This study investigated the association between physical activity facilities at childcare (e.g., play equipment) and physical activity of 2- and 3-year olds. Observations of physical activity intensity were performed among 175 children at 9 childcare centers in The Netherlands, using the OSRAC-P. The physical activity facilities were assessed for indoors and outdoors separately, using the EPAO instrument. Regular (single-level) multivariate and multilevel linear regression analyses examined the association of the facilities and child characteristics (age and sex) with children's activity levels. Various physical activity facilities were available in all childcare centers (e.g., balls). Riding toys and a small playing area were associated with lower indoor physical activity levels. Outdoor physical activity levels were positively associated with the availability of portable jumping equipment and the presence of a structured track on the playground. Portable slides, fixed swinging equipment, and sandboxes were negatively associated with outdoor activity levels. In addition, the 3-year old children were more active outdoors than the 2-year olds. In conclusion, not all physical activity facilities at childcare were indeed positively associated with children's activity levels. The current findings provide concrete leads for childcare providers regarding which factors they can improve in the physical environment to facilitate children's physical activity.
Childhood overweight prevalence is increasing globally, with over 42 million children under 5 years already overweight [
In Europe, over half of the toddlers attend some form of childcare or education facilities [
A review of correlates of preschool children’s physical activity level showed that the preschool a child attends is significantly associated with the child’s total physical activity [
The design of the study is based on a study by Bower and colleagues [
Each childcare centre was visited three times in May and/or June of 2008: once for an interview with the center manager and a rating of the physical activity facilities and twice for direct observations of children’s activity level. The observations were performed by two observers, both trained in using the instruments described below. Children were randomly selected for observations and observed simultaneously by both observers.
The physical activity level was observed by a momentary sampling procedure with observations lasting 15 seconds each. The 30 seconds following the observation period were used to record the observation. This procedure was repeated four times over a period of three minutes for each child. Each child was observed for two nonconsecutive blocks of four observations. In total, 10 children were observed per center per day, resulting in a total of 80 observations. This protocol was implemented on two days for each of the nine centers, during one morning and one afternoon, with at least one week between the two observation days. This resulted in 2880 single observations regarding 180 children (2 observers × 9 centers × 2 days/center × 10 children/day × 2 blocks/child × 4 observations/block).
During the observations, physical activity level was assessed by means of a translated version of the Observational System for Recording Physical Activity in Children-Preschool Version (OSRAC-P [
The physical childcare environment (i.e., physical activity facilities) was rated using translated items of the Environment and Policy Assessment and Observation Instrument (EPAO [
Subscales of the EPAO were used, for example, portable and fixed play equipment, and an additional subscale for total size of the playing area. These subscales were rated separately for indoors and outdoors. Portable equipment was rated by checking the availability of 9 types of equipment: balls, climbing structures (e.g., ladders), floor play equipment (e.g., tumbling mats), jumping equipment (e.g., jump ropes, hula hoops), push/pull toys (e.g., wagons), riding toys (e.g., tricycles, cars), slides, sand/water toys (e.g., buckets, scoops), and twirling equipment (e.g., ribbons, batons). Fixed equipment was rated in a similar manner for structured tracks (e.g., playground markings), merry-go-rounds, climbing structures (e.g., jungle gyms), see-saws, slides, tunnels, balancing surfaces (e.g., balance beams), sandboxes, and swinging equipment (e.g., swings, ropes). All play equipment was rated as either present (1) or not (0). Total playing area was rated on a scale from 0 (no playing area) to 10 (very large area).
Background information regarding the childcare centers, such as the number of enrolled children, was recorded during interviews with the manager of each childcare center. In addition, child’s sex and age were assessed by asking present staff after the observations were finished. Weather conditions and outdoor temperature were recorded per observation day.
All analyses were performed using SPSS 17.0. In all analyses
All analyses were performed separately for indoor and outdoor observations. Various background characteristics were explored using descriptive statistics. The distribution of the physical activity facilities and the mean activity levels corresponding to the presence and absence of these facilities were explored. The significance of the differences between the activity levels with and without the facilities present were examined using
Next, we conducted backward regression analyses with the physical activity facilities and child characteristics (age and sex) as independent variables and the activity level as the outcome variable. Insignificant independent variables were stepwise deleted from the model in order of their significance, starting with the least significant variable. This procedure was repeated until all remaining independent variables were significant.
Stepwise multilevel linear model analyses with 3 levels (i.e., measurement level; child level; center level) were executed to examine the association between activity level and the physical activity facilities, while modeling the interdependence between observations within individuals and between individuals within childcare centers. In the starting model, random intercepts at the child and center level were included, as well as a first-order autoregressive (AR(1)) correlation structure for repeated measures. Furthermore, random slopes at the centre level were included for child sex and age. Insignificant random effects were backward removed from the model, starting with the least significant random effect. When all remaining random effects were significant, the fixed effects were examined. The fixed effects were then examined analogous to the regression analyses described above (i.e., through the backward procedure).
We performed both the multivariate analyses where we corrected for the multilevel structure of data, and those without correction of the data, because the multilevel analyses might unintentionally overcorrect for the dependence between repeated measures within one subject in case an activity lasted longer than the duration of a single observation period (i.e., 45 seconds). This might especially be the case for various sedentary activities, such as playing in the sandbox.
Five children were not present during the observations, leading to a total of 175 children that were each observed eight times. This resulted in 1400 observations per observer (i.e., 2800 single observations). Data regarding 18 observation periods were missing because these children were absent during one or more of the eight observation periods (e.g., because parents had already picked them up), which left 1382 observation periods for analyses. Eighty-nine (50.9%) of the observed children were male. The mean age was 2.6 years, with 75 two-year olds (42.9%) and 100 three-year olds (57.1%). The mean outdoor temperature during the observations was 20.4°C (range: 14°C–26°C). Most of the time the weather was sunny with clear skies (37.7%); least prevalent weather type was rain (11.4%).
The mean activity intensity level during indoor observations was 2.36 (on a scale from 1 to 5). Only 5.5% of the indoor physical activity observations were classified as MVPA (moderate and vigorous physical activity; activity level ≥4), whereas 59.4% were classified as sedentary behavior (activity level ≤2). Outdoors, the mean activity level was 2.82, with 21.3% being MVPA, and 31.2% being sedentary.
Table
Physical activity facilities at childcare centers (
Equipment | Indoor (Obs. = 710) | Outdoor (Obs. = 689) | |||||||
---|---|---|---|---|---|---|---|---|---|
Not present | Present | Not present | Present | ||||||
Frequency | Mean activity level (sd)a | Frequency | Mean activity level (sd)a | Frequency | Mean activity level (sd)a | Frequency | Mean activity level (sd)a | ||
Balls | 0 | — | 9 | 2.36 (.61) | 0 | — | 9 | 2.82 (.72) | |
Climbing structures | 1 | 2.36 (.68) | 8 | 2.36 (.60) | 7 | 2.80 (.74) | 2 | 2.87 (.64) | |
Floor play equipment | 0 | — | 9 | 2.36 (.61) | 7 | 2.79 (.72) | 2 | 2.96 (.69)* | |
Jumping equipment | 4 | 2.26 (.49) | 5 | 2.40 (.85)** | 4 | 2.71 (.71) | 5 | 2.93 (.71)** | |
Portable | Push/pull toys | 6 | 2.29 (.55) | 3 | 2.44 (.66)** | 0 | — | 9 | 2.82 (.72) |
Riding toys | 7 | 2.39 (.63) | 2 | 2.30 (.57) | 0 | — | 9 | 2.82 (.72) | |
Slides | 8 | 2.29 (.55) | 1 | 2.70 (.76)** | 6 | 2.80 (.71) | 3 | 2.89 (.76) | |
Sand/water toys | 4 | 2.45 (.67) | 5 | 2.29 (.55)** | 0 | — | 9 | 2.82 (.72) | |
Twirling equipment | 4 | 2.32 (.59) | 5 | 2.38 (.62) | 9 | 2.82 (.72) | 0 | — | |
| |||||||||
Structured track | 9 | 2.36 (.61) | 0 | — | 3 | 2.71 (.71) | 6 | 2.93 (.71)** | |
Merry-go-round | 9 | 2.36 (.61) | 0 | — | 9 | 2.82 (.72) | 0 | — | |
Climbing structures | 1 | 2.29 (.40) | 8 | 2.36 (.62) | 1 | 2.67 (.69) | 8 | 2.86 (.72)** | |
See-saw | 8 | 2.36 (.62) | 1 | 2.34 (.51) | 5 | 2.79 (.72) | 4 | 2.87 (.72) | |
Fixed | Slides | 8 | 2.29 (.55) | 1 | 2.70 (.76)** | 1 | 2.67 (.69) | 8 | 2.86 (.72)** |
Tunnels | 9 | 2.36 (.61) | 0 | — | 5 | 2.76 (.70) | 4 | 2.94 (.74)** | |
Balancing surfaces | 2 | 2.18 (.49) | 7 | 2.38 (.63)** | 0 | — | 9 | 2.82 (.72) | |
Sandbox | 9 | 2.36 (.61) | 0 | — | 1 | 2.67 (.69) | 8 | 2.86 (.72)** | |
Swinging equipment | 9 | 2.36 (.61) | 0 | — | 6 | 2.84 (.73) | 3 | 2.78 (.70) |
Obs.: number of observations.
*
aActivity level assessed on a scale from 1 to 5. Significance levels of
In line with indoors, all childcare centers also provided balls outdoors. In addition, all centers had push or pull toys and riding toys available outdoors, as well as sand or water toys and balancing surfaces. Most centers (89%) also provided fixed climbing structures, fixed slides, and a sandbox outdoors. None of the observed childcare centers had a merry-go-round or twirling equipment available outdoors. The size of the outdoor playground was rated with an average of 6.22 (
Table
Table
Backward regression analyses and multilevel analyses of the association between the indoor childcare physical activity facilities and children’s physical activity levels (number of observations = 710).
Regression analysisa | Multilevel analysisa,b | |||
---|---|---|---|---|
Regression coefficient (B) |
|
Regression coefficient (B) |
|
|
Portable riding toys |
|
<.001 |
|
<.001 |
0 = not present, 1 = present | ||||
Size playground | .10 | <.001 | .10 | <.001 |
0 (very small)–10 (very large) |
aVariables excluded from the analyses because they were present in either all or none of the childcare centers: portable equipment: ball equipment and floor play equipment; fixed equipment: structured track, merry-go-round, tunnels, sandbox, and swinging equipment. Variables excluded from the final model because they were nonsignificant: portable equipment: climbing structures, jumping equipment, push/pull toys, slides, sand/water toys, and twirling equipment; fixed equipment: climbing structures, see-saw, slides, and balancing surfaces; background variables: sex, age.
bFinal model comprises a first-order autoregressive (AR1) correlation for repeated measures within children. Other random effects were not included in the final model.
The mean activity levels of the children in the childcare centers where the various outdoor facilities were either present or not are presented in Table
Table
Backward regression analyses and multilevel analyses of the association between the outdoor childcare physical activity facilities and children’s physical activity levels (number of observations = 689).
Regression analysisa,b | Multilevel analysisa,c | |||
---|---|---|---|---|
Regression coefficient (B) |
|
Regression coefficient (B) |
|
|
Age in years | .13 | .019 | — | — |
Portable jumping equipment | .36 | <.001 | — | — |
0 = not present, 1 = present | ||||
Portable slides |
|
<.001 | — | — |
0 = not present, 1 = present | ||||
Fixed structured track |
|
<.001 | .23 | .003 |
0 = not present, 1 = present | ||||
Fixed sandbox |
|
.002 | — | — |
0 = not present, 1 = present | ||||
Fixed swinging equipment |
|
.001 | — | — |
0 = not present, 1 = present |
aVariables excluded from the analyses because they were present in either all or none of the childcare centers: portable equipment: ball equipment, push/pull toys and riding toys, and sand/water toys, twirling equipment; fixed equipment: merry-go-round, balancing surfaces.
bVariables excluded from the final model because they were nonsignificant: portable equipment: climbing structures, floor play equipment; fixed equipment: climbing structures, see-saw, slides, and tunnels; background variables: sex.
cFinal model comprises a first-order autoregressive (AR1) correlation for repeated measures within children. Other random effects were not included in the final model. Variables excluded from the final model because they were non-significant: portable equipment: climbing structures, floor play equipment, jumping equipment, and slides; fixed equipment: climbing structures, see-saw, slides, tunnels, sandbox, and swinging equipment; background variables: sex, age.
The current study examined the association between the availability of various physical activity facilities at the childcare center and 2- and 3-year olds’ physical activity levels. In general, children’s activity levels were comparable to those found in an earlier study applying the same protocol in US childcare centers (mean overall activity level 2.55 [
Indoors, children were more active when more space was available for playing. This is in line with a previous study by Cardon and colleagues [
In line with what could be expected from previous studies, which summarized the facilities assessed in the current study into one measure for activity opportunities and found a positive association between those activity opportunities and activity levels [
However, there were also several play facilities that were found to be inversely associated with children’s activity levels. Indoors the availability of riding toys seemed to decrease children’s activity levels, and outdoors portable slides, sandboxes, and swinging equipment were associated with lower activity levels. With regard to the riding toys, this could probably be explained by space limitations and regulations indoors. The limited space restrains them from going very fast [
The negative associations found between various facilities and children’s activity levels make the use of “activity opportunity" sum scores such as the EPAO score [
We found that the variability of the physical childcare environments was quite limited. Several facilities were provided in either all childcare centers (i.e., balls indoor and outdoor, indoor floor play equipment and outdoor push or pull toys, riding toys, sand or water toys and balancing surfaces) or in none of the centers (i.e., indoor structured track, merry-go-round, tunnels, sandboxes, and swinging equipment and outdoor merry-go-round or twirling equipment) in the current study. In case of the facilities that were present in none of the centers, this partly has to do with cultural differences between The Netherlands (in which the present study was conducted) and the USA (in which the EPAO instrument was developed [
A strong point of the current study is that the environment and physical activity intensity were directly observed and that it did not rely on less valid measures such as self-report. Furthermore, all observations were performed by 2 observers and interobserver reliability indicated substantial agreement [
Childcare organizations can use the findings of the current study to optimize the physical environment to promote children’s physical activity. Not all childcare play facilities that were expected to be physical activity promoting were actually associated with increased activity levels in children. For promoting physical activity, childcare centers should try to optimize indoor space for playing, create outdoor play ground markings, and provide jumping equipment. The use of riding toys should probably be avoided in restricted spaces. Finally, the use of various larger facilities such as slides, swings, and sandboxes should be further examined, since they possibly limit children’s activity levels. These findings need further testing, specifically using experimental research designs.
With regard to future research into environmental influences on physical activity at childcare, the current study showed that physical activity facilities are probably better not summarized into general quality measures. It is, however, important to map the physical environment as completely as possible. Existing instruments (e.g., [
The current study examined the influence of physical activity facilities on children’s activity levels at childcare. Many other studies have previously examined the association between the childcare environment and children’s activity levels, applying many different research designs and various focuses [
The present study was (partly) funded by the Netherlands Organisation for Scientific Research (NWO) and the Netherlands Organization for Health Research and Development (ZonMW), Project no. 200130003.