Correction: Maternal gestational weight gain and objectively measured physical activity among offspring.

[This corrects the article DOI: 10.1371/journal.pone.0180249.].

The effect of a physical activity intervention on preschoolers' fundamental motor skills - A cluster RCT.

OBJECTIVES: To assess the effect of a physical activity intervention delivered in the childcare centres (CC), with or without a parent-driven home physical activity component, on children's fundamental motor skills (FMS). DESIGN: Six-month 3-arm cluster randomized controlled trial. METHODS: Preschoolers were recruited from 18 licensed CC. CC were randomly assigned to a typical curriculum comparison group (COM), childcare intervention alone (CC), or childcare intervention with parental component (CC+HOME). FMS was measured with the Test of Gross Motor Development-2. Linear mixed models were performed at the level of the individual while accounting for clustering. RESULTS: Raw locomotor skills score increased significantly in the CC group (mean difference=2.5 units, 95% Confidence Intervals, CI, 1.0-4.1, p<0.001) and the CC+HOME group (mean difference=2.4 units, 95% CI, 0.8-4.0, p<0.001) compared to the COM group. No significant (p>0.05) between group differences were observed in the raw object control skills, sum of raw scores, or gross motor quotient. No significant sex differences were found in any of the measured outcomes. CONCLUSIONS: A physical activity intervention delivered in childcare with or without parents' involvement was effective in increasing locomotor skills in preschoolers.

Maternal gestational weight gain and objectively measured physical activity among offspring.

OBJECTIVE: Animal studies have suggested that maternal weight-related factors during pregnancy can program offspring physical activity in a sex-dependent manner. However, there is limited evidence in humans. The purpose of this study was to investigate the association between maternal gestational weight gain (GWG) and offspring total physical activity (TPA) level and to determine whether these associations are moderated by sex of offspring or maternal pre-pregnancy weight status. METHOD: We studied 56 boys (mean age = 3.7 years, standard deviation (SD) 0.5) and 57 girls (mean age = 3.5±0.5 years) enrolled in licensed childcare centers. TPA was objectively measured using Actical® accelerometers. Information on pre-pregnancy body mass index (BMI), GWG, and other maternal factors were collected with a maternal health questionnaire. Associations between GWG, as a continuous variable or categorically (inadequate, adequate, and excessive), and offspring TPA were analysed using linear mixed models to take into account the intraclass correlation between the clusters (childcare centers). Models were adjusted for gestational age, accelerometer weartime, socioeconomic status, and pre-pregnancy BMI status. RESULTS: We found a significant sex interaction (P-value = 0.009). In boys, greater GWG was associated with decreased offspring TPA (ß = -3.2 counts⋅1000-1/d, 95% confidence intervals (CI) = -6.4-0.02, P-value = 0.049). In girls born to mothers categorized as overweight or obese, the association between the GWG and TPA followed an inverted U-shape curve (ß for GWG squared = -0.1 counts⋅1000-1/d, 95% CI = (-0.2 --0.04), P-value = 0.005). In contrast, a U-shaped curve was found in girls born to mothers classified as lean (pre-pregnancy BMI<25 kg/m2) (ß for GWG squared = 0.7 counts⋅1000-1/d, 95% CI = 0.2-1.2, P-value = 0.011). In boys, TPA in offspring was higher among women with inadequate GWG compared to adequate GWG (P-value = 0.0137), whereas no significant differences were found in girls (P-value = 0.107). CONCLUSION: Maternal GWG can be an important biological marker of offspring TPA. These findings support the sex-dependent early developmental programming influence of GWG on TPA.

Effects of Child Care Intervention on Physical Activity and Body Composition.

INTRODUCTION: This study evaluated whether intervening with child care providers would increase physical activity (PA) and reduce adiposity in preschoolers. METHODS: This was a two-arm, parallel group, cluster RCT whereby six child care centers were randomly assigned in equal numbers to intervention (n=40 children) or control (n=43 children). Participants were aged 3-5 years and attended licensed child care centers. Child care providers received two 3-hour train-the-trainer workshops and a training manual at program initiation aimed at increasing structured and unstructured PA through active play. Control child care centers implemented their standard curriculum. PA and sedentary behavior were measured by accelerometry, and body composition was measured using bioelectrical impedance at baseline and 6 months. Data were collected in 2011-2012 and analyzed in April 2015. RESULTS: Linear mixed-effects modeling showed that at 6 months, children in the intervention group demonstrated greater increases in minutes per preschool day spent in overall PA (22.5 minutes, 95% CI=8.9, 36.1, p=0.002), and light-intensity PA (16.1 minutes, 95% CI=5.2, 26.7, p=0.004), but changes between groups in moderate to vigorous PA did not differ. The intervention group showed greater reductions in body fat percentage (-1.9%, 95% CI=-3.5, -0.3, p=0.023) and fat mass (-0.3 kg, 95% CI=-0.7, -0.1, p=0.018), but groups did not differ on fat-free mass, BMI, or z-BMI. CONCLUSIONS: Provider-led intervention in child care centers increased preschoolers' PA and reduced adiposity, therefore may represent a viable approach to promoting PA and related health benefits in preschool-aged children. TRIAL REGISTRATION: This study is registered at www.clinicaltrials.gov NCT02293278.

Does Intervening in Childcare Settings Impact Fundamental Movement Skill Development?

PURPOSE: Knowing that motor skills will not develop to their full potential without opportunities to practice in environments that are stimulating and supportive, we evaluated the effect of a physical activity (PA)-based intervention targeting childcare providers on fundamental movement skills (FMS) in preschoolers attending childcare centers. METHODS: In this two-arm cluster-randomized controlled trial, six licensed childcare centers in Ottawa, Canada, were randomly allocated into one of two groups (three controls, n = 43; three interventions, n = 40). Participants were between the ages of 3 and 5 yr. Childcare providers in the experimental condition received two 3-h workshops and a training manual at program initiation aimed at increasing PA through active play and several in-center "booster" sessions throughout the 6-month intervention. Control childcare centers implemented their standard curriculum. FMS were measured at baseline and 6 months using the Test of Gross Motor Development-2. RESULTS: Groups did not differ on sociodemographic variables. Compared with control, children in the intervention group demonstrated significantly greater improvement in their standardized gross motor quotient (score, 5.70; 95% confidence interval [95% CI], 0.74-10.67; P = 0.025 and gross motor quotient percentile, 13.33; 95% CI, 2.17-24.49; P = 0.020). Over the 6-month study period, the intervention group showed a significantly greater increase in locomotor skills score (1.20; 95% CI, 0.18-2.22; P = 0.022) than the control group. There was a significant decrease in the object control scores in the control group over the study period. CONCLUSIONS: A childcare provider-led PA-based intervention increased the FMS in preschoolers, driven by the change in locomotor skills. The childcare environment may represent a viable public health approach for promoting motor skill development to support future engagement in PA.

Activity Begins in Childhood (ABC) - inspiring healthy active behaviour in preschoolers: study protocol for a cluster randomized controlled trial.

BACKGROUND: Today's children are more overweight than previous generations and physical inactivity is a contributing factor. Modelling and promoting positive behaviour in the early years is imperative for the development of lifelong health habits. The social and physical environments where children spend their time have a powerful influence on behaviour. Since the majority of preschool children spend time in care outside of the home, this provides an ideal setting to examine the ability of an intervention to enhance movement skills and modify physical activity behaviour. This study aims to evaluate the efficacy of the Activity Begins in Childhood (ABC) intervention delivered in licensed daycare settings alone or in combination with a parent-driven home physical activity-promotion component to increase preschoolers' overall physical activity levels and, specifically, the time spent in moderate to vigorous physical activity. METHODS/DESIGN: This study is a single site, three-arm, cluster-randomized controlled trial design with a daycare centre as the unit of measurement (clusters). All daycare centres in the National Capital region that serve children between the ages of 3 and 5, expressing an interest in receiving the ABC intervention will be invited to participate. Those who agree will be randomly assigned to one of three groups: i) ABC program delivered at a daycare centre only, ii) ABC program delivered at daycare with a home/parental education component, or iii) regular daycare curriculum. This study will recruit 18 daycare centres, 6 in each of the three groups. The intervention will last approximately 6 months, with baseline assessment prior to ABC implementation and follow-up assessments at 3 and 6 months. DISCUSSION: Physical activity is an acknowledged component of a healthy lifestyle and childhood experiences as it has an important impact on lifelong behaviour and health. Opportunities for physical activity and motor development in early childhood may, over the lifespan, influence the maintenance of a healthy body weight and reduce cardiovascular disease risk. If successful, the ABC program may be implemented in daycare centres as an effective way of increasing healthy activity behaviours of preschoolers. TRIAL REGISTRATION: Current Controlled Trials: ISRCTN94022291. Registered in December 2012, first cluster randomized in April 2013.

Impact of accelerometer epoch length on physical activity and sedentary behaviour outcomes for preschool-aged children.

BACKGROUND: The Canadian Health Measures Survey uses accelerometry to collect physical activity and sedentary behaviour data. Between cycles 2 and 3, a transition was made from 60-second to 15-second epochs in accelerometry data for children aged 3 to 5. This study examines the impact of epoch length on physical activity and sedentary behaviour outcomes. DATA AND METHODS: Twenty-nine children aged 3 to 5 wore two accelerometers at the same time, one initialized to collect data in 60-second epochs, and the other, in 15-second epochs. Comparisons between epoch settings were made for several physical activity variables. RESULTS: Compared with the 60-second epoch setting, the 15-second setting captured more moderate-to-vigorous physical activity (MVPA) and sedentary time, but fewer steps and less light and total physical activity. The correlation between epoch settings was high for all variables except steps. INTERPRETATION: The epoch length used in accelerometer data collection affects physical activity and sedentary behaviour data for preschool-aged children.

Evaluating a fruit and vegetable program: in eastern Ontario schools.

PURPOSE: Effectiveness was evaluated for a fruit and vegetable program developed to encourage Canadian elementary school children to eat the recommended number of daily servings. Also examined was whether the program modified children's personal factors, perceived social environment, and perceived physical environment. METHODS: A prospective, quasi-experimental trial was conducted to compare the eight schools receiving the intervention curriculum (Freggie Friday schools [FFS]) with six control schools (CS). A food frequency questionnaire was used to measure differences in fruit and vegetable consumption. Personal factors, perceived social environment, and perceived physical environment supporting fruit and vegetable consumption were assessed with an adapted version of the validated Pro Children study questionnaire. RESULTS: Of the 942 children who completed the baseline assessment, 807 also completed the follow-up questionnaire (FFS, 450; CS, 357). A mixed-effects regression model indicated no significant intervention effects on fruit or vegetable consumption, snack food consumption, or knowledge or attitudes related to fruit and vegetable consumption. CONCLUSIONS: The results suggest that an intervention based on a single visit from an external group, followed by teacher-led programming, may be an ineffective method of eliciting dietary behaviour change in this population. Future programs may need to implement multicomponent intervention designs.