Effectiveness of an intervention to facilitate the implementation of healthy eating and physical activity policies and practices in childcare services: a randomised controlled trial Parent-focused change to prevent obesity in preschoolers: results from the KAN-DO study. Effects of locomotor skill program on minority preschoolers' physical activity levels. Effect of a school-based active play intervention on sedentary time and physical activity in preschool children. Prevention of overweight in children younger than 2 years old: a pilot cluster-randomized controlled trial. Healthy Beginnings Trial Phase 2 study: follow-up and cost-effectiveness analysis. The effect of a cluster randomised control trial on objectively measured sedentary time and parental reports of time spent in sedentary activities in Belgian preschoolers: the ToyBox-study Promotion of a healthy lifestyle among 5-year-old overweight children: health behavior outcomes of the 'Be active, eat right’ study Effect of a family focused active play intervention on sedentary time and physical activity in preschool children The value of social-cognitive theory to reducing preschool TV viewing: a pilot randomized trial. Effect of multidimensional lifestyle intervention on fitness and adiposity in predominantly migrant preschool children (Ballabeina): cluster randomised controlled trial Office-Based Randomized Controlled Trial to Reduce Screen Time in Preschool Children Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial: postintervention results. A Parent-Focused Intervention to Reduce Infant Obesity Risk Behaviors: A Randomized Trial Reducing electronic media use in 2–3 year-old children: feasibility and efficacy of the Family@play pilot randomised controlled trial A participatory physical activity intervention in preschools: a cluster randomized controlled trial. Hip-Hop to Health Jr. for Latino preschool children. A parent-based intervention to promote healthy eating and active behaviours in pre-school children: evaluation of the MEND 2-4 randomized controlled trial. Promoting physical activity at the pre-school playground: the effects of providing markings and play equipment. An intervention for improving the lifestyle habits of kindergarten children in Israel: a cluster-randomised controlled trial investigation. Outcomes of the 5-4-3-2-1 Go! Childhood obesity community trial. An intervention to reduce television viewing by preschool children. Impact Evaluation of Enabling Mothers to Prevent Pediatric Obesity Through Web-Based Education and Reciprocal Determinism (EMPOWER) Randomized Control Trial Randomized controlled trial to improve primary care to prevent and manage childhood obesity: the High Five for Kids study. Healthy Habits, Happy Homes: randomized trial to improve household routines for obesity prevention among preschool-aged children. Two-year follow-up results for Hip-Hop to Health Jr.: a randomized controlled trial for overweight prevention in preschool minority children. An intervention to preschool children for reducing screen time: a randomized controlled trial.
Background The primary aim of this study was to evaluate the effectiveness of an intervention to increase the implementation of healthy eating and physical activity policies and practice s by centre-based childcare services . The study also sought to determine if the intervention was effective in improving child dietary intake and increasing child physical activity levels while attending childcare . Methods A parallel group , r and omised controlled trial was conducted in a sample of 128 childcare services . Intervention strategies included provision of implementation support staff , securing executive support , staff training , consensus processes , academic detailing visits , tools and re sources , performance monitoring and feedback and a communications strategy . The primary outcome of the trial was the proportion of services implementing all seven healthy eating and physical activity policies and practice s targeted by the intervention . Outcome data were collected via telephone surveys with nominated supervisors and room leaders at baseline and immediately post-intervention . Secondary trial outcomes included the differences between groups in the number of serves consumed by children for each food group within the Australian Guide to Healthy Eating and in the proportion of children engaged in sedentary , walking or very active physical activity assessed via observation in a r and om sub sample of 36 services at follow-up . Results There was no significant difference between groups for the primary trial outcome ( p = 0.44 ) . Relative to the control group , a significantly larger proportion of intervention group services reported having a written nutrition and physical activity policy ( p = 0.05 ) and providing adult-guided activities to develop fundamental movement skills ( p = 0.01 ) . There were no significant differences between groups at follow-up on measures of child dietary intake or physical activity . Conclusions The findings of the trial were equivocal . While there was no significant difference between groups for the primary trial outcome , the intervention did significantly increase the proportion of intervention group services implementing two of the seven healthy eating and physical activity policies and practice s. High levels of implementation of a number of policies and practice s at baseline , significant obesity prevention activity in the study region and higher than previously reported intra-class correlation of child behaviours may , in part , explain the trial findings .Trial registration Australian Clinical Trials Registry ( reference ACTRN12612000927820 ) OBJECTIVE The study presents the immediate post-intervention results of Kids and Adults Now - Defeat Obesity ! , a r and omized controlled trial to enhance healthy lifestyle behaviors in mother-preschooler ( 2 - 5 years old ) dyads in North Carolina ( 2007 - 2011 ) . The outcomes include change from baseline in the child 's diet , physical activity and weight , and in the mother 's parenting behaviors , diet , physical activity , and weight . METHOD The intervention targeted parenting through maternal emotion regulation , home environment , feeding practice s , and modeling of healthy behaviors .  400 mother-child dyads were r and omized . RESULTS Mothers in the intervention arm , compared to the control arm , reduced  instrumental feeding  ( -0.24 vs. 0.01 , p<0.001 ) and TV snacks ( -.069 vs. -0.24 , p=0.001 ) . There were also improvements in emotional feeding ( p=0.03 ) , mother 's sugary beverage ( p=0.03 ) and fruit/vegetable ( p=0.04 ) intake , and dinners eaten in front of TV ( p=0.01 ) ; these differences were not significant after adjustment for multiple comparisons . CONCLUSION KAN-DO , design ed to maximize the capacity of mothers as agents of change , improved several channels of maternal influence . There were no group differences in the primary outcomes , but differences were observed in the parenting and maternal outcomes and there were trends toward improvement in the preschoolers ' diets . Long-term follow-up will address whether these short-term trends ultimately improve weight status This pilot study examined the effects of a teacher-taught , locomotor skill (LMS)-based physical activity ( PA ) program on the LMS and PA levels of minority preschooler-aged children . Eight low-socioeconomic status preschool classrooms were r and omized into LMS-PA ( LMS-oriented lesson plans ) or control group ( supervised free playtime ) . Interventions were delivered for 30 min/day , five days/week for six months . Changes in PA ( accelerometer ) and LMS variables were assessed with MANCOVA .  LMS-PA group exhibited a significant reduction in during-preschool ( F ( 1,16 ) = 6.34 , p = .02 , d = 0.02 ) and total daily ( F ( 1,16 ) = 9.78 , p = .01 , d = 0.30 ) percent time spent in sedentary activity .  LMS-PA  group also exhibited significant improvement in leaping skills , F ( 1 , 51 ) = 7.18 , p = .01 , d = 0.80 ) . No other , significant changes were observed . The implementation of a teacher-taught , LMS-based PA program could potentially improve LMS and reduce sedentary time of minority preschoolers Early childhood is a critical time for promoting physical activity . Few studies have investigated the effect of interventions in this population . The aim of this study was to investigate the effect of a school-based active play intervention on preschool children 's sedentary time and physical activity .  Preschool children were recruited from r and omly selected preschools . Schools were r and omly assigned to an intervention or comparison group . One teacher per intervention school received training from active play professionals in the delivery of a 6-week active play programme . Comparison schools continued their usual practice . Children wore a  uni-axial accelerometer  for 7 days at baseline , immediately after and at 6-month post-intervention . No significant intervention effects were observed for sedentary time or physical activity . However , sex and hours spent at school were significant predictors of physical activity . Children who spent fewer hours ( half-day children ) at school were significantly more active than their full-day counterparts . Physical activity during the intervention classes was high even though neither daily physical activity nor sedentary time changed . Notably children who spent more time at preschool were less active suggesting that preschool was not as conducive to physical activity engagement as other environments OBJECTIVE The aim of the present study was to evaluate the effects of a 1-year family-based healthy lifestyle intervention implemented through day-care centres on toddlers ' BMI Z-scores  and reported activity- and dietary-related behaviours . DESIGN Pilot cluster-r and omized controlled trial . SETTING Seventy child-care centres in three different intervention communities and three paired-matched control communities in Fl and ers , Belgium . SUBJECTS A sample of 203 Belgian toddlers aged 9 - 24 months was included in the study . Objective ly assessed weight and height were used to calculate BMI Z-scores .  A parental-report question naire was used to assess children  's  lifestyle behaviours .  RESULTS Positive intervention effects were found on BMI Z-score . No intervention effects were found for activity- and dietary-related behaviours targeted by the intervention . In both intervention and control groups , daily consumption of water , soft drinks , sweets and savoury snacks increased while daily consumption of fruit and vegetables decreased over 1 year . Daily physical activity remained stable but screen-time behaviour increased in both groups over time . CONCLUSIONS The study showed that a family-based healthy lifestyle intervention implemented through day-care centres can lead to healthier weight outcomes in toddlers . In both groups , an unhealthier lifestyle pattern was observed over 1 year which underlines the importance of the early childhood period as the focus of future behavioural interventions BACKGROUND In 2007 , we commenced the Healthy Beginnings Trial ( HBT ) Phase 1 study , which is the first r and omised controlled trial ( RCT ) to test the effectiveness of an  early childhood obesity intervention in children aged up to 2 years . The results were promising with significant improvements in infant feeding practice s and a lower mean body mass index ( BMI ) . The aims of this proposed Phase 2 study are to determine if the early intervention will lead to a lower mean BMI , lower screen time , improved dietary behaviours and demonstrated cost-effectiveness of the intervention , in children aged 3½ and 5 years . METHODS / DESIGN In Phase 1 of HBT 667 families participated in the RCT . No further intervention will be carried out in HBT Phase 2 . In this study the intervention and control groups will be compared for children 's outcomes at ages 3½ and 5 years . Primary outcome measures will be 1 ) BMI , 2 ) selected dietary measures using a vali date d survey tool , and 3 ) physical activity and screen time using a new generation of tri-axial accelerometers . Intention to treat principles will be used in the analysis . Multiple imputation will be used to impute outcomes for subjects lost to follow-up . A cost-effectiveness analysis ( CEA ) and cost-utility analysis for both HBT Phase 1 and 2 will also be conducted . DISCUSSION This is the first time that a home-based early intervention strategy has been implemented to prevent the development of childhood obesity and obesity-conducive behaviours . The results of this trial will ascertain whether early intervention during the first 2 years of life is effective and cost-effective in preventing childhood overweight and obesity at 3½ and 5 years old Background In preschoolers , high levels of sedentary behaviour are associated with several adverse health outcomes . The purpose of this study is to report the effects of the ToyBox-intervention ( a European 24-week cluster r and omised controlled trial ) on sedentary behaviour  in preschoolers . Methods In Belgium , 859 preschoolers from 27 kindergartens ( 15 intervention and 12 control ) wore an accelerometer  to objective ly measure  their  sedentary time  and 1715 parents/caregivers completed a question naire to assess sedentary activities in which preschoolers participate at home . Main outcomes were objective ly measured sedentary time , time spent watching TV , using the computer and time spent in quiet play . Multilevel repeated measures analyses were conducted to take clustering into account . Intention to treat analysis was used to h and le missing data . Results A sample of 859 ( 29.5 % of all contacted children ) preschoolers ( 4.4 ± 0.6 years , 54.4 % boys ) provided valid accelerometer data at either baseline or follow-up and parents of 1715 ( 58.9 % of all contacted children ) preschoolers ( 4.4 ± 0.5 years , 52.5 % boys ) completed a question naire at either baseline or follow-up . No intervention effects were found on objective ly and subjectively measured total sedentary time in the total sample . However , some effects on objective ly and subjectively measured sedentary time were found in specific subgroups . Preschoolers from the intervention group from high SES kindergartens and preschoolers with high levels of sedentary time at baseline decreased their sedentary time , while preschoolers from the control group increased their sedentary time . Girls in the intervention group decreased their TV viewing time during weekend days ( -5.83 min/day ) , while girls ’ & TV viewing in the control group increased ( + 4.15 min/day ) . In low SES kindergartens , a smaller increase for computer time during weekend days was found in preschoolers in intervention kindergartens ( + 6.06 min/day ) than in control kindergartens ( + 12.49 min/day ) . Conclusion While some small positive effects were found in some sub-groups , the ToyBox-intervention had no effect on objective ly and subjectively measured sedentary time in the total sample . A longer period to implement the intervention and a more active involvement of parents/caregivers might enhance intervention effects . The ToyBox- study is registered with the clinical trials registry clinical trials.gov , ID : NCT02116296 Background This study evaluates the effects of an intervention performed by youth health care professionals on  child health behaviors .  The intervention consisted of offering healthy lifestyle counseling to parents of overweight ( not obese ) 5-year-old children . Effects of the intervention on the child having breakfast , drinking sweet beverages , watching television and playing outside were evaluated . Methods Data were collected with the ' Be active , eat right ’ study , a cluster r and omized controlled trial among nine youth health care centers in the Netherl and s. Parents of overweight children received lifestyle counseling according to the intervention protocol in the intervention condition ( n = 349 )  and usual care in the control condition ( n = 288 ) . Parents completed question naires regarding demographic characteristics , health behaviors and the home environment at baseline and at 2-year follow-up . Cluster adjusted regression models were applied ; interaction terms were explored . Results The population for analysis consisted of 38.1 % boys ; mean age 5.8 [ sd 0.4 ] years ; mean BMI SDS 1.9 [ sd 0.4 ] . There were no significant differences in the number of minutes of outside play or television viewing a day between children in the intervention and the control condition . Also , the odds ratio for having breakfast daily or drinking two or less glasses of sweet beverages a day showed no significant differences between the two conditions . Additional analyses showed that the odds ratio for drinking less than two glasses of sweet beverages at follow-up compared with baseline was significantly higher for children in both the intervention ( p < 0.001 ) and the control condition ( p = 0.029 ) . Conclusions Comparison of the children in the two conditions showed that the intervention does not contribute to a change in health behaviors . Further studies are needed to investigate opportunities to adjust the intervention protocol , such as integration of elements in the regular well-child visit . The intervention protocol for youth health care may become part of a broader approach to tackle childhood overweight and obesity . Trial registration Current Controlled Trials IS RCT Background Early childhood provides a window of opportunity for the promotion of physical activity . Given the limited effectiveness of interventions to date , new approaches are needed . Socio-ecological models suggest that involving parents as intervention targets may be effective in fostering healthier lifestyles in children . This study describes the effectiveness of a family-focused ‘ Active Play ’ intervention in decreasing sedentary time and increasing total physical activity in preschool children . MethodS eventy-seven families were recruited from 8 r and omly selected SureStart children ’s centres in the North West of Engl and . Centres were r and omly assigned to either an intervention ( n = 4 ) or a comparison group ( n = 4 ) . Parents and children in the intervention group received a 10-week active play programme delivered by trained active play professionals ; this included an activity and educational component . Families in the comparison group were asked to maintain their usual routine . Each participating parent and child wore a  uni-axial accelerometer  for 7 days at baseline and post-test . Week and weekend day sedentary time and total physical activity adjusted for child- and home- level covariates were analysed using multilevel analyses . Results Significant intervention effects were observed for sedentary time and physical activity for both week and weekend days . Children in the intervention group engaged in 1.5 % and 4.3 % less sedentary time during week and weekend days , respectively and 4.5 % and 13.1 % more physical activity during week and weekend days , respectively than children in the comparison group . Parent ’s participation in sport and their physical activity levels , child ’s sex , availability of media in the home and attendance at organised activities were significant predictors of sedentary time and physical activity in this age group . Conclusion A 10-week family focused active play intervention produced positive changes in sedentary time and total physical activity levels in preschool children . Specific covariates were identified as having a significant effect on the outcome measures . Moreover , children whose parents were active engaged in less sedentary time and more physical activity suggesting that parent ’s activity habits are mediators of physical activity engagement in this age group OBJECTIVE To ( a ) reduce the total amount of television viewing to which preschool children are exposed ; and ( b ) shift the balance of exposure away from commercial television toward educational content . METHOD R and omized controlled clinical trial . Data collected in 2007 ; analyzed 2008 - 2011 . Participants were 67 English-speaking families in Seattle with a preschool-aged child exposed to more than 90 min of television viewing on average per day . A case manager for each group used in-person conferences , monthly newsletters , and e-mail contact to motivate behavior change around child television viewing ( intervention ) or child safety ( control ) . RESULTS Compared to those in the control group , families r and omized to the intervention group experienced a significant reduction by 37 minutes/day in total viewing time ( 95 % CI : 5.6 - 68.7 ) , including a marginally significant reduction by 29 minutes/day in viewing of commercial content ( 95 % CI : -4.6 - 63 ) . Compared to those in the control group , those in the intervention group experienced a positive change in outcome expectations . There were no significant changes in self-efficacy or volitional control . An advance in stage-of-change was marginally significant . CONCLUSIONS Targeting commercial TV viewing may prove a successful behavioral intervention to achieve public health goals in this population Objective To test the effect of a multidimensional lifestyle intervention on aerobic fitness and adiposity in predominantly migrant preschool children . Design Cluster r and omised controlled single blinded trial ( Ballabeina study ) over one school year ; r and omisation was performed after stratification for linguistic region . Setting 40 preschool classes in areas with a high migrant population in the German and French speaking regions of Switzerl and . Participants 652 of the 727 preschool children had informed consent and were present for baseline measures ( mean age 5.1 years ( SD 0.7 ) , 72 % migrants of multicultural origins ) . No children withdrew , but 26 moved away . Intervention The multidimensional culturally tailored lifestyle intervention included a physical activity programme , lessons on nutrition , media use ( use of television and computers ) , and sleep and adaptation of the built environment of the preschool class . It lasted from August 2008 to June 2009 . Main outcome measures Primary outcomes were aerobic fitness ( 20 m shuttle run test ) and body mass index ( BMI ) . Secondary outcomes included motor agility , balance , percentage body fat , waist circumference , physical activity , eating habits , media use , sleep , psychological health , and cognitive abilities . Results Compared with controls , children in the intervention group had an increase in aerobic fitness at the end of the intervention ( adjusted mean difference : 0.32 stages ( 95 % confidence interval 0.07 to 0.57 ; P=0.01 ) but no difference in BMI ( −0.07 kg/m2 , −0.19 to 0.06 ; P=0.31 ) . Relative to controls , children in the intervention group had beneficial effects in motor agility ( −0.54 s , −0.90 to −0.17 ; P=0.004 ) , percentage body fat ( −1.1 % , −2.0 to −0.2 ; P=0.02 ) , and waist circumference ( −1.0 cm , −1.6 to −0.4 ; P=0.001 ) . There were also significant benefits in the intervention group in reported physical activity , media use , and eating habits , but not in the remaining secondary outcomes . Conclusions A multidimensional intervention increased aerobic fitness and reduced body fat but not BMI in predominantly migrant preschool children . Trial registration Clinical Trials NCT00674544 OBJECTIVE : To determine if an intervention for preschool-aged children in primary care is effective in reducing screen time , meals in front of the television , and BMI . METHODS : A r and omized controlled trial was conducted at a primary care pediatric group practice in Toronto , Canada . Three-year-old children and their parents were r and omly assigned to receive a short behavioral counseling intervention on strategies to decrease screen time .  The primary outcome 1 year later was parent reported screen time . Secondary outcomes included television in the child ’s bedroom , number of meals in front of the television , and BMI . RESULTS : In the intention-to-treat analysis at 1 year , there were no significant differences in mean total weekday minutes of screen time ( 60 , interquartile range [ IQR ] : 35–120 vs 65 , IQR : 35–120 ; P = .68 ) or mean total weekend day minutes of screen time ( 80 , IQR : 45–130 vs 90 , IQR : 60–120 ; P = .33 ) between the intervention and control group . Adjusting for baseline BMI , there was a reduction in the number of weekday meals in front of the television ( 1.6 ± 1.0 vs 1.9 ± 1.2 ; P = .03 ) but no differences in BMI or number of televisions in the bedroom . CONCLUSIONS : This pragmatic trial was not effective in reducing screen time or BMI but was effective in reducing meals in front of the screen . Short interventions focused solely on reducing screen time implemented in the primary care practice setting may not be effective in this age group The preschool years offer an opportunity to interrupt the trajectory toward obesity in black children . The Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial was a group-r and omized controlled trial assessing the feasibility and effectiveness of a teacher-delivered weight control intervention for black preschool children . The 618 participating children were enrolled in 18 schools administered by the Chicago Public Schools . Children enrolled in the nine schools r and omized to the intervention group received a 14-week weight control intervention delivered by their classroom teachers . Children in the nine control schools received a general health intervention .  Height and weight , physical activity , screen time , and diet data were collected at baseline and postintervention . At postintervention , children in the intervention schools engaged in more moderate-to-vigorous physical activity ( MVPA ) than children in the control schools ( difference between adjusted group means = 7.46 min/day , P = 0.02 ) . Also , children in the intervention group had less total screen time ( -27.8 min/day , P = 0.05 ) . There were no significant differences in BMI , BMI Z score , or dietary intake . It is feasible to adapt an obesity prevention program to be taught by classroom teachers . The intervention showed positive influences on physical activity and screen time , but not on diet . Measuring diet and physical activity in preschool children remains a challenge , and interventions delivered by classroom teachers require both intensive initial training and ongoing individualized supervision OBJECTIVE : To assess the effectiveness of a  parent-focused intervention on  infants ’ obesity-risk behaviors and BMI . METHODS : This cluster r and omized controlled trial recruited 542 parents and their infants ( mean age 3.8 months at baseline ) from 62 first-time parent groups . Parents were offered six 2-hour dietitian-delivered sessions over 15 months focusing on parental knowledge , skills , and social support around infant feeding , diet , physical activity , and television viewing . Control group parents received 6 newsletters on nonobesity-focused themes ; all parents received usual care from child health nurses . The primary outcomes of interest were child diet ( 3 × 24-hour diet recalls ) , child physical activity ( accelerometry ) , and child TV viewing ( parent report ) . Secondary outcomes included BMI z-scores ( measured ) . Data were collected when children were 4 , 9 , and 20 months of age . RESULTS : Unadjusted analyses showed that , compared with controls , intervention group children consumed fewer grams of noncore drinks ( mean difference = –4.45 ; 95 % confidence interval [ CI ] : –7.92 to –0.99 ; P = .01 ) and were less likely to consume any noncore drinks ( odds ratio = 0.48 ; 95 % CI : 0.24 to 0.95 ; P = .034 ) midintervention ( mean age 9 months ) . At intervention conclusion ( mean age 19.8 months ) , intervention group children consumed fewer grams of sweet snacks ( mean difference = –3.69 ; 95 % CI : –6.41 to –0.96 ; P = .008 ) and viewed fewer daily minutes of television ( mean difference = –15.97 : 95 % CI : –25.97 to –5.96 ; P = .002 ) . There was little statistical evidence of differences in fruit , vegetable , savory snack , or water consumption or in BMI z-scores or physical activity . CONCLUSIONS : This intervention result ed in reductions in sweet snack consumption and television viewing in 20-month-old children Background Participation in electronic media use among 2–3 year olds is high and associated with adverse health and developmental outcomes . This study sought to test the feasibility and potential efficacy of a family-based program to decrease electronic media ( EM ) use in 2–3-year-old children . Methods Family@play was a six-session pilot r and omised controlled trial delivered to parents of 2–3 year-old children from August to September 2012 in a community environment in the Illawarra region of New South Wales , Australia . Development of program content was guided by Social Cognitive and Family Systems Theories . The primary outcome was children ’s electronic media use . Secondary outcomes included children ’s time in sitting , st and ing and stepping . Data collectors were blinded to group allocation . Parents completed comprehensive process evaluation measures and participated in focus group discussion s following completion of the program . Regression analyses were undertaken and effect sizes calculated using principles of intention to treat . Results Twenty-two participants ( n = 12 intervention ; n = 10 control ) provided complete baseline data ; complete data from 16 participants ( n = 6 intervention ; n = 10 control ) were available post-intervention . Process evaluation results were high , showing the acceptability of the program . Compared with children in the control group , there were greater decreases in total EM use among children in the intervention group ( adjusted difference [ 95 % CI ] = −31.2 mins/day [ −71.0–8.6 ] Cohen ’s d = 0.70 ) . Differences for other outcomes were in the hypothesised direction and ranged from small for postural ( sitting , st and ing , stepping ) outcomes to moderate to large for individual electronic media ( e.g. TV viewing , DVD/video viewing ) . Conclusions This is the first family-based study to engage families of 2–3 year old children outside the United States and target multiple EM behaviours . Family@play was shown to be a feasible and acceptable intervention to deliver to families of 2–3 year old children . Potential efficacy is evident from moderate to large effect sizes . A larger trial is warranted to test the efficacy of the program . Trial registration Australian New Zeal and Clinical Trials Registry ( ACTRN12612000470897 ) BACKGROUND Previous studies on physical activity interventions in preschools have reported limited effectiveness . Participatory community-based approaches hold promise for increasing intervention effectiveness and involving parents as key stakeholders in a sustainable way . PURPOSE To assess whether a  participatory parent-focused approach using parents as agents of behavioral change enhances the efficacy of a  preschool physical activity ( PA ) intervention . DESIGN Two-armed , cluster- RCT with preschool as unit of r and omization and children as unit of analysis . SETTING / PARTICIPANTS 39 South German preschools applying for an existing state-sponsored PA program with 826 children ( 52 % boys , aged 5.0±0.2 years ) , with 441 allocated to the intervention arm .  INTERVENTION Control preschools received a state-sponsored program consisting of twice-weekly gym classes over 6 months . In intervention preschools , this program was augmented by motivating parents to develop and implement their own project ideas for promoting children 's PA . MAIN OUTCOME MEASURES Primary outcomes included mean accelerometry counts and time spent in moderate- to vigorous-intensity PA or sedentary behavior . Secondary outcomes were BMI , percentage body fat , quality of life , sleep quality , and general health . Outcomes were measured at baseline and at 6 and 12 months in both study arms ( time period : 2008 - 2010 ) . Using an intention-to-treat- analysis , linear multilevel regression models assessed change over time and across study arms , adjusted for age , gender , season , and preschool location . Analysis was conducted in 2011 . RESULTS In 15 intervention preschools , parents implemented 25 PA projects . Compared with controls , intervention arm children were 11 minutes less sedentary per day ( 95 % CI=5.39 , 17.01 , p=0.014 ) ; had significantly more mean accelerometry counts ( 1.4 counts/15 seconds [ 95 % CI=0.22 , 2.54 ] , p=0.019 ) ; and showed benefits in perceived general health and quality of life . All other outcomes showed no difference between study arms . CONCLUSIONS A participatory preschool intervention focusing on parents as agents of behavioral change may be able to promote PA and reduce sedentary behavior in preschoolers . These benefits may go beyond the effects of existing nonparticipatory interventions . TRIAL REGISTRATION This study is registered at clinical trials.gov NCT00987532 OBJECTIVE Hip-Hop to Health Jr. was a diet/physical activity intervention design ed to reduce gains in BMI ( kilograms per meter squared ) in preschool minority children . RESEARCH METHODS AND PROCEDURES Twelve predominantly Latino Head Start centers participated in a group-r and omized trial conducted between Fall 2001 and Winter 2003 . Six centers were r and omized to a culturally proficient 14-week ( three times weekly  ) diet/physical activity intervention . Parents participated by completing weekly homework assignments . The children in the other six centers received a general health intervention that did not address either diet or physical activity . The primary outcome was change in BMI , and secondary outcomes were changes in dietary intake and physical activity . Measures were collected at baseline , post-intervention , and at Years 1 and 2 follow-up . RESULTS There were no significant differences between intervention and control schools in either primary or secondary outcomes at post-intervention , Year 1 , or Year 2 follow-ups . DISCUSSION When Hip-Hop to Health Jr. was conducted in predominantly black Head Start centers , it was effective in reducing subsequent increases in BMI in preschool children . In contrast , when the program was conducted in Latino centers , it was not effective . Although the intervention did not prevent excessive weight gain in Latino children , it was very well received . Future interventions with this population may require further cultural tailoring and a more robust parent intervention BACKGROUND There is a paucity of studies evaluating targeted obesity prevention interventions in pre-school children . OBJECTIVES We conducted a r and omized controlled trial to evaluate the efficacy of a  parent-based obesity prevention intervention for pre-schoolers - MEND ( Mind , Exercise , Nutrition … Do It ! ) 2 - 4 on child diet , eating habits , physical activity/sedentary behaviours , and body mass index ( BMI ) . METHODS Parent-child dyads attended 10 weekly 90-min workshops relating to nutrition , physical activity and behaviours , including guided active play and healthy snack time . Assessment s were conducted at baseline , immediately post-intervention , and 6 and 12 months post-intervention ; child intake of vegetables , fruit , beverages , processed snack foods , fussiness , satiety responsiveness , physical activity , sedentary behaviour and neophobia were assessed via parent proxy report . Parent and child height and weight were measured . RESULTS Two hundred one parent-child dyads were r and omized to intervention ( n = 104 ) and control ( n = 97 ) . Baseline mean child age was 2.7 ( st and ard deviation [ SD ] 0.6 ) years , and child BMI -for-age z-score ( World Health Organization ) was 0.66 ( SD 0.88 ) . We found significant positive group effects for vegetable ( P = 0.01 ) and snack food ( P = 0.03 ) intake , and satiety responsiveness ( P = 0.047 ) immediately post-intervention . At 12 months follow-up , intervention children exhibited less neophobia ( P = 0.03 ) than controls . CONCLUSION Future research should focus on additional strategies to support parents to continue positive behaviour change . ACTRN12610000200088 OBJECTIVES We aim ed to investigate the effects of providing play equipment and markings at the pre-school playground on physical activity engagement levels . METHODS We performed a cluster r and omised control trial . In November and December 2007 , a convenience sample of 40 public pre-schools in Fl and ers , Belgium , was r and omly assigned to one of the following conditions : 1 ) in 10 pre-schools play equipment was provided , 2 ) in 10 pre-schools markings were painted on the playground , 3 ) in 10 schools play equipment was provided and markings were painted , 4 ) 10 schools served as a control condition . Accelerometer-based physical activity levels during recess were evaluated at baseline and 4 to 6 weeks after the implementation of the intervention in 583 children ( 52 % boys ; mean age 5.3 years , SD 0.4 ) . RESULTS At baseline pre-schoolers spent only 11.2 % ( average : 4.7 min ) of recess time in moderate to vigorous activity , while 61.3 % ( average : 25.7 min ) was spent in sedentary activity . The interventions were not effective in increasing the average activity levels or the percentages of engagement in moderate or vigorous activity , or in decreasing sedentary time . CONCLUSION Providing playground markings or play equipment is not sufficient to increase activity levels and decrease levels of sedentary activity during pre-school recess . More activating supervision and the inclusion of more structured physical activity seem needed OBJECTIVE To assess the effectiveness of an intervention programme to improve kindergarten children 's eating and leisure habits in Israel . DESIGN A cluster-r and omised controlled trial . SETTING Six full-day kindergartens in Israel were r and omly divided into three groups . Group A received the full intervention programme , which included lessons on good eating habits and daily physical exercise . Group B received a partial intervention of lessons only . Group C , the reference group , did not receive any intervention . SUBJECTS Children aged 4 - 6 years ( n 204 ) were recruited for the study . METHODS Objective data for weight and height were collected to calculate BMI Z-scores . Activity , sedentary time , sleeping hours and daily energy intake were assessed via a parental question naire .  Nutritional knowledge was assessed by a single dietitian using a question naire addressed to the children . Assessment s were done at baseline and at the end of the intervention . RESULTS After adjustment for baseline levels we observed a significant reduction in daily energy intake for the full intervention group A ( P = 0.03 ) . A positive intervention effect was demonstrated on nutritional knowledge in the partial intervention group B ( P = 0.03 ) , although no significant change was demonstrated for BMI Z-score . CONCLUSIONS The study supports the incorporation of education on healthy lifestyle habits and physical activity into the curricula of kindergartens OBJECTIVES To determine effects of the 5 - 4 - 3 - 2 - 1 Go ! community social marketing campaign on obesity risk factors . METHODS We r and omly assigned 524 parents of 3- to 7-year-old children to receive 5 - 4 - 3 - 2 - 1 Go ! counseling or not . We surveyed parents about 5 - 4 - 3 - 2 - 1 Go ! behaviors and perceptions of children 's behaviors at baseline and one year later . We conducted multivariable logistic regression for each outcome . RESULTS Parents who received counseling  consumed more fruits and vegetables at follow-up ( OR 1.749 , [ 95 % CI : 1.01 - 3.059 ] ) . Parental exposure to messaging at children 's school events was associated with higher water consumption ( 6.879 , [ 1.954 - 24.212 ] ) . CONCLUSIONS 5 - 4 - 3 - 2 - 1 Go ! is a promising intervention BACKGROUND Television viewing has been associated with increased violence in play and higher rates of obesity . Although there are interventions to reduce television viewing by school-aged children , there are none for younger children . OBJECTIVE To develop and evaluate an intervention to reduce television viewing by preschool children . DESIGN R and omized controlled trial conducted in 16 preschool and /or day care centers in rural upstate New York . PATIENTS Children aged 2.6 through 5.5 years . INTERVENTION Children attending intervention centers received a 7-session program design ed to reduce television viewing as part of a health promotion curriculum , whereas children attending the control centers received a safety and injury prevention program . OUTCOME MEASUREMENTS Change in parent-reported child television/video viewing and measured growth variables . RESULTS Before the intervention , the intervention and control groups viewed 11.9 and 14.0 h/wk of television/videos , respectively . Afterward , children in the intervention group decreased their television/video viewing 3.1 h/wk , whereas children in the control group increased their viewing by 1.6 h/wk , for an adjusted difference between the groups of -4.7 h/wk ( 95 % confidence interval , -8.4 to -1.0 h/wk ; P = .02 ) . The percentage of children watching television/videos more than 2 h/d also decreased significantly from 33 % to 18 % among the intervention group , compared with an increase of 41 % to 47 % among the control group , for a difference of -21.5 % ( 95 % confidence interval , -42.5 % to -0.5 % ; P = .046 ) . There were no statistically significant differences in children 's growth between groups . CONCLUSIONS This study is the first to show that a preschool-based intervention can lead to reductions in  young children 's television/video viewing . Further research is needed to determine the long-term effects associated with reductions in young children 's television viewing Background . The family and home environment is an influential antecedent of childhood obesity . The purpose of this study was to pilot test The Enabling Mothers to Prevent Pediatric Obesity through Web-Based Education and Reciprocal Determinism ( EMPOWER ) intervention ; a newly developed , theory-based , online program for prevention of childhood obesity . Method . The two-arm , parallel group , r and omized , participant-blinded trial targeted mothers with children between 4 and 6 years of age . Measures were collected at baseline , 4 weeks , and 8 weeks to evaluate programmatic effects on constructs of social cognitive theory ( SCT ) and obesity-related behaviors . Process evaluation transpired concurrently with each intervention session . Results . Fifty-seven participants were r and omly assigned to receive either experimental EMPOWER ( n = 29 ) or active control Healthy Lifestyles ( n = 28 ) intervention . Significant main effects were identified for child physical activity , sugar-free beverage consumption , and screen time , indicating that both groups improved in these behaviors . A significant group-by-time interaction was detected for child fruit and vegetable ( FV ) consumption as well as the SCT construct of environment in the EMPOWER cohort . An increase of 1.613 cups of FVs ( 95 % confidence interval = [ 0.698 , 2.529 ] ) was found in the experimental group , relative to the active control group . Change score analysis found changes in the home environment accounted for 31.4 % of the change in child FV intake for the experimental group . Conclusions . Child physical activity , sugar-free beverage consumption , and screen time improved in both groups over the course of the trial . Only the theory-based intervention was efficacious in increasing child FV consumption . The EMPOWER program was robust for inducing change in the home environment leading to an increase in child FV intake ( Cohen ’s f = 0.160 ) OBJECTIVE To examine the effectiveness of a primary care-based obesity intervention over the first year ( 6 intervention contacts ) of a planned 2-year study . DESIGN Cluster r and omized controlled trial . SETTING Ten pediatric practice s , 5 intervention and 5 usual care . PARTICIPANTS Four hundred seventy-five children aged 2 to 6 years with body mass index ( BMI ) in the 95th percentile or higher or 85th to less than 95th percentile if at least 1 parent was overweight ; 445 ( 93 % ) had 1-year outcomes . INTERVENTION Intervention practice s received primary care restructuring , and families received motivational interviewing by clinicians and educational modules targeting television viewing and fast food and sugar-sweetened beverage intake . OUTCOME MEASURES Change in BMI and obesity-related behaviors from baseline to 1 year . RESULTS Compared with usual care , intervention participants had a smaller , nonsignificant change in BMI ( -0.21 ; 95 % confidence interval [ CI ] , -0.50 to 0.07 ; P = .15 ) , greater decreases in television viewing ( -0.36 h/d ; 95 % CI , -0.64 to -0.09 ; P = .01 ) , and slightly greater decreases in fast food ( -0.16 serving/wk ; 95 % CI , -0.33 to 0.01 ; P = .07 ) and sugar-sweetened beverage ( -0.22 serving/d ; 95 % CI , -0.52 to 0.08 ; P = .15 ) intake . In post hoc analyses , we observed significant effects on BMI among girls ( -0.38 ; 95 % CI , -0.73 to -0.03 ; P = .03 ) but not boys ( 0.04 ; 95 % CI , -0.55 to 0.63 ; P = .89 ) and among participants in households with annual incomes of $ 50 000 or less ( -0.93 ; 95 % CI , -1.60 to -0.25 ; P = .01 ) but not in higher-income households ( 0.02 ; 95 % CI , -0.30 to 0.33 ; P = .92 ) . CONCLUSION After 1 year , the High Five for Kids intervention was effective in reducing television viewing but did not significantly reduce BMI IMPORTANCE Racial/ethnic and socioeconomic disparities exist across risk factors for childhood obesity . OBJECTIVE To examine the effectiveness of a home-based intervention to improve household routines known to be associated with childhood obesity among a sample of low-income , racial/ethnic minority families with young children . DESIGN R and omized trial . SETTING The intervention was delivered in the families ' homes . PARTICIPANTS The study involved 121 families with children aged 2 to 5 years who had a television ( TV ) in the room where he or she slept ; 111 ( 92 % ) had 6-month outcome data ( 55 intervention and 56 control ) . The mean ( SD ) age of the children was 4.0 ( 1.1 ) years ; 45 % were overweight/obese . Fifty-two percent of the children were Hispanic , 34 % were black , and 14 % were white/other . Nearly 60 % of the families had household incomes of $ 20,000 or less . INTERVENTIONS The 6-month intervention promoted 4 household routines , family meals , adequate sleep , limiting TV time , and removing the TV from the child 's bedroom , using ( 1 ) motivational coaching at home and by phone , ( 2 ) mailed educational material s , and ( 3 ) text messages . Control subjects were mailed material s focused on child development . MAIN OUTCOMES AND MEASURES Change in parent report of frequency of family meals ( times/wk ) , child sleep duration ( hours/d ) , child weekday and weekend day TV viewing ( hours/d ) , and the presence of a TV in the room where the child slept from baseline to 6 months . A secondary outcome was change in age- and sex-adjusted body mass index ( calculated as weight in kilograms divided by height in meters squared ) . RESULTS Compared with control subjects , intervention participants had increased sleep duration ( 0.75 hours/d ; 95 % CI , 0.06 to 1.44 ; P = .03 ) , greater decreases in TV viewing on weekend days ( -1.06 hours/d ; 95 % CI , -1.97 to -0.15 ; P = .02 ) , and decreased body mass index ( -0.40 ; 95 % CI , -0.79 to 0.00 ; P = .05 ) . No significant intervention effect was found for the presence of a TV in the room where the child slept or family meal frequency . CONCLUSIONS AND RELEVANCE Our results suggest that promoting household routines , particularly increasing sleep duration and reducing TV viewing , may be an effective approach to reduce body mass index among low-income , racial/ethnic minority children . Longer-term studies are needed to determine maintenance of behavior change . TRIAL REGISTRATION clinical trials.gov Identifier : NCT01565161 OBJECTIVES To assess the impact of a culturally proficient dietary/physical activity intervention on changes in body mass index ( BMI ) ( kg/m 2 ) . STUDY DESIGN R and omized controlled trial ( Hip-Hop to Health Jr. ) conducted between September 1999 and June 2002 in 12 Head Start preschool programs in Chicago , Illinois . RESULTS Intervention children had significantly smaller increases in BMI compared with control children at 1-year follow-up , 0.06 vs 0.59 kg/m 2 ; difference -0.53 kg/m 2 ( 95 % CI -0.91 to -0.14 ) , P = .01 ; and at 2-year follow-up , 0.54 vs 1.08 kg/m 2 ; difference -0.54 kg/m 2 ( 95 % CI -0.98 to -0.10 ) , P = .02 , with adjustment for baseline age and BMI . The only significant difference between intervention and control children in food intake/physical activity was the Year 1 difference in percent of calories from saturated fat , 11.6 % vs 12.8 % ( P = .002 ) . CONCLUSIONS Hip-Hop to Health Jr. was effective in reducing subsequent increases in BMI in preschool children . This represents a promising approach to prevention of overweight among minority children in the preschool years BACKGROUND Screen time , defined as time spent watching television , DVDs , or videos or playing computer or video games , has been related to serious health consequences in children , such as impaired language acquisition , violent behaviour , tobacco smoking and obesity . Our aim was to determine if a simple intervention aim ed at preschool-aged children , applied at the health maintenance visits , in the primary care setting , would be effective in reducing screen time . METHODS We used a two group r and omized controlled trial design . Two- to 6-year-old children and their parents were r and omly assigned to receive an intervention to reduce their screen time , BMI and parental report of aggressive behaviour . At the end of the intervention we made home visits at 2 , 6 and 9 months and the parents completed question naire . RESULTS Parents in the intervention group reported less screen time and less aggressive behaviour than those in the control group but there were no differences in BMI z scores . CONCLUSIONS This study shows that a preschool-based intervention can lead to reductions in young children 's television/video viewing
Aim or objective To evaluate the effectiveness of behavioural interventions that report sedentary behaviour outcomes during early childhood .