Position Statement on Active Outdoor Play

A Systematic Review Protocol to Identify the Key Benefits and Efficacy of Nature-Based Learning in Outdoor Educational Settings

Outdoor Learning in natural environments is a burgeoning approach in the educational sector. However, the evidence-base of research has not kept pace with teacher perceptions and increased practitioner usage. Anecdotal evidence and formal research suggest the significant health and wellbeing benefits of nature connection. Offering low-cost, non-invasive pedagogical solutions to public health challenges—particularly around mental health, wellbeing, physical literacy, and increasing physical activity–the pedagogical benefits of Outdoor Learning are yet to be fully enunciated. The proposed systematic review will search for studies across eight academic databases which measure the academic and socio-emotional benefits of Outdoor Learning, with a focus on school-aged educational settings. Using the inclusion criteria set out in this paper (and registered with PROSPERO: CRD42020153171), relevant studies will be identified then summarised to provide a synthesis of the current literature on Outdoor Learning. The goal of this review is to document the widespread international investigation into Outdoor Learning and its associated benefits for development, wellbeing, and personal growth. The systematic review will provide insights for teacher-training institutions, educational policy makers, and frontline teachers to improve the learning experiences of future students.

Developing a comprehensive school-based physical activity program with flexible design - from pilot to national program

This article focuses on the process of designing the vital, participatory school-based intervention program aiming to increase the physical activity in schools. The program analyzed is Estonian nationwide comprehensive physical activity program Schools in Motion (SiM) that recently received European Commission's #BeActive Education Award. The program has a good performance in terms of willingness of schools to participate in co-creation of program development, the high interest to join the program and zero dropouts, and strong partnership with ministries which enables to actively participate in policy making. Authors analyze the key elements of the planning, piloting, implementation, and scaling phases of the SiM program and share their lessons learnt in co-working with schools. The difficulties faced during the development process, the strengths and challenges associated with an interdisciplinary approach, and involvement of schools as experts have been addressed.

Individual differences in social play behaviour predict alcohol intake and control over alcohol seeking in rats

RATIONALE

Social play behaviour is a rewarding social activity displayed by young mammals, thought to be important for the development of brain and behaviour. Indeed, disruptions of social play behaviour in rodents have been associated with cognitive deficits and augmented sensitivity to self-administration of substances of abuse, including alcohol, later in life. However, the relation between social development and loss of control over substance use, a key characteristic of substance use disorders including alcohol use disorder (AUD), has not been investigated. Moreover, it remains unknown how inherent differences in playfulness relate to differences in the sensitivity to substance use and AUD.

OBJECTIVE

The objective of this study is to determine how individual differences in juvenile social play behaviour predict alcohol intake and loss of control over alcohol seeking.

METHODS

Juvenile male Lister hooded rats were characterized for their tendency to engage in social play behaviour. Subsequently, alcohol consumption and conditioned suppression of alcohol seeking were assessed in the tertiles of rats that showed the most and least social play.

RESULTS

The rats that engaged most in social play behaviour consumed more alcohol than their less playful counterparts. However, whereas the most playful rats showed intact conditioned suppression of alcohol seeking, the least playful rats showed no such suppression.

CONCLUSION

Individual levels of playfulness predict the sensitivity to alcohol-directed behaviour. Highly playful rats are more prone to alcohol intake, yet show greater control over alcohol seeking. These findings increase our understanding of the relationship between social development and vulnerability to AUD.

School recess and pandemic recovery efforts: ensuring a climate that supports positive social connection and meaningful play

As Canada’s schools reopen, attention to healing the school community is essential. Given the considerable stressors of the COVID-19 pandemic, it is unsurprising that recent studies find Canadian children’s mental health in decline. As social connection is tightly entwined with children’s mental health, supporting school-based spaces for quality social interactions and play will be an important postpandemic recovery strategy. Children will need opportunities to re-establish positive social connections at school, and informal spaces such as recess and lunch are an ideal time to afford these opportunities. Yet many schoolyards have long been challenged by social conflict that can interfere with children’s need to connect with peers. Therefore, efforts should be directed not only at mitigating the effects of social harm, but also toward ensuring social and physical landscapes that are meaningful, inclusive, and engaging for children and adolescents of all ages. Recommendations for postpandemic recovery are provided.

Regional differences in access to the outdoors and outdoor play of Canadian children and youth during the COVID-19 outbreak

To reduce the spread of COVID-19, public health authorities across the country have recommended that Canadians keep their distance, wash their hands, and stay home. To enforce these measures, restrictions on outdoor behaviour have been implemented, limiting access to parks and recreational outdoor spaces. New evidence shows that COVID-19 restrictions are associated with an overall lower amount of time spent in outdoor play among Canadian children and youth. This is concerning, as outdoor play is important for children's physical and mental health and helps provide them with a sense of control during times of uncertainty and stress. As policies on access to the outdoors during the COVID-19 outbreak vary by province, it is possible that policy differences have led to regional differences in changes in outdoor play among children and youth. In this commentary, we examine regional differences in outdoor play among children and youth across Canada, and the association between provincial policies related to COVID-19 and outdoor play. We argue that through the recovery process, in the event of a second wave of infections, and in preparing for future public health challenges, policy decisions should consider ways to preserve outdoor play for Canadian children and youth.

Methodological Challenges in Investigating Supracondylar Fractures of the Humerus From a Child's Viewpoint: Evolution of Study Protocol

Background

Outdoor play and risk-taking behaviors, including play at heights, are important to children’s physical, social, and cognitive development. These aspects of play are important to consider when informing prevention policies for serious injuries that commonly occur on play structures. Supracondylar fractures of the humerus (SCH) are the most common type of elbow fractures that result from falls on an outstretched hand among healthy children. Despite being one of the leading causes of admission to the hospital and surgical intervention, the details surrounding the cause of these injuries are often not recorded. Previous research has correlated decreased overall playground safety with higher rates of SCH fractures. Play structure height and the type of undersurface have been identified as potential risk factors for severe injuries, including SCH fractures, in part due to low compliance with safety standards. This paper explores the challenges we encountered designing the study and the resulting insights and methodological modifications we made.

Objective

The aim of this paper is to discuss the challenges related specifically to clinical research in pediatrics and strategies developed to conduct a study that prioritizes the engagement and perspective of children and their families.

Methods

To explore the link between the severity of SCH fractures and children’s behavioral, environmental, and mechanistic factors, we conducted a mixed-methods study.

Results

During phase 1 (the original methodology) from April 2017 to July 2018, there were 58 eligible study participants and 17 were recruited. For phase 2 (the revised methodology) between October 2018 and October 2019, there were 116 eligible participants and 47 were recruited.

Conclusions

The changes in methodology made following the first phase of data collection were effective in our ability to recruit participants. By identifying and addressing challenges pertaining to recruitment and resource limitations, we were able to collect data in a concise manner while not compromising the quality of the data and make for an easily adoptable methodology for other sites interested in participating in the study. We hope that future studies that plan to employ a similar methodology can gain insight through the methodological challenges we have encountered and the way we adapted the methodology to build a more pragmatic approach.

International Registered Report Identifier (IRRID)

DERR1-10.2196/21816

Can Functionalised Play Make Children Happy? A Critical Sociology Perspective

The functionalisation of play basically stems from the diagnosis of a global childhood inactivity crisis, the so-called "children's obesity pandemic." Hence, in the context of the activity-related guidelines, children's play appears no longer to be unproductive and purpose-free. It is rather considered an anti-obesity tool that will help children to meet physical activity recommendations. It is questionable whether such a functionalised tool can also provide what has been called the salience of the pleasures of free-play for children. Furthermore, a "normalization" of functionalised practices of play, in turn, could stigmatize children who do not or cannot adhere to these practices. Based upon this background, this paper will take a critical sociology perspective to analyse the functionalisation and medicalisation of children's play in an individualized, mediatized, and pedagogised society. In this sense, the paper aims to pay attention to how the primary goal of play in the sense of "simply make children happy" has given way to the goal of making them healthy and functional.

Playground equipment-related extremity fractures in children presenting to US emergency departments, 2006-2016

Background

Despite updated playground equipment and improved industry standards, playgrounds remain a common source of childhood injury. Fractures account for 35% of all playground injuries presenting to emergency departments (EDs). We aimed to examine the time trends and epidemiologic patterns of playground equipment-related extremity fractures in children in the United States.

Methods

We analyzed data from the National Electronic Injury Surveillance System. Children ≤14 years presenting to US emergency departments from 2006 to 2016 with playground equipment-related injuries were included. We used weighted complex survey analysis to describe the epidemiologic patterns and severity of playground equipment-related extremity fractures and Joinpoint linear weighted regression analysis to determine trends in extremity fractures.

Results

An annual average of 72,889 children were treated in US EDs for playground equipment-related extremity fractures, yielding a national annual incidence rate of 119.2 per 100,000 children. Playground equipment-related extremity fractures accounted for 33.9% of ED presentations and 78.7% of hospitalizations for playground equipment-related injuries. Of patients with playground equipment-related extremity fractures, 11.2% had severe fractures requiring hospitalization. The annual rate of ED visits due to playground equipment-related extremity fractures remained stable (annual rate of change = 0.74, p = 0.14) from 2006 to 2016. Adjusted for age, injuries on monkey bars or climbing gyms were associated with significantly increased odds of extremity fractures in comparison to injuries from other playground equipment (adjusted odds ratio [aOR]: 2.0; 95% CI: 1.9–2.1). Overall, 49.8% of extremity fractures and 54.7% of severe extremity fractures (i.e. those requiring hospitalization) occurred on monkey bars or climbing gyms.

Conclusions

Despite enhanced playground safety standards, national rates of playground equipment-related extremity fractures have remained stable in the US. Extremity fractures remain the most common type of playground injury presenting to EDs and most commonly occur on monkey bars and climbing gyms.

Examining correlates of outdoor play in childcare centres

OBJECTIVES

Childcare centres are an important setting for young children to engage in outdoor play. The objectives for this study were to (1) determine the average outdoor play duration and frequency for toddlers (19-35 months) and preschoolers (36-60 months) in childcare centres, (2) determine if duration and frequency differed across winter (December-March) and non-winter (April-November) months, and (3) determine correlates of outdoor play duration and frequency.

METHODS

Childcare centre directors (n = 240) in Alberta, Canada, completed a questionnaire adapted from the Nutrition and Physical Activity Self-Assessment for Child Care (GO NAP SACC) Outdoor Play Tool that measured outdoor play separately for toddlers/preschoolers and winter/non-winter months. Consistent with the tool, centres were categorized as meeting or not meeting best practices for outdoor play duration and frequency. The questionnaire also measured demographic, socio-cultural, environmental, and policy correlates. Chi-squared tests and multiple logistic regression models were conducted.

RESULTS

More centres met the outdoor play duration and frequency best practices in non-winter than in winter months for toddlers (duration: 79.2% vs 24.9%; frequency: 11.4% vs 1.4%) and preschoolers (duration: 55.7% vs 14.6%; frequency: 20.2% vs 3.4%). Correlates of outdoor play duration and frequency varied across age groups and seasons. However, educator certification, educator professional development, and play areas were most consistent across final models.

CONCLUSIONS

Findings from this study suggest correlates of outdoor play may differ across age groups and seasons. Interventions aimed at increasing outdoor play in childcare centres appear warranted, especially in winter months for northern locations.

A qualitative study reporting maternal perceptions of the importance of play for healthy growth and development in the first two years of life

Background

In order for infants and toddlers to meet recommended movement guidelines, their caregivers need to encourage play daily. This study used a qualitative approach to understand how mothers perceive and promote play and physical activity during the first 2 years of life.

Methods

Mothers with children between 0 and 24 months were recruited from the SAMRC/Wits Developmental Pathways for Health Research Unit in Soweto, South Africa. 19 mothers agreed to participate and were grouped into three focus group discussions (FGDs) by age of the child: 0–6-months, 7–14-months, and 15–24-months. Thereafter, 12 mothers (4 from each FGD) were selected for inclusion in in-depth interviews (IDIs). After coding and theme/sub-theme identification had been completed for all IDIs, a process of cross-cutting theme identification and confirmation across FGDs and IDIs was carried out.

Results

The mothers were (mean ± SD) 27 (6) years old. All mothers had attended secondary school, but only nine had matriculated. Only one mother was married (and lived with the child’s father), and the majority (n = 15) were unemployed. Most children were male (63%) and were aged 11 (7) months. Four main themes emerged: 1) Physical activity as an indicator for health, 2) Promoting play and development, 3) Gender bias in play, and 4) Screen time.

Conclusions

This study showed that developmental attainment was the most important outcome for mothers, and so focussing intervention content on the promotion of child development through movement is advised. Screen time was freely available to children, and we recommend educating mothers on the movement guidelines, with a particular focus on the detrimental effects of screen time in this age group. Mothers reported many barriers to promoting play, and these are essential to consider when designing interventions in this context, in order to allow for equal opportunities for play to be provided to all children.

Healthy movement behaviours in children and youth during the COVID-19 pandemic: Exploring the role of the neighbourhood environment

This paper explores patterns of increased/ decreased physical activity, sedentary and sleep behaviours among Canadian children and youth aged 5-17 years during the COVID-19 pandemic, and examines how these changes are associated with the built environment near residential locations. A cluster analysis identified two groups who were primarily distinguished by the changes in outdoor activities. Compliance to 24-hour movement guidelines was low among both groups. For children, houses (versus apartments) was correlated with increased outdoor activities; proximity to major roads was a barrier. For youth, low dwelling density, and access to parks in high-density neighbourhoods, increased the odds of increased outdoor activities during the pandemic. Our findings can inform future urban and health crisis planning practices by providing new insights into the desirable public health messaging and characteristics of healthy and resilient communities.

Healthy movement behaviours in children and youth during the COVID-19 pandemic: Exploring the role of the neighbourhood environment

This paper explores patterns of increased/ decreased physical activity, sedentary and sleep behaviours among Canadian children and youth aged 5-17 years during the COVID-19 pandemic, and examines how these changes are associated with the built environment near residential locations. A cluster analysis identified two groups who were primarily distinguished by the changes in outdoor activities. Compliance to 24-hour movement guidelines was low among both groups. For children, houses (versus apartments) was correlated with increased outdoor activities; proximity to major roads was a barrier. For youth, low dwelling density, and access to parks in high-density neighbourhoods, increased the odds of increased outdoor activities during the pandemic. Our findings can inform future urban and health crisis planning practices by providing new insights into the desirable public health messaging and characteristics of healthy and resilient communities.

Results from the Netherlands' 2018 Report Card and Report Card+ on physical activity for children and youth with and without chronic medical condition

OBJECTIVE

The objective of this study was to summarize the results of the 2018 the Netherlands' Physical Activity Report Card (PARC) for children and youth as well as for children and youth with a chronic medical condition (CMC; PARC⁺).

STUDY DESIGN

This study is a survey.

METHODS

A total of 12 indicators were graded using the Active Healthy Kids Global Alliance PARC development process, which includes a synthesis of the best available research, surveillance, policy and practice findings and expert consensus. Grades were based on the best available evidence and ranged from grade A (>80% of the children succeed) to grade F (less than 20% succeed) or incomplete (INC). Sources included national surveys, peer-reviewed literature and grey literature such as government and non-government reports and online content.

RESULTS

Grades assigned for PARC/PARC⁺ were as follows: Overall Physical Activity: C-/D+; Organized Sports Participation: B/B-; Active Play: D/D; Active Transportation: A-/B+; Sedentary Behaviour: D/D; Physical Fitness: INC /INC; Family and Peers: C/INC; School: C+/A-; Community and Environment: INC /INC; Government: INC /INC; Sleep: A-/B+ and Weight Status: A-/A-, respectively.

CONCLUSIONS

The report shows that the Netherlands' youth scores well on (organized) participation in sports and active transport to and from school. However, they do not participate enough in overall physical activity. Despite the fact that outdoor play is the most important exercise activity for children, outdoor play scores an insufficient score for both healthy children and children with a CMC. Sports participation also contributed significantly to daily physical activity. However, sports participation alone is not enough to comply with the national activity guidelines.

Impact of the COVID-19 virus outbreak on movement and play behaviours of Canadian children and youth: a national survey

Background

Healthy childhood development is fostered through sufficient physical activity (PA; including time outdoors), limiting sedentary behaviours (SB), and adequate sleep; collectively known as movement behaviours. Though the COVID-19 virus outbreak has changed the daily lives of children and youth, it is unknown to what extent related restrictions may compromise the ability to play and meet movement behaviour recommendations. This secondary data analysis examined the immediate impacts of COVID-19 restrictions on movement and play behaviours in children and youth.

Methods

A national sample of Canadian parents (n = 1472) of children (5–11 years) or youth (12–17 years) (54% girls) completed an online survey that assessed immediate changes in child movement and play behaviours during the COVID-19 outbreak. Behaviours included PA and play, SB, and sleep. Family demographics and parental factors that may influence movement behaviours were assessed. Correlations between behaviours and demographic and parental factors were determined. For open-ended questions, word frequency distributions were reported.

Results

Only 4.8% (2.8% girls, 6.5% boys) of children and 0.6% (0.8% girls, 0.5% boys) of youth were meeting combined movement behaviour guidelines during COVID-19 restrictions. Children and youth had lower PA levels, less outside time, higher SB (including leisure screen time), and more sleep during the outbreak. Parental encouragement and support, parental engagement in PA, and family dog ownership were positively associated with healthy movement behaviours. Although families spent less time in PA and more time in SB, several parents reported adopting new hobbies or accessing new resources.

Conclusions

This study provides evidence of immediate collateral consequences of the COVID-19 outbreak, demonstrating an adverse impact on the movement and play behaviours of Canadian children and youth. These findings can guide efforts to preserve and promote child health during the COVID-19 outbreak and crisis recovery period, and to inform strategies to mitigate potential harm during future pandemics.

Categorizing mothers' and fathers' conceptualizations of children's serious play-related injuries: "You won't grow a finger back"

BACKGROUND

There is inconsistency across child development and care literature in operationalizing serious play-related injury and also a lack of understanding of how mothers and fathers conceptualize serious play-related injury. The current study explores parents' perspectives of their 2- to 7-year-old children's serious play-related injuries in urban and rural areas of British Columbia and Québec, Canada, and provides an urban/rural and gender analysis of the results.

METHODS

We conducted semistructured interviews with 41 mothers and 63 fathers from 57 families, a total of 104 participants, in urban and rural locations in British Columbia and Québec, Canada. We used a social constructionist approach to the research and reflexive thematic analysis to construct themes from participant responses and to inform the consequent categorizations of serious play-related injury.

RESULTS

The results indicate four categories of parents' conceptualizations of serious play-related injury: (a) injury requiring medical intervention, (b) injury resulting in head trauma, (c) injury resulting in debilitation, and (d) broken bones.

CONCLUSIONS

Child development and care advocates can use these categories to strengthen their communications with parents and to improve understanding of parents' conceptualizations of children's serious play-related injury.

Children's active outdoor play: 'good' mothering and the organisation of children's free time

This qualitative study draws on the Foucault-inspired notion of biopedagogies to examine and problematise the salient factors of contemporary motherhood impacting children's active outdoor play (AOP). The study positions mothering as a practice, through which children's health and bodies are constructed and disciplined. A discourse analysis of 21 interviews with Canadian mothers identified three discursive constructions of the 'good mother': mothers as time managers, risk managers and screen-time managers. Each was characterised by discursive conflicts that compromised the provision of AOP by mothers. This study provides data necessary for successfully including AOP as a leisure practice within family-centred health promotion.

Development of a consensus statement on the role of the family in the physical activity, sedentary, and sleep behaviours of children and youth

BACKGROUND

Children and youth who meet the physical activity, sedentary, and sleep behaviour recommendations in the Canadian 24-Hour Movement Guidelines are more likely to have desirable physical and psychosocial health outcomes. Yet, few children and youth actually meet the recommendations. The family is a key source of influence that can affect lifestyle behaviours. The purpose of this paper is to describe the process used to develop the Consensus Statement on the Role of the Family in the Physical Activity, Sedentary, and Sleep Behaviours of Children and Youth (0-17 years) and present, explain, substantiate, and discuss the final Consensus Statement.

METHODS

The development of the Consensus Statement included the establishment of a multidisciplinary Expert Panel, completion of six reviews (three literature, two scoping, one systematic review of reviews), custom data analyses of Statistics Canada's Canadian Health Measures Survey, integration of related research identified by Expert Panel members, a stakeholder consultation, establishment of consensus, and the development of a media, public relations, communications and launch plan.

RESULTS

Evidence from the literature reviews provided substantial support for the importance of family on children's movement behaviours and highlighted the importance of inclusion of the entire family system as a source of influence and promotion of healthy child and youth movement behaviours. The Expert Panel incorporated the collective evidence from all reviews, the custom analyses, other related research identified, and stakeholder survey feedback, to develop a conceptual model and arrive at the Consensus Statement: Families can support children and youth in achieving healthy physical activity, sedentary and sleep behaviours by encouraging, facilitating, modelling, setting expectations and engaging in healthy movement behaviours with them. Other sources of influence are important (e.g., child care, school, health care, community, governments) and can support families in this pursuit.

CONCLUSION

Family is important for the support and promotion of healthy movement behaviours of children and youth. This Consensus Statement serves as a comprehensive, credible, and current synopsis of related evidence, recommendations, and resources for multiple stakeholders.

Correlates of Children's Physical Activity: A Canadian Multisite Study

PURPOSE

To inform future physical activity (PA) interventions among children, we investigated the correlates of PA among 8- to 12-yr-olds in three regions of Canada: Ottawa, Trois-Rivières, and Vancouver.

METHODS

We recruited 1699 children (55.0% girls) in 37 schools located in urban, suburban, and rural areas that differed in socioeconomic status. Children wore a sealed SC-StepRx pedometer capable of measuring moderate- to vigorous-intensity physical activity (MVPA) for seven consecutive days. Children and one of their parents/guardians completed a questionnaire that captured multiple potential PA correlates. Publicly available data on weather and neighborhood walkability were obtained. Multiply-imputed gender-stratified linear mixed models were used to examine the correlates of daily step counts and MVPA while controlling for age, site, type of urbanization, and area-level socioeconomic status.

RESULTS

Each additional hour spent outdoors was associated with higher PA in boys (+769 steps per day; +3.7 min MVPA per day) and girls (+596 steps per day; +3.5 min·d). Boys' PA declined with age (-500 steps per day; -3.7 min·d). Boys were less active if they had a long-standing injury/illness (-1862 steps per day; -3.7 min·d) or their parents reported driving to work (-835 steps per day; -4.4 min·d), were worried about traffic (-982 steps per day; -6.4 min·d), or about other people in their neighborhood (-1250 steps per day). Girls speaking neither English nor French at home were less active (-620 steps per day; -3.7 min·d). In girls, each degree Celsius increase in morning temperature was associated with 77 additional steps per day, and each kilometer increase in active school travel distance was associated with 0.5 more MVPA minutes per day.

CONCLUSION

Consistent with previous studies, our results suggest that PA interventions should aim to increase outdoor time. The observed gender differences in PA correlates suggest the need for a gender-sensitized approach to PA promotion.

Physical Activity Assessment and Counseling in Pediatric Clinical Settings

Physical activity plays an important role in children's cardiovascular health, musculoskeletal health, mental and behavioral health, and physical, social, and cognitive development. Despite the importance in children's lives, pediatricians are unfamiliar with assessment and guidance regarding physical activity in children. With the release of the 2018 Physical Activity Guidelines by the US Department of Health and Human Services, pediatricians play a critical role in encouraging physical activity in children through assessing physical activity and physical literacy; providing guidance toward meeting recommendations by children and their families; advocating for opportunities for physical activity for all children in schools, communities, and hospitals; setting an example and remaining physically active personally; advocating for the use of assessment tools and insurance coverage of physical activity and physical literacy screening; and incorporating physical activity assessment and prescription in medical school curricula.

France's 2018 Report Card on Physical Activity for Children and Youth: Results and International Comparisons

BACKGROUND

Insufficient levels of physical activity and increasing sedentary time among children and youth are being observed internationally. The purpose of this paper is to summarize findings from France's 2018 Report Card on physical activity for children and youth, and to make comparisons with its 2016 predecessor and with the Report Cards of other countries engaged in the Global Matrix 3.0.

METHODS

The France's 2018 Report Card was developed following the standardized methodology established for the Global Matrix 3.0 by grading 10 common physical activity indicators using best available data. Grades were informed by national surveys, peer-reviewed literature, government and nongovernment reports, and online information.

RESULTS

The expert panel awarded the following grades: overall physical activity, D; organized sport participation and physical activity, C-; active play, INC; active transportation, C-; sedentary behaviors, D-; physical fitness, B-; family and peers, INC; school, B; community and the built environment, INC; and government, C.

CONCLUSIONS

Very concerning levels of physical activity and sedentary behaviors among French children and youth were observed, highlighting the urgent need for well-designed national actions addressing the presented physical inactivity crisis. The top 3 strategies that should be implemented in priority to improve the lifestyle of French children and youth are provided.

Electronic screen technology use and connection to nature in Canadian adolescents: a mixed methods study

OBJECTIVES

Declines in exposure to nature may deprive young people of experiences that are positive for their mental health. One factor that may interfere with connections to nature is use of electronic screen technologies. The objectives of this study are to (1) document variations in the perceived importance of connections to nature nationally among adolescents; (2) explore relationships between these connections and the use of electronic screens, both epidemiologically and qualitatively; and (3) integrate core findings from both strands in order to provide evidence-based recommendations for health promotion.

METHODS

The study involved a mixed methods design. Strand 1 involved a qualitative study of 74 Canadians (ages 10-18, years 2016-2018) with data collected through focus groups and interviews. Strand 2 involved a cross-sectional observational analysis of a national survey of 23,920 Canadians (ages 11-15, years 2013-2014). Findings from both strands were integrated through an established protocol.

RESULTS

Increased use of electronic screen technology was consistently associated with lower perceived importance of connections to nature. Barriers to connecting to nature included choices that young people are making, the addictive properties of technology, and beliefs that being indoors is more comfortable and safer than being outdoors. When young people disconnected, their appreciation of being outdoors increased.

INTERPRETATION

This novel study showed, quantitatively, that the time young people spend with electronic screens displaces time that they spend engaging in outdoor activities. Deeper reasons why such associations occur emerged in the qualitative strand. Temporary disconnection from screens may lead to renewed opportunities for outdoor exposures.

Outdoor Time is Not Associated with Metabolically Healthy Overweight and Obesity Phenotype in Canadian Children Aged 6-14 Years

A large proportion of children living with obesity have favorable cardiometabolic profiles despite their adiposity levels, who are referred to as metabolically healthy overweight or obese (MHO). However, the contribution of active outdoor time to the MHO phenotype is unknown. The purpose of this study was to investigate the association between outdoor time and moderate-to-vigorous physical activity (MVPA) with the MHO phenotype. A cross-sectional analysis of overweight/obese children aged 6-14 (n = 386) from the Canadian Health Measures Survey was performed. Outdoor time was self-reported using five questions in relation to the school schedule to produce a computed score ranging from 0-25. MVPA was measured using accelerometers. The MHO phenotype was defined based on the absence of cardiometabolic risk factors: triglycerides, HDL-cholesterol, systolic and diastolic blood pressure, and glucose (MHO: 0 cardiometabolic risk factors). The proportion of children living with obesity with the MHO phenotype was 58.5%. No significant differences were observed between MHO and non-MHO according to outdoor time or MVPA (p > 0.05). Logistic regressions indicated that outdoor time was not significantly associated with the MHO phenotype (OR: 0.99, 95% CI = 0.92-1.06; p = 0.694), while MVPA was significantly associated with the MHO phenotype (OR: 1.41, 95% CI = 1.01-1.98; p = 0.047) after adjusting for confounders. We conclude that outdoor time is not associated with the MHO phenotype, even though Canadian children living with obesity are more likely to be MHO with greater amounts of MVPA, regardless of whether these activities are completed outdoors or not.

Playground features and physical activity in U.S. neighborhood parks

All people need to engage in routine physical activity and children require it daily. Playgrounds are settings designed for children to be physically active, yet there has been little research assessing which play elements and structures are associated with more moderate-to-vigorous physical activity (MVPA) among both youth and adults. We conducted a national study of neighborhood parks with the goal of identifying factors that promote more MVPA. We selected a nationally representative sample of 162 parks between 3 and 22 acres in 25 U.S. cities with a population >100,000. We used direct observation to measure MVPA in 147 playgrounds during spring and summer of 2016, documented playground characteristics and assessed hours of use and MVPA by age group and gender. We analyzed data using descriptive statistics and generalized linear models. The most common play elements and structures were slides and ladders (92% of parks) and swings (81%); elements supporting balancing, crawling, spinning, sand and water play were in <30% of playgrounds. Each additional play element was associated with about 50% more users and 50% more MVPA. Spinning structures and splash pads were associated with more playground use and more MVPA. Playgrounds with signage advertising park programs and on-site restrooms had more person-hours of use, but only half the parks had restrooms and <30% had signage. To address insufficient physical activity, upgrades to playgrounds should include restrooms, structures that support a wide variety of movements, and elements that also encourage adults to be active.

Development and Testing of a Brief Play Space Audit Tool

BACKGROUND

Spaces that promote play are important for the physical, social, and psychological growth of children. Public spaces, including playgrounds, provide an important venue for children to engage in play. A simple tool is needed to evaluate playground features and conditions.

METHODS

A simple play space audit instrument to assess the presence and condition of playground features was tested on a sample of 70 playgrounds during the summer of 2017, in Chicago, IL. Duplicate observations were collected on 17 playgrounds. Frequencies of features were tabulated, and reliability of variables was assessed using percent agreement and kappa statistic. Scores were created to summarize playground "playability," overall and within domains of general overview, surface, path, and play equipment/structure features.

RESULTS

The tool demonstrated acceptable reliability with high kappa values between .79 and .90 for all items in domains. The overall score, general overview score, and play equipment/structure scores were correlated with mean playground usage.

CONCLUSIONS

This brief instrument allows reliable assessment of playground features and their conditions. The scoring method generates a summary of playground conditions and features, which facilitates comparison of playgrounds. This tool has the potential to assist communities in evaluating their play spaces and identifying where to focus resources for improvements.

Outdoor time and dietary patterns in children around the world

Background

Whether outdoor time is linked to dietary patterns of children has yet to be empirically tested. The objective of this study was to examine the association between outdoor time and dietary patterns of children from 12 countries around the world.

Methods

This multinational, cross-sectional study included 6229 children 9-11 years of age. Children self-reported the time that they spent outside before school, after school and on weekends. A composite score was calculated to reflect overall daily outdoor time. Dietary patterns were assessed using a food frequency questionnaire, and two components were used for analysis: healthy and unhealthy dietary pattern scores.

Results

On average, children spent 2.5 h outside per day. After adjusting for age, sex, parental education, moderate-to-vigorous physical activity, screen time and body mass index z-score, greater time spent outdoors was associated with healthier dietary pattern scores. No association was found between outdoor time and unhealthy dietary pattern scores. Similar associations between outdoor time and dietary patterns were observed for boys and girls and across study sites.

Conclusions

Greater time spent outside was associated with a healthier dietary pattern in this international sample of children. Future research should aim to elucidate the mechanisms behind this association.

Educator perceptions on the benefits and challenges of loose parts play in the outdoor environments of childcare centres

It is important to consider physical activity and movement in early life to ensure children establish and maintain healthy physical activity patterns. Recent evidence has highlighted the importance of outdoor play and the childcare environment. Active outdoor play, especially free play, supports independence, self-regulation and allows children to explore their world and make decisions. Loose parts or open-ended materials are natural or synthetic resources that can be used in more than one way, allowing children to experiment through play. Incorporating loose parts into play environments creates opportunity for new play experiences. Despite growing evidence supporting loose parts play, the perspectives of childcare providers on the benefits and challenges of this type of play have been overlooked. The purpose of this study was to identify the benefits and challenges of incorporating loose parts play into the outdoor environments of childcare centres, from the perspectives of educators who took part in the Physical Literacy in the Early Years (PLEY) project. PLEY is a larger, mixed methods intervention study with the goal of evaluating a loose parts intervention in early childcare settings. This portion of the project used qualitative description to explore educators' perspectives. Data were collected using focus groups (n = 15) with early childhood educators (n = 3–5 in each group). Thematic analysis was used to identify five themes relating to benefits, and four themes relating to challenges. Benefit themes included: loose parts enable children to take risks; loose parts spark creativity and imagination; loose parts contribute to problem-solving abilities; loose parts cultivate independence and confidence; and loose parts build relationships and leadership. Challenges included: apprehension of loose parts; loose parts as a novelty; sustainability of loose parts; and loose parts present challenges with storage. Overall, we found educators perceived outdoor loose parts play to have multiple social and cognitive benefits for preschool-aged children that are critical for optimal growth and development, and overall health and wellness.

What Is the Relationship between the Neighbourhood Built Environment and Time Spent in Outdoor Play? A Systematic Review

Outdoor play has been associated with children’s and adolescents’ healthy development and physical activity. Attributes of the neighbourhood built environment can influence play behaviours. This systematic review examined the relationship between attributes of the neighbourhood built environment and the time children and adolescents (0–18 years) spend in self-directed outdoor play. We identified and evaluated 18 relevant papers using the Mixed Methods Appraisal Tool and developed a narrative synthesis of study results. We found moderate evidence that lower traffic volumes (ages 6–11), yard access (ages 3–10), and increased neighbourhood greenness (ages 2–15) were positively associated with time spent in outdoor play, as well as limited evidence that specific traffic-calming street features such as fewer intersections, low traffic speeds, neighbourhood disorder, and low residential density were positively associated with time spent in outdoor play. To our knowledge, this is the first systematic review on this topic. The limited number of “good quality” studies identified highlights the need for additional research on the topic.

Active streets for children: The case of the Bogotá Ciclovía

INTRODUCTION

The Ciclovía is a worldwide program in which streets are temporarily closed to motorized transport to create a space for recreation and outdoor play among children and adults. The aim of this study was to assess the associations between physical activity (PA), sedentary time (SED), body mass index and Ciclovía participation among children aged 9 to 13 years.

METHODS

All students in the 4th and 5th grades from the selected schools were invited to participate in the study. The study included 923 children. PA and SED were measured using waist-worn accelerometers, and height and weight were measured using standardized procedures. Ciclovía participation was self-reported. The analyses included multilevel linear, generalized mixed and generalized additive models.

RESULTS

The mean age of the sample was 10.1±0.7 years, and 49.5% were boys. In the last year, 46% of the children participated in the Ciclovía, and 34% reported participating frequently (at least once per month). No differences were found in the mean minutes of moderate-to-vigorous PA on weekdays between frequent Ciclovía users and sporadic and non-Ciclovía users (72 vs 69; p = 0.09). In contrast, frequent Ciclovía users had higher moderate-to-vigorous PA on Sundays than sporadic and non-Ciclovía users (65.6 vs 59.2; p = 0.01), specifically between the hours of 12:00 and 16:00. In addition, frequent Ciclovía users did not differ from the sporadic and non-Ciclovía users in SED (515.3 vs 521.3; p = 0.19). Frequent Ciclovía users had lower SED on Sundays than the sporadic and non-Ciclovía users (437.7 vs 456.5; p = 0.005). Additionally, frequent Ciclovía users were more likely to be overweight (28.3% vs 20.4% p = 0.01). We did not find differences in participation by sex, and low-to-middle income children were more likely to participate.

CONCLUSIONS

The Ciclovías offer an innovative, inclusive recreational space and consequently provide opportunities to increase moderate-to-vigorous PA and reduce SED among children.

Examining the Implementation of Play Streets: A Systematic Review of the Grey Literature

CONTEXT

Outdoor play has been described as essential for healthy childhood development. Lack of safety is one barrier to children participating in outdoor play. Play Streets are an intervention to help increase outdoor play by temporarily closing public streets (closures are recurring or episodic) to traffic, creating a safe place for active play.

OBJECTIVE

This systematic grey literature review aimed to examine and describe what is known about implementing Play Streets using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, which is widely used in implementation research.

DESIGN

A systematic search for and review of nonacademic, or grey, literature was conducted using Academic Search Complete, Google Scholar, and a general Google search.

ELIGIBILITY CRITERIA

Included literature was published in English, through December 2017, in nonacademic sources (ie, organizational/grant/municipal reports, newspapers, conference presentations, previous intervention advertisement materials, Web-based articles) or found in reference lists of academic articles about Play Streets, Pop-up Parks, or Open Streets/Ciclovías with a Play Street component.

STUDY SELECTION

Resources were selected that documented Play Streets, which are defined as recurring or episodic temporary street closures to traffic that provide the public with a no-cost, safe space to actively play and be physically active. These approaches are designed primarily for youth and may include various marked play areas, loose equipment, and/or group activities.

MAIN OUTCOME MEASURES

RE-AIM measures guided data extraction.

RESULTS

Of the 36 articles composing the final sample, 100% reported on implementation, although the level of detail varied. Only 14 of 36 articles reported measures of effectiveness; limited information was provided for other RE-AIM components.

CONCLUSIONS

In the grey literature, there are several inconsistencies in how the implementation of Play Streets is reported and level of detail. Specific details regarding implementing and evaluating Play Streets are needed to support widespread replication.

A Loose Parts Randomized Controlled Trial to Promote Active Outdoor Play in Preschool-aged Children: Physical Literacy in the Early Years (PLEY) Project

BACKGROUND

The Physical Literacy in the Early Years (PLEY) intervention is a randomized mixed-methods controlled trial focused on embedding loose parts materials into the outdoor play spaces of regulated child care centres across Nova Scotia. The aim is to evaluate the efficacy of the PLEY intervention versus standard regulated childcare practice in influencing thoughts and behaviors of children, parents, and educators.

METHODS

Participating early child care centres (n = 19) were randomly assigned to intervention or control sites. Intervention sites received loose parts kits at the beginning of the project while control sites received kits upon project completion. The kits included items such as rocks, tree cookies, balls, wood planks, tubes, tires, ropes, and pulleys. Children (n = 183 at baseline) had their physical activity (accelerometers) and movement skills (TGMD-3 and PGMQ) measured before and after the intervention. All centres provided responses to environmental surveys (Go NAP SACC and Site Context Questionnaire), and educators in intervention sites participated in focus group and photovoice sessions. Educators were also provided with a full day professional development opportunity (plus ongoing mentoring) focused on physical activity, physical literacy, outdoor play, risk-taking, and loose parts. Parents participated in an interview addressing active outdoor play, physical literacy, and attitudes towards risk taking during play.

DISCUSSION

This study will provide a better understanding of how integrating loose parts materials into outdoor play spaces impacts children's health, and the impact on educator and parent attitudes, beliefs, and understanding around physical literacy, active outdoor play and risk-taking during play.

Children's Cortisol and Cell-Free DNA Trajectories in Relation to Sedentary Behavior and Physical Activity in School: A Pilot Study

The worldwide prevalence of mental disorders in children and adolescents increased constantly. Additionally, the recommended amount of physical activity (PA) is not achieved by this age group. These circumstances are associated with negative impacts on their health status in later life and can lead to public health issues. The exposure to natural green environments (NGE) seems to be beneficial for human health. The compulsory school system offers great opportunities to reach every child with suitable health-related contents and interventions at an early stage. The concept of Education Outside the Classroom (EOtC) uses NGE and sets focus on PA. Therefore, EOtC might be a beneficial educational intervention to promote students health. The association between biological stress markers and sedentary behavior (SB) plus PA is insufficiently evaluated in school settings. This exploratory study aims to evaluate the association between students' cortisol, plus circulating cell-free deoxyribonucleic acid (cfDNA) levels, and their SB, light PA (LPA), and moderate-to-vigorous PA (MVPA). We assessed data from an EOtC program (intervention group [IG], n = 37; control group [CG], n = 11) in three seasons (fall/spring/summer) in outdoor lessons (IG) in a NGE and normal indoor lessons (CG). SB and PA were evaluated by accelerometry, and cortisol and cfDNA levels by saliva samples. Fitted Bayesian hierarchical linear models evaluated the association between cortisol and cfDNA, and compositional SB/LPA/MVPA. A steady decline of cortisol in the IG is associated with relatively high levels of LPA (posterior mean = −0.728; credible interval [CRI 95%]: −1.268; −0.190). SB and MVPA tended to exhibit a similar effect in the CG. A high amount of cfDNA is positively associated with a relatively high amount of SB in the IG (posterior mean, 1.285; CRI: 0.390; 2.191), the same association is likely for LPA and MVPA in both groups. To conclude, LPA seems to support a healthy cortisol decrease in children during outdoor lessons in NGEs. Associations between cfDNA and SB/PA need to be evaluated in further research. This study facilitates the formulation of straightforward and directed hypotheses for further research with a focus on the potential health promotion of EOtC.

Make Room for Play: An Evaluation of a Campaign Promoting Active Play

In the context of rising screen time, only a third of Canadian children are achieving adequate amounts of active play, an important source of physical activity. ParticipACTION, a national not-for-profit organization, created the "Make Room for Play" campaign targeting parents with television advertisements depicting how screen time takes away from active play. The advertisements featured children engaging in active play (e.g., jump rope) while a black screen progressively sequesters the room for them to play. This study's purpose was to evaluate the campaign using the hierarchy of effects model, a framework for conceptualizing the impact of mass media campaigns. It was hypothesized that recall would relate to intermediate (e.g., cognitions, self-efficacy) and distal (e.g., parental support) factors. Twenty-six percent of the general population and caregiver samples surveyed (N = 1576) recalled (unaided) the advertisement and 45.9% recalled when prompted. Parental support was significantly higher in those recalling the campaign, p = .009. Twenty-four percent of parents reporting unaided recall (versus 14.0% of those not) tried to engage in active play with their children and 21.2% (versus 12.0%) tried to create opportunities for children to engage in play. Strengths and limitations of mass media approaches targeting active play and screen time are discussed.

Relationships Between Outdoor Time, Physical Activity, Sedentary Time, and Body Mass Index in Children: A 12-Country Study

PURPOSE

This study investigated the relationship between outdoor time and physical activity (PA), sedentary time (SED), and body mass index z scores among children from 12 lower-middle-income, upper-middle-income, and high-income countries.

METHODS

In total, 6478 children (54.4% girls) aged 9-11 years participated. Outdoor time was self-reported, PA and SED were assessed with ActiGraph GT3X+ accelerometers, and height and weight were measured. Data on parental education, neighborhood collective efficacy, and accessibility to neighborhood recreation facilities were collected from parent questionnaires. Country latitude and climate statistics were collected through national weather data sources. Gender-stratified multilevel models with parental education, climate, and neighborhood variables as covariates were used to examine the relationship between outdoor time, accelerometry measures, and body mass index z scores.

RESULTS

Each additional hour per day spent outdoors was associated with higher moderate- to vigorous-intensity PA (boys: +2.8 min/d; girls: +1.4 min/d), higher light-intensity PA (boys: +2.0 min/d; girls: +2.3 min/d), and lower SED (boys: -6.3 min/d; girls: -5.1 min/d). Effect sizes were generally weaker in lower-middle-income countries. Outdoor time was not associated with body mass index z scores.

CONCLUSIONS

Outdoor time was associated with higher PA and lower SED independent of climate, parental education, and neighborhood variables, but effect sizes were small. However, more research is needed in low- and middle-income countries.

Youth get a D+ grade in physical activity: How can we change public health messages to help reverse this trend?

The purpose of this paper is to critique how the promotion of physical activity (PA) is communicated and offer evidence-based alternative framings to encourage PA in youth. We argue that PA promotion messaging should not be tied to outcomes that focus on changing physical appearance, preventing or treating diseases, or sport performance or competition. From a public health perspective, we suggest that PA should instead focus on campaigns, policies, and programs that tie PA to enjoyment, wellbeing, and play.

Duration and intensity of different types of physical activity among children aged 10-13 years

OBJECTIVES

To use a predominately objective measurement approach to assess and describe: (1) the amount of time that children aged 10-13 years spend participating in outdoor active play, active travel, curriculum-based physical activity at school, and organized sport; (2) the movement intensity composition of these four types of physical activity (i.e., % of time spent at a sedentary, light, or moderate-to-vigorous intensity); and (3) the proportion of each movement intensity obtained by participating in these four types of physical activity.

METHODS

Three hundred seventy-seven children aged 10-13 years from Kingston, Canada, were studied. Children wore an accelerometer and GPS watch for 7 days and recorded the start and end times of the school day, recess periods, and organized sport sessions on a log. These data were used to estimate time spent in the four types of physical activity and the movement intensity composition of these activities.

RESULTS

Time spent in outdoor active play (36 min/day) and organized sport (40 min/day) was higher than that for active travel (17 min/day) and curriculum-based physical activity (26 min/day). With the exception of organized sport, values were higher for boys than for girls. Older children accumulated less outdoor active play and more active travel than younger children. The greatest proportion of light- and moderate-to-vigorous-intensity movement was attributed to outdoor active play.

CONCLUSION

We used a primarily objective measurement approach to assess and describe the amount of time children aged 10-13 participate in four types of physical activity. These descriptive findings could be used to identify target areas for physical activity interventions and policies.

Results from South Korea's 2018 Report Card on physical activity for children and youth

Background/Objective

South Korea's 2018 Report Card on Physical Activity for Children and Youth is the second comprehensive evaluation of physical activity and the sources of influence based on the 10 core indicators provided by the Active Healthy Kids Global Alliance. It will serve as an advocacy tool to promote physical activity among children and youth.

Methods

Three national surveillance data (i.e., 2017 Korea Youth Risk Behavior Web-based Survey, 2016 Korea National Health and Nutrition Examination Survey, 2016 Physical Activity Promotion System) were used as main sources to evaluate the indicators. Descriptive statistics were performed to obtain prevalence estimates of physical activity-related indicators. In addition, expert opinions as well as the most recently available published or unpublished relevant sources were synthesized.

Results

South Korea's 2018 Report Card, compared to the 2016 Report Card, showed favourable changes in the Active Transportation (B+), Organized Sports Participation (C), Sedentary Behaviours (D), and School (D+) indicators, while unfavourable changes were shown in Overall Physical Activity (F) and Government (D). Physical Fitness was graded as D+. In parallel with the 2016 Report Card, Active Play, Family and Peers, and Community and Environment remain ungraded due to insufficient data.

Conclusions

Successes as well as gaps and research needs were identified in the 2018 Report Card. Though some indicators have shown improvement, most children and youth continue to be insufficiently physically active with overall poor grades (Average of D+). To achieve substantial improvement in all grades in future Report Cards, more institutional and governmental support and investment is needed to promote physical activity. Furthermore, effort should be made to generate data pertaining to the indicators that were ungraded.

Exploring the impact of the 'new' ParticipACTION: overview and introduction of the special issue

ParticipACTION is the Canadian physical activity communications and social marketing organization first launched in the fall of 1971 and then ceased operations in 2001. ParticipACTION was relaunched in 2007. Framed as a public health natural experiment, evidence was collected from a population-based survey of knowledge, awareness, understanding of physical activity, and physical activity levels among Canadians (individual level), and key informant surveys and interviews examining capacity, readiness and advocacy for physical activity promotion among physical activity organizations (organizational level). The purpose of this paper is to first provide an overview of some of the major initiatives undertaken by the 'new' ParticipACTION that may have contributed to any changes at these individual or organizational levels. Second, the paper sets the stage for the three empirical papers in this special series reporting follow-up results.

Video Games and Outdoor Physical Activity for the Elderly: Applications of the HybridPLAY Technology

The incorporation of the elderly into digital leisure has been especially driven by the development of games and applications that link the experience of play with beneficial effects for the user. Some of these benefits arise at a cognitive level, fostering intellectual activity of adults through playful experiences that combine audio-visual entertainment with brain training. Seniors are also engaged by active video games that use control interfaces to perform physical actions or activities, encouraging motor play. In this paper, we present the application of HybridPLAY for the elderly, a self-developed technology initially thought to transform playgrounds into scenarios for a set of interactive digital games. In this paper, we show that, although HybridPLAY was initially developed for children and teenagers, the versatile features of this technology make it appropriate also for the elderly. After having tested HybridPLAY with a small group of seniors who completed a usability test and a satisfaction questionnaire, we show that it is possible to combine playful entertainment with physical and mental activities in outdoor environments for the elderly.

Physical Activity and Outdoor Play of Children in Public Playgrounds-Do Gender and Social Environment Matter?

Background: Few studies have delved into the relationship of the social environment with children’s physical activity and outdoor play in public playgrounds by considering gender differences. The aim of the present study was to examine gender differences and the relationship of the social environment with children’s physical activity and outdoor play in public playgrounds. Methods: A quantitative, observational study was conducted at ten playgrounds in one district of a middle-sized town in Germany. The social environment, physical activity levels, and outdoor play were measured using a modified version of the System for Observing Play and Leisure Activity in Youth. Results: In total, 266 observations of children (117 girls/149 boys) between four and 12 years old were used in this analysis. Significant gender differences were found in relation to activity types, but not in moderate-to-vigorous physical activity (MVPA). The presence of active children was the main explanatory variable for MVPA. In the models stratified by gender, the presence of opposite-sex children was a significant negative predictor of MVPA in girls but not in boys. Conclusions: The presence of active children contributes to children’s physical activity levels in public playgrounds. Girls’ physical activity seems to be suppressed in the presence of boys.

Utilising active play interventions to promote physical activity and improve fundamental movement skills in children: a systematic review and meta-analysis

BACKGROUND

Children's physical activity levels are low and efforts to improve their physical activity levels have proven difficult. Freely chosen and unstructured physical activity (active play) has the potential to be promoted in a variety of settings and potentially every day of the year in contrast to other physical activity domains, but active play interventions are an under-researched area. Therefore, the primary aim of this systematic review was to determine the effect of active play interventions on children's physical activity levels, particularly moderate-to-vigorous intensity physical activity (MVPA), and fundamental movement skills (FMS).

METHODS

Studies were included if they were solely or  predominantly active play randomised, or cluster randomised controlled trials that targeted children aged 3-12 years. They had to report on at least one of the following outcomes: objectively measured physical activity, FMS, cognition and weight status. During December 2016, four databases (PE Index, SPORTDiscus, Medline and ERIC) were searched for relevant titles. Duplicates and irrelevant titles and abstracts were removed. The included studies had their quality assessed using the Effective Public Health Practice Project (EPHPP) tool. Suitable studies were combined in a meta-analysis using a random-effect model. A narrative synthesis was conducted for all outcomes.

RESULTS

Of the 4033 records, 91 studies were eligible for full text screening, of which 87 were removed, leaving four studies (representing five papers). The meta-analysis of two studies highlighted there was no significant effect of active play interventions on MVPA. However, the narrative synthesis suggested that active play interventions may increase total volume of physical activity. Only two studies examined the effect of active play interventions on children's FMS, one study examined effects on weight status and none examined effects on cognition.

CONCLUSIONS

Due to the small number of eligible studies and their heterogeneity, the review could not draw firm conclusions on the effect of active play interventions on children's physical activity levels. High-quality active play interventions, targeting different times of the day (school and after school) in different populations and settings, and with a wider range of outcomes, are required to determine the potential of active play.

Pedestrian traffic safety and outdoor active play among 10-13 year olds living in a mid-sized city

This cross-sectional study examined the independent and interactive associations between objective and perceived measures of neighborhood pedestrian traffic safety and outdoor active play. A total of 458 children aged 10–13 years from Kingston, Canada were studied in 2015–2016. Outdoor active play was measured over 7 days using data from activity logs, accelerometers, and Global Positioning System loggers. Geographic Information System data were collected within 1 km of participants' homes and used to create traffic volume, traffic calming, traffic speed, and pedestrian infrastructure indexes. Parents' perceptions of these pedestrian safety domains were obtained by questionnaire. Most of the pedestrian safety measures were not significantly associated with outdoor active play, and there were no interactions between the objective and perceived measures (p > 0.3). The significant relationships are listed here. Children whose parents perceived moderate or high traffic speeds in their neighborhood had outdoor active play values that were 0.35 (SE = 0.10, p = 0.021) and 0.20 (SE = 0.15, p = 0.048) SD units higher, respectively, then children whose parents perceived low traffic speed. By comparison to children from neighborhoods in the lowest tertile, children from the highest traffic volume tertile had higher outdoor active play levels (0.26, SE = 0.12, p = 0.029), while children from neighborhoods in the moderate traffic calming tertile (−0.28, SE = 0.11, p = 0.008) and the moderate pedestrian infrastructure tertile (−0.25, SE = 0.11, p = 0.023) had lower outdoor active play levels.

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We determined if traffic safety was related to children's outdoor active play.

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A cross-sectional study design was used.

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Traffic safety was measured using subjectively and objectively.

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Relationships between traffic safety and outdoor active play were inconsistent.

Playground slide-related injuries in preschool children: increased risk of lower extremity injuries when riding on laps

Background

The purpose of this study was to better understand the factors associated with playground slide-related injuries in preschool children and to test the hypothesis that riding on laps increases the likelihood of lower extremity injuries.

Methods

Playground slide-related injuries (product code 1242) in children ≤5 years of age treated in emergency departments from 2002 to 2015 were identified (N = 12,686) using the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS). Descriptive and comparative analyses, including chi-square testing and binary logistic regression, were performed.

Results

Based on NEISS stratified national sampling estimates, over 350,000 children ≤5 years of age were injured on slides from 2002 to 2015. Overall, 59% of the children were male, and 65% were white. Almost 60% of injuries occurred in parks or other public areas. The most frequent diagnosis was a fracture (36%); lacerations were 19% of the injuries. A higher proportion of musculoskeletal injuries were seen in toddlers < 3 years old as compared to those 3–5 years of age (p < 0.001). Injuries to the lower extremities increased in frequency as age decreased, whereas injuries to the upper extremities and head/neck/face were more common in older preschoolers. Children < 3 years of age were 12 times more likely to be identified from narratives as being on another person’s lap at the time of injury. Children identified as being on a lap had an increased odds of injury to the lower extremity than to other body parts (OR 43.0, 95% confidence interval (CI) 32.0–58.0), and of lower leg/ankle fracture than fractures elsewhere (OR 49.5, 95% CI 31.7–77.4).

Conclusions

Decreasing age was associated with a higher likelihood of being identified as sliding down on another person’s lap and a higher likelihood of lower extremity injuries. Healthcare providers should be mindful of the potential for these slide-related injuries as they can result in a toddler’s fracture of the tibia, which may be occult. Parents should also be made aware of this increased risk and counseled that a child’s foot can catch on the slide’s surfaces when going down on a person’s lap with subsequent twisting forces that can result in a fracture.

The home electronic media environment and parental safety concerns: relationships with outdoor time after school and over the weekend among 9-11 year old children

BACKGROUND

Time spent outdoors is associated with higher physical activity levels among children, yet it may be threatened by parental safety concerns and the attraction of indoor sedentary pursuits. The purpose of this study was to explore the relationships between these factors and outdoor time during children's discretionary periods (i.e., after school and over the weekend).

METHODS

Data from 462 children aged 9-11 years old were analysed using generalised linear mixed models. The odds of spending > 1 h outdoors after school, and > 2 h outdoors on a weekend were computed, according to demographic variables, screen-based behaviours, media access, and parental safety concerns. Interactions with sex and socioeconomic status (SES) were explored.

RESULTS

Boys, low SES participants, and children who played on their computer for < 2 h on a school day had higher odds of spending > 1 h outside after school than girls, high SES children and those playing on a computer for ≥2 h, respectively. Counterintuitive results were found for access to media devices and crime-related safety concerns as both of these were positively associated with time spent outdoors after school. A significant interaction for traffic-related concerns*sex was found; higher road safety concerns were associated with lower odds of outdoor time after school in boys only. Age was associated with weekend outdoor time, which interacted with sex and SES; older children were more likely to spend > 2 h outside on weekends but this was only significant among girls and high SES participants.

CONCLUSIONS

Our results suggest that specific groups of children are less likely to spend their free time outside, and it would seem that only prolonged recreational computer use has a negative association with children's outdoor time after school. Further research is needed to explore potential underlying mechanisms, and parental safety concerns in more detail.

Cross sectional associations of screen time and outdoor play with social skills in preschool children

Screen time and physical activity behaviours develop during the crucial early childhood period (0–5 years) and impact multiple health and developmental outcomes, including psychosocial wellbeing. Social skills, one component of psychosocial wellbeing, are vital for children’s school readiness and future mental health. This study investigates potential associations of screen time and outdoor play (as a proxy for physical activity) with social skills. Cross sectional data were available for 575 mothers with a child (54% boys) aged 2–5 years. Mothers reported their child’s screen time, outdoor play time and social skills (Adaptive Social Behavior Inventory; ASBI). Multiple linear regression analyses assessed associations of screen and outdoor play time (Model 1) and compliance with screen time and physical activity recommendations (Model 2) with three ASBI subscales. Boys and girls spent a mean of 2.0 and 2.2 hours per day in screen time, and 3.3 and 2.9 hours per day in outdoor play, respectively. Girls scores for express and comply skills were significantly higher than boys (p<0.005). After applying the Benjamini-Hochberg Procedure to adjust for multiple associations, children’s television/DVD/video viewing was inversely associated with their compliant scores (B = -0.35 95% CI -0.26, -0.14; p = 0.001) and outdoor play time was positively associated with both expressive (B = 0.20 95% CI 0.07, 0.34; p = 0.004) and compliant (B = 0.22 95% CI 0.08, 0.36; p = 0.002) scores. Findings indicate that television/DVD/video viewing may be adversely, and outdoor play favourably, associated with preschool children’s social skills. Future research is required to identify the direction of causation and explore potential mechanisms of association.

Development of a measurement approach to assess time children participate in organized sport, active travel, outdoor active play, and curriculum-based physical activity

BACKGROUND

Children participate in four main types of physical activity: organized sport, active travel, outdoor active play, and curriculum-based physical activity. The objective of this study was to develop a valid approach that can be used to concurrently measure time spent in each of these types of physical activity.

METHODS

Two samples (sample 1: n = 50; sample 2: n = 83) of children aged 10-13 wore an accelerometer and a GPS watch continuously over 7 days. They also completed a log where they recorded the start and end times of organized sport sessions. Sample 1 also completed an outdoor time log where they recorded the times they went outdoors and a description of the outdoor activity. Sample 2 also completed a curriculum log where they recorded times they participated in physical activity (e.g., physical education) during class time.

RESULTS

We describe the development of a measurement approach that can be used to concurrently assess the time children spend participating in specific types of physical activity. The approach uses a combination of data from accelerometers, GPS, and activity logs and relies on merging and then processing these data using several manual (e.g., data checks and cleaning) and automated (e.g., algorithms) procedures. In the new measurement approach time spent in organized sport is estimated using the activity log. Time spent in active travel is estimated using an existing algorithm that uses GPS data. Time spent in outdoor active play is estimated using an algorithm (with a sensitivity and specificity of 85%) that was developed using data collected in sample 1 and which uses all of the data sources. Time spent in curriculum-based physical activity is estimated using an algorithm (with a sensitivity of 78% and specificity of 92%) that was developed using data collected in sample 2 and which uses accelerometer data collected during class time. There was evidence of excellent intra- and inter-rater reliability of the estimates for all of these types of physical activity when the manual steps were duplicated.

CONCLUSIONS

This novel measurement approach can be used to estimate the time that children participate in different types of physical activity.

A systematic review of the risk factors and interventions for the prevention of playground injuries

OBJECTIVES

The primary objectives of this work were to (1) identify the risk and/or protective factors associated with playground injuries among children less than 18 years of age and (2) identify interventions/programs/policies aimed at preventing playground-related injuries among children less than 18 years of age. Secondary objectives include a summary of the data that reflect alignment with current playground standards.

METHODS

For the primary outcome, 4 databases and 12 online resources were systematically searched to include observational and experimental studies examining risk and/or protective factors or interventions associated with playground injury or outcomes related to playground injury (e.g., risky playground behaviour). Data extraction included study design, participants, outcome, exposure or intervention, data analysis, and effect estimates. The quality of evidence for all studies was assessed using the Downs and Black criteria.

RESULTS

This review included studies of moderate quality, revealing a number of risk factors and effective interventions for playground injury. Risk factors included absence of handrails and guardrails on playground equipment, non-impact-absorbing surfacing, and critical fall heights. Effective interventions included modifying playground surfacing and reducing equipment height to less than 1.5 m.

CONCLUSION

Equipment- and structure-based playgrounds should adhere to and maintain playground standards in order to reduce the risk of serious injury. Organizations responsible for installing and maintaining playgrounds should consider alternative play spaces that allow children to play outdoors, in a natural environment that supports healthy child development and promotes physical activity.

Go Play Outside! Effects of a risk-reframing tool on mothers' tolerance for, and parenting practices associated with, children's risky play: study protocol for a randomized controlled trial

Background

Children’s risky play is associated with a variety of positive developmental, physical and mental health outcomes, including greater physical activity, self-confidence and risk-management skills. Children’s opportunities for risky play have eroded over time, limited by parents’ fears and beliefs about risk, particularly among mothers. We developed a digital tool and in-person Risk-reframing (RR) workshop to reframe parents’ perceptions of risk and change parenting behaviours. The purpose of this paper is to describe our RR intervention, rationale and protocol for a randomised controlled trial to examine whether it leads to increases in mothers’ tolerance of risk in play and goal attainment relating to promoting their child’s opportunities for risky play.

Methods

We use a randomised controlled trial design and will recruit a total of 501 mothers of children aged 6–12 years. The RR digital tool is designed for a one-time visit and includes three chapters of self-reflection and experiential learning tasks. The RR in-person tool is a 2-h facilitated workshop in which participants are guided through discussion of the same tasks contained within the digital tool. The control condition consists of reading the Position Statement on Active Outdoor Play.

Primary outcome is increased tolerance of risk in play, as measured by the Tolerance of Risk in Play Scale. Secondary outcome is self-reported attainment of a behaviour-change goal that participants set for themselves.

We will test the hypothesis that there will be differences between the experimental and control conditions with respect to tolerance of risk in play using mixed-effects models. We will test the hypothesis that there will be differences between the experimental and control conditions with respect to goal attainment using logistic regression.

Discussion

The results of this trial will have important implications for facilitating the widespread change in parents’ risk perception that is necessary for promoting broad societal understanding of the importance of children’s risky play. In addition, the findings may provide relevant information for the design of behaviour-change tools to increase parental tolerance of risk.

Trial registration

ClinicalTrials.gov, ID: NCT03374683. Retrospectively registered on 15 December 2017.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-2552-4) contains supplementary material, which is available to authorized users.

Physical activity and sedentary time during childcare outdoor play sessions: A systematic review and meta-analysis

Outdoor playtime has been highly correlated with moderate-to vigorous-intensity physical activity (MVPA), while also being associated with decreased sedentary time. This systematic review and meta-analysis sought to examine the physical activity levels and sedentary time of young children (2-5years) during outdoor play periods at centre-based childcare. Eight online databases were searched for peer-reviewed, English-language, original research. Two reviewers independently extracted data (study design, participants, method of measurement, and physical activity and/or sedentary time of participants). Time spent in outdoor activity intensities were converted to percentage of time, and averaged across the two measurement types: accelerometry and observational. Of the 26 included articles, 11 used accelerometry, 13 employed direct observation, and 2 adopted a combination of both measurement methods. Average percentage of time engaged in MVPA and sedentary pursuits ranged from 6.7% to 43% and 23.2% to 63.5% by accelerometry, and 2% to 53.9% and 46.1% to 80.2% by observation, respectively. Total physical activity (only measured by accelerometry) ranged from 23.2% to 63.5% of outdoor playtime. Meta-analysis of 11 accelerometer studies found that children spent a mean (95% CI) of: 13.99% (10.35-17.63) of outdoor playtime in MVPA, 43.77% (32.95-54.58) in TPA, and 52.81% (44.1-61.51) in sedentary time. Overall, young children have the potential to be highly active during outdoor play sessions at centre-based childcare; however, many children still engage in substantial amounts of sedentary time. Future research should explore the frequency and/or duration of outdoor time which best support young children's physical activity and limits sedentary time in childcare.

Behavior Tracking and 3-Year Longitudinal Associations Between Physical Activity, Screen Time, and Fitness Among Young Children

PURPOSE

Understanding the correlates of children's fitness as they develop is needed. The objectives of this study were to 1) examine the longitudinal associations between physical activity (PA), screen time (ST), and fitness; 2) determine if sex moderates associations; and 3) track PA and ST over 3 years.

METHODS

Findings are based on 649 children [baseline = 4.5 (0.5) y; follow-up = 7.8 (0.6) y] from Edmonton, Canada. Parental-reported hour per week of PA and ST were measured at baseline and 3 years later. Fitness (vertical jump, sit and reach, waist circumference, grip strength, predicted VO_2max, push-ups, and partial curl-ups) was measured using established protocols at follow-up. Sex-specific z scores or low/high fitness groups were calculated. Linear or logistic multiple regression models and Spearman correlations were conducted.

RESULTS

Baseline ST was negatively associated with follow-up grip strength [β = -0.010; 95% confidence interval (CI), -0.019 to -0.001]. Associations between baseline PA and follow-up overall fitness (β = 0.009; 95% CI, 0.002 to 0.016) were significant, whereas baseline PA and follow-up VO_2max (β = 0.014; 95% CI, 0.000 to 0.027) approached significance (P < .06). No sex interactions were observed. Moderate and large tracking were observed for PA (r_s = .30) and ST (r_s = .53), respectively.

CONCLUSIONS

PA and ST may be important modifiable correlates of overall fitness in young children.