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Effectiveness of centre-based childcare interventions in increasing child physical activity: a systematic review and
Insights
Physical activity interventions in childcare significantly boost children's activity levels, especially when structured and led by experts. However, pragmatic trials showed no effect, and data on adverse events and cost-effectiveness are missing.
Area of Science:
- Child Health
- Public Health Interventions
- Pediatric Exercise Science
Background:
- Centre-based childcare services are key settings for promoting physical activity in young children.
- Understanding the effectiveness of different intervention characteristics is crucial for optimizing physical activity promotion.
- Existing reviews lack comprehensive analysis of intervention design, pragmatic vs. non-pragmatic approaches, and cost-effectiveness.
Purpose of the Study:
- To evaluate the effectiveness of physical activity interventions in center-based childcare.
- To identify intervention characteristics influencing effectiveness, including structured activities and theoretical basis.
- To compare the effects of pragmatic and non-pragmatic interventions and assess adverse effects and cost-effectiveness.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) in center-based childcare.
- Inclusion of children under 6 years with objectively measured physical activity interventions.
- Data synthesis using random effects models and standardized mean difference (SMD).
Main Results:
- Interventions significantly improved child physical activity (SMD 0.44).
- Structured activities (SMD 0.53), expert delivery (SMD 1.26), and theory-based interventions (SMD 0.76) were effective.
- Non-pragmatic interventions showed significant effects (SMD 0.80), while pragmatic interventions did not (SMD 0.10).
Conclusions:
- Intervention effectiveness is influenced by design and trial characteristics.
- Pragmatic trials were ineffective, highlighting a gap in real-world applicability.
- Further research is needed on cost and adverse effects to inform policy and practice.
Context:
The review describes the effectiveness of physical activity interventions implemented in centre-based childcare services and (i) examines characteristics of interventions that may influence intervention effects; (ii) describes the effects of pragmatic interventions and non-pragmatic interventions; (iii) assesses adverse effects; and (iv) describes cost-effectiveness of interventions
Methods:
Data sources were Cochrane Central Register of Controlled trials, MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, SCOPUS and SPORTDISCUS. Studies selected included randomized controlled trials conducted in centre-based childcare including an intervention to increase objectively measured physical activity in children aged less than 6 years. Data were converted into standardized mean difference (SMD) and analysed using a random effects model.
Results:
Overall interventions significantly improved child physical activity (SMD 0.44; 95% confidence interval [CI]: 0.12-0.76). Significant effects were found for interventions that included structured activity (SMD 0.53; 95% CI: 0.12-0.94), delivery by experts (SMD 1.26; 95% CI: 0.20-2.32) and used theory (SMD 0.76; 95% CI: 0.08-1.44). Non-pragmatic (SMD 0.80; 95% CI: 0.12-1.48) but not pragmatic interventions (SMD 0.10; 95% CI:-0.13-0.33) improved child physical activity. One trial reported adverse events, and no trials reported cost data.
Conclusions:
Intervention effectiveness varied according to intervention and trial design characteristics. Pragmatic trials were not effective, and information on cost and adverse effects was lacking. Evidence gaps remain for policymakers and practitioners regarding the effectiveness and feasibility of childcare-based physical activity interventions.
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