A growing body of evidence suggest that the children’s physical activity (PA) level in childhood education and care (ECEC) settings are insufficient [1, 2]. Moreover, sedentary behaviour, defined as any waking behaviour characterized by an energy expenditure ≤ 1.5 metabolic equivalents, while in a sitting, reclining, or lying posture [3], is highly prevalent [4] and has been identified as detrimental to children’s health [5]. Although many children have healthy and active lifestyles, there seems to be a relatively large group of children with a low PA level [6]. In turn, this could lead to negative developmental effects such as low fitness level, weak motor skills and obesity [7]. This is especially worrying because it is known that PA level often tracks from childhood into adulthood [8, 9]. Thus, early intervention is crucial, given that PA plays a pivotal role in children’s overall health and is associated with many positive health outcomes, including physical fitness [10], cardiovascular health [11], bone health [12] and psychosocial and cognitive development [12, 13].
PA levels has been found to be highly variable among children in ECEC settings [14, 15], 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 [16], and these institutions reach children across the socioeconomic spectrum, the ECEC settings may serve as an ideal avenue for increasing PA level, reduce sedentary time and enhancing the overall health of young children. Yet, early childhood educators identify parents rather than themselves as persons responsible for promoting children’s PA [17], and may assume that young children receive adequate PA throughout the week, regardless of activities during their stay in the ECEC setting [18]. 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 time in the ECEC, may provide substantial public health benefits [19].
In earlier studies, PA interventions conducted in ECEC settings [20, 21], have only shown small to moderate effects and were rather inconsistent across studies [20, 22-24]. Most PA interventions that have been implemented in ECEC settings are structured programs developed by PA experts and delivered by staff alone or with great influence of trained research personnel [25]. In some studies, staff-led interventions have shown to be less effective in increasing PA compared to interventions implemented by PA experts [25, 26]. Similar findings have emerged regarding intervention effects on fundamental movement skills [27]. The main explanation for lower efficiency of staff led interventions may be that PA experts have more knowledge and competencies regarding this issue [27, 28]. In order to succeed with staff-led programs the need for multiple staff training sessions and maximizing the number of trained staff has been emphasized [26, 29].
Recently, several reviews have summarized the body of knowledge regarding various aspects of the contexts and prerequisites for PA in different kinds of out of home services for children in preschool age [29-31]. In a review including 34 studies, Hnatiuk at al. (2019) [31] revealed small, but positive and significant intervention effects only for children’s (£ 5 years) moderate- to vigorous intensity PA (MVPA) but not light intensity PA. Based on their findings, the authors recommend interventions tailored to the target group, where cultural considerations, community needs and the provision of ongoing support should have a key role. Furthermore, they also conclude that daily structured PA sessions, integrated as part of the everyday activities in the institutions (routines) and delivered through a hands-on approach, will most likely contributed to increase children’s MVPA. Finally, Hnatiuk and colleagues claim that one should strive to influence the practices of both parents and staff as well as assessing and documenting changes in their PA levels, in order to illuminate the importance of their behaviour on children's activity levels.
Jones et al. 2019 [29] conducted a review of 24 PA interventions in childcare mostly targeting children between three and five years of age where staff was participating in professional development either before or during the intervention period and providing children with opportunities for additional PA. Less than half of the included studies, caused positive effects on children's PA level. For further intervention studies in ECEC the authors provided four recommendations, two of which were based on the papers included in the review and two based on evidence “from broader ECEC literature” (p. 8). Firstly, there is a need for high-quality professional development prior to and during the intervention, and, secondly, the necessity of “Interventions that are ‘outside the box’” (p. 8) in terms of e.g. blended professional development, the role of technology, targeting health, well-being and activity levels of the educators, focus on PA learning experiences, outdoor marking, and energy breaks and integration of interventions in the institutions daily routines. The third and broader based recommendation addresses the importance of developing meaningful and trustworthy cooperation and relationships between staff and researchers [32]. The fourth and final recommendation focuses on the ECEC environment as a key factor for providing good opportunities for PA and, thus, should be increasingly emphasized regarding future interventions.
A missing perspective in recent studies focusing on PA interventions in ECEC settings might be that they may not fully take into account the fact that ECEC teaching professions practice has become increasingly complex due to growing multi-diverse societies and multiple components related to working conditions [33]. Thus, top-down approaches and standardized solutions (programs) will possibly be harder to implement in an ever more diverse environment in terms of individual, social, cultural and physical differences within and between institutions. Therefore, it might be a suitable approach to establish an organizational and collaborative learning processes, a community of professional learning, to improve and maintain the staffs’ competence [29, 33, 34]. This means to contextualize pedagogical practice through continuous negotiation and reflection between staff members and through collective responsibility for improvement of practice, instead of purely implementing structured programs 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 a greater potential for developing a sustainable and improved long-term practice.
The current study therefore suggests a dialogical and bottom up approach that will take into account differences within and between local ECEC settings such as child group characteristics, staffs’ competencies and personal preferences and practices for sustainable implementation, differencies in the physical indoor and outdoor environments, as well as available equipment to promote physically active play [35]. Interventions that can be adapted to specific circumstances within an organization while maintaining overall fidelity are more likely to be successful [35]. Hence, the theoretical frame of the current intervention is based on Wenger’s theory on Communities of Practice (COP) [36]. Crucial for this theoretical perspective is the idea that organizations are learning communities sharing competence and experiences to develop new practices. Trusting in the staff’s professionalism and their knowledge about and sensitivity towards the individual child and the child groups as well as their awareness regarding barriers and possibilities in terms of environment and equipment. COP includes three modes of belongings; engagement, imagination and alignment. Engagement is active participating in the practice revealing needs for learning and changes, and establishing collective development of the organization. Imagination connects to the staff’s visions and their experience of meaning regarding the intervention, as well as their understanding of the purpose. Alignment is about the commitment to the entire project. To achieve positive changes based on COP these types of belonging has to be linked to particular processes such as the establishment of mutual engagement over time to promote changes, self-awareness and reflection concerning institutional practices. It is also important to transfer 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 the staff members can use 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 children’s PA level and reduce sedentary time within the ECEC setting compared to standard care.