The effects of the COVID-19 lockdowns on motor skill development of 6- and 7-year old children in the Netherlands: a longitudinal study.

BACKGROUND: The closing of schools and sports clubs during the COVID-19 lockdown raised questions about the possible impact on children's motor skill development. Therefore, we compared motor skill development over a one-year period among four different cohorts of primary school children of which two experienced no lockdowns during the study period (control cohorts) and two cohorts experienced one or two lockdowns during the study period (lockdown cohorts). METHODS: A total of 992 children from 9 primary schools in Amsterdam (the Netherlands) participated in this study (age 5 - 7; 47.5% boys, 52.5% girls). Their motor skill competence was assessed twice, first in grade 3 (T1) and thereafter in grade 4 (T2). Children in control group 1 and lockdown group 1 were assessed a third time after two years (T3). Motor skill competence was assessed using the 4-Skills Test, which includes 4 components of motor skill: jumping force (locomotion), jumping coordination (coordination), bouncing ball (object control) and standing still (stability). Mixed factorial ANOVA's were used to analyse our data. RESULTS: No significant differences in motor skill development over the study period between the lockdown groups and control groups (p > 0.05) were found, but a difference was found between the two lockdown groups: lockdown group 2 developed significantly better than lockdown group 1 (p = 0.008). While socioeconomic status was an effect modifier, sex and motor ability did not modify the effects of the lockdowns. CONCLUSIONS: The COVID-19 lockdowns in the Netherlands did not negatively affect motor skill development of young children in our study. Due to the complexity of the factors related to the pandemic lockdowns and the dynamic systems involved in motor skill development of children, caution must be taken with drawing general conclusions. Therefore, children's motor skill development should be closely monitored in the upcoming years and attention should be paid to individual differences.

The relationships between children's motor competence, physical activity, perceived motor competence, physical fitness and weight status in relation to age.

The goal of this cross-sectional study was to further explore the relationships between motor competence, physical activity, perceived motor competence, physical fitness and weight status in different age categories of Dutch primary school children. Participants were 2068 children aged 4 to 13 years old, divided over 9 age groups. During physical education classes, they completed the 4-Skills Test, a physical activity questionnaire, versions of the Self-Perception Profile for Children, Eurofit test and anthropometry measurements. Results show that all five factors included in the analyses are related to each other and that a tipping point exists at which relations emerge or strengthen. Physical fitness is related to both motor competence and physical activity and these relationships strengthen with age. A relationship between body mass index and the other four factors emerges in middle childhood. Interestingly, at a young age, motor competence and perceived motor competence are weakly related, but neither one of these have a relation with physical activity. In middle childhood, both motor competence and perceived motor competence are related to physical activity. Our findings show that children in late childhood who have higher perceived motor competence are also more physically active, have higher physical fitness, higher motor competence and lower body mass index. Our results indicate that targeting motor competence at a young age might be a feasible way to ensure continued participation in physical activities throughout childhood and adolescence.

Effect and process evaluation of a preschool-based intervention to promote an early childhood education and care teacher-parent partnership about healthy behaviours in children: Study protocol for the cluster randomised controlled trial CO-HEALTHY.

BACKGROUND: Early Childhood Education and Care (ECEC) teachers at urban preschools are potential key figures to promote healthy behaviours in disadvantaged young children and to engage parents in lifestyle-related topics. An ECEC teacher-parent partnership regarding healthy behaviours may support parents and stimulate their children's development. However, it is not an easy task to establish such a collaboration and ECEC teachers need tools to communicate with parents about lifestyle-related topics. This paper describes the study protocol of a preschool-based intervention (CO-HEALTHY) to promote an ECEC teacher-parent partnership regarding healthy eating, physical (in)activity and sleeping behaviours in young children. METHODS: A cluster randomised controlled trial will be performed at preschools in Amsterdam, the Netherlands. Preschools will be randomly allocated to an intervention or control group. The intervention consists of a toolkit with 10 parent-child activities and associated training for ECEC teachers. The activities were composed using the Intervention Mapping protocol. At intervention preschools, ECEC teachers will carry out the activities during standard contact moments. Parents will receive associated intervention materials and will be encouraged to perform similar parent-child activities at home. At control preschools, the toolkit and training will not be implemented. The primary outcome will be the teacher- and parent-reported partnership regarding healthy eating, physical (in)activity and sleeping behaviours in young children. The perceived partnership will be assessed by a questionnaire at baseline and at 6 months. In addition, short interviews with ECEC teachers will be held. Secondary outcomes include the knowledge, attitude, food- and activity-related practices of ECEC teachers and parents. Furthermore, children's eating, physical (in)activity and sleeping behaviours, and weight development will be assessed. A process evaluation of the intervention will be made. DISCUSSION: The intervention aims to provide a practical tool for ECEC teachers at urban preschools to promote an ECEC teacher-parent partnership regarding a healthy lifestyle in young children. TRIAL REGISTRATION: Netherlands Trial Register (NTR): NL8883. Date registered: September 8, 2020.

A Tale of Two Cities: Understanding Children's Cycling Behavior From the Socio-Ecological Perspective.

The childhood obesity epidemic has persisted for over three decades, which has presented serious social, economic and health consequences worldwide. For researchers and policy makers alike, cycling has been a promising focus over recent years for developing long-term physically active lifestyles in urban environments, in addition to contributing to the global quest to combat climate change. Promoting cycling thus presents a win-win situation not just for individuals' well-being, but for multiple involved sectors such as public health, transport ministry and environmental agencies. For children, cycling promotes exercise engagement, active transport opportunities, motor skill development and social interaction. However, across European cities, there are considerable discrepancies in the uptake of cycling amongst children. To understand and subsequently promote children's cycling behavior, it is crucial that the complex social, physical and policy environment, and their interrelationships, are considered. Therefore, in this perspective article, we adopt the socio-ecological model to gain insight into how children's cycling behavior is shaped at the interpersonal, organizational and community level embedded within city policies, relevant to increase future cycling participation in children. Our perspective is based on a review of cycling policies of two European cities, Amsterdam (Netherlands) and Newcastle (UK), where stark contrasts in children's cycling participation can be observed. Our findings show that cycling policies in Amsterdam have mainly contributed to comprehensive organizational level changes, for example, cycling infrastructure development within the city, whereby these initiatives have made significant progress at the community level where cycling has become part of the "Dutch culture". Hence, cycling is a more common transportation mode among children in Amsterdam than in Newcastle. In Newcastle, policies primarily focus on organizational or community level changes, and progress has recently been accelerated in response to COVID-19. In addition to differences, we have also identified similar challenges in the two cities, such as the urgency to support uptake of cycling for children with low socio-economic background or challenges related to cultural differences. We also propose a "shared (cycle-)path" for policy makers and researchers as working together is crucial in producing multi-component interventions at a policy level that recognize individual, as well as interpersonal, community and organizational factors.

The effects of a preschool-based intervention for Early Childhood Education and Care teachers in promoting healthy eating and physical activity in young children: A cluster randomised controlled trial.

The need for excess weight gain prevention in disadvantaged young children is widely recognised. Early Childhood Education and Care teachers are potential key actors in early interventions to prevent overweight and obesity. This study examines the effects of a preschool-based intervention for teachers in promoting healthy eating and physical activity in young children. A cluster randomised controlled trial was conducted at 41 preschools in a deprived area of Amsterdam, The Netherlands. The intervention consisted of 2 programmes that were applied in succession: A Healthy Start and PLAYgrounds for TODdlers. The study period was 9 months. Primary outcomes were assessed via questionnaires and included teachers' knowledge, attitude, food/activity-related practices, and level of confidence in promoting healthy behaviours. Secondary outcomes in this study were teachers' and children's BMI (z-score), body composition, dietary intake and physical activity level. Intention-to-treat analyses were performed using linear mixed models. In total, 115 teachers and 249 children (mean age 3.0 (0.2) years) were included. A positive effect on teachers' knowledge about the Dutch dietary guidelines was found after the programme A Healthy Start (difference = 1.38; 1-sided 95% CL = 0.29; p = 0.02). This effect was not sustained at 9 months (difference = 0.34; 1-sided 95% CL = -0.76; p = 0.31). The overall intervention had a positive effect on 3 of the 5 attitude statements regarding a healthy lifestyle (difference ranged from 0.34 to 0.55) and on the practice scale Activity-related-Modelling (difference = 0.16; 1-sided 95% CL = 0.06; p = 0.01). No intervention effects were observed on food-related practice scales and the level of confidence in promoting healthy behaviours. At this stage, no effects were seen on teachers' and children's BMI (z-score). This study contributes to the professional development of Early Childhood Education and Care teachers and addresses the call for interventions to prevent overweight/obesity and to minimise health inequalities in young children.

Improving Physical Activity Levels in Prevocational Students by Student Participation: Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: A consistent finding in the literature is the decline in physical activity during adolescence, resulting in activity levels below the recommended guidelines. Therefore, promotion of physical activity is recommended specifically for prevocational students. OBJECTIVE: This protocol paper describes the background and design of a physical activity promotion intervention study in which prevocational students are invited to participate in the design and implementation of an intervention mix. The intervention is expected to prevent a decline in physical activity in the target group. METHODS: The effectiveness of the intervention was evaluated in a two-group cluster randomized controlled trial with assessments at baseline and 2-year follow-up. A simple randomization was applied, allocating 11 schools to the intervention group and 11 schools to the control group, which followed the regular school curriculum. The research population consisted of 3003 prevocational students, aged 13-15 years. The primary outcome measures were self-reported physical activity levels (screen time, active commuting, and physical activity). As a secondary outcome, direct assessment of physical fitness (leg strength, arm strength, hip flexibility, hand speed, abdominal muscle strength, BMI, and body composition) was included. An intervention-control group comparison was presented for the baseline results. The 2-year interventions began by mapping the assets of the prevocational adolescents of each intervention school using motivational interviewing in the structured interview matrix and the photovoice method. In addition, during focus group sessions, students, school employees, and researchers cocreated and implemented an intervention plan that optimally met the students' assets and opportunities in the school context. The degree of student participation was evaluated through interviews and questionnaires. RESULTS: Data collection of the SALVO (stimulating an active lifestyle in prevocational students) study began in October 2015 and was completed in December 2017. Data analyses will be completed in 2021. Baseline comparisons between the intervention and control groups were not significant for age (P=.12), screen time behavior (P=.53), nonschool active commuting (P=.26), total time spent on sports activities (P=.32), total physical activities (P=.11), hip flexibility (P=.22), maximum handgrip (P=.47), BMI (P=.44), and sum of skinfolds (P=.29). Significant differences between the intervention and control groups were found in ethnicity, gender, active commuting to school (P=.03), standing broad jump (P=.02), bent arm hang (P=.01), 10× 5-m sprint (P=.01), plate tapping (P=.01), sit-ups (P=.01), and 20-m shuttle run (P=.01). CONCLUSIONS: The SALVO study assesses the effects of a participatory intervention on physical activity and fitness levels in prevocational students. The results of this study may lead to a new understanding of the effectiveness of school-based physical activity interventions when students are invited to participate and cocreate an intervention. This process would provide structured health promotion for future public health. TRIAL REGISTRATION: ISRCTN Registry ISRCTN35992636; http://www.isrctn.com/ISRCTN35992636. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/28273.

The Effects of the PLAYTOD Program on Children's Physical Activity at Preschool Playgrounds in a Deprived Urban Area: A Randomized Controlled Trial.

Interventions to improve children's physical activity in Early Childhood Education and Care (ECEC) settings are needed. This randomized controlled trial examines the effects of a preschool-based playground program for ECEC teachers in a deprived urban area. On intervention preschools, the PLAYgrounds for TODdlers program (PLAYTOD) was performed. It focused on teacher's knowledge and skills in order to create a challenging outdoor environment in which young children (2.5 to 4 years old) are able to practice their motor skills. Observations were performed before and after the program with a modified version of the SOPLAY protocol. The activating role of teachers (score from 0 = inactive to 4 = participating), the number of different physical activities, and the quality of children's physical activity on playgrounds were observed. The latter included the number of performed fundamental movement skills and the estimated physical activity intensity (score from 0 = sedentary to 3 = vigorous). Descriptive statistics and linear regression analyses were used to evaluate the effects of PLAYTOD. After the program, the activating role of teachers on intervention playgrounds improved. Moreover, the program and consecutively the changes made by teachers had a positive effect on the number of different activities and the quality of children's physical activity. The results emphasize an important role for ECEC teachers in improving physical activity in young children.

A preschool-based intervention for Early Childhood Education and Care (ECEC) teachers in promoting healthy eating and physical activity in toddlers: study protocol of the cluster randomized controlled trial PreSchool@HealthyWeight.

BACKGROUND: Interventions to prevent overweight and obesity in toddlers are needed to minimize health inequalities, especially in migration and lower socio-economic groups. Preschools are identified as important environments for interventions to prevent overweight and obesity. Early Childhood Education and Care (ECEC) teachers in preschools are potential key actors in promoting healthy eating and physical activity. This paper describes the research design of a Dutch preschool-based intervention for ECEC teachers in promoting healthy eating and physical activity in toddlers. METHODS: PreSchool@HealthyWeight concerns a cluster randomized controlled trial on preschools in Amsterdam Nieuw-West, Netherlands. This city district is characterised by inhabitants with a migration background and low socio-economic status. Forty-one preschools, with 115 ECEC teachers and 249 toddlers/parents, were randomly allocated to an intervention or control group. An intervention for teachers will be carried out on intervention locations and consists of modified versions of 2 existing programs: 'A Healthy Start' and 'PLAYgrounds'. In 'A Healthy Start', ECEC teachers learn to provide a healthy and active environment for toddlers. The 'PLAYgrounds for Toddlers' program, coaches ECEC teachers to stimulate physical activity in the playgrounds of preschools. PreSchool@HealthyWeight aims to evaluate the effectiveness of the intervention after 9 months. Primary outcomes are the teachers' knowledge, attitude and practices concerning healthy eating and physical activity, and consequently the level of confidence of ECEC teachers in promoting healthy eating and physical activity in toddlers. Secondary outcomes include the Body Mass Index, body composition, dietary intake and physical activity level of teachers and toddlers. In addition, the activating role of ECEC teachers and the physical activity of toddlers on the playgrounds will be evaluated. Lastly, the knowledge, attitude and practices of parents concerning healthy eating and physical activity will be assessed. DISCUSSION: It is hypothesized that this preschool-based intervention for ECEC teachers improves the knowledge, attitude and practices regarding healthy eating and physical activity, and consequently the level of confidence of ECEC teachers in promoting healthy eating and physical activity of toddlers. The intervention addresses the call for early intervention to prevent overweight and obesity and to minimize health inequalities. TRIAL REGISTRATION: Netherlands Trial Register (NTR): NL5850 . Date registered: August 26, 2016.

Effectiveness of the PLAYgrounds programme on PA levels during recess in 6-year-old to 12-year-old children.

AIMS: Worldwide levels of daily physical activity (PA) in children are low. This has negative health consequences. Schools have been recognised as key settings to promote PA. This study evaluates the effectiveness of the playground programme PLAYgrounds on increasing PA. METHODS: PLAYgrounds was evaluated by a controlled trial, with a follow-up during one school year (10 months). Accelerometer data were collected on 1500 children in total, divided over 19 sampling moments (every 2 weeks). SOPLAY data were collected at nine sampling moments (once a month). Four intervention and four control schools were matched for playground size, number of pupils and PA levels at baseline. The intervention consisted of restructuring the playground by playground markings and by encouragement of the active use of the playground, through the provision of play equipment and educational measures such as adult encouragement and supporting physical education classes. Multilevel regression analyses were performed to analyse the effects of the intervention. RESULTS: PA levels in the intervention group (moderate PA) were significantly different (p<0.001) from the control group (light PA). During the intervention on an average 77.3% of the children engaged in moderate-to-vigorous physical activity in the intervention group and 38.7% in the control group. The effect of the intervention was significantly stronger for girls than for boys (p<0.001). CONCLUSIONS: The PLAYgrounds programme was effective in increasing PA levels in children during recess over the course of one school year. Thus, the programme could be used to provide structured PA promotion.

Effects of acute bouts of physical activity on children's attention: a systematic review of the literature.

The aim of this review was to describe the effects of acute bouts of physical activity on attention levels of children. A systematic review was performed of English studies from searches in PubMed, Sportdiscus and PsycINFO from 1990 to (May) 2014 according to the PRISMA statement. Only prospective studies of children aged 4-18 years old were included, detailing acute effects of physical activity bouts with the primary outcome attention. One reviewer extracted data on the study characteristics. Two reviewers conducted the methodological quality assessment independently using a criteria checklist, which was based on the Downs and Black checklist for non-randomised studies. Overall the evidence is thin and inconclusive. The methodological differences in study sample (size and age), study design and measurement of attention make it difficult to compare results. There is weak evidence for the effect of acute bouts of physical activity on attention. More experimental studies with a comparable methodology, especially in the school setting, are needed to strengthen this evidence.

Translating the PLAYgrounds program into practice: a process evaluation using the RE-AIM framework.

OBJECTIVES: To present the results of the process evaluation of the PLAYgrounds program, using the RE-AIM framework. DESIGN: This study provides information regarding Reach, Adoption, Implementation and Maintenance. METHODS: The PLAYgrounds program promotes increasing levels of physical activity in 6-12 years old children and was evaluated using the RE-AIM framework in 4 intervention schools. Data collection consisted of a physical activity questionnaire with children (n=765, Reach), SOPLAY observations (Implementation and Maintenance), questionnaires on the satisfaction of the implemented elements with teachers (n=59) and children (n=730, Implementation) and interviews for increased depth of information. In addition a simple counting of participating schools, describing of non-participating reasons and characteristics of the schools were documented (Adoption). RESULTS: Reach of the target population (i.e. inactive children) was 60.7% (n=464) and the target population was representative for populations in low-SES neighbourhoods. The PLAYgrounds program was adopted by 4 schools (80%), at which 5 (from 7) program elements were successfully implemented. At 18 months follow-up, 3 of those 5 elements were completely maintained. CONCLUSIONS: Adoption, Implementation, and Maintenance proved to be very high. Most likely due to the PLAYgrounds program being a complete intervention package that included financial, material, and staff support. Therefore, it is recommended to retain this high level of support when introducing the PLAYgrounds (or any other intervention) program in schools. In the future it would be recommended to evaluate the PLAYgrounds program on maintenance in schools where the key-person is employed at the school and funding is not available.

PLAYgrounds: effect of a PE playground program in primary schools on PA levels during recess in 6 to 12 year old children. Design of a prospective controlled trial.

BACKGROUND: The relative number of children meeting the minimal required dose of daily physical activity remains execrably low. It has been estimated that in 2015 one out of five children will be overweight. Therefore, low levels of physical activity during early childhood may compromise the current and future health and well-being of the population, and promoting physical activity in younger children is a major public health priority. This study is to gain insight into effects of a Physical Education based playground program on the PA levels during recess in primary school children aged 6-12. METHODS/DESIGN: The effectiveness of the intervention program will be evaluated using a prospective controlled trial design in which schools will be matched, with a follow-up of one school year. The research population will consist of 6-12 year old primary school children. The intervention program will be aimed at improving physical activity levels and will consist of a multi-component alteration of the schools' playground. In addition, playground usage will be increased through altered time management of recess times, as well as a modification of the Physical Education content. DISCUSSION: The effects of the intervention on physical activity levels during recess (primary outcome measure), overall daily physical activity and changes in physical fitness (secondary outcome measures) will be assessed. Results of this study could possibly lead to changes in the current playground system of primary schools and provide structured health promotion for future public health. TRIAL REGISTRATION: Netherlands Trial Register (NTR): NTR2386.

Effects of drafting on hydrodynamic and metabolic responses in front crawl swimming.

PURPOSE: Effects of drafting on the hydrodynamic and metabolic responses of the drafter behind and at the side of a passive and an active lead swimmer were related to the influence of a lead swimmer on the flow field of the draftee. METHODS: Passive drag of the draft swimmer was compared for the nondrafting condition, in the drafting conditions behind a passive and an active lead swimmer, and at the side of a passive and an active lead swimmer. The effect was also evaluated with oxygen uptake measurements. Fluid pressure measurements were made behind and at the side of a passive and an active lead swimmer to examine the flow field. RESULTS: Behind a passive lead swimmer, passive drag was significantly reduced by 20%, and behind an active lead swimmer, it was reduced by 9%. At the side of a passive lead swimmer, passive drag was significantly increased by 9%, and at the side of an active lead swimmer, it increased by 8%. Oxygen uptake was significantly reduced by 25% behind a passive lead swimmer, by 11% behind an active lead swimmer, and only marginally changed at the side of a lead swimmer. The pressure measurements indicated a 33% decrease in mean flow velocity behind an active lead swimmer but an increase in peak flow velocities due to the kick of the lead swimmer. These increases could explain the lesser decrease in passive drag behind an active versus a passive lead swimmer. CONCLUSION: The best position for a draft swimmer was found to be directly behind an active lead swimmer at a distance of 0.50 m between the toes of lead swimmer and the hands of drafter, with significant reductions in both passive drag and oxygen uptake when drafting.