Preschoolers in the Playground: a pilot cluster randomised controlled trial of a physical activity intervention for children aged 18 months to 4 years

Abstract

BackgroundThe preschool years are considered critical for establishing healthy lifestyle behaviours such as physical activity. Levels of physical activity track through childhood into adulthood and establishing habitual physical activity early in life is therefore 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 preschool, playground-based interventions and these have given inconclusive results. A report published by the UK’s Chief Medical Officer (CMO) highlighted the need for new interventions to promote movement in the early years (0–5 years).ObjectivesThis study aimed to undertake a pilot cluster randomised controlled trial (RCT) of an outdoor playground-based physical activity intervention for parents and their children aged from 18 months to 4 years (Preschoolers in the Playground or PiP) and to assess the feasibility of conducting a full-scale cluster RCT.DesignThe study was a two-armed pilot cluster RCT with economic and qualitative evaluations. Participants were randomised on a 1 : 1 basis to the PiP intervention (n = 83) or usual practice (control;n = 81).SettingBradford, West Yorkshire, UK.ParticipantsChildren aged from 18 months to 4 years.InterventionThe PiP intervention is grounded in behavioural theory (social cognitive theory) and is in accordance with CMO guidance for physical activity in the early years. It is informed by existing literature and data collected from focus groups with parents. The intervention was delivered in primary school playgrounds. Six 30-minute PiP sessions per week were available for 30 weeks; families were encouraged to come to three a week. The 10-week initiation phase was facilitated by a member of school staff and the maintenance phase was unsupervised.Main outcome measuresRecruitment and retention of schools and families to the trial were the main outcome measures. The acceptability of trial procedures and the intervention, the feasibility of collecting health outcome data and the fidelity of the implementation of the intervention were also evaluated. A preliminary assessment of cost-effectiveness and a sample size calculation for a full trial were conducted.ResultsIn total, 37% of schools and 48% of parents approached agreed to take part. Levels of retention were good at 10 and 52 weeks’ follow-up (82.3% and 83.5% respectively). Both the trial procedures and the intervention were acceptable. However, attendance was low during the autumn and winter/spring initiation phases but somewhat better in the summer initiation phase. Attendance was poor throughout all maintenance phases. The accelerometry protocol for measuring physical activity requires modification. The fidelity of intervention implementation was good (81% adherence). The intervention was borderline cost-effective. A sample size of 600 children from 38 schools is required for a full trial.ConclusionA full RCT of the PiP intervention is feasible. The PiP intervention requires some modification, for example running the intervention during the summer term only, but was found to be acceptable to schools and families.Trial registrationCurrent Controlled Trials ISRCTN54165860.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 3, No. 5. See the NIHR Journals Library website for further project information.

Efficacy of an Enhanced Implementation Strategy to Increase Parent Engagement with a Health Promotion Program in Childcare

“…Similar to other studies, ECE providers expressed generally positive opinions about the acceptability and feasibility of the intervention [40][41][42]. This study extended the work of others by seeking parents' opinions which, interestingly, were less favorable than ECE providers' opinions.…”

Relationships between Motor Competence, Physical Activity, and Obesity in British Preschool Aged Children

“…Use of cut-points derived from American preschoolers to assess PA in a British population may not fully capture the PA behavior of children, due to the different social and economic environments in which PA takes place in the U.S. compared to the U.K. Conversely, other research has reported that 95.6% of British preschoolers completed TPA recommendations for health. Similar to the aforementioned studies by O’Dwyer et al [ 8 , 12 , 13 ], Barber et al [ 15 ] used cut points which were validated in American preschoolers [ 16 ] despite investigating children from Bradford [ 15 ]. Preschool-based approaches that decrease sedentary behavior and increase PA may aid in combating the epidemic of juvenile obesity.…”

“Unmapping” the Ural Playscapes: An Analysis of Playgrounds and Child Play under the Post-Soviet Urban Transition of Yekaterinburg, Russia

“…Playgrounds are a conducive means for child development with respect to physical, intellectual, emotional, and social processes (Hughes 1995). Recent developments foreground playgrounds as an intervention to promote child health (Barber et al 2015). Studies also deal with safety in playgrounds, such as injury cases (Ball 2002), and ergonomic structures that need to adjust for children's needs given increased urbanization (Nowakowski and Charytonowicz 2007).…”

“…This user of public playgrounds did not opt to completely prohibit her children from playing there. 23 21 Such playgrounds are considered insufficient for further cognitive and physical development of children since their designs prioritize safety over challenging children's abilities and promoting learning (Barber et al 2015).…”

“…However, playgrounds have been subject to little political analysis. Most research on this subject is found in the fields of urban planning, psychology, early childhood education, and ergonomics (Barber et al 2015), but rarely has it been under the study of politics. The relevance of political analysis of playgrounds is that these spaces become venues of struggle for contesting symbolic or actual control over children's activities and geographies (Katz 2002).…”