Tunneling a crosstown highway: a natural experiment testing the longitudinal effect on physical activity and active transport.

BACKGROUND: In the city of Maastricht in the Netherlands, a highway crossing several deprived neighborhoods was tunneled in 2016. The vacant space on top of this tunnel was redesigned and prioritized for pedestrians and cyclists. The aim of this study was to evaluate the effect of this major infrastructural change, named the Green Carpet, on total and transport-based physical activity (PA) levels. METHODS: Participants (≥18 years) were part of one of three area-based exposure groups. The maximal exposure group lived in neighborhoods directly bordering the Green Carpet. The minimal exposure group consisted of individuals living at the other side of the city, and the no exposure group consisted of individuals living in a nearby city. Actual use of the new infrastructure was incorporated as a second measure of exposure. Data were collected before and 3-15 months after the opening of the Green Carpet. Device-based measurements were conducted to obtain PA levels and collect location data. Changes in PA over time and intervention effects were determined using linear mixed models. RESULTS: PA levels in the Green Carpet area increased for the maximal and minimal exposure groups, but did not lead to an increase in total or transport-based PA. For the no exposure group, transport-based MVPA decreased and transport-based SB increased. The significant interaction (time x exposure) for transport-based SB, indicated differences in trends between the no exposure and maximal exposure group (B=-3.59, 95% CI - 7.15; -0.02) and minimal exposure group (B= -4.02, 95% CI -7.85, -0.19). Trends in the results based on analyses focusing on actual use and non-use of the new infrastructure were similar to those of the area-based analyses. CONCLUSIONS: Results suggest that the Green Carpet led to more PA in this specific area, but did not increase the total volume of PA. The area-based differences might reflect the differences between users and non-users, but we should be careful when interpreting these results, due to possible interference of selective mobility bias. This paper reflects that the relationship between infrastructure and PA is not unambiguous. TRIAL REGISTRATION: This research was retrospectively registered at the Netherlands Trial Register ( NL8108 ).

Longitudinal Perspectives on Children's Physical Activity Patterns: "Do Physical Education-Related Factors Matter?"

BACKGROUND: This study examined longitudinal associations of motor competence (MC) and physical activity (PA) enjoyment with moderate to vigorous PA and sedentary behavior among boys and girls aged 10-12 years old. In addition, this study explored the predictive strength of satisfaction of basic psychological needs in physical education (PE) and PA enjoyment. METHODS: At 3 time points (baseline, +1 y, and +2 y), PA levels, MC, PA enjoyment, satisfaction of basic psychological needs in PE and height and weight of 371 children were measured. Data were analyzed using repeated-measures linear mixed model analyses stratified for gender and adjusted for relevant covariates. RESULTS: Sedentary behavior decreased over time and was significantly predicted by PA enjoyment in boys and by PA enjoyment and MC in girls. Boys' moderate to vigorous PA decreased over time and was predicted by MC, whereas girls' moderate to vigorous PA remained low, yet stable over time and was predicted by PA enjoyment and MC. Furthermore, children's need for competence and teacher relatedness (girls only) during PE significantly predicted PA enjoyment. CONCLUSIONS: Children need sufficient and well-designed opportunities to improve their MC and PA enjoyment. PE may be pivotal in advancing PA enjoyment, indicating that PE could have more beneficial effects on PA levels in children, especially in girls.

Do parenting practices moderate the association between the physical neighbourhood environment and changes in children's time spent at various physical activity levels? An exploratory longitudinal study.

BACKGROUND: As many children do not meet the recommended daily physical activity (PA) levels, more research is needed towards environmental determinants of children's PA levels. The aims of this longitudinal study were to investigate whether the physical environment and parenting practices have an impact on changes in children's weekday time spent at various PA levels and whether associations between physical neighbourhood environment and changes in children's PA are moderated by parenting practices. METHODS: We performed a secondary data analysis of longitudinal data collected at three timepoints (baseline, 6, and 18 months) from 10 control schools of the Active Living study, a quasi-experimental study, which took place in South Limburg, the Netherlands. In total, 240 children aged 8-12 years were included in the analyses. PA levels were measured using accelerometry (ActiGraph GT3X+). The physical environment was assessed at baseline through neighbourhood audits of the school environment, and PA parenting practices were measured at baseline via validated parental questionnaires. Multivariate multilevel regression analyses were conducted to determine the main effects of the physical environment and parenting practices on changes in children's time spent in sedentary behaviour (SB), light PA and moderate-to-vigorous PA (MVPA) over 18 months. Additionally, moderation of the association between the physical environment and children's PA levels by parenting practices was examined by adding interacting terms to the regression equations. RESULTS: Walkability of the physical environmental was associated with a decrease in SB at 18 months (B = -5.45, p < .05). In addition, the parenting practice logistic support was associated with an increase in MVPA (at all time points, B = .68, B = .73 and B = 1.02, respectively, all p < .05) and a decrease in SB (at 18 months, B = -1.71, p < .05). Stratified analyses (based on significant interaction terms) showed that the effect of specific physical environmental features (e.g., sports facilities) on children's improvements in PA levels were strengthened by favourable parenting practices. DISCUSSION: Besides the main effects of walkability and logistic support, there were indications that several parenting practices moderate the association between the physical environment and changes in children's time in various PA levels. The current findings are exploratory, and need to be confirmed in further research.

Effects of the KEIGAAF intervention on the BMI z-score and energy balance-related behaviors of primary school-aged children.

The aim of the current study was to evaluate the one- and two-year effectiveness of the KEIGAAF intervention, a school-based mutual adaptation intervention, on the BMI z-score (primary outcome), and energy balance-related behaviors (secondary outcomes) of children aged 7-10 years.A quasi-experimental study was conducted including eight intervention schools and three control schools located in low socioeconomic neighborhoods in the Netherlands. Baseline measurements were conducted in March and April 2017 and repeated after one and 2 years. Data were collected on children's BMI z-score, sedentary behavior (SB), physical activity (PA) behavior, and nutrition behavior through the use of anthropometric measurements, accelerometers, and questionnaires, respectively. All data were supplemented with demographics, and weather conditions data was added to the PA data. Based on the comprehensiveness of implemented physical activities, intervention schools were divided into schools having a comprehensive PA approach and schools having a less comprehensive approach. Intervention effects on continuous outcomes were analyzed using multiple linear mixed models and on binary outcome measures using generalized estimating equations. Intervention and control schools were compared, as well as comprehensive PA schools, less comprehensive PA schools, and control schools. Effect sizes (Cohen's d) were calculated.In total, 523 children participated. Children were on average 8.5 years old and 54% were girls. After 2 years, intervention children's BMI z-score decreased (B = -0.05, 95% CI -0.11;0.01) significantly compared to the control group (B = 0.20, 95% CI 0.09;0.31). Additionally, the intervention prevented an age-related decline in moderate-to-vigorous PA (MVPA) (%MVPA: B = 0.95, 95% CI 0.13;1.76). Negative intervention effects were seen on sugar-sweetened beverages and water consumption at school, due to larger favorable changes in the control group compared to the intervention group. After 2 years, the comprehensive PA schools showed more favorable effects on BMI z-score, SB, and MVPA compared to the other two conditions.This study shows that the KEIGAAF intervention is effective in improving children's MVPA during school days and BMI z-score, especially in vulnerable children. Additionally, we advocate the implementation of a comprehensive approach to promote a healthy weight status, to stimulate children's PA levels, and to prevent children from spending excessive time on sedentary behaviors.Trial registrationNetherlands Trial Register, NTR6716 ( NL6528 ), Registered 27 June 2017 - retrospectively registered.

Involving Parents to Help Improve Children's Energy Balance-Related Behaviours Through a School-Based Intervention.

The Challenge Me intervention aimed to indirectly involve parents in a school-based intervention, by challenging primary school children to perform physical activity (PA) and nutrition-related activities with their parents. The aim of this study is to gain insight in whether this was a feasible strategy to engage children and parents, especially those of vulnerable populations. An exploratory cross-sectional study design was applied. Four primary schools implemented the intervention. Data consisted of challenges completed (intervention posters) and child and family characteristics (questionnaires and anthropometric measurements). Associations between challenges performed and child and family characteristics were assessed using linear regression analysis. Of the 226 study participants, 100% performed at least one challenge, and 93% performed at least one challenge involving parents. Children who performed more PA challenges were often younger, a sports club member, lived in higher socioeconomic status neighbourhoods, of Western ethnicity and from larger families. Regarding nutrition challenges involving parents, younger children performed more challenges. There was no difference in intervention engagement regarding gender, weight status, PA preference, healthy nutrition preference, or the Family PA and Family Nutrition Climate. Challenge Me has potential in involving parents in a school-based intervention. However, certain characteristics were associated with higher involvement.

Disentangling Physical Activity and Sedentary Behavior Patterns in Children with Low Motor Competence.

Children with low motor competence (MC) are at high-risk for physical inactivity, yet little is known about their physical activity (PA) and sedentary behavior (SB) patterns throughout the day. The purpose of this study is to disentangle PA and SB patterns among children with low MC across segmented day periods taking into account differences in gender and age. Data collection took place between May and July 2017. The Athletic Skills Track was used to measure MC. PA levels were objectively measured using accelerometers (ActiGraph, GT3X+) on school days. Data were segmented for (1) time before school, (2) time during school (based on school schedules), and (3) time after school. In total, data from 117 7-to-11 years-old children with low MC were eligible for analyses (N = 58 girls; N = 59 boys). Differences in moderate-to-vigorous PA (MVPA) and SB between segmented periods, gender, and grade were analyzed by ANOVAs with post hoc tests (Tukey) and Independent Sample T-tests respectively. Time spent at school is the major contributor of time spent in SB in children with low MC. Low MC is equally distributed among gender, but large differences exist among boys and girls in both MVPA and SB, indicating low-MC girls as most inactive group. This pattern is found in all segmented periods of the school day, i.e., before, during, and after school. This study stresses the negative contribution of current school curricula on PA and SB in children with low MC, indicating the most efficient period of the day to intervene. Future school-based PA and SB interventions should particularly focus on specific high-risk populations, i.e., children with low MC, and girls in particular.

Effectiveness of school-based physical activity and nutrition interventions with direct parental involvement on children's BMI and energy balance-related behaviors - A systematic review.

BACKGROUND: The aims of this systematic review were to study the effectiveness of primary school-based physical activity, sedentary behavior and nutrition interventions with direct parental involvement on children's BMI or BMI z-score, physical activity, sedentary behavior and nutrition behavior and categorize intervention components into targeted socio-cognitive determinants and environmental types using the Environmental Research framework for weight Gain prevention. METHODS: In March 2018, a systematic search was conducted in four electronic literature databases. Articles written in English about effectiveness studies on school-based interventions with direct parental involvement targeting 4-12 year olds were included. Interventions with indirect parental involvement, interventions not targeting the school environment, and pilot studies were excluded. Study and intervention characteristics were extracted. Study quality and study effectiveness were assessed and effect sizes (Cohen's d) were calculated for the outcome measures. Types of socio-cognitive factors and environmental types targeted were distinguished. RESULTS: In total, 25 studies were included. Most studies on BMI or BMI z-score, physical activity and sedentary behavior found favorable results: 61.1%, 81.1% and 75%, respectively. Results regarding nutrition behavior were inconclusive. Methodological study quality varied. All interventions targeted multiple environmental types in the school and family environment. Five targeted socio-cognitive determinants (knowledge, awareness, attitude, self-efficacy and intrinsic motivation) of the children were identified. No consistent pattern was found between either type of environment targeted, number of type of environment targeted, or the child's targeted socio-cognitive determinants and intervention effectiveness. DISCUSSION: School-based interventions with direct parental involvement have the potential to improve children's weight status, physical activity and sedentary behavior. Based on the results, it is recommended that school-based interventions with direct parental involvement target more than one EBRB, last at least one year, and focus particularly on the physical and social environment within both the school and the family environment.

Activating Childcare Environments for All Children: the Importance of Children's Individual Needs.

Characteristics of the physical childcare environment are associated with children’s sedentary behavior (SB) and physical activity (PA) levels. This study examines whether these associations are moderated by child characteristics. A total of 152 1- to 3-year-old children from 22 Dutch childcare centers participated in the study. Trained research assistants observed the physical childcare environment, using the Environment and Policy Assessment Observation (EPAO) protocol. Child characteristics (age, gender, temperament and weight status) were assessed using parental questionnaires. Child SB and PA was assessed using Actigraph GT3X+ accelerometers. Linear regression analyses including interaction terms were used to examine moderation of associations between the childcare environment and child SB and PA. Natural elements and portable outdoor equipment were associated with less SB and more PA. In addition, older children, boys and heavier children were less sedentary and more active, while more use of childcare and an anxious temperament were associated with more SB. There were various interactions between environmental factors and child characteristics. Specific physical elements (e.g., natural elements) were especially beneficial for vulnerable children (i.e., anxious, overactive, depressive/withdrawn, overweight). The current study shows the importance of the physical childcare environment in lowering SB and promoting PA in very young children in general, and vulnerable children specifically. Moderation by child characteristics shows the urgency of shaping childcare centers that promote PA in all children, increasing equity in PA promotion in childcare.

Study protocol of the quasi-experimental evaluation of "KEIGAAF": a context-based physical activity and nutrition intervention for primary school children.

BACKGROUND: The environment affects children's energy balance-related behaviors to a considerable extent. A context-based physical activity and nutrition school- and family-based intervention, named KEIGAAF, is being implemented in low socio-economic neighborhoods in Eindhoven, The Netherlands. The aim of this study was to investigate: 1) the effectiveness of the KEIGAAF intervention on BMI z-score, waist circumference, physical activity, sedentary behavior, nutrition behavior, and physical fitness of primary school children, and 2) the process related to the implementation of the intervention. METHODS: A quasi-experimental, controlled study with eight intervention schools and three control schools was conducted. The KEIGAAF intervention consists of a combined top-down and bottom-up school intervention: a steering committee developed the general KEIGAAF principles (top-down), and in accordance with these principles, KEIGAAF working groups subsequently develop and implement the intervention in their local context (bottom-up). Parents are also invited to participate in a family-based parenting program, i.e., Triple P Lifestyle. Children aged 7 to 10 years old (grades 4 to 6 in the Netherlands) are included in the study. Effect evaluation data is collected at baseline, after one year, and after two years by using a child questionnaire, accelerometers, anthropometry, a physical fitness test, and a parent questionnaire. A mixed methods approach is applied for the process evaluation: quantitative (checklists, questionnaires) and qualitative methods (observations, interviews) are used. To analyze intervention effectiveness, multilevel regression analyses will be conducted. Content analyses will be conducted on the qualitative process data. DISCUSSION: Two important environmental settings, the school environment and the family environment, are simultaneously targeted in the KEIGAAF intervention. The combined top-down and bottom-up approach is expected to make the intervention an effective and sustainable version of the Health Promoting Schools framework. An elaborate process evaluation will be conducted alongside an effect evaluation in which multiple data collection sources (both qualitative and quantitative) are used. TRIAL REGISTRATION: Dutch Trial Register NTR6716 (registration date 27/06/2017, retrospectively registered), METC163027, NL58554.068.16, Fonds NutsOhra project number 101.253.

Do Physical Activity Friendly Neighborhoods Affect Community Members Equally? A Cross-Sectional Study.

An activity-friendly environment may increase physical activity (PA) levels and decrease sedentary behavior (SB). This study investigated associations between socio-demographic characteristics, health-related quality of life (HRQoL), perceived environment and objectively measured PA outcomes. Socio-demographic characteristics were assessed using a questionnaire and HRQoL was measured using the EQ-5D. The Neighborhood Environment Walkability Scale (NEWS-A) was used to assess the perceived environment. SB, light PA (LPA) and moderate-to-vigorous PA (MVPA) were measured using the Actigraph GT3X+. Data from 622 Dutch adults were used in multivariate linear regression analyses to investigate associations between NEWS-A and PA outcomes. Analyses were controlled for socio-demographic characteristics and HRQoL. The presence of attractive buildings was associated with less SB (ß = -0.086, p < 0.01) and more MVPA (ß = 0.118, p < 0.01). Presence of destinations within walking distance was also positively associated with MVPA (ß = 0.106, p < 0.01). Less crime was associated with less MVPA (ß = 0.092, p < 0.05). Interactions between personal and environmental characteristics showed that the absence of PA-hindering characteristics (e.g., heavy traffic) was associated with less SB and more MVPA, but only for residents with problems regarding pain and usual activities. The presence of PA-facilitating characteristics (e.g., aesthetics and destinations) was associated with less SB, more LPA and more MVPA but only for the more advantaged people in society. Results suggest that to reduce health inequalities, it would be more helpful to remove barriers rather than introduce PA facilitating characteristics.

A Multicomponent Schoolyard Intervention Targeting Children's Recess Physical Activity and Sedentary Behavior: Effects After 1 Year.

BACKGROUND: The aim of the study was to test the 12-month effects of a multicomponent physical activity (PA) intervention at schoolyards on morning recess PA levels of sixth- and seventh-grade children in primary schools, using accelerometry and additional global positioning system data. METHODS: A quasi-experimental study design was used with 20 paired intervention and control schools. Global positioning system confirmatory analyses were applied to validate attendance at schoolyards during recess. Accelerometer data from 376 children from 7 pairs of schools were included in the final analyses. Pooled intervention effectiveness was tested by multilevel linear regression analyses, whereas effectiveness of intervention components was tested by multivariate linear regression analyses. RESULTS: Children exposed to the multicomponent intervention increased their time spent in light PA (+5.9%) during recess. No pooled effects on moderate to vigorous PA were found. In-depth analyses of intervention components showed that physical schoolyard interventions particularly predicted a decrease in time spent in sedentary behavior during recess at follow-up. Intervention intensity and the school's commitment to the project strengthened this effect. CONCLUSIONS: The multicomponent schoolyard PA intervention was effective in making children spend a larger proportion of recess time in light PA, which was most likely the result of a shift from sedentary behavior to light PA.

Schoolyard Characteristics, Physical Activity, and Sedentary Behavior: Combining GPS and Accelerometry.

BACKGROUND: Physical activity (PA) is decreasing among children, while sedentary behavior (SB) is increasing. Schoolyards seem suitable settings to influence children's PA behavior. This study investigated the associations between schoolyard characteristics and moderate-to-vigorous physical activity (MVPA) and SB of children aged 8-11 years at schoolyards. METHODS: Twenty primary schools in the Netherlands were involved. A total of 257 children wore an accelerometer and global positioning system (GPS) device for 5 consecutive days to objectively assess their PA levels and presence at the schoolyard, respectively. Accelerometer and GPS data were merged using the personal activity and location measurement system. Multilevel linear regression analyses were used to study correlates of MVPA and SB at schoolyards. RESULTS: On average, children spent 54 minutes a day at the schoolyard, 9 minutes of which were spent in MVPA and 20 minutes in SB. Boys engaged in MVPA longer than girls at the schoolyard. Fixed equipment, such as high bars and soccer goals, teacher-initiated activities, and the presence of a ball games policy were correlates of more MVPA and less SB. CONCLUSION: Well-designed schoolyards, including PA-enhancing fixed equipment, a supportive PA climate created by teachers, and supportive schoolyard policies may contribute to increased PA and decreased SB during school recess among school-aged children.

A Multicomponent Schoolyard Intervention Targeting Children's Recess Physical Activity and Sedentary Behavior: Effects After One Year.

Background Aim of the study was to test the 12-month effects of a multicomponent physical activity (PA) intervention at schoolyards on recess PA levels of 6th and 7th grade children in primary schools, combining Global Positioning System (GPS) and accelerometry data. Methods A quasi-experimental study design was used with 20 paired intervention and control schools. GPS confirmatory analyses were applied to validate attendance at schoolyards during recess. Data from 376 children from 7 pairs of schools were included in the final analyses. Pooled intervention effectiveness was tested by multilevel linear regression analyses, whereas effectiveness of intervention components was tested by multivariate linear regression analyses. Results Children exposed to the multicomponent intervention increased their time spent in light PA (+5.9%) during recess. No pooled effects on Moderate-to-Vigorous PA were found. In depth-analyses on intervention components showed that physical schoolyard interventions particularly predicted a decrease in time spent in sedentary behavior during recess at follow-up. Intervention intensity and school's commitment to the project strengthened this effect. Conclusions The multicomponent schoolyard PA intervention was effective in making children spend a larger proportion of recess time in light PA, which was most likely the result of a shift from sedentary behavior to light PA.

Active Living: development and quasi-experimental evaluation of a school-centered physical activity intervention for primary school children.

BACKGROUND: The worldwide increase in the rates of childhood overweight and physical inactivity requires successful prevention and intervention programs for children. The aim of the Active Living project is to increase physical activity and decrease sedentary behavior of Dutch primary school children by developing and implementing tailored, multicomponent interventions at and around schools. METHODS/DESIGN: In this project, school-centered interventions have been developed at 10 schools in the south of the Netherlands, using a combined top-down and bottom-up approach in which a research unit and a practice unit continuously interact. The interventions consist of a combination of physical and social interventions tailored to local needs of intervention schools. The process and short- and long-term effectiveness of the interventions will be evaluated using a quasi-experimental study design in which 10 intervention schools are matched with 10 control schools. Baseline and follow-up measurements (after 12 and 24 months) have been conducted in grades 6 and 7 and included accelerometry, GPS, and questionnaires. Primary outcome of the Active Living study is the change in physical activity levels, i.e. sedentary behavior (SB), light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), and counts-per-minute (CPM). Multilevel regression analyses will be used to assess the effectiveness of isolated and combined physical and social interventions on children's PA levels. DISCUSSION: The current intervention study is unique in its combined approach of physical and social environmental PA interventions both at school(yard)s as well as in the local neighborhood around the schools. The strength of the study lies in the quasi-experimental design including objective measurement techniques, i.e. accelerometry and GPS, combined with more subjective techniques, i.e. questionnaires, implementation logbooks, and neighborhood observations. TRIAL REGISTRATION: Current Controlled Trials ISRCTN25497687 (registration date 21/10/2015), METC 12-4-077, Project number 200130003.

Play equipment, physical activity opportunities, and children's activity levels at childcare.

This study investigated the association between physical activity facilities at childcare (e.g., play equipment) and physical activity of 2- and 3-year olds. Observations of physical activity intensity were performed among 175 children at 9 childcare centers in The Netherlands, using the OSRAC-P. The physical activity facilities were assessed for indoors and outdoors separately, using the EPAO instrument. Regular (single-level) multivariate and multilevel linear regression analyses examined the association of the facilities and child characteristics (age and sex) with children's activity levels. Various physical activity facilities were available in all childcare centers (e.g., balls). Riding toys and a small playing area were associated with lower indoor physical activity levels. Outdoor physical activity levels were positively associated with the availability of portable jumping equipment and the presence of a structured track on the playground. Portable slides, fixed swinging equipment, and sandboxes were negatively associated with outdoor activity levels. In addition, the 3-year old children were more active outdoors than the 2-year olds. In conclusion, not all physical activity facilities at childcare were indeed positively associated with children's activity levels. The current findings provide concrete leads for childcare providers regarding which factors they can improve in the physical environment to facilitate children's physical activity.

Interaction between physical environment, social environment, and child characteristics in determining physical activity at child care.

OBJECTIVE: To investigate the association between the child-care environment and physical activity of 2- and 3-year-olds. Based on an ecological view of environmental influences on health behavior, we hypothesized that the social and physical environment, as well as child characteristics (age and gender), would show independent and interactive effects on children's physical activity intensity. DESIGN: Observations of physical activity intensity were performed among children (N = 175) at 9 Dutch child-care centers. Aspects of the child-care environment were assessed using the validated Environment and Policy Assessment and Observation (EPAO) Instrument. Multilevel linear regression analyses examined the association of environment and child characteristics with children's activity intensity. Moderation was tested by including interaction terms in the analyses, with subsequent post hoc analyses for significant interaction terms. MAIN OUTCOME MEASURE: Observed child physical activity intensity, measured with the Observational System for Recording Physical Activity in Children-Preschool Version. RESULTS: A large proportion of the observed activities were classified as sedentary, while far fewer observations were classified as moderate or vigorous. Activity opportunities in the physical environment (assessed using EPAO) and prompts by staff and peers were significantly and positively related to physical activity intensity, while group size was negatively related to activity intensity. The influence of the physical environment was moderated by social environment (peer group size), while the social environment in turn interacted with child characteristics (age and gender) in determining activity intensity. CONCLUSION: Our findings are in line with the ecological perspective regarding environmental influences on behavior, and stress the importance of incorporating the child-care environment in efforts to prevent childhood overweight and obesity.