The aim of this study was to investigate the effect of a 10-week family focused ‘Active Play’ intervention on children’s weekday and weekend day sedentary time and total physical activity. Secondary objectives were to investigate the influence of specific confounding variables on children’s weekday and weekend day sedentary time and total physical activity.
Compared with an age-matched comparison group, a family focused intervention delivered in children’s centres located in areas of high deprivation resulted in a positive significant intervention effect on children’s sedentary time and total physical activity assessed using accelerometry for weekday and weekend day. The presence of a significant intervention effect on children’s sedentary time and physical activity are similar to the findings from other empirical family focused studies, which have demonstrated significant increases in physical activity levels [65–67]. Furthermore these results suggest that children in the intervention group engaged in 1.5% and 4.3% less sedentary time during weekdays and weekend days respectively, and 4.5% and 13.1% more total physical activity during weekdays and weekend days respectively than children in the comparison group. Of interest is the change in sedentary time and physical activity from weekdays to weekend days. The results indicate that children in the intervention group participated in 23.1 minutes less sedentary time and 10.2 minutes more total physical activity than children in the comparison group. If maintained, this equates to approximately 64 hours less sedentary time and 16 hours more total physical activity over 6 months, which in turn may have positive effects on children’s BMI , cardio metabolic disease  and fundamental movement skills . A possible reason for this may be that children were more exposed to support from their parents at the weekend which is positively associated with children’s physical activity at home but not when attending childcare . The positive changes in children’s sedentary time and physical activity suggest that the intervention successfully convinced parents about the importance of physical activity for their children. Further, our findings confirmed that parents were motivated to encourage their children to spend more time engaging in physical activity and less time in sedentary behaviours. The intervention influenced factual and direct messages that matched the preferences of parents with young children. The varied conveyance of key messages to parents during the intervention allowed for differences between parents’ knowledge base and their ability to process information e.g. through practical tasks, group discussion, supplementary information and text alerts .
Compared with other interventions varying in duration from six months to three years [2, 65, 70–72], this intervention was relatively short in duration, with contact sessions occurring every other week. The significant reduction in sedentary time and increase in total physical activity may be attributed to the intense delivery style, continual reinforcement of key messages and active involvement of parents over the 10 weeks [2, 45, 65]. Parents and children received high exposure  to the intervention, for example both participating in the Active Play sessions together, which has been found to positively affect changes in behaviour over time . To maximise the chances of a long term intervention effect we employed a number of behaviour change processes and techniques. Similar to other studies , these included building self-efficacy by setting home activities and providing performance feedback, identifying and motivating readiness to change by consistently providing general information on the importance of physical activity for young children. Follow up prompts were also used in the prevention and management of relapse, this included sending text alerts with key messages relating to home-based activity. Parents were asked to log their home activity progress in the “Move It, Snap It, Log It” diary. Process evaluation at post-intervention implied that parents had increased their awareness of the importance of physical activity and made behavioural changes. While this is a promising indicator of the intervention effect, this information told us little about the short or long-term changes made by the families and whether these behaviours had become habitual. Our intervention also placed a strong emphasis on parental role-modelling, with parents encouraged to join in the active play sessions; complete the home activity diary with their child and attend the end of intervention celebration event together.
A review of the correlates of sedentary time  and physical activity  in preschool children highlight how these behaviours are influenced by individual and environmental factors. In this study, a number of confounders for weekday and weekend day sedentary time and total physical activity were identified. These included parent’s participation in sport and their physical activity levels, child’s sex, availability of media in the home and attendance at organised activities. Potential effect modification was assessed for all covariates in order to investigate whether the intervention effect was different for different subgroups . The results revealed a significant interaction for parent’s participation in sport, but not for any other variables. The intervention effect was stronger for weekday physical activity for children whose parents participated in sport. This finding may be related to the positive relationship which exists between increased child activity and parents own activity levels as well as their support for their child’s physical activity .
Gustafson and colleagues  conducted a review on the parental correlates of children’s physical activity and despite a lack of existing studies to draw firm conclusions from; unanimous results supported the importance of parents’ physical activity on their children’s activity levels. In the current study parent’s participation in sport and physical activity were positively associated with children’s physical activity levels and sedentary time. Few studies have investigated the relationship between parent and child activity levels among children in this age group using an objective measure of physical activity; research using self-report as a measure of physical activity for parents report conflicting results ranging from no relationship with accelerometer-derived physical activity  to positive results with directly observed physical activity [75, 76]. Other studies which have objectively monitored parent’s physical activity have also reported a significant positive association between parent and child levels of activity [24, 77]. This study adds objective evidence for a relationship between parent’s activity and child’s sedentary time, highlighting the importance of parental involvement in preschool physical activity intervention design and promotion. It is difficult to state the precise nature of parental involvement required. Our results suggest that parents should be encouraged to be physically active themselves to stimulate increased child physical activity.
Previous family focused studies have evaluated the effects that enable children to be active, including providing a family orientated health education programme, as well as the provision of extra physical activity . While some empirical research has compared intervention effects between boys and girls activity, to the best of the authors knowledge, no family focused intervention studies have considered the effect of the intervention effect or the differences in the intervention effect when individual and environmental factors have been controlled for.
Consistent with most other studies boys accumulated less sedentary time than girls during weekdays . In contrast to our findings, a review of sedentary time correlates concluded that there was an indeterminate association between child’s sex and sedentary behaviour as measured by accelerometry . The contrasting findings are perhaps due to the multi-dimensional nature of children’s sedentary behaviours and the lack of consistent evidence surrounding sedentary time and other potential correlates . Other studies investigating the relationship between child’s sex and sedentary time have found inconsistent results [15, 79, 80]. We found no gender differences for physical activity; however we did not investigate intensity specific physical activity such as moderate and vigorous levels. The number of television sets in the child’s home significantly contributed to children’s sedentary time, no other studies report the number of televisions in the home, however television viewing and the presence of a television set in the home have been the most commonly examined sedentary behaviour, but a lack of consistency within studies make it difficult to draw robust conclusions about associations . Lastly, children who attended organised activities accumulated less sedentary time at the weekend, this maybe also related to parents support for physical activity and their likelihood to facilitate engagement by participation in active play at home, by playing with their child, providing transportation to parks and other activity-related facilities, and providing reinforcement for physical activity participation .
Our study has several unique elements. First, our intervention moves beyond an educational focus by fostering a “learning by doing” approach evident within the child and parent Active Play sessions. Second, we have designed and implemented a multi-component intervention that incorporates an existing Active Play programme to promote physical activity in this age group. Third, this intervention was inexpensive and relatively straight forward to implement costing approximately £4.12 per family per week to deliver. As a fourth element we use a multi-pronged strategy to change behaviours. We chose to broaden our focus by including lifestyle-related activities (e.g. encouraging active travel) that could be practiced daily. We also included ‘non-sport related’ forms of physical activity (e.g. providing an interactive dance resource and a city map of green spaces and playgrounds), which may appeal to the broader preschool population and their families. Finally, the use of an objective measure of sedentary time and physical activity as well as the use of multilevel analyses adds to the rigour of our methodology.
Despite its strengths, we acknowledge the limitations of our study design. Our intervention does not target all levels of the socio-ecological system, in which pre-schoolers’ behaviours develop. For example, the intervention has not been developed with teachers and childcare staff in mind and is not anchored within the early year’s foundation stage national curriculum. Previous research suggests that this might hinder the readiness of teachers to take ownership in the intervention change process . Second, while a user group was formed and its members consulted individually on the intervention content initially, they were not consulted on the planning of the intervention. Therefore, our study cannot purely be characterised as community-based research. However, a systematic review of community-based research found only 4 of 60 studies demonstrating community participation across all research phases . A further limitation of our intervention is that due to time restraints the initial set of ideas was not refined and discussed with input from parents of children enrolled at the intervention preschools, but rather from parents involved in the user group. Our intervention required a degree of parental time commitment at a level that might exceed parental resources. This may, in turn, threaten sustainability through fluctuations in parental time availability and as children progress from voluntary childcare to mandatory formal preschool over the next 1–2 years. Future interventions should consider including preschool teachers in elements of interventions to assist with the adoption of key messages thus limiting potential effects on the changing school process. Additionally, there was a low number of fathers involved in the intervention, future studies should make an effort to involve more fathers given how influential their parenting styles can be on preschool children’s makers of health . Lastly, the absence of a long term follow-up does not allow us to make concrete assumptions on the sustainability of the intervention.