Longitudinal Change in Physical Activity in Children 6 to 36 Months of Age.

OBJECTIVE: To describe the developmental pattern for physical activity (PA) in children 6-36 months of age and to identify factors that are longitudinally associated with PA as children transition from infancy to preschool age. STUDY DESIGN: The study employed a prospective, longitudinal design with baseline data collected when children were approximately 6 months of age. Mothers and infants (n = 124) were recruited through community and educational settings in South Carolina. Data were collected at 6-month intervals from 6 through 36 months. PA was measured via accelerometry. Mothers completed questionnaires that assessed independent variables, including parent characteristics, the child's sex, race, and ethnicity, birth/delivery type, motor milestones, sleep habits, dietary practices, childcare setting, and home environmental factors. Trained research staff administered anthropometric measures and assessed motor developmental status. Growth curve models described the age-related pattern for PA and evaluated relationships between independent variables and change in PA. RESULTS: PA increased by approximately 45% between 6 and 36 months of age and followed a curvilinear pattern, with most of the increase occurring between 6 and 24 months. The child's exposure to television/electronic media was negatively associated with change in PA, and the presence of older siblings in the home was positively associated with change in PA. CONCLUSION: As children develop from infancy to early childhood, their PA increases substantially, with most of the increase occurring by 24 months of age.

Longitudinal Associations Between Physical Activity and Sleep Duration in Infants and Toddlers.

PURPOSE: This study examined longitudinal associations between average physical activity (PA) levels in children and their sleep duration, and whether changes in PA levels are associated with their sleep duration. METHODS: Data were collected on 108 children at 4 time points: when children were 6, 12, 18, and 24 months of age (44% female, 50% Non-Hispanic White). PA was assessed using accelerometry. Children's daytime, nighttime, and 24-hour sleep duration were measured with actigraphy. Linear mixed model analyses estimated the associations between average PA levels over time and changes in PA over time, treating each sleep duration variable as an outcome in separate linear mixed model analyses. RESULTS: Children with higher total PA levels slept less during the day compared with children with lower total PA levels over the 2-year period. The strength of the relationship between a child's PA levels and their 24-hour sleep duration decreased as they approached 24 months of age. CONCLUSIONS: The results suggest that while PA may be developmentally beneficial overall, it appears that its relationship with sleep duration is not clinically relevant in very young children.

Children's physical activity in family child care homes: Influence of quality status, environment and policy features, and child characteristics.

BACKGROUND: About half of preschool-age children are not meeting recommendations of 15 min/h of physical activity (PA), and nearly one out of seven children between the ages of 2-5 years are living with obesity. Furthermore, children attending family child care homes (FCCHs), compared with larger child care centers, engage in lower levels of PA and appear to be at a higher risk of obesity. Therefore, examining PA and multi-level factors that influence PA in children who attend FCCHs is essential. METHODS: The Childcare Home Eating and Exercise Study (CHEER) examined PA behaviors of 184 children enrolled in 56 FCCHs and FCCH quality status, environment and policy features, and child characteristics. PA was assessed by accelerometer, and FCCH environment and policy was assessed via structured observation. Multiple linear regression was used to model associations between school day total PA and FCCH quality status, environment and policy features, and child characteristics. RESULTS: Child participants were on average 3.1 years old; participants were non-Hispanic Black (47.3%), Non-Hispanic White (42.9%), other race/ethnicity (7.1%), and Hispanic/Latin (2.7%). Children in FCCH settings participated in 11.2 min/h of total PA, which is below the recommended 15 min per hour. The PA environment and policy observation yielded a score of 11.8 out of a possible 30, which is not supportive of child PA. There were no associations between total child PA and FCCH quality status, environment and policy features, and child characteristics in these FCCH settings. CONCLUSIONS: This study was unique in its examination of PA and a comprehensive set of factors that may influence PA at the individual, organizational, environmental, and policy levels in a diverse sample of children attending FCCHs in South Carolina. Additional research is needed to better understand how to increase children's physical activity while they are in the FCCH setting. This research should use multi-level frameworks and apply longitudinal study designs.

The association of physical activity to oral glucose tolerance test outcomes in multiple autoantibody positive children: The TEDDY Study.

OBJECTIVE: To examine the association of physical activity (PA), measured by accelerometry, to hemoglobin AIC (HbA1c) and oral glucose tolerance test (OGTT) outcomes in children who were multiple persistent confirmed autoantibody positive for type 1 diabetes (T1D). METHODS: The Environmental Determinants of Diabetes in the Young (TEDDY) multinational study followed children from birth. Children ≥3 years of age who were multiple persistent confirmed autoantibody positive were monitored by OGTTs every 6 months. TEDDY children's PA was measured by accelerometry beginning at 5 years of age. We examined the relationship between moderate plus vigorous (mod + vig) PA, HbA1c, and OGTT in 209 multiple autoantibody children who had both OGTT and PA measurements. RESULTS: Mod + vig PA was associated with both glucose and C-peptide measures (fasting, 120-min, and AUC); higher mod + vig PA was associated with a better OGTT response primarily in children with longer duration of multiple autoantibody positivity. Mod + vig PA also interacted with child age; lower mod + vig PA was associated with a greater increase in C-peptide response across age. Mod + vig PA was not related to fasting insulin, HOMA-IR or HbA1c. CONCLUSIONS: The OGTT is the gold standard for diabetes diagnosis and is used to monitor those at high risk for T1D. We found higher levels of mod + vig PA were associated with better OGTT outcomes in children ≥5 years of age who have been multiple autoantibody positive for longer periods of time. Physical activity should be the focus of future efforts to better understand the determinants of disease progression in high-risk children.

The role of parental support for youth physical activity transportation and community-level poverty in the healthy communities study.

This study evaluates whether parental provision of transportation for physical activity is associated with child/adolescent moderate-to-vigorous physical activity, while also evaluating community-level poverty. Self- and parental-reported surveys were administered with parents/caregivers and children in the Healthy Communities Study (N = 5138). Associations between individual-level demographics, community-level poverty, parental provision of transportation for physical activity, and moderate-to-vigorous physical activity were examined in multi-level models. Even when accounting for community-level poverty, which was significantly associated with lower moderate-to-vigorous physical activity, parental provision of transportation for physical activity was positively associated with greater moderate-to-vigorous physical activity. This study provides evidence for the importance of considering multiple systems of influence (e.g., community and individual factors) and considering how gaps in physical activity transportation for youth can be addressed in future health policies.

Group-based physical activity trajectories in children transitioning from elementary to high school.

BACKGROUND: Physical activity has been observed repeatedly to decline as children transition into adolescence; however, few studies have explored the possibility that sub-groups of children experience unique patterns of change during this transition. The purpose of this longitudinal study was to examine the physical activity trajectories in clusters of youth transitioning from 5th to 11th grade. METHODS: Participants (n = 652) were recruited as 5th graders (ages 10-12 years) from elementary schools (n = 21) in two school districts. Demographic, anthropometric, and physical activity data were collected once per year when children were in 5th, 6th, 7th, 9th, and 11th grades. Children wore accelerometers for 7 consecutive days. Group-based trajectory modeling statistical techniques were applied to identify patterns of physical activity trajectories. Posterior probabilities confirmed participants' membership in their respective group. RESULTS: Three distinct physical activity trajectories were identified. Group 1 (n = 27) remained highly active over time, and physical activity increased from ages 14 to 16 years. Group 2 (n = 365) was active at baseline, but activity declined and remained low as group members aged. Group 3 (n = 260) had the lowest levels of physical activity at all ages, and activity declined from ages 10 to 16 years. CONCLUSIONS: While most children experienced a decline in physical activity as they transitioned into high school, some remained highly active and increased their level of physical activity. Future studies should test physical activity interventions for youth that are tailored for age-related trajectory groups.

Children's metabolic expenditure during object projection skill performance: New insight for activity intensity relativity.

Objective: To examine children's energy expenditure (EE) during object projection skill performance at three intensity intervals. Methods: Children's (42, Mage = 8.1) average metabolic equivalents of task (METs) were calculated using a COSMED K4b2 while they repeatedly performed blocks of kicking, throwing (overhand), and striking (two-handed) during 6, 12, and 30-s interval conditions. A repeated-measures analysis of covariance examined differences in METs while controlling for skill level. Results: Data indicated a main effect for interval condition (df = 2, 123, F = 94.36, p <.001, η2 = .605). Post hoc t-tests demonstrated decreasing performance interval times yielded progressively higher METs (p <.001) across the three conditions (30s = 4.5±0.8 METs, 12s = 6.3±1.3, 6s = 8.3±1.6). There also was a main effect for sex (df = 1,120, F = 52.28, p <.001 η2 = .305). Boys demonstrated higher METs at each performance interval (p <.001). Conclusion: Skill practice with a maximum of one trial every 30s resulted in the equivalent of at least moderate physical activity (>4.0 METs) and intervals of 6s demonstrated vigorous physical activity (>7.0 METs). Practicing/performing object projection skills, even at intervals that allow for adequate instruction and feedback (i.e., 1 trial/30s), promotes MVPA in children.

New insight for activity intensity relativity, metabolic expenditure during object projection skill performance.

This study examined the metabolic cost (METs) of performing object projection skills at three practice trial intervals (6, 12, and 30 seconds). Forty adults (female n = 20) aged 18-30 (M = 23.7 ± 2.9 years) completed three, nine-minute sessions of skill trials performed at 6, 12, and 30 second intervals. Participants performed kicking, throwing and striking trials in a blocked schedule with maximal effort. Average METs during each session were measured using a COSMED K4b2. A three (interval condition) X two (sex) ANOVA was conducted to examine differences in METs across interval conditions and by sex. Results indicated a main effect for interval condition (F(5,114) = 187.02, p < .001, η2 = 0.76) with decreased interval times yielding significantly higher METs [30 sec = 3.45, 12 sec = 5.68, 6 sec = 8.21]. A main effect for sex (F(5, 114) = 35.39, p < .001, η2 = 0.24) also was found with men demonstrating higher METs across all intervals. At a rate of only two trials/min, participants elicited moderate physical activity, with 12 and 6-second intervals exhibiting vigorous PA. Demonstrating MVPA during the performance of object projection skill performance has potential implications for PA interventions.

Myths, presumptions, and facts about obesity.

BACKGROUND: Many beliefs about obesity persist in the absence of supporting scientific evidence (presumptions); some persist despite contradicting evidence (myths). The promulgation of unsupported beliefs may yield poorly informed policy decisions, inaccurate clinical and public health recommendations, and an unproductive allocation of research resources and may divert attention away from useful, evidence-based information. METHODS: Using Internet searches of popular media and scientific literature, we identified, reviewed, and classified obesity-related myths and presumptions. We also examined facts that are well supported by evidence, with an emphasis on those that have practical implications for public health, policy, or clinical recommendations. RESULTS: We identified seven obesity-related myths concerning the effects of small sustained increases in energy intake or expenditure, establishment of realistic goals for weight loss, rapid weight loss, weight-loss readiness, physical-education classes, breast-feeding, and energy expended during sexual activity. We also identified six presumptions about the purported effects of regularly eating breakfast, early childhood experiences, eating fruits and vegetables, weight cycling, snacking, and the built (i.e., human-made) environment. Finally, we identified nine evidence-supported facts that are relevant for the formulation of sound public health, policy, or clinical recommendations. CONCLUSIONS: False and scientifically unsupported beliefs about obesity are pervasive in both scientific literature and the popular press. (Funded by the National Institutes of Health.).

Associations Between Maternal Support and Physical Activity Among 5th Grade Students.

BACKGROUND: A large body of research has established an association between parental support for children's physical activity (PA) and children's PA. However, there has been little attention to the relative influences of parent and child perceptions of that parental support. PURPOSE: To examine agreement among parent and child perceptions of parent support for PA and whether these perceptions are associated with objectively-measured moderate-to-vigorous physical activity (MVPA) among those children. METHODS: Cross-sectional associations between PA of children measured via accelerometers and child-reported and mother-reported perceptions of parental support for children's PA were assessed via mixed-model regression analyses in a cohort of 693 5th graders. Results Children's perceptions of parental support for PA were consistent with those of their mothers. Nonetheless, in models that included both children's and mothers' perceptions of parental support for PA, mothers' perceptions, but not children's perceptions, were significantly associated with children's PA. Associations were consistent for Total MVPA, After School MVPA, and Evening MVPA, with stronger associations among males than among females. CONCLUSION: Maternal support may influence children's PA. Studies which consider only children's accounts of parental support may overlook important mechanisms.

Creating a Physical Activity Self-Report Form for Youth Using Rasch Methodology.

Measurement of youth's physical activity levels is recommended to ensure that children are meeting recommended activity guidelines. This article describes the creation of an instrument to measure youth's levels of physical activity, where a strong test validation perspective (Benson, 1998) was followed to create the scale. The development process involved a mixed-method (qualitative followed by quantitative) framework. First, focus groups were conducted, where results informed item creation. Next, three alternative forms were created with different response formats to measure childrens' frequency of participation in various physical activities and intensity of participation. Lastly, a sample of over 500 middle school children was obtained, where three different response scales were investigated. The optimal scale considered measurement of physical activity using a three-point Likert frequency; intensity of activity participation did not strongly contribute to the measurement of children's activity levels. The final version form is thought to be acceptable for use with children in surveillance and large-group studies, as well as in smaller sample applications.

Assessing physical activity during youth sport: the Observational System for Recording Activity in Children: Youth Sports.

The purpose of this study was to evaluate the validity and interrater reliability of the Observational System for Recording Activity in Children: Youth Sports (OSRAC:YS). Children (N = 29) participating in a parks and recreation soccer program were observed during regularly scheduled practices. Physical activity (PA) intensity and contextual factors were recorded by momentary time-sampling procedures (10-second observe, 20-second record). Two observers simultaneously observed and recorded children's PA intensity, practice context, social context, coach behavior, and coach proximity. Interrater reliability was based on agreement (Kappa) between the observer's coding for each category, and the Intraclass Correlation Coefficient (ICC) for percent of time spent in MVPA. Validity was assessed by calculating the correlation between OSRAC:YS estimated and objectively measured MVPA. Kappa statistics for each category demonstrated substantial to almost perfect interobserver agreement (Kappa = 0.67-0.93). The ICC for percent time in MVPA was 0.76 (95% C.I. = 0.49-0.90). A significant correlation (r = .73) was observed for MVPA recorded by observation and MVPA measured via accelerometry. The results indicate the OSRAC:YS is a reliable and valid tool for measuring children's PA and contextual factors during a youth soccer practice.

Child and mother characteristics associated with 6-month weight gain for infants and toddlers during 6 to 36 months.

BACKGROUND: The prevalence of childhood obesity in the U.S. has increased, likely due to decreased physical activity, increased sedentary behaviour and unhealthy diets. Little is known about the relationships between these factors and weight gain in those under the age of three. OBJECTIVES: This study aimed to understand the longitudinal associations of weight gain over 6-month intervals with child and parent characteristics as children develop from 6 to 36 months. METHODS: Mother and infant data were collected at 6-month intervals from 6 to 36 months. Weight (kg) was the primary outcome variable, and potential explanatory variables included child and parent characteristics, physical activity, motor development, diet and sleep. Structural equation modelling was used to assess associations between explanatory variables and 6-month weight gain. RESULTS: Weight increased ~1 kg per 6-month interval (p < 0.001) from 6 to 36 months. Childcare outside of the home at 12 months was associated with 0.272 kg (p = 0.002) greater weight gain at 18 months, while children's physical activity was associated with 0.228 kg (per 2 SD, p = 0.051) less weight gain during the same time period. Mother's TV and screen media use (0.102 kg per hour/day, p = 0.046) and child's intake of high-energy beverages at 18 months (0.387 kg, p = 0.037) were both associated with greater weight gain at 24 months. CONCLUSION: Childcare, physical activity, screen media use and high-energy beverage consumption might affect weight gain at different time points in early childhood. These insights can inform efforts to prevent excessive weight gain and childhood obesity effectively.

Construct validity of selected measures of physical activity beliefs and motives in fifth and sixth grade boys and girls.

OBJECTIVE: Scales used to measure selected social-cognitive beliefs and motives for physical activity were tested among boys and girls. METHODS: Covariance modeling was applied to responses obtained from large multi-ethnic samples of students in the fifth and sixth grades. RESULTS: Theoretically and statistically sound models were developed, supporting the factorial validity of the scales in all groups. Multi-group longitudinal invariance was confirmed between boys and girls, overweight and normal weight students, and non-Hispanic black and white children. The construct validity of the scales was supported by hypothesized convergent and discriminant relationships within a measurement model that included correlations with physical activity (MET • min/day) measured by an accelerometer. CONCLUSIONS: Scores from the scales provide valid assessments of selected beliefs and motives that are putative mediators of change in physical activity among boys and girls, as they begin the understudied transition from the fifth grade into middle school, when physical activity naturally declines.

Factors Associated with Children's Physical Activity During Youth Soccer Practices.

Purpose: To identify practice and social contextual factors that associate with physical activity (PA) levels of children during their participation in a youth soccer program. Methods: Twenty-seven youth soccer teams serving children ages 6-11 years participated. Research staff directly observed and recorded PA intensity and practice and social contextual factors using momentary time-sampling procedures. Each team was observed for 1 practice, during which approximately 6 children were each observed for twenty 30-s observation blocks (10-s observation, 20-s recording). In total, children were observed for 3,102 intervals. Multilevel logistic regression analyses were conducted to describe associations between PA intensity and practice and social contexts. Interaction terms were introduced into the models to determine if the associations differed across girls-only, boys-only, and coed teams. Results: A total of 158 children were observed across the 27 teams. Children were more likely to engage in moderate or vigorous PA while performing fitness (Odds Ratio [OR], 9.9, 95% CI = 5.34-18.04), game (OR, 4.0, 95% CI = 2.88-5.66), warm-up (OR, 2.8, 95% CI = 1.85-4.11), and drill (OR, 1.9, 95% CI = 1.41-2.67) activities compared to tactic/instructional activities. The associations between PA intensity levels and practice and social contexts did not differ across girls-only, boys-only, and coed teams. Conclusions: Fitness activities and full-team game play were associated with higher PA intensity levels during children's participation in youth soccer practices. Youth sport practice protocols can be modified to increase children's physical activity.

Longitudinal associations between sleep and weight status in infants and toddlers.

BACKGROUND: The limited research assessing relationships between sleep duration and weight status in infants and toddlers relies primarily on parent-reported sleep and cross-sectional studies. OBJECTIVES: Examine whether average sleep duration and changes in sleep duration among 6-24-month-old children were associated with weight-for-length z-scores, and whether these associations varied by race/ethnicity, socioeconomic status and sex. METHODS: Data were collected when children were approximately 6, 12, 18 and 24 months old (N = 116). Sleep duration was measured using actigraphy. Weight-for-length z-scores were calculated using children's height and weight. Physical activity was assessed using accelerometry. Diet was assessed using a feeding frequency questionnaire. Demographic characteristics included sex, race/ethnicity and socioeconomic status. Separate associations of between- and within-person changes in sleep duration were estimated with weight-for-length z-score treated as the outcome variable in linear mixed model analyses. Additional models were assessed that included interactions between sleep and demographic characteristics. RESULTS: At time points where children slept longer at night compared to their own average, their weight-for-length z-score was lower. This relationship was attenuated by physical activity levels. CONCLUSIONS: Increasing sleep duration can improve weight status outcomes in very young children who have low physical activity levels.

Young Children's Dietary Quality in Family Child Care and in Their Own Home.

BACKGROUND: Some evidence suggests that children may have higher quality dietary intake in early care and education settings, compared with their respective homes, but no studies have explored these differences among children in less formal family child care. OBJECTIVE: The purpose of this study was to compare dietary quality via the Healthy Eating Index 2015 among children in family child care and in their own home. DESIGN: This was a cross-sectional analysis of baseline dietary intake data from the Childcare Home Eating and Exercise Research study, a natural experiment, using directly observed dietary data in child care and 24-hour recall data in homes among children in South Carolina. PARTICIPANTS/SETTING: Participants were 123 children in 52 family child-care homes between 2018 and 2019. MAIN OUTCOME MEASURE: The main outcome was total and component Healthy Eating Index 2015 scores. STATISTICAL ANALYSIS: The analysis was a hierarchical linear regression of children nested within family child care homes adjusting for child, provider, facility, and parent characteristics, including sex, age, race, ethnicity, and income, with parameters and SEs estimated via bootstrap sampling. RESULTS: Children had a mean ± SD Healthy Eating Index 2015 score of 60.3 ± 12.1 in family child-care homes and 54.3 ± 12.9 in their own home (P < 0.001). In adjusted analysis and after accounting for clustering of children in family child care homes, total HEI-2015 scores were lower at home than in care (ß = -5.18 ± 1.47; 95% CI -8.05 to -2.30; P = 0.003). CONCLUSIONS: Children had healthier dietary intake in family child-care homes vs their respective homes.

A Summary of One Research Team's Contributions to Understanding Physical Activity Behavior in Children and Youth.

Schools are well-positioned to provide physical activity opportunities to help youth achieve the recommended 60 or more daily minutes of moderate-to-vigorous physical activity. The Children's Physical Activity Research Group (CPARG) at the University of South Carolina has focused on understanding physical activity in school-aged youth for 30+ years. The purpose of this article was to critically review (CPARG) contributions to the field in school settings and school-age youth. We reviewed 127 published CPARG articles from six research projects conducted between 1993-2019. The review was guided by questions in five categories: measurement of physical activity and its determinants, characteristics of physical activity behavior, correlates/determinants of physical activity, physical activity interventions, and race/ethnicity and physical activity. Results were summarized by question and synthesized across categories. CPARG contributions included assessing physical activity levels, patterns, forms, and contexts; identifying and measuring physical activity correlates/determinants; and conducting school-based physical activity interventions. Identifying multiple domains of physical activity determinants enables researchers and practitioners to select/design age-appropriate, valid, and reliable instruments to assess determinants. Focusing on determinants enables them to create effective physical activity interventions, environments, programs, and policies in schools. These efforts must address race/ethnicity differences, ensuring that measurement instruments and intervention strategies are culturally appropriate.

Behavioral, Environmental, and Demographic Factors Associated with Objectively Measured Physical Activity in Infants.

Background: To describe objectively measured physical activity (PA) in infants, and to identify demographic, behavioral, and environmental factors associated with infants' PA. Methods: Participants were 6-7-month-old infants and their mothers (N = 143 dyads) from two Southeastern US counties. Infant measures included PA assessed by accelerometers at ankle and waist sites, motor developmental status (i.e., stationary and locomotion), and anthropometric characteristics (i.e., height and weight). Mothers provided information on home environment, child care settings, and family demographic factors. PA levels were compared across demographic subgroups. Correlation coefficients described associations between PA and continuous variables, including motor developmental status and anthropometric characteristics. Multiple linear regression analyses examined factors found to be independently associated with PA. Results: Infants' PA counts were greater at the ankle (77,700 counts/hr) vs. the waist site (32,500 counts/hr). In univariate analyses, a diverse set of environmental, behavioral, and infant-level demographic factors were found to be significantly associated with PA at the ankle site. Multivariate analyses indicated that more advanced motor development status (B = 666.3 ± 329.8, p < 0.05), attendance at home child care settings (B = -13,724.4 ± 5083.9, p < 0.05), greater exposure to tummy time (B = 213.5 ± 79.9, p < 0.05), and white racial/ethnic composition (B = -19,953.4 ± 5888.5, p < 0.01) were independently, associated with infants' PA. Conclusions: In 6-7-month-old infants, objectively measured PA was found to be associated with motor developmental status and physical and social environmental factors, including both demographic moderators and factors that are influenced by parents and caregivers. Longitudinal studies are needed to determine if these relationships persist or change as infants develop.

An observation system to assess physical activity of children with developmental disabilities and delays in preschool.

BACKGROUND: Physical activity (PA) behaviors during preschool settings can influence the health and development of children with developmental disabilities (DD). There is a need for a direct observation system that simultaneously assesses PA and preschool environmental contexts. OBJECTIVE: The purpose of this study was to develop an observation instrument for measuring PA and related contextual factors of preschoolers with DD, and to establish content validity and reliability. METHODS: Content validity was established through consultation with experts, informal observations in inclusive and special education preschools, and literature reviews. Categories and codes were identified and modified from existing observational systems for young children. Reliability was assessed in a convenience sample of preschool children with DD using a cross-sectional design. Data were collected using a momentary time sampling system (5-sec observe, 25-sec record) following a focal child. Inter-rater reliability was assessed during 20% of the observation sessions. RESULTS: The instrument development process resulted in ten coding categories that accounted for PA levels, types, and social and physical environmental contexts relevant to preschoolers with disabilities. Observers completed 137.5 observation sessions, yielding 5498 30-s observation intervals. Interval-by-interval percent agreement was excellent (91%-100%) and kappa values were high (0.82-0.99). CONCLUSIONS: The instrument was found to be a reliable measure of PA of preschoolers with DD and provided important contextual information about PA behaviors in early childhood special education settings. Additionally, it allowed for the simultaneous measurement of specific types and contexts of PA behaviors of preschoolers with DD and will be useful for describing PA and informing future interventions.