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

Abstract

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.Electronic supplementary materialThe online version of this article (10.1186/s1296...

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

“…The survey assessed service characteristics including: service days and hours of operation; type of service (preschool or long day care service); suburb (to determine geographical location); number of children enrolled (to determine size); number of children of Aboriginal and/or Torres Strait Islander background enrolled; and number of full‐time equivalent primary contact teaching staff. The items used to assess service characteristics have been used in other Australian surveys of childcare services conducted by the research team . Service postcode (to determine socio‐economic status) was retrieved from the list of Australian centre‐based childcare services supplied by the national government regulating agency.…”

“…Adequate physical activity in early childhood has been associated with various physical and psychosocial benefits . Physical activity habits developed early in life also aid in reducing the risks associated with the onset of overweight and obesity and other chronic illnesses later in life .…”

“…Centre‐based childcare services is a recommended setting to promote child physical activity. In developed countries, Childcare services provide access to the majority of the population aged less than five years, often for prolonged periods each day . There is also significant opportunity to improve child physical activity in care, with only 10% of preschool‐aged children in Australia meeting recommended levels of at least 15 minutes of physical activity per hour while in attendance at childcare .…”

“…Despite the potential to improve child health, there have been no previous studies describing how Australian childcare services schedule continuous free play opportunities. There is also limited literature available identifying perceived barriers to the implementation of such guidelines, and if implementation differs according to various service characteristics . Such information is critical in order to guide efforts to support implementation.…”

“…Such information is critical in order to guide efforts to support implementation. Previous studies have found that children's inappropriate clothing, family and cultural factors, availability of outdoor space and play equipment, structure of daily programming and additional time taken for adhering to sun‐safe policies may negatively impact on the implementation of physical activity promoting initiatives more broadly in childcare. A better understanding of the various factors that impact on the implementation of continuous free play schedules in childcare is required in order to develop effective strategies to support childcare service staff with implementing guidelines.…”