discussion with the interventionist to plan two goals to reduce their child’s sedentary behaviour. Subsequently, the intervention will be delivered over 6 weeks via personalised and interactive text messages promoting positive health behaviours (strategies for decreasing screen time and overall sitting time), goal setting and self-monitoring. Outcomes to be assessed include intervention feasibility and children’s screen time and objectively-assessed sitting time.

Discussion

Few studies have used mobile phone technology to deliver health behaviour programmes to parents of young children. Findings will inform the development of larger-scale interventions to reduce sedentary behaviour during early childhood.

Trial registration

Australian New Zealand Clinical Trials registry, identifier: ACTRN12616000628448. Prospectively registered on 16 May 2016.

Electronic supplementary material

The online version of this article (doi:10.1186/s13063-017-1841-7) contains supplementary material, which is available to authorized users.

Outdoor time, physical activity and sedentary time among young children: The 2012-2013 Canadian Health Measures Survey

OBJECTIVES

Previous studies have shown that children who spend more time outdoors are more active and spend less time sedentary, but these studies were limited by the use of small convenience samples. We examined the relationship between outdoor time and measures of physical activity (PA), screen time and sedentary time in a nationally-representative sample of young children.

METHODS

Parental reports of outdoor time were obtained for 594 children aged 3-6 years (47.8% girls) who participated in the 2012-2013 Canadian Health Measures Survey. Participants were asked to wear an Actical accelerometer for seven consecutive days. Outdoor time and screen time were assessed by parent reports. The relationships between outdoor time and measures of PA, screen time and sedentary time were examined with linear regression models. Adherence to PA guidelines was estimated based on a betabinomial distribution, and adherence with the screen time guidelines was assessed through logistic regression models. All analyses were stratified by age group (3-4 and 5-6 year olds) and adjusted for sex, parental education and household income.

RESULTS

Among 5-6 year olds, each additional hour spent outdoors was associated with an additional 10 minutes of moderate-to-vigorous PA (95% CI: 6-14), 27,455 more accelerometer counts/day (95% CI: 11,929-42,980) and an increased likelihood of meeting the PA guidelines (OR = 2.53; 95% CI: 1.68-3.82). No significant relationships were observed among 3-4 year olds.

CONCLUSION

Outdoor time has a large effect on PA among 5-6 year olds at a population level. Future studies should examine the correlates of outdoor time to inform novel PA promotion interventions.

Physical activity, sedentary behavior and their correlates in children with Autism Spectrum Disorder: A systematic review

Autism Spectrum Disorder affects up to 2.5% of children and is associated with harmful health outcomes (e.g. obesity). Low levels of physical activity and high levels of sedentary behaviors may contribute to harmful health outcomes. To systematically review the prevalence and correlates of physical activity and sedentary behaviors in children with Autism Spectrum Disorder, electronic databases (PsycINFO, SPORTDiscus, EMBASE, Medline) were searched from inception to November 2015. The review was registered with PROSPERO (CRD42014013849). Peer-reviewed, English language studies were included. Two reviewers screened potentially relevant articles. Outcomes of interest were physical activity and sedentary behaviour levels and their potential correlates. Data were collected and analysed in 2015. Of 35 included studies, 15 reported physical activity prevalence, 10 reported physical activity correlates, 18 reported sedentary behavior prevalence, and 10 reported sedentary behavior correlates. Estimates of children’s physical activity (34–166 mins/day, average 86 mins/day) and sedentary behavior (126–558 mins/day in screen time, average 271 mins/day; 428–750 mins/day in total sedentary behavior, average 479 mins/day) varied across studies. Age was consistently inversely associated, and sex inconsistently associated with physical activity. Age and sex were inconsistently associated with sedentary behavior. Sample sizes were small. All but one of the studies were classified as having high risk of bias. Few correlates have been reported in sufficient studies to provide overall estimates of associations. Potential correlates in the physical environment remain largely unexamined. This review highlights varying levels of physical activity and sedentary behavior in children with Autism Spectrum Disorder. Research is needed to consistently identify the correlates of these behaviors. There is a critical need for interventions to support healthy levels of these behaviors.

Developing Intervention Strategies to Optimise Body Composition in Early Childhood in South Africa

Purpose. The purpose of this research was to collect data to inform intervention strategies to optimise body composition in South African preschool children. Methods. Data were collected in urban and rural settings. Weight status, physical activity, and gross motor skill assessments were conducted with 341 3–6-year-old children, and 55 teachers and parents/caregivers participated in focus groups. Results. Overweight and obesity were a concern in low-income urban settings (14%), but levels of physical activity and gross motor skills were adequate across all settings. Focus group findings from urban and rural settings indicated that teachers would welcome input on leading activities to promote physical activity and gross motor skill development. Teachers and parents/caregivers were also positive about young children being physically active. Recommendations for potential intervention strategies include a teacher-training component, parent/child activity mornings, and a home-based component for parents/caregivers. Conclusion. The findings suggest that an intervention focussed on increasing physical activity and improving gross motor skills per se is largely not required but that contextually relevant physical activity and gross motor skills may still be useful for promoting healthy weight and a vehicle for engaging with teachers and parents/caregivers for promoting other child outcomes, such as cognitive development.

Maternal and early life nutrition and physical activity: setting the research and intervention agenda for addressing the double burden of malnutrition in South African children

Early life is important for later health outcomes, yet there are few studies which adequately address all of the potential early life insults that may affect later life health and growth trajectories. This is particularly evident in low- to middle-income countries such as South Africa, where women of childbearing age are particularly vulnerable to high levels of physical inactivity, malnutrition, and obesity. Pregnancy may therefore be an opportune time to change behaviours and improve maternal and offspring health outcomes, and decrease the inter-generational transfer of risk. We show clear evidence that physical activity and nutrition are important target areas for intervention during pregnancy and in the early years of life, yet that current literature in Africa, and specifically South Africa, is limited. We have outlined the available literature concerning the impact of maternal and early life nutrition and physical activity on the health status of South African children, and have provided some recommendations for future research and policy.

Informing Active Play and Screen Time Behaviour Change Interventions for Low Socioeconomic Position Mothers of Young Children: What Do Mothers Want?

Introduction. This study investigated views of mothers from disadvantaged urban and regional areas (i.e., beyond major capital cities) as potential end users of child active play and screen time behaviour change interventions, with a focus on text messaging and web-based delivery platforms. Methods. Thirty-two mothers (22 urban; 10 regional) were interviewed. Purpose-designed questions covered topics regarding mothers' preferences for accessing and receiving information related to parenting and child active play and screen time. Data from transcribed interviews were analysed to identify responses and key themes. Results. Mothers reported frequently accessing parenting- and child-related information online. Regional mothers reported seeking information by talking with other people less frequently than urban mothers and seemed to have a stronger preference for receiving information online. There were few differences between responses from low and high educated mothers. The majority of mothers reported that they would be happy to receive text messages containing information about active play and screen time and that they would find a dedicated website with this information useful. Conclusions. Mothers in this study held favourable views on the potential of receiving information via new communication technologies. Future interventions targeting socioeconomically disadvantaged mothers may benefit from delivering intervention messages via these technologies.

"GET-UP" study rationale and protocol: a cluster randomised controlled trial to evaluate the effects of reduced sitting on toddlers' cognitive development

BACKGROUND

The educational and cognitive differences associated with low socioeconomic status begin early in life and tend to persist throughout life. Coupled with the finding that levels of sedentary time are negatively associated with cognitive development, and time spent active tends to be lower in disadvantaged circumstances, this highlights the need for interventions that reduce the amount of time children spend sitting and sedentary during childcare. The proposed study aims to assess the effects of reducing sitting time during Early Childhood Education and Care (ECEC) services on cognitive development in toddlers from low socio-economic families.

METHODS/DESIGN

We will implement a 12-months 2-arm parallel group cluster randomised controlled trial (RCT) with Australian toddlers, aged 12 to 26 months at baseline. Educators from the ECEC services allocated to the intervention group will receive professional development on how to reduce sitting time while children attend ECEC. Participants' cognitive development will be assessed as a primary outcome, at baseline and post-intervention, using the cognitive sub-test from the Bayley Scales of Infant and Toddler Development.

DISCUSSION

This trial has the potential to inform programs and policies designed to optimize developmental and health outcomes in toddlers, specifically in those from disadvantaged backgrounds.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry: ACTRN12616000471482 , 11/04/2016, retrospectively registered.

A scoping review examining physical activity measurement and levels in the first 2 years of life

BACKGROUND

The first few years of life have been identified as a critical stage in the development of activity behaviours, which have been shown to track into later life. This scoping review aims to assess the literature reporting on physical activity levels in the first 2 years of life in order to answer two main questions: (i) how is physical activity measured in this age group? and (ii) how active are infants and toddlers in the first 2 years of life?

METHODS

A search strategy was employed using PubMed with restrictions only on age and language. After applying exclusion criteria, 20 papers were included in the results.

RESULTS

Seventeen studies used some form of objective assessment of physical activity (accelerometers, actometers, direct observation, doubly labelled water or a metabolic chamber); while the remaining three relied on subjective assessments (parent reported questionnaires or interviews, and activity diaries). Nine studies exclusively assessed infants (<12 months), and five exclusively assessed toddlers (>12 months). Only six studies reported physical activity levels and patterns specifically; most included studies measured activity as a covariate or correlate. Therefore, much of the reported data was difficult to assess, as results were vague or incompletely described. Where data were reported sufficiently for analysis, results were equally conflicted regarding whether toddlers were meeting recommended physical activity guidelines.

CONCLUSIONS

This scoping review re-iterates the fact that more studies need to be conducted, which focus primarily on measuring and reporting physical activity levels and patterns in this age group in a comprehensive and standardized way, so that more informed guidelines can be devised and interventions can be designed and implemented where necessary.

Interventions to reduce sedentary behaviour in 0-5-year-olds: a systematic review and meta-analysis of randomised controlled trials

AIM OR OBJECTIVE

To evaluate the effectiveness of behavioural interventions that report sedentary behaviour outcomes during early childhood.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Academic Search Complete, CINAHL Complete, Global Health, MEDLINE Complete, PsycINFO, SPORTDiscus with Full Text and EMBASE electronic databases were searched in March 2016.

ELIGIBILITY CRITERIA FOR SELECTING STUDIES

Inclusion criteria were: (1) published in a peer-reviewed English language journal; (2) sedentary behaviour outcomes reported; (3) randomised controlled trial (RCT) study design; and (4) participants were children with a mean age of ≤5.9 years and not yet attending primary/elementary school at postintervention.

RESULTS

31 studies were included in the systematic review and 17 studies in the meta-analysis. The overall mean difference in screen time outcomes between groups was -17.12 (95% CI -28.82 to -5.42) min/day with a significant overall intervention effect (Z=2.87, p=0.004). The overall mean difference in sedentary time between groups was -18.91 (95% CI -33.31 to -4.51) min/day with a significant overall intervention effect (Z=2.57, p=0.01). Subgroup analyses suggest that for screen time, interventions of ≥6 months duration and those conducted in a community-based setting are most effective. For sedentary time, interventions targeting physical activity (and reporting changes in sedentary time) are more effective than those directly targeting sedentary time.

SUMMARY/CONCLUSIONS

Despite heterogeneity in study methods and results, overall interventions to reduce sedentary behaviour in early childhood show significant reductions, suggesting that this may be an opportune time to intervene.

TRIAL REGISTRATION NUMBER

CRD42015017090.

Mediation of the Physical Activity and Healthy Nutrition Behaviors of Preschool Children by Maternal Cognition in China

(1) Objective: We aimed to explore the role of social cognitive theory (SCT) of mothers in the physical activity and healthy nutrition behaviors of preschool children; (2) Methods: We used a self-administered five-point Likert common physical activity and nutrition behaviors scale in Chinese based on a social cognitive theory scale in English with established validity and reliability in the USA. The current study adopted the proportional sampling method to survey mothers of preschool children in four areas—namely, Chongqing, Chengdu, Taiyuan, and Shijiazhuang—of China; (3) Results: We included 1208 mothers (80.0% mothers of normal weight children, age 31.87 ± 4.19 years). Positive correlations were found between maternal social cognition and preschool children’s physical activity (PA) behavior (p < 0.0001). However, an insignificant correlation is observed between preschool children’s fruits and vegetables (FV) behavior, screen time (ST) behavior, and maternal social cognition; (4) Conclusions: This study provides some implications for increasing fruit and vegetable consumption, increasing physical activity time, and reducing screen time in preschool children using SCT in China. Maternal social cognition is associated with preschool children’s PA behavior, and the results suggest that maternal social cognition may not affect children FV and ST behaviors. Further research is necessary to test the mediation of maternal social cognition on preschool children’s ST behavior and the correlations between maternal social cognition and children’s ST behavior.

Comparing physical activity and sedentary time among overweight and nonoverweight preschoolers enrolled in early learning programs: a cross-sectional study

Establishing appropriate physical activity and sedentary behaviours during early childhood is important to ensure children accrue the many associated health benefits. While physical activity levels have been reported as low within early learning programs, little research has explored the physical activity and sedentary time of Canadian preschoolers classified as overweight within these facilities. The purpose of this study was to compare objectively measured physical activity and sedentary time among preschoolers classified as overweight and nonoverweight in early learning programs. Direct assessment of physical activity and sedentary time of 216 preschool-aged children was collected via Actical accelerometers during early learning hours, while body mass index percentile was calculated based on preschoolers’ objectively measured height and weight. Results of three 3-way ANOVAs suggest that rates of moderate to vigorous physical activity, total physical activity, and sedentary time (p > 0.05) did not significantly differ based on weight status, sex, and type of early learning facility. This study is one of few that has examined differences in overweight and nonoverweight preschoolers’ sedentary time, and adds to the limited research exploring physical activity levels among overweight and nonoverweight preschoolers during early learning hours. Given the high rates of sedentary time reported, programming within early learning facilities is necessary to support preschoolers, regardless of weight status, to achieve increased physical activity levels and decreased sedentary time.

School environment, sedentary behavior and physical activity in preschool children

Objective:

To analyze physical activity and sedentary behavior in preschool children during their stay at school and the associated factors.

Methods:

370 preschoolers, aged 4–6 years, stratified according to gender, age and school region in the city of Londrina, PR, participated in the study. A questionnaire was applied to principals of preschools to analyze the school infrastructure and environment. Physical activity and sedentary behavior were estimated using accelerometers for five consecutive days during the children's stay at school. The odds ratio (OR) was estimated through binary logistic regression.

Results:

At school, regardless of age, preschoolers spend relatively more time in sedentary behaviors (89.6–90.9%), followed by light (4.6–7.6%), moderate (1.3–3.0%) and vigorous (0.5–2.3%) physical activity. The indoor recreation room (OR 0.20, 95%CI 0.05–0.83) and the playground (OR 0.08, 95%CI 0.00–0.80) protect four-year-old schoolchildren from highly sedentary behavior. An inverse association was found between the indoor recreation room and physical activity (OR 0.20, 95%CI 0.00–0.93) in five-year-old children. The indoor recreation room (OR 1.54, 95%CI 1.35–1.77), the playground (OR 2.82, 95%CI 1.14–6.96) and the recess (OR 1.54, 95%CI 1.35–1.77) are factors that increase the chance of six-year-old schoolchildren to be active.

Conclusions:

The school infrastructure and environment should be seen as strategies to promote physical activity and reduce sedentary behavior in preschool children.

Prospective associations between energy balance-related behaviors at 2 years of age and subsequent adiposity: the EDEN mother-child cohort

BACKGROUND/OBJECTIVES

Sedentary behavior, physical activity and dietary behavior are formed early during childhood and tend to remain relatively stable into later life. No longitudinal studies have assessed the independent influence of these three energy balance-related behaviors during toddlerhood on later adiposity. We aimed to analyze the associations between TV/DVD watching time, outdoor play time and dietary patterns at the age of 2 years and child adiposity at the age of 5 years, in boys and girls separately.

SUBJECTS/METHODS

This study included 883 children from the French EDEN mother-child cohort. TV/DVD watching time, outdoor play time and dietary intakes were reported by parents in questionnaires when the child was aged 2 years. Two dietary patterns, labeled 'Guidelines' and 'Processed, fast foods', were identified in a previous study. The percentage of body fat (%BF) based on bioelectrical impedance analysis and body mass index were measured at the age of 5 years.

RESULTS

In boys, TV/DVD watching time at the age of 2 years was positively associated with %BF at the age of 5 years (β=0.50 (95% confidence interval: 0.001, 1.00) for those boys with ⩾60 min per day of TV/DVD watching time vs those with ⩽15 min per day, P-value for trend 0.05). In girls, outdoor play was inversely associated with %BF (β=-0.96 (95% confidence interval: -1.60, -0.32) for those in the highest tertile of outdoor play time vs those in the lowest tertile, P=0.001). Overall, at the age of 2 years, dietary patterns were associated with both TV/DVD watching time and outdoor play time, but no significant and independent association was observed between dietary patterns and later adiposity.

CONCLUSION

This study shows longitudinal and gender-differentiated relations between both TV/DVD watching time and outdoor play time in toddlerhood and later adiposity, whereas evidence for a relation between dietary patterns and subsequent fat development was less conclusive. Early childhood-by the age of 2 years-should be targeted as a critical time for promoting healthy energy balance-related behaviors.

Effects of Child Care Intervention on Physical Activity and Body Composition

INTRODUCTION

This study evaluated whether intervening with child care providers would increase physical activity (PA) and reduce adiposity in preschoolers.

METHODS

This was a two-arm, parallel group, cluster RCT whereby six child care centers were randomly assigned in equal numbers to intervention (n=40 children) or control (n=43 children). Participants were aged 3-5 years and attended licensed child care centers. Child care providers received two 3-hour train-the-trainer workshops and a training manual at program initiation aimed at increasing structured and unstructured PA through active play. Control child care centers implemented their standard curriculum. PA and sedentary behavior were measured by accelerometry, and body composition was measured using bioelectrical impedance at baseline and 6 months. Data were collected in 2011-2012 and analyzed in April 2015.

RESULTS

Linear mixed-effects modeling showed that at 6 months, children in the intervention group demonstrated greater increases in minutes per preschool day spent in overall PA (22.5 minutes, 95% CI=8.9, 36.1, p=0.002), and light-intensity PA (16.1 minutes, 95% CI=5.2, 26.7, p=0.004), but changes between groups in moderate to vigorous PA did not differ. The intervention group showed greater reductions in body fat percentage (-1.9%, 95% CI=-3.5, -0.3, p=0.023) and fat mass (-0.3 kg, 95% CI=-0.7, -0.1, p=0.018), but groups did not differ on fat-free mass, BMI, or z-BMI.

CONCLUSIONS

Provider-led intervention in child care centers increased preschoolers' PA and reduced adiposity, therefore may represent a viable approach to promoting PA and related health benefits in preschool-aged children.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT02293278.

Adherence to Canadian physical activity and sedentary behaviour guidelines among children 2 to 13 years of age

Active living is relevant for healthy child development and disease prevention. In 2011-2012 new Canadian Physical Activity and Sedentary Behaviour Guidelines were developed for children under four and 5-17 years of age. This cross-sectional study assessed children's adherence to the national guidelines, using a large sample of Alberta children ages 2-4 and 5-13 years in 2013. The proportions of children achieving the average daily duration of physical activity and screen time recommended were determined, and child and parental predictors of non-achievement were identified. Participants were 631 parent and child dyads. Data were collected by parental reports of physical activity and screen time during weekdays, and analysed using univariate and multivariate techniques (p < 0.05). Logistic regression models were used to examine factors associated with children's non-achievement of physical activity and screen time recommendations while adjusting for covariates. Sixty-two percent of children aged 2-4 and 26% of children aged 5-13 did not meet physical activity time recommendations, and 64% of children aged 2-4 and 23% of children aged 5-13 exceeded the maximum screen time recommendation. Several associations between parental age and education with non-achievement were observed but associations were not consistent across age groups or behaviours. Among preschoolers, those with middle-age parents were more likely to not achieve physical activity recommendations. Evidence of high non-achievement of the recommendations among children 2-4 years highlights the need for increased programming targeting preschool children. Further research is required to identify modifiable risk factors that may inform future health promotion efforts.

Physical activity and screen use policy and practices in childcare: results from a survey of early childhood education services in New Zealand

OBJECTIVE

To investigate written policies, equipment, strategies and barriers to children's activity in early childhood education settings, including participation in health promotion programs and reported time children spend in active play and using screens while in care.

METHODS

Cross-sectional online survey of licensed childcare services in Auckland and Waikato. Policies were scored using a validated tool (WellCCAT-NZ). Results were analysed using descriptive statistics and multivariate regression.

RESULTS

Managers, head teachers or similar from 237 services completed the survey (28% of invited services). Of these, 35% had a written activity policy; most policies scored low on the WellCCAT-NZ. Comprehensive and strongly worded policies were associated with a lower adult-to-child ratio (p=0.03, adjusted for ECE characteristics). No policies addressed screen use. Children were reported to have teacher-led activity 80 minutes/day, and child-led activity five hours/day (indoor and outdoor). Children watched television daily in 2% and weekly in 11% the services; and used computers daily in 11% and weekly in 22% of services. Fewer than half of services participated in health promotion programs with a physical activity component.

CONCLUSIONS

Childcare services reported having adequate equipment, space and time for physical activity of children; however, there are low participation rates in activity programs and a notable absence of written policy.

Fit 5 Kids TV Reduction Program for Latino Preschoolers: A Cluster Randomized Controlled Trial

INTRODUCTION

Reducing Latino preschoolers' TV viewing is needed to reduce their risk of obesity and other chronic diseases. This study's objective was to evaluate the Fit 5 Kids (F5K) TV reduction program's impact on Latino preschooler's TV viewing.

STUDY DESIGN

Cluster RCT with randomization at the center level and N=160 participants.

SETTING/PARTICIPANTS

Latino children aged 3-5 years and their parents were recruited from six Head Start centers in Houston TX in 2010-2012 with analyses in 2013-2014.

INTERVENTION

F5K was culturally adapted for Latino preschoolers and the overall goal was to reduce TV viewing. Study staff taught F5K over 7-8 weeks during the regular Head Start day directly to intervention students. Control schools provided the usual Head Start curriculum, which did not specifically cover TV viewing.

MAIN OUTCOME MEASURES

Individual-level outcomes were measured prior to (Time 1) and immediately following (Time 2) the intervention. The primary outcome, TV viewing (minutes/day), was measured by validated 7-day TV diaries (parent-reported). Sedentary time was measured by accelerometers.

RESULTS

Per the adjusted repeated measures linear mixed effects model for TV viewing (minutes/day), intervention children decreased from 76.2 (9.9) at Time 1 to 52.1 (10.0) at Time 2, whereas control children remained about the same from 84.2 (10.5) at Time 1 to 85.4 (10.5) at Time 2. The relative difference from Time 1 to Time 2 was -25.3 (95% CI= -45.2, -5.4) minutes for intervention versus control children (N=160, p=0.01). In a similar adjusted model, there was a relative decrease in sedentary time (minutes/day) from Time 1 to Time 2 favoring the intervention children (-9.5, 95% CI= -23.0, 4.1), although not significant at p<0.05.

CONCLUSIONS

F5K reduced Latino preschoolers' TV viewing by >25 minutes daily. These findings have implications for prevention of obesity, related disorders, and health equity.

TRIAL REGISTRATION

This study is registered at www.clinicaltrials.gov NCT01216306.

Objectively measured sedentary behaviour and health and development in children and adolescents: systematic review and meta-analysis

Sedentary behaviour has emerged as a unique determinant of health in adults. Studies in children and adolescents have been less consistent. We reviewed the evidence to determine if the total volume and patterns (i.e. breaks and bouts) of objectively measured sedentary behaviour were associated with adverse health outcomes in young people, independent of moderate-intensity to vigorous-intensity physical activity. Four electronic databases (EMBASE MEDLINE, Ovid EMBASE, PubMed and Scopus) were searched (up to 12 November 2015) to retrieve studies among 2- to 18-year-olds, which used cross-sectional, longitudinal or experimental designs, and examined associations with health outcomes (adiposity, cardio-metabolic, fitness, respiratory, bone/musculoskeletal, psychosocial, cognition/academic achievement, gross motor development and other outcomes). Based on 88 eligible observational studies, level of evidence grading and quantitative meta-analyses indicated that there is limited available evidence that the total volume or patterns of sedentary behaviour are associated with health in children and adolescents when accounting for moderate-intensity to vigorous-intensity physical activity or focusing on studies with low risk of bias. Quality evidence from studies with robust designs and methods, objective measures of sitting, examining associations for various health outcomes, is needed to better understand if the overall volume or patterns of sedentary behaviour are independent determinants of health in children and adolescents.

School environment, sedentary behavior and physical activity in preschool children

OBJECTIVE

To analyze physical activity and sedentary behavior in preschool children during their stay at school and the associated factors.

METHODS

370 preschoolers, aged 4 to 6 years, stratified according to gender, age and school region in the city of Londrina, PR, participated in the study. A questionnaire was applied to principals of preschools to analyze the school infrastructure and environment. Physical activity and sedentary behavior were estimated using accelerometers for five consecutive days during the children's stay at school. The odds ratio (OR) was estimated through binary logistic regression.

RESULTS

At school, regardless of age, preschoolers spend relatively more time in sedentary behaviors (89.6%-90.9%), followed by light (4.6%-7.6%), moderate (1.3%-3.0%) and vigorous (0.5%-2.3%) physical activity. The indoor recreation room (OR=0.20; 95%CI 0.05 to 0.83) and the playground (OR=0.08; 95%CI 0.00 to 0.80) protect four-year-old schoolchildren from highly sedentary behavior. An inverse association was found between the indoor recreation room and physical activity (OR=0.20; 95%CI 0.00 to 0.93) in five-year-old children. The indoor recreation room (OR=1.54; 95%CI 1.35 to 1.77), the playground (OR=2.82; 95%CI 1.14 to 6.96) and the recess (OR=1.54; 95%CI 1.35 to 1.77) are factors that increase the chance of six-year-old schoolchildren to be active.

CONCLUSIONS

The school infrastructure and environment should be seen as strategies to promote physical activity and reduce sedentary behavior in preschool children.

Determinants of changes in sedentary time and breaks in sedentary time among 9 and 12 year old children

The current study aimed to identify the determinants of objectively measured changes in sedentary time and sedentary fragmentation from age 9- to age 12 years. Data were collected as part of the Gateshead Millennium Birth Cohort study from September 2008 to August 2009 and from January 2012 to November 2012. Participants were 9.3 (± 0.4) years at baseline (n = 508) and 12.5 (± 0.3) years at follow-up (n = 427). Sedentary behaviour was measured using an ActiGraph GT1M accelerometer. Twenty potential determinants were measured, within a socio-ecological model, and tested for their association with changes in sedentary time and the extent to which sedentary behaviour is prolonged or interrupted (fragmentation index). Univariate and multivariate linear regression analyses were conducted. Measurements taken during winter and a greater decrease in moderate-to-vigorous intensity physical activity (MVPA) over time were associated with larger increases in sedentary time (seasonality β: - 3.03; 95% CI: - 4.52, - 1.54; and change in MVPA β: - 1.68; 95% CI: - 1.94, - 1.41). Attendance at sport clubs was associated with smaller increases in sedentary time (- 1.99; - 3.44, - 0.54). Girls showed larger decreases in fragmentation index (- 0.52; - 1.01, - 0.02). Interventions aimed at decreasing the decline in MVPA and increasing/maintaining sport club attendance may prevent the rise in sedentary time as children grow older. In addition, winter could be targeted to prevent an increase in sedentary time and reduction in sedentary fragmentation during this season.

Supporting Physical Activity in the Childcare Environment (SPACE): rationale and study protocol for a cluster randomized controlled trial

BACKGROUND

Young children are prone to low levels of physical activity in childcare. Researchers have identified that preschoolers tend to be more active outdoors than indoors, with higher activity levels occurring during the first 10 minutes of outdoor playtime. Additionally, interventions incorporating either staff training or the inclusion of play equipment have been effective at increasing children's activity in this setting. As such, the overarching objective of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention is to improve the physical activity levels of preschoolers during childcare hours, utilizing a combination of the above components. The purpose of this manuscript is to provide a detailed account of the protocol, innovative methods, and evaluation plans used in the implementation of the SPACE study; in an effort to support the development of further research in this field.

METHODS/DESIGN

The SPACE study, a cluster randomized controlled trial, involves 22 childcare centres randomly allocated to either the experimental (n = 11) or the control (n = 11) group. Childcare centres receiving the intervention will adopt an 8-week physical activity intervention with the following components: 1. shorter, more frequent bouts of outdoor playtime (4 × 30 min periods rather than 2 × 60 min periods); 2. new portable play equipment (e.g., obstacle course, balls); and, 3. staff training (1 × 4 hr workshop). Actical accelerometers will be used to assess total physical activity with measurements taken at baseline (i.e., week 0), immediately post-intervention (i.e., week 8), and at 6- and 12-month follow-up. As secondary objectives, we aim to evaluate the effectiveness of the intervention on preschoolers': a) sedentary time; b) standardized body mass index scores (percentiles); c) health-related quality of life; and childcare providers' physical activity-related knowledge and self-efficacy to implement physical activity.

DISCUSSION

The SPACE study aims to increase the low levels of physical activity observed within childcare centres. The findings of this work may be useful to policy makers and childcare providers to consider modifications to the current childcare curriculum and associated outdoor play time.

TRIAL REGISTRATION

ISRCTN70604107 (October 8, 2014).

The effect of a cluster randomised control trial on objectively measured sedentary time and parental reports of time spent in sedentary activities in Belgian preschoolers: the ToyBox-study

BACKGROUND

In preschoolers, high levels of sedentary behaviour are associated with several adverse health outcomes. The purpose of this study is to report the effects of the ToyBox-intervention (a European 24-week cluster randomised controlled trial) on sedentary behaviour in preschoolers.

METHODS

In Belgium, 859 preschoolers from 27 kindergartens (15 intervention and 12 control) wore an accelerometer to objectively measure their sedentary time and 1715 parents/caregivers completed a questionnaire to assess sedentary activities in which preschoolers participate at home. Main outcomes were objectively measured sedentary time, time spent watching TV, using the computer and time spent in quiet play. Multilevel repeated measures analyses were conducted to take clustering into account. Intention to treat analysis was used to handle missing data.

RESULTS

A sample of 859 (29.5% of all contacted children) preschoolers (4.4 ± 0.6 years, 54.4% boys) provided valid accelerometer data at either baseline or follow-up and parents of 1715 (58.9% of all contacted children) preschoolers (4.4 ± 0.5 years, 52.5% boys) completed a questionnaire at either baseline or follow-up. No intervention effects were found on objectively and subjectively measured total sedentary time in the total sample. However, some effects on objectively and subjectively measured sedentary time were found in specific subgroups. Preschoolers from the intervention group from high SES kindergartens and preschoolers with high levels of sedentary time at baseline decreased their sedentary time, while preschoolers from the control group increased their sedentary time. Girls in the intervention group decreased their TV viewing time during weekend days (-5.83 min/day), while girls' &TV viewing in the control group increased (+4.15 min/day). In low SES kindergartens, a smaller increase for computer time during weekend days was found in preschoolers in intervention kindergartens (+6.06 min/day) than in control kindergartens (+12.49 min/day).

CONCLUSION

While some small positive effects were found in some sub-groups, the ToyBox-intervention had no effect on objectively and subjectively measured sedentary time in the total sample. A longer period to implement the intervention and a more active involvement of parents/caregivers might enhance intervention effects. The ToyBox-study is registered with the clinical trials registry clinicaltrials.gov, ID: NCT02116296.

Adherence to combined lifestyle factors and their contribution to obesity in the IDEFICS study

BACKGROUND

The Identification and prevention of Dietary- and lifestyle-induced health EFfects In Children and infantS (IDEFICS) study investigated the aetiology of childhood obesity and developed a primary prevention programme.

METHODS

Pre-intervention adherence to key behaviours related to childhood obesity, namely water/sweetened drink, fruit/vegetable consumption, daily TV time, physical activity, family time and adequate sleep duration, was measured at baseline. Adherence to international recommendations was converted into a composite score ranging from 0 (none) to 6 (adhering to all). Data on adherence were available for 7,444 to 15,084 children aged 2-9.9 years, depending on the behaviour. By means of multi-level logistic regression models adjusted for age, sex and country, we calculated odds ratios (OR) and 95% confidence intervals (CI) to estimate the relationship between adherence to these recommendations and the risk of being overweight/obese.

RESULTS

Adherence ranged from 15.0% (physical activity) to 51.9% (TV time). As adherence increased, a lower chance of being overweight/obese was observed; adhering to only one key behaviour (score = 1) meant an OR = 0.81 (CI: 0.65-1.01) compared with non-adherence (score = 0), while adhering to more than half of the key behaviours (score ≥ 4) halved the chance for overweight/obesity (OR = 0.54, CI: 0.37-0.80). Adherence to physical activity, TV and sleep recommendations was the main driver reducing the chance of being overweight. Overweight/obese children were more likely not to adhere to at least one of the recommended behaviours (19.8%) than normal-weight/thin children (12.9%)

CONCLUSION

The selected key behaviours do not contribute equally to a reduced chance of being overweight. Future interventions may benefit most from moving more, reducing TV time and getting adequate sleep.

An objective assessment of toddlers' physical activity and sedentary levels: a cross-sectional study

BACKGROUND

Little evidence exists on the physical activity and sedentary time of Canadian toddlers; this study objectively measured such behaviors and compared participants' activity levels to national guidelines. Levels of screen-viewing among toddlers were also explored.

METHODS

Forty toddlers (mean age = 25.7 months) wore Actical accelerometers for seven consecutive days (15 s epoch). Parents/guardians completed a wear-time log and a demographic and screen-viewing questionnaire. Descriptive analyses were used to determine participants' levels of physical activity and sedentary time, to identify whether toddlers were meeting physical activity/sedentary guidelines, and to explore demographic variables. T-tests were used to assess whether toddlers' activity levels differed based on cut-points applied and various demographic and screen-related variables. Regression analyses were conducted to examine associations between toddlers' sedentary time and screen-viewing levels.

RESULTS

Toddlers engaged in 37.27 (SD = 3.79) to 49.40 (SD = 3.29) mins/hr of sedentary time, 9.79 (SD = 2.90) to 18.78 (SD = 3.22) mins/hr of light-intensity physical activity (LPA), 0.82 (SD = 0.72) to 3.95 (SD = 1.93) mins/hr of moderate- to vigorous-intensity physical activity (MVPA), and 10.60 (SD =3.29) to 22.73 (SD = 3.97) mins/hr of total physical activity (TPA), based on the Trost et al. and the Canadian Health Measures Survey (CHMS) cut-points respectively; these rates were significantly different (p <.001). On at least 1 day, 17.5 % (Trost et al. cut-points) and 97.5 % (CHMS cut-points) of the sample met or exceeded the Canadian physical activity guidelines. No statistically significant differences in sedentary time or physical activity (all intensities) based on sex were reported (p <.001); however, LPA (CHMS cut-points) did significantly differ based on childcare attendance (p <.05). Approximately 93.2 % of participants watched television, and 56.8 % utilized computers. Only 18.8 and 25.0 % of children under 2 years and 70.8 and 62.5 % of 2-3 years olds met the screen-use recommendation of the sedentary behavior guidelines on weekdays and weekend days, respectively.

DISCUSSION AND CONCLUSION

The implications of this work suggest that a greater understanding of toddlers' activity patterns is needed; additional mechanisms of promoting active behaviors among this group should be explored.

UK Preschool-aged children's physical activity levels in childcare and at home: a cross-sectional exploration

BACKGROUND

Young children are thought to be inactive in childcare, but little is known about location-specific activity levels. This observational study sought to describe the in-care and out-of-care activity patterns of preschool-aged children and explore differences in physical activity level by childcare attendance.

METHODS

Three to four-year-old children were recruited from 30 preschool and nursery 'settings' in Cambridgeshire, UK. Average minutes per hour (min/h) spent sedentary (SED), in light physical activity (LPA) and in moderate-to-vigorous PA (MVPA) were measured by accelerometry for up to 7 days (mean: 6.7 ± 1.1). Weekly childcare attendance patterns were reported by parents. The within-child association between childcare attendance and outcomes was assessed using two- and three-level hierarchical regression; sex by care (in/out) interactions were considered.

RESULTS

Two hundred and two children (51% female) had valid activity data for ≥2 days. Children, and particularly boys, were less sedentary and more active when in care compared to at home (SED: Boys: β (SE): -6.4 (0.5) min/h, Girls: -4.8 (0.5); LPA: Boys: 0.6 (0.4), Girls: 1.8 (0.4); MVPA: Boys: 5.7 (0.5); Girls: 3.0 (0.4)). Differences between in-care and at-home activity were largest in the (early) mornings and early evenings for boys; no compensation in at-home activity occurred later in the day. On days when children were in care part-time (1-5 h) or full-time (>5 h), they were significantly less sedentary and more active compared with non-care days.

CONCLUSIONS

Young children, and particularly boys, accumulate more MVPA in care compared to at home. Future research should identify factors accounting for this difference and consider targeting non-care time in intervention efforts to increase higher-intensity activity and decrease sedentary time in preschoolers.

Prevalence and influences of preschoolers' sedentary behaviors in early learning centers: a cross-sectional study

Background

Recent research has highlighted the need for increased evidence regarding the sedentary activity levels of preschoolers. Given the large proportion of time this population spends in various early learning facilities, the exploration of sedentary behaviors within this particular environment should be a priority. The purpose of the study was two-fold: (1) to compare sedentary time of preschoolers in three different early learning environments (i.e., full-day kindergarten [FDK], center-, and home-based childcare); and (2) to assess which characteristics (i.e., staff behaviors, sedentary environment, fixed play environment, portable play environment, sedentary opportunities) of these early learning environments influence preschoolers’ sedentary time.

Methods

Data collection occurred between September 2011 and June 2012. Preschoolers’ sedentary time was measured using Actical™ accelerometers at a 15 s epoch. The Environment and Policy Assessment and Observation (EPAO) tool was used to assess the sedentary environment of participating early learning classrooms, and those subscales (n = 5) that were evidence-informed as potentially influencing sedentary time in early learning centers were explored in the current study. A linear mixed model ANCOVA was carried out to determine the differences in sedentary time based on type of early learning environment while direct entry regression analyses were performed to describe the relationships between sedentary time and the five sedentary-specific EPAO subscale.

Results

Preschoolers (n = 218) from 28 early learning programs (i.e., 8 FDK, 9 centre-, and 8 home-based childcare facilities) participated. Accelerometry data revealed that preschoolers attending centre-based childcare engaged in the highest rate of sedentary time (41.62 mins/hr, SD = 3.78) compared to preschoolers in home-based childcare (40.72 mins/hr, SD = 6.34) and FDK (39.68 mins/hr, SD = 3.43). The models for FDK, center-based childcare, and home-based childcare, comprised each of the five EPAO subscales accounted for 10.5 %, 5.9 %, and 40.78 % of the variability in sedentary time, respectively. Only the models for FDK and home-based childcare were found to be statistically significant (p < .05).

Conclusions

This is the first exploration of differences in sedentary time among preschoolers in different early learning arrangements. Findings highlight the substantial portion of the day preschoolers spend in sedentary pursuits, and subsequently, the ongoing need to reduce preschoolers’ sedentary time in early learning programs, particularly among those attending centre-based childcare facilities.

Mothers' perceptions of the UK physical activity and sedentary behaviour guidelines for the early years (Start Active, Stay Active): a qualitative study

OBJECTIVES

Higher levels of physical activity (PA) during early childhood have been associated with improved health outcomes, whereas sedentary behaviour (SB) has been associated with poorer health outcomes in children. In 2011, the UK produced guidelines for PA and SB in children under 5 years. Mothers have been identified as key influences in young children's PA and SB. The aim of this study was to use in-depth interviews with mothers of preschool children to examine attitudes to the guidance.

DESIGN

Qualitative study using one-to-one, semistructured interviews; Data were analysed thematically using a framework approach.

SETTING

Mothers were recruited from preschools, nurseries, and mother and toddler groups located in four areas of varying socioeconomic status within Bristol, UK.

PARTICIPANTS

24 mothers who were considered the main or joint carer for a preschool child who was at least 2 years of age but had not yet started formal schooling.

RESULTS

Mothers are not aware of the UK PA and SB guidelines for the early years. They believe that their child achieves the guideline targets for PA and SB and therefore, they do not believe these quidelines are relevant to them. Mothers feel that an increase in PA and reduction in SB (especially screen-viewing) would cause stress for mothers. Mothers found defining and quantifying PA and SB in their preschool child problematic.

CONCLUSIONS

As mothers do not identify with the need to increase PA or reduce SB in their child, awareness of the guidelines alone is unlikely to initiate behaviour change. Information on how mothers can make a more accurate assessment of their preschool child's PA and SB levels, and information about the benefits of increased PA and reduced SB should be provided alongside the guideline targets. Clear messages need to be developed that reframe the guidelines into pragmatic and usable targets.

Systematic review of sedentary behavior and cognitive development in early childhood

OBJECTIVE

To comprehensively review observational and experimental studies examining the relationship between sedentary behavior and cognitive development during early childhood (birth to 5years).

METHOD

Electronic databases were searched in July, 2014 and no limits were imposed on the search. Included studies had to be peer-reviewed, published, and meet the a priori determined population (apparently healthy children aged birth to 5years), intervention (duration, types, and patterns of sedentary behavior), comparator (various durations, types, or patterns of sedentary behavior), and outcome (cognitive development) study criteria. Data extraction occurred in October and November 2014 and study quality and risk of bias were assessed in December 2014.

RESULTS

A total of 37 studies, representing 14,487 participants from nine different countries were included. Thirty-one studies used observational study designs and six studies used experimental study designs. Across study designs, increased or higher screen time (most commonly assessed as television viewing (TV)), reading, child-specific TV content, and adult-specific TV content had detrimental (negative) associations with cognitive development outcomes for 38%, 0%, 8%, and 25% of associations reported, respectively, and beneficial (positive) associations with cognitive development outcomes for 6%, 60%, 13%, and 3% of associations reported, respectively. Ten studies were moderate quality and 27 studies were weak quality.

CONCLUSIONS

The type of sedentary behavior, such as TV versus reading, may have different impacts on cognitive development in early childhood. Future research with reliable and valid tools and adequate sample sizes that examine multiple cognitive domains (e.g., language, spatial cognition, executive function, memory) are needed. Registration no. CRD42014010004.

Prevalence of sedentary behavior in children under 2years: A systematic review

Sedentary behavior has negative health outcomes, evident even in young children. Identifying the prevalence of sedentary behavior in children <2years is important for determining the necessity for intervention strategies. The aim of this systematic review was to determine the prevalence of sedentary behavior in children <2years. Medline, PsycINFO, SPORTDiscus, and Education Research Complete electronic databases were searched, as were reference lists of included articles and the authors' own collections. Inclusion criteria were: published in a peer-reviewed English language journal; mean age of children <2years; and a reported measure of the prevalence of sedentary behavior. Twenty-four studies met the inclusion criteria. Most studies used parent-reported screen time as the sedentary behavior measure; only one study reported time spent restrained (i.e., kept inactive) and no studies reported objectively assessed sedentary time. Estimates of young children's screen time ranged from 36.6 to 330.9min/day. The proportion of children meeting the zero screen time recommendation ranged from 2.3% to 83.0%. In conclusion, very little is known about sedentary behaviors other than screen time in this age group. Although highly variable, findings suggest that children are already engaging in high levels of screen time by age 2 and the majority exceed current recommendations.

Secular Changes of Adiposity and Motor Development in Czech Preschool Children: Lifestyle Changes in Fifty-Five Year Retrospective Study

Secular trends of adiposity and motor development in preschool children since the fifties of the last century up to the beginning of this millennium were analyzed so as to reveal possible changes due to continuously differentiating lifestyle. In preschool children (n = 3678) height, weight, skinfold thickness over triceps, subscapular, and suprailiac were measured by Harpenden caliper in 1957, 1977, 1980, 1985, 1990, and 2012. Simultaneously, motor performance was tested by evaluating the achievements in broad jump and throwing a ball, as a marker of adaptation to changing level of physical activity, free games, and exercise. Along the period of five decades the values of skinfold thickness increased significantly until 2012, mainly on the trunk. Simultaneously, the level of motor performance significantly decreased. Modifications of the way of life during the mentioned five decades characterized by sedentarism and inadequate food intake as related to energy output influenced negatively both adiposity and motor performance already in preschool children. Mostly increased deposition of fat on the trunk which is considered as a marker of possible development of metabolic syndrome was apparent already in preschool age, indicating the importance of early intervention concerning also physical activity and availability for exercise since early life.