Children's Physical Activity Level and Sedentary Behaviour in Norwegian Early Childhood Education and Care: Effects of a Staff-led Cluster-randomized Controlled Trial

Background A growing body of evidence suggests that children's physical activity (PA) level in childhood education and care (ECEC) settings is insufficient. Moreover, sedentary behaviour, defined as any waking behaviour characterized by an energy expenditure ≤ 1.5 metabolic equivalents while in a sitting, reclining, or lying posture, is highly prevalent and has been identified as detrimental to children's health. Although many children have healthy and active lifestyles, there seems to be a relatively large group of children with a low PA level. This could lead to negative developmental effects such as low fitness levels, weak motor skills and obesity. This is especially worrying because it is known that PA level often tracks from childhood into adulthood. Thus, early intervention is crucial given that PA plays a pivotal role in children's overall health and is associated with many positive health outcomes, including physical fitness, cardiovascular health, bone health and psychosocial and cognitive development.

PA levels have been found to be highly variable among children in ECEC settings and may therefore have great potential for effective interventions. Furthermore, since most children attend ECEC settings for many hours on most days of the week, and these institutions reach children across the socioeconomic spectrum, the ECEC setting may serve as an ideal avenue for increasing PA level, reducing sedentary time and enhancing the overall health of young children. However, early childhood educators identify parents rather than themselves as those responsible for promoting children's PA and may assume that young children receive adequate PA throughout the week regardless of their activities during their stay in the ECEC setting. Thus, intervening with children and staff in ECEC settings to equip them with the knowledge, abilities and motivation to promote PA in children during their ECEC time may provide substantial public health benefits.

In earlier studies, PA interventions conducted in ECEC settings have shown only small to moderate effects and were rather inconsistent across studies. Most PA interventions that have been implemented in ECEC settings have been structured programmes developed by PA experts and delivered by staff alone or with the strong influence of trained research personnel. In some studies, staff-led interventions have been shown to be less effective in increasing PA than interventions implemented by PA experts. Similar findings have emerged regarding intervention effects on fundamental movement skills. The main explanation for the lower efficiency of staff-led interventions may be that PA experts have more knowledge and competencies regarding this issue. For staff-led programmes to succeed, the need for multiple staff training sessions and maximizing the number of trained staff has been emphasized.

Recently, several reviews have summarized the body of knowledge regarding various aspects of the contexts of and prerequisites for PA in different kinds of out-of-home services for children of preschool age. A review including 34 studies revealed small but positive and significant intervention effects for children's (5 years) moderate- to vigorous-intensity PA (MVPA) but not for light-intensity PA. Based on their findings, the authors recommended interventions tailored to the target group and noted that cultural considerations, community needs and the provision of ongoing support should play key roles. Furthermore, they concluded that daily structured PA sessions, integrated into the everyday activities in the institutions (routines) and delivered through a hands-on approach, were most likely to contribute to increasing children's MVPA.

A review of 24 PA interventions in childcare, mostly targeting children between three and five years of age, where staff participated in professional development either before or during the intervention period and provided children with opportunities for additional PA. Less than half of the included studies had positive effects on children's PA level. For further intervention studies in ECEC, the authors provided four recommendations, of which two were based on the papers included in the review and two were based on evidence "from broader ECEC literature". First, there is a need for high-quality professional development prior to and during the intervention, and second, there is a need for "interventions that are 'outside the box'" in terms of, e.g., blended professional development; the role of technology; targeting the health, well-being and activity levels of the educators; focusing on PA learning experiences, outdoor time, and energy breaks; and integrating interventions into the institutions' daily routines. The third, broader-based recommendation addressed the importance of developing meaningful and trustworthy cooperation and relationships between staff and researchers. The fourth and final recommendation focused on the ECEC environment as a key factor for providing good opportunities for PA that thus should be increasingly emphasized in future interventions.