Increase Physical Activity In Children Research Articles

Assessing the implementation of healthy eating and physical activity policies and practices in Early Childhood Education and Care in New South Wales, Australia: A cross-sectional study.

Australian children are not meeting the recommended physical activity (PA) and healthy eating (HE) guidelines. Health behaviour practices implemented in community settings such as early education services can improve child's health outcomes and are therefore key to help meet guidelines. This study aimed to measure the implementation of HE and PA policies and practices in Early Childhood Education and Care (ECEC) services in New South Wales (NSW), Australia, and to examine their association with service characteristics. A random sample of 1122 centre-based ECEC services were invited to a cross-sectional survey measuring HE and PA policy and practice implementation. Regression analyses were conducted to assess the relationship between the service characteristics and implementation of policies/practices. In total, 565 ECEC services completed the survey. Results show that while some practices are implemented, the implementation of practices promoting HE and PA education is low. Practices related to educator training for HE (18%) and PA (13%) were poorly implemented. The implementation of practices such as 'providing educator training around child PA', 'engaging families in activities to increase child PA' and 'encouraging supportive feeding practices' were significantly higher in services located in major cities than regional/remote services. 'Having a PA policy' and the practice of 'limiting the use of screen time' was significantly higher in long day care services than in preschools. The implementation of 'providing educator-led PA', 'providing free play opportunities' and 'having a PA policy' was significantly lower in private not-for-profit community managed services than in private for-profit services. Implementation of various HE and PA policies and practices in regional/remote services, private not-for-profit services and preschools across NSW could be improved. SO WHAT?: Future research should be prioritised towards identifying factors influencing the implementation of these policies and practices to best tailor implementation support efforts for those who need it the most.

A Longitudinal Examination of Direct and Indirect Influences of Parental Behaviors on Child Physical Activity

Many children do not realize the physical health, mental health, cognitive, and academic benefits of physical activity because they are insufficiently active. Effectively promoting physical activity in children requires understanding the determinants of physical activity. Parent physical activity and support for physical activity have emerged as central influences, but few studies have applied longitudinal designs and device-based measures of child physical activity. The purposes of this cohort study were to examine direct associations between parent physical activity and child physical activity, parent physical activity and parent support for physical activity, and parent support and child physical activity; and to examine indirect associations between parent physical activity and child physical activity, mediated through parent support behaviors. We used structural equation modeling with panel analysis to examine direct and indirect influences of parent physical activity and support on 7th grade children’s physical activity, adjusted for 5th grade levels. Parent surveys were administered at the 5th grade time-point. Parent physical activity indirectly affected child physical activity, mediated through the parent support behavior of providing transportation for physical activity. Parent physical activity was also directly related to four parent support behaviors. Increasing parent support for child physical activity, and possibly parent physical activity, may be effective approaches to increasing child physical activity.

Assessing the scalability of evidence-based healthy eating and physical activity interventions in early childhood education and care: A cross-sectional study of end-user perspectives.

ObjectivesTo describe early childhood education and care (ECEC) services: i) perceptions regarding the scalability of healthy eating and physical activity interventions; and ii) associations between scalability and service characteristics. MethodsA cross-sectional survey was conducted with a randomly selected sample of ECEC services across Australia. The scalability of 12 healthy eating and physical activity interventions were assessed using items based on the Intervention Scalability Assessment Tool. Higher scores represented a higher perceived scalability. ResultsFrom 453 participants, the highest scoring healthy eating and physical activity interventions were ‘Providing healthy eating education and activities for children’ (M43.05) (out of 50), and ‘Providing sufficient opportunities for child physical activity’ (M41.43). The lowest scoring was ‘Providing families with lunchbox guidelines’ (M38.99) and ‘Engaging families in activities to increase child physical activity’ (M38.36). Services located in rural areas, compared to urban, scored the overall scalability of both healthy eating and physical activity interventions significantly lower. ConclusionsPerceptions regarding scalability of healthy eating and physical activity interventions in the ECEC setting vary according to service characteristics. Implications for Public HealthFindings identify where government investment and implementation efforts may be prioritised to facilitate scale-up. Investigation into the barriers and support required for lower scoring interventions is warranted.

The development of a family-based wearable intervention using behaviour change and co-design approaches: move and connect

BackgroundPrevious research has explored the effectiveness of wearable activity trackers (wearables) for increasing child physical activity (PA) levels, but there have been mixed results. The use of theoretical frameworks and co-design techniques are recognised ways of increasing an intervention's acceptability and effectiveness. AimsThis study aims to use co-design workshops and an evidence-based theoretical framework (the Behaviour Change Wheel) to develop a family-based PA intervention using wearables. MethodsThree stages of intervention development outlined by the Behaviour Change Wheel were used. Co-design workshops with seven families (11 parents and 12 children) and seven PA experts were conducted where stakeholders discussed how to overcome previously identified barriers to families being active and using wearables. This resulted in the intervention's components being developed, with each component's mechanisms of action (e.g. intervention functions and behaviour change techniques) being retrospectively identified. ResultsThe ‘Move & Connect’ intervention was developed, which targets family PA and wearable use. The intervention takes a flexible approach and includes eight components, including wearable devices (Fitbit Alta HR), support resources, an introductory workshop, collective challenges, goal setting and reviewing, engagement prompts, social support and health-related resources (e.g. educational videos). The intervention incorporates six intervention functions targeting PA and wearable use: education, training, modelling, persuasion, incentivisation and environmental restructuring and 24 behaviour change techniques, including goal setting, social comparison, feedback on behaviour and graded task. ConclusionsThis is the first known study to use an evidence-based framework and co-design to develop a family-based wearable intervention. The identification of the intervention's mechanisms of action will prove useful when implementing and evaluating the ‘Move & Connect’ intervention and allow researchers to replicate its components.

Associations between household garden size and childhood obesity in Wales, UK.

ObjectivesPhysical inactivity directly contributes to the global issue of obesity. Small-scale garden-based interventions have positively impacted on children’s physical activity levels. However, no studies have objectively measured household gardens and assessed associations with childhood obesity on a population scale. We linked garden measures with administrative data for a national population. ApproachOur cross-sectional study examined the relationship between garden size and BMI in 154,444 children aged 5 years living in Wales between 2013-2019. We linked garden size at the home location with individual-level BMI measurements and socio-demographic data in the SAIL databank; a secure research environment. BMI measures were derived from the Child Measurement Programme and were standardised using the LMS method. We calculated descriptive statistics for our cohort and used Generalised Additive Models to investigate associations between garden size and BMI. Our results include adjustment for confounding variables such as deprivation. We stratified our analysis by gender and rurality. ResultsOur cohort consisted of 52% male and 49% females. 18% lived in the most affluent quintile and 28% lived in the most deprived quintile. 74% of the cohort lived in urban areas whilst 26% lived in rural areas. Average garden size was 176m2 and the mean number of individuals living in the home was 4. We found a non-linear statistically significant negative association between garden size and BMI (edf = 2.37, p < 0.01). When we stratified our analysis by gender, for males we found a linear statistically significant negative association between garden size and BMI (edf = 1, p < 0.01). For females we found a non-linear statistically significant association between garden size and BMI (edf = 2.67, p < 0.05). ConclusionOur study is the first to link routinely measured objective household variables with BMI data for a national cohort. Our results suggest that garden-based interventions could be focussed on to increase physical activity in children. Further research is required to investigate the pathways between garden, physical activity and reducing obesity.

Environmental Physical Activity Cues and Children's Active vs. Sedentary Recreation.

Physical activity (PA) benefits health, and intensive environmental modifications can increase children’s PA. Research has not yet addressed if subtle environmental cues, such as posters depicting PA, increase child PA. In the current study, it was hypothesized that children exposed to active posters (vs. nature posters) would spend a larger proportion of free play time engaging with active toys (relative to sedentary toys). Participants were randomly assigned to one of two conditions in which posters on a laboratory wall depicted 1. People being active, or 2. Nature scenes. Children aged 5–10 years (N = 175) could play with up to eight toys (four active, four sedentary) while parents completed study-related surveys. The proportion of playtime that was active was compared between groups. Poster type did not have a significant effect on proportion of active playtime. Previous environmental interventions that increase children’s PA have done so through enhancing access to active opportunities, rather than via signage. It is possible that poster interventions such as this may not influence children’s PA, or perhaps other types of cues would have been more effective. Future research should investigate subtle environmental cues that match both the target audience and the accessible PA options (e.g., posters depicting children playing with available active toys) and explore other low-investment environmental modifications to boost children’s PA.

Health Improvement Plan to Increase Physical Activity in Children from ethnic minority and lower socio-economic class (SEC) in London Borough of Ealing, UK- A theorybased solution

Health Improvement Plan to Increase Physical Activity in Children from ethnic minority and lower socio-economic class (SEC) in London Borough of Ealing, UK- A theorybased solution

Evaluation of a voucher scheme to increase child physical activity in participants of a school physical activity trial in the Hunter region of Australia

BackgroundGlobal population data suggest that physical activity levels in children remain unacceptably low. Improved participation in organised sport has been recommended by the WHO as one strategy to improve population levels of physical activity. In 2018, in the state of New South Wales, Australia, the government introduced the Active Kids scheme, to help families meet the cost of getting children into organized sport. The aim of this study is to describe the uptake of Active Kids and assess the impact of the scheme on organized sport participation and child physical activity in a region of New South Wales.MethodsA pragmatic longitudinal study was undertaken of parents/carers from primary school aged children (5–12 years) in the Hunter region of NSW, Australia. Baseline data were collected between Oct-Dec 2017, with follow-up 12 months later. A telephone survey occurred at both time points, asking questions regarding registration and redemption of an Active Kids voucher for their child, child participation in organised sports and child physical activity levels.ResultsOf the 974 parents/carers who consented to participate, 511 (52.5%) completed the telephone surveys at both time points. A very large proportion of children (n = 454, 89.0%) were reported by their parents/carers at baseline as meeting the minimum physical activity guideline of 60 min per day. Of participating parents/carers in this study, 407 (96.0%) reported redeeming an Active Kids voucher. Children who redeemed a voucher had three times the odds to participate in organized team sports from baseline to follow-up (p = 0.009). Sub group analyses identified that females who redeemed a voucher had four times the odds to participate in organized team sports (p = 0.012).ConclusionsGiven the already active nature of this sample, no significant improvements in physical activity levels were noted, but the positive contribution community sport can have on health and wellbeing amongst children is reinforced. Whilst voucher schemes can address financial burdens across all socio-economic groups, more population targeting is needed to deliver voucher schemes to the most disadvantaged and inactive segments of the population in order to increase physical activity.

Parents and children active together: a randomized trial protocol examining motivational, regulatory, and habitual intervention approaches

BackgroundRegular physical activity (PA) is associated with many health benefits during childhood, and tracks into desirable PA patterns and health profiles in adulthood. Interventions designed to support these behaviours among young children are critical. Family-based interventions focusing on parent-child activities together (i.e., co-activity) among preschool-aged children are warranted. Targeting parental support practices can increase the frequency of co-activity, however interventions must move beyond merely building intention and planning skills for successful maintenance. Interventions designed to increase co-activity habit strength may facilitate the sustainability and thus impact child PA. The purpose of this study is to compare the effects of three intervention conditions designed to increase child PA through co-activity: a standard education condition (information about benefits), a planning (action planning, coping planning) + education condition and a habit (context-dependent repetition from prompts and cues) + planning +education condition.Methods/designA longitudinal three-arm parallel design randomized trial will compare three conditions over six months. Families are eligible if they have at least one child between 3y and 5y that is not meeting 60mins/day of moderate to vigorous physical activity (MVPA). The primary outcome (child MVPA) is assessed via accelerometry at baseline, six weeks, three months and six months (primary endpoint). Intervention materials targeting co-activity are delivered post baseline assessment, with booster sessions at six weeks and three months. Parental co-activity habit, parent-child co-activity and other behavioural constructs are also assessed via questionnaire at all measurement occasions. As tertiary outcomes, parental PA is measured via accelerometry and co-activity is measured via a Bluetooth-enabled proximity feature. A total of 106 families have been recruited thus far from the Greater Victoria region. The study is ongoing with a minimum target of 150 families and an anticipated recruitment completion date of August 2022.DiscussionThis protocol describes the implementation of a randomized trial evaluating the effectiveness of a habit formation group compared with a planning group and an education only group to increase child PA through targeting parent-child co-activity. This information could prove useful in informing public health initiatives to promote PA among families with preschool-aged children.Trial registrationThis trial was prospectively registered on clinicaltrials.gov in February 2016, identifier NCT03055871.

Are There Effective Interventions to Increase Physical Activity in Children and Young People? An Umbrella Review.

Background: Obesity and physical inactivity among children and young people are public health concerns. While numerous interventions to promote physical activity are available, little is known about the most effective ones. This study aimed to summarize the existing evidence on interventions that aim to increase physical activity. Methods: A systematic review of reviews was conducted. Systematic reviews and meta-analyses published from January 2010 until November 2017 were identified through PubMed, Scopus and the Cochrane Library. Two reviewers independently assessed titles and abstracts, performed data extraction and quality assessment. Outcomes as level of physical activity and body mass index were collected in order to assess the efficacy of interventions. Results: A total 30 studies examining physical activity interventions met the inclusion criteria, 15 systematic reviews and 15 meta-analyses. Most studies (N = 20) were implemented in the school setting, three were developed in preschool and childcare settings, two in the family context, five in the community setting and one miscellaneous context. Results showed that eight meta-analyses obtained a small increase in physical activity level, out of which five were conducted in the school, two in the family and one in the community setting. Most promising programs had the following characteristics: included physical activity in the school curriculum, were long-term interventions, involved teachers and had the support of families. Conclusion: The majority of interventions to promote physical activity in children and young people were implemented in the school setting and were multicomponent. Further research is needed to investigate nonschool programs.

Effectiveness of Serious Games to Increase Physical Activity in Children With a Chronic Disease: Systematic Review With Meta-Analysis.

BackgroundPhysical activity (PA) is important for children with a chronic disease. Serious games may be useful to promote PA levels among these children.ObjectiveThe primary purpose of this systematic review was to evaluate the effectiveness of serious games on PA levels in children with a chronic disease.MethodsPubMed, EMBASE, PsycINFO, ERIC, Cochrane Library, and CINAHL were systematically searched for articles published from January 1990 to May 2018. Both randomized controlled trials and controlled clinical trials were included to examine the effects of serious games on PA levels in children with a chronic disease. Two investigators independently assessed the intervention, methods, and methodological quality in all articles using the Cochrane risk of bias tool. Both qualitative and quantitative analyses were performed.ResultsThis systematic review included 9 randomized controlled trials (886 participants). In 2 of the studies, significant between-group differences in PA levels in favor of the intervention group were reported. The meta-analysis on PA levels showed a nonsignificant effect on moderate to vigorous PA (measured in minutes per day) between the intervention and control groups (standardized mean difference 0.30, 95% CI –0.15 to 0.75, P=.19). The analysis of body composition resulted in significantly greater reductions in BMI in the intervention group (standardized mean difference –0.24, 95% CI –0.45 to 0.04, P=.02).ConclusionsThis review does not support the hypothesis that serious games improve PA levels in children with a chronic disease. The meta-analysis on body composition showed positive intervention effects with significantly greater reductions in BMI in favor of the intervention group. A high percentage of nonuse was identified in the study of serious games, and little attention was paid to behavior change theories and specific theoretical approaches to enhance PA in serious games. Small sample sizes, large variability between intervention designs, and limited details about the interventions were the main limitations. Future research should determine which strategies enhance the effectiveness of serious games, possibly by incorporating behavior change techniques.

Using Narrative Game Design to Increase Children's Physical Activity: Exploratory Thematic Analysis.

BackgroundPhysical activity is crucial for child obesity prevention and intervention. Narratives embedded in active games can increase children’s physical activity.ObjectiveLittle is known about the narrative characteristics that would motivate children to exercise. We attempted to fill the gaps in understanding regarding narrative design for active video games.MethodsIn this exploratory study, four animated narratives of different genres were professionally generated. Children (N=41) between the ages of 8 and 12 years were interviewed to identify their preferences. Sessions were digitally recorded, transcribed, and analyzed using exploratory thematic analysis.ResultsFindings revealed that the children rated the dystopian science fiction story as their favorite across all weight, race, and gender groups. The physical activity-friendly narrative strategies included virtuous characters, extraordinary character actions, interesting plots, super powers, and engaging cliffhangers. Alternatively, information not related to physical activity, difficult-to-follow plot lines, passive protagonists, and repetitive narrative tropes were less appealing for physical activity.ConclusionsThis research provides preliminary evidence that narratives have characteristics that may increase child physical activity when playing active games. Future empirical studies should verify and test these design principles.

Implementation of continuous free play schedules in Australian childcare services: A cross‐sectional study

Modifying the scheduling of physical activity opportunities to provide children with more frequent opportunities for outdoor free play has been demonstrated to increase child physical activity while in care. The primary aim of this study was to describe the implementation of continuous free play schedules to allow children to access outdoor play areas, consistent with sector guidelines in a national sample of Australian childcare services. Secondary aims were to investigate the associations between the implementation of such schedules and service characteristics, and assess the perceived barriers and enablers to implementation. A cross-sectional study was undertaken with a random sample of 326 centre-based childcare services located across Australia. Childcare service characteristics, continuous free play scheduling and perceived barriers and enablers to implementation were assessed via a survey administered to service managers online or via telephone. A total of 203 service managers (62%) reported implementing a continuous free play schedule, for three periods of 126minutes per period, each day on average. Service type (long day care services), size (services with higher numbers of child enrolments [≥80 children]) and socio-economic area (services located in lower socio-economic areas) were associated with the implementation of a continuous free play schedule. The most prevalent barriers to implementation included insufficient staff to ensure adequate supervision of children (69%) and service layout being unsuitable (65%), while the most prevalent enablers included advice on how to overcome staffing or supervision issues (89%) and to re-orientate the service layout (54%). There is scope to support the implementation of continuous free play schedules consistent with childcare sector guidelines. SO WHAT?: Future intervention research that targets the reported barriers and enablers to implementation is needed.

Process evaluation of a pilot multi-component physical activity intervention \u2013 active schools: Skelmersdale

BackgroundSchools have been identified as key environments to promote child physical activity (PA). Implementation of multi-component PA interventions within schools is advocated but research has showed that they may not always be effective at increasing child PA. Results of the Active Schools: Skelmersdale (AS:Sk) multi-component pilot intervention indicated no significant positive change to child PA levels. Process evaluations can provide information on which aspects of an intervention were delivered and how. Therefore, the purpose of this study was to use a combination of methods to elicit child and teacher perceptions regarding the feasibility and acceptability of the AS:Sk intervention, alongside systematic researcher observations. The overarching study aim was to understand how schools implemented the AS:Sk intervention, with a specific focus on the frequency of intervention component implementation, and how the components were incorporated into the school day.MethodsThe study generated five data sets. Data elicited from 18 participating children via a write draw, show and tell task included, frequency counts of most enjoyable intervention components, drawings, and verbatim data. Teacher verbatim data was collected from 3 interviews, and 18 researcher observations were recorded using field notes. The data sources were pooled to produce the themes presented in the results section.ResultsThe combination of data sources revealed four themes and 16 sub-themes. Implementation methods: how and when the components were implemented in schools. Child engagement: enjoyment and positive behaviour. Facilitators: peer influence, teacher influence, staggered implementation, incentives, rewards, challenges and competition, flexibility and adaptability, child ownership, routine.Barriers: time within an intense curriculum, space, sustaining child interest, parental support, school policies.ConclusionsThis study revealed that teachers believed classroom based activities were most feasible and acceptable due to the reduced implementation barriers of sufficient time and space. In contrast, children reported that the activities outside of the classroom were preferred. Future school-based PA interventions should aim to achieve a balance between routine PA at a set time and PA that is flexible and adaptable. Further process evaluations of multi-component school-based PA interventions are warranted to develop the limited evidence base.

Efficacy of a free-play intervention to increase physical activity during childcare: a randomized controlled trial.

The primary aim of this study was to assess the efficacy of a childcare-based intervention in increasing child physical activity by allowing children unrestricted access to outdoor areas for free-play when structured activity is not taking place. A randomized controlled trial was conducted in six childcare services. Intervention services provided children unrestricted access outdoors for active free-play, while control services provided their usual scheduled periods of outdoor play. Consent was obtained from 231 children. Child moderate to vigorous activity (MVPA), the primary trial outcome, was assessed via accelerometer at baseline and 3 months post baseline. Intervention effects were examined using Generalised Linear Mixed Models. Controlling for child age, gender and baseline outcome measure, at follow-up there were no significant differences between groups in minutes of MVPA in-care (mean difference: 4.85; 95% CI: -3.96, 13.66; P = 0.28), proportion of wear time in-care spent in MVPA (mean difference: 1.52%; 95% CI: -0.50, 3.53; P = 0.14) or total physical activity in-care (mean difference in counts per minute: 23.18; 95% CI: -4.26, 50.61; P = 0.10), nor on measures of child cognition (P = 0.45-0.91). It was concluded that interventions addressing multiple aspects of the childcare and home environment might provide the greatest potential to improve child physical activity.

Impact of scheduling multiple outdoor free-play periods in childcare on child moderate-to-vigorous physical activity: a cluster randomised trial

BackgroundIncreasing the frequency of periods of outdoor free-play in childcare may represent an opportunity to increase child physical activity. This study aimed to assess the efficacy of scheduling multiple periods of outdoor free-play in increasing the time children spend in moderate-to-vigorous physical activity (MVPA) while attending childcare.MethodsThe study employed a cluster randomised controlled trial design involving children aged 3 to 6 years, attending ten childcare services in the Hunter New England region of New South Wales, Australia. Five services were randomised to receive the intervention and five to a control condition. The intervention involved services scheduling three separate periods of outdoor free-play from 9 am to 3 pm per day, each at least 15 min in duration, with the total equivalent to their usual daily duration of outdoor play period. Control services implemented the usual single continuous period of outdoor free-play over this time. The primary outcome, children’s moderate-to-vigorous physical activity (MVPA) while in care per day, was measured over 5 days via accelerometers at baseline and at 3 months post baseline. Secondary outcomes included percentage of time spent in MVPA while in care per day, total physical activity while in care per day and documented child injury, a hypothesised potential unintended adverse event. Childcare services and data collectors were not blind to the experimental group allocation.ResultsParents of 439 (71.6%) children attending participating childcare services consented for their child to participate in the trial. Of these, 316 (72.0%) children provided valid accelerometer data at both time points. Relative to children in control services, mean daily minutes of MVPA in care was significantly greater at follow-up among children attending intervention services (adjusted difference between groups 5.21 min, 95% CI 0.59–9.83 p = 0.03). Percentage of time spent in MVPA in care per day was also greater at follow-up among children in intervention services relative to control services (adjusted difference between groups 1.57, 95% CI 0.64–2.49 p < 0.001). Total physical activity while in care per day, assessed via counts per minute approached but did not reach significance (adjusted difference between groups 14.25, 95% CI 2.26–30.76 p = 0.09). There were no differences between groups in child injury nor subgroup interactions for the primary trial outcome by child age, sex, or baseline MVPA levels.ConclusionScheduling multiple periods of outdoor free-play significantly increased the time children spent in MVPA while in attendance at childcare. This simple ecological intervention could be considered for broader dissemination as a strategy to increase child physical activity at a population level.Trial registrationThis trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) (ACTRN1261000347460). Prospectively registered 17th March 2016.

Predictors of stationary cycling exergame use among inactive children in the family home

ObjectivesExergames may be one viable way to increase child physical activity, but investigation of long term motivation, and prediction of adherence has seen little research attention. The purpose of this study was to compare the effect of an exergame intervention (exergame bike, standard bike) among children aged 10–14 years on motivational variables (self-determination theory, theory of planned behavior) and to explore whether these variables could predict use of the equipment across three months. DesignRandomized controlled trial. Method: Seventy-three insufficiently active children were recruited through advertisements within the community/schools and randomized to either an exergame condition (n = 39) or a standard bike condition (n = 34). Weekly bike use was recorded in a log-book and motivational variables were assessed after a familiarization session and at six weeks. ResultsExposure to exergames conferred higher affective and instrumental attitudes, perceived behavioral control, intention, and intrinsic motivation compared to the comparison condition, but this difference was not present by the six-week point of the trial. Children who had higher intention to use the bikes and extrinsic regulation were more likely to use the bikes from six weeks to three months, but no assessed psychological variable could account for use during the first six weeks. ConclusionsSingle-exposure research designs may not accurately reflect the motivations for longer term exergame play. Further, parent consumers of exercise equipment for the family home may benefit from considering how much their children would enjoy using the equipment after repeated exposures.

Gender-specific effects of physical activity on children's academic performance: The Active Smarter Kids cluster randomized controlled trial

Active learning combines academic content with physical activity (PA) to increase child PA and academic performance, but the impact of active learning is mixed. It may be that this is a moderated relationship in which active learning is beneficial for only some children. This paper examine the impact of baseline academic performance and gender as moderators for the effects of active learning on children's academic performance.In the ASK-study, 1129 fifth-graders from 57 Norwegian elementary schools were randomized by school to intervention or control in a physical activity intervention between November 2014 and June 2015. Academic performance in numeracy, reading, and English was measured and a composite score was calculated. Children were split into low, middle and high academic performing tertiles. 3-way-interactions for group (intervention, control)∗gender (boys, girls)∗academic performance (tertiles) were investigated using mixed model regression.There was a significant, 3-way-interaction (p=0.044). Both boys (ES=0.11) and girls (ES=0.18) in the low performing tertile had a similar beneficial trend. In contrast, middle (ES=0.03) and high performing boys (ES=0.09) responded with small beneficial trends, while middle (ES=−0.11) and high performing girls (ES=−0.06) responded with negative trends.ASK was associated with a significant increase in academic performance for low performing children. It is likely that active learning benefited children most in need of adapted education but it may have a null or negative effect for those girls who are already performing well in the sedentary classroom. Differences in gendered responses are discussed as a possible explanation for these results.Trial registration: Clinicaltrials.gov registry, trial registration number: NCT02132494.

Stationary cycling exergame use among inactive children in the family home: a randomized trial.

Exergames may be one way to increase child physical activity, but long term adherence has seen little research attention. The primary objective of this study was to evaluate the usage of an exergame bike in comparison to a stationary bike in front of a TV across 3-months within a family home environment among children aged 10-14years old. Seventy-three inactive children were recruited through advertisements and randomized to either the exergame condition (n=39) or the standard bike condition (n=34). Weekly bike use was recorded in a log-book. Both groups declined in bike use over time (t=3.921, p<.01). Although the exergame group reported higher use (t=2.0045, p<.05), this was most prominent during the first week. Overall, these results do not support exergames as a standalone physical activity intervention, and suggest that short duration examinations of exergames may be misleading.

A randomised controlled trial of multiple periods of outdoor free-play to increase moderate-to-vigorous physical activity among 3 to 6year old children attending childcare: study protocol.

BackgroundThe implementation of physical activity interventions in centre-based childcare services has been recommended to improve child health. This study aims to evaluate the efficacy of scheduling multiple periods of outdoor free play in increasing the time children spend in moderate-to-vigorous physical activity (MVPA) during childcare.MethodsThe study will employ a between group cluster randomised controlled trial design. Fourteen childcare services in the Hunter New England region of New South Wales, Australia, who currently implement a single session of free outdoor play between their core operational hours of 9 am to 3 pm will be recruited into the trial. Childcare services will be randomised to an intervention or a no intervention control group. Childcare services in the intervention group will be supported by an early childhood education specialist to provide three periods of outdoor free play for children between the hours of 9 am to 3 pm. Each period of outdoor free play will be at least 15 min in duration but must equate to their total usual duration of outdoor play. Services in the control group will continue to implement a single period of outdoor play. The primary trial outcome is minutes of time children spend in MVPA whilst in care assessed objectively via accelerometer over 5 days. Outcome assessment will occur at baseline and 3 months post baseline. Generalised Linear Mixed Models (GLMM) under an intention to treat framework will be used to compare differences between groups in the primary trial outcome at follow-up. Sensitivity analysis will be conducted to test assumptions of missing data. Per protocol analysis will be performed using services that implemented the intervention as intended and subgroup analysis undertaken by gender and baseline physical activity levels of children.DiscussionThe study tests a simple ecological intervention that has the potential to increase child physical activity in care.Trial registrationAustralian New Zealand Clinical Trials Registry 12616000347460. Prospectively registered 17th March 2016.