A Scoping Review of Evidence-Informed Recommendations for Designing Inclusive Playgrounds.

Background: Playgrounds provide children with many sensory, motor, and socioemotional experiences that are critical to child development. Unfortunately, playgrounds also represent an environment where children with disabilities experience barriers to accessing play. Structures and materials that are prominently found in almost all playground designs (e.g., swings, slides, sand) can present as obstacles for many children with disabilities to engage in independent play. Aims: This scoping review engaged in the empirical literature to address the research question, "What are the evidence-informed recommendations for designing inclusive playgrounds to enable participation for children with disabilities?" Consideration was given not only to the physical design of playgrounds, but also the playgrounds' surrounding built and social environments. Methods: A systematic search of Medline, PsycINFO, CINAHL, EMBase, ERIC and Scopus was conducted. Only peer-reviewed literature published in English between January 1990 and January 2021, with a primary focus on inclusive playground structure design related to any type of disability were included. Data extraction included the study author(s), year of publication, country of origin, purpose, disability types considered, methods, sample characteristics and key findings. Key findings were synthesized into evidence-informed recommendations, which were later collated, using inductive content analysis, into five broader thematically congruent groups. Results: Thirty-five studies were included using case study (n = 17); observational (n = 6); survey (n = 5); experimental (n = 4); and multiple study (n = 3) designs. Thirteen evidence-based recommendations and one promising practice were categorized into five broad playground elements: entry points; surfacing and paths; features to foster inclusive play; staffing/supervision; and design process. Conclusion: These recommendations build upon previous design-based best-practices that focused exclusively on the physical design of the playground. Our recommendations have implications for how future playgrounds should be designed to maximize usability and inclusiveness and the overall playground experiences for children with disabilities.

The decline in active school transportation (AST): A systematic review of the factors related to AST and changes in school transport over time in North America.

Active travel to school has declined during the last 50years in North America. During the last decade, the children's active school transportation (AST) literature has grown. This systematic review provides an updated examination of AST correlates, and discusses why school travel mode (STM) share may have changed over time. AST trends are described and a systematic literature review of AST correlates in North America for the period 1990-2016 was conducted. Strength of association between correlates and AST, and relationship direction are assessed and reported. Graphical presentation of correlates included in ≥5 studies were included. Sixty-three studies were identified and reviewed. Distance to school was most strongly associated with AST. Individual, parental and societal correlates had moderate positive associations with AST including: child age, lower parental education, income and other income related factors, race and positive perceptions of AST. Longitudinal studies were few in number, as were studies about exceptional populations, policy, and interventions. AST intervention should focus on key AST correlates. Social and environmental diversity calls for local solutions to school travel challenges. Changes in AST correlates over time should be considered for evaluating existing policy approaches, and to support development of new policy, regulation, design, and program interventions.

The freedom to explore: examining the influence of independent mobility on weekday, weekend and after-school physical activity behaviour in children living in urban and inner-suburban neighbourhoods of varying socioeconomic status.

BACKGROUND: Children's independent mobility (CIM) is critical to healthy development in childhood. The physical layout and social characteristics of neighbourhoods can impact opportunities for CIM. While global evidence is mounting on CIM, to the authors' knowledge, Canadian data on CIM and related health outcomes (i.e., physical activity (PA) behaviour) are missing. The purpose of this study was to examine if CIM is related to multiple characteristics of accelerometry-measured PA behaviour (total PA, light PA, moderate-to-vigorous PA, time spent sedentary) and whether associations between CIM and PA behaviour systematically vary by place of residence, stratifying by gender and type of day/period (weekdays, after-school, weekend). METHODS: Participants were recruited through Project BEAT (Built Environment and Active Transport; http://www.beat.utoronto.ca). Children (n = 856) were stratified into four neighbourhood classifications based on the period of neighbourhood development (urban built environment (BE) (old BE) versus inner-suburban BE (new BE)) and socioeconomic status (SES; low SES and high SES). Physical activity was measured via accelerometry (ActiGraph GT1M). CIM was assessed via parental report and two categories were created (low CIM, n = 332; high CIM, n = 524). A series of two-factor ANOVAs were used to determine gender-specific differences in PA for weekdays, weekend days and the after-school period, according to level of CIM, across four neighbourhood classifications. RESULTS: Children who were granted at least some independent mobility (high CIM) had more positive PA profiles across the school week, during the after-school period, and over the weekend; they were also less sedentary. The influence of CIM on PA behaviour was particularly salient during the after-school period. Associations of CIM with PA varied by gender, and also by neighbourhood classification. CIM seemed to matter more in urban neighbourhoods for boys and suburban neighbourhoods for girls. CONCLUSION: Our findings highlight the importance of independent mobility to multiple characteristics of children's PA behaviour across the week. Furthermore, they emphasize that independent mobility-activity relationships need to be considered by gender and the type of neighbourhood independent mobility is offered in. Future work will focus on developing a predictive model of CIM that could be used to inform decision-making around alleviating barriers to CIM.

The "path" not taken: exploring structural differences in mapped- versus shortest-network-path school travel routes.

OBJECTIVES: School route measurement often involves estimating the shortest network path. We challenged the relatively uncritical adoption of this method in school travel research and tested the route discordance hypothesis that several types of difference exist between shortest network paths and reported school routes. METHODS: We constructed the mapped and shortest path through network routes for a sample of 759 children aged 9 to 13 years in grades 5 and 6 (boys = 45%, girls = 54%, unreported gender = 1%), in Toronto, Ontario, Canada. We used Wilcoxon signed-rank tests to compare reported with shortest-path route measures including distance, route directness, intersection crossings, and route overlap. Measurement difference was explored by mode and location. RESULTS: We found statistical evidence of route discordance for walkers and children who were driven and detected it more often for inner suburban cases. Evidence of route discordance varied by mode and school location. CONCLUSIONS: We found statistically significant differences for route structure and built environment variables measured along reported and geographic information systems-based shortest-path school routes. Uncertainty produced by the shortest-path approach challenges its conceptual and empirical validity in school travel research.

Spatial clustering and the temporal mobility of walking school trips in the Greater Toronto Area, Canada.

Interest in utilitarian sources of physical activity, such as walking to school, has emerged in response to the increased prevalence of sedentary behavior in children and youth. Public health practitioners and urban planners need to be able to survey and monitor walking practices in space and time, with a view to developing appropriate interventions. This study explored the prevalence of walking to and from school of 11-13 year olds in the Greater Toronto Area (GTA), Canada. The Getis-Ord (G(i)(*)) local spatial statistic, Markov transition matrices, and logistic regressions were used to examine the spatial clustering of walking trips in the study area, and to document any temporal drift of places in and out of walking clusters. Findings demonstrate that walking tends to cluster within the urban and inner-suburban GTA, and in areas with low household income. Temporally persistent cluster membership was less likely within inner-suburban and outer-suburban places. The evidence suggests that interventions to increase active school transportation need to acknowledge spatial and temporal differences in walking behavior.

Active school transportation in the Greater Toronto Area, Canada: an exploration of trends in space and time (1986-2006).

OBJECTIVE: This study describes temporal and spatial trends in active transportation for school trips in the Greater Toronto Area, Canada's largest city-region. METHODS: Proportions of trips by travel mode to and from school were estimated and compared for children (11-13 years) and youth (14-15 years). Data were drawn from the 1986, 1996, 2001, and 2006 versions of the Transportation Tomorrow Survey (TTS). RESULTS: Between 1986 and 2006, walking mode share for trips to school declined (53.0%-42.5% for 11-13 year olds, 38.6%-30.7% for 14-15 year olds). Although there has also been a decline in walking home from school, walking rates were higher in the afternoon. In 2006, younger children in the suburbs walked less to school (36.1%-42.3% of trips) than 11-13 year olds in Toronto (48.1%) and Toronto's 14-15 year olds walked less (38.3% of trips) but used transit more (44.8% of trips) than students in the suburbs. CONCLUSION: The findings indicate a period of decline (1986-2006) in the use of active modes for journeys to and from school for both age groups. Policies and programs to increase active transportation should acknowledge the spatial, temporal, and demographic heterogeneity of school travel decisions and outcomes.

Active school transport, physical activity levels and body weight of children and youth: a systematic review.

OBJECTIVES: Active school transport (AST) may be an important source of children's physical activity (PA). Innovative solutions that increase PA time for children, without putting added pressure on the school curriculum, merit consideration. Before implementing such solutions, it is important to demonstrate that active school transport is associated with health-related outcomes. METHODS: Following a standardized protocol, we conducted a systematic review of published research to address this question and explore whether children who actively commute to school also have a healthier body weight. Online searches of 5 electronic databases were conducted. Potential studies were screened on the basis of objective measures of physical activity. RESULTS: Thirteen studies were included in this review. Nine studies demonstrated that children who actively commute to school accumulate significantly more PA and two studies reported that they expended significantly more kilocalories per day. Where studies examined body weight (n=10), only one reported active commuters having a lower body weight. CONCLUSIONS: These studies demonstrate that active school commuters tend to be more physically active overall than passive commuters. However, evidence for the impact of AST in promoting healthy body weights for children and youth is not compelling.