Discussion
FMS, PA behaviors
HEAT, RECRUITMENT, FMS
This study investigated the effects of an ECE setting based environmental intervention on increasing PA, FMS, and reducing sedentary time in preschool-age children. PA behaviors did not increase after the implementation of the program in the intervention compared to the control groups. There was partial evidence that FMS performance significantly improved for the ECE centers who received the playground markings; however, this FMS improvement was not significant when compared to the control group. Children were actively engaged with the markings, and there were differences in which marking with which boys vs. girls more frequently engaged. ECE directors and teachers supported the implementation of these markings and the curriculum provided (both written and video) for the program. Overall, this investigation into a low-cost, outdoor playground enhancement was feasible and satisfactory, but could be improved for a significant effect on child PA and FMS.To our knowledge, this is the first study that examined the effects of a playground stencil intervention among preschoolers’ PA and FMS performance. One study by Cardon and colleagues targeted PA improvements for preschoolers in a few ways, including playground markings, game equipment, and a combination of the two [There are several possibilities of why the lack of change in PA results were found. First, overall recess engagement was not captured during the six to eight weeks between measurements, so it is unclear if PA levels changed initially (perhaps due to a novelty effect) and then returned once this reactivity period subsided. Other research utilizing playground markings suggested that initial “novelty effects” might explain increases in PA for shorter interventions (i.e., < 4 weeks) [In regards to FMS, the current study results indicate that change in ball skills, locomotor skills, and total FMS raw scores among preschoolers in the intervention group did not differ significantly with those in the control group. However, there was a significant improvement in ball skills and locomotor skills among preschoolers from the intervention group only. The mean of changes of ball skill and locomotor skill percentile scores after the intervention were slightly higher (but not at the level of statistical significance) among the preschoolers in the intervention group compared to those in the control group. Improvement of FMS is important to ensure children’s development trajectories of health [One strength of this study is that painted markings on a playground is a pragmatic, low-cost intervention. As playground equipment is generally expensive and portable equipment may be damaged or lost over time, centers might find that enhancing playgrounds in this semi-permanent way may contribute to more opportunities for outdoor play at a lower cost. Directors and teachers indicated that students used the markings to reinforce academic concepts, which has more additive benefits for programs to reinforce both PA and academics in this population.Limitations include the small sample for this pilot study. Only four schools were examined in one region of the United States, so results may only be generalizable to this area or to programs with similar characteristics. Children and teachers may use playground markings differently across varied outdoor environments such as urban vs. rural settings, in areas of high pollution, or in areas that experience extreme weather, such as heat or heavy snow. The main barrier to recruiting centers was the lack of adequate concrete space or concrete space that was limited (i.e., sidewalks, space against the buildings, or small bike paths, or concrete space that was not within safe confines like a fence or playground). The limited access to concrete space in most ECE centers is a limitation that must be considered for the expansion of this intervention. During the recruitment period, it was observed that rural ECE centers were more likely to have larger spaces, access to concrete spaces, and be under-resourced. Therefore, expansion may be better suited to rural areas and to smaller centers.Finally, intervention fidelity was not measured, nor was PA measured immediately after introducing the markings on the playground. The goal was to ensure that enough time had elapsed to avoid any “novelty effect” (i.e., four weeks based on previous research) that might have accompanied this playground enhancement. Therefore, an investigation of the time course of children’s engagement with painted playgrounds would be helpful in planning future interventions. Extending the follow-up observations past the 6–8 weeks used in the present study might have allowed for reactivity to subside and allowed for additional FMS practice. Future work could extend the follow-up assessments to determine whether or not more time might have influenced either PA or FMS with additional recess practice time or if adding new markings as interest and trends change elicits continued PA. Additionally, a brief playground observation was used to see how children were engaging with the markings. Results showed that most of the play was child-led, the majority of activities took place in small groups, and boys and girls tended to engage with different markings. Teachers may be able to better integrate classroom lessons into the playground to increase use, as teacher engagement influenced children’s use of the stencils and engagement in PA. In addition, more insight from teachers and directors would be useful in understanding the dynamics surrounding this type of environmental change. More observations during the first few weeks may have provided additional insight into how to maximize these markings on the playground and how to better integrate PA opportunities during outdoor play time.