From: The value of (pre)school playgrounds for children’s physical activity level: a systematic review
Study; | Study design; | School(s) (type) | Outcome (unit) [measurement] | Intervention effects |
---|---|---|---|---|
Country; | Level of randomization; | Intervention mode(s) | ||
Methodological quality | Study population (mean age/range; % girls) | |||
PRESCHOOL INTERVENTIONS | ||||
Non-randomized controlled trial | 2 preschools | MVPA (% of intervals in which MVPA is performed) [OSRAP]1 | No significant difference on intervention days compared to no-intervention days | |
US | 5 children (80% girls) | Teacher-implemented promotion of MVPA (3 children) | ||
5.5 | Teacher-implemented promotion of MVPA + guided discussions, initial pep talks on the playground, teacher participation, brief review and acknowledgement after the activity, and stickers for child participation (2 children) | |||
No-intervention days (5 children) | ||||
Cardon, 2009 [33] | RCT | 40 preschools | I. % in sedentary activity during recess | I-V. No significant differences in intervention schools compared to control schools |
Belgium | Randomization: school-level | Provision of play equipment (10 schools) | II. % in LPA during recess | |
10 | 583 children (mean age 5.3; 47% girls) | Painting of playground markings (10 schools) | III. % in MPA during recess | |
Provision of play equipment and painting of playground markings (10 schools) | IV. % in VPA during recess | |||
No intervention (10 schools) | V. % in average PA during recess[accelerometer] | |||
Hannon, 2008 [36] | Non-randomized trial 64 children (age 3–5; 53% girls) | 1 preschool | I. % time spent in sedentary activity | I. Significant decrease after the intervention compared to pre-intervention (F(1,61) = 243.90)a |
US | Provision of play equipment: hurdles to jump over and hoops to jump through, tunnels to crawl through, balance beams, target toss/throw sets, bean bags, various sized playground balls | II. % time spent in LPA | II. Significant increase after the intervention compared to pre-intervention (F(1,61) = 16.30)a | |
9 | III. % time spent in MPA | III. Significant increase after the intervention compared to pre-intervention (F(1,61) = 212.43)a | ||
IV. % time spent in VPA [accelerometer] | IV. Significant increase after the intervention compared to pre-intervention (F(1,61) = 50.35)a | |||
Secondary analyses: | ||||
Younger children showed significantly more moderate activity after the intervention compared to pre-intervention than older children (F(2,61) = 9.64)a | ||||
Older children showed more vigorous activity after the intervention compared to pre-intervention than younger children (F(2,61) = 2.83)a | ||||
Holmes, 2006 [38] | Non-randomized trial | 1 preschool | Post-recess attention (% attentive) [observations] | Significant increase in post-recess attention as recess duration increased (F(2,24) = 13.08) |
US | 27 children (age 50–63 months; 70% girls) | Recess duration of 10, 20 and 30 min | Secondary analyses: | |
4.5 | Intervention effect was strongest following the 20 min recess and for girls | |||
Van Cauwenberghe, 2012 [42] | Non-randomized trial | 4 preschools | During recess | During recess |
Belgium | 128 children (age 4–6; 46% girls) | Decrease of playground density | I. min and % spent in sedentary time | I. Significant decrease after the intervention compared to pre-intervention (χ2(2,N = 128) = 26.0, p < 0.001; χ2(2,N = 128) = 19.5, p < 0.001)b |
6.5 | II. min and % spent in LMVPA | II. Significant increase after the intervention compared to pre-intervention ((χ2(2,N = 128) = 26.0, p < 0.001; χ2(2,N = 128) = 19.5, p < 0.001)b | ||
III. min and % spent in MVPA | III. Significant increase after the intervention compared to pre-intervention ((χ2(2,N = 128) = 15.3, p < 0.001; χ2(2,N = 128) = 27.2, p < 0.001)b | |||
During preschool time | During preschool time | |||
IV. min and % spent in sedentary time | IV. No significant difference after the intervention compared to pre-intervention | |||
V. min and % spent in LMVPA | V. No significant difference after the intervention compared to pre-intervention | |||
VI. min and % spent in MVPA | VI. No significant difference after the intervention compared to pre-intervention | |||
During the entire day | During the entire day | |||
VII. min and % spent in sedentary time | VII. No significant difference after the intervention compared to pre-intervention | |||
VIII. min and % spent in LMVPA | VIII. No significant difference after the intervention compared to pre-intervention | |||
IX. min and % spent in MVPA [accelerometer] | IX. Significant increase (χ2(2,N = 107) = 5.8, p < 0.05)b | |||
Secondary analyses: | ||||
Intervention effect was stronger for girls compared to boys for the% spent in sedentary time and LMVPA | ||||
PRIMARY SCHOOL INTERVENTIONS | ||||
Brink, 2010 [41] | Non-randomized controlled trial | 9 primary schools | I. % active boys/girls on school grounds [SOPLAY]2 | I. Significantly more active boys and girls in established and recently rebuilt schools compared to in control schools |
US | 5488 children (age 4–11; 48% girls) | Schoolyard renovations (installation of play equipment, asphalt areas for structured games, and a grassed multipurpose playfield) within the past year (3 schools=’recently rebuilt schools’) | II. % sedentary boys/girls on school grounds [SOPLAY]2 | II. No significant differences in established and recently rebuilt schools compared to in control schools |
8.5 | Schoolyard renovations in place for at least 2 years (3 schools=’established schools’) | III. Energy expenditure rate (EER) on school grounds [calculated] | III. Significant higher EER in boys and girls in established and recently rebuilt schools compared to in control schools | |
No renovations/minimal improvements over the years (3 schools=’control schools’) | Secondary analyses: | |||
Significantly more active boys when there was an unstructured hard surface | ||||
Significant less sedentary behavior among girls in established and recently rebuilt schools compared to in control schools | ||||
Significantly more active girls when there was a soft structured surface | ||||
Bundy, 2008 [43] | Non-randomized trial | 1 primary school | Playfulness (score 0–3; 30 items) [ToP]3 | Significant increase after the intervention (ES = 0.55; 95% CI = −0.08,1.19) compared to pre-intervention |
Australia | 20 children (age 5–7; 70% girls) | Introduction of play materials | ||
7.5 | ||||
Non-randomized controlled trial | 20 primary schools | I. % active children on school grounds | I. No significant differences in intervention schools compared to control schools | |
US | 136 children | Renovation of playground (new play equipment, safety and site improvements) (10 schools) | II. % moderately active children on school grounds | II. No significant difference in intervention schools compared to control schools |
8.5 | No intervention (10 schools) | III. % vigorously active children on school grounds [SOPLAY]2 | III. No significant difference in intervention schools compared to control schools | |
Huberty, 2011 [39] | Non-randomized trial | 2 primary schools (public and parochial) | During recess | During recess |
US | Public school: | Staff training, recreational equipment and playground markings (2 schools) | I. MPA (counts/min) | I. Significant increase after the intervention compared to pre-intervention |
8.5 | 45 children (age 9.6; 42% girls) | II. VPA (counts/min) | II. Significant increase after the intervention compared to pre-intervention | |
Parochial school: | During the school day | During the school day | ||
48 children (age 9.6; 50% girls) | III. MPA (counts/min) | III. Significant increase after the intervention compared to pre-intervention | ||
IV. VPA (counts/min) [accelerometer] | IV. Significant increase after the intervention compared to pre-intervention | |||
Loucaides, 2009 [34] | RCT Randomization: school-level | 3 primary schools (innercity) | I. Steps/min during recess | I. Significant increase in the intervention schools compared to the control school (F(2,222) = 3.08) |
Cyprus | 228 children (age 11.2; 50% girls) | Allocating play space for team games, playground markings and ropes for jumping (school 1) | II. Steps/min after school [pedometer] | II. No significant difference in the intervention schools compared to the control school |
9 | Allocating play space for team games (school 2) | |||
No intervention (school 3) | ||||
Non-randomized controlled trial 297 children (age 5–10; 50% girls) | 26 primary schools | I. % time spent in MVPA during recess | I. Significant increase in intervention schools compared to control schools (β = 5.95; 95% CI = 0.14,11.77) | |
UK | Incentive for change of playground with use of playground markings and physical structures (15 schools) | II. % time spent in VPA during recess [accelerometer] | II. Significant increase in intervention schools compared to control schools (β = 1.07; 95% CI = 0.01,3.39) | |
8.5 | No intervention (11 schools) | No significant effects when analyses were adjustedc | ||
Secondary analyses: | ||||
Intervention effect was stronger for younger children and when recess duration increased | ||||
Non-randomized controlled trial | 26 primary schools | I. % time spent in MVPA during recess | I. Significant increase in intervention schools compared to control schoolsa(heart rate: β = 4.03; 95% CI = 0.15, 7.91), accelerometer: β = 4.53; 95% CI = 0.59, 8.47) | |
UK | 470 children (age 8.1-10.1; 51% girls) | Incentive for change of playground with use of playground markings and physical structures (15 schools) | II. % time spent in VPA during recess [heart rate telemetry, accelerometer] | II. Significant increase in intervention schools compared to control schoolsa(heart rate: β = 2.34; 95% CI = 0.06, 4.80, accelerometer: β = 2.32; 95% CI = 0.71,3.93) |
7 | No intervention (11 schools) | |||
Non-randomized controlled trial | 26 primary schools | Morning recess | I-IV. No significant increase in intervention schools compared to control schools | |
UK | 470 children (age 8.1-10.1; 51% girls) | Incentive for change of playground with use of playground | I. % time spent in MVPA | |
8 | markings and physical structures (15 schools) | II. % time spent in VPA | ||
No intervention (11 schools) | Lunch recess | |||
III. % time spent in MVPA | ||||
IV. % time spent in VPA [heart rate telemetry, accelerometer] | ||||
Stratton, 2005 [32] | Non-randomized controlled trial | 8 primary schools (4 early primary; 4 late primary) | I.% time spent in MVPA during recess | I. Significant increase in intervention schools compared to control schools (F(1,204) = 13.7) |
UK | 99 children (age 4–11; 49% girls) | Painting of playground markings (2 early primary and 2 late primary schools) | II. % time spent in VPA during recess [heart rate telemetry] | II. Significant increase in intervention schools compared to control schools (F(1,204 = 4.05 |
9 | No intervention (2 early primary and 2 late primary schools) | cSecondary analyses: | ||
Increase in MVPA in late primary schools was more than double than that found in early primary schools | ||||
Stratton, 2000 [31] | Non-randomized controlled trial | 2 early primary schools | I. % of playtime in MVPA | I-II. No significant differences in intervention schools compared to control schools |
UK | 47 children (age 5–7; 51% girls) | Playground markings and no play equipment allowed on playground (except for a single football) (1 school) | II. % of playtime in VPA [heart rate telemetry] | |
8.5 | No playground markings and limited play equipment allowed (1 school) | |||
Verstraete, 2006 [35] | RCT | 7 primary schools | Morning recess | Morning recess |
Belgium | Randomization: school-level | Presentation and provision of game equipment (two jump ropes, two double Dutch ropes, two scoop sets, two | I. % time spent in LPA | I. No significant difference in intervention schools compared to control schools |
9 | 235 children (age ±10.8; 49% girls) | scoop sets, two flying discs, two catch balls, one poco ball, one | II. % time spent in MPA | II. Significantly higher in intervention schools compared to control schools (F(4) = 10.6)d |
plastic ball, two plastic hoops, two super grips, three juggling | III. % time spent in VPA | III. No significant difference in intervention schools compared to control schools | ||
scarves, six juggling rings, six juggling bean balls, one diabolo, | IV. % time spent in MVPA | IV. No significant difference in intervention schools compared to control schools | ||
one angel-stick, four spinning plates, two sets of badminton | Lunch break | Lunch break | ||
racquets and two sets of oversized beach paddles) and activity cards with examples of games and activities that can be performed with the equipment (4 schools) | V. % time spent in LPA | V. No significant difference in intervention schools compared to control schools | ||
VI. % time spent in MPA | VI. Significantly higher in intervention schools compared to control schools (F(4) = 28.3)d | |||
No intervention (3 schools) | VII. % time spent in VPA | VII. Significantly higher in intervention schools compared to control schools (F(4) = 13.1)d | ||
VIII. % time spent in MVPA [accelerometer] | VIII. Significantly higher in intervention schools compared to control schools (F(4) = 44.2)d | |||
Secondary analyses: | ||||
Girls spent significantly more time in LPA F(4) = 2.4)d, MPA (F(4) = 2.2)d, VPA (F(4) = 0.5)d and MVPA (F(4) = 2.9)d during morning recess |