Design and baseline characteristics of the Short bouTs of Exercise for Preschoolers (STEP) study Supporting Physical Activity in the Childcare Environment (SPACE): rationale and study protocol for a cluster randomized controlled trial Child Care Center Characteristics Associated With Preschoolers' Physical Activity. 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 Impact of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention on preschoolers’ physical activity levels and sedentary time: a single-blind cluster randomized controlled trial Effects of a Preschool Intervention on Physical Activity and Body Composition Effect of a school-based active play intervention on sedentary time and physical activity in preschool children. Feasibility and Effects of Short Activity Breaks for Increasing Preschool-Age Children's Physical Activity Levels. Physical Activity in Children Attending Preschools A participatory physical activity intervention in preschools: a cluster randomized controlled trial. Objectively measured physical activity level and sedentary behavior in Norwegian children during a week in preschool☆ Promoting fundamental movement skill development and physical activity in early childhood settings: a cluster randomized controlled trial. Effect of a family focused active play intervention on sedentary time and physical activity in preschool children Feasibility and Effectiveness of a Wearable Technology-Based Physical Activity Intervention in Preschoolers: A Pilot Study Activity Begins in Childhood (ABC) – inspiring healthy active behaviour in preschoolers: study protocol for a cluster randomized controlled trial Effects of Child Care Intervention on Physical Activity and Body Composition. A comparison of parent and childcare provider's attitudes and perceptions about preschoolers' physical activity and outdoor time.
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 , 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 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 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 Background Physical activity levels among preschoolers in childcare are low and sedentary time high . The Supporting Physical Activity in the Childcare Environment ( SPACE ) intervention had three components : 1 . portable play equipment ; 2 . staff training ; and , 3 . modified outdoor playtime ( i.e. , shorter , more frequent periods ) . This study aim ed to examine the effectiveness of the SPACE intervention on preschoolers ’ physical activity levels and sedentary time during childcare hours ( compared to st and ard care ) . Methods Via a single-blind cluster r and omized controlled trial , 338 preschoolers ( 39.86 ± 7.33 months ; 52 % boys ) from 22 centre-based childcare facilities ( 11 experimental , 11 control ) were enrolled . Preschoolers wore an Actical ™ accelerometer for 5 days during childcare hours at baseline , post-intervention , and 6- and 12-month follow-up , and were included in the analyses if they had a minimum of two valid days ( 5 h each day ) at baseline and one additional time point . Intervention effectiveness was tested using a linear mixed effects model for each of the four outcome variables ( i.e. , sedentary time , light physical activity [ LPA ] , moderate-to-vigorous physical activity [ MVPA ] , and total physical activity [ TPA ] ) . Fixed effects were further evaluated with t-tests , for which degrees of freedom were estimated using a Satterthwaite approximation . Results One hundred and ninety-five preschoolers were retained for analyses .  The intervention did not significantly impact LPA . MVPA was significantly greater among children in the experimental group when comparing post-intervention to pre-intervention , t(318 ) = 3.50 , p = .0005 , but no intervention effects were evident at 6- or 12-month follow-up . TPA was significantly greater for children in the intervention group at post-intervention when compared to pre-intervention , t(321 ) = 2.70 , p = .007 , with no intervention effects evident at later time periods . Finally , sedentary time was significantly lower among preschoolers in the experimental group when comparing post-intervention to pre-intervention , t(322 ) = 2.63 , p = .009 , with no significant effects at follow-up . Conclusions The SPACE intervention was effective at increasing MVPA and TPA among preschoolers , while simultaneously decreasing sedentary time . The ability of the SPACE intervention to target higher intensity activity is promising , as MVPA levels have been documented to be low in centre-based childcare . The changes in physical activity were not sustained long term ( 6- or 12-month follow-up).Trial registration IS RCT N70604107 ( October 8 , 2014 ) Objective To investigate the effect of a  preschool physical activity intervention program delivered in licensed childcare setting s , with or without a parent‐facilitated home component , on  children 's daily physical activity , sedentary time , and body composition . Study design For this cluster r and omized controlled trial , 18 childcare centers were r and omly allocated in equal numbers to the typical curriculum comparison group , childcare intervention alone ( CC ) , or childcare intervention with parental involvement . Accelerometers  were used to asses physical activity and sedentary time , and body composition was measured by bioelectrical impedance . Results Linear mixed model regression analyses showed no differences between the CC , the childcare intervention with parental involvement , and the comparison groups in changes from baseline to 6 months in total physical activity ( P for time × group interaction = .665 ) or moderate‐to‐vigorous physical activity ( P for time × group interaction = .164 ) when adjusted for baseline physical activity levels . Furthermore , no group differences were found for changes in light physical activity , sedentary time , or anthropometric variables . Conclusions An affordable and easily scalable preschool intervention program delivered in licensed childcare setting s , with or without the addition of a parent‐driven home physical activity promotion , seems to have no significant effect on physical activity , sedentary time , or body composition . Trial registration IS RCT N : IS RCT N94022291 Early childhood is a critical time for promoting physical activity . Few studies have investigated the effect of interventions in this population . The aim of this study was to investigate the effect of a school-based active play intervention on preschool children 's sedentary time and physical activity .  Preschool children were recruited from r and omly selected preschools . Schools were r and omly assigned to an intervention or comparison group . One teacher per intervention school received training from active play professionals in the delivery of a 6-week active play programme . Comparison schools continued their usual practice . Children wore a  uni-axial accelerometer  for 7 days at baseline , immediately after and at 6-month post-intervention . No significant intervention effects were observed for sedentary time or physical activity . However , sex and hours spent at school were significant predictors of physical activity . Children who spent fewer hours ( half-day children ) at school were significantly more active than their full-day counterparts . Physical activity during the intervention classes was high even though neither daily physical activity nor sedentary time changed . Notably children who spent more time at preschool were less active suggesting that preschool was not as conducive to physical activity engagement as other environments 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 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 Previous studies on physical activity interventions in preschools have reported limited effectiveness . Participatory community-based approaches hold promise for increasing intervention effectiveness and involving parents as key stakeholders in a sustainable way . PURPOSE To assess whether a  participatory parent-focused approach using parents as agents of behavioral change enhances the efficacy of a  preschool physical activity ( PA ) intervention . DESIGN Two-armed , cluster- RCT with preschool as unit of r and omization and children as unit of analysis . SETTING / PARTICIPANTS 39 South German preschools applying for an existing state-sponsored PA program with 826 children ( 52 % boys , aged 5.0±0.2 years ) , with 441 allocated to the intervention arm .  INTERVENTION Control preschools received a state-sponsored program consisting of twice-weekly gym classes over 6 months . In intervention preschools , this program was augmented by motivating parents to develop and implement their own project ideas for promoting children 's PA . MAIN OUTCOME MEASURES Primary outcomes included mean accelerometry counts and time spent in moderate- to vigorous-intensity PA or sedentary behavior . Secondary outcomes were BMI , percentage body fat , quality of life , sleep quality , and general health . Outcomes were measured at baseline and at 6 and 12 months in both study arms ( time period : 2008 - 2010 ) . Using an intention-to-treat- analysis , linear multilevel regression models assessed change over time and across study arms , adjusted for age , gender , season , and preschool location . Analysis was conducted in 2011 . RESULTS In 15 intervention preschools , parents implemented 25 PA projects . Compared with controls , intervention arm children were 11 minutes less sedentary per day ( 95 % CI=5.39 , 17.01 , p=0.014 ) ; had significantly more mean accelerometry counts ( 1.4 counts/15 seconds [ 95 % CI=0.22 , 2.54 ] , p=0.019 ) ; and showed benefits in perceived general health and quality of life . All other outcomes showed no difference between study arms . CONCLUSIONS A participatory preschool intervention focusing on parents as agents of behavioral change may be able to promote PA and reduce sedentary behavior in preschoolers . These benefits may go beyond the effects of existing nonparticipatory interventions . TRIAL REGISTRATION This study is registered at clinical trials.gov NCT00987532 Although many studies have reported on  physical activity ( PA ) levels using accelerometers , a thorough description of the PA pattern in preschool children during their stay in the preschool , is lacking in the current literature . Furthermore , there remains a lack of underst and ing of the PA level and pattern in children in the lower end of the PA continuum . The first aim of this study was therefore to describe the PA pattern during a week-long stay in a preschool in all children born in 2011 ( either three or four-year-olds ) attending public preschools in a municipality in Norway . The second aim was to describe the PA level and pattern of the children who are the least physically active . This cross-sectional study included baseline data from 95 % of children ( N = 111 ) participating in a r and omized controlled physical activity intervention ( Active Kindergarten – Active Children study ) . The participants wore an Actigraph accelerometer , in week 39 in 2015 , from when they arrived at the preschool on Monday morning and throughout their stay of five consecutive days . The amount of moderate- to vigorous-intensity PA ( MVPA ) per day ranged from 16 min to 116 min , and sedentary time ranged from 2.7 h to 6.5 h per day in the least and most sedentary child , respectively . The least physically active 25 % of children were less active throughout the entire day , and only a few of them managed to achieve the recommended level of MVPA on any weekday . The physical activity levels and patterns among the least active children described in this study may help to inform interventions targeting this group 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 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 The purpose of this pilot study was to evaluate the feasibility and the effectiveness of an intervention that employed a technology-based physical activity ( PA ) monitoring system and teacher-regulated strategies to promote PA  in preschoolers . A total of 93 preschoolers ( 53 % girls , 4.7 years ) from 5 child care centers were recruited for a one-week intervention and r and omly assigned into control ( 2 centers , n = 45 ) or intervention ( 3 centers , n = 48 ) group . Key intervention components included : ( 1 ) wearable device-based , real-time monitoring of children ’s PA by classroom teachers and ( 2 ) teacher-regulated strategies for providing more opportunities for PA . Sedentary behavior ( SED ) and PA were measured using accelerometers . Overall , children in the intervention group showed significantly lower level of SED ( 31.6 vs. 33.6 min/h ) and higher level of total PA ( 28.4 vs. 26.4 min/h ) than children in the control group , after adjusting for age , sex , race , parent education level , parent perception of their child ’s PA , BMI , and childcare centers . Teachers in the intervention group reported that the intervention was highly feasible to be implemented in their current classroom setting s. In conclusion , we observed high acceptability and initial effectiveness of the current intervention . Subsequent research at larger-scale is warranted to fully evaluate the effectiveness of the intervention strategies tested in this study Background Today ’s children are more overweight than previous generations and physical inactivity is a contributing factor . Modelling and promoting positive behaviour in the early years is imperative for the development of lifelong health habits . The social and physical environments where children spend their time have a powerful influence on behaviour . Since the majority of preschool children spend time in care outside of the home , this provides an ideal setting to examine the ability of an intervention to enhance movement skills and modify physical activity behaviour . This study aims to evaluate the efficacy of the Activity Begins in Childhood ( ABC ) intervention delivered in licensed daycare setting s alone or in combination with a parent-driven home physical activity-promotion component to increase preschoolers ’  overall physical activity levels and , specifically , the time spent in moderate to vigorous physical activity . Methods / design This study is a single site , three-arm , cluster-r and omized controlled trial design with a daycare centre as the unit of measurement ( clusters ) . All daycare centres in the National Capital region that serve children between the ages of 3 and 5 , expressing an interest in receiving the ABC intervention will be invited to participate . Those who agree will be r and omly assigned to one of three groups : i ) ABC program delivered at a daycare centre only , ii ) ABC program delivered at daycare with a home/parental education component , or iii ) regular daycare curriculum . This study will recruit 18 daycare centres , 6 in each of the three groups . The intervention will last approximately 6 months , with baseline assessment prior to ABC implementation and follow-up assessment s at 3 and 6 months . Discussion Physical activity is an acknowledged component of a healthy lifestyle and childhood experiences as it has an important impact on lifelong behaviour and health . Opportunities for physical activity and motor development in early childhood may , over the lifespan , influence the maintenance of a healthy body weight and reduce cardiovascular disease risk . If successful , the ABC program may be implemented in daycare centres as an effective way of increasing healthy activity behaviours of preschoolers . Trial registration Current Controlled Trials : IS RCT N94022291 . Registered in December 2012 , first cluster r and omized in April 2013 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 BACKGROUND Young children depend on  adult caregivers  to provide opportunities for physical activity . Research has focused on barriers and facilitators to children 's physical activity while in childcare , but parental influences remain largely unknown . This study examines parent 's attitudes about preschoolers ' physical activity and outdoor time , compares them with those of childcare providers and determines the association between parental attitudes and preschoolers ' measured activity . METHODS Parents and childcare providers from 30 childcare centres were surveyed regarding attitudes towards  preschoolers ' physical activity and outdoor time . Children 's moderate-to-vigorous physical activity was determined by using 24-h accelerometry . Parent and childcare providers ' responses were compared . Mixed-effect linear regression examined moderate-to-vigorous physical activity and sedentary time as outcomes with parental attitudes as predictors , family demographics as covariates and centre as a r and om effect . RESULTS Three hundred eighty-eight parents and 151 childcare providers participated . On average , children were 4.3 ( 0.7 ) years old . Parents and childcare providers both considered daily physical activity important for preschoolers , but providers rated the importance of daily outdoor time higher on a 10-point scale ( 8.9 vs. 7.6 , P < 0.001 ) . More parents than providers believed that children would get sick by playing outside in the cold ( 25 vs. 11 % , P < 0.05 ) . Parents were more comfortable with their child playing outside at childcare compared with outside at home ( 8.9 vs. 6.9 , P < 0.001 ) . Lower income parents felt less comfortable than higher income parents with their child playing outside either near home or at childcare . Neither home nor total child activity levels were associated with most parental attitudes queried . CONCLUSIONS While parents and childcare providers value daily physical activity for children , some parents expressed discomfort about their young children engaging in outdoor play , especially around home and in cold weather . These findings highlight the importance of childcare-based interventions to promote preschoolers ' physical activity and outdoor play
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 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 ) .