A comparative analysis of movement and physical activity in early childhood teacher education policy in five Nordic countries.

Introduction: The aim of this study is to investigate the integration of movement and physical activity (MoPA) within Early Childhood Teacher Education (ECTE) policies across Denmark, Finland, Iceland, Norway, and Sweden. This knowledge can inform the development of ECTE policies and practices that promote MoPA in Early Childhood Education and Care (ECEC) in Nordic countries and other countries worldwide. Methods: In this study, a Nordic cross-national network of researchers collaborated in investigating policy documents at the national and university levels, which govern the education of ECEC teachers. This study was inspired by the Non-affirmative Theory of Education, which provides a framework for understanding the various influences on curricular development in higher education. Based on this, a four-step comparative analytical process of national and university documents across the Nordic countries was conducted. It included keyword search for MoPA related courses and a qualitative description of MoPA in ECTE. Thus, a combination of investigations of policy documents at the national and university level and expert knowledge set a solid foundation for international comparison. Results: The comparative analysis of MoPA in ECTE reveals diverse approaches influenced by national and university policies. A central theme is the variability in MoPA integration across these nations. Finland and Norway prioritize MoPA with independent mandatory courses. In Iceland, compulsory MoPA courses exist at one of two universities, and in Sweden at three out of 19. All university colleges in Denmark offer an elective course. Furthermore, learning objectives related to MoPA are, to varying degrees, part of the internships in the countries, with Sweden being an exception. In the participating countries, the teachers decide the content of the MoPA courses with little guidance, support, and agreement on essential MoPA content within and across the ECTE's. Norway has established guidelines, and in Finland, there is a network of ECTE Physical Education (PE) educators, which, to some degree, increases the consistency and quality of MoPA in education. Discussion: The Nordic countries present diverse MoPA integration approaches rooted in national policies and educational traditions. The findings emphasize the necessity of independent and mandatory MoPA courses, integration of MoPA into internships and promoting networks across the educational and academic sectors to equip future early childhood educators with competencies for fostering physical activity, motor development and children's well-being.

Effectiveness of a Preschool Motor Skill Intervention on Body Mass Index and Movement Behavior: 6-, 18-, and 30-Month Findings From a Cluster Randomized Controlled Trial.

PURPOSE: To study the effectiveness of a preschool staff-delivered motor skills intervention on body composition and physical activity over a 2.5-year time frame. METHODS: In this pragmatic parallel cluster randomized controlled trial (16 preschools), outcome data were collected after 6 (body composition only), 18, and 30 months of intervention. The main physical activity outcomes were accelerometer behavior measures summarizing the total percentage of child daily movement (walk, run, cycle, and standing that included minor movements) and preschool movement during preschool attendance. To estimate between-group mean differences in outcomes, mixed-linear regression analyses including baseline value of the selected outcome and a treatment × time interaction term as a fixed effect were applied. In addition, the baseline preschool and child were included as a random effect. RESULTS: For body mass index, a total of 437 children (90%) had at least one valid baseline and one follow-up assessment. The corresponding numbers for preschool movement and daily movement were 163 (55%) and 146 (49%), respectively. No significant between-group mean difference was identified for body mass index, waist-to-height ratio, or any physical activity outcomes. CONCLUSION: Overall, this preschool motor skills intervention had no effect on either child anthropometry or physical activity, consistent with previous studies.

Parental Recreational Screen Media Practices and Behavioral Difficulties Among Danish 7-Year-Old Children.

OBJECTIVE: This study aimed to investigate the association of parental recreational screen media practices, including time use and level of smartphone addiction, with behavioral difficulties in 7-year-old children. METHODS: The study was based on cross-sectional data from the Odense Child Cohort, a community-based birth-cohort study. A total of 1152 parent-child dyads with complete data were included based on data from the 7-year examination conducted in 2018-21. Parental recreational screen use was self-reported as hours/day using the SCREENS-questionnaire, and their smartphone addiction was self-reported using the Smartphone Addiction Scale Short Version. Child behavioral difficulties were assessed by the parent-reported version of the Strengths and Difficulties Questionnaire (SDQ). RESULTS: Parental recreational screen time was not consistently associated with behavioral difficulty SDQ subscales and total difficulty scores when adjusted for other determinants of child mental well-being such as sociodemographic factors, parental well-being, and number of siblings. Children had higher total behavioral difficulty scores (adjusted mean difference 2.12 (95% CI, 1.19-3.05)) when comparing fourth quartile versus first quartile of maternal smartphone addiction score. Also, higher maternal smartphone addiction scores were associated with more externalizing and internalizing behavioral problems of their child (adjusted mean difference 1.61 points (95% CI, 0.95-2.27), and 0.81 points (95% CI, 0.19-1.43)) for fourth quartile versus first quartile, respectively. CONCLUSIONS: No cross-sectional association was found between total parental recreational screen use and behavioral difficulties in their 7-year-old children, but an association between maternal obsessive smartphone use and behavioral difficulties of their children was found.

Recreational screen media use among Danish children aged 6-11 years: influence of parental screen media habits and attitudes.

AIMS: Little is known about the influence of parents' screen media habits and attitudes towards screen media on children's screen use. We investigated associations of parental screen use, their smartphone addiction and screen media attitudes, with children's recreational screen use. METHODS: This study was based on a population-based cross-sectional survey sent between May 2019 and November 2020 to a random sample of 6820 Danish parent-child dyads who answered questions regarding their screen media habits. Children were 6-11 years of age and had to reside with the parent. Multivariable adjusted regression analyses were conducted (in October 2021) separately for screen media use on weekdays and weekend days. RESULTS: The analyses included 5437 parents (41.0 years, 67.6% girls) and 5437 children (8.9 years, 48.2% girls). The adjusted relative odds of excessive amounts of screen use of children (>3 hours/weekday and >4 hours/weekend day) was 5.8 (95% confidence interval (CI) 4.6; 7.3) on weekdays and 7.2 (95% CI 5.9; 8.8) on weekend days comparing the fourth and first quartile of parental screen use. Children of parents in the fourth quartile of parental screen use had 2.1 (95% CI 1.7; 2.5) and 2.5 (95% CI 2.2; 3.0) greater odds of screen use before bedtime on all week and weekend days, respectively. Children of parents who had a positive attitude towards their child's screen use or were at high risk of smartphone addiction had significantly higher screen use and more frequent problematic screen use. CONCLUSIONS: Parent's screen media habits and attitudes were strongly associated with their children's recreational screen use.

Effects of Limiting Recreational Screen Media Use on Physical Activity and Sleep in Families With Children: A Cluster Randomized Clinical Trial.

Importance: Children and adults spend large amounts of their leisure time using screen media, which may affect their health and behavior. Objective: To investigate the effect of reducing household recreational screen media use on physical activity and sleep in children and adults. Design, Setting, and Participants: This was a cluster randomized clinical trial with a 2-week follow-up. Enrollment began on June 6, 2019, and ended on March 30, 2021. This study included a population-based sample from 10 Danish municipalities. A total of 89 families (181 children and 164 adults) were recruited based on a population-based survey on screen media habits in families with children. To be eligible, the responding parent had to list self-reported recreational screen use greater than the 40th percentile of recreational screen time use in the source population (>2.4 hours per day). In addition, the parent had to be full-time employed (with no regular night shifts) or enrolled in full-time education. Interventions: Families were randomly assigned to the screen media reduction intervention (45 families, 86 children, 82 adults) designed to ensure participant compliance to a maximum use of screen media (≤3 hours per week) for a 2-week period. Families randomly assigned to the control group (44 families, 95 children, 82 adults) were instructed to carry on as usual. Main Outcomes and Measures: The primary outcome was between-group difference in leisure nonsedentary activity (in minutes per day) measured by combined thigh and waist accelerometry. Secondary outcomes included other physical activity and sleep parameters measured by single-channel electroencephalography. Results: Among the 89 randomized families (intervention group [45 families]: 86 children; mean [SD] age, 8.6 [2.7] years; 44 boys [51%]; 42 girls [49%]; control group [44 families]: 95 children, mean [SD] age, 9.5 [2.5] years; 38 boys [40%]; 57 girls [60%]), 157 children (87%) had complete data on the primary outcome. Eighty-three children (97%) in the intervention group were compliant to the screen use reduction during the intervention. The mean (SD) change in leisure nonsedentary activity in the intervention group was 44.8 (63.5) minutes per day and in the control group was 1.0 (55.1) minute per day (intention-to-treat between-group mean difference, 45.8 minutes per day; 95% CI, 27.9-63.6 minutes per day; P < .001). No significant between-group mean differences were observed between intervention and control for the electroencephalography-based sleep outcomes. Conclusions and Relevance: In this cluster randomized clinical trial, a recreational screen media reduction intervention resulted in a substantial increase in children's engagement in physical activity. The large effect size suggests that the high levels of recreational screen media use seen in many children should be a public health concern. Trial Registration: ClinicalTrials.gov Identifier: NCT04098913.

Effects of limiting digital screen use on well-being, mood, and biomarkers of stress in adults.

Studies have linked higher digital screen use with poorer mental health. However, there is limited experimental evidence to suggest a causal relationship. In this trial, we aimed to investigate the effects of limiting recreational digital screen use on mental well-being, mood, and biomarkers of stress in healthy young and middle-aged adults. We randomly allocated 89 families (including 164 adults) to participate in an extensive screen media reduction intervention or control. Participants in the intervention group were instructed to decrease their recreational screen use to less than 3 hours/week/person. Intervention compliance was assessed using applications and tv-monitors. Overall subjective mental well-being and mood, and collected daily biomarkers of stress (salivary cortisol and cortisone) was assessed at baseline and 2-week follow-up. Reducing recreational digital screen use resulted in significantly improved self-reported well-being and mood in adults allocated to the intervention compared to control. We observed no intervention effects for biomarkers of stress. (ClinicalTrials.gov: NCT04098913, 23/09/2019).

Recreational screen media use in Danish school-aged children and the role of parental education, family structures, and household screen media rules.

Screen media use is part of most children's everyday lives, but organisations have advised that use should be limited. The aims of this study were to describe 6-11-year-old Danish children's screen device ownership and screen media use (weekdays and weekends), including the role of parental education, family structure and household screen media rules. We conducted a cross-sectional study including 5274 Danish children aged 6-11-years sampled from ten Danish municipalities from May 2019 to November 2020. Characteristics of the sample and source population were obtained from the Danish Health Data Authority. Parent's completed the SCREENS questionnaire, which was developed to assess children's screen media habits. We used inverse probability weighted logistic and linear regression models. Smartphone and laptop ownership was higher with increasing age, and use of screen media varied across day type, age and gender. The proportion of children using screen media more than 4 h/day was 13% (95% CI 12%;14%) for weekdays and 28% (95% CI 27%;29%) for weekend days. Children of parents with medium-length or long educations had statistically significant lower odds of using screen media more than 4 h/day. We found a statistically significant graded relationship between household screen media rules and children's screen media use; the less parents reported presence of rules, the more time their children spent on screen media engagements. Our results suggest that parental educational level and family structure are related to unfavourable screen media habits, and household screen media rules may play an important role for parents to limit children's screen use.

Movement and Physical Activity in Early Childhood Education and Care Policies of Five Nordic Countries.

The purpose of this study was to examine the values of movement and physical activity (MoPA) using government policy documents (e.g., laws and curricula) on early childhood education and care (ECEC) from Denmark, Finland, Iceland, Norway, and Sweden. This descriptive, comparative study was designed based on curriculum theory and used word count and content analyses to identify similarities and differences in the occurrence of MoPA in the ECEC policies of Nordic countries. Seven terms were identified as MoPA-related in Nordic policy documents. These terms occurred in various content contexts: development, environment, expression, health and well-being, learning and play, albeit sparsely. MoPA was referred to as both a goal in and of itself and as a means of achieving other goals (e.g., learning or development in another area). Formulations specifically dedicated to MoPA as a goal were present in the Danish and Finnish curricula and, to some extent, also in the Norwegian curriculum, while the Icelandic and Swedish curricula mentioned MoPA mostly as a means. Findings indicated that MoPA, which is important for children's development, health, and well-being, is a low-priority value, to varying degrees, in the ECEC policies enacted by Nordic countries and the guidance provided to educators and stakeholders therein is inexplicit.

Feasibility of two screen media reduction interventions: Results from the SCREENS pilot trial.

BACKGROUND: Advancements in screen media devices has transformed the way families engage with screen media. Although these modern devices offer many opportunities, e.g. communication and research online, an in-depth understanding of how these devices affect our health, is lacking. Before a definite randomized controlled trial, the SCREENS pilot study was conducted to assess compliance to and feasibility of two interventions, a measurement protocol, and a survey-based recruitment strategy. Also, the potential of the interventions to impact leisure time spent non-sedentary in children six-to-ten years of age was explored. METHODS: Families (N = 12) were recruited through a population-based survey sent out in October of 2018 to adults (N = 1,675) in the Municipality of Middelfart, Denmark. Families were randomized to one of two two-week interventions; an Evening Restriction intervention (no screen media use after six pm) and a General Restrict intervention (limit entertainment-based screen media to three hours/week/person). Intervention compliance was assessed objectively by measuring household TV usage, smartphone and tablet activity via an application, and via screen media diaries. During baseline and follow-up, as part of larger protocol, family members wore two triaxial accelerometers for seven consecutive days. The potential of the interventions to impact non-sedentary time was explored based on means and standard errors (SEs). RESULTS: Despite almost 85% and 75% reductions in leisure screen media use 0% and 50% of families were compliant in the Evening Restrict group and General Restrict group, respectively, based on strict a priori criteria. Participant feedback indicated that the General Restrict intervention generally was feasibly. Compliance to the accelerometry wear protocol was high (median non-wear was <1 hour/week). Moreover, the recruitment strategy was implemented and was feasible. The General restrict intervention might increase children's non-sedentary time (mean (SE): 36.6 (23) min/day, N = 6). CONCLUSIONS: The General Restriction intervention, the accelerometer wear protocol and recruitment strategy, appeared feasible. TRIAL REGISTRATION: NCT03788525 at https://clinicaltrials.gov [Retrospectively registered; 27th of December, 2018].

Simple Method for the Objective Activity Type Assessment with Preschoolers, Children and Adolescents.

Background: The objective and accurate assessment of children's sedentary and physical behavior is important for investigating their relation to health. The purpose of this study is to validate a simple and robust method for the identification of sitting, standing, walking, running and biking performed by preschool children, children and adolescents in the age from 3 to 16 years from a single thigh-worn accelerometer. Method: A total of 96 children were included in the study and all subjects followed a structured activity protocol performed in the subject's normal kindergarten or school environment. Thigh acceleration was measured using the Axivity AX3 (Axivity, Newcastle, UK) device. Method development and accuracy was evaluated by equally dividing the subjects into a development and test group. Results: The sensitivity and specificity for identifying sitting and standing was above 99.3% and for walking and running above 82.6% for all age groups. The sensitivity and specificity for identifying biking was above 85.8% for children and adolescents and above 64.8% for the preschool group using running bikes. Conclusion: The accurate assessment of sitting, standing, walking, running and biking from thigh acceleration and with children in the age range of 3 to 16 is valid, although not with preschool children using running bikes.

The development of a questionnaire to assess leisure time screen-based media use and its proximal correlates in children (SCREENS-Q).

BACKGROUND: The screen-media landscape has changed drastically during the last decade with wide-scale ownership and use of new portable touchscreen-based devices plausibly causing changes in the volume of screen media use and the way children and young people entertain themselves and communicate with friends and family members. This rapid development is not sufficiently mirrored in available tools for measuring children's screen media use. The aim of this study was to develop and evaluate a parent-reported standardized questionnaire to assess 6-10-year old children's multiple screen media use and habits, their screen media environment, and its plausible proximal correlates based on a suggested socio-ecological model. METHODS: An iterative process was conducted developing the SCREENS questionnaire. Informed by the literature, media experts and end-users, a conceptual framework was made to guide the development of the questionnaire. Parents and media experts evaluated face and content validity. Pilot and field testing in the target group was conducted to assess test-retest reliability using Kappa statistics and intraclass correlation coefficients (ICC). Construct validity of relevant items was assessed using pairwise non-parametric correlations (Spearman's). The SCREENS questionnaire is based on a multidimensional and formative model. RESULTS: The SCREENS questionnaire covers six domains validated to be important factors of screen media use in children and comprises 19 questions and 92 items. Test-retest reliability (n = 37 parents) for continuous variables was moderate to substantial with ICC's ranging from 0.67 to 0.90. For relevant nominal and ordinal data, kappa values were all above 0.50 with more than 80% of the values above 0.61 indicating good test-retest reliability. Internal consistency between two different time use variables (from n = 243) showed good correlations with rho ranging from 0.59 to 0.66. Response-time was within 15 min for all participants. CONCLUSIONS: SCREENS-Q is a comprehensive tool to assess children's screen media habits, the screen media environment and possible related correlates. It is a feasible questionnaire with multiple validated constructs and moderate to substantial test-retest reliability of all evaluated items. The SCREENS-Q is a promising tool to investigate children screen media use.

Short-term efficacy of reducing screen media use on physical activity, sleep, and physiological stress in families with children aged 4-14: study protocol for the SCREENS randomized controlled trial.

BACKGROUND: During the recent decade presence of digital media, especially handheld devices, in everyday life, has been increasing. Survey data suggests that children and adults spend much of their leisure on screen media, including use of social media and video services. Despite much public debate on possible harmful effects of such behavioral shifts, evidence from rigorously conducted randomized controlled trials in free-living settings, investigating the efficacy of reducing screen media use on physical activity, sleep, and physiological stress, is still lacking. Therefore, a family and home-based randomized controlled trial - the SCREENS trial - is being conducted. Here we describe in detail the rationale and protocol of this study. METHODS: The SCREENS pilot trial was conducted during the fall of 2018 and spring of 2019. Based on experiences from the pilot study, we developed a protocol for a parallel group randomized controlled trial. The trial is being conducted from May 2019 to ultimo 2020 in 95 families with children 4-14 years recruited from a population-based survey. As part of the intervention family members must handover most portable devices for a 2-week time frame, in exchange for classic mobile phones (not smartphones). Also, entertainment-based screen media use during leisure must be limited to no more than 3 hours/week/person. At baseline and follow-up, 7-day 24-h physical activity will be assessed using two triaxial accelerometers; one at the right hip and one the middle of the right thigh. Sleep duration will be assessed using a single channel EEG-based sleep monitor system. Also, to assess physiological stress (only assessed in adults), parameters of 24-h heart rate variability, the cortisol awakening response and diurnal cortisol slope will be quantified using data sampled over three consecutive days. During the study we will objectively monitor the families' screen media use via different software and hardware monitoring systems. DISCUSSION: Using a rigorous study design with state-of-the-art methodology to assess outcomes and intervention compliance, analyses of data from the SCREENS trial will help answer important causal questions of leisure screen media habits and its short-term influence on physical activity, sleep, and other health related outcomes among children and adults. TRIAL REGISTRATION: NCT04098913 at https://clinicaltrials.gov [20-09-2019, retrospectively registered].

Variations in accelerometry measured physical activity and sedentary time across Europe - harmonized analyses of 47,497 children and adolescents.

BACKGROUND: Levels of physical activity and variation in physical activity and sedentary time by place and person in European children and adolescents are largely unknown. The objective of the study was to assess the variations in objectively measured physical activity and sedentary time in children and adolescents across Europe. METHODS: Six databases were systematically searched to identify pan-European and national data sets on physical activity and sedentary time assessed by the same accelerometer in children (2 to 9.9 years) and adolescents (≥10 to 18 years). We harmonized individual-level data by reprocessing hip-worn raw accelerometer data files from 30 different studies conducted between 1997 and 2014, representing 47,497 individuals (2-18 years) from 18 different European countries. RESULTS: Overall, a maximum of 29% (95% CI: 25, 33) of children and 29% (95% CI: 25, 32) of adolescents were categorized as sufficiently physically active. We observed substantial country- and region-specific differences in physical activity and sedentary time, with lower physical activity levels and prevalence estimates in Southern European countries. Boys were more active and less sedentary in all age-categories. The onset of age-related lowering or leveling-off of physical activity and increase in sedentary time seems to become apparent at around 6 to 7 years of age. CONCLUSIONS: Two third of European children and adolescents are not sufficiently active. Our findings suggest substantial gender-, country- and region-specific differences in physical activity. These results should encourage policymakers, governments, and local and national stakeholders to take action to facilitate an increase in the physical activity levels of young people across Europe.

The effect of a multi-component camp-based weight-loss program on children's motor skills and physical fitness: a randomized controlled trial.

BACKGROUND: Many weight-loss programs in children are performed without specific foci on training both physical fitness and motor skills. The aim of this study was to describe the effect of a one-year weight-loss program on children's motor skills and physical fitness. METHODS: Participants included 115 overweight fifth-grade children (12.0 years) randomized into either a Day-Camp Intervention Arm (DCIA), with a subsequent family-based support program or a low-intense Standard Intervention Arm (SIA). Physical fitness was assessed by vertical jump, hand grip strength, and a progressive cardio-respiratory fitness test. Motor skills were assessed by the Movement Assessment Battery for Children - second edition (M-ABC-2), age band 3. RESULTS: Loss to follow-up after 52 weeks was 19 % and 32 % in the DCIA and SIA, respectively. Balance skills were improved post-camp, but not after 52 weeks in children from the DCIA compared to the SIA. Contrary to the expected, children from the SIA improved aiming and catching skills relative to the DCIA children. Overall z-scores of the physical fitness components and cardio-respiratory fitness improved more in children from the DCIA compared to children from the SIA. CONCLUSION: In conclusion, the day-camp intervention led to improvements in physical fitness but not in motor skills compared to the standard intervention. Including both motor skills and physical fitness could advantageously be considered in future immersive intervention programmes. TRIAL REGISTRATION: Clinicaltrials NCT01574352, March 26, 2012 (retrospectively registered).

Physical activity and motor skills in children attending 43 preschools: a cross-sectional study.

BACKGROUND: Little is known about health characteristics and the physical activity (PA) patterns in children attending preschools. The objective of this study was to describe the gender differences in relation to body mass index (BMI), motor skills (MS) and PA, including PA patterns by the day type and time of day. Additionally, the between-preschool variation in mean PA was estimated using the intraclass correlation. METHODS: We invited 627 children 5-6 years of age attending 43 randomly selected preschools in Odense, Denmark. Aiming and catching MS was assessed using subtests of the Movement Assessment Battery for Children (Second Edition) and motor coordination MS was assessed by the Kiphard-Schilling body coordination test, Körperkoordination Test für Kinder. PA was measured using accelerometry. The PA patterns were analysed using mixed models. RESULTS: No gender differences in the BMI or norm-referenced MS risk classification, or the average weekly PA level or patterns of PA were observed. However, boys performed better in the aiming and catching score (p < 0.01) and in the motor coordination score (p < 0.05) on average. Girls performed better in the balance subtest (p < 0.001). Relative to the norm-referenced classification of MS, the Danish sample distribution was significantly well for aiming and catching but poorer for the motor coordination test.The total sample and the least active children were most active on weekdays, during preschool time and in the late afternoon at the weekend. However, a relatively larger decrease in PA from preschool to weekday leisure time was observed in children in the lowest PA quartile compared to children in the highest PA quartile. Finally, the preschool accounted for 19% of the total variance in PA, with significant gender differences. CONCLUSIONS: Results of this study could provide a valuable reference material for studies monitoring future trends in obesity, MS and PA behaviour in Denmark and other countries.Knowledge about sources of variation in PA among preschool children is scarce and our findings need to be replicated in future studies. A potentially important finding is the large between-preschool variation in PA, indicating that especially girls are very susceptible to the environment offered for PA during preschool attendance.