Discussion
In our study, family caregivers on average implemented only 2 of 9 physical activity–related best practices. For every physical activity practice met by caregivers, the percentage of children’s MVPA time increased by 0.8%, and the percentage of their sedentary time decreased by 2.1%. Physical activity during the preschool years is associated with many health benefits (Our previous research found that the following physical activity best practices were least likely to be met by caregivers (ie, met by less than 20% of caregivers): providing children with at least 60 minutes of outdoor play daily, providing children with at least 45 minutes of adult-led physical activity each day, participating in outdoor physical activity with children, participating in indoor physical activity with children, prompting and praising children for being active, and talking with children informally about the importance of physical activity (Our analysis found that meeting best practices related to providing enough outdoor physical activity time and the caregiver leading both indoor and outdoor play were significantly associated with more MVPA levels and less sedentary time. This finding agrees with previous studies that reported that frequency of outdoor play and opportunities for structured physical activity were strongly associated with higher physical activity levels in both center-based childcare settings and FCCHs (We also found in our study that children were more active in FCCHs if caregivers participated in indoor physical activity with them. Caregivers’ encouragement of indoor play in childcare centers has been associated with children’s physical activity (In our study, for every screen time practice met by caregivers, the percentage of child MVPA time increased by 0.7%, and the percentage of child sedentary time decreased by 2.1%. Our previous research found that although more than half of caregivers in FCCHs met guidelines for no television viewing during the child’s meal and snack time and providing families with information about children’s screen time, less than a third of caregivers limited screen time to less than 30 minutes per week (We found that the most important caregiver practice in promoting children’s physical activity was leading the physical activity and active play indoors and outdoors. Future interventions and training should support caregivers in implementing these physical activity–related best practices. However, such interventions should also acknowledge the barriers that caregivers may face related to implementing these practices. For example, lack of indoor play space has been consistently identified as a barrier to promotion of physical activity in FCCHs (Outdoor play in general and neighborhood-level inequities (eg, access to parks and playgrounds) are also clearly linked (Several opportunities exist to use policy to improve physical activity environments in FCCHs, for example, the guidelines for physical activity and screen time of the federal Child and Adult Care Food Program (Our study had several limitations. We purposely over-recruited Hispanic caregivers because they have been ignored in most prior research. Thus, selection bias may be a concern, and results may not be representative of all FCCHs. Because only baseline data were analyzed, we cannot provide cause-and-effect interpretations of the data. Although the use of accelerometers to assess physical activity and our observation methods for assessing physical activity and screen time practices are both study strengths, we had only 2 days of data; thus, these data may not be completely representative of caregivers’ usual physical activity and screen time practices and children’s usual physical activity patterns in the childcare setting. Furthermore, our binary scores likely did not capture the variability of activity-related practices in FCCHs, which would decrease the likelihood of finding significant differences in child activity levels.