Two Approaches to Increase Physical Activity for Preschool Children in Child Care Centers: A Matched-Pair Cluster-Randomized Trial
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Recruitment and Participants
2.3. Interventions
2.3.1. Active Play! Intervention
2.3.2. Outdoor Play! Intervention
2.4. Measures
2.4.1. Active Play Opportunities
2.4.2. PA Levels
2.4.3. Demographics
2.4.4. Acceptability/Satisfaction
2.5. Analyses
3. Results
3.1. Child Physical Activity
3.1.1. Pre-Intervention
3.1.2. Post-Intervention
3.1.3. Characterization of Children’s PA Levels by PA Opportunities
3.2. Acceptability/Satisfaction
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- Carson, V.; Hunter, S.; Kuzik, N.; Wiebe, S.A.; Spence, J.C.; Friedman, A.; Tremblay, M.S.; Slater, L.; Hinkley, T. Systematic review of physical activity and cognitive development in early childhood. J. Sci. Med. Sport. 2016, 19, 573–578. [Google Scholar] [CrossRef] [PubMed]
- LeBlanc, A.G.; Spence, J.C.; Carson, V.; Connor Gorber, S.; Dillman, C.; Janssen, I.; Kho, M.E.; Stearns, J.A.; Timmons, B.W.; Tremblay, M.S. Systematic review of sedentary behaviour and health indicators in the early years (aged 0–4 years). Appl. Physiol. Nutr. Metab. 2012, 37, 753–772. [Google Scholar] [CrossRef] [PubMed]
- Carson, V.; Kuzik, N.; Hunter, S.; Wiebe, S.A.; Spence, J.C.; Friedman, A.; Tremblay, M.S.; Slater, L.G.; Hinkley, T. Systematic review of sedentary behavior and cognitive development in early childhood. Prev. Med. 2015, 78, 115–122. [Google Scholar] [CrossRef] [PubMed]
- Timmons, B.W.; LeBlanc, A.G.; Carson, V.; Connor Gorber, S.; Dillman, C.; Janssen, I.; Kho, M.E.; Spence, J.C.; Stearns, J.A.; Tremblay, M.S. Systematic review of physical activity and health in the early years (aged 0–4 years). Appl. Physiol. Nutr. Metab. 2012, 37, 773–792. [Google Scholar] [CrossRef] [PubMed]
- National Association for Sport and Physical Education. Active Start: A Statement of Physical Activity Guidelines for Children from Birth to Age 5, 2nd ed.; American Alliance for Health, Physical Education, Recreation, and Dance: Sewickley, PA, USA, 2009. [Google Scholar]
- Tucker, P. The physical activity levels of preschool-aged children: A systematic review. Early Child. Res. Q. 2008, 23, 547–558. [Google Scholar] [CrossRef]
- Hinkley, T.; Salmon, J.; Okely, A.D.; Crawford, D.; Hesketh, K. Preschoolers’ physical activity, screen time, and compliance with recommendations. Med. Sci. Sports Exerc. 2012, 44, 458–465. [Google Scholar] [CrossRef]
- Federal Interagency Forum on Child and Family Statistics. America’s Children in Brief: Key National Indicators of Well-Being, 2016; Government Printing Office: Washington, DC, USA, 2016.
- Bower, J.K.; Hales, D.P.; Tate, D.F.; Rubin, D.A.; Benjamin, S.E.; Ward, D.S. The childcare environment and children’s physical activity. Am. J. Prev. Med. 2008, 34, 23–29. [Google Scholar] [CrossRef]
- Willenberg, L.J.; Ashbolt, R.; Holland, D.; Gibbs, L.; MacDougall, C.; Garrard, J.; Green, J.B.; Waters, E. Increasing school playground physical activity: A mixed methods study combining environmental measures and children’s perspectives. J. Sci. Med. Sport 2010, 13, 210–216. [Google Scholar] [CrossRef]
- Ridgers, N.D.; Stratton, G.; Fairclough, S.J.; Twisk, J.W. Long-term effects of a playground markings and physical structures on children’s recess physical activity levels. Prev. Med. 2007, 44, 393–397. [Google Scholar] [CrossRef]
- Brown, W.H.; Googe, H.S.; McIver, K.L.; Rathel, J.M. Effects of Teacher-Encouraged Physical Activity on Preschool Playgrounds. J. Early Interv. 2009, 31, 126–145. [Google Scholar] [CrossRef]
- Brown, W.H.; Pfeiffer, K.A.; McIver, K.L.; Dowda, M.; Addy, C.L.; Pate, R.R. Social and environmental factors associated with preschoolers’ nonsedentary physical activity. Child Dev. 2009, 80, 45–58. [Google Scholar] [CrossRef] [PubMed]
- Henderson, K.E.; Grode, G.M.; O’Connell, M.L.; Schwartz, M.B. Environmental factors associated with physical activity in childcare centers. Int. J. Behav. Nutr. Phys. Act. 2015, 12, 43. [Google Scholar] [CrossRef] [PubMed]
- Finch, M.; Jones, J.; Yoong, S.; Wiggers, J.; Wolfenden, L. Effectiveness of centre-based childcare interventions in increasing child physical activity: A systematic review and meta-analysis for policymakers and practitioners. Obes. Rev. 2016, 17, 412–428. [Google Scholar] [CrossRef]
- Preventing Childhood Obesity in Early Care and Education: Selected Standards from Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition. Available online: http://nrckids.org/CFOC3/PDFVersion/preventing_obesity.pdf (accessed on 1 February 2015).
- Florez, H.; Martinez, R.; Chacra, W.; Strickman-Stein, N.; Levis, S. Outdoor exercise reduces the risk of hypovitaminosis D in the obese. J. Steroid Biochem. Mol. Biol. 2007, 103, 679–681. [Google Scholar] [CrossRef] [PubMed]
- Fjortoft, I. The Natural Environment as a Playground for Children: The Impact of Outdoor Play Activities in Pre-Primary School Children. Early Child. Educ. J. 2001, 29, 111–117. [Google Scholar] [CrossRef]
- Rose, K.A.; Morgan, I.G.; Ip, J.; Kifley, A.; Huynh, S.; Smith, W.; Mitchell, P. Outdoor activity reduces the prevalence of myopia in children. Ophthalmology 2008, 115, 1279–1285. [Google Scholar] [CrossRef]
- Burdette, H.L.; Whitaker, R.C. Resurrecting free play in young children: Looking beyond fitness and fatness to attention, affiliation, and affect. Arch. Pediatr. Adolesc. Med. 2005, 159, 46–50. [Google Scholar] [CrossRef]
- Wells, N.M. At Home with Nature. Environ. Behav. 2000, 32, 775–795. [Google Scholar] [CrossRef] [Green Version]
- Wells, N.M. Evans GW: Nearby Nature. Environ. Behav. 2003, 35, 311–330. [Google Scholar] [CrossRef]
- Taylor, A.F.; Kuo, F.E. Children with attention deficits concentrate better after walk in the park. J. Atten. Disord. 2009, 12, 402–409. [Google Scholar] [CrossRef]
- Tandon, P.S.; Saelens, B.E.; Christakis, D.A. Active Play Opportunities at Child Care. Pediatrics 2015, 135(6), e1425–e1431. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Alhassan, S.; Sirard, J.R.; Robinson, T.N. The effects of increasing outdoor play time on physical activity in Latino preschool children. Int. J. Pediatr. Obes. 2007, 2, 153–158. [Google Scholar] [CrossRef] [PubMed]
- Hesketh, K.R.; O’Malley, C.; Paes, V.M.; Moore, H.; Summerbell, C.; Ong, K.K.; Lakshman, R.; van Sluijs, E.M.F. Determinants of Change in Physical Activity in Children 0–6 years of Age: A Systematic Review of Quantitative Literature. Sports Med. 2017, 47, 1349–1374. [Google Scholar] [CrossRef]
- Craft, D.; Smith, C. Active Play! Fun Physical Activities for Young Children; Active Play Books: Cortland, NY, USA, 2008. [Google Scholar]
- Pate, R.R.; Almeida, M.J.; McIver, K.L.; Pfeiffer, K.A.; Dowda, M. Validation and calibration of an accelerometer in preschool children. Obesity 2006, 14, 2000–2006. [Google Scholar] [CrossRef] [PubMed]
- Maynard, T.; Waters, J.; Clement, J. Moving outdoors: Further explorations of ‘child-initiated’ learning in the outdoor environment. Education 3-13 2013, 41, 282–299. [Google Scholar] [CrossRef]
- Alhassan, S.; Nwaokelemeh, O.; Mendoza, A.; Shitole, S.; Whitt-Glover, M.C.; Yancey, A.K. Design and baseline characteristics of the Short bouTs of Exercise for Preschoolers (STEP) study. BMC Public Health 2012, 12, 582. [Google Scholar] [CrossRef] [PubMed]
- Tucker, P.; Burke, S.M.; Gaston, A.; Irwin, J.D.; Johnson, A.M.; Timmons, B.W.; Vanderloo, L.M.; Driediger, M. Supporting Physical Activity in the Childcare Environment (SPACE): Rationale and study protocol for a cluster randomized controlled trial. BMC Public Health 2016, 16, 112. [Google Scholar] [CrossRef]
- Sisson, S.B.; Krampe, M.; Anundson, K.; Castle, S. Obesity prevention and obesogenic behavior interventions in child care: A systematic review. Prev. Med. 2016, 87, 57–69. [Google Scholar] [CrossRef]
- Ward, D.S.; Vaughn, A.; McWilliams, C.; Hales, D. Interventions for Increasing Physical Activity at Child Care. Med. Sci. Sports Exerc. 2010, 42, 526–534. [Google Scholar] [CrossRef]
- Pate, R.R.; Brown, W.H.; Pfeiffer, K.A.; Howie, E.K.; Saunders, R.P.; Addy, C.L.; Dowda, M. An intervention to increase physical activity in children: A randomized controlled trial with 4-year-olds in Preschools. Am. J. Prev. Med. 2016, 51, 12–22. [Google Scholar] [CrossRef]
- Centers for Disease Control and Prevention. Spectrum of Opportunities for Obesity Prevention in the Early Care and Education (ECE) Setting. Available online: https://www.cdc.gov/obesity/strategies/early-care-education/pdf/TheSpectrumofOpportunitiesFramework_May2018_508.pdf (accessed on 18 October 2019).
Category | Description | Examples |
---|---|---|
No Opportunities for PA | ||
1. Non-active time | All indoor/outdoor structured and non-structured ‘non-active’ activities | Circle time, seated learning activities, meals |
2. Naptime | Children required to sleep or lay on a mat for ‘quiet’ activities | Naptime |
Opportunities for PA | ||
3. Outdoor child-initiated activity | Children free to choose activities outdoors | Free play in playground |
4. Outdoor teacher-led activity | Teacher-led activities outdoors | Running laps, active games; all children expected to participate |
5. Indoor child-initiated activity | Active play encouraged indoors with children initiating activities | Climbing equipment, balls (in an indoor playroom) |
6. Indoor teacher-led activity | Teacher-led activities indoors | Yoga, ball games; all children expected to participate |
Active Play! | Outdoor Play! | p-Value * | |
---|---|---|---|
Child | (n = 35) | (n = 47) | |
Female | 61.3 | 52.5 | 0.32 |
Age, mean (SD) | 4.5 (0.6) | 4.6 (0.4) | |
Race/ethnicity | |||
White | 57.1 | 63.8 | 0.54 |
African American/ black | 5.7 | 4.3 | 0.76 |
Asian/ Native American/ Pacific Islander | 8.6 | 4.3 | 0.42 |
Hispanic | 5.7 | 2.1 | 0.39 |
>1 race | 22.9 | 25.5 | 0.78 |
Highest educational attainment in household | |||
Less than high school | 0 | 4.3 | 0.22 |
Completed high school | 24.2 | 25.5 | 0.78 |
Completed college | 51.5 | 53.2 | 0.68 |
Graduate/professional degree | 24.2 | 17.0 | 0.51 |
Household income, $ | |||
≤29,000 | 27.3 | 34.1 | 0.54 |
30,000-49,000 | 27.3 | 9.1 | 0.04 |
50,000-69,000 | 0.0 | 9.1 | 0.08 |
70,000-89,000 | 15.0 | 11.4 | 0.82 |
≥90,000 | 30.3 | 36.4 | 0.60 |
Teacher | (n = 6) | (n = 8) | |
Female | 100 | 100 | - |
Age, mean (SD) | 32.0 (14.1) | 39.8 (12.5) | 0.32 |
Race | |||
White | 16.7 | 75.0 | 0.03 |
African American/ black | 16.7 | 12.5 | 0.83 |
Asian/ Native American/ Pacific Islander | 33.4 | 12.5 | 0.35 |
Hispanic | 33.3 | 0.0 | 0.08 |
Highest educational attainment | |||
Completed high school | 66.7 | 87.5 | 0.35 |
Completed college | 0.0 | 12.5 | 0.37 |
Graduate/professional degree | 33.3 | 0.0 | 0.08 |
Min/day | Active Play! (n = 43) | Outdoor Play! (n = 54) | Adjusted Diff between Groups 2 | ||||
---|---|---|---|---|---|---|---|
Pre Mean (SD) | Post Mean (SD) | Adjusted Change Mean (95% CI) 2 | Pre Mean (SD) | Post Mean (SD) | Adjusted Change Mean (95% CI) 2 | ||
Sedentary time | 276.5 (41.9) | 256.6 (50.9) | −8.4 (−19.2, 2.3) | 281.2 (50.2) | 268.2 (54.7) | 2.6 (−7.6, 12.9) | 3.4 (−11.3, 18.1) |
LPA | 46.6 (12.4) * | 44.7 (11.3) | 2.5 (−1.8, 6.7) | 51.5 (11.6) * | 47.0 (13.1) | −3.1 (−7.1, 0.9) | −3.0 (−8.7, 2.7) |
MVPA | 51.1 (18.0) | 53.2 (16.4) | 5.7 (−2.1, 13.4) | 56.7 (17.9) | 57.8 (20.1) | 0.4 (−6.6, 7.5) | −0.5 (−10.8, 9.8) |
Min/day | Active Play! (n = 43) | Outdoor Play! (n = 54) | Adjusted Diff between Groups 2 | ||||
---|---|---|---|---|---|---|---|
Pre Mean (SD) | Post Mean (SD) | Adjusted Change Mean (95% CI) 2 | Pre Mean (SD) | Post Mean (SD) | Adjusted Change Mean (95% CI) 2 | ||
No opportunity for PA, total | 382.1 (52.6) | 366.7 (62.3) | −8.4 (−16.4, −0.5) | 380.0 (54.5) | 361.3 (57.1) | −13.4 (−17.6, −9.3) | 0.8 (−7.2, 8.7) |
Non-active time | 251.5 (41.7) * | 231.4 (48.8) | −12.4 (−25.8, 0.9) | 282.0 (42.8) * | 257.3 (49.4) | −21.6 (−29.0, −14.1) | 0.3 (−13.4, 14.1) |
Naptime | 130.6 (30.5) * | 135.3 (31.0) | 3.2 (−6.9, 13.3) | 98.0 (25.8) * | 104.0 (27.5) | 8.0 (0.8, 15.2) | 0.5 (−11.0, 11.9) |
Opportunity for PA, total | 46.1 (15.1) | 61.8 (27.4) | 11.3 (4.0, 18.7) | 50.4 (13.7) | 59.7 (13.8) | 13.7 (9.7, 17.8) | −2.8 (−10.4, 4.8) |
Outdoor child-initiated | 27.8 (10.9) * | 48.6 (24.2) | 18.8 (12.6, 25.0) | 35.8 (14.6) * | 55.9 (14.4) | 23.8 (19.1, 28.4) | 2.0 (−5.1, 9.1) |
Outdoor teacher-led | 0.4 (1.2) | 3.1 (7.4) | 2.5 (0.1, 4.9) | 0.4 (0.9) | 0.4 (0.8) | 0.1 (−0.2, 0.5) | −2.6 (−4.5, −0.7) |
Indoor child-initiated | 9.0 (9.4) | 2.4 (3.8) | −8.2 (−11.5, −4.9) | 6.1 (7.2) | 0.0 (0.0) | −5.5 (−7.3, −3.7) | 1.5 (−1.8, 4.8) |
Indoor teacher-led | 8.8 (11.0) | 7.7 (6.3) | −1.9 (−5.1, 1.4) | 8.2 (6.7) | 3.4 (4.2) | −4.7 (−6.5, −2.9) | −3.7 (−6.9, −0.4) |
Total outdoor time 3 | 28.3 (10.7) * | 51.7 (26) | 21.4 (14.6, 28.3) | 36.1 (15.0) * | 56.3 (14.4) | 23.9 (19.3, 28.6) | −0.6 (−8.1, 6.9) |
Total indoor time 4 | 399.9 (56.3) | 376.7 (63.9) | −18.7 (−27.0, −10.5) | 394.3 (55.8) | 364.7 (58.2) | −23.6 (−28.4, −18.9) | −1.3 (−9.7, 7.1) |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Tandon, P.S.; Downing, K.L.; Saelens, B.E.; Christakis, D.A. Two Approaches to Increase Physical Activity for Preschool Children in Child Care Centers: A Matched-Pair Cluster-Randomized Trial. Int. J. Environ. Res. Public Health 2019, 16, 4020. https://doi.org/10.3390/ijerph16204020
Tandon PS, Downing KL, Saelens BE, Christakis DA. Two Approaches to Increase Physical Activity for Preschool Children in Child Care Centers: A Matched-Pair Cluster-Randomized Trial. International Journal of Environmental Research and Public Health. 2019; 16(20):4020. https://doi.org/10.3390/ijerph16204020
Chicago/Turabian StyleTandon, Pooja S., Katherine L. Downing, Brian E. Saelens, and Dimitri A. Christakis. 2019. "Two Approaches to Increase Physical Activity for Preschool Children in Child Care Centers: A Matched-Pair Cluster-Randomized Trial" International Journal of Environmental Research and Public Health 16, no. 20: 4020. https://doi.org/10.3390/ijerph16204020