Ignite Creation Date:
2024-05-06 @ 3:13 PM
Last Modification Date:
2024-10-26 @ 1:45 PM
Study NCT ID:
NCT04555746
Status:
COMPLETED
Last Update Posted:
2020-09-22
First Post:
2020-09-09
Brief Title:
Active Kindergarten - Active Children
Sponsor:
University of South-Eastern Norway
Organization:
University of South-Eastern Norway
Study Overview
Official Title:
Childrens Physical Activity Level and Sedentary Behaviour in Norwegian Early Childhood Education and Care Effects of a Staff-led Cluster-randomized Controlled Trial
Status:
COMPLETED
Status Verified Date:
2020-09
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
False
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
AK-AC
Brief Summary:
The AK-AC study was designed as a two-arm randomised by ECEC institution evaluative controlled trial with the overarching aim of increasing the childrens PA level and reduce sedentary time
Detailed Description:
Background A growing body of evidence suggests that childrens physical activity PA level in childhood education and care ECEC settings is insufficient Moreover sedentary behaviour defined as any waking behaviour characterized by an energy expenditure 15 metabolic equivalents while in a sitting reclining or lying posture is highly prevalent and has been identified as detrimental to childrens health Although many children have healthy and active lifestyles there seems to be a relatively large group of children with a low PA level This could lead to negative developmental effects such as low fitness levels weak motor skills and obesity This is especially worrying because it is known that PA level often tracks from childhood into adulthood Thus early intervention is crucial given that PA plays a pivotal role in childrens overall health and is associated with many positive health outcomes including physical fitness cardiovascular health bone health and psychosocial and cognitive development
PA levels have been found to be highly variable among children in ECEC settings and may therefore have great potential for effective interventions Furthermore since most children attend ECEC settings for many hours on most days of the week and these institutions reach children across the socioeconomic spectrum the ECEC setting may serve as an ideal avenue for increasing PA level reducing sedentary time and enhancing the overall health of young children However early childhood educators identify parents rather than themselves as those responsible for promoting childrens PA and may assume that young children receive adequate PA throughout the week regardless of their activities during their stay in the ECEC setting Thus intervening with children and staff in ECEC settings to equip them with the knowledge abilities and motivation to promote PA in children during their ECEC time may provide substantial public health benefits
In earlier studies PA interventions conducted in ECEC settings have shown only small to moderate effects and were rather inconsistent across studies Most PA interventions that have been implemented in ECEC settings have been structured programmes developed by PA experts and delivered by staff alone or with the strong influence of trained research personnel In some studies staff-led interventions have been shown to be less effective in increasing PA than interventions implemented by PA experts Similar findings have emerged regarding intervention effects on fundamental movement skills The main explanation for the lower efficiency of staff-led interventions may be that PA experts have more knowledge and competencies regarding this issue For staff-led programmes to succeed the need for multiple staff training sessions and maximizing the number of trained staff has been emphasized
Recently several reviews have summarized the body of knowledge regarding various aspects of the contexts of and prerequisites for PA in different kinds of out-of-home services for children of preschool age A review including 34 studies revealed small but positive and significant intervention effects for childrens 5 years moderate- to vigorous-intensity PA MVPA but not for light-intensity PA Based on their findings the authors recommended interventions tailored to the target group and noted that cultural considerations community needs and the provision of ongoing support should play key roles Furthermore they concluded that daily structured PA sessions integrated into the everyday activities in the institutions routines and delivered through a hands-on approach were most likely to contribute to increasing childrens MVPA
A review of 24 PA interventions in childcare mostly targeting children between three and five years of age where staff participated in professional development either before or during the intervention period and provided children with opportunities for additional PA Less than half of the included studies had positive effects on childrens PA level For further intervention studies in ECEC the authors provided four recommendations of which two were based on the papers included in the review and two were based on evidence from broader ECEC literature First there is a need for high-quality professional development prior to and during the intervention and second there is a need for interventions that are outside the box in terms of eg blended professional development the role of technology targeting the health well-being and activity levels of the educators focusing on PA learning experiences outdoor time and energy breaks and integrating interventions into the institutions daily routines The third broader-based recommendation addressed the importance of developing meaningful and trustworthy cooperation and relationships between staff and researchers The fourth and final recommendation focused on the ECEC environment as a key factor for providing good opportunities for PA that thus should be increasingly emphasized in future interventions
A missing perspective in recent studies focusing on PA interventions in ECEC settings might be that they do not fully take into account the fact that ECEC teaching professional practice has become increasingly complex due to increasingly diverse societies and multiple components related to working conditions Thus top-down approaches and standardized solutions programmes will possibly be difficult to implement in an ever more diverse environment in terms of individual social cultural and physical differences within and between institutions Therefore a suitable approach might be to establish organizational and collaborative learning processes a community of professional learning to improve and maintain staff competence This means contextualizing pedagogical practice through continuous negotiation and reflection between staff members and through collective responsibility for improvement of practice instead of merely implementing structured programmes developed by external experts While expert-delivered interventions seem to be best suited for effect studies real-world approaches implemented by preschool teachers may have greater potential for developing sustainable and improved long-term practice
The current study therefore suggests a dialogical and bottom-up approach that takes into account differences within and between local ECEC settings such as child group characteristics staff competencies personal preferences and practices for sustainable implementation differences in the physical indoor and outdoor environments and available equipment to promote physically active play Interventions that can be adapted to specific circumstances within an organization while maintaining overall fidelity are more likely to be successful Hence the theoretical frame of the current intervention is based on Wengers theory on communities of practice COP Crucial for this theoretical perspective is the idea that organizations are learning communities that share competence and experiences to develop new practices Such a community involves trusting in staff professionalism and their knowledge about and sensitivity towards the individual child and child groups as well as their awareness of barriers and possibilities in terms of environment and equipment COP includes three modes of belonging engagement imagination and alignment Engagement is actively participating in practice revealing needs for learning and change and establishing the collective development of the organization Imagination connects to the staffs visions and experience of meaning regarding the intervention as well as their understanding of the purpose Alignment is about commitment to the entire project To achieve positive changes based on COP these types of belonging must be linked to particular processes such as the establishment of mutual engagement over time to promote change self-awareness and reflection on institutional practices It is also important to transfer the knowledge and purpose of a practice across boundaries in the institution A further key element is to establish practices where multiple perspectives are heard and appreciated to ensure that staff members can take advantage of opportunities to develop and experience themselves as acknowledged contributors to the institution The current study Active Kindergarten - Active Children AK-AC aims to examine the potential of a staff-led and expert-supported intervention to increase childrens PA level and reduce sedentary time within the ECEC setting compared to standard care
Methods Participants All children attending one of the 11 public ECEC institutions in Sandefjord municipality and born in 2011 three- or four-year-olds n130 were invited to participate in the study Parents of a total of 116 children 89 signed the informed consent form and the children of these parents were included in the study The intervention and control groups were formed at the centre level six ECEC institutions were randomly assigned to the intervention group and five institutions were assigned to the control group The ECEC institutions varied in size and number of children range 28 to 100 children Most ECEC institutions follow the national recommended staff-child ratio of one staff member per three children under the age of three and per six children over the age of three The regulations also demand one ECEC-educated teacher per nine children under the age of three and per 18 children over the age of three The distribution showed a mixture of centre sizes in both the intervention and control group
Intervention Four PA experts researchers PhD within the field of PA and health in children and physical education teachers in collaboration with two members of the ECEC staff and two members of the municipal health department paediatric physiotherapists developed a frame for the intervention based on COP elements to be further developed concretized and implemented by the staff The intervention lasted for four months and contained the following components pre-meetings and follow-up meetings in each ECEC institution a start-up seminar and two follow-up courses with all staff members ongoing planning and collective reflection practice in the ECEC institutions a Facebook group and an equipment package
PA levels have been found to be highly variable among children in ECEC settings and may therefore have great potential for effective interventions Furthermore since most children attend ECEC settings for many hours on most days of the week and these institutions reach children across the socioeconomic spectrum the ECEC setting may serve as an ideal avenue for increasing PA level reducing sedentary time and enhancing the overall health of young children However early childhood educators identify parents rather than themselves as those responsible for promoting childrens PA and may assume that young children receive adequate PA throughout the week regardless of their activities during their stay in the ECEC setting Thus intervening with children and staff in ECEC settings to equip them with the knowledge abilities and motivation to promote PA in children during their ECEC time may provide substantial public health benefits
In earlier studies PA interventions conducted in ECEC settings have shown only small to moderate effects and were rather inconsistent across studies Most PA interventions that have been implemented in ECEC settings have been structured programmes developed by PA experts and delivered by staff alone or with the strong influence of trained research personnel In some studies staff-led interventions have been shown to be less effective in increasing PA than interventions implemented by PA experts Similar findings have emerged regarding intervention effects on fundamental movement skills The main explanation for the lower efficiency of staff-led interventions may be that PA experts have more knowledge and competencies regarding this issue For staff-led programmes to succeed the need for multiple staff training sessions and maximizing the number of trained staff has been emphasized
Recently several reviews have summarized the body of knowledge regarding various aspects of the contexts of and prerequisites for PA in different kinds of out-of-home services for children of preschool age A review including 34 studies revealed small but positive and significant intervention effects for childrens 5 years moderate- to vigorous-intensity PA MVPA but not for light-intensity PA Based on their findings the authors recommended interventions tailored to the target group and noted that cultural considerations community needs and the provision of ongoing support should play key roles Furthermore they concluded that daily structured PA sessions integrated into the everyday activities in the institutions routines and delivered through a hands-on approach were most likely to contribute to increasing childrens MVPA
A review of 24 PA interventions in childcare mostly targeting children between three and five years of age where staff participated in professional development either before or during the intervention period and provided children with opportunities for additional PA Less than half of the included studies had positive effects on childrens PA level For further intervention studies in ECEC the authors provided four recommendations of which two were based on the papers included in the review and two were based on evidence from broader ECEC literature First there is a need for high-quality professional development prior to and during the intervention and second there is a need for interventions that are outside the box in terms of eg blended professional development the role of technology targeting the health well-being and activity levels of the educators focusing on PA learning experiences outdoor time and energy breaks and integrating interventions into the institutions daily routines The third broader-based recommendation addressed the importance of developing meaningful and trustworthy cooperation and relationships between staff and researchers The fourth and final recommendation focused on the ECEC environment as a key factor for providing good opportunities for PA that thus should be increasingly emphasized in future interventions
A missing perspective in recent studies focusing on PA interventions in ECEC settings might be that they do not fully take into account the fact that ECEC teaching professional practice has become increasingly complex due to increasingly diverse societies and multiple components related to working conditions Thus top-down approaches and standardized solutions programmes will possibly be difficult to implement in an ever more diverse environment in terms of individual social cultural and physical differences within and between institutions Therefore a suitable approach might be to establish organizational and collaborative learning processes a community of professional learning to improve and maintain staff competence This means contextualizing pedagogical practice through continuous negotiation and reflection between staff members and through collective responsibility for improvement of practice instead of merely implementing structured programmes developed by external experts While expert-delivered interventions seem to be best suited for effect studies real-world approaches implemented by preschool teachers may have greater potential for developing sustainable and improved long-term practice
The current study therefore suggests a dialogical and bottom-up approach that takes into account differences within and between local ECEC settings such as child group characteristics staff competencies personal preferences and practices for sustainable implementation differences in the physical indoor and outdoor environments and available equipment to promote physically active play Interventions that can be adapted to specific circumstances within an organization while maintaining overall fidelity are more likely to be successful Hence the theoretical frame of the current intervention is based on Wengers theory on communities of practice COP Crucial for this theoretical perspective is the idea that organizations are learning communities that share competence and experiences to develop new practices Such a community involves trusting in staff professionalism and their knowledge about and sensitivity towards the individual child and child groups as well as their awareness of barriers and possibilities in terms of environment and equipment COP includes three modes of belonging engagement imagination and alignment Engagement is actively participating in practice revealing needs for learning and change and establishing the collective development of the organization Imagination connects to the staffs visions and experience of meaning regarding the intervention as well as their understanding of the purpose Alignment is about commitment to the entire project To achieve positive changes based on COP these types of belonging must be linked to particular processes such as the establishment of mutual engagement over time to promote change self-awareness and reflection on institutional practices It is also important to transfer the knowledge and purpose of a practice across boundaries in the institution A further key element is to establish practices where multiple perspectives are heard and appreciated to ensure that staff members can take advantage of opportunities to develop and experience themselves as acknowledged contributors to the institution The current study Active Kindergarten - Active Children AK-AC aims to examine the potential of a staff-led and expert-supported intervention to increase childrens PA level and reduce sedentary time within the ECEC setting compared to standard care
Methods Participants All children attending one of the 11 public ECEC institutions in Sandefjord municipality and born in 2011 three- or four-year-olds n130 were invited to participate in the study Parents of a total of 116 children 89 signed the informed consent form and the children of these parents were included in the study The intervention and control groups were formed at the centre level six ECEC institutions were randomly assigned to the intervention group and five institutions were assigned to the control group The ECEC institutions varied in size and number of children range 28 to 100 children Most ECEC institutions follow the national recommended staff-child ratio of one staff member per three children under the age of three and per six children over the age of three The regulations also demand one ECEC-educated teacher per nine children under the age of three and per 18 children over the age of three The distribution showed a mixture of centre sizes in both the intervention and control group
Intervention Four PA experts researchers PhD within the field of PA and health in children and physical education teachers in collaboration with two members of the ECEC staff and two members of the municipal health department paediatric physiotherapists developed a frame for the intervention based on COP elements to be further developed concretized and implemented by the staff The intervention lasted for four months and contained the following components pre-meetings and follow-up meetings in each ECEC institution a start-up seminar and two follow-up courses with all staff members ongoing planning and collective reflection practice in the ECEC institutions a Facebook group and an equipment package
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
False
Is a FDA Regulated Device?:
False
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None