Beyond Physical Activity: The Importance of Play and Nature-Based Play Spaces for Children's Health and Development

Using the Theory of Affordances to Understand Environment-Play Transactions: Environmental Taxonomy of Outdoor Play Space Features-A Scoping Review

IMPORTANCE

The transactions between the physical environment and children's play have not been well studied. The theory of affordances provides a way to better understand how environmental characteristics offer opportunities for play occupation.

OBJECTIVE

To investigate the relationship between environmental characteristics of outdoor play spaces and children's outdoor play and to develop an environmental taxonomy to support the analysis of play affordances in community play spaces.

DATA SOURCES

Peer-reviewed literature (1974-2023) was sourced from a previously published scoping review (Morgenthaler, Schulze, et al., 2023). The Academic Search Complete, Avery Index to Architectural Periodicals, CINAHL, MEDLINE, PsycINFO, Scopus, and Web of Science databases were searched using the keywords and synonyms of playground, environmental qualities, and children with and without disabilities.

STUDY SELECTION AND DATA COLLECTION

A secondary analysis of the previously published scoping review was conducted. Included studies were those that provided descriptions of physical environment-play activity transactions.

FINDINGS

A qualitative content analysis of 45 articles was conducted and used to form an environmental taxonomy. This taxonomy consisted of 14 space and object categories defined by their functional qualities and linked to play affordances. An array of 284 play occupations were identified in different forms. Play affordances of spaces and object categories and their functional environmental qualities were subsequently identified.

CONCLUSIONS AND RELEVANCE

This study provides evidence to support the understanding of how the physical environment shapes children's outdoor play occupations. Plain-Language Summary: The study authors developed the Environmental Taxonomy of Outdoor Play Space Features as a tool that occupational therapists can use to better understand and describe how the physical environment shapes opportunities for play. The tool could also be useful to justify environmental intervention in schools and public playgrounds to create spaces that support more play for a diversity of children.

Independent and Joint Effects of Prenatal Incense-Burning Smoke Exposure and Children's Early Outdoor Activity on Preschoolers' Obesity

Incense burning is a significant source of indoor air pollution in many Asian regions. There is emerging evidence that maternal prenatal exposure to incense-burning smoke may be a risk factor for childhood obesity. We aimed to extend this new line of research by investigating the independent and joint effect of incense-burning smoke exposure, and children's outdoor activity in early life, on preschoolers' obesity. A total of 69,637 mother-child dyads were recruited from all kindergartens in the Longhua District of Shenzhen, China. Information on sociodemographic characteristics, maternal exposure to incense-burning smoke (IBS) during pregnancy, and frequency and duration of outdoor activity at the age of 1-3 years was collected by a self-administered questionnaire. In addition, the heights and weights of the children were measured by the research team. Logistic regression models and cross-over analyses were conducted to investigate the independent and combined effects of maternal exposure to incense-burning smoke during pregnancy and children's early outdoor activity on obesity in preschoolers. We found that prenatal exposure to incense-burning smoke increased the risk of the presence of obesity in preschoolers' (AOR = 1.13, 95% CI = 1.03-1.23). Additionally, lower frequencies (<3 times/week) or shorter durations (<60 min/time) of outdoor activity from the age of 1-3 years were significantly associated with the presence of obesity, with AORs of 1.24 (95% CI =1.18-1.32) and 1.11 (95% CI = 1.05-1.17), respectively. Furthermore, the cross-over analysis showed that prenatal exposure to IBS combined with a lower frequency of early outdoor activity (AOR = 1.47, 95% CI = 1.31-1.66) or a shorter duration of outdoor activity during ages of 1-3 years (AOR = 1.22, 95% CI = 1.07-1.39) increased the risk of obesity in preschoolers. Finally, additive interactions between prenatal exposure to IBS and postnatal outdoor activity on obesity were identified. Our study indicates that maternal exposure to incense-burning smoke during pregnancy and early lower postanal outdoor activity may independently and jointly increase the risk of obesity among preschoolers.

The Power of Play: Examining the Impact of a School Yard Playground on Attitudes Toward School and Peer Relationships Among Elementary School Students in Chennai, India

Introduction. School environments may impact elementary school students' attachment levels to school as well as their mental and emotional well-being. Yet investments in recess/play infrastructure lag commitments to academic resources, particularly in developing countries. The main objective was to examine the impact of installing playground equipment, in the school yard, on students' attitudes toward school, peers, and the capacity to play of elementary-school children in an underserved, inner-city school in Chennai, India. Methods. A previously validated school attachment questionnaire was modified and administered to 140 and 148 students in pre- and post-playground installation, respectively. Results. For 7 out of 13 survey questions, student attitudes about their own recreational time and their attitudes toward peers significantly improved after playground installation. Conclusion. These results highlight the need for investments in play spaces, and recreational equipment may be just as important as addressing academic needs, especially among underserved children.

Neighbourhood characteristics and socioeconomic inequalities in child mental health: Cross-sectional and longitudinal findings from the Growing Up in Ireland study

This study examined the role of neighbourhood characteristics in explaining socioeconomic inequalities in child mental health (the total difficulties score from the Strengths and Difficulties Questionnaire) using data from Cohort '08 of Growing Up in Ireland Waves 3 (age 5; baseline) and 5 (age 9; follow-up). Twenty neighbourhood items were grouped into neighbourhood safety, built environments, cohesion, interaction, and disorder. Data were analysed using regression, single and multiple mediation, and network psychometric analyses. We found that neighbourhood safety, cohesion, interaction, and disorder were associated with child mental health. These four domains separately (by up to 18 %) or in concert (by up to 23 %) partially explained socioeconomic inequalities in child mental health. Built environments may explain socioeconomic inequalities in mental health in urban children only. Findings from network analysis indicated that specific concerns over "people being drunk or taking drugs in public" and "this is a safe neighbourhood" had the strongest connections with child mental health. Improving neighbourhood characteristics may be important to reduce socioeconomic inequalities in child mental health in Ireland.

Feasibility and Acceptability of an ABCD Program for Child Development Among Skipped Families in Rural Thailand: A Pilot Study

Introduction

The study aimed to develop and examine the aesthetic, bedtime story, connecting with nature, and drawing (ABCD), community based, program for grandparents to help them promote their grandchildren's development.

Methods

The action research was conducted in two phases. In the first phase, semi-structured interviews and focus group discussions were utilized to gather information from healthcare providers, teachers, and community leaders to develop the ABCD program. This was followed by a critical evaluation of the program's activities, materials, and contents. The second phase was to examine the program's effectiveness. A one-group pretest-posttest design was used to study the effectiveness of the program among 20 dyads of grandparents and grandchildren.

Results

All grandparents attended and completed the program. The grandparents' knowledge increased significantly (p = 0.024), and satisfaction with the program was high (X = 9, SD = 0.93) while children's development was not statistically different (p = 0.317).

Conclusion

The ABCD program was found to be feasible and acceptable to grandparents of skipped families to promote their grandchildren's development. The importance of healthcare providers, teachers, and community leaders in providing ABCD programs must also be recognized.

Mitigating the effects of climate change in children's outdoor play environments

BACKGROUND

For many children, public playgrounds represent environments that are playful and important in developing good health. Without efforts to facilitate climate change adaptation of outdoor playgrounds there may be a negative impact on children's health and well-being.

AIM

With a special focus on play value, to explore the reasoning and described strategies among professionals responsible for development, planning and solutions concerning outdoor playgrounds in the context of climate change.

MATERIALS AND METHODS

Eight semi-structured interviews were held with purposefully selected interviewees. Analysis was conducted with manifest content analysis.

RESULTS

Four themes with supporting categories; 1: a new design paradigm for outdoor play environments, 2: a need for updated regulation- and security guidelines for outdoor play environments, 3: nature-based play environments are more climate change resilient, and 4: maintenance and construction of nature-based outdoor play environments. The findings showed an overall awareness and a will to use innovative and nature-based strategies and planning to deal with climate change implications for outdoor play environments.

CONCLUSIONS AND SIGNIFICANCE

The findings suggest that the strategies employed lean towards implementation of increased ecosystem services and natural elements. Ensuring strengthened resilience against hazardous climate change effects may positively facilitate diverse play activities with high play value.

Epidemiological Characteristics of School Playground Injuries

Reports of children's play-related injuries have remained stagnant according to epidemiology studies of the past 3 decades. This article provides a unique look into the context of playground injuries within an entire school district, demonstrating the prevalence of these injuries. This study reports that playgrounds are the leading location of school injury, comprising one-third of all elementary school injuries. This study found that while head/neck injuries were the most commonly injured body region within the playground environment, the proportion of head/neck injuries decreased with age, whereas the proportion of extremity injuries increased with age. At least 1 upper extremity injury required outside medical attention for every 4 that were treated on-site, making upper extremity injuries roughly twice as likely to require outside medical attention as injuries to other body regions. The data in this study are useful for interpreting injury patterns in the context and evaluation of existing safety standards for playgrounds.

Cost-Effectiveness Analysis of Myopia Progression Interventions in Children

Importance

Several interventions exist for treating myopia progression in children. While these interventions' efficacy has been studied, their cost-effectiveness remains unknown and has not been compared.

Objective

To determine cost-effective options for controlling myopia progression in children.

Design, Setting, and Participants

In this cost-effectiveness analysis, a Markov model was designed to compare the cost-effectiveness of interventions for controlling myopia progression over 5 years from a societal perspective in a simulated hypothetical cohort of patients aged 10 years with myopia. Myopia interventions considered included atropine eye drops, 0.05% and 0.01%, defocus incorporated multiple segment spectacles, outdoor activity, soft contact lenses (daily disposable and multifocal), rigid gas-permeable contact lenses, progressive addition lenses, bifocal spectacle lenses, orthokeratology, highly aspherical lenslets (HALs), and red light therapy; all interventions were compared with single-vision lenses. Deterministic and probabilistic sensitivity analysis determined the association of model uncertainties with the cost-effectiveness. Costs were obtained from the charges of the Hospital Authority of Hong Kong and The Chinese University of Hong Kong Eye Center.

Main Outcome and Measures

The mean costs (in US dollars) per child included the cost of hospital visits, medications, and optical lenses. The outcomes of effectiveness were the annual spherical equivalent refraction (SER) and axial length (AL) reductions. Incremental cost-effectiveness ratios (ICERs) were calculated for each strategy relative to single-vision lenses over a time horizon of 5 years.

Results

Outdoor activity, atropine (0.05%), red light therapy, HALs, and orthokeratology were cost-effective. The ICER of atropine, 0.05%, was US $220/SER reduction; red light therapy, US $846/SER reduction; and HALs, US $448/SER reduction. Outdoor activity yielded a savings of US $5/SER reduction and US $8/AL reduction. Orthokeratology resulted in an ICER of US $2376/AL reduction.

Conclusions and Relevance

These findings suggest that atropine eye drops, 0.05%, and outdoor activity are cost-effective for controlling myopia progression in children. Though more expensive, red light therapy, HALs, and orthokeratology may also be cost-effective. The use of these interventions may help to control myopia in a cost-effective way.

Physical environment features that predict outdoor active play can be measured using Google Street View images

BACKGROUND

Childrens' outdoor active play is an important part of their development. Play behaviour can be predicted by a variety of physical and social environmental features. Some of these features are difficult to measure with traditional data sources.

METHODS

This study investigated the viability of a machine learning method using Google Street View images for measurement of these environmental features. Models to measure natural features, pedestrian traffic, vehicle traffic, bicycle traffic, traffic signals, and sidewalks were developed in one city and tested in another.

RESULTS

The models performed well for features that are time invariant, but poorly for features that change over time, especially when tested outside of the context where they were initially trained.

CONCLUSION

This method provides a potential automated data source for the development of prediction models for a variety of physical and social environment features using publicly accessible street view images.

Environment and child well-being: A scoping review of reviews to guide policies

Background

Acting on social determinants is the most effective, efficient, and fairest strategy to improve population health and health equity. Because of their vulnerability and dependence, children are particularly exposed to the deleterious effects of their living environment. Taking these issues into account in the development of public policies and identifying levers for action are crucial. The objective of this scoping review of reviews is to identify the main environmental determinants on children's health and development, and their mechanisms of effect, to be addressed by public policies.

Methods

We conducted a scoping review of reviews in accordance with the method developed by Arksey and O'Malley, and Levac and colleagues' methodology advancement and the PRISMA guideline. Inclusion criteria were identified with the PICos (population-phenomena of interest-context-study design) framework. We used the PubMed database and conducted a thematic analyze.

Results

Forty-seven articles were selected. Their analysis allowed us to identify five categories of interdependent environmental determinants of child health: i) urban design ii) contaminants, iii) parenting environment, iv) social conditions, v) climate change. Together and in a systemic way, they act on the health of the child.

Conclusion

The review carried out allows us to propose a pragmatic framework for clarifying the effects of the physical, social, and economic environment on children's health and wellbeing.

Is more prolonged sun exposure associated with healthier life habits and obesity indicators in Portuguese children?

OBJECTIVES

Sun exposure seems to have an indirect effect on the development of obesity through vitamin D synthesis in the skin, the primary source of this vitamin. The present study aimed to investigate associations among sun exposure time, obesity indicators, and lifestyle habits in children.

METHODS

A total of 4755 children (3-10 years; 49.86% boys) from the north, center and south-central Portugal were included in the present study. During 2016/2017 children's sun exposure time, screen time, time devoted to the practice of physical activity and active play were collected through standard questionnaires answered by parents. Statistical analyses were conducted to investigate differences among sun exposure time according to the sex, age, obesity indicators and lifestyle habits.

RESULTS

Linear regression analysis showed that sun exposure time presented a negative association with Body Mass Index (β = -0.09, 95% CI: -0.18; -0.003; p = .042), body fat % (β = -0.31, 95%; CI: -0.54; -0.07; p = .010), computer time (β = -0.08, 95% CI: -0.12; - 0.05; p < .0001) and a positive association with active play time (β = 0.22, 95% CI: 0.17; 0.27; p < .0001) and total time of physical activity practice (β = 10.01, 95% CI: 4.52; 15.20; p < .0001).

CONCLUSIONS

The results reinforce the need for future guidance on the ideal sun exposure time, especially in children, who are at risk for vitamin D deficiency. Standardization of criteria for classifying optimal sun exposure time in this age group, considering the parameters that affect vitamin D status, such as age and seasonality, should be considered when planning future guidelines.

Process Evaluation of Two Interventions to Improve Health Environments in Family Child Care Homes

Early care and education (ECE) environments influence children's lifelong health behaviors, growth, and development. Although the number of interventions to improve health in ECE environments is increasing, few have been designed for and tested in family child care homes (FCCHs). This study reports the process evaluation of two interventions to improve FCCH health environments, both part of Happy Healthy Homes, a matched-attention randomized-controlled intervention trial conducted in Oklahoma FCCHs. Participating child care providers received one of two multicomponent interventions: (a) an intervention focused on enhancing the quality of the nutrition environment, self-efficacy, and practices or (b) an intervention focused on improving providers' environmental health literacy, self-efficacy, and practices. Guided by "Implementation" constructs of the RE-AIM framework (i.e., reach, effectiveness, adoption, implementation, maintenance), intervention report forms and participant tracking were used to assess intervention dose delivered and interventionist-perceived challenges and successes to implementation. Interviews were conducted to obtain participant feedback after the intervention. Dose delivered was high for both interventions overall and across individual sessions, and provider feedback was positive. Implementation challenges and strengths identified for both interventions may be useful for further enhancing intervention appropriateness and success, particularly for interventions with FCCHs. Process evaluation findings indicate that the two Happy Healthy Home interventions can be conducted with high delivery and are well attended and considered to be valuable to FCCH providers.

A Nature’s Way—Our Way Pilot Project Case Assemblage: (Re)Storying Child/Physical Literacy/Land Relationships for Indigenous Preschool-Aged Children’s Wholistic Wellness

Physical literacy (PL) is gaining more attention from educational policy-makers, practitioners, and researchers as a way to improve health and wellness outcomes for children and youth. While the development of PL is important for early years children, there is limited attention in the literature that explores the political, cultural, and social discourses imbued in colonialism that implicate how PL is actualized in Indigenous early childhood education (ECE) contexts. This case assemblage explores how the culturally rooted, interdisciplinary, and community-based PL initiative, Nature’s Way–Our Way (NWOW), negotiated movement with three early childhood educators in the pilot project with an early childhood education centre (ECEC) in Saskatchewan, Canada. Through postqualitative approaches to research, this case assemblage adopts new materialist methodologies to show how the natural order of knowing in movement was disrupted through moments of rupture generating stories of PL to encompass radical relationality with land. As land becomes a vital and lively part of PL storying, it can function as an important protective factor for Indigenous preschool-aged children’s wholistic wellness.

Biopsychosocial Factors Related to Postural Sway During Sit-to-Stand Movement in Children and Adolescents With Down Syndrome: A Cross-Sectional Study

We investigated factors related to postural sway during sit-to-stand movement in children and adolescents with Down syndrome (DS). Our assessment of participants followed the biopsychosocial model. Body function and structure were represented by muscle strength and postural sway during sit-to-stand movement, which were assessed by manual muscle testing and kinetics analysis, respectively. The Gross Motor Function Measure and Pediatric Balance Scale depicted the activity component. In addition, we included these relevant contextual factors: age, Home Observation for Measurement of the Environment, family income, and maternal schooling. A correlation analysis verified a suspected association between biopsychosocial and postural sway variables. There were significant separated correlations between postural sway in the three phases of the sit-to-stand movement, and age, GMFM-88 dimension D, and muscle strength. Thus, postural control in sit-to-stand movement was related to biopsychosocial factors involving different life aspects of children and adolescents with DS, and these factors should be addressed in rehabilitation therapy intended to improve postural control among these individuals.

The Development and Validation of an Outdoor Free Play Scale for Preschool Children

Children's outdoor free play, which is characterized by intensive physical engagement and diverse social interactions, plays a unique role in early childhood development and education. However, existing scales cannot comprehensively measure children's performance in outdoor free play. The research purpose of this study was to develop and validate an Outdoor Free Play Scale for Children-Preschool Version (OFPS-P) with good reliability and validity, in order to provide a practical tool for teachers to understand the level of children's outdoor free play. Based on the review of existing scales of children's play and the uniqueness of children's outdoor free play, we developed a scale with 12 items and validated the scale with two samples of preschool children with exploratory (n_sample1 = 140) and confirmatory (n_sample2 = 241) factor analyses. Four factors were identified in this scale: physical fitness, approaches to learning, social interaction, and imagination. The results indicated good reliability and validity of OFPS-P, which can be used to evaluate preschool children's performance on outdoor free play and to support teachers' effective support in outdoor play activities in kindergartens.

Motivating playgrounds: understanding how school playgrounds support autonomy, competence, and relatedness of tweens

Purpose

Physical activity (PA) is an important factor contributing to general health. PA declines rapidly during tween years (9–12 years) when children’s social world changes. School playgrounds can contribute substantially to children’s PA, but little is known about how to motivate tweens to use school playgrounds. Using the three basic psychological needs (autonomy, competence, and relatedness) proposed by the Self-Determination Theory, this qualitative study aimed to investigate how school playgrounds can support tweens’ needs.

Methods

Tweens (n = 56) participated in focus group go-along interviews in their school playground.

Results

We found that tweens needed a variety of play possibilities (autonomy) that challenged their skills (competence) as well as areas to retract and be with friends (relatedness).

Conclusion

This research highlights the importance of incorporating tweens’ perspectives in playground design to attract and retain them in play and PA in school playgrounds.

Nature play in early childhood education: A systematic review and meta ethnography of qualitative research

Play in nature-based environments in childhood education has positive benefits for child development. Although previous reviews showed the benefits of play in nature-based environments for child development they did not attempt to understand how and why nature-based environments contribute to play quality. This review aims to explore the value of play in nature-based environments compared to non-nature-based environments for developmental outcomes of young children (2–8 year). We searched for studies that investigated the relation between play and nature-based environments on the databases PsycINFO, ERIC, and Web of Science. Inclusion/exclusion criteria were: (1) the study focused on play in/on a nature based environment, (2) the study included participants between the age of 2–8 years, (3) it was an empirical study, (4) the study was conducted in the context of early childhood education (ECE), and (5) the study included participants without special needs or disabilities. Using these criteria we selected 28 qualitative studies with an overall sample size of N = 998 children aged 2–8 years. The studies were synthesized using an adaptation of Noblit and Hare’s meta-ethnographic approach. Three overarching themes were found: (1) the aspects of play quality that are related to nature-based environments, (2) the aspects of nature-based environments that support play, and (3) the aspects of teacher-child interactions that contribute to nature play quality. The meta themes resonate with play theories and theories of the restorative value of nature. We draw on the qualitative data to refine and extend these theories, and to come up with a definition of the concept “nature play.” This systematic review also sets a base for future research on play interventions in nature-based environments. We argue that (1) research will benefit from thoroughly conceptualizing the role of play in the development of young children, (2) using the affordances theory research will benefit from moving beyond the individual play actions as a unit of analysis, and (3) from an educational perspective it is important to shift the focus of nature play to its benefits for children’s cognitive development.

Residential Proximity to Urban Play Spaces and Childhood Overweight and Obesity in Barcelona, Spain: A Population-Based Longitudinal Study

Findings on the relationship between play spaces and childhood overweight and obesity are mixed and scarce. This study aimed to investigate the associations between residential proximity to play spaces and the risk of childhood overweight or obesity and potential effect modifiers. This longitudinal study included children living in the city of Barcelona identified in an electronic primary healthcare record database between 2011 and 2018 (N = 75,608). Overweight and obesity were defined according to the WHO standards and we used 300 m network buffers to assess residential proximity to play spaces. We calculated the risk of developing overweight or obesity using Cox proportional hazard models. A share of 29.4% of the study population developed overweight or obesity, but we did not find consistent associations between play space indicators and overweight or obesity. We did not find any consistent sign of effect modification by sex, and only some indications of the modifying role of area socioeconomic status and level of exposure. Although it is not possible to draw clear conclusions from our study, we call for cities to continue increasing and improving urban play spaces with an equitable, healthy, and child-friendly perspective.

Comparative Review of Environmental Audit Tools for Public Open Spaces from the Perspective of Children's Activity

Public open spaces are important venues for children's participation in outdoor activities and social life. This study performs a comparative and qualitative review of the tools that can be used to audit the environments of children-focused public open spaces. The analysis reviews 25 studies involving 11 tools for comparison. The results reveal that (1) the tools were developed in different fields; (2) the tools use two data resources, field investigation and geographic databases; (3) the tool dimensions are diverse, as are the number of items covered, and are generally related to four categories: surrounding environment and accessibility, activity and perceived safety, children's sports and play opportunities, and aesthetic and comfort of the environment; (4) the reliability of most tools has been verified, with some validity still to be confirmed; (5) there are differences in tool users, settings, and aims. Among the tools, the CPAT and the EAPRS are the most comprehensive. Comparative analysis of the tools provides a reference for studies on children-focused public open spaces and for the development and improvement of corresponding tools in the future.

Playing in 'The Backyard': Environmental Features and Conditions of a Natural Playspace Which Support Diverse Outdoor Play Activities among Younger Children

Outdoor play in nature-rich spaces has been associated with healthy development among young children. The diverse play opportunities afforded to children by natural playspaces can scaffold health benefits, appreciation of nature, and pro-environmental behaviors into adulthood. Environmental features and conditions of outdoor playspaces significantly influence the diversity and quality of play opportunities. Understanding how the physical environment can support high-quality play experiences can inform the design of stimulating, health-promoting playscapes for children. An observational behavior mapping framework was utilized to examine the environmental features of The Backyard, a large natural playscape, associated with play activities among young children. The Tool for Observing Play Outdoors was used to capture outdoor play types OPT), along with associated behavioral and environmental data, during seven days of field observation. While the playspace supported most OPTs, Physical and Exploratory play were most prevalent. Associations with activity intensity and risk play are also presented. Loose parts, particularly natural loose parts, were highly involved in most OPTs, but especially associated with Exploratory play. Ground topography showed some association with several OPTs and warrants further investigation. The environmental features of The Backyard supported an abundant and diverse range of outdoor play activities for young children and families.

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

Background

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

Methods

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

Results

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

Conclusions

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

Trial registration

PROSPERO registration: CRD42021238719.

Supplementary Information

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

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

Background

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

Methods

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

Results

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

Conclusions

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

Supplementary Information

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

Recommendations for Resuming PA after Prolonged Rest in Children and Adolescents: A Systematic Integrative Review of Relevance for Immunity

This systematic integrative review aims to summarize the protective effect of PA on children and adolescents, with special reference to the immune system. Periods of prolonged inactivity in children and adolescents are rare and due to exceptional events, such as illness or environmental circumstances, e.g., natural disasters, wars, or epidemics. The recent COVID-19 pandemic forced billions of children in developmental ages into inactivity. This exceptional event was the reason for studying the compensational behavioral strategies adopted by children and adolescents to counteract physical inactivity. Several studies showed the rise of spontaneous physical activity (PA) among children and adolescents to compensate for sedentarism. However, for some children, sedentarism could in turn foster other sedentarism. With the restart of "normal daily life" worldwide, a question is posed on both how to resume PA without causing damage and how to improve the immune response. Some key points emerged from the literature. Children must resume PA gradually using different methods, considering age, sex, health status, and the presence of overweight conditions. Immunity can be stimulated with PA by aerobic exercise, resistance training, flexibility exercise, relaxation, and coordinative exercises.

Social Inequalities in the Association between Social Infrastructure and Mental Health: An Observational Cross-Sectional Analysis of Children and Adolescents in Germany

The mental health (MH) of especially children and adolescents with low socioeconomic status (SES) benefits from access to greenspaces. This study aimed at investigating social inequalities in the association between several types of social infrastructure (SI) and MH in children and adolescents. The sample comprised 12,624 children and adolescents of the KiGGS Wave 2 study (2014–2017). KiGGS provided information on SI (access to playgrounds, sports fields, swimming pools, parks) for all children and the environmental module (GerES V) within KiGGS on the walking time to SI for a subsample. Social inequality was measured by parental SES and the German Index of Socioeconomic deprivation and MH by the Strengths and Difficulties Questionnaire. Ordinal logistic regression analyses showed that access to fewer SI places was associated with higher odds of MH problems. Children and adolescents experiencing high (but not medium or low) socioeconomic deprivation at the municipal level were more likely to have MH problems when having less access to SI places. At the individual level, MH problems in high- and low-SES, but not medium-SES children and adolescents were associated with no access to SI places. Children and adolescents from high socioeconomically deprived areas and with low and high SES might benefit from high-availability SI.

Urban design and adolescent mental health: A qualitative examination of adolescent emotional responses to pedestrian- and transit-oriented design and cognitive architecture concepts

With the continued migration of people into cities, urban environments are becoming increasingly important determinants of health. However, the study of how precise environmental designs are linked to mental health are generally lacking, especially among adolescent populations. Using a qualitative approach featuring 23 go-along interviews with adolescents, we investigated the relationships between specific urban designs as outlined in pedestrian- and transit-oriented design (imageability, enclosure, scale, transparency, complexity) and cognitive architecture (biophilic architecture, symmetries, fractals) concepts and adolescent mental health indicators (i.e., emotional responses). Central findings from the subsequently undertaken framework analysis include considerably different perceptions regarding natural versus built enclosure and landmarks, significantly more expressed emotional engagement with visually rich and transparent urban designs relative to grey/concrete and windowless designs, and strong positive reactions to the three cognitive architecture concepts. Additional exploratory gender-based analyses were conducted and found potential differences in perceptions of design concepts between boys and girls. We note the broader relevance of these findings by discussing their implications for practitioners and suggesting how they can advance certain UN Sustainable Development Goals.

Influence of a Socially Assistive Robot on Physical Activity, Social Play Behavior, and Toy-Use Behaviors of Children in a Free Play Environment: A Within-Subjects Study

Background: Play is critical for children's physical, cognitive, and social development. Technology-based toys like robots are especially of interest to children. This pilot study explores the affordances of the play area provided by developmentally appropriate toys and a mobile socially assistive robot (SAR). The objective of this study is to assess the role of the SAR on physical activity, play behavior, and toy-use behavior of children during free play. Methods: Six children (5 females, Mage = 3.6 ± 1.9 years) participated in the majority of our pilot study's seven 30-minute-long weekly play sessions (4 baseline and 3 intervention). During baseline sessions, the SAR was powered off. During intervention sessions, the SAR was teleoperated to move in the play area and offered rewards of lights, sounds, and bubbles to children. Thirty-minute videos of the play sessions were annotated using a momentary time sampling observation system. Mean percentage of time spent in behaviors of interest in baseline and intervention sessions were calculated. Paired-Wilcoxon signed rank tests were conducted to assess differences between baseline and intervention sessions. Results: There was a significant increase in children's standing (∼15%; Z = -2.09; p = 0.037) and a tendency for less time sitting (∼19%; Z = -1.89; p = 0.059) in the intervention phase as compared to the baseline phase. There was also a significant decrease (∼4.5%, Z = -2.70; p = 0.007) in peer interaction play and a tendency for greater (∼4.5%, Z = -1.89; p = 0.059) interaction with adults in the intervention phase as compared to the baseline phase. There was a significant increase in children's interaction with the robot (∼11.5%, Z = -2.52; p = 0.012) in the intervention phase as compared to the baseline phase. Conclusion: These results may indicate that a mobile SAR provides affordances through rewards that elicit children's interaction with the SAR and more time standing in free play. This pilot study lays a foundation for exploring the role of SARs in inclusive play environments for children with and without mobility disabilities in real-world settings like day-care centers and preschools.

Nature and Children's Health: A Systematic Review

CONTEXT

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

OBJECTIVE

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

DATA SOURCES

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

STUDY SELECTION

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

DATA EXTRACTION

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

RESULTS

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

LIMITATIONS

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

CONCLUSIONS

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

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

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

Foundational Movement Skills and Play Behaviors during Recess among Preschool Children: A Compositional Analysis

This study aimed to examine the associations between play behaviors during preschool recess and foundational movement skills (FMS) in typically developing preschool children. One hundred and thirty-three children (55% male; mean age 4.7 ± 0.5 years) from twelve preschools were video-assessed for six locomotor and six object-control FMS using the Champs Motor Skill Protocol. A modified System for Observing Children's Activity and Relationships during Play assessed play behaviors during preschool recess. Associations between the composition of recess play behaviors with FMS were analyzed using compositional data analysis and linear regression. Results: Relative to time spent in other types of play behaviors, time spent in play without equipment was positively associated with total and locomotor skills, while time spent in locomotion activities was negatively associated with total and locomotor skills. No associations were found between activity level and group size play behavior compositions and FMS. The findings suggest that activity type play behaviors during recess are associated with FMS. While active games without equipment appear beneficial, preschool children may need a richer playground environment, including varied fixed and portable equipment, to augment the play-based development of FMS.

Reimagining spaces where children play: developing guidance for thermally comfortable playgrounds in Canada

Setting

Planning and designing thermally comfortable outdoor spaces is increasingly important in the context of climate change, particularly as children are more vulnerable than adults to environmental extremes. However, existing playground standards focus on equipment and surfacing to reduce acute injuries, with no mention of potential negative health consequences related to heat illness, sun exposure, and other thermal extremes. The goal of this project was to develop proposed guidelines for designing thermally comfortable playgrounds in Canada for inclusion within the CAN/CSA-Z614 Children’s playground equipment and surfacing standard.

Intervention

The project to develop guidance for thermally comfortable playgrounds was initiated with a municipal project in Windsor, Ontario, to increase shade, vegetation, and water features at parks and playgrounds to provide more comfortable experiences amid the increased frequency of hot days (≥30°C). The lack of available information to best manage environmental conditions led to a collaborative effort to build resources and raise awareness of best practices in the design of thermally comfortable playgrounds.

Outcomes

A group of multidisciplinary experts developed technical guidance for improving thermal comfort at playgrounds, including a six-page thermal comfort annex adopted within a national playground and equipment standard. The annex has been used by Canadian schools in a competition to design and implement green playgrounds.

Implications

Both the technical report and the thermal comfort annex provide increased awareness and needed guidance for managing environmental conditions at playgrounds. Thermally safe and comfortable play spaces will help ensure that Canada’s playgrounds are designed to minimize environmental health risks for children.

Does the Spatial Layout of a Playground Affect the Play Activities in Young Children? A Pilot Study

Background

The objective of this study was to describe, through measurement of physical activity and observation of free outdoor play, the relation between children's free play and the spatial layout of the playground. To accomplish this, we altered the spatial layout of the same playground to see how the layout affects the play activity and the physical activity levels in the same children.

Methods

Participants were six young children (four girls and two boys; mean age = 5 years and 1 month, SD = 2.59 months). Participants' physical activity level and the duration of different types of action that occurred in each area and their transitions were compared before and after the alteration of the play-equipment layout using the data from accelerometers and video recordings.

Results

A significant increase in physical activity occurred after the spatial layout alteration, which was related to action differences. Before the alteration, children tended to play in a similar manner for a given play area; however, after the alteration, pronounced interindividual variation in play activity across children was observed.

Conclusion

The present pilot study found that in free play situations in the outdoor playground, the spatial layout of playground affects the pattern of play activity and the physical activity levels of young children.

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

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

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

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

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

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

Associations between Children's Risky Play and ECEC Outdoor Play Spaces and Materials

Children spend a large amount of time each day in early childhood education and care (ECEC) institutions, and the ECEC play environments are important for children’s play opportunities. This includes children’s opportunities to engage in risky play. This study examined the relationship between the outdoor play environment and the occurrence of children’s risky play in ECEC institutions. Children (n = 80) were observed in two-minute sequences during periods of the day when they were free to choose what to do. The data consists of 935 randomly recorded two-minute videos, which were coded second by second for several categories of risky play as well as where and with what materials the play occurred. Results revealed that risky play (all categories in total) was positively associated with fixed equipment for functional play, nature and other fixed structures, while analysis of play materials showed that risky play was positively associated with wheeled toys. The results can support practitioners in developing their outdoor areas to provide varied and exciting play opportunities.

A Pilot Study Examining Body Composition Classification Differences Between Body Mass Index and Bioelectrical Impedance Analysis in Children With High Levels of Physical Activity

Background: Body mass index (BMI) is frequently labeled as "flawed" in assessing obesity since it cannot differentiate between muscle and fat leading to misclassifications of healthy individuals. Bioelectrical impedance analysis (BIA) may be a more accurate indicator of obesity since it can distinguish the difference between muscle and fat in children. This pilot study investigated discrepancies between BMI and BIA body composition classifications in children with high levels of physical activity. Methods: Participants were selected from three elementary schools (N = 380, K = 76, 1st = 64, 2nd = 62, 3rd = 61, 4th = 83, and 5th = 34) receiving 60 min of outdoor, unstructured play daily. BIA scales were used to collect each child's body fat percentage and BMI score, then those numbers were categorized by BIA and BMI normative values as either underweight, healthy, overweight, or obese. Results: Overall, 26% of the students were classified differently when using the normative classifications for BMI and BIA, with the largest discrepancy found in the overweight category at 38%. Similar inconsistencies were found when students were divided as younger (42%) vs older students (36%), and males (40%) vs. females (35%). Conclusions: This pilot study demonstrated that there is a significant difference in how BMI and BIA discriminate between the different body composition categories. BIA consistently shows to be a more accurate tool in assessing obesity rates in children since it directly measures body fat.

Benefits of Outdoor Sports in Blue Spaces. The Case of School Nautical Activities in Viana do Castelo

Participating in outdoor sports in blue spaces is recognized to produce a range of significant social benefits. This case study empirically analyzes the social benefits associated with the School Nautical Activities project carried out in Viana do Castelo (Portugal) in school-age children and adolescents. It consisted of a 4 year program in which scholars took part in nautical activities (surfing, rowing, sailing, and canoeing) in blue spaces once a week during a semester as a part of their physical education course. The methods used for data collection were as follows: (1) a survey answered by 595 participants in the program and (2) five focus groups (FG): two FGs with participants (seven on each FG), two FGs with their parents (eight participants each), and one FG with the physical education teachers (five participants). Interviews were transcribed and qualitative analysis with NVivo software was developed. Results revealed clear evidence on the social benefits for school-age children and adolescents associated with participation in outdoor activities in blue spaces both in the overall health and in all the following analyzed categories: mental health and well-being, education, active citizenship, social behavior, and environmental awareness. More than 40% state that their overall health is much better now (13.4%) or somewhat better now (29.9%) due to their participation in the program. Thus, this article provides support for the anecdotal recognition of the benefits for school-age children and adolescents from participating in sports in the outdoors and especially in blue spaces.

Tool for Observing Play Outdoors (TOPO): A New Typology for Capturing Children's Play Behaviors in Outdoor Environments

Engagement in play has been definitively linked to the healthy development of children across physical, social, cognitive, and emotional domains. The enriched nature of high-quality outdoor play environments can afford a greater diversity of opportunities for play than indoor settings. To more effectively design outdoor play settings, we must better understand how the physical environment supports, or hinders, the different types of play which suit children's needs and interests. However, play typologies or observation tools available to date do not adequately capture the unique characteristics of outdoor play. This paper outlines the development and testing of the Tool for Observing Play Outdoors (TOPO), a new typology of outdoor play, as well as a systematic field observational protocol which can be used to effectively depict children's behaviors in outdoor spaces, as well as evaluate the play environment itself. The tool can be deployed in either a collapsed or expanded form to serve the needs of a wide range of studies and environments. This new tool represents a significant advance in the ability to fully and effectively study and plan outdoor play environments to provide more diverse, high-quality play settings that will support the healthy development of children across the spectrum.

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.

Fitness as a Mediator of the Enhancement of Quality of Life after a 6-Months Exercise Program

Purpose: The study aimed to test whether improvement in fitness components, mediates the changes in Health-related Quality of Life (HRQoL) after exercise intervention in overweight and obese children. Methods and design: 170 obese and overweight children (121 exercise group and 49 control group) participated in a public exercise program based on sports practice for 6 months, 2 h per week. Anthropometry, physical fitness, and HRQoL were measured. Magnitude-based inferences and Cohen's effect size were performed to analyze the program effect. To know which physical fitness components mediated the improvement on children's HRQoL, multiple mediation analyses were performed. Results: the analysis showed a moderate effect on some fitness components and a moderate and small effect on HRQoL. The improvement of agility or cardiorespiratory fitness showed a significant indirect effect on the enhancements in some HRQoL dimensions. Conclusion: after a 6-months exercise program in overweight and obese children, all physical fitness components improved, being responsible for the improvement of the HRQoL, agility and cardiorespiratory fitness.

Determining public perceptions of a proposed national heat protection policy for Australian schools

ISSUE ADDRESSED

Across Australia there are inconsistent and varying guidelines or 'recommendations' across a number of jurisdictions for the protection of school children from heat-related consequences, yet there is no national policy for heat protection in school settings. The aim of this study was to determine public perceptions of the efficacy of implementing a heat protection policy for Australian schools.

METHODS

A sample of public perceptions was drawn upon from public comments posted on a national Australian Broadcasting Corporation (ABC) news article on the proposed heat protection policy. Public comments were analysed using a social-ecological model thematic content analysis.

RESULTS

Themes that emerged to support a national heat protection policy for schools included: protection from the consequences of extreme heat, reliance of children on adult/school decisions and utilising modern knowledge/technology advancements. In contrast, criticism emerged relating to the importance of having resilient children, air conditioning costs, perceived over-regulation and heat exposure being a lifestyle choice in some contexts.

CONCLUSIONS

Overall, this study provides support for the introduction of a national heat protection policy with a number of key considerations identified for implementation to benefit and protect Australian school children. SO WHAT?: As a number of the heat guidelines are developed by individual organisations with differing messages, determining the public efficacy of comprehensive heat protection strategies can help lead to the development of policy for a widespread and consistent heat protection program across Australian schools.

The impacts of unstructured nature play on health in early childhood development: A systematic review

BACKGROUND

Nature play is growing in popularity as children's play spaces are transforming from traditional playgrounds into more nature-based play spaces with considerable financial and resource investment from government bodies. This has resulted in the re-development of children's play spaces to incorporate more natural elements such as trees, plants and rocks. Despite this, it is unclear whether there is empirical evidence to support claims that play in nature is beneficial for child health and development.

AIM

To conduct a systematic review examining the impacts of nature play on the health and developmental outcomes of children aged 2-12 years.

METHODS

Seven electronic databases were searched (MEDLINE, ERIC, Embase, PsycINFO, The Cochrane Library, The Joanna Briggs Institute and Emcare) from inception to July/August 2018 (search updated July/August 2019). The Inclusion criteria were children aged 2-12 years with no health/developmental conditions. The exposure/intervention of interest was unstructured, free play in nature. Critical appraisal of included studies was conducted using the McMaster Critical Appraisal Tool. Descriptive synthesis was then undertaken using the NHMRC FORM Framework.

RESULTS

Out of 2927 articles identified, 16 studies met the inclusion criteria. The nature play exposure/intervention was heterogeneously described, and a plethora of outcome measures were used. Nature play had consistent positive impacts on physical activity outcomes and cognitive play behaviours (imaginative and dramatic play). However, there remain some concerns regarding the quality of the evidence base, heterogeneity in intervention description and parameters in the outcome measures used.

CONCLUSIONS

While the positive impacts of nature play were encouraging in terms of physical activity and cognitive development, nature play stakeholders should focus on producing a universal definition for nature play, the development of standardised outcome measures and the conduct of robust research designs. Implications of these findings suggest the need for the development of standardised guidelines to inform practice and policy in the design of children's play spaces in different contexts.

Nature Play and Fundamental Movement Skills Training Programs Improve Childcare Educator Supportive Physical Activity Behavior

Background: Physical activity professional development programs for Early Childhood Education and Care (ECEC) educators are a viable strategy for improving preschool children’s physical activity behavior. This pilot intervention evaluated the effectiveness of ‘nature play’ and ‘fundamental movement skills’ (FMS) professional development programs on ECEC educators’ practices on physical activity. Methods: 148 ECEC educators from 20 ECEC centers took part in either the Nature play or FMS professional development programs in Perth, Western Australia. Educators self-reported their physical activity related practices at baseline and three months post-professional development training, using established items. Wilcoxon’s test and adjusted models using Mann–Whitney U tests were run at the individual educator level to examine the change between baseline and post-professional development educator physical activity behavior. Results: Educators’ self-efficacy to engage children to be active significantly increased in both the Nature play and FMS professional development programs (p < 0.05). In the Nature play professional development program, ECEC educators’ perceived time set aside for children to participate in nature-based play increased by 9.2%, and their perceived behavioral control for supporting general and nature-based play activities for preschool children increased by 5% and 10.3%, respectively (p < 0.05). However, these results were no longer significant after adjusting for educator socio-demographics. Conclusion: Both the Nature play and FMS professional development programs were effective in improving educators’ self-efficacy to engage children to be active in Nature play or FMS activities. Larger pragmatic trials are required to confirm the impact of these professional development programs on educator perceived physical activity behavior.

Preschool group practices and preschool children's sedentary time: a cross-sectional study in Finland

OBJECTIVES

Preschool is an important setting for regulating sedentary time (ST). The preschool day in Finland follows daily structures by having morning and afternoon slots for group-based activities that can encourage children for movement (eg, free play and outdoor time) or be still (eg, teacher-led sessions and sitting-based circles). This study aims to explore if the weekly routines in preschool and if more frequent visits in places encouraging physical activity (PA) are associated with children's ST during preschool hours.

DESIGN

Cross-sectional DAGIS (Increased Health and Wellbeing in Preschools) study in the years 2015 and 2016.

SETTING

In Finland.

PARTICIPANTS

864 children (48% girls, 4.7 years) from 159 preschool groups in 66 preschools OUTCOME MEASURES: A total of 778 children wore required lengths of time (at least 240 min per preschool day, at least 2 days) the accelerometer during preschool hours. Each preschool group reported their weekly schedule during the week, and one early educator completed a questionnaire covering practices. The following five measures related to weekly structures were formed; times of outdoors (times per day), teacher-led sessions (times per day), free play (low, middle or high), organised PA lessons (no lessons at all/others) and mixed activities (no lessons at all/others), and the following five measures about the frequencies of visits in places encouraging PA; nature trips (times per week), play parks (times per week), neighbourhood sport facilities (no visits at all/others), visits to gym or other indoor facility (no visits at all/others) and field trips to neighbourhoods (times per week). Multilevel linear regression analyses were conducted to measure the associations.

RESULTS

Of all the tested associations, only more frequently conducted nature trips were associated with lower children's ST during preschool hours (β=-1.026; 95% CI -1.804 to -0.248).

CONCLUSION

Frequent nature trips in preschools may be important due to its association with lower preschool children's ST.

Designing Activating Schoolyards: Seen from the Girls' Viewpoint

Girls are typically less active in the schoolyard during recess than boys. It is therefore necessary to understand influences on girls’ recess activity in schoolyards. The aim of this qualitative study was to investigate girls’ perceptions of physical environmental factors influencing recess physical activity in re-designed schoolyards and to compare the perceptions of girls from different age groups. In 2018, 50 girls from five Danish schools were interviewed using photo-elicitation. The girls were from Grade 4 (n = 28, age 10–11) and Grade 6 (n = 22, age 12–13). Data were analysed using pen profiles constructed from verbatim transcripts. Ten factors emerged: variety, accessibility, size, designated spaces, greenery, playground markings, active play facilities, sports facilities, play equipment, and speakers. Play facilities (trampolines, obstacle courses, dancing and gymnastic appliances) were favoured over traditional sport facilities. Designated spaces, greenery and speakers were important for feeling comfortable within the schoolyard. Although similar factors were raised by the two age groups, some factors were perceived as enablers by the youngest and as barriers by the oldest girls, highlighting the complexity of designing schoolyards that cater to all ages. A greater understanding of how different designs and facilities may be perceived by girls of different ages is important for the design of future schoolyards.

Moving Beyond the Gym: A Content Analysis of YouTube as an Information Resource for Physical Literacy

The Internet, and particularly YouTube, has been found to be and continues to develop as a resourceful educational space for health-related information. Understanding physical literacy as a lifelong health-related outcome and facilitator of an active lifestyle, we sought to assess the content, exposure, engagement, and information quality of uploaded physical literacy videos on YouTube. Two researchers collected 300 YouTube videos on physical literacy and independently coded each video's: title, media source of upload, content topics related to physical literacy, content delivery style, and adherence to adapted Health on the Net Foundation Code of Conduct (HONcode) principles of information quality. Physical literacy videos that focused on physical activity and behaviors were the strongest predictor of high quality ratings, followed closely by videos covering affective domains (motivation, confidence, and self-esteem) of physical literacy. The content delivery method was also important, with videos utilizing presentations and testimonials containing high quality information about physical activity. Thus, providers of physical literacy and health-related online video content should be aware of and adhere to the expected quality standards. As health information expectations and ethical standards increase, the Internet, and specifically YouTube, has the potential to enhance video resources, virtual networking opportunities, as well as the sharing, dissemination, accumulation, and enrichment of physical literacy information for all.

Roaming the Neighbourhood: Influences of Independent Mobility Parenting Practices and Parental Perceived Environment on Children's Territorial Range

Children’s independent mobility (IM), their freedom to move about their neighbourhood without supervision by adults, has been in steady decline in recent decades. Previous research has linked perceptions of the environment with various measures of IM, but recently concerns have been raised regarding inconsistency in measuring IM. This study used various measures of IM and aimed to address how parental perceptions of the neighbourhood environment are associated with children’s territorial range (actual IM), as well as how this relationship is mediated by IM parenting practices (allowed IM). A sample of 105 child/parent dyads from Vancouver, Canada participated in this study. Children (age 10–13) wore a global positioning system (GPS) watch and an accelerometer and completed an activity diary for seven days to assess their territorial range. Parents completed a questionnaire that assessed perceptions of their neighbourhood environment and IM parenting practices—license for IM and roaming allowance. Path analyses were used to address the research aims. License for IM and roaming allowance mediated the relationship between perceived walking facilities, crime safety, and neighbourhood relations and children’s territorial range. Findings suggest that future interventions to increase children’s territorial range should focus primarily on attitude and behaviour change among parents to grant children more freedom.

Greening of Daycare Yards with Biodiverse Materials Affords Well-Being, Play and Environmental Relationships

Nature contacts are recognized as positively contributing to humans’ health and well-being. Although there have been projects to green daycare or schoolyards, yard greening and microbial biodiversity have never been studied simultaneously. We asked whether simultaneously increasing biodiversity exposure and greening urban daycare yards affects 3–5 years-old children’s physical activity and play, their environmental relationships, and their perceived well-being. For transforming six daycare yards in Finland, we used a forest floor with high biodiversity, sod, peat blocks, and planters for vegetable and flower growing. We used qualitative interview and survey-based data collected from the daycare personnel and parents to analyze how green yards encourage children’s engagement with their everyday life-worlds. We identified the functional possibilities provided by the yards and the dynamic aspects related to the greening. Green, biodiverse yards were considered safe, and inspired children’s play, diversified their activities, and increased physical activity. The greenery offered embodied experiences of nature and provided the children with multi-sensory exploration and diverse learning situations. The dynamic and emotional ways of engaging with the natural environment increased their well-being. The activities related to caring for the yards and exploring them promoted the development of environmental relationships. The results can be used for designing health-enhancing yards

Kindergarten: Producer or Reducer of Inequality Regarding Physical Activity Levels of Preschool Children

Several studies have shown that children have sub-optimal physical activity levels. Since preschool children (4-6 years-old) spend most of their time awake in kindergarten on weekdays, physical activity level at kindergarten is crucial. The study examines preschool children's physical activity level at kindergarten. Preschool children's activity level at kindergarten is also investigated related to activity level at leisure, gender, and mothers' education level, income, and age. Two hundred and forty four children (125 boys and 119 girls) supplied valid accelerometer data, and mothers' education level, income, and age were measured using a questionnaire. One-way ANOVA and linear regression were utilized as statistical analyses. The results demonstrated that physical activity level during kindergarten is the main contributor to preschool children's physical activity level on weekdays. Furthermore, boys were more active than girls, and preschool children's physical activity level at both leisure and at kindergarten were not associated with mothers' age, education level, or income. However, a positive association was found between physical activity level at leisure and physical activity level at kindergarten, in which physical activity level at kindergarten increases when physical activity level at leisure increases. Physical activity level was also significantly different between kindergartens. The study indicated that kindergartens increase inequality according to physical activity level among preschool children-contributing to creating differences according to low-active and high-active children.