Environmental/Family/Psychosocial Influences on Physical Activity in Young Children

Introduction

For many years, parents and researchers believed that “young children are naturally physically active.”¹ Recent evidence suggests that this is not the case with studies showing that young children spend around 80-85% of their time being sedentary, very little time being active^2-3 and between two and four hours a day watching television.^{2, 4-6} Recommendations for physical activity vary between countries. The U.S. recommends that young children participate in at least two hours of physical activity each day,⁷ while the more recent Australian and U.K. recommendations suggest three or more hours per day.^8-9 Recent estimates of compliance with the physical activity recommendations suggest that the majority of children (up to 95%) fail to achieve the recommended amount.^2,10 Recommendations for screen-based entertainment (television, computer, electronic games) vary between age groups and countries but consistently suggest that children younger than two years should participate in no screen-based entertainment.^8,11 In Australia, children aged 2-5 years are recommended to participate in no more than one hour per day,⁸ while in the U.S. no more than two hours is recommended for that age group.¹² Recent estimates of children meeting these guidelines vary between about 22%² and 34%.⁴ Studies in children younger than three years of age are sparse however these suggest that low levels of physical activity¹³ and high levels of screen-based entertainment⁵ might also be evident in infants and toddlers. These behaviours are important to investigate and understand as evidence shows that they are associated with health and other outcomes, including obesity,^14-15 bone mineral content¹⁶ and cognitive and behavioural outcomes.^17-18

Subject

Given the small number of young children achieving the recommended amount of physical activity and screen-based entertainment, it is important to investigate and identify the factors, or correlates, that might support or constrain those behaviours. In so doing, it may be possible to identify targets for intervention to support healthy levels of physical activity during early childhood.

Problems and Research Context

There exist several challenges to measuring physical activity and screen-based entertainment and their correlates during the early childhood period. Young children cannot self-report how much time they spend in such behaviours and it may also be difficult for parents to estimate as their children may spend many hours each day in non-parental care, for instance in preschool or childcare. Objective measures of physical activity, such as activity monitors (accelerometers) are available and commonly used, however, objective measures of screen-based entertainment, although available, are seldom used.

Many studies investigating potential correlates of physical activity and screen-based entertainment during the early childhood period have focused on the preschool years, that is, roughly three to five years of age. Subsequently, there is very little understanding of children’s behaviours during the period from birth to two years of age. Importantly, knowledge of behaviours and their correlates during the preschool period may not be transferrable to younger children.

Studies investigating correlates of physical activity and screen-based entertainment have also typically measured only a few correlates, such as parental factors^19-20 or variables in the preschool/childcare²¹ or home²² environments. Because of this, there is little understanding of how the correlates might be associated with each of the behaviours when considered in their broader context. That is: how might parental factors such as self efficacy be associated with young children’s physical activity or screen-based entertainment when environmental factors such as availability of equipment in the home or access to parks in the neighbourhood are also considered?

Key Research Questions

Key questions in this field include identifying the domains of correlates of behaviour during early childhood. That is, are there correlates at the individual, social and physical environment levels that might be associated with young children’s behaviours? It is also important to identify what the key correlates in each of those domains might be as these can then be used as targets in programs to support healthy behaviours in young children.

Recent Research Results

Correlates of young children’s physical activity and screen-based entertainment, mostly in  three- to five-year-olds, have previously been reported across several studies. Correlates are evident in different domains – that is, individual (sex, age, individual preferences), social (parental factors) and physical environment (home, preschool, neighbourhood factors) correlates appear to be associated with young children’s physical activity²³ and screen-based entertainment.²⁴ For instance, across many studies, boys are consistently reported to be more active than girls, even in this young age group^2,21,23 however there appears to be no difference in time in screen-based entertainment between boys and girls.²⁴ Associations between age with physical activity or screen-based entertainment are less clear. Some studies report that older children are less active than young children in this age group^2,25-26 and participate in more screen-based entertainment,²⁷ while others report that there is no difference in behaviours between older and younger children during the early childhood period.^22,28-30 Differences in findings may be attributable to different sample characteristics, such as social or geographical considerations, or sizes, or methods of measuring behaviours or correlates. There appears to be no association between socioeconomic position and physical activity or screen-based entertainment during early childhood.^23-24 Virtually nothing is known about children’s innate preferences to be active or engage in other behaviours and these may also be important considerations.

Social correlates such as parental physical activity^19,23,26 and supporting their child to be active³¹ have been shown to be associated with physical activity in young children. For screen-based entertainment, parental rules restricting such entertainment are associated with children spending less time in those behaviours.^20,22,32 Parents who spend more time in screen-based entertainment themselves appear to also have children with higher levels of participation.³³ However little is known about many other social factors that may be potential correlates of these behaviours (e.g. sibling influence or interaction, and interaction with other people such as grandparents who increasingly play more prominent roles in young children’s lives).

While many potential correlates of physical activity and screen-based entertainment have been investigated in the physical environment, most have only been explored in one or two studies, so it is difficult to draw overall conclusions.^23-24 However more time spent outdoors²³ appears to be consistently associated with higher levels of physical activity in young children. Conversely, the amount of play equipment in the home has been shown to have no association with how active young children are^34-35 and an intervention designed to increase physical activity by introducing new play equipment into the preschool environment found no change in physical activity.³⁶ For screen-based entertainment, having the television constantly on in the home appears to be associated with higher levels of television viewing in young children.^20,32 Other factors in the physical environment, such as access to facilities, require further investigation.

Research Gaps

Many gaps exist in the current knowledge base around the correlates of physical activity and screen-based entertainment in young children. Specifically these include very limited knowledge about the level of physical activity and screen-based entertainment in children younger than about three years¹³ or of any potential correlates that might be associated with those behaviours during that period.

While many correlates have been investigated, studies have primarily looked at only a small number of potential correlates or have investigated only correlates in one domain, such as individual or social level correlates.^23-24 Research therefore needs to investigate a larger number of correlates, across multiple domains simultaneously, to gain a more comprehensive understanding of how specific factors may be associated with physical activity and screen-based entertainment in their broader contexts. One study that did this for physical activity found that correlates were mainly at an individual level but varied between boys and girls.³⁵ However, the number of correlates that the study investigated was quite small and further investigation is required. Evidence supporting differences or similarities in correlates between boys and girls is also required.

Correlates in the physical environment have typically shown little association with physical activity or screen-based entertainment during early childhood and are generally measured by parent report. Objective measures of such correlates, including availability and accessibility of facilities, aesthetics in the neighbourhood environment, and safety, may provide further insight into factors which may support healthy behaviours during the early childhood period. Additionally, interventions aiming to change correlates and observe subsequent change in physical activity or screen-based entertainment during this period are sparse, and as they provide stronger evidence than the cross-sectional studies typically undertaken to date, would be a valuable addition to the literature.

Conclusions

Recommendations for participation in physical activity and screen-based entertainment during the early childhood period (birth to five years) are now available in several countries, including the U.S. and Australia.^7-8,11-12 However, young children still largely fail to achieve the recommended amount of physical activity and the majority of children exceed recommendations for screen-based entertainment. Identifying the correlates of these behaviours is therefore crucial for the development of programs to support healthy levels of physical activity and screen-based entertainment during the early childhood period, which, in turn, support healthy outcomes for children. Although few individual correlates have shown consistent associations with young children’s behaviours, parental correlates appear to be important across studies. Given the amount of time and input parents have in their young children’s lives, this is hardly surprising. Supporting parents is therefore important in achieving the ultimate goal of providing healthy environments for children’s development.

Implications for Parents, Services and Policy

From a policy perspective, it is important to disseminate information about health behaviours, including recommended levels of physical activity and screen-based entertainment. Such dissemination enables parents and service providers to be aware of how much time young children should spend in these behaviours. Additionally, dissemination of information about the health outcomes of excessive screen-based entertainment or inadequate physical activity would provide parents and service providers with further evidence to support decisions regarding children’s opportunities to be active or engage in screen-based entertainment.

Service providers such as preschools, childcare centres, and health providers, should be required to undertake training in provision of physical activity during the early childhood period. Ensuring that children have several hours outside during the day may also be important to support adequate opportunities to be active. Given young children spend so much time in screen-based entertainment, removal of such opportunities from preschools and childcare centres may be warranted. Service providers are also often a point of reference and information for parents of young children, and as such, have a responsibility to be able to provide evidence-based information to those parents for the care of their children.

Parents require information, advice and support about what the optimal levels of a range of behaviours, including physical activity and screen-based entertainment, are for their young children, and this role falls primarily with policy makers and service providers. However, parents also have an important role to play in modelling healthy behaviours to their children, ensuring their children have adequate opportunities for outdoor play and minimising opportunities for screen-based entertainment.

References

1. American Academy of Pediatrics: Committee on Sports Medicine and Fitness. Fitness in the Preschool Child. Pediatrics 1976;58(1):88-89.
2. Hinkley T, Salmon J, Okely AD, Crawford DA, Hesketh KD. Preschoolers' physical activity, screen time and compliance with recommendations. Medicine and Science in Sports and Exercise. In press.
3. Cardon G, De Bourdeaudhuij I. Are preschool children active enough? Objectively measured physical activity levels. Research Quarterly for Exercise and Sport 2008;79(3):326-32.
4. Tandon PS, Zhou C, Lozano P, Christakis DA. Preschoolers' total daily screen time at home and by type of child care. Journal of Pediatrics 2011;158(2):297-300.
5. Zimmerman FJ, Christakis DA, Meltzoff AN. Television and DVD/video viewing in children younger than 2 years. Archives of Pediatrics and Adolescent Medicine 2007;161(5):473-479.
6. Stolley MR, Fitzgibbon ML, Dyer A, Horn LV, KauferChristoffel K, Schiffer L. Hip-Hop to Health Jr., an obesity prevention program for minority preschool children: baseline characteristics of participants. Preventive Medicine 2003;36(3):320.
7. American Alliance for Health PE, Recreation and Dance (AAHPERD). NASPE releases first ever physical activity guidelines for infants and toddlers. Illinois Journal for Health, Physical Education, Recreation, and Dance 2002;50:31-32.
8. Department of Health and Aging (DoHA). Get Up and Grow: Healthy Eating and Physical Activity for Early Childhood. Available at: http://www.health.gov.au/internet/main/publishing.nsf/Content/EDFEDB588460BCE3CA25762B00232A13/$File/gug-directorscoord-2.pdf. Accessed April 24, 2012.
9. Department of Health Physical Activity Health Improvement and Protection. Start Active, Stay Active: A report on physical activity from the four home countries' Chief Medical Officers. In. London: Department of Health, Physical Activity, Health Improvement and Protection; 2011:1-62.
10. Beets MW, Bornstein D, Dowda M, Pate RR. Compliance with national guidelines for physical activity in U.S. preschoolers: measurement and interpretation. Pediatrics 2011;127(4):658-64.
11. American Academy of Pediatrics. Policy statement: media use by children younger than 2 years. Pediatrics 2011;128(5):1040-1045.
12. American Academy of Pediatrics Committee on Public Education. Children, adolescents, and television. Pediatrics 2001;107(2):423-426.
13. Cardon G, van Cauwenberghe E, de Bourdeaudhuij I. Physical activity in infants and toddlers. In: Tremblay RE, Barr RG, Peters RDeV, Boivin M, eds. Encyclopedia on Early Childhood Development [online]. Montreal, Quebec: Centre of Excellence for Early Childhood Development; 2011:1-6. Available at: http://www.child-encyclopedia.com/documents/Cardon-van_Cauwenberghe-de_BourdeaudhuijANGxp1.pdf. Accessed April 24, 2012.
14. Jiménez-Pavón D, Kelly J, Reilly JJ. Associations between objectively measured habitual physical activity and adiposity in children and adolescents: Systematic review. International Journal of Pediatric Obesity 2010;5(1):3-18.
15. Hancox RJ, Poulton R. Watching television is associated with childhood obesity: but is it clinically important? International Journal of Obesity 2006;30:171-175.
16. Janz KF, Burns TL, Torner JC, et al. Physical activity and bone measures in young children: the Iowa Bone Development Study. Pediatrics 2001;107(6):1387.
17. Mistry KM, Minkovitz CS, Strobino DM, Borzekowski DLG. Children's television exposure and behavioural and social outcomes at 5.5 years: Does timing of exposure matter? Pediatrics 2007;120:762-769.
18. Hancox RJ, Milne BJ, Poulton R. Association of television viewing during childhood with poor educational achievement. Archives of Pediatrics and Adolescent Medicine 2005;159(7):614-618.
19. Oliver M, Schofield GM, Schluter PJ. Parent influences on preschoolers' objectively assessed physical activity. Journal of Science and Medicine in Sport 2010;13(4):403-9.
20. Vandewater EA, Rideout VJ, Wartella EA, Huang X, Lee JH, Shim M. Digital childhood: electronic media and technology use among infants, toddlers, and preschoolers. Pediatrics 2007;119:e1006-e1015.
21. Cardon G, Van Cauwenberghe E, Labarque V, Haerens L, De Bourdeaudhuij I. The contribution of preschool playground factors in explaining children's physical activity during recess. International Journal of Behavioral Nutrition and Physical Activity 2008;5:11.
22. Kuepper-Nybelen J, Lamerz A, Bruning N, Hebebrand J, Herpertz-Dahlmann B, Brenner H. Major differences in prevalence of overweight according to nationality in preschool children living in Germany: determinants and public health implications. Archives of Disease in Childhood 2005;90(4 (Electronic)):359-363.
23. Hinkley T, Crawford D, Salmon J, Okely AD, Hesketh K. Preschool children and physical activity: a review of correlates. American Journal of Preventive Medicine 2008;34(5):435–441.
24. Hinkley T, Salmon J, Okely AD, Trost SG. Correlates of sedentary behaviours in preschool children: a review. International Journal of Behavioral Nutrition and Physical Activity 2010;7:66.
25. Pate RR, McIver K, Dowda M, Brown WH, Addy C. Directly observed physical activity levels in preschool children. Journal of School Health 2008;78(8):438-444.
26. Taylor RW, Murdoch L, Carter P, Gerrard DF, Williams SM, Taylor BJ. Longitudinal study of physical activity and inactivity in preschoolers: the FLAME study. Medicine and Science in Sports and Exercise 2009;41(1):96-102.
27. Dennison BA, Erb TA, Jenkins PL. Television viewing and television in bedroom associated with overweight risk among low-income preschool children. Pediatrics 2002;109(6):1028-1035.
28. Kelly LA, Reilly JJ, Fisher A, et al. Effect of socioeconomic status on objectively measured physical activity. Archives of Disease in Childhood 2006;91(1):35-38.
29. Pate RR, Pfeiffer KA, Trost SG, Ziegler P, Dowda M. Physical activity among children attending preschools. Pediatrics 2004;114(5):1258-1263.
30. Miller SA, Taveras EM, Rifas-Shiman SL, Gillman MW. Association between television viewing and poor diet quality in young children. International Journal of Pediatric Obesity 2008;1(9).
31. Zecevic CA, Tremblay L, Lovsin T, Michel L. Parental influence on young children's physical activity. International Journal of Pediatrics 2010;2010:468526.
32. Spurrier NJ, Magarey AA, Golley R, Curnow F, Sawyer MG. Relationships between the home environment and physical activity and dietary patterns of preschool children: a cross-sectional study. International Journal of Behavioral Nutrition and Physical Activity 2008;5:31.
33. Kourlaba G, Kondaki K, Liarigkovinos T, Manios Y. Factors associated with television viewing time in toddlers and preschoolers in Greece: the GENESIS study. Journal of Public Health (Oxford) 2009;31(2):222-30.
34. Sallis JF, Nader PR, Broyles SL, et al. Correlates of physical activity at home in Mexican-American and Anglo-American preschool children. Health Psychology 1993;12(5):390-398.
35. Pfeiffer KA, Dowda M, McIver KL, Pate RR. Factors related to objectively measured physical activity in preschool children. Pediatric Exercise Science 2009;21(2):196-208.
36. Cardon G, Labarque V, Smits D, De Bourdeaudhuij I. Promoting physical activity at the pre-school playground: The effects of providing markings and play equipment. Preventive Medicine 2009;48(4):335-40.