Means of Optimizing Physical Activity in the Preschool Environment

Systematic review of educator behaviours associated with physical activity of early years children

BACKGROUND

Educators in early years settings influence children's physical activity (PA) levels through their pedagogical choices and behaviours. To date, minimal research has been conducted on the relationship between educator action and children's PA levels. The purpose of this systematic review was to understand which educator behaviours and actions in early years settings have been shown to engage children in PA.

METHODS

Five online databases (Academic Search Complete, ERIC, SPORTDiscus, CINAHL Complete and PubMed) were searched for articles that showed an association between educator behaviour and the PA level of children between the ages of zero and eight.

RESULTS

Eleven studies met all inclusion criteria, yet showed great variability in design and data collection methods. The risk of bias was assessed using previously published criteria adapted to this study and inline with the CONSORT statement. A binomial test on the data revealed a statistically significant deviation from chance expectation (p < .001) in relation to educator action influencing child PA. Ten of the studies focussed on educator PA, four studies highlighted the use of prompting and encouragement, three studies analysed broad statements of adult interaction, two studies called for planning activity sessions and discussions and two studies encouraged role modelling. The low number of studies included in the review and the high risk of bias indicates that caution with these results is needed.

CONCLUSIONS

While this review highlights the importance of educator PA (and other behaviours that had a positive association) on child PA level, it underscores the need for high-quality research to examine the relationship between educator actions and child PA. (PROSPERO registration: CRD42022338819).

Healthy Life Habits in Caregivers of Children in Vulnerable Populations: A Cluster Analysis

Intervention programs aimed at mitigating the effects of chronic noncommunicable disease (CNDs) focus on promoting healthy lifestyle habits (HLH), especially in the early stages of life. Because of this, different typologies of caregivers have been identified according to HLH during middle childhood and adolescence. However, the available studies have focused on aspects such as nutrition, physical activity, and rest, ignoring other HLHs that are equally important for children's well-being. Likewise, few studies address HLH during the first five years of life and how caregivers affect children's health. In a sample of 544 caregivers of children aged zero to five years from low-income Colombian communities, we established a typology of attitudes toward different HLHs. The results indicate the presence of three clusters that grouped caregivers with (1) positive attitudes toward all HLHs, (2) toward some HLHs, and (3) relatively low positive attitudes toward all HLHs. Membership in clusters with less positive attitudes toward HLHs was also found to be associated with low educational levels and living in rural areas. This study detected profiles of caregivers who may have unhealthy lifestyles, so the results would allow social workers to design differential interventions on HLHs in non-industrialized countries.

Gardening in Childcare Centers: A Randomized Controlled Trial Examining the Effects of a Garden Intervention on Physical Activity among Children Aged 3-5 Years in North Carolina

This study examined the effects of a childcare gardening intervention on children's physical activity (PA). Eligible childcare centers were randomly assigned to: (1) garden intervention (n = 5; year 1); (2) waitlist control (n = 5; control year 1, intervention year 2); or (3) control (n = 5; year 2 only) groups. Across the two-year study, PA was measured for 3 days at four data collection periods using Actigraph GT3X+ accelerometers. The intervention comprised 6 raised fruit and vegetable garden beds and a gardening guide with age-appropriate learning activities. The sample included a total of 321 3-5-year-olds enrolled in childcare centers in Wake County, North Carolina, with n = 293 possessing PA data for at least one time point. The analyses employed repeated measures linear mixed models (SAS v 9.4 PROC MIXED), accounting for clustering of the children within the center and relevant covariates (e.g., cohort, weather, outside days, accelerometer wear). A significant intervention effect was found for MVPA (p < 0.0001) and SED minutes (p = 0.0004), with children at intervention centers acquiring approximately 6 min more MVPA and 14 min less sedentary time each day. The effects were moderated by sex and age, with a stronger impact for boys and the youngest children. The results suggest that childcare gardening has potential as a PA intervention.

Factors Associated with Motor Competence in Preschoolers from a Brazilian Urban Area

Background

Preschool is a crucial period for developing motor skills.

Objective

This study evaluated factors associated with motor competence in preschoolers from a Brazilian urban area.

Methods

A total of 211 preschoolers (51.2% girls and 48.8% boys) were evaluated. Body mass index was calculated; the Brazilian Economic Research Criterion, the Mini-Mental Scale (MMC) and the Early Childhood Environment Rating Scale®, Revised (ECERS-R™) were applied; the Habitual Physical Activity time was recorded; the Test of Gross Motor Development (TGMD-2) was performed. Univariate analysis was performed using simple linear regression for the independent variables, considering the motor test subscales as dependent variables. Variables with p < 0.20 in the univariate analysis were considered for the multiple linear regression model and were entered into the stepwise method.

Results

The independent variables remaining in the Standard Score Locomotor model were BMI, presence of park at school, and MMC (R2 = 0.16). The independent variables remaining in the Standard Object Control score were MMC and gender (R2 = 0.03). The variables associated with the highest scores of Gross Motor Quotient were MMC, body mass index, and presence of a park at school, respectively (R2 = 0.11).

Conclusion

Male eutrophic preschoolers who are physically active and attend schools with parks or courtyards in a Brazilian urban area have the highest scores for global cognitive function and motor competence.

Increasing Children's physical Activity by Policy (CAP) in preschools within the Stockholm region: study protocol for a pragmatic cluster-randomized controlled trial

Background

Systematic reviews suggest that preschool environmental/organizational changes may be effective in increasing physical activity (PA) levels of preschool children, but evidence is scarce regarding feasible, effective, and equitable interventions that can be scaled up. Specifically, it is essential to understand whether introducing a multicomponent organizational change in terms of policy in the preschool context may be beneficial for children’s PA levels and concomitant health outcomes. To bridge this knowledge gap, our main aim is to examine the feasibility and effectiveness of a policy package in increasing PA levels in preschool children, using a large-scale pragmatic cluster-randomized controlled trial.

Methods

This proposed study is a pragmatic cluster-randomized controlled trial with two conditions (intervention and control with a 1:1 ratio) with preschools as clusters and the unit of randomization. We aim to recruit approximately 4000 3–5-year-old children from 90 preschools and retain more than 2800 children from 85 preschools to provide adequate statistical power for the analyses. The intervention to implement is a co-created, multicomponent policy package running for 6 months in preschools randomized to intervention. Change in accelerometer measured PA levels in children between intervention and control from pre- and post-intervention will be the primary outcome of the study, while secondary outcomes include health outcomes such as musculoskeletal fitness, psychosocial functioning, and absence due to illness in children among others. Implementation will be studied carefully using both quantitative (dose, fidelity) and qualitative (interview) methodologies. The change in primary and secondary outcomes, from pre- to post-intervention, will be analyzed with linear mixed-effect models (to allow both fixed and random effects) nested on a preschool level.

Discussion

This is a large-scale co-creation project involving the City of Stockholm, childcare stakeholders, preschool staff, and the research group with the potential to influence more than 30,000 preschool children within the Stockholm area. The study will add reliable evidence for the implementation of PA policies at the organizational level of preschools and clarify its potential effect on objectively measured PA and health markers in children.

Trial registration

ClinicalTrials.govNCT04569578. Prospectively registered on September 20, 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-022-06513-4.

Examining the state, quality and strength of the evidence in the research on built environments and physical activity among children and youth: An overview of reviews from high income countries

BACKGROUND

Built environments have shown to be associated with health, with physical activity (PA) considered one of the critical pathways for achieving benefits. Navigating available evidence on the built environment and PA is challenging given the number of reviews.

OBJECTIVE

Examine the current state and quality of research looking at associations between built environments and total PA and domains of PA (i.e., leisure/recreation, transportation, school) among children and youth (1-18 years).

METHODS

We systematically searched the grey literature and six bibliographic databases from January 2000 to May 2020. Review quality was assessed using the AMSTAR2. Results by age group were synthesized using narrative syntheses and harvest plots, and certainty of the evidence was assessed using a modified GRADE approach.

RESULTS

This overview included 65 reviews. Most reviews were of very low-to-low quality. High certainty was found for positive associations between transportation PA and walking/cycling/active transportation (AT) infrastructure. There was high certainty for positive associations between streets/play streets and total PA, alongside lower certainty for transportation and leisure PA. Very low-to-moderate certainty supports schoolyards designed to promote PA were positively associated with total PA, but mixed for school PA (except children). Less consistent positive associations were found for forests/trees, greenspace/open space, recreation facilities, street lighting, traffic safety, population/residential density, proximity/access to destinations, neighbourhood characteristics, and home environments. There is very low-to-moderate certainty for negative associations between greater distance to school and traffic volume and domains of PA. Generally, null or mixed associations were observed for aesthetics, parks, AT comfort infrastructure, land-use mix, street connectivity, urban/rural status, and public transit.

DISCUSSION

There remains a need for high quality systematic reviews and studies to evaluate the effects of environmental changes across the pediatric age spectrum and using a PA domain approach. Given the global physical inactivity crisis the built environment remains and important means to promote PA among children/youth.

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.

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

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

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.

Physical Activity During Early Childhood: The Importance of Parental Modeling

Increasing physical activity (PA) is a critical issue in improving overall health. Prior attempts by public health campaigns to promote PA through health-focused messaging have faced challenges. As PA and sedentary behaviors are developed during the early childhood period (ages 0 to 5 years), this stage represents a unique opportunity for clinicians to encourage activity at the family level. Clinicians should discuss the holistic benefits of PA, including the development of social skills and relationships, motor skills that could be applicable to sports later in life, and cognitive skills that could translate to academic achievements in school. For PA to occur in children, parents should also be engaged in and model the PA behaviors, increasing the likelihood of young children learning to be physically active.

Exploring the Feasibility and Effectiveness of a Childcare PhysicaL ActivitY (PLAY) Policy: Rationale and Protocol for a Pilot, Cluster-Randomized Controlled Trial

Background: Young children are prone to low levels of physical activity in childcare. This environment, inclusive of equipment, policies, and staff, has been identified as influencing young children's activity behaviours. To date, no study has examined the feasibility and effectiveness of such policies in Canadian childcare centres, while the provision of physical activity policies in other countries has shown some promise for improving the activity levels of young children. As such, the primary objective of the Childcare PhysicaL ActivitY (PLAY) Policy study is to examine the feasibility of an evidence-based, stakeholder-informed, written physical activity and sedentary time policy for centre-based childcare (i.e., at the institutional level). The secondary objectives are to examine the impact of policy implementation on the physical activity levels and sedentary time of young children, subsequent environmental changes in childcare centres, and childcare providers' self-efficacy to implement a physical activity policy. This study will examine both policy implementation and individual (behavioural) outcomes. Methods/Design: The Childcare PLAY Policy study, a pilot, cluster-randomized controlled trial, involves the random allocation of childcare centres to either the experimental (n = 4) or control (n = 4) group. Childcare centres in the experimental group will adopt a written physical activity policy for eight weeks (at which time they will be asked to stop enforcing the policy). Physical activity levels and sedentary time in childcare will be assessed via ActiGraph™ accelerometers with measurements at baseline (i.e., week 0), mid-intervention (i.e., week 4), immediately post-intervention (i.e., week 9), and at six-month follow-up. Policy implementation and feasibility will be assessed using surveys and interviews with childcare staff. The Environment and Policy Assessment and Observation Self-Report tool will capture potential changes to the childcare setting. Finally, childcare providers' self-efficacy will be captured via a study-specific questionnaire. A nested evaluation of the impact of policy implementation on young children's physical activity levels will be completed. A linear mixed effects models will be used to assess intervention effects on the primary and secondary outcomes. Descriptive statistics and thematic analysis will be employed to assess the feasibility of policy implementation. Discussion: The Childcare PLAY Policy study aims to address the low levels of physical activity and high sedentary time observed in childcare centres by providing direction to childcare staff via a written set of evidence-informed standards to encourage young children's activity and reduce sedentary time. The findings of this work will highlight specific aspects of the policy that worked and will inform modifications that may be needed to enhance scalability. Policy-based approaches to increasing physical activity affordances in childcare may inform future regulations and programming within this environment.