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Defining and Measuring Active Play Among Young Children: A Systematic Review

Stephanie Truelove, Leigh M. Vanderloo, and Patricia Tucker

Background:

Many young children are not meeting the Canadian physical activity guidelines. In an effort to change this, the term active play has been used to promote increased physical activity levels. Among young children, physical activity is typically achieved in the form of active play behavior. The current study aimed to review and synthesize the literature to identify key concepts used to define and describe active play among young children. A secondary objective was to explore the various methods adopted for measuring active play.

Methods:

A systematic review was conducted by searching seven online databases for English-language, original research or reports, and were eligible for inclusion if they defined or measured active play among young children (ie, 2 to 6 years).

Results:

Nine studies provided a definition or description of active play, six measured active play, and 13 included both outcomes. While variability in active play definitions did exist, common themes included: increased energy exerted, rough and tumble, gross motor movement, unstructured, freely chosen, and fun. Alternatively, many researchers described active play as physical activity (n = 13) and the majority of studies used a questionnaire (n = 16) to assess active play among young children.

Conclusion:

Much variability in the types of active play, methods of assessing active play, and locations where active play can transpire were noted in this review. As such, an accepted and consistent definition is necessary, which we provide herein.

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Physical Activity Opportunities in Canadian Childcare Facilities: A Provincial/Territorial Review of Legislation

Leigh M. Vanderloo, Patricia Tucker, Ali Ismail, and Melissa M. van Zandvoort

Background:

Preschoolers spend a substantial portion of their day in childcare; therefore, these centers are an ideal venue to encourage healthy active behaviors. It is important that provinces’/territories’ childcare legislation encourage physical activity (PA) opportunities. The purpose of this study was to review Canadian provincial/territorial childcare legislation regarding PA participation. Specifically, this review sought to 1) appraise each provincial/territorial childcare regulation for PA requirements, 2) compare such regulations with the NASPE PA guidelines, and 3) appraise these regulations regarding PA infrastructure.

Methods:

A review of all provincial/territorial childcare legislation was performed. Each document was reviewed separately by 2 researchers, and the PA regulations were coded and summarized. The specific provincial/territorial PA requirements (eg, type/frequency of activity) were compared with the NASPE guidelines.

Results:

PA legislation for Canadian childcare facilities varies greatly. Eight of the thirteen provinces/territories provide PA recommendations; however, none provided specific time requirements for daily PA. All provinces/territories did require access to an outdoor play space.

Conclusion:

All Canadian provinces/territories lack specific PA guidelines for childcare facilities. The development, implementation, and enforcement of national PA legislation for childcare facilities may aid in tackling the childhood obesity epidemic and assist childcare staff in supporting and encouraging PA participation.

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Physical and Sedentary Activity Levels Among Preschoolers in Home-Based Childcare: A Systematic Review

Leigh M. Vanderloo, Olivia J. M. Martyniuk, and Patricia Tucker

Background:

Although preschoolers’ physical activity in center-based childcare has received considerable attention, less is known regarding this group’s activity levels within home-based childcare. This review aimed to explore and synthesize the literature on preschoolers’ physical and sedentary activity levels in home-based childcare. Outdoor playtime was also examined to contribute to the understanding of preschoolers’ activity levels within this particular setting.

Methods:

Nine online databases were searched for peer-reviewed, English-language, primary studies that quantitatively measured physical and sedentary activity levels of preschoolers attending home-based childcare. Studies were excluded if they were nonprimary research, if they lacked a preschool-aged sample, if they did not quantitatively measure physical or sedentary activity, or if they took place in an ineligible environment.

Results:

Seven articles were included in this review; 3 had objective measures of activity levels, and 4 relied on nonobjective measures. Accelerometry data suggest that preschoolers’ average sedentary, moderate-to-vigorous, and total physical activity levels in home-based childcare ranged from 39.5 to 49.6, 1.8 to 9.7, and 10.4 to 33.8 min/hr, respectively. Outdoor playtime appears to be inconsistent in home-based childcare.

Conclusion:

Physical activity among preschoolers attending home-based childcare appears to be relatively low and widely varied. Sedentary time has received less attention in home-based childcare settings. Future research examining activity levels in this unique environment is warranted.

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Exploring Preschoolers’ Physical Activity and Sedentary Time During Outdoor Play at Childcare: A Cross-Sectional Analysis of the Supporting Physical Activity in the Childcare Environment Study

Brianne A. Bruijns, Leigh M. Vanderloo, Brian W. Timmons, and Patricia Tucker

Background: Moderate-to-vigorous physical activity (MVPA) offers many health benefits for preschoolers (2.5–5 y). In childcare, MVPA is predominantly accumulated outdoors, with higher rates purported among children within the first few minutes outside. The Supporting Physical Activity in the Childcare Environment intervention included shorter, more frequent outdoor play sessions; this study sought to explore children’s activity levels during various outdoor play schedules. Methods: During the final week of the Supporting Physical Activity in the Childcare Environment intervention, preschoolers wore an Actical accelerometer for 5 days during childcare and staff logged outdoor times. Separate linear mixed effects models were run to explore the effect of the intervention on preschoolers’ physical activity (total and MVPA) and sedentary time during outdoor play. Sex was entered as an interaction effect. Results: Preschoolers (n = 292) were significantly more active in the first 10 minutes outdoors compared with remaining time (P < .0083). For total outdoor time, children in the experimental group engaged in significantly less sedentary time than those in the control group (P < .017), and experimental group boys and girls engaged in higher MVPA than boys and girls in the control group (P < .017). Conclusions: Findings support scheduling more frequent outdoor play sessions in childcare to increase physical activity participation among young children.

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Comparing the Actical and ActiGraph Approach to Measuring Young Children’s Physical Activity Levels and Sedentary Time

Leigh M. Vanderloo, Natascja A. Di Cristofaro, Nicole A. Proudfoot, Patricia Tucker, and Brian W. Timmons

Young children’s activity and sedentary time were simultaneously measured via the Actical method (i.e., Actical accelerometer and specific cut-points) and the ActiGraph method (i.e., ActiGraph accelerometer and specific cut-points) at both 15-s and 60-s epochs to explore possible differences between these 2 measurement approaches. For 7 consecutive days, participants (n = 23) wore both the Actical and ActiGraph side-by-side on an elastic neoprene belt. Device-specific cut-points were applied. Paired sample t tests were conducted to determine the differences in participants’ daily average activity levels and sedentary time (min/h) measured by the 2 devices at 15-s and 60-s time sampling intervals. Bland-Altman plots were used to examine agreement between Actical and ActiGraph accelerometers. Regardless of epoch length, Actical accelerometers reported significantly higher rates of sedentary time (15 s: 42.7 min/h vs 33.5 min/h; 60 s: 39.4 min/h vs 27.1 min/h). ActiGraph accelerometers captured significantly higher rates of moderate-to-vigorous physical activity (15 s: 9.2 min/h vs 2.6 min/h; 60 s: 8.0 min/h vs 1.27 min/h) and total physical activity (15 s: 31.7 min/h vs 22.3 min/h; 60 s: = 39.4 min/h vs 25.2 min/h) in comparison with Actical accelerometers. These results highlight the present accelerometry-related issues with interpretation of datasets derived from different monitors.

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Association Between Children’s and Parents’ Physical Activity During the COVID-19 Pandemic: A Cross-Lagged Analysis

Monika Szpunar, Matthew Bourke, Leigh M. Vanderloo, Brianne A. Bruijns, Stephanie Truelove, Shauna M. Burke, Jason Gilliland, Jennifer D. Irwin, and Patricia Tucker

Background: COVID-19 caused closures of movement supporting environments such as gyms and schools in Canada. This study evaluated the association between Ontario parents’ and children’s physical activity levels across time during COVID-19, controlling for variables that were identified as significant predictors of children’s and parents’ physical activity (e.g., children’s age, parents’ employment status). Methods: Parents (n = 243; mean age = 38.8 y) of children aged 12 and under (n = 408; mean age = 6.3 y) living in Ontario, Canada completed 2 online surveys, the first between August and December 2020 and the second between August and December 2021. At baseline, parents were asked to recall prepandemic physical activity levels. To determine the association between parent and child physical activity during COVID-19, a cross-lagged model was estimated to determine the cross-sectional and longitudinal associations between parents’ and children’s physical activity across time. Results: Bivariate associations revealed that parents’ and children’s physical activity levels were significantly related during lockdown and postlockdown but not prelockdown. The autoregressive paths from prelockdown to during lockdown were significant for children (β = 0.53, P < .001) and parents (β = 1.058, P < .001) as were the autoregressive paths from during lockdown to postlockdown for children (β = 0.61, P < .001) and parents (β = 0.48, P < .001). In fully adjusted models, the cross-lagged association between parents’ physical activity prelockdowns was significantly positively associated with their children’s physical activity during lockdowns (β = 0.19, P = .013). Conclusions: Resources are needed to ensure that children and parents are obtaining sufficient levels of physical activity, particularly during a pandemic.

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Changes in Pediatric Movement Behaviors During the COVID-19 Pandemic by Stages of Lockdown in Ontario, Canada: A Longitudinal Cohort Study

Priya Patel, Xuedi Li, Charles D.G. Keown-Stoneman, Leigh M. Vanderloo, Laura M. Kinlin, Jonathon L. Maguire, and Catherine S. Birken

Background: Children’s movement behaviors have been affected by the COVID-19 pandemic; however, little is known regarding movement behavior patterns over time by government-issued lockdowns. Our primary objective was to evaluate how children’s movement behaviors changed by stages of lockdown/reopening in Ontario, Canada, from 2020 to 2021. Methods: A longitudinal cohort study with repeated measures of exposure and outcomes was conducted. The exposure variables were dates from before and during COVID-19 when child movement behavior questionnaires were completed. Lockdown/reopening dates were included as knot locations in the spline model. The outcomes were daily screen, physical activity, outdoor, and sleep time. Results: A total of 589 children with 4805 observations were included (53.1% boys, 5.9 [2.6] y). On average, screen time increased during the first and second lockdowns and decreased during the second reopening. Physical activity and outdoor time increased during the first lockdown, decreased during the first reopening, and increased during the second reopening. Younger children (<5 y) had greater increases in screen time and lower increases in physical activity and outdoor time than older children (≥5 y). Conclusions: Policy makers should consider the impact of lockdowns on child movement behaviors, especially in younger children.

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Identifying Risk Profiles for Nonadherence to the 24-Hour Movement Guidelines for Children and Youth 6 Months Into the COVID-19 Pandemic

Michelle D. Guerrero, Sarah Moore, Guy Faulkner, Karen C. Roberts, Raktim Mitra, Leigh M. Vanderloo, Ryan E. Rhodes, and Mark S. Tremblay

Purpose: The purposes of the current study were to identify risk profiles for nonadherence among children and youth (5–17 y) at the 6-month mark of the COVID-19 pandemic and to discuss similarities and differences between risk profiles identified in the current study and those identified at the 1-month mark of the pandemic. Methods: Data were part of a nationally representative sample of 1143 parents (M age = 43.07 y, SD = 8.16) of children and youth (5–17 y) living in Canada. Survey data were collected in October 2020. Results: Results showed that 3.8% met all movement behavior recommendations, 16.2% met the physical activity recommendation, 27% met the screen time recommendation, and 63.8% met the sleep recommendation. Characteristics associated with nonadherence to all movement behaviors included low parental perceived capability to restrict screen time and decreased overall time spent outdoors. Characteristics associated with nonadherence to the physical activity and screen time recommendations included youth (12–17 y), low parental perceived capability to restrict screen time, decreased time spent outdoors, and increased screen time. Conclusion: Results emphasized the importance of parental perceived capability to restrict screen time and children’s and youth’s outdoor time and showed that pandemic-related factors have impacted children and youth differently.

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Physical Activity Among Young Children With Disabilities: A Systematic Review

Leah G. Taylor, Leigh M. Vanderloo, Julia Yates, Rebecca L. Bassett-Gunter, Meagan Stanley, and Patricia Tucker

Physical activity (PA) in the early years is foundational for growth and development and associated with numerous health benefits. However, the prevalence of PA participation among the pediatric population with disabilities is less clear. This systematic review aimed to synthesize the existing literature on PA levels of young children (0–5.99 years) with disabilities. Empirical quantitative studies were collected from seven databases and reference hand searching; 21 studies were included in the review. PA levels varied widely based on disability type and measurement strategies, but overall, PA levels were low. Future research should address the underrepresentation of measurement and reporting of the PA levels of young children with disabilities.

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Association of Physical Activity and Cardiometabolic Risk in Children 3–12 Years

Leigh M. Vanderloo, Jonathan L. Maguire, David W. H. Dai, Patricia C. Parkin, Cornelia M. Borkhoff, Mark S. Tremblay, Laura N. Anderson, Catherine S. Birken, and on behalf of the TARGet Kids! Collaboration*

Background: This study aimed to examine the association between physical activity (PA) and a total cardio metabolic risk (CMR) score in children aged 3–12 years. Secondary objectives were to examine the association between PA and individual CMR factors. Methods: A longitudinal study with repeated measures was conducted with participants from a large primary care practice-based research network in Toronto, Canada. Mixed effects models were used to examine the relationship between parent-reported physical activity and outcome variables (total CMR score, triglycerides, glucose, high-density lipoprotein cholesterol, systolic blood pressure, waist circumference, weight-to-height ratio, and non-high-density lipoprotein cholesterol). Results: Data from 1885 children (6.06 y, 54.4% male) with multiple visits (n = 2670) were included in the analyses. For every unit increase of 60 minutes of PA, there was no evidence of an association with total CMR score (adjusted: −0.02 [−0.014 to 0.004], P = .11]. For the individual CMR components, there was evidence of a weak association between PA and systolic blood pressure (−0.01 [−0.03 to −0.01], P < .001) and waist-to-height ratio (−0.81 [−1.62 to −0.003], P < .001). Conclusion: Parent-reported PA among children aged 3–12 years was not statistically associated with total CMR, but was weakly associated with systolic blood pressure and waist-to-height ratio.