Abstract

The goal of this study was to complete a systematic review of research on the occurrence the levels of physical activity (PA), forms of intervention and factors associated with this practice among preschool children. Studies published in the period between 2006 and 2016 were investigated, using the PubMed and SPORTDiscus databases. The search terms identified 177 articles, of which 41 met the inclusion criteria. Goals, methodologies and results were analysed. The studies used various cut-off points to establish the desired level of PA, along with different types of interventions. Overall, the problem of low level of PA among preschool children appears to be increasing. Involvement and participation of parents and teachers, guidance from booklets and other information sources, parent instruction and availability of extracurricular activities were considered positive factors that tended to increase children’s PA levels, whereas parental obesity was a negative factor. New studies to define sedentary behaviour in preschool children are required to clarify the nature of this problem, along with the establishment of prevention programmes with ecological design aimed at schools, families and other sectors of society.

Key words:
Review; Child Preschool; Physical Activity; Sedentary lifestyle

Resumo

O objetivo deste estudo foi realizar uma revisão sistemática sobre níveis de atividade física (AF), formas de intervenção e fatores associados a essa prática em pré-escolares. Foram considerados os estudos publicados na última década, as bases de dados consultadas foram: PubMed e SPORTDiscus. As palavras chave identificaram 177 artigos, dos quais 41 preencheram os critérios de inclusão. Foram analisados os objetivos, as metodologias e os resultados de cada artigo selecionado. As pesquisas utilizaram diferentes frequências e tipos de intervenções em atividade física. Em geral, o problema do baixo nível de AF em pré-escolares tem aumentado. O envolvimento e a participação dos pais e professores, cartilhas de orientação, outras fontes de informação, instrução aos pais e professores e disponibilidade de atividades extracurriculares foram considerados como fatores positivos que provocam a elevação dos níveis de AF nas crianças, por outro lado, a obesidade dos pais foi um fator negativo. São necessários novos estudos para definir o comportamento sedentário de pré-escolares, esclarecer a natureza desse problema juntamente com o estabelecimento de programas de prevenção, baseados em metodologias ecológicas, direcionados as escolas, famílias e outros setores da sociedade.

Palavras-chave:
Revisão; Pré-escolar; Atividade Física; Estilo de vida sedentário

Introduction

According to Kohl et al.¹1 Kohl HW, Craig CL, Lambert EV, Inoue S, Alkandari JR, Leetongin G, Kahlmeier S. The pandemic of physical inactivity: global action for public health. Lancet 2012; 380(9838):294-305. the sedentary lifestyle is the world’s fourth leading cause of death. It is manifested at all ages and has been linked with numerous diseases, such as obesity, hypertension and heart disease. It also has impaired aspects of human development and welfare, accentuating inadequate health and nutrition.

Until the end of the twentieth century, sedentary lifestyle and obesity were studied as public health problems in adults, especially the elderly and little was known about their incidence in children under age five²2 Pate RR, Pfeiffer KA, Trost SG, Ziegler P, Dowda M. Physical activity among children attending preschools. Pediatrics 2004; 114(5):1258-1263.. Studies concerning preschool children began to emerge in the early 21st century, demonstrating the negative consequences of obesity, sedentary behaviour, low physical activity levels and motor deficits. In addition, there is evidence to suggest engaging in physical activity in the early years of life, as behavioral changes in the lifestyle healthy are more likely in children than in youth and adults³3 Finn K, Johannsen N, Specker B. Factors associated with physical activity in preschool children. J Pediatr 2002; 140(1):81-85.^,44 Trost SG, Sirard JR, Dowda M, Pfeiffer KA, Pate RR. Physical activity in overweight and nonoverweight preschool children. Int J Obes Relat Metab Disord 2003; 27(7):834-839..

It is predicted that by the year 2020, nearly 60 million preschool children will be overweight or obese; currently there are 43 million such children⁵5 De Onis M, Blossner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 2010; 92(5):1257-1264.. The probability of an overweight young child becoming obese by adolescence is four times greater than that among children with normal weight⁶6 Cunningham SA, Kramer MR, Narayan KM. Incidence of childhood obesity in the United States. N Engl J Med 2014; 370(5):403-411..

Meanwhile, studies have demonstrated the importance of PA for children, showing its benefits for intellectual and cognitive development, psychosocial development and the promotion and acquisition of fundamental motor skills⁷7 Gagen L, Getchell N. Using 'constraints' to Design Developmentally Appropriate Movement Activities for Early Childhood Education. Early Child Educ J 2006; 34(3):227-232.^,88 Williams HG, Pfeiffer KA, O'Neill JR, Dowda M, McIver KL, Brown WH, Pate RR. Motor skill performance and physical activity in preschool children. Obesity 2008; 16(16):1421-1426..

Researches on the level of physical activity aimed at children up to five years of age are still inconclusive²2 Pate RR, Pfeiffer KA, Trost SG, Ziegler P, Dowda M. Physical activity among children attending preschools. Pediatrics 2004; 114(5):1258-1263., recommendations on the level of physical activity, methods and intervention strategies need to be better investigated.

Currently, the lack of PA and the tendency towards sedentary behaviour among preschool children have attracted considerable attention from researchers and from society in general, but the factors leading to this condition have still not been clearly elucidated. Therefore, the goal of this study was to complete a systematic review of research on the occurrence the levels of physical activity (PA), forms of intervention and factors associated with this practice among preschool children.

Methods

As a systematic review, this study sought to complete a systematic review the current state of research knowledge related to PA among preschoolers. The PRISMA checklist⁹9 Moher D, Liberati A, Tetzlaff J, Altman DG. The PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA statement. In J Surgery 2010; 8(5):336-341. was applied. The articles were selected between May and July 2016 through the CAPES periodic portal, linked to a university, from the databases PubMed and SPORTDiscus using the following descriptors from DECS/MeSH (Medical Subject Headings): preschool children, physical activity, sedentary behaviour, environment, parents and preschool teachers.

To be included in this systematic review, papers must have been published between 2006 and 2016 (period chosen because of the exponential increase in sedentary behaviour) in journals with a peer review system. Three levels of stratification were carried out. First level stratification, all articles with one of the descriptors were selected. Second level stratification the abstracts were subjected to a screening in relation to the research problem. And the stratification of third levels the articles in which the main subject of the study, did not refer to the theme of physical activity in preschool children (levels, factors and interventions), articles that were not obtained due to lack of access to the full text and articles that age group did not agree with the research were excluded along with all duplicated articles.

The stratification identified 177 articles in the two databases used, but most of them did not relate to the theme of this study. Their removal left 41 studies (24 original articles presented in the tables and 12 review articles used to substantiate the analyses and five international recommendations of physical activity for preschool children to compare with the studies) that met all the criteria, and these became the sample used in the present study. Figure 1 display the flow chart of the stratification the articles selected.

After the inclusion and selection of the articles, were analysed the primary and secondary objectives, methods, results, in which it provided a reflexive analysis (by comparison among the findings); answers to the questions addressed and suggestions for future research.

This analysis revealed three units for study: (a) PA levels for preschool children and sedentary behavior, (b) implementation of PA programmes for preschool children and (c) factors associated with the practice of PA among preschool children, factors associated with teachers, factors associated with the family context and factors associated with the school context.

To clarify the cut-off points that can be used to establish the desired level for such activities among the different studies, five official recommendations to guide PA for children under five years old were examined.

Literature Review

Physical Activity Levels for Preschool Children

Seven cross-sectional studies from between 2006 and 2016 were found that analysed the PA levels of preschool children. They examined Portuguese¹⁰10 Vale S, Silva P, Santos R, Soares-Miranda L, Mota J. Compliance with physical activity guidelines in preschool children. J Sports Sci 2010; 28(6):603-608., Danish¹¹11 Olesen LG, Kristensen PL, Korsholm L, Froberg K. Physical Activity in Children Attending Preschools. Pediatrics 2013; 132(5):1310-1318., Canadian¹²12 Botey AP, Bayrampour H, Carson V, Vinturache A, Tough S. Adherence to Canadian physical activity and sedentary behaviour guidelines among children 2 to 13 years of age. Prev Med Rep 2015; 3(3):14-20., Brazilian¹³13 Barros SSH, Lopes AS, Barros MVG. Prevalence of low physical activity level among preschool children. Rev Bras Cineantropom Desempenho Hum 2012; 14(4):390-400.^,1414 Barbosa SC, Coledam DHC, Stabelini AN, Elias RGM, Oliveira AR. School environment, sedentary behavior and physical activity in preschool children. Rev Paul Pediatr 2016; 34(3):301-308. and American children¹⁵15 Henderson KE, Grode GM, O'Connell ML, Schwartz MB. Environmental factors associated with physical activity in child care centers. Int J Behav Nutr Phys Act 2015; 12(43):1-9.^,1616 Tandon PS, Saelens BE, Christakis DA. Active Play Opportunities at Child Care. Pediatrics 2015; 135(6):1425-1431.. The subjects’ age group from two to six years; the smallest group had 65 preschool children and the largest had 631.

Of the 7 studies, five used accelerometers Actigraph GT3X or GTM1: two only accelerometer¹⁰10 Vale S, Silva P, Santos R, Soares-Miranda L, Mota J. Compliance with physical activity guidelines in preschool children. J Sports Sci 2010; 28(6):603-608.^,1616 Tandon PS, Saelens BE, Christakis DA. Active Play Opportunities at Child Care. Pediatrics 2015; 135(6):1425-1431.; one accelerometer and observation in the institutional context¹¹11 Olesen LG, Kristensen PL, Korsholm L, Froberg K. Physical Activity in Children Attending Preschools. Pediatrics 2013; 132(5):1310-1318.; one accelerometer and routine observation¹⁵15 Henderson KE, Grode GM, O'Connell ML, Schwartz MB. Environmental factors associated with physical activity in child care centers. Int J Behav Nutr Phys Act 2015; 12(43):1-9.; and one accelerometer and questionnaire in school¹⁴14 Barbosa SC, Coledam DHC, Stabelini AN, Elias RGM, Oliveira AR. School environment, sedentary behavior and physical activity in preschool children. Rev Paul Pediatr 2016; 34(3):301-308., as the literature attributed greater precision and objectivity, and the others two studies used questionnaire: one validated questionnaire and adapted to Brazil¹³13 Barros SSH, Lopes AS, Barros MVG. Prevalence of low physical activity level among preschool children. Rev Bras Cineantropom Desempenho Hum 2012; 14(4):390-400. and one semi qualitative questionnaire to parents¹²12 Botey AP, Bayrampour H, Carson V, Vinturache A, Tough S. Adherence to Canadian physical activity and sedentary behaviour guidelines among children 2 to 13 years of age. Prev Med Rep 2015; 3(3):14-20..

Meantime this instrument (accelerometers) does not provide additional information of environment frequented by children¹⁷17 Pate RR, O'Neill JR, Mitchell J. Measurement of physical activity in preschool children. Med Sci Sports Exerc 2010; 42(3):508-512. and also need to unify measures of the level of PA performed by accelerometer¹⁸18 Bornstein DB, Beets MW, Byun W, McIver K.J. Accelerometer-derived physical activity levels of preschoolers: a meta-analysis. Sci Med Sport 2011; 14(6):504-511., because dependent on the interpretation of accelerometry data.

Different cut-off points to indicate the desired level of PA practice were used, as various countries have different official recommendations. The first guide containing PA practice recommendations for preschool children was proposed in the United States, by the National Association for Sport and Physical Education¹⁹19 National Association for Sport and Physical Education (NASPE). Active Start: A statement of physical activity guidelines for children birth to 5 years. Oxon Hill: Aahperd Publications; 2002.. It recommended at least 60 minutes of moderate and vigorous PA daily (at least 3 day/week). The second edition of this guide suggested that preschool children (age three to five) should engage in at least 120 minutes of total PA per day, including 60 minutes of structured activities (planned with professional guidance) and another 60 minutes of unstructured activities²⁰20 National Association for Sport and Physical Education (NASPE). Active Start: A Statement of Physical Activity Guidelines for Children from Birth to Age 5. 2nd ed. Oxon Hill: Aahperd Publications; 2009..

Other recommendations published in Australia²¹21 Ageing DH. Move and play every day. National Physical Activity Recommendations for Children 0-5 Years [Internet]. Commonwealth of Australia; 2010 [cited 2017 Jun 14]. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/npra-0-5yrs-brochure
http://www.health.gov.au/internet/main/p... , the United Kingdom²²22 United Kingdom. Department of Health. Start Active, Stay Active: A Report on Physical Activity for Health from the Four Home Countries. London: Department of Health; 2011. and Canada²³23 Tremblay MS, Leblanc AG, Carson V, Choquette L, Connor GS, Dillman C, Mary Duggan M, Gordon M, Hicks A, Janssen I, Kho M, Latimer-Cheung A, LeBlanc C, Murumets K, Okely A, Reilly J, Spence J, Stearns J, Timmons B. Canadian Society for Exercise Physiology. Canadian physical activity guidelines for the early years (aged 0-4 years). Appl Physiol Nutr Metab 2012; 37(2): 345-369. called for at least 180 minutes of daily PA for preschool children. Thus, there is no consensus on this issue. Brazil and Denmark did not indicate having any guidelines or official recommendations regarding PA for preschool children.

Using the original NASPE guidelines (which called for a minimum of 60 minutes of daily exercise), four studies found low levels of PA in 25% to 87% of the total participants, and sedentary behaviour in 50% to 83% of them. For instance, Tucker²⁴24 Tucker P. The physical activity levels of preschool-aged children: A systematic review. Early Child Res Q 2008; 23(4):547-558. investigated 39 studies from seven countries (United States, Scotland, Finland, Australia, Chile, Estonia and Belgium) and determined that across all these studies, 46% of preschool children showed low levels of PA, considering the recommendation of 60 minutes daily.

Three studies adopted the Canadian recommendations (180 minutes of daily PA) and found low levels of activity in 62% to 90% of all participants, while the incidence of sedentary behaviour varied from 64% to 90%. Chart 1 illustrates the findings of these studies.

Since three countries prescribe a daily minimum of 180 minutes of PA for preschool children (the Australia²¹21 Ageing DH. Move and play every day. National Physical Activity Recommendations for Children 0-5 Years [Internet]. Commonwealth of Australia; 2010 [cited 2017 Jun 14]. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/npra-0-5yrs-brochure
http://www.health.gov.au/internet/main/p... , United Kingdom²²22 United Kingdom. Department of Health. Start Active, Stay Active: A Report on Physical Activity for Health from the Four Home Countries. London: Department of Health; 2011. and Canada²³23 Tremblay MS, Leblanc AG, Carson V, Choquette L, Connor GS, Dillman C, Mary Duggan M, Gordon M, Hicks A, Janssen I, Kho M, Latimer-Cheung A, LeBlanc C, Murumets K, Okely A, Reilly J, Spence J, Stearns J, Timmons B. Canadian Society for Exercise Physiology. Canadian physical activity guidelines for the early years (aged 0-4 years). Appl Physiol Nutr Metab 2012; 37(2): 345-369.), whereas the American recommendations have had cut-off points of 60 or 120 min/day (NASPE¹⁹19 National Association for Sport and Physical Education (NASPE). Active Start: A statement of physical activity guidelines for children birth to 5 years. Oxon Hill: Aahperd Publications; 2002.^,2020 National Association for Sport and Physical Education (NASPE). Active Start: A Statement of Physical Activity Guidelines for Children from Birth to Age 5. 2nd ed. Oxon Hill: Aahperd Publications; 2009.), the choice between classification systems affects the number of children characterised as having insufficient PA. This inconsistency concerning the desirable minimum amount of PA was highlighted by Timmons et al.²⁵25 Timmons BW, Leblanc AG, Carson V, Connor GS, Dillman C, Janssen I, Kho ME, Spence JC, Stearns JA, Tremblay MS. Systematic review of physical activity and health in the early years (aged 0-4 years). Appl Physiol Nutr Metab 2012; 37(4):773-792. and hinders comparisons among PA levels found in the studies. Moreover, all four countries’ (United States, England, Canada and Australian) recommendation of PA was derived from studies of adult populations and was adjusted for children under age five based on empirical observations. Although these actions are justified in view of the evidence of a relationship between lack of PA and increased health risks in early childhood, a more focused review is still desirable to establish consistent guidelines, identify suitable health goals and assess worldwide levels of inactivity among preschool children, as well as to clarify observations across different countries.

Despite this analytical difficulty, the results of the present review indicate that sedentary behaviour is increasing and that PA levels of preschoolers are often lower than those prescribed even by the US recommendations. Considering the NASPE criterion of 60 min/day of PA, the average percentage of children with low levels of PA across two review studies²⁴24 Tucker P. The physical activity levels of preschool-aged children: A systematic review. Early Child Res Q 2008; 23(4):547-558.^,2626 Hnatiuk JA, Salmon J, Hinkley T, Okely AD, Trost S. A review of preschool children's physical activity and sedentary time using objective measures. Am J Prev Med 2014; 47(4):487-497. varied in 34% a 94% and in this study it is 86% (sum of all mean of each study). This confirms that the risk of sedentary behaviour has increased in the period between 2006 and 2016. Of course, if one uses the stronger NASPE criterion of 120 min/day or the other three countries’ recommendation of 180 min/day, the percentage of insufficiently active children is even higher.

This situation is dangerous from a public health perspective because low levels of PA may enhance the risk of developing diseases associated with sedentary behaviour, such as obesity and cardiovascular diseases⁵5 De Onis M, Blossner M, Borghi E. Global prevalence and trends of overweight and obesity among preschool children. Am J Clin Nutr 2010; 92(5):1257-1264., as well as other developmental risks⁸8 Williams HG, Pfeiffer KA, O'Neill JR, Dowda M, McIver KL, Brown WH, Pate RR. Motor skill performance and physical activity in preschool children. Obesity 2008; 16(16):1421-1426.^,2525 Timmons BW, Leblanc AG, Carson V, Connor GS, Dillman C, Janssen I, Kho ME, Spence JC, Stearns JA, Tremblay MS. Systematic review of physical activity and health in the early years (aged 0-4 years). Appl Physiol Nutr Metab 2012; 37(4):773-792..

Timmons et al.²⁵25 Timmons BW, Leblanc AG, Carson V, Connor GS, Dillman C, Janssen I, Kho ME, Spence JC, Stearns JA, Tremblay MS. Systematic review of physical activity and health in the early years (aged 0-4 years). Appl Physiol Nutr Metab 2012; 37(4):773-792.. and Ginsburg²⁷27 Ginsburg K. The Importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics 2007; 119(1):182-191. have disagreed with the idea of defining an exact period of time for which all preschool children should perform PA, arguing that it should be a natural and meaningful action for all children, everywhere and at all times²⁵25 Timmons BW, Leblanc AG, Carson V, Connor GS, Dillman C, Janssen I, Kho ME, Spence JC, Stearns JA, Tremblay MS. Systematic review of physical activity and health in the early years (aged 0-4 years). Appl Physiol Nutr Metab 2012; 37(4):773-792.^,2727 Ginsburg K. The Importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics 2007; 119(1):182-191.. However, systematic observations of the daily life activities of preschool children have shown that children often do not receive adequate opportunities to experience PA as a meaningful and natural action²⁸28 Faria MCM, Brolo ALR, Horita KY, Tolocka RE, Santos DCC, Silva JVP. Daily living motor activities and their influences on the development of preschool. Movimento 2010; 16(1):113-130..

Therefore, it is important to establish reliable and efficient guidance that considers the various characteristics of preschoolers and analyses other factors that may be associated with low PA levels in preschool children. Additionally, it is important to review how PA programmes have been implemented for such children during the period between 2006 and 2016.

Implementation of Physical Activity Programmes for Preschool Children in the Period between 2006-2016

Among the studies of PA programmes in actual practice in the period between 2006 and 2016, this review focused on ones that examined children from the US²⁹29 Annesi JJ, Smith AE, Tennant GA. Effects of the Start for Life treatment on physical activity in primarily African American preschool children of ages 3-5 years. Psychol Health Med 2013; 18(3):300-309.^,3030 Pate RR, Brown WH, Pfeiffer KA, Howie EK, Saunders RP, Addy CL, Dowda M. An Intervention to Increase Physical Activity in Children: A Randomized Controlled Trial With 4-Year-Olds in Preschools. Am J Prev Med 2016; 51(1):12-22., Germany³¹31 De Bock F, Genser B, Raat H, Fischer JE, Renz-Polster H. A participatory physical activity intervention in preschools: a cluster randomized controlled trial. Am J Prev Med 2013; 45(1):64-74.^,3232 Roth K, Kriemler S, Lehmacher W, Ruf KC, Graf C, Hebestreit H. Effects of a Physical Activity Intervention in Preschool Children. Med Sci Sports Exerc 2015; 47(12):2542-2551., England³³33 O'Dwyer MV, Fairclough SJ, Ridgers ND, Knowles, ZR, Foweather L, Stratton G. Effect of a school-based active play intervention on sedentary time and physical activity in preschool children. Health Educ Res 2013; 28(6):931-942., Belgium³⁴34 De Craemer M, De Decker E, Verloigne M, De Bourdeaudhuij I, Manios Y, Cardon G. The effect of a kindergarten-based, family involved intervention on objectively measured physical activity in Belgian preschool boys and girls of high and low SES: the ToyBox-study. Int J Behav Nutr Phys Act 2014; 11(1):38-51. and Canada³⁵35 Goldfield GS, Harvey AL, Grattan KP, Temple V, Naylor PJ, Alberga AS, Ferraro ZM, Wilson S, Cameron JD, Barrowman N, Adamo KB. Effects of Child Care Intervention on Physical Activity and Body Composition. Am J Prev Med 2016; 51(2):225-231.. The age of children studied ranged from three to six years old and the sample size of children varied from 50 to 826 participants. The period of the intervention programmes ranged between six weeks and two years.

The instruments for data collection were: Accelerometer ActiGraph GT3X²⁹29 Annesi JJ, Smith AE, Tennant GA. Effects of the Start for Life treatment on physical activity in primarily African American preschool children of ages 3-5 years. Psychol Health Med 2013; 18(3):300-309.; accelerometer (model not specified) and anthropometric measurements³¹31 De Bock F, Genser B, Raat H, Fischer JE, Renz-Polster H. A participatory physical activity intervention in preschools: a cluster randomized controlled trial. Am J Prev Med 2013; 45(1):64-74.; accelerometer ActiGraph GT1M and structured questionnaire to parents³³33 O'Dwyer MV, Fairclough SJ, Ridgers ND, Knowles, ZR, Foweather L, Stratton G. Effect of a school-based active play intervention on sedentary time and physical activity in preschool children. Health Educ Res 2013; 28(6):931-942.; ToyBox-intervention (six steps)³⁴34 De Craemer M, De Decker E, Verloigne M, De Bourdeaudhuij I, Manios Y, Cardon G. The effect of a kindergarten-based, family involved intervention on objectively measured physical activity in Belgian preschool boys and girls of high and low SES: the ToyBox-study. Int J Behav Nutr Phys Act 2014; 11(1):38-51.; accelerometer (model not specified), motor test and anthropometric measurements and semi qualitative questionnaire to parents³²32 Roth K, Kriemler S, Lehmacher W, Ruf KC, Graf C, Hebestreit H. Effects of a Physical Activity Intervention in Preschool Children. Med Sci Sports Exerc 2015; 47(12):2542-2551.; accelerometer (model not specified) and instruction to teacher’s³⁰30 Pate RR, Brown WH, Pfeiffer KA, Howie EK, Saunders RP, Addy CL, Dowda M. An Intervention to Increase Physical Activity in Children: A Randomized Controlled Trial With 4-Year-Olds in Preschools. Am J Prev Med 2016; 51(1):12-22.; accelerometry (model not specified), body composition and instruction to teacher’s³⁵35 Goldfield GS, Harvey AL, Grattan KP, Temple V, Naylor PJ, Alberga AS, Ferraro ZM, Wilson S, Cameron JD, Barrowman N, Adamo KB. Effects of Child Care Intervention on Physical Activity and Body Composition. Am J Prev Med 2016; 51(2):225-231..

All studies implemented daily PA, except De Bock et al.³¹31 De Bock F, Genser B, Raat H, Fischer JE, Renz-Polster H. A participatory physical activity intervention in preschools: a cluster randomized controlled trial. Am J Prev Med 2013; 45(1):64-74. in which PA took place twice a week. The amount of PA time provided varied among 30, 35, 60, 120 and 180 minutes per day; De Bock et al.³¹31 De Bock F, Genser B, Raat H, Fischer JE, Renz-Polster H. A participatory physical activity intervention in preschools: a cluster randomized controlled trial. Am J Prev Med 2013; 45(1):64-74. did not clarify this information.

An increase in PA levels was demonstrated in five studies; Goldfield et al.³⁵35 Goldfield GS, Harvey AL, Grattan KP, Temple V, Naylor PJ, Alberga AS, Ferraro ZM, Wilson S, Cameron JD, Barrowman N, Adamo KB. Effects of Child Care Intervention on Physical Activity and Body Composition. Am J Prev Med 2016; 51(2):225-231. and O’Dwyer et al.³³33 O'Dwyer MV, Fairclough SJ, Ridgers ND, Knowles, ZR, Foweather L, Stratton G. Effect of a school-based active play intervention on sedentary time and physical activity in preschool children. Health Educ Res 2013; 28(6):931-942. documented the best results. They offered, respectively, 60 min/day and 180 min/day of activity, complying with the American²⁰20 National Association for Sport and Physical Education (NASPE). Active Start: A Statement of Physical Activity Guidelines for Children from Birth to Age 5. 2nd ed. Oxon Hill: Aahperd Publications; 2009. and United Kingdom²²22 United Kingdom. Department of Health. Start Active, Stay Active: A Report on Physical Activity for Health from the Four Home Countries. London: Department of Health; 2011. determinations. Although the results were positive, in three studies, the estimated time of the daily activity did not reach the minimum PA time recommended for preschool children. De Craemer et al.³⁴34 De Craemer M, De Decker E, Verloigne M, De Bourdeaudhuij I, Manios Y, Cardon G. The effect of a kindergarten-based, family involved intervention on objectively measured physical activity in Belgian preschool boys and girls of high and low SES: the ToyBox-study. Int J Behav Nutr Phys Act 2014; 11(1):38-51., was the only one study that did not obtain positive results. Study findings are shown in Chart 2.

The ages correspond to the age group proposed in preschool children, therefore it is in agreement with the expected parameters, and the PA was offered with different frequency, duration, intensity and quantity. The methods of determining the level of PA also varied. De Craemer et al.³⁴34 De Craemer M, De Decker E, Verloigne M, De Bourdeaudhuij I, Manios Y, Cardon G. The effect of a kindergarten-based, family involved intervention on objectively measured physical activity in Belgian preschool boys and girls of high and low SES: the ToyBox-study. Int J Behav Nutr Phys Act 2014; 11(1):38-51., Goldfield et al.³⁵35 Goldfield GS, Harvey AL, Grattan KP, Temple V, Naylor PJ, Alberga AS, Ferraro ZM, Wilson S, Cameron JD, Barrowman N, Adamo KB. Effects of Child Care Intervention on Physical Activity and Body Composition. Am J Prev Med 2016; 51(2):225-231. and Pate et al.³⁰30 Pate RR, Brown WH, Pfeiffer KA, Howie EK, Saunders RP, Addy CL, Dowda M. An Intervention to Increase Physical Activity in Children: A Randomized Controlled Trial With 4-Year-Olds in Preschools. Am J Prev Med 2016; 51(1):12-22. classified three intensity levels of PA, whereas Annesi et al.²⁹29 Annesi JJ, Smith AE, Tennant GA. Effects of the Start for Life treatment on physical activity in primarily African American preschool children of ages 3-5 years. Psychol Health Med 2013; 18(3):300-309., Bock et al.³¹31 De Bock F, Genser B, Raat H, Fischer JE, Renz-Polster H. A participatory physical activity intervention in preschools: a cluster randomized controlled trial. Am J Prev Med 2013; 45(1):64-74., O’Dwyer et al.³³33 O'Dwyer MV, Fairclough SJ, Ridgers ND, Knowles, ZR, Foweather L, Stratton G. Effect of a school-based active play intervention on sedentary time and physical activity in preschool children. Health Educ Res 2013; 28(6):931-942. and Roth et al.³²32 Roth K, Kriemler S, Lehmacher W, Ruf KC, Graf C, Hebestreit H. Effects of a Physical Activity Intervention in Preschool Children. Med Sci Sports Exerc 2015; 47(12):2542-2551. analysed only one or two distinct levels.

As a result of these differences, appropriate comparisons among the studies cited are difficult, corroborating the conclusion by Timmons et al.²⁵25 Timmons BW, Leblanc AG, Carson V, Connor GS, Dillman C, Janssen I, Kho ME, Spence JC, Stearns JA, Tremblay MS. Systematic review of physical activity and health in the early years (aged 0-4 years). Appl Physiol Nutr Metab 2012; 37(4):773-792. that there is no consensus as to the amount, type, frequency or intensity of PA proposed for preschool children.

However, a meta-analysis of Gordon et al.³⁶36 Gordon ES, Tucker P, Burke SM, Carron AV. Effectiveness of physical activity interventions for preschoolers: a meta-analysis. Res Q Exerc Sport 2013; 84(3):287-294. on the effects of PA programmes for preschoolers determined that strategies with at least four weeks of intervention achieved positive results in raising moderate levels of PA in children. These interventions primarily involved changes in the environment and the introduction of outdoor activities³⁶36 Gordon ES, Tucker P, Burke SM, Carron AV. Effectiveness of physical activity interventions for preschoolers: a meta-analysis. Res Q Exerc Sport 2013; 84(3):287-294..

Factors Associated with Physical Activity Practice in Preschool Children

Factors associated with PA levels among preschool children were analysed in 14 studies, nine of which referred to the factors of physical environment and socio-economic characteristics (Barros et al.¹³13 Barros SSH, Lopes AS, Barros MVG. Prevalence of low physical activity level among preschool children. Rev Bras Cineantropom Desempenho Hum 2012; 14(4):390-400., Barbosa et al.¹⁴14 Barbosa SC, Coledam DHC, Stabelini AN, Elias RGM, Oliveira AR. School environment, sedentary behavior and physical activity in preschool children. Rev Paul Pediatr 2016; 34(3):301-308., Henderson et al.¹⁵15 Henderson KE, Grode GM, O'Connell ML, Schwartz MB. Environmental factors associated with physical activity in child care centers. Int J Behav Nutr Phys Act 2015; 12(43):1-9., Tandon et al.¹⁶16 Tandon PS, Saelens BE, Christakis DA. Active Play Opportunities at Child Care. Pediatrics 2015; 135(6):1425-1431., Faria et al.²⁸28 Faria MCM, Brolo ALR, Horita KY, Tolocka RE, Santos DCC, Silva JVP. Daily living motor activities and their influences on the development of preschool. Movimento 2010; 16(1):113-130., Bürgi et al.³⁷37 Bürgi F, Meyer U, Niederer I, Ebenegger V, Marques-Vidal P, Granacher U, Kriemler S, Puder JJ. Socio-cultural determinants of adiposity and physical activity in preschool children: A crossectional study. BMC Public Health 2010, 10(733):1-8., Dawson-Hahn et al.³⁸38 Dawson-Hahn EE, Fesinmeyer MD, Mendoza JA. Correlates of Physical Activity in Latino Preschool Children Attending Head Start. Pediatr Exerc Sci 2015; 27(3):372-379., Olesen et al.³⁹39 Olesen LG, Kristensen PL, Ried-Larsen M, Grøntved A, Froberg K. Physical activity and motor skills in children attending 43 preschools: a cross-sectional study. BMC Pediatr 2014; 14(229):1-11., Vale et al.⁴⁰40 Vale S, Ricardo N, Soares-Miranda L, Santos R, Moreira C, Mota J. Parental education and physical activity in pre-school children. Child Care Health Dev 2014; 40(3):446-452.). Three studies referred specifically to parental or family factors (Loprinzi and Trost⁴¹41 Loprinzi PD, Trost SG. Parental influences on physical activity behavior in preschool children. Prev Med 2010; 50(3):129-133., O’Dwyer et al.⁴²42 O'Dwyer MV, Fairclough SJ, Knowles Z, Stratton G. Effect of a family focused active play intervention on sedentary time and physical activity in Preschool children. Int J Behav Nutr Phys Act 2012; 9(117):1-13., Remmers et al.⁴³43 Remmers T, Broeren SM, Renders CM, Hirasing RA, van Grieken A, Raat H. A longitudinal study of children's outside play using family environment and perceived physical environment as predictors. Int J Behav Nutr Phys Act 2014; 11(76):1-9.). The other two examined issues of professional preparation (Androutsos et al.⁴⁴44 Androutsos O, Katsarou C, Payr A, Birnbaum J, Geyer C, Wildgruber A, Kreichauf S, Lateva M, De Decker E, De Craemer M, Socha P, Moreno L, Iotova V, Koletzko BV, Manios Y. Designing and implementing teachers' training sessions in a kindergarten-based, family-involved intervention to prevent obesity in early childhood. The Toy Box-study. Obes Rev 2014; 15(3):48-52., Howie et al.⁴⁵45 Howie EK, Brewer AE, Dowda M, Mclver KL, Saunders RP, Pate RR. A Tale of 2 Teachers: A Preschool Physical Activity Intervention Case Study. J Sch Health 2016; 86(1):23-30.).

Among the 14 studies, ten used questionnaires (validated questionnaire and adapted to Brazil¹³13 Barros SSH, Lopes AS, Barros MVG. Prevalence of low physical activity level among preschool children. Rev Bras Cineantropom Desempenho Hum 2012; 14(4):390-400.; structured form of daily preschool analysis¹⁴14 Barbosa SC, Coledam DHC, Stabelini AN, Elias RGM, Oliveira AR. School environment, sedentary behavior and physical activity in preschool children. Rev Paul Pediatr 2016; 34(3):301-308.^,2828 Faria MCM, Brolo ALR, Horita KY, Tolocka RE, Santos DCC, Silva JVP. Daily living motor activities and their influences on the development of preschool. Movimento 2010; 16(1):113-130.^,4343 Remmers T, Broeren SM, Renders CM, Hirasing RA, van Grieken A, Raat H. A longitudinal study of children's outside play using family environment and perceived physical environment as predictors. Int J Behav Nutr Phys Act 2014; 11(76):1-9.; parental characteristics questionnaire³⁷37 Bürgi F, Meyer U, Niederer I, Ebenegger V, Marques-Vidal P, Granacher U, Kriemler S, Puder JJ. Socio-cultural determinants of adiposity and physical activity in preschool children: A crossectional study. BMC Public Health 2010, 10(733):1-8.^,3838 Dawson-Hahn EE, Fesinmeyer MD, Mendoza JA. Correlates of Physical Activity in Latino Preschool Children Attending Head Start. Pediatr Exerc Sci 2015; 27(3):372-379.^,4040 Vale S, Ricardo N, Soares-Miranda L, Santos R, Moreira C, Mota J. Parental education and physical activity in pre-school children. Child Care Health Dev 2014; 40(3):446-452.; semi qualitative questionnaire³⁹39 Olesen LG, Kristensen PL, Ried-Larsen M, Grøntved A, Froberg K. Physical activity and motor skills in children attending 43 preschools: a cross-sectional study. BMC Pediatr 2014; 14(229):1-11.; international physical activity questionnaire - IPAQ⁴¹41 Loprinzi PD, Trost SG. Parental influences on physical activity behavior in preschool children. Prev Med 2010; 50(3):129-133.^,4242 O'Dwyer MV, Fairclough SJ, Knowles Z, Stratton G. Effect of a family focused active play intervention on sedentary time and physical activity in Preschool children. Int J Behav Nutr Phys Act 2012; 9(117):1-13.) and nine used accelerometers (ActiGraph GT1M¹⁵15 Henderson KE, Grode GM, O'Connell ML, Schwartz MB. Environmental factors associated with physical activity in child care centers. Int J Behav Nutr Phys Act 2015; 12(43):1-9.^,3737 Bürgi F, Meyer U, Niederer I, Ebenegger V, Marques-Vidal P, Granacher U, Kriemler S, Puder JJ. Socio-cultural determinants of adiposity and physical activity in preschool children: A crossectional study. BMC Public Health 2010, 10(733):1-8.^,3838 Dawson-Hahn EE, Fesinmeyer MD, Mendoza JA. Correlates of Physical Activity in Latino Preschool Children Attending Head Start. Pediatr Exerc Sci 2015; 27(3):372-379.^,4040 Vale S, Ricardo N, Soares-Miranda L, Santos R, Moreira C, Mota J. Parental education and physical activity in pre-school children. Child Care Health Dev 2014; 40(3):446-452.^,4242 O'Dwyer MV, Fairclough SJ, Knowles Z, Stratton G. Effect of a family focused active play intervention on sedentary time and physical activity in Preschool children. Int J Behav Nutr Phys Act 2012; 9(117):1-13.; ActiGraph GT3X¹⁴14 Barbosa SC, Coledam DHC, Stabelini AN, Elias RGM, Oliveira AR. School environment, sedentary behavior and physical activity in preschool children. Rev Paul Pediatr 2016; 34(3):301-308.^,1616 Tandon PS, Saelens BE, Christakis DA. Active Play Opportunities at Child Care. Pediatrics 2015; 135(6):1425-1431.; ActiGraph GT1M and GT3X³⁹39 Olesen LG, Kristensen PL, Ried-Larsen M, Grøntved A, Froberg K. Physical activity and motor skills in children attending 43 preschools: a cross-sectional study. BMC Pediatr 2014; 14(229):1-11.; ActiGraph 7164⁴¹41 Loprinzi PD, Trost SG. Parental influences on physical activity behavior in preschool children. Prev Med 2010; 50(3):129-133.) to associate environmental factors with PA levels and sedentary behaviour; to identify the activities performed by children and discussed capacity strategies and the participation of parents and teachers. Chart 3 presents relevant details on these studies.

The studies identified the following as positive factors that contributed towards increasing or preserving children’s level of PA: (a) recreational time; (b) time for outdoor activities; (c) physical space for games and recreation; (d) use of parks; and (e) indoor space for adapted games. Negative aspects included (a) rigid school routines; (b) overuse of academic activities that leave children in queues, sitting and waiting; (c) time spent playing with toys; (d) lack of space at home; (e) full-day school attendance; and (f) time spent watching television.

The availability of open space and a suitable environment is clearly essential to raise the level of PA among preschool children in educational or child-care settings, at home and in public areas¹⁵15 Henderson KE, Grode GM, O'Connell ML, Schwartz MB. Environmental factors associated with physical activity in child care centers. Int J Behav Nutr Phys Act 2015; 12(43):1-9.^,1616 Tandon PS, Saelens BE, Christakis DA. Active Play Opportunities at Child Care. Pediatrics 2015; 135(6):1425-1431.^,4343 Remmers T, Broeren SM, Renders CM, Hirasing RA, van Grieken A, Raat H. A longitudinal study of children's outside play using family environment and perceived physical environment as predictors. Int J Behav Nutr Phys Act 2014; 11(76):1-9.. Another favourable step is to reserve dedicated time in school or elsewhere for children to move around¹⁴14 Barbosa SC, Coledam DHC, Stabelini AN, Elias RGM, Oliveira AR. School environment, sedentary behavior and physical activity in preschool children. Rev Paul Pediatr 2016; 34(3):301-308.^,2828 Faria MCM, Brolo ALR, Horita KY, Tolocka RE, Santos DCC, Silva JVP. Daily living motor activities and their influences on the development of preschool. Movimento 2010; 16(1):113-130..

Children’s sedentary behaviour has been linked with the amount of time spent watching television³⁸38 Dawson-Hahn EE, Fesinmeyer MD, Mendoza JA. Correlates of Physical Activity in Latino Preschool Children Attending Head Start. Pediatr Exerc Sci 2015; 27(3):372-379., the absence of space for physical activities¹³13 Barros SSH, Lopes AS, Barros MVG. Prevalence of low physical activity level among preschool children. Rev Bras Cineantropom Desempenho Hum 2012; 14(4):390-400., inflexibility in the school routine and a heavy emphasis on academic activities that require children to stay seated for long periods of time²⁸28 Faria MCM, Brolo ALR, Horita KY, Tolocka RE, Santos DCC, Silva JVP. Daily living motor activities and their influences on the development of preschool. Movimento 2010; 16(1):113-130.. This last practice is contrary to official recommendations, which discourage engaging children in sedentary activities for more than 60 minutes at a time²⁰20 National Association for Sport and Physical Education (NASPE). Active Start: A Statement of Physical Activity Guidelines for Children from Birth to Age 5. 2nd ed. Oxon Hill: Aahperd Publications; 2009.

21 Ageing DH. Move and play every day. National Physical Activity Recommendations for Children 0-5 Years [Internet]. Commonwealth of Australia; 2010 [cited 2017 Jun 14]. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/npra-0-5yrs-brochure
http://www.health.gov.au/internet/main/p...

22 United Kingdom. Department of Health. Start Active, Stay Active: A Report on Physical Activity for Health from the Four Home Countries. London: Department of Health; 2011.^-2323 Tremblay MS, Leblanc AG, Carson V, Choquette L, Connor GS, Dillman C, Mary Duggan M, Gordon M, Hicks A, Janssen I, Kho M, Latimer-Cheung A, LeBlanc C, Murumets K, Okely A, Reilly J, Spence J, Stearns J, Timmons B. Canadian Society for Exercise Physiology. Canadian physical activity guidelines for the early years (aged 0-4 years). Appl Physiol Nutr Metab 2012; 37(2): 345-369..

In studies related to professional factors, the following were associated with increasing or preserving PA levels: (a) suggestions and training models, capacity and professional qualification between universities and schools; (b) the teacher’s actual participation in and encouraging children to engage in physical activities; and (c) planning and the choice of activities⁴⁴44 Androutsos O, Katsarou C, Payr A, Birnbaum J, Geyer C, Wildgruber A, Kreichauf S, Lateva M, De Decker E, De Craemer M, Socha P, Moreno L, Iotova V, Koletzko BV, Manios Y. Designing and implementing teachers' training sessions in a kindergarten-based, family-involved intervention to prevent obesity in early childhood. The Toy Box-study. Obes Rev 2014; 15(3):48-52.^,4545 Howie EK, Brewer AE, Dowda M, Mclver KL, Saunders RP, Pate RR. A Tale of 2 Teachers: A Preschool Physical Activity Intervention Case Study. J Sch Health 2016; 86(1):23-30..

Although the literature has still not proven a direct relationship between training programmes for teachers and increased PA levels for preschool children, the case study conducted by Howie et al.⁴⁵45 Howie EK, Brewer AE, Dowda M, Mclver KL, Saunders RP, Pate RR. A Tale of 2 Teachers: A Preschool Physical Activity Intervention Case Study. J Sch Health 2016; 86(1):23-30. observed two teachers during three years of training, which enabled them to increase the PA opportunities offered to children.

Teachers’ professional development and behaviour can influence the healthy habits of preschoolers, especially with regard to their practice of PA; this finding was reported by Ward et al.⁴⁶46 Ward S, Bélanger M, Donovan D, Carrier N. Systematic review of the relationship between childcare educators' practices and preschoolers' physical activity and eating behaviours. Obes Rev 2015; 16(12):1055-1070., in a review of studies on the daily behaviours adopted by teachers that contributed towards children’s healthy development.

In the studies related to family factors, those associated with increasing or maintaining high levels of PA included (a) parents’ involvement and participation; (b) guidance booklets, information and instructions offered to parents; and (c) the availability of extracurricular activities¹³13 Barros SSH, Lopes AS, Barros MVG. Prevalence of low physical activity level among preschool children. Rev Bras Cineantropom Desempenho Hum 2012; 14(4):390-400.^,4141 Loprinzi PD, Trost SG. Parental influences on physical activity behavior in preschool children. Prev Med 2010; 50(3):129-133.

42 O'Dwyer MV, Fairclough SJ, Knowles Z, Stratton G. Effect of a family focused active play intervention on sedentary time and physical activity in Preschool children. Int J Behav Nutr Phys Act 2012; 9(117):1-13.^-4343 Remmers T, Broeren SM, Renders CM, Hirasing RA, van Grieken A, Raat H. A longitudinal study of children's outside play using family environment and perceived physical environment as predictors. Int J Behav Nutr Phys Act 2014; 11(76):1-9.. Factors shown to have a negative impact were (a) inadequate parental health habits or obesity³⁷37 Bürgi F, Meyer U, Niederer I, Ebenegger V, Marques-Vidal P, Granacher U, Kriemler S, Puder JJ. Socio-cultural determinants of adiposity and physical activity in preschool children: A crossectional study. BMC Public Health 2010, 10(733):1-8.^,3838 Dawson-Hahn EE, Fesinmeyer MD, Mendoza JA. Correlates of Physical Activity in Latino Preschool Children Attending Head Start. Pediatr Exerc Sci 2015; 27(3):372-379. and (b) higher level of parental education⁴⁰40 Vale S, Ricardo N, Soares-Miranda L, Santos R, Moreira C, Mota J. Parental education and physical activity in pre-school children. Child Care Health Dev 2014; 40(3):446-452..

Loprinzi and Trost⁴¹41 Loprinzi PD, Trost SG. Parental influences on physical activity behavior in preschool children. Prev Med 2010; 50(3):129-133. demonstrated promising results in terms of increased PA among children when the parents became participants in activities and projects developed by children in their school. Similarly, both O’Dwyer et al.⁴²42 O'Dwyer MV, Fairclough SJ, Knowles Z, Stratton G. Effect of a family focused active play intervention on sedentary time and physical activity in Preschool children. Int J Behav Nutr Phys Act 2012; 9(117):1-13. and Remmers et al.⁴³43 Remmers T, Broeren SM, Renders CM, Hirasing RA, van Grieken A, Raat H. A longitudinal study of children's outside play using family environment and perceived physical environment as predictors. Int J Behav Nutr Phys Act 2014; 11(76):1-9. showed how parents’ healthy life habits influence the behaviour and habits of children, both within and outside school, which contributes to the review of Brown et al.⁴⁷47 Brown HE, Atkin AJ, Panter J, Wong G, Chinapaw MJ, van Sluijs EM. Family-based interventions to increase physical activity in children: a systematic review, meta-analysis and realist synthesis. Obes Rev 2016; 17(4):345-360. about of the involvement of the family to increase physical activity in children.

Barros et al.¹³13 Barros SSH, Lopes AS, Barros MVG. Prevalence of low physical activity level among preschool children. Rev Bras Cineantropom Desempenho Hum 2012; 14(4):390-400. and Vale et al.⁴⁰40 Vale S, Ricardo N, Soares-Miranda L, Santos R, Moreira C, Mota J. Parental education and physical activity in pre-school children. Child Care Health Dev 2014; 40(3):446-452. found an association between lower levels of child PA and higher levels of parental education, but Bürgi et al.³⁷37 Bürgi F, Meyer U, Niederer I, Ebenegger V, Marques-Vidal P, Granacher U, Kriemler S, Puder JJ. Socio-cultural determinants of adiposity and physical activity in preschool children: A crossectional study. BMC Public Health 2010, 10(733):1-8. and Dawson-Hahn et al.³⁸38 Dawson-Hahn EE, Fesinmeyer MD, Mendoza JA. Correlates of Physical Activity in Latino Preschool Children Attending Head Start. Pediatr Exerc Sci 2015; 27(3):372-379. reported opposite results (higher level of parental education higher level of PA). Therefore, the interaction between the socio-cultural context and levels of PA should be further investigated.

The negative factors associated with PA levels of preschool children suggest the need for modifications of the institutional environment, not only in the structural and physical sense but also to provide better incentives and opportunities for children to develop, researches that use ecological models is necessary⁴⁸48 Bingham DD, Costa S, Hinkley T, Shire KA, Clemes SA, Barber SE. Physical Activity During the Early Years: A Systematic Review of Correlates and Determinants. Am J Prev Med 2016; 51(3):384-402..

The context in which the child is inserted must respect his or her individual characteristics, such as whether the child enjoys running. It should also encourage social relationships and diverse experiences in environments frequented by other children, both at school and elsewhere. The insertion of active play, as noted by Ginsburg²⁷27 Ginsburg K. The Importance of play in promoting healthy child development and maintaining strong parent-child bonds. Pediatrics 2007; 119(1):182-191., has been identified as a positive factor in encouraging PA among small children.

Limitations and Recommendations for Future Research

The points of uncertainty and disagreement that exist between official recommendations and between the methods used to detect and to improve PA levels do not seem to have benefitted scientific research in this area. They may also have held back efforts to devise strategies to combat sedentary lifestyles and increase PA among preschool children. Therefore, further discussion of these topics should take place.

The influence of parental education on children’s PA remains to be clarified, as the results of existing studies were contradictory on this point; high levels of parent education were associated with high PA among preschool children in two studies and low PA in two others.

Although there is no consensus on what amount of time spent in a sitting position constitutes sedentary behaviour in children, there is evidence that the percentage of preschool children with inadequate PA time has increased in recent years. This lack of PA could damage their development as well as increasing their risk of various diseases. And contextual variables (family environment, school environment, the child and activities performed) have too that influence the PA levels of children. Consequently, an increase in PA among preschoolers is urgently required, and public policy should encourage this change.

To construct efficient policies and to design actions that will lead to increased PA, it is essential to better understand how preschool children experience different aspects of PA. Therefore, more research should be conducted on contextual variables related to PA among preschoolers.

Conclusions

Existing studies have contributed to our knowledge of preschool children’s level of PA; they have shown the impact of the implementation of various PA programmes in preschools and have revealed factors associated with PA among preschool children.

There is lack of studies of the minimum time of PA ideal for preschool children. However, the risk of sedentary behaviour among preschoolers has increased during the period between 2006 and 2016, regardless of the frequency level applied.

The implementation of some PA programmes has succeeded in increasing children’s average PA time, even though the amount of PA provided was still below official recommendations in some cases. Such programmes had different methodologies and varied with regard to the amount, frequency, intensity and type of PA offered. The approaches to assessing levels of PA and the strategies to improve PA levels also were differed.

Low levels of PA for preschool children were associated with various contextual variables: lack of stimulation at home and at school, lack of time and space to play outdoors, infrastructure problems and resources in schools, rigid routines and time spent watching television or using other electronic devices (computers, tablets and cell phones).

Accordingly, teachers, parents and other segments of society should be encouraged to discuss strategies, criteria and recommendations the adoption of which will increase the PA level of preschool children.

References

Publication Dates

History