The Youth-Nex Conference on Physical Health and Well-Being for Youth, Oct 10 & 11, 2013, University of Virginia Ward is Professor of Nutrition in the Gillings School of Global Public Health at the University of North Carolina. Panel 2 - How can we increase physical activity in children and adolescents? The presentations in this panel will describe programs that have successfully increased physical activity at preschool, in the home, at school, in communities, and in the private sector. Website: http://bit.ly/YNCONF13

1. Moving Kids:
at Preschool and
Home
Dianne S. Ward
Youth-Nex Conference
October 10-11, 2013

2. Guidelines for Physical Activity:
Children 0-5 Years

3. NASPE Guidelines (2002)
• Infants:
– Should interact with parents and/or caregivers in
daily physical activities and in settings that
encourage activity and do not restrict
• Toddlers and Preschoolers:
– Should engage in at least 60 minutes – up to several
hours per day– of unstructured activity
– Should accumulate 30 – 60 minutes of structured PA
each day (Toddlers-30 min; Preschool-60 min)

4. International Recommendations
Australia (2010)
• Encourage supervised
floor-based play from
birth
• 3hrs/day physical activity
spread through the day
UK (2011)
• Encourage
supervised floorbased play from
birth
• 3hrs/day physical
activity spread
through the day
Slide from Dr. Anthony Okely, U. of Gollagoong
Canada (2012)
• Encourage supervised floorbased play from birth
• 3hrs/day physical activity
spread through the day

5. Institute of Medicine. Early childhood obesity
prevention policies: Goals,
recommendations, and potential actions.
Washington: Institute of Medicine; 2011.
Slide from Dr. Anthony Okely, U. of Gollagoong

6. What do we know?
Moving Kids at Home

7. Challenges Working with Parents
•
•
•
•
Parents of young children mostly young adults
Time is a premium
Often both parents work outside of home
Demands related to caring for a younger child
are great (e.g., closer oversight, less
independence, safety issues, less
structured approaches available)
• Need to find strategies for engagement

8. Parenting for Activity or “Physical
Activity Parenting”
• A recent conference focused on “Measuring
Parenting” (ISBNPA Pre-Conference, 2011)
• Identified concept of “PA Parenting”
• Work by Davison and other tried to identify
and conceptualize parent actions for PA
• Found research lacking including absence of
quality measurements of PA parenting
• More research work needed
See 2 papers by Davison et al. and Trost et al. Childhood Obesity, 2013

9. Parents have different “styles” of
managing children
• Parenting “style” is described as how parents
respond to their children based on control
(demandingness) and warmth
(responsiveness)
• Positive parenting refers the a balance
between warmth and control
• Greater control, less warmth results in
“punitive” or authoritarian parenting
• Concerns for safety and protection may
favor control over warmth

10. Study Overview
• Compared general
parenting style and
practices, physical
activity-related
practices, and child
physical activity
N=324
Parent Characteristics
White
African Amer
51.4%
39.8%
Parent Age
34.9 y
Parent BMI
30.1 kg/m2
Income <$50K
36.6%
Education≥ College
75.3%
Child Characteristics
Measured:
•parenting style
•parenting practice
•physical activity
Child Age
41.8 mo
Child BMI %ile
59.1 %ile

11. CONTROLING PRACTICES
Results
Inside rules for active play (-0.515)
Conditions on
outside play - clean
Conditions on
outside play - weather
Positive Parenting
SUPPORTIVE PRACTICES
Reward w/ PA (0.150)
Modeling (0.247)
Family activity (0.263)
Encouragement (0.400)
Education (0.206)
CONTROLING PRACTICES
Control over screen time (0.076, p=.162)
Monitoring screen time
SUPPORTIVE PRACTICES
--- Positive assoc.
--- Negative assoc.
Reward w/ TV
Modeling screen time

12. CONTROLING PRACTICES
Results
Inside rules for active play (0.167)
Conditions on outside
play – clean (0.121)
Conditions on outside
play – weather (0.102, p=.063)
SUPPORTIVE PRACTICES
Reward w/ PA
Modeling (-0.132)
Family activity (-0.213)
Encouragement (-0.115)
Education
Punitive Parenting
CONTROLING PRACTICES
Control over screen time (-0.091, p=.104)
Monitoring screen time (-0.201)
SUPPORTIVE PRACTICES
--- Positive assoc.
--- Negative assoc.
Reward w/ TV (0.109)
Modeling screen time (0.201)

13. Parenting Style-Parenting Practice
• What works positively for one parenting style
may not work as well for another
– Positive parenting works well with supportive PA
practices but not with controlling practices
– Inconsistent parenting style using supportive PA
practices did not increase kids’ PA
– Punitive parenting style can use controlling
practices effectively but long-term impacts of
style-practice interaction unknown

14. Conclusions
• Model explains a small but significant amount of
variance in child activity (16. 5% MVPA & 12.8 % sed.)
– Positive parenting  supportive practices  child MVPA
– Punitive parenting  controlling practices
– Associations with inconsistent parenting somewhat
unexpected (some positive, some not)
• Similarities and differences with feeding
literature
• Much more work in needed in this area

15. Which policies result in more physical activity?
Child Care Policies, Practices &
Environments for Physical Activity

16. Best Practice Guidelines
1. Amount of play time (minutes) provided
(both inside & outside): 120 minutes
2. Occasions (#) of teacher-led physical
activity: 2 or more per day
3. Staff joining in activity with children:
regularly
4. Staff trained on physical activity
5. Center’s written policies about physical
activity
McWilliams et al., Pediatrics, 2008

17. Procedures
• 50 child-care centers in North Carolina
– 45 centers were rated 3-5 stars; others 2-3 stars
– 23 centers participated in the Child and Adult Care
Food Program (CACFP)
• Data collected during 4 days at the centers
• 4 day of observation at each center (full day)
• Children’s activity assessed by accelerometers
– About 10 children measured per day at each
center (~500 total)

18. Measures
Physical Activity
• GT1M worn for 4 days while
at child-care center
• Average wear time was 7
hours/day
• 15 second epochs
– Cut-points
• Sedentary = <25 counts per
15 seconds
• MVPA = >500 counts per 15
seconds
Child Care Practices

19. Results

20. Amount of PA time at centers with
≥120 min/day of active play
At centers providing
≥120 min/day of active
play, children spent
More minutes/hour in
MVPA (p=0.04)
Fewer minutes/hour in
sedentary activities
(p=0.11, ES = -0.81)

21. PA time at centers providing ≥2
occasions of teacher-led activity
At centers providing≥2
occasions of teacher-led
PA, children spent
More minutes/hr. in
MVPA (p=0.03)
Fewer minutes/hr. in
sedentary activities
(p=0.02)

22. PA time at centers where staff
joined in active play on >1day
At centers where staff
joined children in active
play on >1 day, children
spent
More minutes/hr. in
MVPA (p=0.01)
Fewer minutes/hr. in
sedentary activity
(p=0.14, ES=-0.48)

23. PA time at centers where staff
received PA training
At centers where at least
1 staff had received PA
training, children spent
No effect on minutes of
MVPA/hr. (p=0.07,
ES=0.04)
More minutes in
sedentary activity
(p=0.18, ES =0.43)

24. PA time at centers with ≥4 Written
Physical Activity Policies
No policy effect on time
spent in MVPA (p=0.08,
ES= -0.32) or sedentary
activity (p=0.49,
ES=0.13)

25. Summary
• Found a positive effect of:
– Providing 120 min/day of activity time
– Teachers who lead activities at least twice per day
– Teachers joining in active play
• Found no effect of:
– PA training (at least 1 staff)
– written policies had no effect
• Lack of finding for training and policy may
be related to type training; non-specific
policies

26. Overall Conclusions and Future
Directions
• Settings (home & child care) and caregivers
(parents & providers) influence the amount of
physical activity children
• Parents can influence child activity, but new
strategies may be needed to engage parents
and modifying PA parenting practices
• Child care centers can increase children’s PA
through their policies and practices; efforts to
improve are needed

27. Go NAP SACC
www.gonapsacc.org
Online tools coming
soon!
@gonapsacc