Interventions to increase physical activity in children 0-5 years old: a systematic review, meta-analysis and realist synthesis

The Effectiveness of Physical Activity Policies in Center-Based Childcare: A Systematic Review and Meta-Analysis

Purpose: Many young children spend a significant portion of time in center-based childcare settings; however, these children are often not sufficiently active during care. Promoting physical activity through policy implementation is one mechanism which has the potential to increase physical activity. The purpose of this systematic review and meta-analysis was to provide an overview of physical activity policies implemented in childcare centers and determine their effect on children's physical activity. Methods: Electronic searches were conducted in CINAHL, Medline, PsycINFO, EMBASE, Scopus, SPORTDiscus, and Sports Medicine and Education Database. Two reviewers independently examined 3,286 articles to find peer-reviewed, original studies that assessed the impact of physical activity policies on children's physical activity. Random effects meta-analyses were used to determine the impact of policies. Results: A total of 13 articles met the inclusion criteria; in which 12 unique policies were implemented. Results of the meta-analyses suggest that introducing new physical activity policies did not increase children's moderate-to-vigorous physical activity (MVPA); however, compared to centers without a formalized physical activity policy, children in centers with a formalized policy engaged in significantly more MVPA and total physical activity. Conclusions: Introducing new physical activity policies alone may not be sufficient to increase children's engagement in physical activity, and it may be important to combine with capacity-building initiatives for childcare staff and early childhood educators. Results reinforce the value of childcare centers implementing their own formalized physical activity policies to support children's physical activity, which highlights the importance of regulating physical activity practices in childcare. Registration: CRD42022326037.

Pre-school-based behaviour change intervention to increase physical activity levels amongst young children: a feasibility cluster randomised controlled trial

Background

A significant rise in childhood obesity worldwide over the past three decades highlights the urgent need for early interventions, especially in preschools as key settings for child development. This study aimed to assess the feasibility and fidelity of a randomised controlled trial of "I'm an Active Hero" (IAAH), a theory- and evidence-based multi-component behaviour change intervention targeting physical activity and sedentary behaviour amongst preschool-aged children.

Methods

Two preschools in Taif city, Saudi Arabia were randomly assigned to either the intervention (n = 3 classrooms) or the usual curriculum control group (n = 3 classrooms). The intervention ran for 10 weeks from February to April 2023 and consisted of teacher-led physical activity and sedentary behaviour sessions in preschools, with an additional interactive home component. Primary outcome measures included intervention fidelity, recruitment rates, attrition rates, and compliance with trial procedures. Secondary outcomes included body mass index (BMI), objectively measured physical activity, and sedentary time via the ActiGraph GT3X accelerometer. Outcomes were measured at baseline and at 10 weeks in both study arms.

Results

The preschool intervention component had high fidelity (93.3%), but the home component fidelity was lower (74%). A cluster-level recruitment rate of 12% (13/112 centres) was attained, whilst the individual-level recruitment rate stood at 36% (52/143 children, mean age of 4.16 years; 23 girls). Attrition was 10%. Compliance varied with 90% for BMI, 71% for accelerometery, and 45% for questionnaires. The intervention group showed small decreases in BMI, slight increases in physical activity, and decreases in sedentary time at follow-up compared to the control group. Parents, facilitators, and assistant teachers considered the intervention to be feasible and beneficial.

Conclusion

The IAAH intervention was feasible to implement in Saudi Arabian preschools. Facilitators showed high fidelity in delivering it. However, preliminary data did not demonstrate effectiveness. A more comprehensive evaluation across a broader population is warranted. The intervention could be revised to optimise recruitment, compliance, and fidelity of the home-based component. Successful elements from this pilot should be retained whilst adaptations to implementation are made to strengthen key areas.Clinical trial registration: ClinicalTrials.gov, NCT05754359.

Effects of eHealth Interventions on 24-Hour Movement Behaviors Among Preschoolers: Systematic Review and Meta-Analysis

BACKGROUND

The high prevalence of unhealthy movement behaviors among young children remains a global public health issue. eHealth is considered a cost-effective approach that holds great promise for enhancing health and related behaviors. However, previous research on eHealth interventions aimed at promoting behavior change has primarily focused on adolescents and adults, leaving a limited body of evidence specifically pertaining to preschoolers.

OBJECTIVE

This review aims to examine the effectiveness of eHealth interventions in promoting 24-hour movement behaviors, specifically focusing on improving physical activity (PA) and sleep duration and reducing sedentary behavior among preschoolers. In addition, we assessed the moderating effects of various study characteristics on intervention effectiveness.

METHODS

We searched 6 electronic databases (PubMed, Ovid, SPORTDiscus, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) for experimental studies with a randomization procedure that examined the effectiveness of eHealth interventions on 24-hour movement behaviors among preschoolers aged 2 to 6 years in February 2023. The study outcomes included PA, sleep duration, and sedentary time. A meta-analysis was conducted to assess the pooled effect using a random-effects model, and subgroup analyses were conducted to explore the potential effects of moderating factors such as intervention duration, intervention type, and risk of bias (ROB). The included studies underwent a rigorous ROB assessment using the Cochrane ROB tool. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment.

RESULTS

Of the 7191 identified records, 19 (0.26%) were included in the systematic review. The meta-analysis comprised a sample of 2971 preschoolers, which was derived from 13 included studies. Compared with the control group, eHealth interventions significantly increased moderate to vigorous PA (Hedges g=0.16, 95% CI 0.03-0.30; P=.02) and total PA (Hedges g=0.37, 95% CI 0.02-0.72; P=.04). In addition, eHealth interventions significantly reduced sedentary time (Hedges g=-0.15, 95% CI -0.27 to -0.02; P=.02) and increased sleep duration (Hedges g=0.47, 95% CI 0.18-0.75; P=.002) immediately after the intervention. However, no significant moderating effects were observed for any of the variables assessed (P>.05). The quality of evidence was rated as "moderate" for moderate to vigorous intensity PA and sedentary time outcomes and "low" for sleep outcomes.

CONCLUSIONS

eHealth interventions may be a promising strategy to increase PA, improve sleep, and reduce sedentary time among preschoolers. To effectively promote healthy behaviors in early childhood, it is imperative for future studies to prioritize the development of rigorous comparative trials with larger sample sizes. In addition, researchers should thoroughly examine the effects of potential moderators. There is also a pressing need to comprehensively explore the long-term effects resulting from these interventions.

TRIAL REGISTRATION

PROSPERO CRD42022365003; http://tinyurl.com/3nnfdwh3.

Which behaviour change techniques are associated with interventions that increase physical activity in pre-school children? A systematic review

BACKGROUND

Insufficient physical activity (PA) is a significant risk factor that contributes to several health problems and there is a need to improve our understanding of how to increase PA, particularly among young children. This review (PROSPERO registration: CRD42022328841) investigated the relationship between behaviour change techniques (BCTs) and interventions that increased PA among pre-school children aged < 6 years old.

METHODS

Systematic searches of six databases were undertaken from inception to July 2022, updated in December 2022, to locate studies that evaluated interventions and reported a positive change in PA levels in children aged < 6 years old.

RESULTS

A total of 5,304 studies were screened, and 28 studies involving 10,605 subjects aged 2.5 to 5.9 years met the eligibility criteria. Each eligible study (n = 28) was independently appraised by two researchers using the Cochrane risk of bias tool. The BCT Taxonomy v1 and the Template for Intervention Description and Replication (TIDieR) guided the extraction and analysis of data, and this process led to the identification of 27 BCTs.

CONCLUSIONS

Potentially promising BCTs for increasing PA among young children included 'shaping knowledge,' 'antecedents,' 'goals and planning,' and 'comparison of behaviour.' Future PA interventions that target young children should consider integrating these promising BCTs into their programmes. However, such consideration needs to be tempered by the fact that most of the reviewed studies were deemed to have a high or unclear risk of bias and/or were limited with respect to the populations that they targeted. Further research using rigorous methodologies is required to establish a higher standard that addresses the needs of young children who are expected to have insufficient levels of physical activity.

Policy, systems, and environmental interventions addressing physical activity in early childhood education settings: A systematic review

Policy, systems, and environmental (PSE) approaches can facilitate physical activity in priority populations (e.g., racial and ethnic minority, low wealth groups) within early childhood education (ECE) settings. The purpose of this review was to 1) characterize the inclusion of priority populations within ECE physical activity interventions containing PSE approaches and 2) identify and describe interventions within these populations. Seven databases were systematically searched (January 2000-Febrary 2022) for ECE-based interventions focusing on children (0-6 years) that utilized at least one PSE approach. Eligible studies included a child physical activity or physical activity environment outcome and child or center-level population characteristics. Forty-four studies, representing 42 interventions were identified. For Aim 1, half of interventions included one PSE approach (21/42), with only 11/42 including three or more approaches. Physical environment changes [e.g., adding play equipment, modifying space (25/42)] were the most used PSE approaches followed by system [e.g., integrating activity into routines, (21/42)] and policy [e.g., outdoor time (20/42)] approaches. Nearly half of interventions were conducted in predominantly priority populations (18/42). Studies were primarily rated as good (51%) or fair (38%) methodological quality using the Downs and Black checklist. In Aim 2, of the 12 interventions assessing child physical activity in priority populations, 9/12 reported at least one physical activity outcome in the expected direction. Of the 11 interventions assessing the physical activity environment, 9/11 reported an effect in the expected direction. Findings indicate clear opportunities exist to target priority populations by incorporating PSE approaches in ECE physical activity interventions.

Physical activity in young children across developmental and health states: the ActiveCHILD study

Background

Evidence about physical activity of young children across developmental and health states is very limited. Using data from an inclusive UK cohort, ActiveCHILD, we investigated relationships between objectively measured physical activity, child development, social context, and health-related quality of life (HRQoL).

Methods

Children (12-36 months), purposively sampled across health pathways, developmental abilities, and sociodemographic factors, were recruited through thirteen National Health Service organisations in England. Data were collected from 07/2017 to 08/2019 on: weekly physical activity (3-7 days) using waist-worn accelerometer (ActiGraph 3GTX); sociodemographics, parent actions, child HRQoL, and child development using questionnaires; and child health conditions using clinical records. A data-driven, unsupervised method, called hidden semi-Markov model (HSMM) segmented the accelerometery data and provided estimates of the total time spent active (any intensity) and very active (greater intensity) for each child. Relationships with the explanatory factors were investigated using multiple linear regression.

Findings

Physical activity data were obtained for 282 children (56% females, mean age 21 months, 37.5% with a health condition) covering all index of multiple deprivation deciles. The patterns of physical activity consisted of two daily peaks, children spending 6.44 (SD = 1.39) hours active (any intensity), of which 2.78 (SD = 1.38) hours very active, 91% meeting WHO guidelines. The model for total time active (any intensity) explained 24% of variance, with mobility capacity the strongest predictor (β = 0.41). The model for time spent very active explained 59% of variance, with mobility capacity again the strongest predictor (β = 0.76). There was no evidence of physical activity explaining HRQoL.

Interpretation

The findings provide new evidence that young children across developmental states regularly achieve mainstream recommended physical activity levels and challenges the belief that children with development problems need lower expectations for daily physical activity compared to peers. Advancing the rights of all children to participate in physical activity requires inclusive, equally ambitious, expectations for all.

Funding

Niina Kolehmainen, HEE/NIHR Integrated Clinical Academic Senior Clinical Lecturer, NIHR ICA-SCL-2015-01-00, was funded by the NIHR for this research project. Christopher Thornton, Olivia Craw, Laura Kudlek, and Laura Cutler were also funded from this award. Tim Rapley is a member of the NIHR Applied Research Collaboration North East and North Cumbria, with part of his time funded through the related award (NIHR200173). The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR, NHS, or the UK Department of Health and Social Care. The work of Kianoush Nazarpour is supported by Engineering and Physical Sciences Research Council (EPSRC), under grant number EP/R004242/2.

A Pilot Randomised Controlled Trial to Increase the Sustainment of an Indoor-Outdoor-Free-Play Program in Early Childhood Education and Care Services: A Study Protocol for the Sustaining Play, Sustaining Health (SPSH) Trial

Early Childhood Education and Care (ECEC) settings are important environments to support children's physical activity (PA). In 2021, COVID-19 regulations recommended the provision of indoor-outdoor free-play programs in ECEC settings to reduce the transmission of COVID-19, resulting in an increased uptake of this practice. As the context has since changed, research suggests that ECEC services could cease the implementation of these practices. Therefore, this pilot randomised controlled trial (RCT) aims to examine the feasibility, acceptability, and impact of a sustainment strategy to ensure the ongoing implementation (sustainment) of ECEC-delivered indoor-outdoor free-play programs. Twenty ECEC services located in New South Wales, Australia that have implemented indoor-outdoor free-play programs since the release of COVID-19 guidelines will be recruited. The services will be randomly allocated either the sustainment strategy or usual care. The "Sustaining Play, Sustaining Health" program consists of eight strategies, developed to address key barriers against and facilitators of sustainment informed by the Integrated Sustainability Framework. The outcomes will be assessed via internal project records, staff surveys, and a self-reported measure of free play. This study will provide important data to support the performance of a fully powered trial within Australian ECEC settings and to inform the development of future sustainment strategies.

Influence of pilot and small trials in meta-analyses of behavioral interventions: a meta-epidemiological study

BACKGROUND

Pilot/feasibility or studies with small sample sizes may be associated with inflated effects. This study explores the vibration of effect sizes (VoE) in meta-analyses when considering different inclusion criteria based upon sample size or pilot/feasibility status.

METHODS

Searches were to identify systematic reviews that conducted meta-analyses of behavioral interventions on topics related to the prevention/treatment of childhood obesity from January 2016 to October 2019. The computed summary effect sizes (ES) were extracted from each meta-analysis. Individual studies included in the meta-analyses were classified into one of the following four categories: self-identified pilot/feasibility studies or based upon sample size but not a pilot/feasibility study (N ≤ 100, N > 100, and N > 370 the upper 75th of sample size). The VoE was defined as the absolute difference (ABS) between the re-estimations of summary ES restricted to study classifications compared to the originally reported summary ES. Concordance (kappa) of statistical significance of summary ES between the four categories of studies was assessed. Fixed and random effects models and meta-regressions were estimated. Three case studies are presented to illustrate the impact of including pilot/feasibility and N ≤ 100 studies on the estimated summary ES.

RESULTS

A total of 1602 effect sizes, representing 145 reported summary ES, were extracted from 48 meta-analyses containing 603 unique studies (avg. 22 studies per meta-analysis, range 2-108) and included 227,217 participants. Pilot/feasibility and N ≤ 100 studies comprised 22% (0-58%) and 21% (0-83%) of studies included in the meta-analyses. Meta-regression indicated the ABS between the re-estimated and original summary ES where summary ES ranged from 0.20 to 0.46 depending on the proportion of studies comprising the original ES were either mostly small (e.g., N ≤ 100) or mostly large (N > 370). Concordance was low when removing both pilot/feasibility and N ≤ 100 studies (kappa = 0.53) and restricting analyses only to the largest studies (N > 370, kappa = 0.35), with 20% and 26% of the originally reported statistically significant ES rendered non-significant. Reanalysis of the three case study meta-analyses resulted in the re-estimated ES rendered either non-significant or half of the originally reported ES.

CONCLUSIONS

When meta-analyses of behavioral interventions include a substantial proportion of both pilot/feasibility and N ≤ 100 studies, summary ES can be affected markedly and should be interpreted with caution.

Correlates of Physical Activity in 0- to 5-year-olds: A Systematic Umbrella Review and Consultation of International Researchers

BACKGROUND

Many children aged 0-5 years do not meet the WHO physical activity guidelines. To develop effective, evidence-based interventions, it is necessary to understand which factors are associated with physical activity in early childhood.

OBJECTIVE

To summarize the current evidence on correlates of physical activity in 0- to 5-year-old children.

METHODS

First, a systematic umbrella review was conducted following PRISMA guidelines. PubMed, Embase, PsycINFO, and SPORTDiscus were searched up to May 2020 for systematic reviews examining the association between potential correlates and quantitatively measured physical activity in children aged 0-5.9 years. Included reviews were assessed on methodological quality, and results were categorized according to the socio-ecological model. Second, 31 international researchers of physical activity in young children participated in an expert panel to reflect on the outcomes of the umbrella review and propose directions for future research.

RESULTS

Twenty-one reviews were included that examined a total of 98 potential correlates. When synthesizing all reviews, 23 correlates were found with consistent evidence for an association with a physical activity outcome. For most other potential correlates there was inconsistent evidence across reviews for associations with physical activity in young children. Although there was little overlap between the correlates identified in the umbrella review and determinants suggested by the expert panel, both confirmed the importance of socio-cultural, policy, and physical environmental factors in general.

CONCLUSION

Multiple correlates of young children's physical activity were identified. However, various methodological challenges (e.g., measurement instruments) and the large heterogeneity (e.g., study samples, correlates, and outcome measures) hindered formulating definitive conclusions. Moreover, none of the reviews reported on the interrelatedness between correlates, which would align with more holistic understandings of behavior. Our findings indicate the urgent need for establishing a common ground in definitions, assessment methods, and analytical methods to further the field of physical activity research in this tremendously important age group.

PROSPERO REGISTRATION NUMBER

CRD42020184159.

Using a design-based research approach to develop a technology-supported physical education course to increase the physical activity levels of university students: Study protocol paper

BACKGROUND

Promoting physical activity (PA) for university students is essential as PA levels decrease during the transition from secondary to higher education. Providing technology-supported university courses targeting students' PA levels may be a viable option to combat the problem. However, it is still unclear how and what technologies should be implemented in university courses to promote PA. This study aims to create a series of design principles for technology-supported physical education courses that aim to increase university students' PA knowledge, motivation and levels.

METHOD

The proposed methodology underpinning the research program is a seven-phase design-based research (DBR) approach, with the seven phases encompassed in four sequential studies. These four studies are a systematic review, a qualitative focus group study, a pilot study, and a randomised controlled trial (RCT) study. The protocol paper aims to detail the plan for conducting the four studies in a comprehensive and transparent manner, thus contributing to the methodological evidence base in this field.

DISCUSSION

Design principles generated from this project will contribute to the growing evidence focusing on effective design and implementation features. Future practitioners can also use these to develop physical education courses that aim to promote university students' physical activity levels, knowledge, and motivation.

TRIAL REGISTRATION

The RCT registry number: ACTRN12622000712707, 18/05/2022.

Association between childcare movement behaviour compositions with health and development among preschoolers: Finding the optimal combinations of physical activities and sedentary time

Little is known about how wake-time movement behaviour compositions while in childcare relate to children's health and development. This study aimed to use compositional analysis to examine how childcare movement behaviour compositions were associated with standardised body mass index (zBMI) and physical and psychosocial functioning among children in the preschool setting. A total of 405 preschoolers wore accelerometers during childcare hours to measure their moderate-to-vigorous physical activity (MVPA), light intensity physical activity (LPA) and sedentary time. Compositional regression, isotemporal substitution models, and the "Goldilocks" approach was used to examine how wake-time childcare movement behaviour compositions related to each of the outcomes. Engaging in greater LPA relative to MVPA and sedentary time was associated with higher BMI z-scores, replacing sedentary time or time spent in MVPA with LPA was associated with greater physical functioning, and spending more time in sedentary behaviours relative to overall physical activity was related with greater psychosocial functioning. It is not clear what the optimal wake-time movement behaviour composition while in childcare is for health and development; however, LPA and sedentary time while in childcare may have some benefits. More research is needed to aid the development of childcare-specific guidelines for physical activity and sedentary behaviours.

Acceptability of a parent-focused program for physical literacy development among parents and children during the COVID-19 pandemic: A qualitative study

Background

A 3-month parent education program was designed and implemented in Hong Kong to improve physical literacy (PL) among primary school children and their parents during the COVID-19 pandemic. This study aims to probe into the acceptability of the intervention from parental perspectives, providing more insights for future implementation.

Methods

Following the 3-month parent-focused PL program, 16 parents (mean age = 43.73 years, 15 mothers) were recruited to participate in semi-structured individual interviews in June 2021. Interviews were analyzed using thematic analysis in NVivo 12. Two coders analyzed interview transcripts deductively based on the interview guide and social cognitive theory (SCT).

Results

Three themes were identified that captured the acceptability of the program: (1) Addressing needs through appropriate delivery enhances acceptability of intervention; (2) Positive behavioral and psychological changes to families; (3) Appropriate support of environmental factors can enhance the sustainability of program effects. The high levels of acceptability were attributable to the fact that parents were able to learn and be a gatekeeper to impact their children positively. Moreover, the design and contents of the program were appropriate for the participating parents because the program provided adequate learning resources and interactive learning support without being overly rigid, and the online learning mode was feasible and convenient. Consequent to their participation in the program, parents expressed that they became more aware of the importance of PL, established physical activity routines with their children, and modified their parenting styles which resulted in improved parent-child relationships.

Conclusions

The current study provided evidence that engaging parents in the intervention was feasible and acceptable approach in supporting both parents and children to establish physically active routines in the family setting. The insights gained regarding the appropriateness and acceptability of the program in this specific context may be used to inform the design, implementation and sustainability of other parent-focused PL programs.

Parent-focused online intervention to promote parents' physical literacy and support children's physical activity: results from a quasi-experimental trial

Background

The development of physical literacy (PL) early in life may influence children's subsequent physical activity (PA) participation and consequent health benefits across the life course. Interventions designed for parents are lacking, but such efforts can potentially enhance the PL of parents and their children’s PA participation. Additionally, there is insufficient evidence to support the feasibility of delivering a PL intervention using an online format. Therefore, the purpose of this study was to examine the feasibility and effectiveness of a parent-focused, theory-driven, online-delivered intervention designed to improve the parents’ PL and children’s PA behaviors.

Methods

A non-randomized trial was conducted to evaluate the effects of the program. 224 Hong Kong families (primary school-aged children and their parents) registered to the program were considered the experimental group and were exposed to an online intervention over three months. Another 220 families in Hong Kong were considered the comparison group and did not receive any intervention. Outcome measures included PA behaviors (daily steps and moderate-to-vigorous PA), parent–child co-activity behaviors, family PA routines, and parent perceived PL. Linear mixed models were used to analyze the differences in terms of changes in measured outcomes between groups over time.

Results

No significant group-by-time effects were found for children’s or parents’ PA behaviors. In terms of the family Co-PA routines, a small positive effect size in favor of the experimental group was found (p = .44, d = 0.2). Group-by-time effects favorable to the experimental group was detected for parent–child co-activity (p < .001, d = 0.7) and parental PL (p < .001, d = 0.9) at post-intervention. The results demonstrated that the intervention was acceptable and that there was potential for scale up.

Conclusions

Findings indicated that the intervention was effective in increasing parent–child co-activity and parent perceived PL. During the pandemic, online intervention delivery was found to be feasible. Using this mode of delivery, the intervention has the potential to reach a wide population in the local context.

Trial registration

The study was prospectively registered at the Chinese Clinical Trial Registry, Registration number: ChiCTR2100041903, Registered 09 January 2021.

Impact of the 'Healthy Youngsters, Healthy Dads' program on physical activity and other health behaviours: a randomised controlled trial involving fathers and their preschool-aged children

Background

Targeting fathers may be a key strategy to increase physical activity among their preschool-aged children, but limited research exists in this area. The primary study aim was to examine the impact of a lifestyle program for fathers and their preschool-aged children on child physical activity levels.

Methods

A total of 125 fathers (aged: 38 ± 5.4 years, BMI: 28.1 ± 4.9 kg/m²) and 125 preschool-aged children (aged: 3.9 ± 0.8 years, BMI z-score: 0.3 ± 0.9, 39.2% girls) recruited from Newcastle, Australia, NSW were randomised to (i) the Healthy Youngsters, Healthy Dads (HYHD) program, or (ii) wait-list control group. The program included two fathers-only workshops (2 h each) and eight father-child weekly educational and practical sessions (75 min each), plus home-based activities targeting family physical activity and nutrition. Assessments took place at baseline, 10-weeks (post-intervention) and 9-months follow-up. The primary outcome was the children’s mean steps/day at 10-weeks. Secondary outcomes included: co-physical activity, fathers’ physical activity levels and parenting practices for physical activity and screen time behaviours, children’s fundamental movement skill (FMS) proficiency, plus accelerometer based light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), screen time and adiposity for fathers and children. Process measures included; attendance, satisfaction, fidelity and retention. Linear mixed models estimated the treatment effect at all time-points for all outcomes.

Results

Intention-to-treat analyses revealed a significant group-by-time effect for steps per day at 10-weeks (+ 1417, 95%CI: 449, 2384) and 9-months follow-up (+ 1480, 95%CI: 493, 2467) in intervention children compared to control. There were also favourable group-by-time effects for numerous secondary outcomes including fathers’ physical activity levels, children’s FMS proficiency, and several parenting constructs. No effects were observed for both fathers’ and children’s accelerometer based LPA or MVPA, co-physical activity, screen-time and adiposity measures. Process evaluation data revealed very high levels of satisfaction, attendance, retention, and intervention fidelity.

Conclusion

Engaging fathers in a lifestyle program is a promising strategy to increase physical activity among preschool-aged children. Additional benefits to fathers’ physical activity levels, children’s FMS proficiency and parenting practices further support the importance of engaging fathers to improve family health outcomes.

Trial Registration

Australian New Zealand Clinical Trials Registry: ACTRN12619000105145. Registered 24/01/2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13424-1.

Effectiveness of a Parent-Focused Intervention Targeting 24-H Movement Behaviors in Preschool-Aged Children: Study Protocol for a Randomized Controlled Trial

Background

Interventions targeting single behaviors of preschool-aged children have been mainstream for some time, but integrated interventions targeting all three 24-h movement behaviors (physical activity [PA], sedentary behavior [SB], and sleep hygiene) are less studied. The aims of this study will be to test the feasibility, acceptability, and effectiveness of a parent-focused intervention for preschool-aged children targeting multiple 24-h movement behaviors.

Methods

This three-arm randomized controlled trial will comprise a 12-week intervention and a 12-week follow-up. A total of 150 parent-child dyads will be recruited and randomly allocated to one of three arms: (1) a PA + SB group (dyadic approach), (2) a PA + SB + sleep group (integrated approach), and (3) a wait-list control group. The theory of planned behavior and behavioral change techniques will guide the development of the intervention via workshops, education materials, interactive questionnaires, and reminders. The intervention strategies for the integrated group will be the same as for the dyadic approach except that the intervention will also target sleep hygiene in addition to PA and SB. The primary outcomes will be preschoolers' 24-h movement behaviors (e.g., activity sleep index, compositional data of PA, SB, screen time, and sleep duration). The secondary outcomes will be preschoolers' sleep quality, weight status, cognitive function, and parents' movement behaviors. The feasibility and acceptability of the intervention will also be evaluated.

Discussion

The proposed study will be a theory-based, parent-focused intervention designed to improve all three 24-h movement behaviors among preschoolers. The trial is expected to improve preschoolers' movement behaviors and health outcomes, as well as their parents' movement behaviors. Given the urgent need to promote active lifestyles, our findings will help to determine best practices for movement behavior change among young children.

Trial Registration

The study is prospectively registered at the Chinese Clinical Trial Registry (ChiCTR2200055958).

Thinking inside the box: The future of young children's physical activity and the home environment

Parrish et al.'s (2021) investigation of caregiver perceptions of preschoolers' physical activity (PA) within the home environment posits important opportunities for public policy to consider space and available opportunities for PA for preschoolers. This study uncovered qualitative themes on preschoolers' PA in the home, referencing the use of indoor and outdoor spaces, adaptations within the home, interplay between space and caregiving, and variability in child's PA. This work sparks a discussion into the current understanding of the home environment for preschooler PA and future research directions. We propose three main areas to bring forward physical activity and public health research, including 1) role of policies and community (e.g., societal norms) on the home environment and child physical activity, 2) reimagination of the home environment beyond the physical components as a complex system, and 3) advanced measurement of child physical activity using modern technology. Merging these new opportunities with past efforts may help design and facilitate healthier PA and movement patterns for preschoolers now and into the future.

Feasibility of the Mothers and Daughters Moving Together Physical Activity Intervention

PURPOSE

Preschool-aged children, especially girls, have low levels of physical activity that may be influenced through parent role modeling. Evidence for mother-daughter interventions that include preschool-aged children is sparse. The primary purpose of this study was to examine the feasibility of recruitment procedures, protocol compliance, and participant retention for the Mothers and Daughters Moving Together intervention. The secondary aim was to provide initial estimates of the intervention effect on mother-daughter and family physical activity co-participation, moderate to vigorous physical activity, and maternal physical activity enjoyment and support.

METHOD

This nonrandomized feasibility study included mother-daughter (2-5 y) dyads who self-selected into the intervention (n = 21 dyads) or comparison (n = 10 dyads) group.

RESULTS

The recruitment rate was 41.9% (31 enrolled/74 interested). Intervention group mother-daughter dyads attended 57% of intervention sessions. Among the whole sample, 70% to 80% of participants (mothers and daughters) had at least 4 valid days of accelerometer data at preintervention and postintervention. The retention rate was 90% (28/31 dyads completed the study). Initial estimates of intervention effect indicated small, positive changes for mother-daughter physical activity co-participation, and maternal physical activity support and enjoyment.

CONCLUSIONS

This study provides valuable information that should be confirmed using an adequately powered and randomized study design.

Pediatric Obesity Prevention and Treatment Among Hispanics: A Systematic Review and Meta-Analysis

INTRODUCTION

The rates of pediatric obesity in the U.S. are highest among Hispanics. There is no existing meta-analysis of the effects of obesity interventions among Hispanic youth. This systematic review and meta-analysis assesses the effects of obesity prevention and treatment interventions on Hispanic youth's weight status and lifestyle behaviors.

METHODS

PubMed, PsycINFO, and Scopus were searched between January 1, 2000 and October 30, 2020. Interventions with ≥50% Hispanic youth aged 0-18 years were included. Using a weighted inverse-variance procedure, fixed-effects and random-effects models were run for an overall effect size on the basis of the Q_total test statistic. Hedges' g was calculated for outcomes of interest between baseline and postintervention separately for studies with multiple versus single conditions. Continuous and categorical moderators were also examined.

RESULTS

A total of 1,103 articles were screened, of which 117 were included in the narrative synthesis and 105 in the meta-analysis (n=49,276 youth). The overall effects for RCT/quasi-experimental studies on BMI status (g= -0.15, SE=0.03, 95% CI= -0.20, -0.10), waist circumference (g= -0.15, SE=0.10, 95% CI= -0.35, -0.05), physical activity (g=0.12, SE=0.05, 95% CI=0.03, 0.22), fruit and vegetable intake (g=0.08, SE=0.02, 95% CI=0.03, 0.12), and sugar-sweetened beverage intake (g= -0.07, SE= 0.03, 95% CI= -0.13, -0.01) were small. Intervention effects varied by participant developmental stage, SES, study setting, and lifestyle behavior target.

DISCUSSION

Beyond developing more impactful interventions to address obesity among Hispanic youth, findings highlight the need for targeted policies and more easily disseminable interventions that can spread small effects across a population for maximal public health impact.

Physical environmental opportunities for active play and physical activity level in preschoolers: a multicriteria analysis

Background

Active play opportunities seems to influence the level of physical activity during childhood. However, a gap remains about which environmental opportunities including the daycare physical environment could have a positive impact on the level of physical activity in preschoolers.

Objectives

(1) To develop an index to measure the environmental opportunities of free active play for preschoolers of middle-income countries; (2) to check the relationship and contribution of the index to explain objectively the level of physical activity.

Methods

A quantitative, cross-sectional, exploratory study with 51 preschool children. The established criteria for the index according to the literature were: (1) Outdoor time on typical days of the week. (2) Outdoor time on a typical weekend day. (3) The presence of internal space and external environment in the child’s home that allows playing. (4) Presence of patio with space for games at the school. (5) Presence of a playground with a toy at the school. We applied multi-attribute utility theory for the determination of the multicriteria index of physical environmental opportunities. Pearson’s correlation analysis and simple linear regression were used to verify the association between the index and the physical activity level.

Results

The index showed a positive correlation with the level of physical activity, e.g., the average time of MVPA (r = 0.408, p = 0.003). The univariate linear regression demonstrated that the quality of physical environmental opportunities for physical activity explained 20% of the preschooler’s classification as active and 16% of the time in moderate to vigorous physical activity (p < 0.001).

Conclusion

Physical environmental opportunities for active play have a positive effect on physical activity in preschoolers and should be encouraged in different social segments.

Interventions to Improve Child Physical Activity in the Early Childhood Education and Care Setting: An Umbrella Review

Early childhood education and care (ECEC) services are a key setting to support improvements in the physical activity of young children. This umbrella review gathered and synthesised systematic review evidence of the effectiveness of interventions in the ECEC setting on the physical activity levels of children aged 0-6. We also mapped the current evidence to the existing ECEC sector-specific physical activity practice recommendations. Five electronic databases were searched to identify systematic reviews that evaluated the impact of any ECEC-based interventions on the physical activity levels (e.g., moderate-to-vigorous physical activity, total physical activity) of children aged 0-6. One reviewer extracted data on intervention effectiveness and quality of the reviews, checked by a second reviewer. Ten reviews were included. Overall, the majority of the reviews found interventions delivered in ECEC improved child physical activity. Across reviews, the impact of six intervention strategies were identified, mapped to four (of eight) broad recommendations (i.e., providing opportunity, offering educator training, educators promoting the benefits of physical activity, creating a physical activity-promoting environment). The impact of the majority of recommendations, however, did not have systematic review evidence. Further investigation of the effectiveness of ECEC-based physical activity strategies is required to demonstrate support for the existing recommended practices.

Strategies to promote health behaviors in parents with small children-A systematic review and realist synthesis of behavioral interventions

In this systematic review and realist synthesis, we aimed to identify strategies to improve dietary and physical activity behaviors for parents with small children. A systematic literature search was conducted in MEDLINE, Embase, CINAHL, and PsycINFO in July 2021. Included studies had to: (i) target one or both parents with at least one child (0-3 years), (ii) aim to improve diet and physical activity, and (iii) report on diet and physical activity outcomes. Intervention context, delivery, and outcomes were extracted, and behavior change techniques were coded. A program theory was developed, and context-mechanism-outcome configurations were identified. In total, 17 interventions reported in 28 studies (19 effectiveness studies; nine protocols) were included. Nine interventions showed small improvements: in diet (n = 5), physical activity (n = 2), or both (n = 2) in mothers. The realist synthesis revealed three strategies to improve health behaviors: (1) using knowledge and role modelling to improve family dynamics, (2) providing various home-based activities to change home environment, and (3) offering flexible delivery, for example, phone or website-based to increase social support. Future interventions for parents with small children should consider involving the whole family, focusing on home-based and practical components, and offering various delivery modes. The protocol for the systematic review and realist synthesis was registered in Research Registry (registration ID: reviewregistry860) March 30th, 2020.

Preventing Childhood Obesity in Primary Schools: A Realist Review from UK Perspective

Childhood obesity is a global public health concern. While evidence from a recent comprehensive Cochrane review indicates school-based interventions can prevent obesity, we still do not know how or for whom these work best. We aimed to identify the contextual and mechanistic factors associated with obesity prevention interventions implementable in primary schools. A realist synthesis following the Realist And Meta-narrative Evidence Syntheses-Evolving Standards (RAMESES) guidance was with eligible studies from the 2019 Cochrane review on interventions in primary schools. The initial programme theory was developed through expert consensus and stakeholder input and refined with data from included studies to produce a final programme theory including all of the context-mechanism-outcome configurations. We included 24 studies (71 documents) in our synthesis. We found that baseline standardised body mass index (BMIz) affects intervention mechanisms variably as a contextual factor. Girls, older children and those with higher parental education consistently benefitted more from school-based interventions. The key mechanisms associated with beneficial effect were sufficient intervention dose, environmental modification and the intervention components working together as a whole. Education alone was not associated with favourable outcomes. Future interventions should go beyond education and incorporate a sufficient dose to trigger change in BMIz. Contextual factors deserve consideration when commissioning interventions to avoid widening health inequalities.

Cooperative planning in childcare centers to improve physical activity: a qualitative investigation of directors' perspectives

Interventions to promote physical activity (PA) in childcare centers have been shown to increase children’s PA levels; moreover, a growing number of evidence-based best practice guidelines exist for this setting. However, there is a lack of knowledge on the facilitators of and barriers to the successful implementation of PA guidelines and interventions. We used Cooperative Planning to improve capabilities for PA in childcare centers. This qualitative study aimed to explore childcare center directors’ views on the Cooperative Planning process and identify the facilitators of and barriers to its implementation. We conducted guided semi-structured interviews with the directors of nine childcare centers after completion of the 12-month Cooperative Planning process. The interviews were recorded, transcribed and analyzed using qualitative content analysis with inductive category development. Facilitators and barriers were systematized according to the Consolidated Framework for Implementation Research (CFIR). Cooperative Planning was regarded as being helpful for structuring the process and involving all team members. Several facilitators within the CFIR domains inner setting (structural characteristics, networks and communications, implementation climate), outer setting (support from parents and provider), characteristics of individuals (intrinsic motivation of the staff) and process (individual drivers) were identified. The reported barriers included structural characteristics (e.g. lack of time), networks and communications (e.g. team conflicts) and characteristics of individuals (e.g. lack of willingness to accept change). Several contextual and interpersonal factors seem to influence the extent to which a Cooperative Planning process can be implemented by a childcare center’s team. Future research is needed to evaluate the strategies needed to overcome the identified barriers.

A peer coach intervention in childcare centres enhances early childhood physical activity: The Active Early Learning (AEL) cluster randomised controlled trial

Background

As numbers of children and time spent in childcare centres increase, so does the potential influence of these centres on early childhood physical activity (PA). However, previous reports indicate little success of interventions aimed at improving PA. The Active Early Learning (AEL) program is a multi-component pragmatic intervention designed to imbed PA into the daily curriculum. Delivered by childcare centre staff, it is directed and supported by a peer coach who works across a network of centres. The objective of the study is to investigate the effect of the AEL program on children’s PA.

Methods

Fifteen childcare centres (8 intervention, 7 control centres; 314 children, 180 boys, 4.3y ± 0.4) participated in a 22-week stratified cluster randomised controlled trial. To be eligible to participate, centres needed to have ≥15 preschool children aged 3 to 5-years. The primary outcome was PA measured by accelerometer (Actigraph GT3X) during childcare centre hours over a 3-day period, calculated in min/h of Total PA and moderate-to-vigorous PA (MVPA). The effect of the intervention was evaluated using linear mixed models adjusted for age, sex, accelerometer wear time and centre clustering.

Results

There was an intervention effect for Total PA (+ 4.06 min/h, 95% CI [2.66 to 5.47], p < .001) and MVPA (+ 2.33 min/h, 95% CI [1.31 to 3.34] p < .001). On average, a child taking part in the intervention attending a childcare centre from 8 am to 3 pm performed 28 min more Total PA and 16 min more MVPA per day than children receiving usual practice care.

Conclusion

In contrast with the findings of previous pragmatic trials in early childcare centres, this study shows that a peer-coach facilitated program, focussed on integrating PA into the daily childcare routine, can elicit increases in preschool children’s PA of practical as well as statistical significance.

Trial registration

Australian New Zealand Clinical Trials registry: ACTRN12619000638134. Registered 30/04/2019.

Response to 'Systematic reviews do not always capture context of real-world intervention programmes for childhood obesity' by Wild et al., 2021 in BMC Public Health

In a correspondence to BMC Public Health, Wild et al. respond to our systematic review that synthesised results of interventions to prevent or treat childhood obesity in Māori and Pacific Islanders. Our review included the Whānau Pakari study as one of six included studies – a multidisciplinary intervention for Māori children and adolescents living with obesity led by their research team. Our review suggested that future research can incorporate stronger co-design principles when designing culturally-tailored interventions to maximise cultural specificity, enhance engagement, facilitate program ownership and contribute to improved health and weight-related outcomes. We commend Whānau Pakari and the team of Wild et al. on their sustained commitment to addressing obesity in priority populations and agree that systematic reviews struggle to capture real-world context of interventions for complex diseases such as obesity. In this article, we respond sequentially to the comments made by Wild et al. and (1) clarify the scope of our review article (2) reiterate our commendation of mixed-methods approaches that capture real-world context (3) explain a referencing error that caused a misinterpretation of our results (4) clarify our interpretation of some Whānau Pakari characteristics (5) welcome partnership to facilitate shared learning with Wild et al.

Effects of a teacher training program to promote physically active play among preschoolers with autism spectrum disorders

Wellness Enhancing Physical Activity for Young Children (WE PLAY) is an intervention intended to promote physical activity (PA) among typically-developing preschool children in child care settings. It was adapted for use by teachers who educate children with Autism Spectrum Disorders (ASD). This study used a multiple baseline design across participants to evaluate the impact of WE PLAY-Autism on teachers' PA facilitating behaviors and on the PA levels of children with ASD. Visual analysis and effect size estimates indicated that two of the three teachers increased their PA facilitating behavior, although this was insufficient to demonstrate a functional relation. Children's (n = 5) PA was measured daily during school hours using accelerometry. Visual analysis, which was further supported by effect size calculations, indicated higher average levels of moderate-to-vigorous PA (MVPA) among preschoolers with ASD in the intervention phase (Tau-U_{A vs. B} = 0.53, p < .001, Hedges' g = 0.99, 95% CI [0.56, 1.43]) and post-training phase (Tau-U_{A vs. B} = 0.55, p < .001, Hedges' g = 1.17, 95% CI [0.73, 1.60]) in comparison to the baseline phase. WE PLAY-Autism is an intervention deserving of further investigation given its meaningful impact on the MVPA of preschoolers with ASD paired with its potential for broad implementation in preschools.

Children's physical activity level and sedentary behaviour in Norwegian early childhood education and care: effects of a staff-led cluster-randomised controlled trial

BACKGROUND

A growing body of evidence suggest that the children's physical activity (PA) level in early childhood education and care (ECEC) settings are insufficient. Since most children attend ECEC settings for many hours on most days of the week, and these institutions reach children across the socioeconomic spectrum, the ECEC settings may serve as an ideal avenue for increasing physical activity level, reduce sedentary time and enhance the overall health of young children. This paper investigates the effectiveness of the "Active Kindergarten - Active Children" study to increase children's PA level and reduce sedentary time within the ECEC setting.

METHODS

Accelerometers were used to asses PA and sedentary time. A total of 116 three to four-year olds took part in a randomised controlled trial in 11 ECEC settings. Participants were cluster-randomised, by ECEC setting, to either a 12 week staff-led and expert-supported intervention or a waiting list control group.

RESULTS

The intervention group increased time spent in moderate- and vigorous intensity PA by 10 min/day (95% CI = 3, 18; P = 0.01), took 1909 more steps per day (95% CI = 1130, 2688; P < 0.01) and reduced sedentary time with 14 min/day (95% CI = - 27, - 1; P = 0.04) compared to the control group. The intervention group had a 2.4 higher odds (95% CI = 1.05, 5.7; P = 0.04) of meeting the PA recommendations compared to the control group at follow-up.

CONCLUSIONS

Our results show that a flexible staff-led and expert-supported multicomponent PA intervention can increase total PA level, moderate- and vigorous intensity PA and reduce time spent sedentary in three to four-year old children during their stay in ECEC settings.

TRIAL REGISTRATION

The trial was retrospectively registered on September 19, 2020 and available online at ClinicalTrials.gov: No. NCT04555746 .

Content development for a physical activity and sedentary behaviour e-learning module for early childhood education students: a Delphi study

Background

Early childhood educators play a prominent role in promoting healthy activity behaviours in childcare. However, they have expressed that they lack the appropriate pre-service training to confidently lead physical activity (PA), and minimize sedentary behaviour (SB), in childcare. As such, the purpose of this Delphi study was to generate and reach agreement on content areas for inclusion in a PA and SB e-Learning module for Early Childhood Education (ECE) students.

Methods

Purposeful sampling of Canadian/international researchers was used to form two expert panels: a PA/SB expert panel (n = 26), and a Canadian ECE panel (n = 35). The PA/SB experts suggested their top 12 PA/SB topics for the module via online survey. These topics were then pooled to generate a list of 19 content areas. In a second online survey, both panels of experts rated the importance of each content area (0 = unimportant to 5 = very important). Mean ratings (M) were ranked separately for each panel, and then ratings were pooled to create an overall ranking of the 19 content areas. Inter-panel agreement of importance rankings was visually represented as a scatterplot and quantified using Spearman’s rho (r_s).

Results

The top-rated content area was Outdoor Play (M = 4.77 ± 0.64), followed by Benefits of PA in the Early Years (M = 4.75 ± 0.66), and Factors Influencing PA and SB in Childcare (M = 4.71 ± .74). Monitor PA and Sedentary Time Within Your Classroom had the lowest combined score (M = 3.77 ± 1.44). There was moderate-to strong inter-panel agreement for content area importance rankings (r_s = 0.60, 95% CI: 0.20 to 0.83). The majority of the ECE expert panel considered this training important for ECE students (94.3%), aligning with ECE curriculum objectives (91.4%) and accreditation standards (78.8%), and complementary to the present ECE curriculum (88.6%).

Conclusions

Providing PA and SB training to ECE students is a proactive way to ensure healthy movement behaviours are prioritized in childcare programming. With the PA/SB expert-developed content areas, and endorsement by the ECE expert panel, implementing this training within ECE programs is a necessary next step.

Supplementary information

Supplementary information accompanies this paper at 10.1186/s12889-020-09670-w.

Effects of a Nine-Month Physical Activity Intervention on Morphological Characteristics and Motor and Cognitive Skills of Preschool Children

(1) Background: Regular physical activity (PA) plays an important role during early childhood physical and psychological development. This study investigates the effects of a 9-month PA intervention on physiological characteristics and motor and cognitive skills in preschool children. (2) Methods: Preschool children (n = 132; age 4 to 7 years) attending regular preschool programs were nonrandomly assigned to PA intervention (n = 66; 60 min sessions twice per week) or a control group (n = 66; no additional organized PA program) for 9 months. Exercise training for the intervention group included various sports games, outdoor activities, martial arts, yoga, and dance. Anthropometry, motor skills (7 tests), and cognitive skills (Raven’s Colored Progressive Matrices and Cognitive Assessment System) were assessed before and after an intervention period in both groups. Data were analyzed using repeated-measures ANOVA. (3) Results: Body weight significantly increased in both groups over time. Compared to the changes observed in the control group, the intervention group significantly increased in chest circumference (p = 0.022). In contrast, the control group demonstrated an increase in waist circumference (p = 0.001), while these measures in the intervention group remained stable. Participants in the intervention group improved running speed (p = 0.016) and standing broad jump (p = 0.000). The flexibility level was maintained in the intervention group, while a significant decrease was observed in the control group (p = 0.010). Children from the intervention group demonstrated progress in the bent-arm hang test (p = 0.001), unlike the control group subjects. Varied improvements in cognitive skills were observed for different variables in both intervention and control groups, with no robust evidence for PA-intervention-related improvements. (4) Conclusions: Preschool children’s participation in a preschool PA intervention improves their motor skills.

Impact of "JolinchenKids-Fit and Healthy in Daycare" on Children's Objectively Measured Physical Activity: A Cluster-Controlled Study

BACKGROUND

To evaluate a multicomponent health promotion program targeting preschoolers' physical activity (PA).

METHODS

PA of children from 23 German daycare facilities (DFs; 13 intervention DFs, 10 control DFs) was measured via accelerometry at baseline and after 12 months. Children's sedentary time, light PA, and moderate to vigorous PA were estimated. Adherence was tracked with paper-and-pencil calendars. Mixed-model regression analyses were used to assess intervention effects.

RESULTS

PA data were analyzed from 183 (4.2 [0.8] y, 48.1% boys) children. At follow-up, children in DF groups with more than 50% adherence to PA intervention components showed an increase of 9 minutes of moderate to vigorous PA per day (β = 9.28; 95% confidence interval [CI], -0.16 to 18.72) and a 19-minute decrease in sedentary time (β = -19.25; 95% CI, -43.66 to 5.16) compared with the control group, whereas children's PA of those who were exposed to no or less than 50% adherence remained unchanged (moderate to vigorous PA: β = 0.34; 95% CI, -13.73 to 14.41; sedentary time: β = 1.78; 95% CI, -26.54 to 30.09). Notable effects were found in children with migration background.

CONCLUSIONS

Only small benefits in PA outcomes were observed after 1 year. A minimum of 50% adherence to the intervention seems to be crucial for facilitating intervention effects.

Prevention of Childhood Obesity: A Position Paper of the Global Federation of International Societies of Paediatric Gastroenterology, Hepatology and Nutrition (FISPGHAN)

Global childhood obesity increased more than 8-fold over 40 years, inducing a very large personal, societal, and economic burden. Effects of available treatments are less than satisfactory; therefore, effective prevention is of high priority. In this narrative review, we explore preventive opportunities. The available evidence indicates large benefits of improving nutrition and lifestyle during early life, such as promoting breast-feeding and improving the quality of infant and early childhood feeding. Promoting healthy eating patterns and limiting sugar-containing beverage consumption from early childhood onwards are of great benefit. Regular physical activity and limited sedentary lifestyle and screen time alone have limited effects but are valuable elements in effective multicomponent strategies. The home environment is important, particularly for young children, and can be improved by educating and empowering families. School- and community-based interventions can be effective, such as installing water fountains, improving cafeteria menus, and facilitating regular physical activity. Reducing obesogenic risk factors through societal standards is essential for effective prevention and limiting socioeconomic disparity; these may comprise food, drink, and physical activity standards for day cares and schools, general food quality standards, front-of-pack food labeling, taxation of unhealthy foods, restriction of food advertisements to children, and others. Effective prevention of childhood obesity is not achieved by single interventions but by integrated multicomponent approaches involving multiple stakeholders that address children, families, and societal standards. Pediatricians and their organizations should be proactive in supporting and empowering families to support their children's health, and in promoting societal measures that protect children.

Co-participation in physical activity: perspectives from Australian parents of pre-schoolers

Co-participation in physical activity may be important for helping families with young children meet physical activity recommendations. Yet, little is known about what families perceive to be the benefits, barriers and facilitators of co-participation. This study explored (i) parents’ perceptions about physical activity and possible benefits of family-based co-participation in physical activity, (ii) their perceived facilitators and barriers to co-participation and (iii) their recommendations for improving co-participation within their community. Fifteen parents (14 mothers, 1 father) of 2- to 4-year-old children residing in Western Sydney, Australia, participated in one-on-one interviews between September 2016 and January 2017. Interviews were audio-recorded and transcribed verbatim. Four main themes and seven sub-themes emerged from the thematic analysis of the interview data. When parents were asked to reflect on their understanding of physical activity, they discussed a range of well-known activities (e.g. active play, active transport) and also reported ‘anything but screen time’. The major benefits parents reported about co-participation were spending quality time together, improving children’s general health and well-being and the development of physical skills. Social (e.g. social networks, negative stereotypes) and environmental (e.g. home space, neighbourhood design, shading) facilitators and barriers were identified, yet their impact on co-participation often varied depending on the presence (or lack thereof) of other factors in the physical or social environment. Key recommendations suggested by parents included improvements to home outdoor spaces, neighbourhood design and play spaces and community services.

"AMPE" Exercise Programme Has Positive Effects on Anthropometric and Physiological Parameters of School Children: A Pilot Study

Background

Projection of the effectiveness of house-hold physical activity may be a vital tool to improve active lifestyle. Although ampe is a common house-hold recreational physical activity among all population groups especially school children in Ghana, no empirical evidence of its effects on the anthropometric and physiological parameters of the children. This pilot study examined the effect of ampe exercise programme on the anthropometric and physiological parameters of school children.

Methods

Purposive and stratified sampling techniques were applied to recruit 78 school children (ages of 9 to 12, mean age of 10.65±0.94 years). The participants attended 40 minutes of ampe exercise program three times per week, for four weeks consecutively. Body mass index, waist circumference, hip circumference, waist-to-hip ratio; % body fat, diastolic blood pressure, systolic blood pressure and heart rate were measured prepost training.

Results

Ampe exercise programme produced positive effects on all parameters. Body weight (0.31%) and body mass index (0.58%) decreased significantly (P<0.05). Systolic blood pressure (3.15%), diastolic blood pressure (1.92%) and heart rate (2.13) significantly improved (P<0.05). CONCLUSION: Ampe exercise programme is effective as paediatric obesity house-hold intervention to provide the impetus for active lifestyles of school children.

Clusters of diet, physical activity, television exposure and sleep habits and their association with adiposity in preschool children: the EDEN mother-child cohort

Background

Despite the growing interest in the relation between adiposity in children and different lifestyle clusters, few studies used a longitudinal design to examine a large range of behaviors in various contexts, in particular eating- and sleep-related routines, and few studies have examined these factors in young children. The objectives of this study were to identify clusters of boys and girls based on diet, sleep and activity-related behaviors and their family environment at 2 and 5 years of age, and to assess whether the clusters identified varied across maternal education levels and were associated with body fat at age 5.

Methods

At 2 and 5 years, respectively, 1436 and 1195 parents from the EDEN mother-child cohort completed a questionnaire including behavioral data. A latent class analysis aimed to uncover gender-specific behavioral clusters. Body fat percentage was estimated by anthropometric and bioelectrical impedance measurements. Association between cluster membership and body fat was assessed with mutivariable linear regression models.

Results

At 2 years, two clusters emerged that were essentially characterized by opposite eating habits. At 5 years, TV exposure was the most distinguishing feature, but the numbers and types of clusters differed by gender. An association between cluster membership and body fat was found only in girls at 5 years of age, with girls in the cluster defined by very high TV exposure and unfavorable mealtime habits (despite high outdoor playing and walking time) having the highest body fat. Girls whose mother had low educational attainment were more likely to be in this high-risk cluster. Girls who were on a cluster evolution path corresponding to the highest TV viewing time and the least favorable mealtime habits from 2 to 5 years of age had higher body fat at 5 years.

Conclusions

Efforts to decrease TV time and improve mealtime routines may hold promise for preventing overweight in young children, especially girls growing up in disadvantaged families. These preventive efforts should start as early in life as possible, ideally before the age of two, and should be sustained over the preschool years.

Intervention Strategies to Elicit MVPA in Preschoolers during Outdoor Play

Approximately 50% of preschoolers do not meet physical activity recommendations and children who reside in low-income rural communities may be further at risk for higher levels of sedentary behavior. Outdoor play is essential for preschool children; however, literature is unclear as to which types of interventions elicit moderate-to-vigorous physical activity (MVPA) for all preschoolers. The aim of this study was to determine which type of intervention, physical activity or fundamental motor skill focus, elicits MVPA during outdoor play. Ninety-eight preschool children (M age = 4.48 years) from one Head Start center participated in an outdoor play intervention two days per week for 7 weeks. Classes were randomly assigned to one of four groups: fundamental motor skill focus (FMS), physical activity focus (PA), FMS and PA (FMS + PA), and control. An accelerometer worn on the hip measured MVPA. Results showed that age, sex and group assignment contributed to MVPA at the beginning of the intervention and age, sex, group assignment and MVPA during the beginning of the intervention contributed to MVPA at the end of the intervention. Overall, the FMS + PA group elicited MVPA from males and females of all ages. Interventions that combine both FMS and PA may reduce physical activity disparities in preschool children.

Supporting healthy lifestyle behaviours in families attending community playgroups: parents' perceptions of facilitators and barriers

BACKGROUND

Establishing healthy nutrition, activity, and sleep behaviours early in life is a key strategy in childhood obesity prevention. Parents are the primary influence on the development and establishment of obesity-related behaviours in young children. There is evidence that autonomy supporting parenting practices are crucial for the development of self-regulation and the internalisation of healthy behaviours in children. It is therefore imperative that parenting practices are targeted as part of an obesity prevention intervention. However, there is limited understanding of barriers and facilitators to parents using autonomy supporting parenting practices with their children aged 0-5 years. Therefore, the aim of the study was to identify barriers and facilitators to using autonomy supporting parenting practices. A secondary aim was to determine parent preferences in respect to an intervention program to be delivered in community playgroups.

METHODS

Parents were recruited through Playgroup Queensland (PGQ), a not-for-profit organisation in Brisbane, Australia, to attend a focus group during their usual playgroup session. The focus group interview guide was designed to promote discussion among the participants in respect to their shared experiences as parents of young children. The focus group transcripts were coded and analysed using qualitative content analysis. Five focus groups with parents (n = 30) were conducted in May 2018. Most of the participants were mothers [1], and the majority (76%) had a child at playgroup aged between 2 and 4 years.

RESULTS

The support and guidance received from other parents at playgroup was a facilitator to autonomy supporting parenting practices. Barriers included beliefs around the need to use rewards to encourage child eating, beliefs around the need for screens as babysitters, and feeling disempowered to change sleep behaviours. Parents were enthusiastic about a potential program that would leverage off the existing playgroup support networks, but they did not want to be "educated", or to lose their "playgroup time" to an intervention. Rather they wanted strategies and support to deal with the frustrations of food, screen and sleep parenting.

CONCLUSION

These results will be used to inform the development of a childhood obesity prevention intervention to be delivered in a community playgroup setting.

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

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

Analysis of infant physical activity in the childcare environment: An observational study

This study utilized behavior-mapping to describe behavior and levels of activity in infants attending Early Childhood Education and Care (ECEC). Descriptive statistics were used to determine proportion of time spent in certain locations, body positions, activities and engagement with others. To establish whether location, the presence of equipment or engagement with others influenced levels of activity, a paired t-test was used. Results indicated that of all locations, infants spent the greatest amount of time in the meals area (35%), with half of this period spent physically inactive (sedentary). The indoor play area was where infants were most active. Infants also spent a significantly greater proportion of their upright time (64%) supported by either furniture or equipment than without (MD 28, 95% CI 13-44, p < 0.01). Interestingly, infants displayed more sedentary behavior when engaged with others than when not engaged (MD 21, 95% CI 6-36, p < 0.01). The environment, presence of others and equipment availability appear to influence activity levels of infants in ECEC centers. Findings suggest that time spent in meal areas, provisions of furniture/equipment, and opportunities for infants to play independently warrant further exploration to determine their influence on activity levels in typically-developing infants.