Effects of a playground marking intervention on school recess physical activity in French children

The role of playgrounds in promoting children's health - a scoping review

BACKGROUND

Active outdoor play is important for children's health and development, and playgrounds provide good places for play. However, the importance of playground use for health and well-being is unclear. Our scoping review aims to create an overview of all research on playground use and health benefits for children.

METHODS

Scopus, Web of Science, SportDiscus, and PsycInfo were searched using two search blocks, focusing on 'playground' and 'children' respectively, for publications from 2000 to November 2023. The primary inclusion criterion was examining the relationship between playground use and positive physical, mental, or social health outcomes. Only papers published in English were reviewed. For each publication, we synthesized and condensed the results, categorizing them by playground setting, reported health outcome, participant age group, study design, methodologies, publication's country, year, and 'stage of evidence'.

RESULTS

Data from 247 studies were extracted and nearly 80% of these publications were descriptive or exploratory studies. Fifty-two were intervention studies. Adding playground markings to schoolyards led to increased physical activity. Greening schoolyards had mainly positive effects on social and mental health. In Early Childhood Education and Care, renewing play structures had a positive effect on physical activity in three publications. All Public Open Space interventions we found were different, with mixed effects on health outcomes.

CONCLUSIONS

The existing evidence provides good arguments for policy makers, city planners and school-leaders to invest in adding playground markings in schoolyards as this will likely result in more physical activity. The evidence for the health benefits of investing in new play structures indicated that tailoring the playground to local needs is important as 'one size does not fit all' and playgrounds need to be designed as engaging and interesting places for children's play if they are to generate health benefits. Investing in 'greening' playgrounds is likely to result in social and mental health benefits for children, but does not always result in more physical activity. The research field needs more efficacy and effectiveness studies, and in particular replication and scale-up studies to demonstrate which type of playground interventions are successful.

PROTOCOL

The review protocol was registered at Open Science Framework ( https://doi.org/10.17605/OSF.IO/UYN2V ).

A multivariate multilevel approach to unravel the associations between individual and school factors on children's motor performance in the REACT project

OBJECTIVE

The aim was to (1) estimate the relationship between physical fitness (PF) and object control fundamental movement skills (FMS), (2) identify child characteristics that relate with PF and FMS, and (3) examine associations between the school environment, PF, and FMS.

METHODS

The sample included 1014 Portuguese children aged 6-10 years from the REACT project. PF was assessed via running speed, shuttle run, standing long jump, handgrip, and the PACER test. Object control FMS were assessed with stationary dribble, kick, catch, overhand throw, and underhand roll. Test performances were transformed into z-scores, and their sum was expressed as overall PF and FMS. Child-level variables included body mass index (BMI) z-scores, accelerometer-measured sedentary time and moderate-to-vigorous physical activity, and socioeconomic status (SES). School size, physical education classes, practice areas, and equipment were also assessed.

RESULTS

Approximately, 90% of the variance in object control PF and FMS was at the child level, and 10% at the school level. The correlation between PF and object control FMS was .62, which declined to .43 with the inclusion of covariates. Older, more active, and higher SES children had higher object control PF and FMS, and boys outperformed girls. BMI was negatively associated with PF but not with object control FMS. Sedentary time and number of physical education classes were not significant predictors. Most school predictors did not jointly associate with PF and object control FMS.

CONCLUSION

PF and object control FMS z-scores were moderately related. Not all child characteristics were associated with both PF and object control FMS, and their effect sizes were different. School characteristics only explained 10% of the total variation in PF and object control FMS.

Associations between outdoor play features and children's behavior and health: A systematic review

The decline of children's opportunities to play outdoors raises a new concern about the quality of outdoor play environments, and their developmental and well-being benefits for children. This systematic review aims to synthesize the associations between outdoor play features and children's behavior and health. PRISMA guidelines were followed (2021). The inclusion criteria were studies with children aged between 5 and 12 (Population); that addressed presence, absence or disposition of equipment, natural elements, loose parts, resources availability, type of terrain and space modifications (Intervention or Exposure); in pre-post intervention or between groups (Comparison); related to health and behavior in different domains (Outcomes); with an experimental, observational, descriptive or longitudinal design (Study design). Indoor context, adult-led activities and structured activities were excluded. A literature search of five databases (PubMed, Web of Science, ERIC, Scopus, and PsycINFO) was concluded in March 2022. After identifying 28,772 records, duplicates and irrelevant titles were removed, and abstracts and full-text articles were screened in duplicate. The remaining 51 eligible articles (45 primary studies) were assessed for risk of bias with QualSyst. A narrative synthesis of the results was conducted. The most frequent behavioral or health outcome addressed was physical activity. Included studies focused on the following space features: fixed structures, space naturalness, floor markings, loose parts/equipment, area available, and the combination of factors. Although some positive effects were found, the heterogeneity between studies did not allow to draw firm conclusions on the effects of each environmental feature on primary children's health and behavior. Systematic review registration: PROSPERO CRD42020179501.

Improving Recess through Collaboration: Exploring the Facilitators and Barriers to Sustaining Positive Playground Behavior

BACKGROUND

School recess quality is vital to children's social and emotional skill development. However, there is a research-to-practice gap where academic findings are ineffectively translated back to schools. The aims of this study were to examine how a co-designed intervention would impact negative behaviors observed during recess and to explore the facilitators and barriers to recess implementation over the course of a school year.

METHODS

Utilizing a research-practice partnership, the authors collaborated with staff at an elementary school to design, implement, and assess an intervention focused on improving recess quality. The intervention offered training in research-supported recess practices through professional development training and teaching students transitions and games. The school's recess behavioral report log of negative playground behaviors across the academic year and notes from recess staff meetings were analyzed.

RESULTS

Quantitative results pointed to a stable decrease in negative playground behaviors post-intervention compared to pre-intervention. Qualitative analyses suggest school leadership and practitioners should focus on "reculturing" recess prior to making structural changes, and empowering recess staff to sustain change.

CONCLUSION

Prior to considering interventions at recess, there is a need to assess both school and recess culture. In doing so, reculturing around the importance of recess during the school day and the roles of adults in the process is needed to ensure the sustainability of any changes made.

School Children's Physical Activity and Preferred Activities during Outdoor Recess in Estonia: Using Accelerometers, Recess Observation, and Schoolyard Mapping

Studies about recess have found that children have higher physical activity (PA) during outdoor recess compared to indoor recess, and well-constructed schoolyards play an important role in stimulating PA in children. This study aimed at investigating the affordances of schoolyards and outdoor recess PA in two urban and two rural primary schools in Estonia. Schoolyards were described with the geographical mapping method, children's activities during outdoor recess were registered by using observations, and PA levels were measured with accelerometers. Students from grades two to six (8-13-year-olds) were included in the study. All observed schoolyards had different spaces including various ball game areas, climbing facilities, and slacklines. The natural environment dominated in the rural schools, and artificial surfaces dominated in the urban schools. Boys in the study tended to enjoy more sport-related activities, whereas girls preferred more social and less active activities. Students participating in outdoor recess spent about twice as much time (20.4%) on moderate-to-vigorous PA (MVPA) compared to indoor recess (9.5%), although boys were more active than girls (22.9% vs. 17.3%). All schoolyards afforded more MVPA during outdoor recess compared to indoor recess, whereas schoolyards with more space per child and natural environment elements generated more varied PA and higher MVPA. These findings confirm the importance of schoolyard design and quality for the variety and intensity of students' PA during outdoor recess.

Environment modification at school to promote physical activity among adolescents: a cluster randomized controlled trial

OBJECTIVE

To assess the effect of modifications of the school environment on physical activity in Brazilian adolescent students.

METHODS

Seven public schools in Duque de Caxias (Brazil) were randomized into control and intervention groups. The intervention group underwent modifications in the school environment (painting of hopscotch and school courts) and the provision of sports equipment (balls, basketball table, soccer goalpost, volleyball nets, and others) to stimulate physical activity. Additionally, footsteps towards the court and materials were painted, and a superhero character called Super Active was introduced. Total physical activity was measured using a validated questionnaire for adolescents. Generalized linear models were used to evaluate the effect of the intervention, adjusted by sex.

RESULTS

The sample consisted of 975 adolescents, with a mean age of 11.52 years (standard deviation - SD 1.43), and 56.7% were boys. After the one-month intervention, both groups' total physical activity time increased. The estimated changes from baseline were not different between the intervention and control groups (Δ=102.75 and Δ=99.76, respectively; p=0.52).

CONCLUSION

The painting, supply of equipment and other strategies to encourage physical activity in the school environment did not promote a positive effect on improving physical activity among adolescents. Future research is necessary to evaluate the effect of the intervention in the long-term period, particularly in other population contexts in middle-income countries.

The Effects of Playground Interventions on Accelerometer-Assessed Physical Activity in Pediatric Populations: A Meta-Analysis

Playgrounds are designed to be a safe, enjoyable, and effective means to promote physical activity in children and adolescents. The purpose of this study was to conduct a meta-analysis to determine the effectiveness of playground interventions for improving accelerometer-assessed ambulatory moderate-to-vigorous physical activity (MVPA) and to identify common aspects of playground interventions that may be beneficial to promote behavior change. An internet database search was performed. The final analyzed sample of studies was obtained from several criteria, including being a playground-based intervention targeting children or adolescents, having a control or comparison group, having an accelerometer-assessed MVPA outcome target variable, and reporting of the mean difference scores' variability. A random-effects model meta-analysis was employed to obtain pooled effect sizes. Ten studies (n = 10) were analyzed from the internet search. The weighted pooled effect (Hedges' g) across all studies was Hedges' g = 0.13, 95% CI: 0.02-0.24, p = 0.023. There was moderate study heterogeneity (I² = 55.3%) but no evidence for publication bias (p = 0.230). These results suggest that school-based playground interventions have a small effect on increasing accelerometer-assessed MVPA within the pediatric population. The playground should still be an environmental target during school or community-based interventions aimed at providing opportunities to promote MVPA.

Use of Wearable Devices to Study Physical Activity in Early Childhood Education

Physical activity recommendations for early childhood are gradually being met to a lesser extent today. The objectives of the study were: (i) to assess the degree of compliance with physical activity (PA) recommendations by gender; and (ii) to analyze the level of PA and steps in different periods over a week. This study was an observational cross-sectional study. Sixty-three young children (33 boys and 30 girls) aged two years (2.15 ± 0.35) were recruited for this study. Participants wore a “Garmin vivofit® jr.” activity tracker for seven days, collecting minutes of moderate-to-vigorous physical activity (MVPA) and step volume (Out-of-School Time and School Time). The results show a 50% compliance of the 120 min/day MVPA and 13,000 steps per day. No gender differences were detected. The findings in the analysis indicated a trend towards higher PA and steps at the Weekend. Moreover, participants reached higher PA and steps values “Out-of-School Time” than “School Time” (MVPA) (min/day). This study can provide strategies and motivational PA guidelines at school to enhance well-being at an early age. These activity trackers could stimulate more sustainable forms of urban mobility, such as walking, as the environment would accompany the child to meet daily PA recommendations.

School-based physical activity programs for promoting physical activity and fitness in children and adolescents aged 6 to 18

BACKGROUND

Physical activity among children and adolescents is associated with lower adiposity, improved cardio-metabolic health, and improved fitness. Worldwide, fewer than 30% of children and adolescents meet global physical activity recommendations of at least 60 minutes of moderate to vigorous physical activity per day. Schools may be ideal sites for interventions given that children and adolescents in most parts of the world spend a substantial amount of time in transit to and from school or attending school.

OBJECTIVES

The purpose of this review update is to summarise the evidence on effectiveness of school-based interventions in increasing moderate to vigorous physical activity and improving fitness among children and adolescents 6 to 18 years of age. Specific objectives are: • to evaluate the effects of school-based interventions on increasing physical activity and improving fitness among children and adolescents; • to evaluate the effects of school-based interventions on improving body composition; and • to determine whether certain combinations or components (or both) of school-based interventions are more effective than others in promoting physical activity and fitness in this target population.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, BIOSIS, SPORTDiscus, and Sociological Abstracts to 1 June 2020, without language restrictions. We screened reference lists of included articles and relevant systematic reviews. We contacted primary authors of studies to ask for additional information.

SELECTION CRITERIA

Eligible interventions were relevant to public health practice (i.e. were not delivered by a clinician), were implemented in the school setting, and aimed to increase physical activity among all school-attending children and adolescents (aged 6 to 18) for at least 12 weeks. The review was limited to randomised controlled trials. For this update, we have added two new criteria: the primary aim of the study was to increase physical activity or fitness, and the study used an objective measure of physical activity or fitness. Primary outcomes included proportion of participants meeting physical activity guidelines and duration of moderate to vigorous physical activity and sedentary time (new to this update). Secondary outcomes included measured body mass index (BMI), physical fitness, health-related quality of life (new to this update), and adverse events (new to this update). Television viewing time, blood cholesterol, and blood pressure have been removed from this update.  DATA COLLECTION AND ANALYSIS: Two independent review authors used standardised forms to assess each study for relevance, to extract data, and to assess risk of bias. When discrepancies existed, discussion occurred until consensus was reached. Certainty of evidence was assessed according to GRADE. A random-effects meta-analysis based on the inverse variance method was conducted with participants stratified by age (children versus adolescents) when sufficient data were reported. Subgroup analyses explored effects by intervention type.

MAIN RESULTS

Based on the three new inclusion criteria, we excluded 16 of the 44 studies included in the previous version of this review. We screened an additional 9968 titles (search October 2011 to June 2020), of which 978 unique studies were potentially relevant and 61 met all criteria for this update. We included a total of 89 studies representing complete data for 66,752 study participants. Most studies included children only (n = 56), followed by adolescents only (n = 22), and both (n = 10); one study did not report student age. Multi-component interventions were most common (n = 40), followed by schooltime physical activity (n = 19), enhanced physical education (n = 15), and before and after school programmes (n = 14); one study explored both enhanced physical education and an after school programme. Lack of blinding of participants, personnel, and outcome assessors and loss to follow-up were the most common sources of bias.  Results show that school-based physical activity interventions probably result in little to no increase in time engaged in moderate to vigorous physical activity (mean difference (MD) 0.73 minutes/d, 95% confidence interval (CI) 0.16 to 1.30; 33 studies; moderate-certainty evidence) and may lead to little to no decrease in sedentary time (MD -3.78 minutes/d, 95% CI -7.80 to 0.24; 16 studies; low-certainty evidence). School-based physical activity interventions may improve physical fitness reported as maximal oxygen uptake (VO₂max) (MD 1.19 mL/kg/min, 95% CI 0.57 to 1.82; 13 studies; low-certainty evidence). School-based physical activity interventions may result in a very small decrease in BMI z-scores (MD -0.06, 95% CI -0.09 to -0.02; 21 studies; low-certainty evidence) and may not impact BMI expressed as kg/m² (MD -0.07, 95% CI -0.15 to 0.01; 50 studies; low-certainty evidence). We are very uncertain whether school-based physical activity interventions impact health-related quality of life or adverse events.

AUTHORS' CONCLUSIONS

Given the variability of results and the overall small effects, school staff and public health professionals must give the matter considerable thought before implementing school-based physical activity interventions. Given the heterogeneity of effects, the risk of bias, and findings that the magnitude of effect is generally small, results should be interpreted cautiously.

Evidence-Based Overview of Accelerometer-Measured Physical Activity during School Recess: An Updated Systematic Review

Interest in analyzing physically active behaviors during school recesses has grown in recent years as the school environment has consolidated (recess, physical education classes, lunch-time, before and after school) as a crucial space to bring these levels towards those recommended through intervention programs and improvements in the school environment. Unfortunately, in most of these studies, children do not achieve the 60 min a day of moderate to vigorous physical activity (MVPA) recommended by the World Health Organization. The aim of this systematic review is to analyze the cross-sectional, longitudinal, and intervention studies objectively measured with accelerometers that have emerged in recent years to determine the amount of MVPA of children at recess. This systematic review followed the PRISMA guidelines. The extraction process for the studies included in this systematic review yielded a total of 43 articles. The studies were classified according to the methodological nature of the research: cross-sectional (n = 34), longitudinal (n = 3) and quasi-experimental (n = 6). The results of the studies confirm that during the recess period younger children are physically more active than older ones and that in general, boys are more physically active than girls. In addition, the data show that the school contributes to more than 40% of the total MVPA. The intervention programs led to an increase in MVPA of up to 5%. Providing schools with equipment and facilities shows that intervention programs are beneficial for raising children's levels of physical activity.

Occupational Therapy Practice Guidelines for Children and Youth Ages 5-21 Years

IMPORTANCE

Demand is increasing for activity- and occupation-based interventions to address occupational performance and support maximal participation of children and youth.

OBJECTIVE

This Practice Guideline was developed to guide decision making and support best practices in service delivery for children and youth ages 5-21 yr at home, at school, and in the community.

METHOD

The results from three systematic reviews (SRs) of activity- and occupation-based interventions for children and youth ages 5-21 yr were reviewed, synthesized, and translated into recommendations for education, practice, and research.

RESULTS

One hundred eighty-five articles were included in the three SRs examining the evidence for interventions to promote activities of daily living, instrumental activities of daily living, play and leisure, and rest and sleep; to improve mental health, positive behavior, and social participation; and to enhance learning, academic achievement, and successful participation in school. The reviews provide evidence for interventions associated with typical concerns addressed by occupational therapy practitioners.

CONCLUSIONS AND RECOMMENDATIONS

On the basis of the evidence, this guideline recommends that occupational therapy practitioners consistently collaborate with families and caregivers and provide services in the natural context of the desired occupation. The evidence also supports group service models and models that include peer mediation; these models can promote participation across areas of occupation. Skills-based training and therapeutic practice in the context of valued occupations are recommended over isolated sensorimotor approaches. Technology, manualized programs, and sports activities can be effective but should be evaluated and matched to age, diagnosis, and outcomes as guided by the evidence.

WHAT THIS ARTICLE ADDS

When guided by evidence, activity- and occupation-based interventions are effective in promoting participation and enhancing performance in valued occupations of children and youth ages 5-21 yr.

Sedentariness and Physical Activity during School Recess Are Associated with VO2Peak

Recess time (RT) is a main component of school-based activities, and could contribute up to 40% of the physical activity (PA) recommended in the health guidelines. The main goal was to analyze the association between accelerometer-measured PA and sedentary time during RT with cardiorespiratory fitness (CRF). A total of 146 children and adolescents, aged 8-19 years, were recruited from six schools. PA levels were measured with GT3X accelerometers over 7 days. CRF was measured using a portable breath-by-breath gas analyzer. A general linear model (GML) was conducted to analyze the association between PA intensities and CRF during RT. Additionally, a logistic binary regression was used to evaluate the risk of unhealthy CRF among different categories of PA and sedentary time. Participants classified as healthy showed higher PA levels during RT than those classed as unhealthy. GML analysis showed that sedentary time during RT was significantly associated with VO2Peak. Finally, individuals who were sedentary for more than 15 min during RT presented 97.7% lower odds of having unhealthy CRF (adjusted Odds Ratio = 0.023, 95% CI -0.002 to 0.263). Our data suggest an association between recess sedentary time and unhealthy CRF. Thus, school-aged children and adolescents must be empowered to perform PA during RT to prevent the deleterious effects of sedentary time on CRF.

Physical Activity and Social Behaviors of Urban Children in Green Playgrounds

INTRODUCTION

Nature exposure is associated with many wellbeing benefits. However, the influence of green space on the physical activity and social behaviors of children is not completely understood. The purpose of the study was to complete a stepwise impact evaluation of a large-scale playground greening project at a Title 1 elementary school in Los Angeles, California.

METHODS

Physical activity and social interaction data were collected with direct observation and accelerometers pre-, immediately post-, and 4 months post-greening at control (students enrolled=393) and experimental (students enrolled=538) locations from 2016 to 2017. Effects of relevant variables on recess behavior were analyzed with linear mixed models in 2018.

RESULTS

Zone popularity and recess behaviors did not change for control students during the study (p>0.05). Areas replaced by green space became the most popular for experimental students who transitioned from traditional playground games/sports to tag/chasing, gymnastics, climbing/jumping, and creative play. The percentage of students observed as sedentary decreased by 10.0% (95% CI=4.9%, 15.0%) at 4 months, p=0.003. Vigorous activity participation increased pre to post at the individual (48.5%, 95% CI=29.1%, 67.9%, p<0.001) and population level (41.2%, 95% CI=27.3%, 55.1%, p=0.003) and remained higher than pre-greening at 4 months (p<0.05) for girls in the experimental group only. The moderate to vigorous physical activity differential between green space and hardscape was greater for fifth graders than all other grades, p=0.002. Student physical and verbal conflict rates decreased below pre-greening rates after 4 months for the experimental group, p<0.001.

CONCLUSIONS

Results suggest that adding green space to asphalt-covered schoolyards helps expose children to nature, increases daily activity levels, and promotes social wellbeing in sex- and age-dependent ways.

Deprivation amplification due to structural disadvantage? Playgrounds as important physical activity resources for children and adolescents

OBJECTIVES

The deprivation amplification hypothesis postulates that the socially disadvantaged are exposed to further structural deprivation by their residential environment such that social inequalities are therefore amplified. To date, no publication has investigated deprivation amplification solely using playgrounds; the present health geography study investigates this hypothesis with regard to the availability of playgrounds in a typical large German city.

STUDY DESIGN

Between July 2016 and January 2017, all playgrounds in the city of Mannheim, Germany, were identified and evaluated by systematic audits. The playground attributes such as availability, accessibility, surface area, and provided amenities were operationalized using well-established, validated instruments.

METHODS

Geo-information about playgrounds was digitalized in ArcGIS 10.2-10.4 and linked to socioeconomic indicators on the meso-level, that is, on the level of 44 social areas. Availability and accessibility of playgrounds were quantified by calculating kernel density and Euclidean distance, respectively. Playground surface area and equipment provided were linked to the number of children and adolescents in the particular social area. The association between availability and accessibility of playgrounds and area-level indicators were assessed using bivariate and multiple Poisson regressions on the meso-level.

RESULTS

In the city of Mannheim, which covers 145 km² and is home to 311,000 inhabitants, 271 playgrounds were identified. Bivariate and multiple analyses showed no association between availability and accessibility of playgrounds and area-level indicators. However, significant negative associations were found in the bivariate analyses between playground area and amenities provided per child and various area-level indicators, but not in multiple models.

CONCLUSIONS

Children are provided with different opportunities to play and to be physically active, depending upon the population density of their social neighborhood. At least in our study area, many socially disadvantaged families are forced to move to densely populated areas for economic reasons. Against that background, the phenomenon of 'deprivation amplification' was not confirmed for availability and accessibility of playgrounds but for playground area and number of amenities provided.

Longitudinal Follow-Up of Physical Activity During School Recess: Impact of Playground Markings

To promote physical activity (PA) among children, few studies have reported long-term effects of playground marking during school recess. The aim of this study was to investigate the impact of a playground design on children's recess PA across 12 months and to evaluate the influence of covariates on the intervention effects with accelerometry data. Two hundred and eighty-three children (aged 6-11 years) were selected from 3 elementary schools. Two experimental schools received a recess-based intervention; the third one served as a control group. The design of playgrounds was based on a multicolored zonal design. Children's PA was measured with a uniaxial accelerometer twice a day (morning and afternoon recess) during a 4-day school week. Times spent below and above different PA levels, varying from sedentary (SED, <1.5 METs), light PA (LPA, <4 METs), and from moderate to very high (MVPA, ≥ 4 METs) were calculated before and after 6 and 12 months intervention. A three level (time, pupil, school) multilevel analysis was used to control the intervention effect across time on SED, LPA, and MVPA. The playground intervention was effective after 6 months for LPA (+2.5%, CI 0.65/4.29, P < 0.01) and after 12 months for MVPA (+3.1%, CI 0.62/5.54, P < 0.01). Moreover, negative non-significant intervention effects were found for SED and LPA. Baseline PA and sex were significant covariates to the contrary of body mass index and age. Playground markings intervention can modify positively long-term school recess total PA.

Comparison of daily physical activity parameters using objective methods between overweight and normal-weight children

PURPOSE

The purpose of the present study was to determine if there were any differences in various aspects of physical activity such as energy expenditure, intensity, and type of activity between normal-weight and overweight boys.

METHODS

Children aged 9-12 years were recruited from 2 elementary schools located in different urban districts in Republic of Korea. The present study included 45 Korean boys, of which 19 were normal-weight and 26 were overweight. Daily physical activity was estimated over the same 1-week study period under free-living conditions using the doubly labeled water (DLW) method and a tri-axial accelerometer. Resting metabolic rate (RMR) was measured using the Douglas bag method and open-circuit indirect calorimetry. We calculated the physical activity level (PAL) as the total energy expenditure (TEE)/RMR.

RESULTS

PAL was not significantly different between the groups. In the accelerometer data, time spent in locomotive moderate-to-vigorous physical activity (MVPA) was significantly lower in overweight boys than in normal-weight subjects, whereas other variables including non-locomotive activity did not differ between groups. In addition, among all participants, time spent in total locomotive activity was significantly associated with PAL. Time spent in locomotive MVPA was significantly associated with PAL.

CONCLUSION

Overweight boys may be less physically active based on locomotive MVPA, which was positively related with PAL. Our findings suggest that the contribution of locomotive MVPA to the increase in PAL was relatively significant.

A Multicomponent Schoolyard Intervention Targeting Children's Recess Physical Activity and Sedentary Behavior: Effects After 1 Year

BACKGROUND

The aim of the study was to test the 12-month effects of a multicomponent physical activity (PA) intervention at schoolyards on morning recess PA levels of sixth- and seventh-grade children in primary schools, using accelerometry and additional global positioning system data.

METHODS

A quasi-experimental study design was used with 20 paired intervention and control schools. Global positioning system confirmatory analyses were applied to validate attendance at schoolyards during recess. Accelerometer data from 376 children from 7 pairs of schools were included in the final analyses. Pooled intervention effectiveness was tested by multilevel linear regression analyses, whereas effectiveness of intervention components was tested by multivariate linear regression analyses.

RESULTS

Children exposed to the multicomponent intervention increased their time spent in light PA (+5.9%) during recess. No pooled effects on moderate to vigorous PA were found. In-depth analyses of intervention components showed that physical schoolyard interventions particularly predicted a decrease in time spent in sedentary behavior during recess at follow-up. Intervention intensity and the school's commitment to the project strengthened this effect.

CONCLUSIONS

The multicomponent schoolyard PA intervention was effective in making children spend a larger proportion of recess time in light PA, which was most likely the result of a shift from sedentary behavior to light PA.

Effect of major school playground reconstruction on physical activity and sedentary behaviour: Camden active spaces

Background

The physical school environment is a promising setting to increase children’s physical activity although robust evidence is sparse. We examined the effects of major playground reconstruction on physical activity and sedentary time in primary schools using a quasi-experimental design (comparison group pre-test/post-test design).

Methods

Five experimental and two control schools from deprived areas of inner city London were recruited at baseline. Main outcome was physical activity and sedentary time measured from objective monitoring (Actigraph accelerometer) at one year follow up. Pupils’ impressions of the new playground were qualitatively assessed post construction.

Results

A total of 347 pupils (mean age = 8 years, 55% boys; 36% Caucasian) were recruited into the study at baseline; 303 provided valid baseline Actigraph data. Of those, 231 (76%) completed follow-up (n = 169 intervention; n = 62 control) and 77.4% of the sample recorded at least 4 days of Actigraph wear. In mixed models adjusted for age, sex, ethnicity, ratio activity or sedentary/wear time at baseline, wear time at follow up, and school, no differences were observed in total moderate – vigorous activity (B = −1.4, 95% CI, −7.1, 4.2 min/d), light activity (B = 4.1, 95% CI, −17.9, 26.1), or sedentary time (B = −3.8, 95% CI, −29.2, 21.6 min/d) between groups. There were significant age interactions for sedentary (p = 0.002) and light intensity physical activity (p = 0.008). We observed significant reductions in total sedentary (−28.0, 95% CI, −1.9, −54.1 min/d, p = 0.037) and increases in total light intensity activity (24.6, 95% CI, 0.3, 48.9 min/d, p = 0.047) for children aged under 9 yrs. old in the intervention.

Conclusion

Major playground reconstruction had limited effects on physical activity, but reduced sedentary time was observed in younger children. Qualitative data suggested that the children enjoyed the new playgrounds and experienced a perceived positive change in well-being and social interactions.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-017-4483-5) contains supplementary material, which is available to authorized users.

Study Protocol of MINI SALTEN: a technology-based multi-component intervention in the school environment targeting healthy habits of first grade children and their parents

BACKGROUND

MINI SALTEN is a program developed to increase moderate to vigorous physical activity (PA) and improve eating habits at home and school in first grade children. It aims to assess the effects of a technology family-based and PA school-based intervention. The purpose of this manuscript is to describe the protocol design and the MINISALTEN intervention.

METHODS

This is cluster-randomized controlled trial designed to run from July 2015 to November 2016 in 12 public schools of the city of Buenos Aires, matched for socio-demographic characteristics. The intervention is based on two main components: (a) "active breaks" (AB): implemented during school breaks by a PA instructor; (b) "virtual" (V): web-based contents delivered to the families via a multiplatform application. Using a computer generated random sequence participants are allocated to one of four intervention conditions: (AB), (V), (AB + V), and control (C). Outcomes are measured at baseline and 12 months post intervention, and will include data collected from the child and her/his mother/father or guardian. Primary outcome measures are: PA and sedentary behaviour (measured with accelerometers). Secondary outcome measures related are: percentage of kilocalories (kcal) from added sugars, and from total and saturated fats; grams of fruits and vegetables; and number of snacks and kcal coming from their added sugars and total and saturated fats. Family socio-economic level, home environment, and school environment will also be assessed. Statistical analysis is on an intention-to-treat principle. Baseline characteristics are described using summary measures and mixed models (with school as random effect). The effect of the two interventions will be estimated using a generalized mixed linear model with link and distribution selected according to the type of outcome. Included random effects are: child (or mother/father or guardian) accounting for repeated measures; school accounting for cluster induced by school. The most parsimonious model for each outcome will be reported. The False Discovery Rate criterion will be used to correct for multiple testing in non-planned analyses.

DISCUSSION

It is a pioneer assessment of the impact of a technology-based virtual intervention and a school-based PA program, designed to prevent obesity, and involving the parents at public schools of Buenos Aires.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN58093412 . Registered March 14th, 2016 (retrospectively registered).

Using cost-effectiveness analysis to prioritize policy and programmatic approaches to physical activity promotion and obesity prevention in childhood

Participation in recommended levels of physical activity promotes a healthy body weight and reduced chronic disease risk. To inform investment in prevention initiatives, we simulate the national implementation, impact on physical activity and childhood obesity and associated cost-effectiveness (versus the status quo) of six recommended strategies that can be applied throughout childhood to increase physical activity in US school, afterschool and childcare settings. In 2016, the Childhood Obesity Intervention Cost Effectiveness Study (CHOICES) systematic review process identified six interventions for study. A microsimulation model estimated intervention outcomes 2015-2025 including changes in mean MET-hours/day, intervention reach and cost per person, cost per MET-hour change, ten-year net costs to society and cases of childhood obesity prevented. First year reach of the interventions ranged from 90,000 youth attending a Healthy Afterschool Program to 31.3 million youth reached by Active School Day policies. Mean MET-hour/day/person increases ranged from 0.05 MET-hour/day/person for Active PE and Healthy Afterschool to 1.29 MET-hour/day/person for the implementation of New Afterschool Programs. Cost per MET-hour change ranged from cost saving to $3.14. Approximately 2500 to 110,000 cases of children with obesity could be prevented depending on the intervention implemented. All of the six interventions are estimated to increase physical activity levels among children and adolescents in the US population and prevent cases of childhood obesity. Results do not include other impacts of increased physical activity, including cognitive and behavioral effects. Decision-makers can use these methods to inform prioritization of physical activity promotion and obesity prevention on policy agendas.

Permanent play facility provision is associated with children's time spent sedentary and in light physical activity during school hours: A cross-sectional study

Objective: To study the associations between: 1) number of permanent outdoor play facilities per pupil and 2) the size of the outdoor play area per pupil with sedentary time and physical activity (PA) during school hours in six-, nine-, and 15-year olds. We conducted a cross-sectional study of nationally representative samples of Norwegian six- (n = 1071), nine- (n = 1421) and 15-year-olds (n = 1106) in 2011 (the Physical Activity Among Norwegian Children Study). The participation rates were 56.4%, 73.1% and 57.8% for six-, nine- and 15-year olds, respectively. We assessed PA objectively for seven consecutive days using accelerometers, the size of a school's outdoor play area (SOPA) using an online map service and the permanent play facility (PPF) provision using a standardized form during school site visits. We successfully measured SOPA and PPF in 99 schools, from which 3040 participants provided valid accelerometer data. We used generalized least-squares random-effects models with robust variance estimation to assess associations. Our results indicate that better provision of permanent play facilities may reduce sedentary time and increase time spent in light PA among six-year-olds. Permanent play facility provision was not associated with sedentary time or PA among nine- and 15-year-olds. Associations found between outdoor play area size, physical activity and sedentary time were negligible. Future research should investigate what types of permanent play facilities may be associated with physical activity in both children and adolescents.

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Permanent play facility provision was associated with sedentary time.

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Permanent play facility provision was associated with light PA.

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Permanent play facility provision was not associated with MVPA.

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Outdoor play area size was not associated with sedentary time or PA.

The relationship among playground areas and physical activity levels in children

INTRODUCTION

Almost 20% of American children aged 6 to 11 years are obese. A decrease in physical activity has been associated with an increase in obesity. The school environment is one place where many children can be reached. This cross-sectional study determined which types of playground areas attract children and promote moderate to vigorous physical activity (MVPA) or sedentarism.

METHOD

Children on two urban elementary school playgrounds (one of which offered a jogging program called Jog and Walk Stars [JAWS]) were observed before school with use of the System for Observing Play and Leisure Activity in Youth and System for Observing Play and Recreation in Communities observational tools. Descriptive statistics, paired-samples t tests, and independent-samples t tests were used to analyze the data.

RESULTS

The highest populated areas for schools K and B on non-JAWS days were the general blacktop areas; however, approximately 50% of the children in these areas were sedentary. At school B on days when the JAWS program was offered, the highest populated area was the JAWS track, and 99% of those children participated in MVPA. There was a significant difference in counts for average total sedentary children per square foot between school K (M = 216.70) and school B on JAWS days: M = 80.38, t (22.02) = 2.24, p < .5, two-tailed.

DISCUSSION

A playground environment assessment to identify areas that promote MVPA, such as offering a JAWS program, may be one avenue to address the need for increasing MVPA levels in children in general, in addition to physical education class, and help them obtain the recommended 60 minutes of daily MVPA.

Relationship Between Break-Time Physical Activity, Age, and Sex in a Rural Primary Schools, Wales, UK

The aim of this study was to examine the physical activity during the break-times of primary school children in rural areas, and its relationship with age and sex. 380 children (192 boys and 188 girls; age=9.5±1.1 years) participated in the study. Break-time physical activity in the morning and lunch breaks was measured by accelerometry. An ANOVA was used to determine differences by sex in each age group, together with the respective confidence intervals and effect sizes. The results showed that 8-year-olds performed more physical exercise than 11-year-olds during the two breaks (p=0.005). For the boys, the 8-year-olds did more physical activity than the 10-year-olds, while, for the girls, those aged 8 and 9 years did more PA than girls aged 11 years (p<0.001). The only difference between boys and girls was for the 10-year-olds (p=0.043), with the boys doing more physical activity. Teachers might find it useful to take these findings into account to design physical activity programmes aimed at increasing the playground physical activity of older children.

Camden active spaces: does the construction of active school playgrounds influence children's physical activity levels? A longitudinal quasi-experiment protocol

INTRODUCTION

Physical activity is essential for every facet of children's health. However, physical activity levels in British children are low. The school environment is a promising setting to increase children's physical activity but limited empirical evidence exists on how a change in the outdoor physical school environment influences physical activity behaviour. The London Borough of Camden is redesigning seven existing school playgrounds to engage children to become more physically active. The primary aim of this project is to evaluate the impact of the redesigned playgrounds on children's physical activity, well-being and physical function/fitness.

METHOD AND ANALYSIS

This project will use a longitudinal quasi-experimental design. Seven experimental schools and one control school will take part. One baseline data collection session and two follow-ups will be carried out. Between baseline and follow-up, the experimental school playgrounds will be redesigned. At baseline, a series of fitness tests, anthropometric and questionnaire measurements, and 7-day objective physical activity monitoring (Actigraph accelerometer) will be carried out on children (aged 5–16 years). This will be repeated at follow-up. Changes in overall physical activity levels and levels during different times of the day (eg, school breaks) will be examined. Multilevel regression modelling will be used to analyse the data.

ETHICS AND DISSEMINATION

The results of this study will be disseminated through peer-review publications and scientific presentations. Ethical approval was obtained through the University College London Research Ethics Committee (Reference number: 4400/002).