Many young children spend a substantial amount of time in center-based childcare programs. Such programs can potentially play an important role in promoting a healthy amount of physical activity in young children. The aim of this systematic review and meta-analysis was to synthesize published information about the physical activity levels and sedentary time of young children during outdoor play at center-based childcare programs.
A total of 26 articles were included in this review; 11 met the criteria for meta-analysis. Most were deemed of high quality. The sample size of the studies ranged from 5 to 388 children, with an average of 109. All but one of the articles were published in 2008 or later, indicating that this field is relatively new. While all of the articles reported on physical activity, only 18 reported on sedentary time. The studies were conducted in a variety of countries, yet results showed no apparent geographical variability in physical activity levels and sedentary time outcomes. Two broad categories of physical activity assessment were used -- accelerometry and observation – with much variability of measurement tools within each.
Generally, studies using direct observation to assess young children's outdoor physical activity levels reported higher values of moderate-to vigorous–intensity physical activity (MVPA) than the accelerometer-based studies. This finding is consistent with other studies regarding observational measures of physical activity which tend to overestimate MVPA compared to accelerometers. However, studies using accelerometers can be inconsistent depending on the measurement tool, and even the particular model of measurement tool. The authors recommend that future research include both observational and accelerometry approaches to data collection. Overall results showed that young children are more active while outdoors at center-based childcare compared to rates of indoor physical activity reported in prior studies. Older children in this age group are more active than younger children. Findings relating to the amount of sedentary time outdoors are troublesome. Results showed that 53% of children's outdoor playtime at childcare was sedentary. While children's physical activity during outdoor playtime at childcare is extremely varied, on average, only 14% involves MVPA and 44% total physical activity (TPA).
While findings of this review and meta-analysis indicate that the outdoor environment of childcare centers appears more conducive to lowering young children's sedentary time than the indoor environment, concerns remain about young children in childcare being too sedentary. One potentially effective way to address this concern is to provide different types of outdoor environments. Some outdoor environments are more likely to support young children's physical activity than others. Related research indicates that natural environments and play areas with natural elements invite more physical activity than other types of playspaces.
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