Almost 90% of experts reported it is the full responsibility of ECEC services to have a physical activity policy. There was also consensus on the components, as well as key physical activity and sedentary behaviour statements and recommendations that should be included in an ECEC specific physical activity policy. The key components of a comprehensive physical activity policy for ECEC included a rationale, scope of the policy, key statements and recommendations (on the amount of physical activity and sedentary time per day at ECEC), links to relevant legislation, procedures for implementation, supporting resources and policy monitoring and review. The findings also highlighted that ECEC physical activity policies should be evidence based and aligned with national and international (e.g., World Health Organization) 24-h movement guidelines .
In Australia, the National Quality Framework for Early Childhood Education and Care minimum standard Quality Area 2.1.3 states that ‘Healthy eating and physical activity are promoted and appropriate for each child’ . However, there is little guidance, and few resources available (including physical activity policy templates) detailing how services go about promoting children’s physical activity. By consulting the literature and involving a range of stakeholders in developing the policy template we were able to ensure that it was evidence-based while still reaching consensus on the key physical activity and sedentary behaviour statements and recommendations included. An evidence informed physical activity policy template as developed in this study will provide clear guidance on the amount of physical activity and sedentary time (including screen time) children should have whilst attending ECEC and align with national/international guidelines.
The ECEC specific physical activity policy template was comprehensive with consensus reached on the inclusion of 25 acceptable strategies. Very few instances exist internationally where comprehensive and detailed physical activity strategies are included in ECEC regulations at a state or national level . One example is the Alberta (Canada) Child Care Accreditation Standards which include nine child physical activity related indicators that cover promoting physical activity and minimising sedentary time, planning and programming for children’s physical activity, modelling and indoor and outdoor physical activities . These indicators are similar to the management/supervisor/educator strategies included in the physical activity policy template. The strategies included in the policy template are more comprehensive for managers/supervisors and educators and uniquely capture strategies relating to the ECEC physical environment, parent engagement and policy monitoring.
The majority of studies to date report the impact of the presence only (not content) of ECEC physical activity policies on children’s physical activity, with many showing little effect due to poor implementation [15, 36]. However, it is likely that the content, comprehensiveness, acceptability, ease of use and implementation strategies included in ECEC physical activity policies are also important, rather than the mere presence of a policy. As outlined in recent reviews of physical activity policies in ECEC many have little content or detail and most lack a specific recommendation on how much physical activity (and screen time) children should have per day while at ECEC [19, 34]. Our findings show it is possible to develop setting- and age-specific physical activity and sedentary time recommendations that are meaningful and agreed upon across a range of stakeholders. For example, experts agreed that it was equally viable for the physical activity recommendation to be based either on a standard 6–8-h day in care or as a proportion of the day (i.e., a third of the day spent physically active). Future research is required to understand the impact of the different features of ECEC physical activity policies and implementation strategies on educator physical activity related practices and children’s physical activity behaviour. A first stage of evaluating the impact of the implementation of a new physical activity policy in ECEC should assess change in educator physical activity related practices, and then determine the effect on children’s physical activity levels.
As outlined in a recent Cochrane review of strategies to improve healthy eating, physical activity and obesity prevention policies, practices or programs in ECEC, there are a number of important factors that require consideration for successful implementation of a physical activity policy in ECEC . These are based on the Consolidated Framework for Implementation Research (CFIR)  and include overall organisation and individual service director support, parent engagement, resources, education and training for ECEC staff in promoting children’s physical activity, continuous quality improvement and monitoring as well as strategies to overcome key barriers to implementation . Experts in the current study confirmed a number of key CFIR based strategies related to management, supervisors and educators; the ECEC physical environment; communicating with families; and accreditation, monitoring and review, which are necessary for the successful implementation of physical activity policy in ECEC. The findings also identified ‘best bets’ for physical activity policy implementation in ECEC. Experts identified these strategies as both easy to implement and likely to have a high level of influence. These included strategies focussed on daily opportunities for outdoor play; programming for active play and physical activity; breaking up prolonged periods of sedentary time; not withholding physical activity to manage challenging behaviours; promoting awareness of the policy and making it available to all staff, families and visitors; and ensuring staff and children wear appropriate clothing and footwear for physical activity. These strategies are given priority in the physical activity policy template. Focussing on easier to implement strategies that also have a greater influence on educator practice and children’s physical activity behaviour, will provide motivation and encouragement for services to further implement their physical activity policy using other moderate to longer term strategies. This is particularly important given the challenges faced by ECEC providers in implementing new policies while balancing the demands of a crowded curriculum, administrative and reporting requirements and meeting the needs of a successful business .
Finally, the experts identified key barriers and enablers to implementing ECEC specific physical activity policies specific to management, supervisors and educators; the ECEC physical environment; and communicating with families. Many of these barriers were consistent with the literature and were common barriers to implementing any type of policy in any organisation i.e., existing workload and competing interests and expectations; lack of training; and costs in time, money and resources [15, 36]. However, some barriers were specific to implementing physical activity policy in ECEC; staff and parent perceptions of risk/injury/illness; insufficient play equipment, lack of indoor and or outdoor space; and weather extremes and have been noted in other studies of ECEC based physical activity interventions [15, 38, 39]. Barriers related to staff and parent perceptions of risk/injury/illness could be addressed through education and training, however barriers related to how supportive the ECEC physical environment is for physical activity may require longer term solutions. Many of the identified barriers to implementing strategies related to the ECEC physical environment and communicating with families. These strategies were identified lowest in terms of ease of implementation in a 1 year period, but would have a strong level of influence on the overall implementation of a physical activity policy in ECEC. Overall, there is little existing evidence of how to overcome implementation barriers related to the ECEC-based physical activity interventions .
Not surprisingly, many of the enablers for physical activity policy implementation in ECEC identified by the expert panel were also the opposite to the barriers identified. Two distinct key enablers to implementation were having a clear, concise and easy to follow policy and regulatory requirements for services to have and implement a physical activity policy . The application of implementation science to physical activity intervention research is relatively new, thus further research is required to better understand the setting, context and barriers to implementing physical activity interventions, strategies to overcome these barriers and how to capitalize on implementation enablers [15, 40].
Our findings underscore the importance of the content, coverage, clarity, simplicity, acceptability, and ease of use of physical activity policies developed for ECEC and the need for expert input and also to engage closely with end-users – educators and service directors. Furthermore, having an evidence based clear, concise and easy to follow physical activity policy template for services is necessary but not sufficient. Implementation strategies should be staged, beginning with easy and more influential strategies to enable services to implement their policy (taking into account their existing workload and priorities) and to encourage them to continue with the process. The most powerful way to ensure this happens is for state or national regulations to require all services have a physical activity policy and for it to be implemented. This appears feasible given some regulations currently require services to have policies on other health promoting behaviours such as healthy eating, sun protection and sleep .
The round two national survey of experts had less representation from some Australian States and Territories with most based in metropolitan areas. However, there was good representation from different stakeholder groups and a high level of expertise as demonstrated by the high education level and years employed in the field. Invitation to take part in the round two survey of experts was based on an identified list of experts and stakeholders, however there was evidence of the survey link being forwarded to others who may have not been considered an expert. In addition, not all (75%) of participants completed both the second and third round surveys which may have resulted in the exclusion of some experts views on the level of influence of strategies to implement physical activity policy in ECEC and the key barriers and enablers to these implementation strategies. As per the Delphi methodology, the survey data collected were subjective and based on expertise and the knowledge and opinion of participants.