A cluster randomised controlled trial evaluating an incentive-based outdoor physical activity programme to increase outdoor time and prevent myopia in children. Correlates of preschool children’s objectively measured physical activity and sedentary behavior: a cross-sectional analysis of the SPLASHY study Active video games to promote physical activity in children with cancer: a randomized clinical trial with follow-up THE IMPACT OF PHYSICAL‐PHYSIOLOGICAL ACTIVITY ON INFANTS' GROWTH AND DEVELOPMENT Fundamental movement skills and habitual physical activity in young children. Activity behaviors in schoolchildren and subsequent 5-yr change in blood pressure. Supporting Physical Activity in the Childcare Environment (SPACE): rationale and study protocol for a cluster randomized controlled trial Contextual factors related to physical activity during daily middle school physical education. Design of the Quality of Life in Motion (QLIM) study: a randomized controlled trial to evaluate the effectiveness and cost-effectiveness of a combined physical exercise and psychosocial training program to improve physical fitness in children with cancer Sedentariness, small-screen recreation, and fitness in youth. A cluster-randomized controlled trial to reduce sedentary behavior and promote physical activity and health of 8-9 year olds: The Transform-Us! Study Suspected Motor Problems and Low Preference for Active Play in Childhood Are Associated with Physical Inactivity and Low Fitness in Adolescence Physical Activity in Children Attending Preschools Effect of a family focused active play intervention on sedentary time and physical activity in preschool children Effect of physical and mental activity on blood pressure “Pre-schoolers in the playground” an outdoor physical activity intervention for children aged 18 months to 4 years old: study protocol for a pilot cluster randomised controlled trial Psychosocial correlates of physical activity in healthy children.
PURPOSE To evaluate an incentive-based intervention to increase time spent outdoors among children in a 9-month cluster r and omised controlled trial . METHODS Two hundred and eighty-five children aged 6 - 12 years of age were r and omised to the intervention ( n = 147 ) or control arm ( n = 138 ) in the Family incentive trial ( FIT ) . The FIT intervention comprised of targeted education on myopia and good eye care habits , structured weekend outdoor activities and incentives for children to increase their daily steps via pedometers . The main outcome measure was outdoor time , measured by the WHO question naire and a 1-week diary . RESULTS Interim analysis at 6 months showed a significant increase in mean outdoor time per week in the intervention arm ( 14.75 h week(-1 ) ) compared to the control arm ( 12.40 h week(-1 ) ) as measured by the question naire ( p = 0.04 ) . However , greater outdoor time was not statistically significant at the end of the trial ( 15.95 h week(-1 ) vs 14.34 h in the control group ( p = 0.29 ) . CONCLUSIONS There was an increase in outdoor time for children in the incentive-based physical activity outdoor program after 6 months but not at the end of the trial . Further larger school trials with better compliance with the intervention and longer duration could be conducted to evaluate clinical outcomes such as myopic shifts Background Identifying ways to promote physical activity and decrease sedentary time during childhood is a key public health issue . Research on the putative influences on preschool children ’s  physical activity ( PA ) and  sedentary behavior  ( SB ) is limited and has yielded inconsistent results . Our aim was to identify correlates of PA and SB in preschool children . Methods Cross-sectional data were drawn from the Swiss Preschoolers ’ Health Study ( SPLASHY ) , a Swiss population -based cohort study . Of 476 two to six year old children , 394 ( 54 % boys ) had valid PA data assessed by accelerometry .  Information on exposure data was directly measured or extracted from parental question naires . Multilevel linear regression modeling was used to separately assess associations between 35 potential correlates and  total PA ( TPA ) , moderate-to-vigorous PA ( MVPA ) and SB . Results In total , 12 correlates from different domains were identified . TPA and MVPA were greater in boys than girls , increased with age and were positively associated with gross motor skills . Children from single parent families had a higher level of TPA and spent less time sedentary than those living with two parents . Time spent outdoors was positively associated with TPA and negatively with SB . The child ’s activity temperament was related all three outcomes , whereas parental sports club membership , living area per person and neighborhood safety were associated with SB only . Fixed and r and om factors in the final models accounted for 28 % , 32 % and 22 % of the total variance in TPA , MVPA and SB , respectively . Variance decomposition revealed that age , sex and activity temperament were the most influential correlates of both , TPA and MVPA , whereas the child ’s activity temperament , time outdoors and neighborhood safety were identified as the most important correlates of SB . Conclusions A multidimensional set of correlates of young children ’s  activity behavior has been identified . Personal factors had the greatest influence on PA , whereas environmental-level factors had the greatest influence on SB . Moreover , we identified a number of previously unreported , potentially modifiable correlates of young children ’s PA and SB . These factors could serve to define target groups or become valuable targets for change in future interventions .Trial registration Current Controlled Trials IS RCT N41045021 ( date of registration : 21.03.14 ) Background Low levels of physical activity , musculoskeletal morbidity and weight gain are commonly reported problems in children with cancer . Intensive medical treatment and a decline in physical activity may also result in reduced motor performance . Therefore , simple and inexpensive ways to promote physical activity and exercise are becoming an increasingly important part of children ’s cancer treatment . Methods The aim of this study is to evaluate the effect of active video games in promotion of physical activity in children with cancer . The research is conducted as a parallel r and omized clinical trial with follow-up . Patients between 3 and 16 years old , diagnosed with cancer and treated with vincristine in two specialized medical centers are asked to participate . Based on statistical estimates , the target enrollment is 40 patients . The intervention includes playing elective active video games and , in addition , education and consultations for the family . The control group will receive a general recommendation for physical activity for 30 minutes per day . The main outcomes are the amount of physical activity and sedentary behavior . Other outcomes include motor performance , fatigue and metabolic risk factors . The outcomes are examined with question naires , diaries , physical examinations and blood tests at baseline and at 2 , 6 , 12 and 30 months after the baseline . Additionally , the children ’s perceptions of the most enjoyable activation methods are explored through an interview at 2 months . Discussion This trial will help to answer the question of whether playing active video games is beneficial for children with cancer . It will also provide further reasoning for physical activity promotion and training of motor skills during treatment . Trial registration Clinical Trials.gov identifier : NCT01748058 ( October 15 , 2012 ) Forty‐seven infants four to 40 weeks of age in Dumaguete City , the Philippines , were given a cycling motion exercise of the upper and lower limbs for Jour five‐minute periods a day , six days a week , for two months . They were measured , against a control group of 17 infants of the same age and sex . Pretest , mid test , and pastiest measurements were taken for weight gain , length gain , and development of motor , language , adaptive , and personal‐social behaviors . Significant differences were found between the two groups of infants to substantiate the hypothesis that increases in growth and development of infants who receive physical care and emotional support plus planned physical‐physiological activity in the form of passive cycling exercises would be greater than those of infants who receive only physical care and , emotional support PURPOSE To test for relationships between objective ly measured habitual physical activity and fundamental movement skills in a relatively large and representative sample of preschool children . METHODS Physical activity was measured over 6 d using the Computer Science and Applications ( CSA ) accelerometer in 394 boys and girls ( mean age 4.2 , SD 0.5 yr ) . Children were scored on 15 fundamental movement skills , based on the Movement Assessment Battery , by a single observer . RESULTS Total physical activity ( r=0.10 , P<0.05 ) and percent time spent in moderate to vigorous physical activity ( MVPA ) ( r=0.18 , P<0.001 ) were significantly correlated with total movement skills score . Time spent in light-intensity physical activity was not significantly correlated with motor skills score ( r=0.02 , P>0.05 ) . CONCLUSIONS In this sample and setting , fundamental movement skills were significantly associated with habitual physical activity , but the association between the two variables was weak . The present study questions whether the widely assumed relationships between motor skills and habitual physical activity actually exist in young children PURPOSE This study aim ed to establish whether time spent in sport-related physical activities and sedentary behaviors ( e.g. , TV viewing , videogame usage , and homework ) was prospect ively associated with change in blood pressure ( BP ) for 5 yr . METHODS Eight hundred and twenty-one students age 6 yr at baseline ( 397 girls and 424 boys ) were examined from 2003 - 2004 to 2009 - 2011 . Children completed detailed activity question naires . BP was measured using a st and ardized protocol . RESULTS After adjusting for age , ethnicity , parental education , parental history of hypertension , baseline height , BP , body mass index ( BMI ) , baseline time spent in corresponding activity behavior , and change in BMI , each hour per day spent in total screen time was associated with a 0.69 and 0.59 mm Hg increase in diastolic BP ( P = 0.01 ) and mean arterial BP ( P = 0.01 ) , respectively . In boys , each hour per day spent in TV viewing was associated with a concurrent 1.42-mm Hg increase in diastolic BP ( P = 0.04 ) during the 5 yr . Children engaging in low sport-related physical activities at baseline but who engaged in high levels of physical activity ( ≥ 60 min · d(-1 ) ) at follow-up ( n = 154 ) compared with those engaging in low sport-related physical activities at both examinations ( n = 305 ) demonstrated significantly lower mean arterial BP , 7.26 versus 9.61 mm Hg ( P = 0.04 ) . CONCLUSIONS Time spent in physical activity and screen time could influence BP measures during childhood 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 OBJECTIVES Given the importance of optimizing physical activity in adolescents , the purpose of this study was to examine the effect of activity mode , environment , and semester on step counts/minute and MVPA during daily middle-school physical education ( PE ) . DESIGN A prospect i ve and observational research design . METHODS Participants included 232 students ( Mean age=13.3±0.4 years ) recruited from the seventh and eighth grade s from one public middle-school in the U.S. Activity modes were employed across the school year including motor skills , games , and fitness activities located in indoor and outdoor environments . Step counts/minute and MVPA  were monitored across 132 PE lessons during Fall and Spring semesters using NL-1000 piezoelectric pedometers . A three-way Multivariate Analysis of Covariance ( MANCOVA ) was employed to examine the effect of activity mode ( skill games vs. fitness ) , environment ( indoors vs. outdoors ) , and semester ( Fall vs. Spring ) on student step counts/minute and MVPA . MANCOVA was followed by separate ANCOVA tests . RESULTS MANCOVA yielded a statistically significant three-way interaction ( Wilks ' Λ=0.98 F(2 , 1153)=8.9 , P<0.001 ) . Follow-up tests supported that physical activity was higher during outdoor fitness activities in the Fall compared to indoor motor skills in the Spring for step counts/minute ( Mean difference=27.0 steps/minute , P<0.001 , Cohen 's d=1.6 ) and MVPA ( Mean difference=7.8min , P<0.001 , Cohen 's d=2.0 ) . CONCLUSIONS Daily middle-school physical activity was the highest during outdoor fitness activities in the Fall and the lowest during indoor motor skill games in the Spring Background Childhood cancer and its treatment have considerable impact on a child 's physical and mental wellbeing . Especially long-term administration of chemotherapy and /or radiotherapy impairs physical fitness both during and after therapy , when children often present with muscle weakness and /or low cardiorespiratory fitness . Physical exercise can improve these two elements of physical fitness , but the positive effects of physical exercise might be further increased when a child 's wellbeing is simultaneously enhanced by psychosocial training . Feeling better may increase the willingness and motivation to engage in sports activities . Therefore , this multi-centre study evaluates the short and long-term changes in physical fitness of a child with a childhood malignancy , using a combined physical exercise and psychosocial intervention program , implemented during or shortly after treatment . Also examined is whether positive effects on physical fitness reduce inactivity-related adverse health problems , improve quality of life , and are cost-effective . Methods This multi-centre r and omized controlled trial compares a combined physical and psychosocial intervention program for children with cancer , with care as usual ( controls ) . Children with cancer ( aged 8 - 18 years ) treated with chemotherapy and /or radiotherapy , and who are no longer than 1 year post-treatment , are eligible for participation . A total of 100 children are being recruited from the paediatric oncology/haematology departments of three Dutch university medical centres . Patients are stratified according to pubertal stage ( girls : age ≤10 or > 10 years ; boys : ≤11 or > 11 years ) , type of malignancy ( haematological or solid tumour ) , and moment of inclusion into the study ( during or after treatment ) , and are r and omly assigned to the intervention or control group . Discussion Childhood cancer patients undergoing long-term cancer therapy may benefit from a combined physical exercise and psychosocial intervention program since it may maintain or enhance their physical fitness and increase their quality of life . However , the feasibility , patient need , and effectiveness of such a program should be established before the program can be implemented as part of st and ard care . Trial registration numberNTR1531 ( The Netherl and s National Trial Register BACKGROUND There are concerns that sedentariness among young people has increased and that this may be detrimental to their health . The purpose of this study was to examine the association between sedentary activities , including  small-screen recreation ( SSR : watching TV/DVDs/videos , recreational computer use ) and cardiorespiratory endurance ( CRE ) in children aged 11 - 15 years . METHODS A cross-sectional representative population survey was taken of New South Wales ( Australia ) school students in Grade s 6 , 8 , and 10 ( N=2750 ) in 2004 .  Sedentary activities and SSR were measured by a self-report question naire .  CRE was determined by the 20-meter multi-stage shuttle run test . The optimal cut point for time spent on SSR was determined by receiver operating characteristic analysis . RESULTS Time spent in sedentary activities was inversely associated with CRE among Grade 8 students ( p=0.01 ) and Grade 10 girls ( p=0.03 ) . CRE was lower among Grade 8 students ( p<0.001 ) and Grade 10 girls ( p<0.001 ) who spent > or=2 hours/day on SSR compared with students who spent < 2 hours/day . The 2-hour/day cut point for SSR had high sensitivity ( boys : 84 % , [ 95 % CI=79 % , 87 % ] ; girls : 79 % [ 95 % CI=74 % , 84 % ] ) and low specificity ( boys : 28 % [ 95 % CI=24 % , 32 % ] ; girls : 42 % [ 95 % CI=38 % , 46 % ] ) . CONCLUSIONS Cardiorespiratory endurance did not differ consistently across quintiles of sedentariness and SSR among boys ; however , among girls there was a consistent inverse association . If confirmed in prospect i ve studies , these findings have important implication s for risk of chronic disease Background Physical activity ( PA ) is associated with positive cardio-metabolic health and emerging evidence suggests sedentary behavior ( SB ) may be detrimental to children 's health independent of PA . The primary aim of the Transform-Us ! study is to determine whether an 18-month , behavioral and environmental intervention in the school and family setting s results in higher levels of PA and lower rates of SB among 8 - 9 year old children compared with usual practice ( post-intervention and 12-months follow-up ) . The secondary aims are to determine the independent and combined effects of PA and SB on  children 's cardio-metabolic health risk factors ; identify the factors that mediate the success of the intervention ; and determine whether the intervention is cost-effective . Methods / design A four-arm cluster-r and omized controlled trial ( RCT ) with a 2 × 2 factorial design , with schools as the unit of r and omization . Twenty schools will be allocated to one of four intervention groups , sedentary behavior ( SB-I ) , physical activity ( PA-I ) , combined SB and PA ( SB+PA-I ) or current practice control ( C ) , which will be evaluated among approximately 600 children aged 8 - 9 years in school year 3 living in Melbourne , Australia . All children in year 3 at intervention schools in 2010 ( 8 - 9 years ) will receive the intervention over an 18-month period with a maintenance ' booster ' delivered in 2012 and children at all schools will be invited to participate in the evaluation assessment s. To maximize the sample and to capture new students arriving at intervention and control schools , recruitment will be on-going up to the post-intervention time point . Primary outcomes are time spent sitting and in PA assessed via accelerometers and inclinometers and survey . Discussion To our knowledge , Transform-Us ! is the first RCT to examine the effectiveness of intervention strategies for reducing children 's overall sedentary time , promoting PA and optimizing health outcomes . The integration of consistent strategies and messages to children from teachers and parents in both school and family setting s is a critical component of this study , and if shown to be effective , may have a significant impact on educational policies as well as on pedagogical and parenting practice s . Trial registration ACTRN12609000715279 ; Current Controlled Trials IS RCT Background This prospect i ve longitudinal study investigates whether suspected motor problems and low preference for active play in childhood are associated with  physical inactivity and low cardiorespiratory fitness in adolescence . Methodology /Principal Findings The study sample consisted of the Northern Finl and Birth Cohort 1986 ( NFBC 1986 ) composed of 5,767 children whose parents responded to a postal inquiry concerning their children 's motor skills at age 8 years and who themselves reported their physical activity at age 16 years .  Cardiorespiratory fitness  was measured with a  cycle ergometer test at age 16 years . Odds ratios ( OR ) and their 95 % confidence intervals ( 95 % CI ) for the level of physical activity and fitness were obtained from multinomial logistic regression and adjusted for socio-economic position and body mass index . Low preference for active play in childhood was associated with physical inactivity ( boys : OR 3.31 , 95 % CI 2.42–4.53 ; girls : OR 1.79 , 95 % CI 1.36–2.36 ) and low cardiorespiratory fitness ( boys : OR 1.87 , 95 % CI 1.27–2.74 ; girls : OR 1.52 , 95 % CI 1.09–2.11 ) in adolescence . Suspected gross ( OR 2.16 , 95 % CI 1.33–3.49 ) and fine ( OR 1.88 , 95 % CI 1.35–2.60 ) motor problems were associated with physical inactivity among boys . Children with suspected motor problems and low preference for active play  tended to have an even higher risk of physical inactivity in adolescence . Conclusions / Significance Low preference for active play in childhood was associated with physical inactivity and low cardiorespiratory fitness in adolescence . Furthermore , children with suspected motor problems and low preference for active play tended to have an even higher risk of physical inactivity in adolescence . Identification of children who do not prefer active play and who have motor problems may allow targeted interventions to support their motor learning and participation in active play and thereby promote their physical activity and fitness in later life 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 Early childhood provides a window of opportunity for the promotion of physical activity . Given the limited effectiveness of interventions to date , new approaches are needed . Socio-ecological models suggest that involving parents as intervention targets may be effective in fostering healthier lifestyles in children . This study describes the effectiveness of a family-focused ‘ Active Play ’ intervention in decreasing sedentary time and increasing total physical activity in preschool children . MethodS eventy-seven families were recruited from 8 r and omly selected SureStart children ’s centres in the North West of Engl and . Centres were r and omly assigned to either an intervention ( n = 4 ) or a comparison group ( n = 4 ) . Parents and children in the intervention group received a 10-week active play programme delivered by trained active play professionals ; this included an activity and educational component . Families in the comparison group were asked to maintain their usual routine . Each participating parent and child wore a  uni-axial accelerometer  for 7 days at baseline and post-test . Week and weekend day sedentary time and total physical activity adjusted for child- and home- level covariates were analysed using multilevel analyses . Results Significant intervention effects were observed for sedentary time and physical activity for both week and weekend days . Children in the intervention group engaged in 1.5 % and 4.3 % less sedentary time during week and weekend days , respectively and 4.5 % and 13.1 % more physical activity during week and weekend days , respectively than children in the comparison group . Parent ’s participation in sport and their physical activity levels , child ’s sex , availability of media in the home and attendance at organised activities were significant predictors of sedentary time and physical activity in this age group . Conclusion A 10-week family focused active play intervention produced positive changes in sedentary time and total physical activity levels in preschool children . Specific covariates were identified as having a significant effect on the outcome measures . Moreover , children whose parents were active engaged in less sedentary time and more physical activity suggesting that parent ’s activity habits are mediators of physical activity engagement in this age group Objectives : The authors measured and recorded the physical ( outdoor playing ) and mental ( home study ) activity behavior and blood pressure amongst school going children and observed their association with the blood pressure levels . Method : It was a cross sectional school-based study from 12 primary schools ; selected by stratified r and om sampling . Participants included 2250 children aged 10 years and above . Explanatory variables were age , sex , outdoor playing ( hours/ day ) and home- study ( hours/ day ) . Outcome variables were mean and st and ard deviation ( SD ) of systolic and diastolic blood pressures in various activity groups . Statistical tools used were proportions , correlation co-efficient ( r ) , coefficient of determination ( r2 ) and Regression analysis . Results : 47.8 % boys and 2.5 % girls were engaged in outdoor playing for more than two hours . No trend was observed for systolic blood pressure ( SBP ) in both the sexes in various activity groups of outdoor playing . Both mean diagnostic blood pressure ( DBP ) and mean BMI showed decreasing trend in boys . Mean BMI had an inverse relationship with outdoor playing in girls . Correlation of age and weight with both SBP and DBP was highly significant in both the sexes and in all the age groups except that of the 15-year age . Both SBP and DBP were not associated with home study in all sex and age groups except the age group of 10 and 12 years . Both SBP and DBP were significantly associated with the outdoor playing taking the whole sample as one group , but not in different sex or age groups ; except that the SBP was significantly cor-related with outdoor playing in 10 to 13 years age groups in boys . Conclusion : Boys spent twice the time in outdoor playing than girls . They were spending more time on outdoor playing than on home study . Conversely girls spent more time in home study . A weak negative correlation was observed between outdoor playing  and blood pressures . Less time spent in physical activities by the girls may have contributed to their higher BMI . They need behavior change communication for involvement in physical Background The pre-school years are considered critical for establishing healthy lifestyle behaviours such as physical activity . Levels of physical activity track through childhood into adulthood , thus establishing habitual physical activity early in life is vital . Time spent outdoors is associated with greater physical activity and playground interventions have been shown to increase physical activity in school aged children . There are few pre-school , playground-based interventions , and evaluations of these have found mixed results . A recent report published by the UK Chief Medical Officer ( CMO ) highlighted that new interventions to promote movement in the early years ( 0–5 years old ) are needed . The aim of this study is to undertake a pilot cluster r and omised controlled trial ( RCT ) of an outdoor playground-based physical activity intervention for parents and their children aged 18 months to 4 years old ( “ Pre-schoolers in the Playground ” ; PiP ) and to assess the feasibility of conducting a full scale cluster RCT . The PiP intervention is grounded in behavioural theory ( Social Cognitive Theory ) , and is in accordance with the CMO guidance for physical activity in the early years . It is informed by existing literature and data collected from focus groups with parents . Methods / Design One hundred and fifty pre-school children affiliated to 10 primary schools will be recruited . Schools will be r and omised to either the PiP intervention arm or the control arm ( usual practice ) . Children in the intervention arm will be invited to attend three 30 minute outdoor play sessions per week for 30 weeks ( 3 school terms ) at the school . Feasibility will be assessed by examining recruitment rates , attendance , attrition , acceptability of the trial and of the PiP intervention to parents , fidelity of intervention implementation , capability and capacity for schools to deliver the intervention . Health outcomes and the feasibility of outcome measurement tools will be assessed . These include physical activity via triaxial , accelerometry ( Actigraph GT3X+ ) , anthropometry ( height , body mass , BMI , waist and upper arm circumference ) , health related quality of life for child ( PedsQL ) and parent ( EQ5D ) , parent wellbeing ( ComQol-A5 ) , injuries and health service use . A health economic evaluation will also be undertaken . Discussion It is anticipated that results of this pilot trial will be published in spring 2015.Trial registration Current controlled trials : IS RCT BACKGROUND Underst and ing the determinants of physical activity in children is critical for the treatment and prevention of childhood obesity . Social-cognitive theory has been used to underst and behavioral patterns in children . OBJECTIVES To explore the relationship between health beliefs , self-efficacy , social support , and sedentary activities and physical  activity levels in children and to examine the relationship between physical activity and  children 's  self-esteem . METHODS Ninety-two children aged 10 to 16 years completed the study .  Physical activity was monitored for 1 week with a motion detector ( Actitrac ; IM Systems , Baltimore , Md ) . Moderate-level activity and high-level activity were defined based on the results of treadmill testing . Health beliefs , self-efficacy , social influences , and time spent in sedentary behaviors were determined through question naires . Self-esteem was measured using the Piers-Harris Children 's Self-Concept Scale . Chronic anxiety was measured with the Revised Children 's Manifest Anxiety Scale . RESULTS There was a significant decline in physical activity levels between ages 10 and 16 years , particularly in girls . Preteen girls spent approximately 35 % more time in low- and high-level activity than did teenage girls ( P<.001 ) . Overall , children spent 75.5 % of the day inactive , with a mean + /- SD of 5.2 + /- 1.8 hours watching television , sitting at the computer , and doing homework . In contrast , only 1.4 % of the day ( 12.6 + /- 12.2 minutes ) was spent in vigorous activity . Time spent in sedentary behaviors was inversely correlated with the amount of moderate-level activity ( P<.001 ) but not high-level activity . In contrast , time spent in high-level activity correlated with self-efficacy scores ( P<.001 ) and social influences scores ( P<.005 ) . High-level physical activity was also associated with improved self-esteem ( P<.05 ) . Higher health beliefs scores were not correlated with physical activity levels . CONCLUSIONS Children and adolescents are largely sedentary . Correlates of high- and low-level physical activity are different . Time spent on sedentary activities is inversely correlated with moderate-level activity , while self-efficacy and social influences are positively correlated with more intense physical activity . In addition , increased high-level physical activity is an important component in the development of self-esteem in children
The systematic review revealed overall positive effects of outdoor time  on physical activity , sedentary behaviour , and cardiorespiratory fitness , although causality could not be assumed due to a lack of RCTs .
Motor skill development was unrelated to outdoor time ; however , this relationship was only examined in a single study of preschool children .
No studies were found that examined associations between outdoor time and musculoskeletal fitness
The objective of this systematic review was to examine the relationship between outdoor time and : ( 1 ) physical activity , ( 2 ) cardiorespiratory fitness , ( 3 ) musculoskeletal fitness , ( 4 ) sedentary behaviour ; or ( 5 ) motor skill development in children aged 3 - 12 years .