The intervention increased four-year-old children’s total PA level, step count, time spent in light- and moderate intensity, and reduced sedentary time during their stay in the ECEC setting. By that, the number of children adhering to the PA recommendations increased significantly. Especially encouraging was that the least physically active at baseline gained the most from the intervention. The lack of effect on vigorous intensity PA can possibly be explained by the fact that the preschools, according to their self-developed plans, did not have specific goals of influencing this behavior. The staff rather focused on routines, games, plays and activities that targeted the general PA level, moderate intensity and sedentary time. The baseline data were in line with findings from other studies indicating an insufficient degree of PA in children in ECEC settings [1, 2, 36]. The findings in this study are important because most children (83.5% and 97.1% of children between 1–2 and 3–5 years of age respectively) attend ECEC settings most days of the week, mostly for more than 40 hours per week [16]. An effective intervention will thus benefit children across the socioeconomic spectrum.
An increase in the number of children adhering to the PA recommendations is important although we are only starting to understand the dose-response relationship of PA with health parameters in young children [37, 38]. However, there are some studies indicating increased PA can cause long time effects in terms of lower blood pressure [39] and improved aerobic fitness and cardiovascular health as well as decrease body fat [40, 41]. Hence, although we did not measure cardiovascular disease risk factors in this study, the results are most likely clinically important.
It is of particular interest, that these effects have been achieved through a staff-led intervention. As such, our results are contrasting studies that indicate no or only weak effects of staff-led interventions compared to the effects that has been achieved in some studies where the interventions was led by PA experts [20, 22, 24, 25, 42]. The explanation for these contrasting findings may be two folded. Firstly, a significant proportion (40%) of the about 93 000 staff in Norwegian ECEC services is trained as pre-school teachers, which means that they have higher education at least on a bachelor level and an additional 18% has relevant vocational education (child- and youth worker) [43]. Another 8% has higher education and 4% other forms of vocational education. This educational profile of staff indicates that staff, as least partly, has high competence in terms of both pedagogical and subject knowledge and, by this, is well suited to lead a PA intervention. This is in accordance with Finch et al. (2014) who have highlighted the importance of competence as a prerequisite for staff-led interventions [25]. Secondly, applying the collaborative and “bottom-up” Communities of Practice approach (COP; Wenger, 1999) might be particularly suited for Norwegian ECEC settings as both the national framework plan for pre-school teacher education [44] and the national framework plan for ECEC [45] emphasizes the importance of staff collaboration and organizational learning. Thus, a large proportion of the employees in ECEC settings might be sufficiently prepared to understand their organization as learning communities and capable of sharing competence and experiences to develop new practices. A high degree of professionalism and a combination of pedagogical and content knowledge relevant for facilitating PA in a collaborative and child centered way might have been an important factor for understanding the findings in this study.
The fact that the intervention in the current study was collaborative and staff-led makes the results especially promising because, in comparison to expert-led programs, staff-led programs may be more cost-effective and easier to scale-up. Furthermore, this approach possibly increases the staff’s “sense of ownership” to the intervention and building a more autonomous organization, making it more likely that the institution will carry on focusing on PA once the research project ends, and succeed in this important work. As MacDonald and Green (2001) highlighted, a dialogical and bottom up approach will take into account the specific context as well as differences within and between ECEC settings relevant for the promotion of physically active play and, by that, have the potential to be successful [30].
This study has some significant strengths and some important limitations. Strengths include a rigorous research design, objective measurement of physical activity and high attendance rate. The fact that almost all of the children that were eligible for the study agreed to wear an accelerometer on two occasions strengthens the generalizability of the study. This is an important point for this kind of studies, because the least physically active individuals, hence those we want to target the most, tend not to volunteer for studies of this nature. Further, a major strength of the study was that it was guided by PA experts but led by staff in each of the ECEC institutions. This flexible and pragmatic approach taken is most likely less costly than expert-driven programs, easier to scale-up and probably more likely to be continued after the research project ends. A limitation of this study is that we are not able to specifically evaluate the contribution of each of the intervention components and by that, assess which one were the most effective or feasible. Furthermore, a lack of process evaluation makes it difficult to determine to what degree the ECEC institutions followed the strategy laid out in the logic model. Furthermore, although we were successful in creating immediate post-program results, a lack of long-term follow-up leaves the question of whether the programme is effective in the long run.
In summary, our results show that a flexible staff-led and expert-supported multicomponent PA intervention can increase total PA level, MVPA and reduce time spent sedentary in four-year-old children during their stay in ECEC settings. Instead of purely implementing structured programs developed by external experts to increase physical active play in ECEC institutions, the findings from the current study indicate that there is a potential for interventions that emphasize collaborative reflection pedagogical practice between staff members for improvement of complex practice.