Correlates of preschool children's physical activity

Where does physical activity fit into preschool postpandemic? A qualitative exploration with parents, teachers and administrators

OBJECTIVES

During the preschool years, children depend on adult caregivers to provide opportunities for physical activity (PA). Research has focused on measuring PA in preschool, as well as barriers and facilitators to children's PA but caregiver perceptions remain largely unknown especially in light of the COVID-19 pandemic. This study aims to understand the value of PA in preschool following the pandemic from three types of adult caregivers, parents of a young child (n=7), preschool teachers (n=7) and preschool administrators (n=7).

METHODS

In-depth qualitative interviews were conducted to explore the following research questions: (a) how do caregivers describe the importance of PA in preschool postpandemic? (b) how do caregivers support and prioritise PA in preschool postpandemic and what challenges do they face in doing so? and (c) how do caregivers interact with one another to promote PA? Qualitative answers were coded using a codebook developed to answer the research questions of interest.

RESULTS

Parents, teachers and administrators all described valuing PA for preschoolers, but each caregiver type described a different way of promoting it. All the caregivers listed barriers that inhibit their ability to prioritise and promote PA, some heightened postpandemic. Lastly, there were limited caregiver interactions when it came to promoting PA, with the burden largely falling on teachers.

CONCLUSION

Our findings indicate that one particularly important area for intervention is supporting parents, teachers and preschool administrators in creating a shared understanding of the importance of PA for young children and ways to collaborate to promote it.

Association between preschooler outdoor play and home yard vegetation as measured by high resolution imagery: Findings from the PLAYCE study

Outdoor play in the home yard is an important source of physical activity for many preschoolers. This study investigated if home yard size and vegetation are related to preschooler outdoor play time. High-resolution remotely sensed data were used to distinguish between types of vegetation coverage in the home yard. Shrub and tree cover, and yard size, were positively associated with outdoor play. Following stratification by socio-economic status (SES - parent education), only tree cover was positively associated with preschooler outdoor play in low SES households. All types of vegetation cover were positively associated with preschooler outdoor play in higher SES households. This study highlights the importance of larger yard sizes and higher levels of vegetation for facilitating outdoor play in preschoolers.

Physical activity in infancy and early childhood: a narrative review of interventions for prevention of obesity and associated health outcomes

In the context of the childhood obesity epidemic, this narrative review aims to explore opportunities to promote physical activity (PA) between birth and age 5 years as well as the health outcomes associated with PA in early childhood. Although early childhood is an ideal time to promote healthy habits, guidelines for PA have often ignored early childhood given the limited evidence for children <5 years old. Herein we discuss and highlight infant, toddler and preschool age interventions to promote PA and prevent obesity both in the short and long-term. We describe novel and modified interventions to promote improved early childhood health outcomes, encompassing cardiorespiratory, muscle, and bone strengthening components necessary for short-term motor development and long-term health. We call for new research aimed at developing and testing innovative early childhood interventions that may be performed in home or childcare settings, monitored by parents or caregivers.

The moderating role of parent perceptions in relationships between objectively measured neighbourhood environment attributes and pre-schooler's physical activity: Findings from the PLAYCE study

We examined the moderating effects of parent perceptions of the neighbourhood environment on associations between objectively measured neighbourhood environment attributes and physical activity among pre-schoolers. The number of neighbourhood parks was positively associated with pre-schooler energetic play when parents had above average perceptions of access to services. Objectively measured street connectivity was associated with fewer minutes of energetic play when pedestrian and traffic safety was perceived to be below average by parents. Greater understanding of the role played by parents in pre-schooler's exposure to physically active supportive environments is needed to inform environmental interventions for specific age groups.

Influence of naps on sedentary time and physical activity in early childhood

The objective was to determine if, in preschool-aged children, (1) nap habituality is associated with sedentary time and physical activity (movement behaviors), (2) nap physiology is associated with movement behaviors, and (3) if missing a nap, compared to taking a nap, affects movement behaviors on the same day and subsequent day. A within-subjects (44 children; 4.2 ± 0.6 years; 55.6% female), at-home study examined two experimental conditions (one afternoon each of nap- and wake-promotion with order counterbalanced) one week apart. Movement behaviors were derived from wrist-worn actigraphy (12.1 ± 3.1 days). Average movement behaviors were calculated from the overall study period with experimental days excluded. Movement behaviors were also extracted for the same day and the subsequent day of the two experimental conditions. Polysomnography was recorded during the nap-promoted condition. Children were classified as non-, intermediate-, or habitual-nappers. Although average movement behaviors were different between nap habituality groups, differences were not significant. There were no associations between movement behaviors and nap sleep stages, and no effects for nap condition or condition by nap habituality on same or next day movement behaviors. Findings do not suggest that naps and movement behaviors are related in children. Although a single missed nap was not detrimental to same or next day movement behaviors, future studies should explore effects of multiple days of subsequent nap restriction to examine potential cumulative effects.

Temporal Associations between Actigraphy-Measured Daytime Movement Behaviors and Nap Sleep in Early Childhood

The purpose of this micro-longitudinal study was to explore daily associations between daytime movement behaviors (sedentary time and physical activity) and nap sleep in young children. In 298 children (age = 51.0 ± 9.6 months, 43.6% female), wrist-based actigraphy (mean wear time = 10 days) assessed sedentary time, total physical activity, and provided an estimate of nap sleep duration and efficiency. Multilevel logistic and linear regression models were used to examine temporal within-person relations between wake behaviors and nap sleep, and adjusted for overnight sleep duration between days of interest, age, sex, and socioeconomic status. Movement behaviors were not related to the likelihood of next-day napping, but when children were less sedentary (OR = 0.96; p < 0.001) or more active (OR = 1.01; p = 0.001) in the morning, they were more likely to nap that same day. Movement behaviors were not associated with nap sleep duration or efficiency. Conversely, on days children napped, they were less sedentary (B = -2.09, p < 0.001) and more active (B = 25.8, p < 0.001) the following day. Though napping and movement behaviors had some reciprocal relations, effect sizes in the present study were small. Further studies should examine children with more diverse sleep health and from different childcare settings.

Movement behaviors during COVID-19 among Latin American/Latino toddlers and pre-schoolers in Chile, Mexico and the US

Movement behaviors (physical activity, sedentary behavior, and sleep) have been impacted by the COVID-19 pandemic. We report changes in and factors that influenced movement behaviors during COVID-19 among Latin American/Latino children aged 1 to 5 years in Chile, Mexico, and the USA. We conducted a cross-sectional study between April and August 2020. Caregivers of 4,136 children (mean age [SD], 3.1 [1.4] years; 51% boys) reported family and household characteristics and changes in their child's movement behaviors. The proportion of children who met the WHO Guidelines decreased significantly in all countries, with the largest declines in meeting the physical activity and screen time guidelines. Factors associated with negative changes in movement behaviors were being an older child, unable to attend an early childhood education and care service, higher parental education levels, not having the opportunity to play with someone, and not having access to spaces to play. The findings highlight the need to minimize disparities faced by families by providing access to early childhood education and care and safe places for children to play.

Environmental correlates of sedentary behaviors and physical activity in Chinese preschool children: A cross-sectional study

OBJECTIVE

This cross-sectional study examined environmental correlates of sedentary behavior (SB) and physical activity (PA) in preschool children in the urban area of Tianjin, China.

METHODS

Data were collected from the Physical Activity and Health in Tianjin Chinese Children study, involving healthy children 3-6 years old and their families. In all children (n = 980), leisure-time SB (LTSB) and leisure-time PA (LTPA) were reported in min/day by parents. In a subgroup (n = 134), overall sedentary time, light PA, and moderate-to-vigorous PA (MVPA) were objectively measured using ActiGraph accelerometry (≥3 days, ≥10 h/day). Environmental correlates were collected using a questionnaire that included home and neighborhood characteristics (e.g., traffic safety, presence of physical activity facilities) and children's behaviors. Potential correlates were identified using linear regression analysis.

RESULTS

Multiple linear regression analysis showed that "having grandparents as primary caregivers" (βs and 95% confidence intervals (95%CIs) for overall sedentary time: 29.7 (2.1-57.2); LTSB (ln): 0.19 (0.11-0.28)) and "having a television (for LTSB (ln): 0.13 (0.00-0.25)) or computer (for LTSB (ln): 0.13 (0.03-0.23)) in the child's bedroom" were both associated with higher SB. Furthermore, "having grandparents as primary caregivers" was associated with less MVPA (β (95%CI): -7.6 (-14.1 to -1.2)), and "active commuting to school by walking" correlated with more MVPA (β (95%CI): 9.8 (2.2-17.4)). The path model showed that "more neighborhood PA facilities close to home" was indirectly related to higher LTPA (ln), which was partly mediated by "outdoor play" (path coefficients (95%CI): 0.005 (0.002-0.008)) and "going to these facilities more often" (path coefficients (95%CI): 0.013 (0.008-0.018)). Traffic safety was not a correlate.

CONCLUSION

Family structure and media exposure in the home maybe important factors in shaping preschoolers' PA patterns. Built environmental correlates could indirectly influence preschoolers' LTPA through parental help with engaging in active behaviors.

Activity Behaviors in British 6-Year-Olds: Cross-Sectional Associations and Longitudinal Change During the School Transition

BACKGROUND

To explore activity behaviors at school entry, we describe temporal/demographic associations with accelerometer-measured physical activity in a population-based sample of British 6-year-olds, and examine change from ages 4 to 6.

METHODS

A total of 712 six-year-olds (308 at both ages) wore Actiheart accelerometers for ≥3 (mean 6.0) days. We derived minutes per day sedentary (<20 cpm) and moderate to vigorous physical activity (MVPA, ≥460 cpm), also segmented across mornings (06:00 AM to 09:00 AM), school (09:00 AM to 3:00 PM), and evenings (3:00 PM to 11:00 PM). Using mixed effects linear regression, we analyzed associations between temporal/demographic factors and children's activity intensities at age 6, and change between ages 4 and 6.

RESULTS

Six-year-old children engaged in MVPA (mean [SD]): 64.9 (25.7) minutes per day (53% met UK guidelines). Girls did less MVPA than boys, particularly during school hours. Children were less active on weekends (vs weekdays) and more active on spring/summer evenings (vs winter). Longitudinally, 6-year-old children did less light physical activity (-43.0; 95% confidence interval, -47.5 to -38.4 min/d) but were more sedentary (29.4; 24.6 to 34.2), and engaged in greater MVPA (7.1; 5.2 to 9.1) compared to when they were aged 4.

CONCLUSION

Half of 6-year-old children met current activity guidelines; MVPA levels were lower in girls and at weekends. UK children became more sedentary but did more MVPA as they entered formal schooling. Physical activity promotion efforts should capitalize on these changes in MVPA, to maintain positive habits.

A Systematic Review of the Relationships Between Physical Activity and Sleep in Early Childhood

The aim of this systematic review was to examine the associations between physical activity and sleep in children aged less than 6 years. Articles were included if participants were primarily aged less than 6 years and study designs were observational or experimental. Study characteristics were extracted, and the Grading Recommendations Assessment, Development and Evaluation framework was used to assess study quality. Thirty-six studies (16 sleep, 16 physical activity, and three fitness outcomes) from 18 countries reported in 29 articles were included. The majority of sleep and physical activity outcome studies reported mixed effects with very low to low quality of evidence. Fitness outcome studies were limited, and therefore, evidence was insufficient. The high prevalence of mixed and null results could be related to study limitations. Importantly, this review points to the critical need for higher quality studies of sleep and physical activity in young children, which would support health recommendations and intervention strategies for healthier child development.

Factors associated with changes in movement behaviors in toddlers and preschoolers during the COVID-19 pandemic: A national cross-sectional study in Mexico

Little is known about physical activity, screen time and sleep among Mexican toddlers and preschoolers. The COVID-19 pandemic led to the closure of childcare education centers and restrictions to spend time outdoors. This study aimed to investigate the correlates of changes in movement behaviors from before to during the early stages of the COVID-19 lockdown in a national sample of toddlers and preschoolers in Mexico. A cross-sectional study was conducted using an open online survey completed by caretakers of children aged 1-5 years from April to July 2020. The questionnaire enquired about the time spent in each movement behavior during a regular week before and during lockdown, and family and household characteristics. Factors associated with changes in movement behaviors were explored using adjusted linear regression models. A total of 631 children (3.3y, 95% CI: 3.1, 3.4) were included in the study. During lockdown, physical activity decreased by 25%, screen time doubled, and sleep quality declined in 17% (p < 0.001). Toddlers and preschoolers of older age, attending a childcare education center before the lockdown, with a screen in their bedroom, higher access to electronic devices, and lower socioeconomic level experienced greater changes during this period. Those with limits on the use of electronic devices, who had someone available to play with them, and availability of toys experienced less pronounced changes. Pandemic restrictions have impacted movement behaviors of toddlers and preschoolers, with disproportionate effects among lower socioeconomic levels. Interventions with a multi-level equity-oriented approach are urgently needed to mitigate these effects.

The 24-h Movement Compositions in Weekday, Weekend Day or Four-Day Periods Differentially Associate with Fundamental Movement Skills

The aim of this study was to investigate the relationship between weekday, weekend day and four-day physical activity (PA) behaviours and fundamental movement skills (FMS) in British preschool children from a low socio-economic status background using compositional data analysis (CoDA). One hundred and eighty-five preschool children aged 3-4 years provided objectively assessed PA and sedentary behaviour (SB) data (GENEActiv accelerometer) and FMS (TGMD-2). The association of 24-h movement behaviours with FMS was explored using CoDA and isotemporal substitution (R Core Team, 3.6.1). When data were considered compositionally (SB, light PA (LPA), moderate and vigorous PA (MVPA)) and adjusted for age, BMI and sex, the weekday-derived composition predicted total motor competence (r² = 0.07), locomotor (r² = 0.08) and object control skills (r² = 0.09); the weekend day-derived composition predicted total motor competence (r² = 0.03) and object control skills (r² = 0.03), the 4-day-derived composition predicted total motor competence (r² = 0.07), locomotor (r² = 0.07) and object control skills (r² = 0.06) (all p < 0.05). Reallocation of 5 min of LPA at the expense of any behaviour was associated with significant improvements in total motor competence, locomotor and object control skills; for weekend-derived behaviours, MVPA was preferential. Considering movement behaviours over different time periods is required to better understand the effect of the 24-h movement composition on FMS in preschool children.

Moving Together: Understanding Parent Perceptions Related to Physical Activity and Motor Skill Development in Preschool Children

Background: Establishing physical activity (PA) and motor behaviors in early childhood are important for developing healthy activity behaviors. Parents play a central role in shaping young children’s PA and fundamental motor skills (FMS). This qualitative study explored parents’ attributes, values, perceptions, and practices related to PA and FMS. Methods: Thirty-one parents (26 mothers) of preschool-aged children participated in semi-structured in-person interviews. Interviews were audio-recorded, transcribed verbatim, coded and analyzed using an iterative approach. Results: Four themes related to PA and FMS emerged: (1) parent attributes; (2) parent–child interactions; (3) parent perception of children’s attributes; and (4) parenting practices. Although most parents enjoyed playing with their child, some did not realize the importance of engaging in PA with their child and even believed that FMS are naturally developed. Parents indicated that children’s temperament may influence their preference for practicing motor skills. Conclusions: Social support and positive parenting practices, including encouragement, monitoring, logistical support, co-participation, and facilitation, are important for the development of PA and FMS. The findings add emphasis to the importance of parents’ role in the development of young children’s PA and FMS, and they inform future strategies aiming to promote young children’s activity behaviors.

Correlates of Sleep Duration in Early Childhood: A Systematic Review

OBJECTIVE

This systematic review aimed to summarize correlates of sleep duration in children under 5 years of age.

METHODS

Six electronic databases (PubMed, PsycINFO, MEDLINE, CINAHL, SPORTDiscus, and Scopus) were searched from inception to May 2019. Observational studies and intervention studies reporting cross-sectional results from baseline data were considered. Data were extracted using a predesigned form and potential correlates were categorized following a sociological framework.

RESULTS

One-hundred and sixteen studies, representing 329,166 children, met the inclusion criteria, with a high risk of bias in 62 included studies. A total of 83 correlates of sleep duration were identified. Among the associations studied four or more times, correlates of nap duration were child's age and nighttime sleep onset/bedtime; correlates of nighttime sleep duration were household income, parent marital status, parental adiposity level, nighttime sleep duration at younger age, nighttime sleep onset/bedtime, nighttime sleep wakeup time, and frequency of current bedtime routine; correlate of total sleep duration was screen time.

CONCLUSIONS

Young children from low-income households, single families, or having overweight parents may be at risk for short sleep duration. Promoting healthy sleep duration from an early age appears essential. Effective practices may include encouraging an earlier bedtime, limiting screen time, and establishing a regular bedtime routine. The absence of consistent evidence in the psychological, cognitive, and emotional domain as well as the physical environmental domain warrants further research.

Barriers and motivators for preschoolers playing and walking with their dog: Results from qualitative research

ISSUES ADDRESSED

A large proportion of preschoolers do not meet the recommended three hours of daily physical activity. A potential source of daily physical activity could be that provided via the family dog. This qualitative study aimed to explore the barriers and motivators to preschoolers playing with their dog and participating in family dog walks.

METHODS

Twelve in-depth interviews were conducted with parents of preschoolers who owned a dog. A semistructured interview guide was used, and transcripts were analysed thematically.

RESULTS

Factors influencing preschoolers playing with their dog and participating in family dog walks included parents' level of attachment to their dog, parental history of dog ownership, parent modelling of safe dog play, type of play the family dog enjoys and proximity to dog- and child-friendly destinations. Other factors such as the size, level of socialisation and perceived exercise requirements of the dog, physical environment factors such as backyard size and individual factors such as time and existing commitments were also reported.

CONCLUSIONS

A number of dog, individual and physical environment specific factors should be considered when promoting preschooler physical activity through dog walking and play. SO WHAT?: A large proportion of preschoolers do not meet the recommended three hours of daily physical activity. In Australia, 43% of Australian households with children aged four to five own a dog. Dog-facilitated physical activity through family dog walks and active play could be an effective strategy for increasing preschooler physical activity.

Associations between Home Environment, Children's and Parents' Characteristics and Children's TV Screen Time Behavior

In Ireland, television (TV) screen time is a highly prevalent sedentary behavior among children aged less than five years. Little is known about the influence of parental rules and policies or screen time availability and accessibility within the home on children’s TV screen time behaviors. This cross-sectional study aimed to examine the extent to which parents’ sociodemographic and sedentary behaviors are associated with children’s TV screen time; and to determine the associations between parents’ rules and practices, home physical environment and children’s daily TV viewing. Three hundred and thirty-two children aged 3–5 years and their parents participated in the study. Children’s TV screen time and home environmental characteristics (parents’ rules and practices and the physical environment) were assessed using questions from standardized and validated questionnaires. The data were analyzed using binary logistic regression. Within the different sedentary behaviors evaluated, parents’ TV viewing was positively associated with children’s TV screen time (OR 1.65, 95%CI 1.09–2.50, p = 0.018). Leaving the TV on, whether or not it was being watched, was associated with a 38% increased probability of children watching ≥ 1 h TV daily. Children whose parents restricted their outdoor activity were more likely to watch ≥ 1 h TV daily (OR 2.01, 95%CI 1.04–3.88, p = 0.036). Findings from the study demonstrated that parents’ own screen time behaviors, leaving the TV on whether it was being watched or not and restricting outdoor play were associated with higher children’s TV viewing in the home environment. This knowledge is essential to inform future interventions aimed to address the increase in screen time among young children.

Cross-Cultural Adaptation of Instruments Measuring Children's Movement Behaviors and Parenting Practices in Brazilian Families

Childhood obesity is a global problem, disproportionately affecting children in low-to-middle income countries (LMIC). Despite this evidence, no previous study has adapted instruments measuring children’s movement behaviors and associated parenting practices for use in LMIC families. This study reports the results of a cross-cultural adaptation of previously validated measures of children’s movement behaviors and parenting practices in economically disadvantaged Brazilian families. Study 1 involved translation of the instruments from English to Portuguese. A team of translators (fluent in both English and Portuguese) and researchers followed established procedures for translating measurement scales, identifying problematic items, and reaching consensus on discrepancies. Study 2 involved cognitive interviews with 24 parents from urban and rural North-eastern Brazil addressing the format, content, and clarity of the items. Half the parents provided feedback on the first 33 items of the questionnaire, with the remaining parents providing feedback on the final 29 items. Notes were recorded during the interview and parents’ feedback summarized in a report. In the translation and back-translation, 15 discrepancies were identified. These were mostly due to multiple Portuguese words having the same meaning in English. The research team discussed these discrepancies and consensus was reached to ensure that the concepts depicted in the Portuguese version were consistent with the English version. In the cognitive interviews, parents identified minor problems with item comprehension resulting in minor adaptations to response options, recall period, and format of the questionnaire. The process of translation and cognitive interviews conducted in Brazilian families resulted in an appropriate cultural adaptation of scales measuring children’s movement behaviors and parenting practices. Future studies should evaluate the validity and reliability of the measures in LMIC families.

Adherence to the Japanese Physical Activity Guideline During Early Childhood Among Rural Preschoolers: A Cross-sectional Study

Background

Physical activity (PA) guidelines for early childhood have been established worldwide, and adherence to PA guidelines has been utilized to assess the effectiveness of policies regarding PA promotion. Although there is a Japanese PA guideline for preschoolers, little is known about adherence to this recommendation. This study examined and compared proportions of meeting the Japanese PA guideline among preschoolers.

Methods

Participants comprised 821 children aged 3–6 years from all 21 preschools and childcare facilities (hereafter collectively “preschools”) within Unnan City, Shimane Prefecture, Japan. Data on PA levels were collected through a parent-report questionnaire in accordance with the Japanese PA guideline. This guideline recommends that preschoolers perform PA for at least 60 minutes every day. Analyses included descriptive statistics, chi-squared, and Mann–Whitney’s tests to compare adherence to the PA guideline.

Results

Data of 441 participants from 20 preschools were analyzed. Of these, 292 (66.2%) preschoolers met the PA guideline. Boys (70.2%) showed a significantly higher proportion of meeting the PA guideline than girls (61.2%; P = 0.048). Proportions of meeting the PA guideline among preschool grades were not statistically different. Prevalence rates of meeting the PA guideline among 20 preschools considerably varied from 14.3% to 100% (P = 0.007).

Conclusions

Two-thirds of preschoolers met the Japanese PA guideline, while adherence to PA recommendations differed between genders. Moreover, there were distinct variations of adherence to PA guideline among preschools. Possible determinants that cause the differences in adherence to the PA guideline at the individual and preschool-levels should be further evaluated.

Cross-Sectional Associations of 24-Hour Sedentary Time, Physical Activity, and Sleep Duration Compositions with Sleep Quality and Habits in Preschoolers

Although some studies indicate physical activity and sleep quality are positively associated in children, most reports examined physical activity independent of other 24-h behaviors and focused on older children. The aim of this cross-sectional study was to examine the predicted changes in sleep efficiency and habits when reallocating time between movement behaviors using compositional isotemporal substitution in preschool-aged children. Accelerometers were worn by 288 participants (51.6 ± 9.5 months) for up to 16 days. Sleep outcomes included sleep efficiency, nap frequency, sleep disturbances, and bedtime resistance. Compositional isotemporal substitution analyses demonstrated that the combined effect of 24-h movement behaviors was associated with sleep efficiency (p < 0.001) and nap frequency (p < 0.003). When sleep increased by 30 min at the expense of stationary time or light physical activity, estimates of sleep efficiency and bedtime resistance decreased while nap frequency increased. When stationary time increased by 30 min from moderate to vigorous physical activity, estimated sleep efficiency increased and sleep disturbances decreased. Although this study presents preliminary evidence that 24-h movement behavior compositions in early childhood are associated with sleep quality and nap frequency, estimated effects from theoretical time reallocations across sleep outcomes were mixed.

SYSTEMATIC REVIEW OF PHYSICAL ACTIVITY AND SEDENTARY BEHAVIOR INDICATORS IN SOUTH-AMERICAN PRESCHOOL CHILDREN

Objective:

To summarize indicators and describe in detail the methods used to physical activity and sedentary behavior measurement in South American preschool children.

Data source:

In 2017, we searched for articles on researches carried out in South American countries, which presented physical activity and/or sedentary behavior indicators in children aged two to six years. These searches were conducted in Spanish, English, and Portuguese in four electronic databases (LILACS, PubMed, SciELO, and Web of Science), Google Scholar, and in reference lists.

Data summary:

Out of 416 articles initially assessed, 13 composed the descriptive summary. Samples from Argentina, Brazil, and Chile were included. Three articles provided accelerometer-based estimates of moderate physical activity: 32, 70.1, and 71.3 minutes per day. The mean total sedentary behavior was 468.3 and 562.9 minutes per day and, considering the cut-off point of 2 hours per day of screen time, we found the following prevalence rates: 39.4, 40.3, and 100%. The studies adopted a wide number of instruments and strategies to evaluate those behaviors.

Conclusions:

Although the summary has pointed to high exposure to sedentary behavior in preschool children, with particular focus on screen time, it is essential to broaden the discussion and approximate the methods used to assess physical activity and sedentary behavior, making the evidence more comparable and strong, so as to elaborate preventive strategies and actions.

Difference in Objectively Measured Physical Activity and Obesity in Children With and Without Siblings

Background/Context: Children without siblings (singletons) have higher rates of obesity than do children with siblings (nonsingletons). Higher moderate to vigorous physical activity (PA) and less sedentary behavior (SB) are associated with lower childhood obesity.

PURPOSE

To examine the difference in PA and SB between singleton and nonsingleton children.

METHODS

Mothers of children ages 5.0-7.9 years old who were singletons or nonsingletons with a sibling between the ages of 2.0 and 4.9 years old were recruited. Height, weight, and waist circumference of the 5.0- to 7.9-year-old children were measured, and age and sex percentiles were calculated. Accelerometry measured SB and PA, including light PA, moderate to vigorous PA, and counts per minute.

RESULTS

Fifty-six mother-child dyads (23 singletons and 33 nonsingletons) with an average child age of 5.7 (0.7) years participated. More singletons were classified as overweight or obese than were nonsingletons (49% vs 17%, P = .04). In adjusted linear models, singletons had less light PA per day (β = -38.1, SE = 19.2, P = .001) and more SB (β = 38.0, SE = 16.5, P = .02) than did nonsingletons, with no difference in moderate to vigorous PA or counts per minute.

CONCLUSION

In this sample, singletons had higher obesity and lower light PA than did nonsingleton children. Investigation into differences in singleton/nonsingleton families, including family health behaviors, may help assess sibling influence in early behavior development.

International Comparison of the Levels and Potential Correlates of Objectively Measured Sedentary Time and Physical Activity among Three-to-Four-Year-Old Children

Physical activity (PA) patterns track from childhood through to adulthood. The study aimed to determine the levels and correlates of sedentary time (ST), total PA (TPA), and moderate-to-vigorous PA (MVPA) in preschool-aged children. We conducted cross-sectional analyses of 1052 children aged three-to-four-years-old from six studies included in the International Children’s Accelerometry Database. Multilevel linear regression models adjusting for age, gender, season, minutes of wear time, and study clustering effects were used to estimate associations between age, gender, country, season, ethnicity, parental education, day of the week, time of sunrise, time of sunset, and hours of daylight and the daily minutes spent in ST, TPA, and MVPA. Across the UK, Switzerland, Belgium, and the USA, children in our analysis sample spent 490 min in ST per day and 30.0% and 21.2% of children did not engage in recommended daily TPA (≥180 min) and MVPA (≥60 min) guidelines. There was evidence for an association between all 10 potential correlates analyzed and at least one of the outcome variables; average daily minutes spent in ST, TPA and/or MVPA. These correlates can inform the design of public health interventions internationally to decrease ST and increase PA in preschoolers.

Physical Activity and Mobile Phone Apps in the Preschool Age: Perceptions of Teachers and Parents

BACKGROUND

Physical activity (PA) is already beneficial at the preschool age. In many countries, young children spend most of their days in the preschool setting, making it a common arena for PA interventions. Mobile health tools are becoming increasingly popular to promote PA in different populations; however, little is known about the interest for and how the preschool setting could incorporate such a tool.

OBJECTIVE

This study aimed to examine how teachers and parents perceive PA in preschool-aged children in general and their perceptions of how a mobile phone app could be used to promote PA in the preschool setting.

METHODS

Semistructured interviews were conducted with 15 teachers (93%, [14/15] women, mean age 43.5 years, 47%, [7/15] with a university degree and 10 parents [91%, 9/10] women, mean age 38.9 years, all with a university degree) recruited from 2 urban preschools in central Sweden. The interviews were recorded, fully transcribed, coded, and analyzed using thematic analysis by means of an inductive approach.

RESULTS

The analysis revealed 4 themes: (1) children are physically active by nature, (2) the environment as a facilitator or a barrier, (3) prerequisites of the adult world, and (4) an app in the preschool setting-challenges and possibilities. Parents and teachers perceived preschoolers as being spontaneously physically active; however, high-intensity PA was perceived as low. The PA was specifically performed during the day in the preschool. Identified facilitators of PA were access to safe and engaging outdoor environments such as forests, spacious indoor areas, and adult involvement. Adult involvement was considered especially important for children preferring sedentary activities. Identified barriers for PA were restricted indoor and outdoor space, rules for indoor activities, and lack of adult involvement because of time constraints. The teachers perceived that they had limited skills and experiences using apps in general, although they also acknowledged the increasing role of technological tools in the curriculum. Thus, the teachers expressed an interest for an app designed as a support tool for them, especially for situations when PA was limited because of perceived barriers. They suggested the app to include accessible information regarding the health benefits of PA in children linked to a library of activities for different settings and seasons. Parents suggested interactive app features including problem-solving tasks and music and dance, but not video clips as they made children passive.

CONCLUSIONS

Vigorous PA was perceived as low in preschool-aged children. Future tailoring of interventions in the preschool setting should work around barriers and support facilitators to PA, especially PA of high intensity. In such work, an app could serve as a source of inspiration for PA in different ages, settings, and seasons and thus reduce environmental and structural inequalities in the preschool setting.

Exploring Mothers' Influence on Preschoolers' Physical Activity and Sedentary Time: A Cross Sectional Study

Objectives Physical activity patterns can track from childhood into adulthood; therefore, establishing active behaviors early is imperative. Given the multidimensional nature of a mother's influence on their children, there is a need to utilize more comprehensive measures to assess the relationship between mother and child activity behaviors. Specifically, mothers have been identified as influencing preschoolers' activity behaviors and are often in control of organizing a family's opportunities to be active. The purpose of this study was to explore maternal influence on preschoolers' physical activity and sedentary time. Methods Preschoolers (n = 24) and their mothers (n = 24) wore Actical™ accelerometers for 7 consecutive days (e.g., 5 weekday, 2 weekend days), and mothers completed the adapted Environmental Determinants of Physical Activity in Preschool Children-Parent Survey. Direct entry regression analyses were conducted to explore maternal influence (e.g., role modeling through mothers' activity levels, maternal support, and enjoyment of being active) on preschoolers' activity levels. Results Maternal support was found to be a significant predictor of preschoolers' light and moderate-vigorous physical activity, and sedentary time (p < .05); accounting for 37.3-46.7% of the variation. Conclusions for Practice Mothers supportive behaviors influenced preschoolers' physical activity and sedentary time. Future research is needed to investigate facilitators/barriers that mothers with preschoolers encounter with regard to providing support to be active or modeling active behaviors themselves.

Physical activity and screen-viewing policies in Canadian childcare centers

BACKGROUND

Physical activity (PA) offers numerous health benefits for young children; however, many children enrolled in childcare engage in low levels of PA and high levels of sedentary time. This study aimed to describe the prevalence and content of written PA and screen-viewing (SV) policies in Canadian childcare centers.

METHODS

Using a modified version of the Environment and Policy Assessment and Observation Self-Report (EPAO-SR) tool, an online survey was distributed to all directors/administrators of center-based childcare facilities across Canada. Reminder emails were sent to encourage survey completion and a strong response rate. Descriptive statistics were used to explore demographic characteristics and frequencies were run to examine the number of centers that implemented a PA or SV policy. Deductive content analysis was completed to identify common themes in participants' open-ended responses.

RESULTS

A total of 1158 childcare representatives participated in the study; 514 provided complete data. Of these, 295 (44%) centers indicated having a written PA policy (with the majority regulated at the provincial/territorial-level; n = 227; 42%). Content of these policies included amount of time: spent outdoors (n = 395; 63%); in teacher-led active play (n = 101; 16%); and PA education for children (n = 91; 16%). Additionally, 178 (29%) respondents reported a written policy regarding SV (with majority regulated at the center-level; n = 173; 34%) and primarily focusing on amount of time children watch television.

CONCLUSIONS

PA regulations are more common than SV policies in Canadian childcare centers; however, less than half implement a PA policy and only a third adopt SV regulations. An opportunity exists to advance practice by adopting proactive approaches to encouraging young children to be more active and less sedentary in childcare (i.e., through written policies). Supplementing policy with accessible resources, as well as consistent provision of early childhood educator (staff) training, represent important steps for putting said policies into action.

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.

Childcare Correlates of Physical Activity, Sedentary Behavior, and Adiposity in Preschool Children: A Cross-Sectional Analysis of the SPLASHY Study

Background

The childcare (CC) environment can influence young children's physical activity (PA), sedentary behavior (SB), and adiposity. The aim of the study was to identify a broad range of CC correlates of PA, SB, and adiposity in a large sample of preschoolers.

Methods

476 preschool children (mean age 3.9 yrs; 47% girls) participated in the Swiss Preschoolers' Health Study (SPLASHY). PA and SB were measured by accelerometry. Outcome measures included total PA (TPA), moderate-to-vigorous PA (MVPA), SB, body mass index (BMI), and skinfold thickness (SF). PA measures consisted of both daily PA during CC attendance days and overall daily PA (CC and non-CC days).

Results

We identified the following CC correlates for higher TPA and/or higher MVPA or lower SB during CC attendance days: older age, sex (boys), more frequent child-initiated interactions during CC, mixing different ages within a group, and the presence of a written PA policy in the CC (all p ≤ 0.02). The CC correlates for overall TPA and/or MVPA or lower overall SB including both CC and non-CC days were the following: older age, sex (boys), more frequent child-initiated interactions during CC, mixing different ages within a group, less parental PA involvement in the CC, and having a larger surface area in CC (all p ≤ 0.046). Correlates for lower SF were sex (boys) and parental PA involvement in the CC (all p ≤ 0.02), and, for lower BMI, only increased age (p=0.001) was a correlate.

Conclusions

More frequent child-initiated interactions and mixing different ages in CC, the presence of a written PA policy, and a larger CC surface are correlates of PA and SB during CC attendance days and/or of overall PA. Parental involvement in CC PA projects was a correlate for reduced body fat. These novel factors are mostly modifiable and can be tackled/addressed in future interventions.

Actual and Perceived Motor Competence Levels of Belgian and United States Preschool Children

Purpose: The present study examined the motor competence of preschool children from Belgium and the United States (US), and the influence of perceived motor competence on actual motor competence. A secondary objective was to compare the levels of motor competence of Belgian and US children using the US norms of the Test of Gross Motor Development, Second Edition (TGMD-2). Methods: All participants (N = 326; ages 4–5 years) completed the TGMD-2 and the Pictorial Scale of Perceived Movement Skill Competence for Young Children. Results: Belgian children performed significantly higher on actual object control and locomotor skills than US children. However, both Belgian and US children scored significantly worse on the TGMD-2 when compared to the US norm group from 1997–1998. Furthermore, perceived motor competence was significantly related to actual object control skills but not locomotor skills. Conclusion: The present study showed cross-cultural differences in actual motor competence in young children. The findings also indicate a secular downward trend in childhood competence levels, possibly due to a decrease in physical activity and increase in sedentary behavior. Future research should consider conducting an in-depth exploration of physical activity contexts such as physical education to better understand cross-cultural differences in motor competence.

Sibling influence on children's objectively measured physical activity: a meta-analysis and systematic review

Abstract

Children without siblings (only children) have higher rates of obesity than children with siblings. Childhood obesity may be prevented by minimising sedentary behaviour and accumulating sufficient physical activity in young children. A growing number of articles have examined the influence of siblings on physical activity and sedentary behaviour, yet these articles have not been synthesised.

Objective

To synthesise literature and describe the influence of siblings on objectively measured physical activity and sedentary behaviour of children (ages 2–18 years).

Design

Outcomes were analysed in a systematic review and meta-analysis.

Data sources

PubMed, EMBASE, Web of Science and Medline OVID were searched for articles related to siblings, physical activity, sedentary behaviour and obesity outcomes from 1947 to March 2018.

Eligibility criteria

Articles that evaluated sibling status on physical activity objectively measured by accelerometer or pedometer were included.

Results

Nineteen articles, representing 17 independent datasets, were included in the review. Nine were included in the quantitative analysis. Pooled data from nine articles indicated children with siblings had higher moderate-to-vigorous physical activity (MVPA) relative to only children, with a potential dose response for higher number of children in household and higher MVPA (Mean Difference=3.13, 95% CI 1.90 to 4.35, p=0.001). Findings were mixed for the influence of siblings on sedentary behaviour and light physical activity.

Summary/Conclusion

Children with siblings had healthier physical activity patterns, as measured by accelerometer or pedometer, than did only children. Suggested mechanisms include peer modelling, encouraging active transport and sports participation, opportunity for playmate and serving as additional caregivers.

Trial registration number

CRD42017055463.

Determinants of Change in Physical Activity in Children 0-6 years of Age: A Systematic Review of Quantitative Literature

BACKGROUND

Understanding the determinants of children's health behaviours is important to develop successful behaviour-change interventions.

OBJECTIVE

We aimed to synthesise the evidence around determinants ('preceding predictors') of change in physical activity (PA) in young children (0-6 years of age).

METHODS

As part of a suite of reviews, prospective quantitative studies investigating change in physical activity in children aged 0-6 years were identified from eight databases (to October 2015): MEDLINE, Embase, CINAHL, PsycINFO, Web of Knowledge, British Nursing Index, Applied Social Sciences Index and Abstracts, and Sociological Abstracts. Determinants and direction of association were extracted, described and synthesised according to the socio-ecological model (individual, interpersonal, organisational, community, policy).

RESULTS

Forty-four determinants, predominantly in the interpersonal and organisational domains, were reported across 44 papers (six prospective cohort, 38 interventional); 14 determinants were assessed in four or more papers. Parental monitoring showed a consistent positive association with change in PA; provider training was positively associated with change in children's moderate-to-vigorous PA only. Five (sex, parental goal setting, social support, motor skill training and increased time for PA) showed no clear association. A further seven (child knowledge, parental knowledge, parental motivation, parenting skills, parental self-efficacy, curriculum materials and portable equipment) were consistently not associated with change in children's PA. Maternal role-modelling was positively associated with change in PA in all three studies in which it was examined.

CONCLUSIONS

A range of studied determinants of change in young children's PA were identified, but only parental monitoring was found to be consistently positively associated. More evidence dealing with community and policy domains from low-/middle-income countries and about lesser-explored modifiable family- and childcare-related determinants is required. INTERNATIONAL PROSPECTIVE REGISTER FOR SYSTEMATIC REVIEWS (PROSPERO) REGISTRATION NUMBER: CRD42012002881.

The Effect of CHAMP on Physical Activity and Lesson Context in Preschoolers: A Feasibility Study

PURPOSE

This feasibility study compared the effects of 2 movement programs, traditional and mastery climate (i.e., the Children's Health Activity Motor Program [CHAMP]), on lesson context and children's physical activity (PA) levels. A secondary aim was to examine sex differences in PA levels in both programs.

METHOD

Seventy-two preschoolers served as participants and were assigned to a movement program. Physical activity levels and lesson context were assessed with the System for Observing Fitness Instruction Time.

RESULTS

Preschoolers in CHAMP spent more time walking (p < .05, d = 3.3), more time in moderate-to-vigorous PA (MVPA; p < .05, d = 3.6), and less time standing (p < .05, d = 3.8) compared with those in a traditional movement program. Boys in both programs spent less time standing (p < .05, d = 4.8) and more time in vigorous activity (p < .05, d = 5.8) and MVPA (p < .05, d = 4.4) compared with girls. During CHAMP, children spent less time engaged in management and knowledge (p < .05, d = 1.4, and p < .001, d = 0.9, respectively) and more time in skill practice (p < .05, d = 1.5).

CONCLUSION

The findings support that participation in CHAMP elicits more MVPA in preschool-age children compared with a traditional movement program. The Children's Health Activity Motor Program provided children with more class time devoted to skill practice. The program appears to be an innovative approach that is beneficial for PA engagement and could contribute positively to children's health.

Physical activity and sedentary behavior legislation in Canadian childcare facilities: an update

Background

Within the childcare sector, physical activity and sedentary behaviors are not legislated at a national level in Canada. Efforts have been undertaken to identify factors within childcare facilities which support and deter physical activity and sedentary behaviors. The purpose of this paper was to provide an amended review of the legislative landscape, at the provincial and territorial level, regarding physical activity and sedentary behaviors (via screen-viewing) in Canadian childcare centers.

Methods

Individual childcare acts and regulations for each province and territory were collected; documents were reviewed with a focus on sections devoted to child health, physical activity, screen time, play, and outdoor time. An extraction table was used to facilitate systematic data retrieval and comparisons across provinces and territories.

Results

Of the 13 provinces and territories, 8 (62%) have updated their childcare regulations in the past 5 years. All provinces provide general recommendations to afford gross motor movement; but the majority give no specific requirements for how much or at what intensity. Only 3 provinces (Northwest Territories, Nunavut, and Nova Scotia) explicitly mentioned daily physical activity while all provinces’ and territories’ required daily outdoor play. Only 1 province (New Brunswick) made mention of screen-viewing.

Conclusions

The variability in childcare regulations results in different physical activity requirements across the country. By providing high-level targets for physical activity recommendations, by way of provincial/territorial legislation, staff would have a baseline from which to begin supporting more active behaviors among the children in their care. Future research is needed to support translating physical activity policies into improved activity levels among young children in childcare and the role of screen-viewing in these venues.

Protocol for digital intervention for effective health promotion of small children-A cluster randomized trial

AIM

This article introduces the protocol of a study aiming to evaluate the effectiveness of digital WellWe intervention in supporting the participation of families with small children in the promotion of their health.

BACKGROUND

Early childhood is a meaningful period for building a strong base for good health. Parents play a key role in affecting the health behaviour and psychosocial development of their children. A family-centred approach makes it possible to support families' individual health literacy needs and empower them to take actions towards promoting healthier behaviour. However, there are a lack of family-centred digital health interventions intended for parents and their small children.

DESIGN

The study is designed as a two-arm cluster, randomized, controlled trial with a 4-month follow-up.

METHODS

The data are being collected from 200 families with a 4-year-old child. Cluster randomization is being performed at the municipality level. Municipalities (N = 4) located in Southwest Finland, comprising child health clinics (N = 15) with their family clients, were randomly allocated to either an intervention (WellWe intervention) or a control group (usual care). The outcome measures include parental self-efficacy for healthy behaviours, mindfulness in parenting and the family-centred approach of the extensive health examination. Data collection is being performed at baseline, after the intervention and at a 4-month follow-up.

DISCUSSION

The results from this study will make it possible to determine whether this new method can be recommended for implementation in child health clinic settings to support the participation of families with small children in promoting their health.

Role of parental and environmental characteristics in toddlers' physical activity and screen time: Bayesian analysis of structural equation models

Background

Guided by the Socialization Model of Child Behavior (SMCB), this cross-sectional study examined direct and indirect associations of parental cognitions and behavior, the home and neighborhood environment, and toddlers’ personal attributes with toddlers’ physical activity and screen time.

Methods

Participants included 193 toddlers (1.6 ± 0.2 years) from the Parents’ Role in Establishing healthy Physical activity and Sedentary behavior habits (PREPS) project. Toddlers’ screen time and personal attributes, physical activity- or screen time-specific parental cognitions and behaviors, and the home and neighborhood environment were measured via parental-report using the PREPS questionnaire. Accelerometry-measured physical activity was available in 123 toddlers. Bayesian estimation in structural equation modeling (SEM) using the Markov Chain Monte Carlo algorithm was performed to test an SMCB hypothesized model. Covariates included toddlers’ age, sex, race/ethnicity, main type of childcare, and family household income.

Results

In the SMCB hypothesized screen time model, higher parental barrier self-efficacy for limiting toddlers’ screen time was associated with higher parental screen time limiting practices (β = 0.451), while higher parental negative outcome expectations for limiting toddlers’ screen time was associated with lower parental screen time limiting practices (β = − 0.147). In turn, higher parental screen time limiting practices was associated with lower screen time among toddlers (β = − 0.179). Parental modeling of higher screen time was associated with higher screen time among toddlers directly (β = 0.212) and indirectly through the home environment. Specifically, higher screen time among parents was associated with having at least one electronic device in toddlers’ bedrooms (β = 0.146) and, in turn, having electronics in the bedroom, compared to none, was associated with higher screen time among toddlers (β = 0.250). Neighborhood safety was not associated with toddlers’ screen time in the SEM analysis. No significant correlations were observed between the SMCB variables and toddlers’ physical activity; thus, no further analyses were performed for physical activity.

Conclusions

Parents and their interactions with the home environment may play an important role in shaping toddlers’ screen time. Findings can inform family-based interventions aiming to minimize toddlers’ screen time. Future research is needed to identify correlates of toddlers’ physical activity.

Systematic review of the relationships between sleep duration and health indicators in the early years (0-4 years)

Background

The objective of this systematic review was to examine for the first time the associations between sleep duration and a broad range of health indicators in children aged 0 to 4 years.

Methods

Electronic databases were searched with no limits on date or study design. Included studies (published in English or French) were peer-reviewed and met the a priori determined population (apparently healthy children aged 1 month to 4.99 years), intervention/exposure/comparator (various sleep durations), and outcome criteria (adiposity, emotional regulation, cognitive development, motor development, growth, cardiometabolic health, sedentary behaviour, physical activity, quality of life/well-being, and risks/injuries). The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Due to high levels of heterogeneity across studies, narrative syntheses were employed.

Results

A total of 69 articles/studies (62 unique samples) met inclusion criteria. Data across studies included 148,524 unique participants from 23 countries. The study designs were randomized trials (n = 3), non-randomized interventions (n = 1), longitudinal studies (n = 16), cross-sectional studies (n = 42), or longitudinal studies that also reported cross-sectional analyses (n = 7). Sleep duration was assessed by parental report in 70% of studies (n = 48) and was measured objectively (or both objectively and subjectively) in 30% of studies (n = 21). Overall, shorter sleep duration was associated with higher adiposity (20/31 studies), poorer emotional regulation (13/25 studies), impaired growth (2/2 studies), more screen time (5/5 studies), and higher risk of injuries (2/3 studies). The evidence related to cognitive development, motor development, physical activity, and quality of life/well-being was less clear, with no indicator showing consistent associations. No studies examined the association between sleep duration and cardiometabolic biomarkers in children aged 0 to 4 years. The quality of evidence ranged from “very low” to “high” across study designs and health indicators.

Conclusions

Despite important limitations in the available evidence, longer sleep duration was generally associated with better body composition, emotional regulation, and growth in children aged 0 to 4 years. Shorter sleep duration was also associated with longer screen time use and more injuries. Better-quality studies with stronger research designs that can provide information on dose-response relationships are needed to inform contemporary sleep duration recommendations.

Electronic supplementary material

The online version of this article (10.1186/s12889-017-4850-2) contains supplementary material, which is available to authorized users.

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

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

Maternal-child co-participation in physical activity-related behaviours: prevalence and cross-sectional associations with mothers and children's objectively assessed physical activity levels

BACKGROUND

Co-participation in physical activity may be a useful strategy for increasing physical activity in mothers and their young children, yet little empirical evidence exists on this topic for young families. This study aimed to identify the prevalence of mother-child co-participation in physical activity and examine the association between co-participatory behaviours and objectively-assessed physical activity in young children and their mothers.

METHODS

One-hundred twenty-three 4-6 year-old children and their mothers were recruited from preschools in Belgium between November 2010 and January 2011. Mothers completed a questionnaire assessing the frequency of co-participation in five activities. Both mothers and children wore ActiGraph GT1M accelerometers concurrently for 7 days to assess the time spent in moderate-to vigorous-intensity physical activity (MVPA) and light- to vigorous-intensity physical activity (LMVPA). Descriptive statistics (means, frequencies) were used to determine the prevalence of co-participation. Separate multiple linear regression analyses examined the association between co-participation and mothers' and children's physical activity on weekdays and weekends.

RESULTS

Most mothers reported infrequent co-participation in physical activities with their children. On weekdays, walking or cycling for short trips was positively associated with children's MVPA while attending a park or similar more than once per week was negatively associated with children's MVPA and LMVPA. Going to an indoor play centre together once or more per week was negatively associated with mother's LMVPA. On weekends, walking or cycling with their child in their free time was positively associated with both children's and mothers' MVPA and childrens' LMVPA. Going to an indoor play centre together 1-3 times/month was negatively associated with children's weekend MVPA.

CONCLUSIONS

Reported rates of co-participation in mothers and their preschool children were low. The association with maternal and child physical activity may be dependent on the co-participatory behaviour assessed and may differ between weekday and weekends. Promoting walking and cycling together during leisure time may be an effective strategy to increase both preschool children's and mothers' MVPA.

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

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

•

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

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Perception of screen time volume associated with preschoolers' screen time

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Concern of poor cognitive, social wellbeing associated with screen time

•

Interventions should target perceptions of impact of screen time.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

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

Influence of the day care, home and neighbourhood environment on young children's physical activity and health: protocol for the PLAYCE observational study

INTRODUCTION

The early years are a critical period in a child's health and development, yet most preschool children fail to meet physical activity guidelines. Outside of the home and neighbourhood, children spend a large proportion of time within early childhood education and care (ECEC) services such as long day care. Research is required to determine how the design of day care outdoor (and indoor) spaces provides opportunities or constraints for physical activity. A significant evidence gap surrounds what objectively measured attributes of the home and neighbourhood environment influence preschoolers' physical activity. The PLAY Spaces & Environments for Children's Physical Activity (PLAYCE) study will empirically investigate the relative and cumulative influence of the day care, home and neighbourhood environment on preschoolers' physical activity.

METHODS AND ANALYSIS

The PLAYCE study is a cross-sectional observational study (April 2015 to April 2018) of 2400 children aged 2-5 years attending long day care in metropolitan Perth, Western Australia. Accelerometers will measure physical activity with indoor physical activity measured using radio frequency identification. Global positioning systems will be used to determine outdoor location of physical activity around the home and neighbourhood for a subsample (n=310). The day care environment will be objectively measured using a validated audit tool. Other potential individual, social and physical environmental influences on preschoolers' physical activity will be collected by geographic information systems measures, parent and day care educator surveys.

ETHICS AND DISSEMINATION

Ethical approval has been granted by The University of Western Australia Human Ethics Research Committee, approval number RA/4/1/7417. Findings will be published in international peer-reviewed journals and presented at international conferences. Key findings will be disseminated to stakeholders, collaborators, policymakers and practitioners working in the ECEC sector. Day care centre directors and parents will be given a summary report of the key findings.

Preschool and childcare center characteristics associated with children's physical activity during care hours: an observational study

Background

Preschools and childcare settings offer opportunities to promote adequate levels of physical activity. Research is needed to identify the key features of these settings to optimize young children’s activity. The aims of this study were to determine if differences existed in preschool children’s physical activity during care hours compared with outside care hours and to examine a comprehensive range of potential center-based correlates of physical activity for preschool boys and girls.

Methods

Data are from the Healthy Active Preschool and Primary Years study: 71 childcare centers, 65 preschools and 1002 preschool children. Percent of time in total (light- to vigorous-intensity) physical activity was measured using Actigraph GT1M accelerometers. Center physical environment characteristics, policies and practices were assessed by trained research staff using comprehensive audit tools. Data were collected in 2008/9 and were analyzed separately for boys and girls in Stata using multilevel mixed effects models.

Results

Boys and girls were less active during care than outside care hours (51.1 % vs. 52.4 %, p = 0.01; 48.0 % vs. 51.5 %, p < 0.0001, respectively). In the final adjusted models, number of outdoor spaces with natural ground coverings was associated with boys’ physical activity (coeff = 0.477, 95 % CI 0.089, 0.867) and the amount of time girls spent indoors before going outdoors was inversely associated with their physical activity (coeff = −0.035, 95 % CI −0.065, −0.004). The models explained 12 and 10 % of boys’ and girls’ physical activity during care hours, respectively.

Conclusions

This study identified that children are significantly less active during than outside care hours. Few center-based correlates of preschool children’s physical activity were identified. Future research should explore other aspects of centers, such as what children actually do while they are outside, and broader potential influences on children’s behaviours including social, cultural and policy contexts within which centers operate.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-016-0444-0) contains supplementary material, which is available to authorized users.

Physical Activity During the Early Years: A Systematic Review of Correlates and Determinants

CONTEXT

Being physically active during the early years (age 0-6 years) is vital for healthy development. Identifying correlates and determinants of physical activity (PA) is crucial to guide effective interventions. This systematic review synthesized studies investigating potential correlates and determinants of PA during the early years, accounting for different types of PA assessment.

EVIDENCE ACQUISITION

Nine electronic databases were searched from inception year (1900) until September 2014; data were analyzed/interpreted in April 2015. The following inclusion criteria were used: written in English, published in peer-reviewed journals, participants not in statutory/school education, and an observational design investigating associations between an exposure/variable, and a quantitative measure of PA. Correlates/determinants of total, moderate to vigorous, and light PA were reported using an ecologic model.

EVIDENCE SYNTHESIS

Of 22,045 identified studies, 130 were included. All took place in high-income countries and few (6%) were of high quality. Correlates of total PA were sex (male, ++); parental PA (+); parental support (+); and time outdoors (+). Determinants of total PA were sex (+) and time spent playing with parents (+). The only correlate of moderate to vigorous PA was sex (male, ++). No determinants of moderate to vigorous or light PA were found. PA correlates/determinants were relatively consistent between objective and subjective PA measures.

CONCLUSIONS

Numerous studies investigated potential correlates and determinants of PA, but overall quality was low. A small number of demographic/biological and social/cultural factors were associated with PA. There is a need for high-quality studies exploring correlates/determinants across all domains of the ecologic model.

Maternal correlates of young children's physical activity across periods of the day

OBJECTIVES

Associations between maternal correlates and young children's physical activity levels across the whole day and the segmented day were examined.

DESIGN

Cross-sectional study METHODS: Participants were 136 mothers and their 1-3 year old children recruited between July 2013 and March 2014. Mothers reported time spent providing physical activity opportunities for their child, co-participating in and modelling physical activity and sedentary behaviours during the morning, afternoon and evening. Participants wore ActiGraph GT3X (mothers) and GT3X+ (children) accelerometers concurrently for seven consecutive days and the time spent in light- (LPA), moderate- to vigorous- (MVPA) and total (LMVPA) physical activity were assessed. Two-level (family; recruitment group) multivariate models examined associations between maternal correlates (including maternal objectively-assessed sedentary time [ST] and physical activity) and children's physical activity.

RESULTS

Maternal self-reported co-participation in sedentary behaviour and provision of child opportunities for physical activity were associated with children's physical activity; associations varied by period and physical activity intensity. During the morning period, mothers' objectively assessed ST was negatively associated with children's MVPA and LMVPA while her LPA was positively associated with children's LPA, MVPA and LMVPA. Mothers' MVPA was negatively associated with children's LPA and LMVPA during the evening period.

CONCLUSIONS

Maternal correlates of young children's physical activity may be period- and intensity-specific. Programmes promoting physical activity for families may need to consider incorporating strategies to reduce mother-child co-participation in sedentary behaviour, increase mothers' provision of opportunities to be active and increase mothers' own LPA over ST during certain periods of the day.

Treating Obesity in Preschoolers: A Review and Recommendations for Addressing Critical Gaps

Developing interventions targeting obesity reduction in preschoolers is an emergent area. Although intensive, multicomponent interventions seem a promising approach to preschool obesity reduction, this review identifies and discusses approaches to 3 critical gaps (poor reach to families from low-income and minority backgrounds, lack of sufficient evidence to determine the most effective and efficient treatment components and approaches to treating obesity in early childhood, and lack of consensus on how best to discern intervention effectiveness) that need to be addressed to advance the preschool obesity literature.

Correlates of home and neighbourhood-based physical activity in UK 3-4-year-old children

Background: Identifying context-specific correlates of home- and neighbourhood-based physical activity in preschool-aged children may help improve intervention program development for these settings. Methods: A total of 153 3–4-year-old children were recruited through preschool settings in Cambridgeshire (January–July 2013). Children wore Actiheart accelerometers for ≤7 days to assess their sedentary time (ST), light-(LPA) and moderate- to vigorous-intensity physical activity (MVPA). A parent-completed questionnaire assessed correlates across the ecological model and the child’s preschool attendance during the measurement week. Only accelerometer data for times when children were at home were used. Multilevel models (Level 1: days; Level 2: child) examined associations between maternal-reported exposure variables and each outcome (children’s home- and neighbourhood-based ST, LPA and MVPA) (main analysis). Further analyses included the subsample of children with complete paternal correlates data (father analysis). Results: In the main analyses, children with older siblings engaged in less ST. Children whose mothers reported being ‘moderately inactive’ or ‘active’ (vs. inactive) engaged in less LPA, while children whose mothers worked >35 h week⁻¹ engaged in less MVPA. More equipment at home was associated with lower LPA but greater MVPA. In the father analysis, father’s television viewing before 6 pm was associated with greater ST and less MVPA in children; the negative association between mother’s activity and children’s LPA was retained. Conclusion: Family demographics and parental behaviours appear to have the strongest association with children’s home- and neighbourhood-based ST, LPA and MVPA. This study further highlights the importance of examining both maternal and paternal behaviours.

Physical Activity Levels in Chinese One-Year-Old Children and Their Parents, an Early STOPP China Study

BACKGROUND

Physical activity (PA) is associated with health benefits, already in childhood. However, little is known about actual levels, patterns and gender differences in PA level in very young children. This study examines Chinese one-year-old children and their parents' PA levels and patterns, and assesses the correlations between children's PA level and gender, body mass index standard deviation score (BMI SDS), parental BMI and parental PA level.

METHODS

Data from 123 families participating in the Early STOPP China study were used. Families were recruited based on parental BMI and were classified as either high-risk or low-risk of obesity. Parents and children wore an ActiGraph GT3X+ to assess the average PA levels. PA levels and hourly patterns during weekdays and weekends were examined as were correlations with gender, BMI SDS, parental BMI and parental PA levels.

RESULTS

There were no significant differences in children's averaged PA between risk groups, genders, or between weekdays and weekends. Children's peak average activity level was at 7 pm and they were least active at 3 pm (p<0.001). Both mothers and fathers demonstrated a similar PA pattern as their children, although paternal PA level was consistently lower than that of mothers and children. No significant association was found between children's PA and their gender, BMI SDS, parental BMI or paternal PA levels. Maternal PA was found positively associated with child PA (p<0.05).

CONCLUSION

PA in one-year-old Chinese children vary over the day but weekdays and weekends are similar. At this age, children's PA is not related to gender, BMI SDS, parental BMI or paternal PA. Larger scale studies with more contextual information are needed to improve the understanding of our findings.

Physical Activity Pattern of Malaysian Preschoolers: Environment, Barriers, and Motivators for Active Play

Children's physical activity has been correlated with child characteristics and social or physical environment. This study aimed to compare preschoolers' physical activity among various sociodemographic characteristics and to determine barriers, motivators, and environmental factors for active play. A total of 835 preschoolers were included in this analysis. Time spent on active play, quiet play, and screen time was reported by parents. Boys spent significantly more time on active play and screen time than girls. Time spent on quiet play was highest in East Coast Peninsular Malaysia and lowest in Sarawak. Some 40% of children achieved active play recommendation while 27% exceeded daily screen time recommendation. Most parents reported that their child played actively in the house area; and that the main barrier and motivator to active play were safety and child's enjoyment, respectively. These findings demonstrate that sociodemographic characteristics and environment should be considered in designing physical activity intervention programs.

A question of balance: Explaining differences between parental and grandparental perspectives on preschoolers' feeding and physical activity

RATIONALE

Although one quarter of US and UK families rely on grandparents as the main providers of informal childcare, grandparental perspectives on the feeding and physical activity of young children remain understudied.

OBJECTIVE

The study's aim was to elucidate parents' and grandparents' perspectives on young children's feeding and physical activity, and identify how they negotiate potential differences between these perspectives.

METHODS

We interviewed 22 parents and 27 grandparents from 16 families of children aged 3-5 years in the Pacific Northwest, US. Using familial homeostasis as a novel theoretical framework, the interviews were analyzed to assess differences between parental and grandparental perspectives on feeding and physical activity.

RESULTS

The analysis yielded six thematic categories: (1) disagreements about feeding stem from parents' and grandparents' differing definitions of healthy feeding; (2) differences between parents' and grandparents' feeding practices reflect differences in perceived caretaking roles; (3) parents and grandparents negotiate differences in feeding practices through grandparental compliance and parental compromise; (4) differences in preschoolers' physical activity are influenced by parents' and grandparents' own access to and engagement in physical activity; (5) parents and grandparents express few disagreements about preschoolers' screen-time; (6) parents and grandparents rarely discuss preschoolers' physical activity. The findings suggest that parental and grandparental decision-making about feeding and exercise is informed by ideas of what constitutes familial balance and a balanced lifestyle for a preschool aged child, rather than by the child's weight status.

CONCLUSIONS

Parents and grandparents appear to engage in practices designed to preserve familial homeostasis, which may provide a compelling explanation for the persistent difficulties in implementing family-based childhood obesity interventions.