title: Effects of Child Care Intervention on Physical Activity and Body Composition. Effects of locomotor skill program on minority preschoolers' physical activity levels. Physical Activity in Children Attending Preschools 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 Promoting fundamental movement skill development and physical activity in early childhood settings: a cluster randomized controlled trial. Design and baseline characteristics of the Short bouTs of Exercise for Preschoolers (STEP) study Child Care Center Characteristics Associated With Preschoolers' Physical Activity. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. The effects of increasing outdoor play time on physical activity in Latino preschool children. Feasibility and Effects of Short Activity Breaks for Increasing Preschool-Age Children's Physical Activity Levels. An Intervention to Increase Physical Activity in Children: A Randomized Controlled Trial With 4-Year-Olds in Preschools. Preschool children physical activity measurement: importance of epoch length choice. Comparison of Actical and activPAL measures of sedentary behaviour in preschool children.
abstract: INTRODUCTION This study evaluated whether intervening with child care providers would increase physical activity ( PA )  and reduce adiposity in preschoolers . METHODS This was a two-arm , parallel group , cluster RCT whereby six child care centers were r and omly assigned in equal numbers to intervention ( n=40 children ) or control ( n=43 children ) . Participants were aged 3 - 5 years and attended licensed child care centers . Child care providers received two 3-hour train-the-trainer workshops and a training manual at program initiation aim ed at increasing structured and unstructured PA through active play . Control child care centers implemented their st and ard curriculum .  PA and sedentary behavior were measured by accelerometry , and body composition was measured using bioelectrical impedance at baseline and 6 months . Data were collected in 2011 - 2012 and analyzed in April 2015 . RESULTS Linear mixed-effects modeling showed that at 6 months , children in the intervention group demonstrated greater increases in minutes per preschool day spent in overall PA ( 22.5 minutes , 95 % CI=8.9 , 36.1 , p=0.002 ) , and light-intensity PA ( 16.1 minutes , 95 % CI=5.2 , 26.7 , p=0.004 ) , but changes between groups in moderate to vigorous PA did not differ . The intervention group showed greater reductions in body fat percentage ( -1.9 % , 95 % CI=-3.5 , -0.3 , p=0.023 ) and fat mass ( -0.3 kg , 95 % CI=-0.7 , -0.1 , p=0.018 ) , but groups did not differ on fat-free mass , BMI , or z- BMI . CONCLUSIONS Provider-led intervention in child care centers increased preschoolers '  PA and reduced adiposity , therefore may represent a viable approach to promoting PA and related health benefits in preschool-aged children . TRIAL REGISTRATION This study is registered at www . clinical trials.gov NCT02293278 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 OBJECTIVE : To identify correlates of objective ly measured moderate and vigorous physical activity ( MVPA ) in children during preschool attendance . METHODS : This cross-sectional study included data from 426 apparently healthy Danish children ( 49.5 % boys ) , 5 to 6 years of age enrolled in 42 r and omly selected preschools . The percentage of time spent in MVPA ( ≥574 counts/15 second ) during preschool attendance was measured using ActiGraph accelerometers over 4.3 preschool days in May and June in 2009 . Thirty-seven potential correlates across the child , preschool staff , and preschool environment domains were tested for associations with MVPA . RESULTS : The final multivariate model identified 9 significant correlates of MVPA . Preterm birth , vegetation on the playground , and rainy days were negatively associated with MVPA , whereas child motor coordination , location of preschool building on the playground , gender ( boys ) , percentage afternoon hours , and size of indoor area per child were positively associated with MVPA . The direction of the significant association with the parental mean education level was unclear . CONCLUSIONS : We identified a number of new modifiable correlates  of MVPA  during preschool attendance . The positive association with size of indoor area per child and location of the preschool building on the playground seem important correlates to be targeted in future studies 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 The aim of this study was to assess the feasibility , acceptability and potential efficacy of a physical activity program for preschool children . A 20-week , 2-arm parallel cluster r and omized controlled pilot trial was conducted . The intervention comprised structured activities for children and professional development for staff . The control group participated in usual care activities , which included design ated inside and outside playtime . Primary outcomes were movement skill development and objective ly measured physical activity . At follow-up , compared with children in the control group , children in the intervention group showed greater improvements in movement skill proficiency , with this improvement statically significant for overall movement skill development ( adjust diff . = 2.08 , 95 % CI 0.76 , 3.40 ; Cohen 's d = 0.47 ) and significantly greater increases in objective ly measured physical activity ( counts per minute ) during the preschool day ( adjust diff . = 110.5 , 95 % CI 33.6 , 187.3 ; Cohen 's d = 0.46 ) . This study demonstrates that a physical activity program implemented by staff within a preschool setting is feasible , acceptable and potentially efficacious Background Most preschool centers provide two 30-min sessions of gross-motor/outdoor playtime per preschool day . Within this time frame , children accumulate most of their activity within the first 10 min . This paper describes the design and baseline participant characteristics of the Short bouTs of Exercise for Preschoolers ( STEP ) study . The STEP study is a cluster r and omized controlled study design ed to examine the effects of short bouts of structured physical activity ( SBS-PA ) implemented within the classroom setting as part of design ated gross-motor playtime on during-school physical activity ( PA ) in preschoolers . Methods / Design Ten preschool centers serving low-income families were r and omized into  SBS-PA versus unstructured PA ( UPA ) . SBS-PA schools were asked to implement age-appropriate 10 min structured PA routines within the classroom setting , twice daily , followed by 20 min of usual unstructured playtime . UPA intervention consisted of 30 min of supervised unstructured free playtime twice daily . Interventions were implemented during the morning and afternoon design ated gross-motor playtime for 30 min/session , five days/week for six months . Outcome measures were between group difference in during-preschool PA ( accelerometers and direct observation ) over six-months . Ten preschool centers , representing 34 classrooms and 315 children , enrolled in the study . The average age and BMI percentile for the participants was 4.1 ± 0.8 years and 69th percentile , respectively . Participants spent 74 % and 6 % of their preschool day engaged in sedentary and MVPA , respectively . Discussion Results from the STEP intervention could provide evidence that a PA policy that exposes preschoolers to shorter bouts of structured PA throughout the preschool day could potentially increase preschoolers ’ PA levels . Trial registration Clinical trials.gov , INTRODUCTION Despite children spending long hours in child care centers , it is unknown what center characteristics are associated with children 's  moderate to vigorous physical activity ( MVPA )  at the center and over the 24-hour day . METHODS Mixed model ANOVA evaluated associations between 23 center characteristics ( e.g. , policies , facilities , practice s , and staff training ) and  time in MVPA  , measured with accelerometers , at the child care center and over the 24-hour day among 388 preschoolers from 30 r and omly selected child care centers in Cincinnati , Ohio . Data collection occurred from November 2009 through January 2011 ; data analyses occurred in 2012 - 2014 . RESULTS Ninety percent of centers reported scheduling two or more outdoor sessions  daily , yet only 40 % of children had two or more outdoor sessions ; 32 % had no time outdoors . Eighty-three percent of centers reported scheduling ≥60 minutes outdoors  ; 28 % of children experienced this during observation . Children spent a mean ( SE ) of 2.0 ( 0.06 ) minutes/hour in MVPA . Children with ≥60 minutes outdoor time had 0.6 minutes/hour more MVPA in child care ( p=0.001 ) , and 0.5 minutes/hour over the 24-hour day ( p=0.001 ) than those who did not . Presence of an indoor play space , large outdoor playground , portable or fixed play equipment , staff PA training , weather and clothing policies , and TV/computer use were not related to children 's MVPA . CONCLUSIONS Outdoor time  occurred less frequently than scheduled . Children with ≥60 minutes of outdoor time at the center were more active than children without . Centers may increase preschoolers ' PA by adhering to the scheduled ≥60 minutes of outdoor time daily OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity OBJECTIVE A r and omized controlled pilot study to test the hypothesis that increasing preschool children 's  outdoor free play time increases their daily physical activity levels . METHODS Physical activity was assessed by accelerometers for four consecutive school days in thirty-two Latino children ( 3.6+/-0.5 years ) attending a preschool for low-income families . After two days of baseline physical activity assessment , participants were r and omly assigned to an intervention ( RECESS ; n = 17 ) or control ( CON ; n = 15 ) group . The RECESS group received two additional 30-minute periods of outdoor free play time per day for two days . The CON group followed their normal classroom schedule . Between group differences in physical activity variables were tested with a Wilcoxon rank-sum test . RESULTS There were no statistically significant differences between groups in changes from baseline in average total daily ( CON , 48.2+/-114.5 ; RECESS , 58.2+/-74.6 ) and during school day ( CON , 64.6+/-181.9 ; RECESS , 59.7+/-79.1 ) counts per minute , or total daily ( CON , 0.4+/-1.3 ; RECESS , 0.3+/-0.8 ) and during school day ( CON , 0.6+/-2.1 ; RECESS , 0.5+/-0.8 ) percent of time spent in moderate to vigorous physical activity . CONCLUSIONS Substantially increasing preschoolers '  outdoor free play time did not increase their physical activity levels BACKGROUND We examined the effects of short bouts of structured physical activity ( SBS-PA ) implemented within the classroom setting as part of design ated gross-motor playtime on preschoolers PA . METHODS Preschools were r and omized to SBS-PA ( centers , N = 5 ; participants , N = 141 ) or unstructured free playtime ( UPA ) ( centers , N = 5 ; participants , N = 150 ) .  SBS-PA consisted of structured PA implemented in the classroom during the first 10 minutes of gross-motor playtime followed by 20 minutes of free playtime . UPA consisted of 30 minutes of unstructured free playtime . Teachers implemented both conditions for 5 days/week for 6 months . PA was assessed with accelerometers ( preschool-day ) and direct observation ( 30-minute sessions ) . Generalized linear mixed models were used to examine the impact of the intervention . RESULTS Regarding the 30-minute sessions , significant group main effects were observed for intervals spent at light ( p < .001 ) and moderate-to-vigorous PA ( MVPA , p < .001 ) . Regarding the preschool-day PA , significant group by visit interaction was observed for percent time spent in total preschool-day MVPA ( F ( 2 , 254 ) = 3.54 , p = .03 ) . Percent of time spent in MVPA significantly decreased in both groups at 3 months and at 6 months . CONCLUSION SBS-PA can be implemented in classroom setting s ; however , further research is needed to examine its impact on preschoolers PA levels INTRODUCTION A majority of preschool-aged children spend a significant portion of every weekday in a preschool or child care setting , where they typically participate in limited physical activity . This study determined if an ecologic physical activity intervention in preschools increases children 's  moderate- to vigorous-intensity physical activity ( MVPA ) . DESIGN RCT , with preschool as the unit of r and omization and analysis . Child physical activity was measured by accelerometry . Mixed model analysis of covariance with preschool as a r and om variable was used to test the effects of the intervention on physical activity in the total group and in sex-specific subgroups . Data were collected in 2008 - 2010 and analyzed in 2012 - 2014 . SETTING / PARTICIPANTS Children in 4-year-olds ' classrooms in 16 preschools , pair matched and assigned to intervention or control groups . INTERVENTION The intervention focused on increasing children 's physical activity by changing instructional practice s. Research ers trained preschool teachers to engage children in physical activity during ( 1 ) structured , teacher-led physical activity opportunities in the classroom ; ( 2 ) structured and unstructured physical activity opportunities at recess ; and ( 3 ) physical activity integrated into pre-academic lessons . Research staff encouraged teachers to adapt the intervention to their classrooms . MAIN OUTCOME MEASURES Minutes/hour of MVPA during the preschool day . RESULTS In an analytic sample of 379 children ( 188 intervention , 191 control ) , those in the intervention schools engaged in significantly more MVPA than children in control schools ( 7.4 and 6.6 minutes/hour , respectively ) . This difference remained significant after adjusting for parent education and length of the school day ( half versus full day ) . In the sex-specific analyses , the difference was significant for girls ( 6.8 vs 6.1 minutes/hour of MVPA , respectively ) but not for boys ( 7.9 vs 7.2 minutes/hour , respectively ) . CONCLUSIONS A flexible ecologic physical activity intervention that trains teachers to provide children with opportunities to be active throughout the school day increased MVPA in preschool children The purpose of this study was twofold : first to document the gender differences in Moderate to Vigorous Physical Activity ( MVPA ) according to two epoch systems ( 5 vs. 60 s ) in preschoolers , and , second to document the differences in physical activity ( PA ) patterns according to two different epoch choices . The sample comprised 59 preschoolers ( 31 girls ) aged 2 - 5 years old .  PA was assessed by accelerometer during school hours . The time spent in MVPA was significantly higher ( p < .001 ) when a 5-s epoch was considered compared to the 60-s epoch , regardless gender . Further , it was found a difference of ? 17 min difference between the 2 epoch systems for MVPA . Different epoch times might affect the time spent in MVPA among preschool children OBJECTIVES The purpose of this study was to examine the convergent validity of the Actical and activPAL to measure  sedentary behaviour ( SB ) and non-SB in preschoolers in a free-living environment . DESIGN A convenience sample of 49 preschoolers ( 22 boys ; 4.0 ± 0.5 years ) from six early childhood centres in Auckl and , New Zeal and were included in data analysis . METHODS Participants wore a hip-mounted Actical and a thigh-mounted activPAL accelerometer simultaneously during centre attendance for one day and data were collected in 15s epochs . Bl and -Altman tests were used to assess differences in group mean minutes and percentage of time in (non-)SB between both monitors . Agreement between binary coded ( SB vs. non-SB ) 15s-by-15s Actical and activPAL data was evaluated by calculating percentage agreement and κ statistic . RESULTS The monitors were worn on average for 294.8 ± 46.3 min result ing in a total of 57,780 15s epochs . Bl and -Altman tests suggested a small group mean difference in (non-)SB ( 1.3 min ; 0.1 % ) and a wide prediction interval ( 121.3 min ; 39.2 % ) . No obvious systematic bias was observed in the Bl and -Altman plot . Percentage agreement between the 15s-by-15s Actical and activPAL data of all participants was 73.0 % ( inter-child range : 36.8 - 93.8 % ) . The κ statistic showed moderate agreement with a value of 0.46 ( 95 % CI : 0.45 - 0.47 ) . CONCLUSIONS Although the group mean estimate of (non-)SB was similar between the Actical and activPAL , the output of both monitors can not be considered convergent as meaningful r and om disagreement was found between both monitors
target: 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: 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 ) .