Impact of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention on preschoolers’ physical activity levels and sedentary time: a single-blind cluster randomized controlled trial Supporting Physical Activity in the Childcare Environment (SPACE): rationale and study protocol for a cluster randomized controlled trial A comparison of parent and childcare provider's attitudes and perceptions about preschoolers' physical activity and outdoor time. Effects of a Preschool Intervention on Physical Activity and Body Composition Association between childcare educators’ practices and preschoolers’ physical activity and dietary intake: a cross-sectional analysis Objectively measured physical activity in four-year-old British children: a cross-sectional analysis of activity patterns segmented across the day Preschoolers' health-related quality of life following the implementation of a childcare physical activity intervention. Effect of a school-based active play intervention on sedentary time and physical activity in preschool children. Protocol for systematic reviews of determinants/correlates of obesity-related dietary and physical activity behaviors in young children (preschool 0 to 6 years): evidence mapping and syntheses Activity Begins in Childhood (ABC) – inspiring healthy active behaviour in preschoolers: study protocol for a cluster randomized controlled trial Impact of a population based intervention to increase the adoption of multiple physical activity practices in centre based childcare services: a quasi experimental, effectiveness study A pragmatic randomised controlled trial of an implementation intervention to increase healthy eating and physical activity-promoting policies, and practices in centre-based childcare services: study protocol The effect of a physical activity intervention on preschoolers' fundamental motor skills - A cluster RCT.
Background Physical activity levels among preschoolers in childcare are low and sedentary time high . The Supporting Physical Activity in the Childcare Environment ( SPACE ) intervention had three components : 1 . portable play equipment ; 2 . staff training ; and , 3 . modified outdoor playtime ( i.e. , shorter , more frequent periods ) . This study aim ed to examine the effectiveness of the SPACE intervention on preschoolers ’ physical activity levels and sedentary time during childcare hours ( compared to st and ard care ) . Methods Via a single-blind cluster r and omized controlled trial , 338 preschoolers ( 39.86 ± 7.33 months ; 52 % boys ) from 22 centre-based childcare facilities ( 11 experimental , 11 control ) were enrolled . Preschoolers wore an Actical ™ accelerometer for 5 days during childcare hours at baseline , post-intervention , and 6- and 12-month follow-up , and were included in the analyses if they had a minimum of two valid days ( 5 h each day ) at baseline and one additional time point . Intervention effectiveness was tested using a linear mixed effects model for each of the four outcome variables ( i.e. , sedentary time , light physical activity [ LPA ] , moderate-to-vigorous physical activity [ MVPA ] , and total physical activity [ TPA ] ) . Fixed effects were further evaluated with t-tests , for which degrees of freedom were estimated using a Satterthwaite approximation . Results One hundred and ninety-five preschoolers were retained for analyses .  The intervention did not significantly impact LPA . MVPA was significantly greater among children in the experimental group when comparing post-intervention to pre-intervention , t(318 ) = 3.50 , p = .0005 , but no intervention effects were evident at 6- or 12-month follow-up . TPA was significantly greater for children in the intervention group at post-intervention when compared to pre-intervention , t(321 ) = 2.70 , p = .007 , with no intervention effects evident at later time periods . Finally , sedentary time was significantly lower among preschoolers in the experimental group when comparing post-intervention to pre-intervention , t(322 ) = 2.63 , p = .009 , with no significant effects at follow-up . Conclusions The SPACE intervention was effective at increasing MVPA and TPA among preschoolers , while simultaneously decreasing sedentary time . The ability of the SPACE intervention to target higher intensity activity is promising , as MVPA levels have been documented to be low in centre-based childcare . The changes in physical activity were not sustained long term ( 6- or 12-month follow-up).Trial registration IS RCT N70604107 ( October 8 , 2014 ) Background Young children are prone to low levels of physical activity in childcare . Research ers have identified that preschoolers tend to be more active outdoors than indoors , with higher activity levels occurring during the first 10 minutes of outdoor playtime . Additionally , interventions incorporating either staff training or the inclusion of play equipment have been effective at increasing children ’s activity in this setting . As such , the overarching objective of the Supporting Physical Activity in the Childcare Environment ( SPACE ) intervention is to improve the physical activity levels of preschoolers during childcare hours , utilizing a combination of the above components . The purpose of this manuscript is to provide a detailed account of the protocol , innovative methods , and evaluation plans used in the implementation of the SPACE study ; in an effort to support the development of further research in this field . Methods / Design The SPACE study , a cluster r and omized controlled trial , involves 22 childcare centres r and omly allocated to either the experimental ( n = 11 ) or the control ( n = 11 ) group . Childcare centres receiving the intervention will adopt an 8-week physical activity intervention with the following components : 1 . shorter , more frequent bouts of outdoor playtime ( 4 × 30 min periods rather than 2 × 60 min periods ) ; 2 . new portable play equipment ( e.g. , obstacle course , balls ) ; and , 3 . staff training ( 1 × 4 hr workshop ) . Actical accelerometers will be used to assess total physical activity with measurements taken at baseline ( i.e. , week 0 ) , immediately post-intervention ( i.e. , week 8) , and at 6- and 12-month follow-up . As secondary objectives , we aim to evaluate the effectiveness of the intervention on  preschoolers ’ : a ) sedentary time ; b ) st and ardized body mass index scores ( percentiles ) ; c ) health-related quality of life ; and childcare providers ’ physical activity-related knowledge and self-efficacy to implement physical activity . Discussion The SPACE study aims to increase the low levels of physical activity observed within childcare centres . The findings of this work may be useful to policy makers and childcare providers to consider modifications to the current childcare curriculum and associated outdoor play time . Trial registration IS RCT N70604107 ( October 8 , 2014 BACKGROUND Young children depend on  adult caregivers  to provide opportunities for physical activity . Research has focused on barriers and facilitators to children 's physical activity while in childcare , but parental influences remain largely unknown . This study examines parent 's attitudes about preschoolers ' physical activity and outdoor time , compares them with those of childcare providers and determines the association between parental attitudes and preschoolers ' measured activity . METHODS Parents and childcare providers from 30 childcare centres were surveyed regarding attitudes towards  preschoolers ' physical activity and outdoor time . Children 's moderate-to-vigorous physical activity was determined by using 24-h accelerometry . Parent and childcare providers ' responses were compared . Mixed-effect linear regression examined moderate-to-vigorous physical activity and sedentary time as outcomes with parental attitudes as predictors , family demographics as covariates and centre as a r and om effect . RESULTS Three hundred eighty-eight parents and 151 childcare providers participated . On average , children were 4.3 ( 0.7 ) years old . Parents and childcare providers both considered daily physical activity important for preschoolers , but providers rated the importance of daily outdoor time higher on a 10-point scale ( 8.9 vs. 7.6 , P < 0.001 ) . More parents than providers believed that children would get sick by playing outside in the cold ( 25 vs. 11 % , P < 0.05 ) . Parents were more comfortable with their child playing outside at childcare compared with outside at home ( 8.9 vs. 6.9 , P < 0.001 ) . Lower income parents felt less comfortable than higher income parents with their child playing outside either near home or at childcare . Neither home nor total child activity levels were associated with most parental attitudes queried . CONCLUSIONS While parents and childcare providers value daily physical activity for children , some parents expressed discomfort about their young children engaging in outdoor play , especially around home and in cold weather . These findings highlight the importance of childcare-based interventions to promote preschoolers ' physical activity and outdoor play Objective To investigate the effect of a  preschool physical activity intervention program delivered in licensed childcare setting s , with or without a parent‐facilitated home component , on  children 's daily physical activity , sedentary time , and body composition . Study design For this cluster r and omized controlled trial , 18 childcare centers were r and omly allocated in equal numbers to the typical curriculum comparison group , childcare intervention alone ( CC ) , or childcare intervention with parental involvement . Accelerometers  were used to asses physical activity and sedentary time , and body composition was measured by bioelectrical impedance . Results Linear mixed model regression analyses showed no differences between the CC , the childcare intervention with parental involvement , and the comparison groups in changes from baseline to 6 months in total physical activity ( P for time × group interaction = .665 ) or moderate‐to‐vigorous physical activity ( P for time × group interaction = .164 ) when adjusted for baseline physical activity levels . Furthermore , no group differences were found for changes in light physical activity , sedentary time , or anthropometric variables . Conclusions An affordable and easily scalable preschool intervention program delivered in licensed childcare setting s , with or without the addition of a parent‐driven home physical activity promotion , seems to have no significant effect on physical activity , sedentary time , or body composition . Trial registration IS RCT N : IS RCT N94022291 Introduction Childcare educators may be role models for healthy eating and physical activity ( PA ) behaviours among young children . This study aim ed to identify which childcare educators ’ practice s are associated with preschoolers ’ dietary intake and PA levels . Methods This cross-sectional analysis included 723 preschoolers from 50 r and omly selected childcare centres in two Canadian provinces . All data were collected in the fall of 2013 and 2014 and analysed in the fall of 2015 .  PA was assessed using Actical accelerometers during childcare hours for 5 consecutive days .  Children ’s dietary intake  was measured at lunch on 2 consecutive days using weighed plate waste and digital photography . Childcare educators ’ nutrition practice s ( modelling , nutrition education , satiety recognition , verbal encouragement and not using food as rewards ) and PA practice s ( informal and formal PA promotion ) were assessed by direct observation over the course of 2 days , using the Nutrition and Physical Activity Self- Assessment for Child Care tool . Associations between educators ’ practice s and preschoolers ’ PA and dietary intake were examined using multilevel linear regressions . Results Overall , modelling of healthy eating was positively associated with children ’s intake of sugar ( β=0.141 , 95 % CI 0.03 to 0.27 ) , while calorie ( β=−0.456 , 95 % CI −1.46 to –0.02 ) and fibre intake ( β=−0.066 , 95 % CI −0.12 to –0.01 ) were negatively associated with providing nutrition education . Not using food as rewards was also negatively associated with fat intake ( β=−0.144 , 95 % CI −0.52 to –0.002 ) . None of the educators ’ PA practice s were associated with children ’s participation in PA  . Conclusions Modelling healthy eating , providing nutrition education and not using food as rewards are associated with children ’s dietary intake at lunch in childcare centres , highlighting the role that educators play in shaping preschoolers ’ eating behaviours . Although PA practice s were not associated with  children ’s PA levels , there is a need to reduce sedentary time in childcare centres Background Little is known about preschool-aged children ’s levels of  physical activity ( PA ) over the course of the day . Using time-stamped data , we describe the levels and patterns of PA in a population -based sample of four-year-old British children . Methods Within the Southampton Women ’s Survey the PA levels of 593 4-year-old children ( 51 % female ) were measured using ( Actiheart ) accelerometry for up to 7 days . Three outcome measures : minutes spent sedentary ( < 20 cpm ) ; in light ( LPA : ≥20 – 399 cpm ) and in moderate-to-vigorous activity ( MVPA : ≥400 cpm ) were derived . Average daily activity levels were calculated and then segmented across the day ( morning , afternoon and evening ) . MVPA was log-transformed . Two-level r and om intercept models were used to analyse associations between activity level and temporal and demographic factors . Results Children were active for 67 % ( mean 568.5 SD 79.5 minutes ) of their daily registered time on average , with 88 % of active time spent in LPA . All children met current UK guidelines of 180 minutes of daily activity . There were no differences in children ’s average daily levels of sedentary activity and LPA by temporal and demographic factors : differences did emerge when activity was segmented across the day . Sex differences were largest in the morning , with girls being more sedentary , spending fewer minutes in LPA and 18 % less time in MVPA than boys . Children were more sedentary and less active ( LPA and MVPA ) in the morning if they attended childcare full-time compared to part-time , and on weekend mornings compared to weekdays . The reverse was true for weekend afternoons and evenings . Children with more educated mothers were less active in the evenings . Children were less sedentary and did more MVPA on summer evenings compared to winter evenings . Conclusions Preschool-aged children meet current physical activity guidelines , but with the majority of their active time spent in LPA , investigation of the importance of activity intensity in younger children is needed . Activity levels over the day differed by demographic and temporal factors , highlighting the need to consider temporality in future interventions . Increasing girls ’ morning activity and providing opportunities for daytime activity in winter months may be worthwhile Being active offers many physical and emotional benefits contributing to a higher health-related quality of life ( HRQoL ) ; however , this relationship remains unexplored among preschoolers ( aged 2.5 - 5 years ) . This study examined the impact of the Supporting Physical Activity in the Childcare Environment ( SPACE ) , which was an intervention implemented using a cluster r and omized controlled trial on preschoolers ' HRQoL. Childcare centres were r and omly allocated to the experimental ( n = 11 ) or control ( n = 11 ) conditions , and preschoolers ' HRQoL was measured using the parent-report Pediatric Quality of Life Inventory 4.0 ( 3 subscales : physical , psychosocial , and total HRQoL ) at baseline , post-intervention ( i.e. , week 8) , and 6- and 12-month follow-up . A linear mixed-effects model was used to determine if preschoolers in the experimental condition displayed an increased HRQoL post-intervention and at follow-up compared with preschoolers in the control condition . Preschoolers ( n = 234 ) with HRQoL data at baseline and one additional time-point were retained for analyses .  Body mass index was not found to impact significantly on the intervention , and no statistically significant interaction effects were found for any of the 3 HRQoL variables . In conclusion , the SPACE intervention had no impact on  preschoolers ' HRQoL. Given the scarcity of research in this population , additional exploration is necessary to better underst and the potential impact of physical activity participation on 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 Background The aim of these review s is to inform the design and content of interventions to reduce obesity in young children . The behaviors that are associated with obesity/overweight have been studied extensively ; however , the factors associated with these behaviors in young children ( 0 to 6 years ) have not been systematic ally review ed . Over the past few years the focus of obesity prevention has shifted to preschool children because of the high prevalence of obesity at school entry and recognition that habits formed in early life could track into adulthood . In order to develop effective interventions and change behavior , it is important to underst and the factors that are associated with those behaviors . For example , we need to underst and whether it would be more important to target the family , childcare setting s or the wider environment and identify the most effective way of changing these energy balance related behaviors . Methods / Design Quantitative ( intervention and observational ) and qualitative literature on determinants/correlates of fruit and vegetable intake , sugar sweetened beverage and other unhealthy diet intake , and physical activity and sedentary behaviors in young children will be systematic ally identified , mapped and review ed . A common search strategy ( no language or period restrictions ) will be used to identify papers from eight electronic data bases and this will be supplemented by h and - search ing . Next , studies in developed countries that examine the factors associated with these behaviors in children aged 0 to 6 years ( at baseline ) will be screened and mapped descriptively followed by in-depth data extraction , quality assessment and synthesis . Data from quantitative studies will be summarized using either forest plots or harvest plots and narrative synthesis , and qualitative studies using thematic analysis . Qualitative evidence will be integrated with the quantitative evidence , using a parallel synthesis approach , to provide a deeper underst and ing of effective strategies to influence these energy balance related behaviors . Discussion In addition to updating and mapping current research , these review s will be the first to comprehensively synthesize and integrate both the quantitative and qualitative evidence pertaining to determinants/correlates/barriers/facilitators of obesity related behaviors in this young age group ( 0 to 6 years ) with the aim of informing future interventions . Systematic review registration International Prospect i ve Register for Systematic Review s ( PROSPERO ) Registration number : Background Today ’s children are more overweight than previous generations and physical inactivity is a contributing factor . Modelling and promoting positive behaviour in the early years is imperative for the development of lifelong health habits . The social and physical environments where children spend their time have a powerful influence on behaviour . Since the majority of preschool children spend time in care outside of the home , this provides an ideal setting to examine the ability of an intervention to enhance movement skills and modify physical activity behaviour . This study aims to evaluate the efficacy of the Activity Begins in Childhood ( ABC ) intervention delivered in licensed daycare setting s alone or in combination with a parent-driven home physical activity-promotion component to increase preschoolers ’  overall physical activity levels and , specifically , the time spent in moderate to vigorous physical activity . Methods / design This study is a single site , three-arm , cluster-r and omized controlled trial design with a daycare centre as the unit of measurement ( clusters ) . All daycare centres in the National Capital region that serve children between the ages of 3 and 5 , expressing an interest in receiving the ABC intervention will be invited to participate . Those who agree will be r and omly assigned to one of three groups : i ) ABC program delivered at a daycare centre only , ii ) ABC program delivered at daycare with a home/parental education component , or iii ) regular daycare curriculum . This study will recruit 18 daycare centres , 6 in each of the three groups . The intervention will last approximately 6 months , with baseline assessment prior to ABC implementation and follow-up assessment s at 3 and 6 months . Discussion Physical activity is an acknowledged component of a healthy lifestyle and childhood experiences as it has an important impact on lifelong behaviour and health . Opportunities for physical activity and motor development in early childhood may , over the lifespan , influence the maintenance of a healthy body weight and reduce cardiovascular disease risk . If successful , the ABC program may be implemented in daycare centres as an effective way of increasing healthy activity behaviours of preschoolers . Trial registration Current Controlled Trials : IS RCT N94022291 . Registered in December 2012 , first cluster r and omized in April 2013 Background There is considerable scope to improve the delivery of practice s that increase the physical activity of children in centre based childcare services . Few studies have reported the effectiveness of interventions to address this , particularly at a population level . The primary aim of this study was to describe the impact of an intervention to increase the adoption of multiple policies and practice s to promote physical activity in centre based childcare services . Methods A quasi experimental study was conducted in centre based childcare services ( n = 228 ) in New South Wales ( NSW ) , Australia and involved a three month intervention to increase the adoption of eight practice s within childcare services that have been suggested to promote child physical activity . Intervention strategies to support the adoption of practice s included staff training , re sources , incentives , follow-up support and performance monitoring and feedback .  R and omly selected childcare services in the remainder of NSW acted as a comparison group ( n = 164 ) and did not receive the intervention but may have been exposed to a concurrent NSW government healthy eating and physical activity initiative . Self reported information on physical activity policies , fundamental movement skills sessions , structured physical activity opportunities , staff involvement in active play and provision of verbal prompts to encourage physical activity , small screen recreation opportunities , sedentary time , and staff trained in physical activity were collected by telephone survey with childcare service managers at baseline and 18 months later . Results Compared with the comparison area , the study found significantly greater increases in the prevalence of intervention services with a written physical activity policy , with policy referring to placing limits on small screen recreation , and with staff trained in physical activity . In addition , non-significant trends towards a greater increase in the proportion of intervention services conducting daily fundamental movement skill sessions , and such services having a physical activity policy supporting physical activity training for staff were also evident . Conclusion The intervention was effective in improving a number of centre based childcare service policies and practice s associated with promoting child physical activity . Adoption of a broader range of practice s may require more intensive and prolonged intervention support Background Promotion of healthy eating and physical activity in early childhood is recommended as a global chronic disease prevention strategy . Centre-based childcare services represent a promising setting to provide children with opportunities to improve healthy eating and physical activity . Evidence to inform implementation of childcare obesity prevention guidelines into routine practice in childcare , however , is lacking . This study aims to assess the effectiveness of an intervention , delivered to childcare staff , aim ing to increasing service implementation of healthy eating and physical activity-promoting policies and practice s. Methods and analysis A pragmatic parallel group r and omised controlled trial will be undertaken with 165 childcare services in the Hunter New Engl and region of New South Wales , Australia . Services will be r and omised to receive either a 10-month evidence -based performance review intervention with other re sources to support practice change , or to a waitlist control group . The primary trial outcome is the proportion of services implementing all of the following recommended healthy eating and physical activity promoting practice s : written nutrition , physical activity and small screen recreation policies ; providing information to families regarding healthy eating ( including breastfeeding ) , physical activity and small screen time ; providing twice weekly healthy eating learning experiences to children ; providing water and only plain milk to children ; providing fundamental movement skills activities for children every day ; and limiting and using electronic screen time more for educational purpose s and learning experiences . Effectiveness will be assessed using a telephone interview of practice implementation with childcare staff at baseline and 12 months following baseline . Ethics and dissemination The study was approved by the Hunter New Engl and Human Research Ethics Committee and the University of Newcastle Human Research Ethics Committee . Study findings will be disseminated widely through peer- review ed publications and conference presentations . Trial registration number Australian New Zeal and Clinical Trials Registry ACTRN12614000972628 OBJECTIVES To assess the effect of a physical activity intervention delivered in the childcare centres ( CC ) , with or without a parent-driven home physical activity component , on children 's fundamental motor skills ( FMS ) . DESIGN Six-month 3-arm cluster r and omized controlled trial . METHODS Preschoolers were recruited from 18 licensed CC . CC were r and omly assigned to a typical curriculum comparison group ( COM ) , childcare intervention alone ( CC ) , or childcare intervention with parental component ( CC+HOME ) . FMS was measured with the Test of Gross Motor Development-2 . Linear mixed models were performed at the level of the individual while accounting for clustering . RESULTS Raw locomotor skills score increased significantly in the CC group ( mean difference=2.5 units , 95 % Confidence Intervals , CI , 1.0 - 4.1 , p<0.001 ) and the CC+HOME group ( mean difference=2.4 units , 95 % CI , 0.8 - 4.0 , p<0.001 ) compared to the COM group . No significant ( p>0.05 ) between group differences were observed in the raw object control skills , sum of raw scores , or gross motor quotient . No significant sex differences were found in any of the measured outcomes . CONCLUSIONS A physical activity intervention delivered in childcare with or without parents ' involvement was effective in increasing locomotor skills in preschoolers
Conclusion Physical activity and sedentary time were highly varied and inconsistent between studies ; therefore , it is difficult to determine preschoolers ’ true amount of physical activity and sedentary time during childcare hours .
Despite this variability , preschoolers were noted to participate in high rates of sedentary time in this setting .
The lack of homogeneity is an important finding in and of itself as it highlights the lack of consistency in measuring , processing , and reporting paediatric physical activity data
Background Many preschoolers spend a substantial portion of their day enrolled in centre-based childcare ; the amounts of physical activity and sedentary time accumulated in this environment are critical to preschoolers ’ ability to meet movement guidelines .
The purpose of this systematic review was to provide a comprehensive overview of the objective ly assessed physical activity  and  sedentary time  of preschoolers in centre-based childcare ( registration no. CRD42016033502 ) .