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Karen Tonge, Rachel A. Jones and Anthony D. Okely

Background: To examine the relationship between attributes of early childhood education and care (ECEC) settings and children’s physical activity and sedentary behavior. Methods: Cross-sectional study involving 490 children aged 2–5 years from 11 ECECs. The ECEC routine, size of the outdoor environment, and time spent in the outdoor environment were calculated for each center. Children’s physical activity and sedentary time were measured using accelerometers. Multivariate linear regressions were used to examine associations of the attributes of ECEC centers with the outcome variables, adjusting for the effects of center clustering and gender. Results: Children in ECECs that offered free routines (where children can move freely between indoor and outdoor environments) had lower levels of sedentary time (28.27 min/h vs 33.15 min/h; P = .001) and spent more time in total physical activity (7.99 min/h vs 6.57 min/h; P = .008) and moderate- to vigorous-intensity physical activity (9.49 min/h vs 7.31 min/h; P = .008). Children in ECECs with an outdoor environment >400 m2 had less sedentary time (28.94 min/h vs 32.42 min/h; P = .012) than those with areas <400 m2. Conclusion: Modifiable practices such as offering a free routine and increasing time spent in outdoor environments could potentially offer an easy and sustainable way for ECEC centers to promote physical activity and reduce sedentary time among children.

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Rachel A. Jones, Jacque Kelly, Dylan P. Cliff, Marijka Batterham and Anthony D. Okely


Single sex after-school physical activity programs show potential to prevent unhealthy weight gain. The aim of this study was to assess the acceptability and potential efficacy of single-sex after-school physical activity programs for overweight and at-risk children from low-income communities.


7-month, 2-arm parallel-group, RCT, conducted at an elementary school in a disadvantaged area in Wollongong, Australia (March-November 2010).


20 boys and 17 girls were randomized to intervention (PA) or active comparison groups (HL). Primary outcomes included implementation, acceptability, percentage body fat and BMI z-score.


The PA programs were acceptable with high implementation and enjoyment rates. At 7 months postintervention girls in the PA group displayed greater changes in percentage body fat (adjust diff. = -1.70, [95% CI -3.25, -0.14]; d = -0.83) and BMI z-score (-0.19 [-0.36, -0.03]; d= -1.00). At 7 months boys in the PA group showed greater changes in waist circumference (-3.87 cm [-7.80, 0.15]; d= -0.90) and waist circumference z-score (-0.33 [-0.64, -0.03]; d= -0.98). For both boys’ and girls’ PA groups, changes in adiposity were not maintained at 12-month follow-up.


Single-sex after-school physical activity programs are acceptable and potentially efficacious in preventing unhealthy weight gain among overweight and at-risk children. However improvements are hard to sustain once programs finish operating.

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Rachel A. Jones, Annaleise Riethmuller, Kylie Hesketh, Jillian Trezise, Marijka Batterham and Anthony D. Okely

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 randomized 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 designated inside and outside playtime. Primary outcomes were movement skill development and objectively 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 objectively 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.

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Simone A. Tomaz, Trina Hinkley, Rachel A. Jones, Rhian Twine, Kathleen Kahn, Shane A. Norris and Catherine E. Draper

Purpose: To assess physical activity (PA) and determine the proportion of preschoolers meeting PA recommendations in different income settings in South Africa. Methods: Preschoolers from urban high-income (UH), urban low-income (UL), and rural low-income (RL) settings wore an ActiGraph GT3X+ accelerometer for 7 days. PA variables of interest included volume moderate- to vigorous-intensity PA (MVPA) and total PA (light- to vigorous-intensity PA), hourly PA patterns, and percentage of children meeting guidelines (180 min/d of total PA, inclusive of 60 min/d of MVPA). Between-sex differences were assessed using t tests and Mann–Whitney U tests; between-setting differences assessed using 1-way analyses of variance and Kruskal–Wallis tests. Results: For all children (n = 229, aged 5.17 [0.69] y), average MVPA was 124.4 (37.5) minutes per day and total PA was 457.0 (61.1) minutes per day; 96.9% of children met guidelines. Boys did significantly more MVPA than girls (136.7 [39.37] vs 111.5 [30.70] min/d, P < .001), and UH preschoolers were significantly less active than UL and RL preschoolers (UH 409.1 [48.4] vs UL 471.1 [55.6] and RL 461.6 [61.4], P < .001). Conclusion: In both practice and research, it is necessary to explore ways to ensure that South African preschoolers from all income settings continue to engage in and benefit from healthy volumes of PA. This is especially important as preschoolers transition to a formal school environment.

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Simone A. Tomaz, Alessandra Prioreschi, Estelle D. Watson, Joanne A. McVeigh, Dale E. Rae, Rachel A. Jones and Catherine E. Draper

Background: Limited research reports on the relationship between body mass index (BMI) and physical activity (PA), sedentary behavior (SB), sleep, and gross motor skills (GMS) in low- and middle-income countries. The aim of this study was to (1) describe BMI, PA, SB, sleep duration, and GMS proficiency in South African preschool children and (2) identify relationships between variables. Methods: BMI, including z scores for height, weight, and BMI were determined. Seven-day PA, SB, and sleep were measured using accelerometry. GMS were assessed using the Test of Gross Motor Development (second edition). Associations were explored by comparing sleep, PA, SB, and GMS between BMI tertiles using the Kruskal–Wallis test. Results: Most (86%) children (n = 78, 50% boys) had a healthy BMI (15.7 [1.3] kg/m2). Children spent 560.5 (52.9) minutes per day in light- to vigorous-intensity PA and 90.9 (30.0) minutes per day in moderate- to vigorous-intensity PA; most (83%) met the current PA guideline. Nocturnal sleep duration was low (9.28 [0.80] h/d). Although daytime naps increased 24-hour sleep duration (10.17 [0.71] h/d), 38% were classified as short sleepers. Around half (54.9%) of participants complied with both PA and sleep guidelines. No associations between variables were found. Conclusion: Despite being lean, sufficiently active, and having adequate GMS, many children were short sleepers, highlighting a possible area for intervention.

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Estelle D. Watson, Mireille N. M. Van Poppel, Rachel A. Jones, Shane A Norris and Lisa K. Micklesfield


Although physical activity during pregnancy may be beneficial, the prenatal period is a vulnerable time for decreasing physical activity levels and increasing sedentary time.


This longitudinal cohort study measured physical activity using the Global Physical Activity Questionnaire (GPAQ) in singleton, pregnant women in the second (14–18 wk gestation; n = 332) and third trimester (29–33 wk; n = 256).


There was a significant decrease in total MVPA (MET mins/wk) between the second and third trimester (P = .01). The majority of physical activity time was spent in walking for transport (80%), and less than 2% in recreational activities. In both trimesters, being married was inversely associated with walking for transport (second trimester: β = –0.12 95% CI = –0.31 to –0.02, third trimester: β = –0.17 95% CI = –0.47 to –0.07) and owning a car was positively associated with recreational physical activity (second trimester: β = 0.16 95% CI = 0.02 to 0.32, third trimester: β = 0.17 95% CI = 0.04 to 0.27). The women spent an average of 5 hours per day sitting.


The low and declining levels of physical activity during pregnancy in this population are a concern. Interventions that include lifestyle education and provision of accessible recreational physical activity programs for pregnant women are needed.

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Sanne L.C. Veldman, Rachel A. Jones, Rebecca M. Stanley, Dylan P. Cliff, Stewart A. Vella, Steven J. Howard, Anne-Maree Parrish and Anthony D. Okely

Background: The aim of this study was to examine the efficacy of an embedded after-school intervention, on promoting physical activity and academic achievement in primary-school-aged children. Methods: This 6-month, 2-arm cluster randomized controlled trial involved 4 after-school centers. Two centers were randomly assigned to the intervention, which involved training the center staff on and implementing structured physical activity (team sports and physical activity sessions for 75 min) and academic enrichment activities (45 min). The activities were implemented 3 afternoons per week for 2.5 hours. The control centers continued their usual after-school care practice. After-school physical activity (accelerometry) and executive functions (working memory, inhibition, and cognitive flexibility) were assessed pre- and postintervention. Results: A total of 60 children were assessed (7.7 [1.8] y; 50% girls) preintervention and postintervention (77% retention rate). Children in the intervention centers spent significantly more time in moderate to vigorous physical activity (adjusted difference = 2.4%; 95% confidence interval, 0.6 to 4.2; P = .026) and scored higher on cognitive flexibility (adjusted difference = 1.9 units; 95% confidence interval, 0.9 to 3.0; P = .009). About 92% of the intervention sessions were implemented. The participation rates varied between 51% and 94%. Conclusion: This after-school intervention was successful at increasing moderate to vigorous physical activity and enhancing cognitive flexibility in children. As the intervention was implemented by the center staff and local university students, further testing for effectiveness and scalability in a larger trial is required.

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Xanne Janssen, Dylan P. Cliff, John J. Reilly, Trina Hinkley, Rachel A. Jones, Marijka Batterham, Ulf Ekelund, Soren Brage and Anthony D. Okely

This study examined the classification accuracy of the activPAL, including total time spent sedentary and total number of breaks in sedentary behavior (SB) in 4- to 6-year-old children. Forty children aged 4–6 years (5.3 ± 1.0 years) completed a ~150-min laboratory protocol involving sedentary, light, and moderate- to vigorous-intensity activities. Posture was coded as sit/lie, stand, walk, or other using direct observation. Posture was classified using the activPAL software. Classification accuracy was evaluated using sensitivity, specificity and area under the receiver operating characteristic curve (ROC-AUC). Time spent in each posture and total number of breaks in SB were compared using paired sample t-tests. The activPAL showed good classification accuracy for sitting (ROC-AUC = 0.84) and fair classification accuracy for standing and walking (0.76 and 0.73, respectively). Time spent in sit/lie and stand was overestimated by 5.9% (95% CI = 0.6−11.1%) and 14.8% (11.6−17.9%), respectively; walking was underestimated by 10.0% (−12.9−7.0%). Total number of breaks in SB were significantly overestimated (55 ± 27 over the course of the protocol; p < .01). The activPAL performed well when classifying postures in young children. However, the activPAL has difficulty classifying other postures, such as kneeling. In addition, when predicting time spent in different postures and total number of breaks in SB the activPAL appeared not to be accurate.