Differences in Energy Balance-Related Behaviours in European Preschool Children: The ToyBox-Study

Background The aim of the current study was to compare levels of energy balance-related behaviours (physical activity, sedentary behaviour, and dietary behaviours (more specifically water consumption, sugar-sweetened beverage consumption and unhealthy snacking)) in four-to six-year-old preschoolers from six European countries (Belgium, Bulgaria, Germany, Greece, Poland, and Spain) within the ToyBox cross-sectional study. Methods A sample of 4, 045 preschoolers (4.77 +/- 0.43 years; 52.2% boys) had valid physical activity data (steps per day), parents of 8, 117 preschoolers (4.78 +/- 0.46 years; 53.0% boys) completed a parental questionnaire with questions on sedentary behaviours (television viewing, computer use, and quiet play), and parents of 7, 244 preschoolers (4.77 +/- 0.44 years; 52.0% boys) completed a food frequency questionnaire with questions on water consumption, sugar-sweetened beverage consumption and unhealthy snacking. Results The highest levels of physical activity were found in Spain (12, 669 steps/day on weekdays), while the lowest levels were found in Bulgaria and Greece (9, 777 and 9, 656 steps/day on weekdays, respectively). German preschoolers spent the least amount of time in television viewing (43.3 min/day on weekdays), while Greek preschoolers spent the most time in television viewing (88.5 min/day on weekdays). A considerable amount of time was spent in quiet play in all countries, with the highest levels in Poland (104.9 min/day on weekdays),and the lowest levels in Spain (60.4 min/day on weekdays). Belgian, German, and Polish preschoolers had the lowest intakes of water and the highest intakes of sugar-sweetened beverages. The intake of snacks was the highest in Belgian preschoolers (73.1 g/day) and the lowest in Greek preschoolers (53.3 g/day). Conclusions Across six European countries, differences in preschoolers' energy balance-related behaviours were found. Future interventions should target European preschoolers' energy balance-related behaviours simultaneously, but should apply country-specific adaptations

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

BACKGROUND: The ToyBox-study developed an evidence- and theory-based intervention to improve preschoolers\u27 energy balance-related behaviours - including physical activity (PA) - by targeting the kindergarten environment and involving their parents/caregivers. The present study aimed to examine the effect of the ToyBox-intervention on increasing Belgian preschoolers\u27 objectively measured PA levels. METHODS: A sample of 472 preschoolers (4.43 ± 0.55 years; 55.1% boys) from 27 kindergartens (15 intervention, 12 control kindergartens) in Flanders, Belgium were included in the data analyses. Preschoolers wore an ActiGraph accelerometer for six consecutive days and were included in the data analyses if they had a minimum of two weekdays and one weekend day, both at baseline and follow-up (one year later). Preschoolers\u27 PA outcomes were estimated for an average day, weekday, weekend day, during school hours, and during after school hours. To assess intervention effects, multilevel repeated measures analyses were conducted for the total sample, and for sub-groups (according to sex, kindergarten levels of socio-economic status (SES) and risk groups (low levels of PA at baseline)) of preschoolers. RESULTS: Small intervention effects were found in the total sample. Most intervention effects were found in boys and in preschoolers from high SES kindergartens. Boys from the intervention group had an increase in vigorous PA (ß=1.47, p=0.03) and moderate-to-vigorous PA (ß=1.27, p=0.03) from baseline to follow-up, whereas PA levels in boys from the control group stagnated or decreased. In preschoolers from high SES kindergartens, the largest effects were found for PA outcomes during school hours and during after school hours. CONCLUSION: The results from the Belgian sample demonstrate that effects of the PA-component of the ToyBox-intervention on objectively measured PA were found in preschool boys and in preschoolers from high SES kindergartens, which means that the ToyBox-intervention was mainly effective in those sub-groups. Future interventions should search for alternative strategies to increase preschoolers\u27 PA levels in preschool girls and preschoolers from low SES kindergartens, as these are the most important at-risk groups regarding PA

Multi-factorial evidence-based approach of sedentary behavior in preschool children

Early childhood, comprising the preschooler period with children aged 3 to 5 years, is a critical period for the development of sedentary behavior habits. High levels of time spent in sedentary activities and screen-related behaviors are already found in this age group and may be detrimental to a wide range of health, developmental and educational outcomes. In order to understand and change preschoolers’ sedentary behavior, it is important that sedentary behavior in this age group can be measured accurately. Different (objective and subjective) methods have been used to measure preschoolers’ sedentary behavior, but to date, the most accurate method to objectively measure this behavior in preschoolers is unknown. Hence, the first aim of this thesis was to meet this present gap in the literature by comparing two popular objective measurement instruments in preschoolers (i.e., the activPALTM and the ActiGraph accelerometer) and to investigate their validity to measure sedentary behavior in preschoolers. The activPALTM measures actual sitting time based on preschoolers’ postures, while the ActiGraph measures sedentary behavior based on the absence of acceleration of the device. Significant differences were found between the estimates of preschoolers’ sedentary behavior measured with these two devices. No definitive conclusions about the most accurate method to measure this behavior in preschoolers could be made. Researchers who want to use one of these objective instruments should take the device specific mechanisms into account and should choose the appropriate device to address their research aims. A second step for a better understanding of preschoolers’ sedentary behavior is the investigation of influencing factors that are related to this behavior. Qualitative focus group research with two important care givers of preschoolers, namely parents and teachers, were executed to investigate opinions and ideas of these care givers on preschoolers’ sedentary behavior and screen time. Parents perceived television viewing as the most prevalent context of sedentary behavior at home and reported that they only had limited informal rules for the amount of time preschoolers could watch television at home. Teachers had the opinion that the lack of play space has an influence on preschoolers’ sedentary behavior at preschool. Nevertheless, both parents and teachers had the general opinion that preschoolers do not spend a lot of time sitting during the day and at preschool. Next to the influencing factors investigated by qualitative research, mediation analyses as part of this thesis revealed that 1 parental role modelling was associated in a direct and indirect way through parental rules with television viewing time in Australian and Belgian preschoolers. Focusing on these influencing factors of preschoolers’ behavior, an intervention to decrease preschoolers’ sedentary behavior was developed and implemented, using a systematic and evidence-based approach, namely the ‘Intervention Mapping’ protocol. This sedentary behavior intervention was part of a large European study (i.e., the ToyBox-study) that conducted an intervention for the prevention of overweight and obesity in preschoolers. In contrast with previous intervention studies, this intervention focused not only on preschoolers’ television viewing time, but also on total sedentary time and other sedentary activities in which preschoolers participate (e.g., sitting down in quiet play). This intervention was implemented by preschool teachers in different preschools and parents were involved by providing them with educational materials. The final chapter in this thesis examined the effect of the intervention on preschoolers’ total sedentary time, screen viewing time and time spent in other sedentary activities. In the total sample, we solely found an intervention effect on the time spent in front of a computer. Preschoolers’ computer time increased less in the intervention group compared to the control group. However, several intervention effects were found when analyses were stratified according to child’s sex, socio-economic status of the preschool and the child’s level of sedentary time at baseline. A stronger decrease for several sedentary outcomes was found in girls, preschoolers in low socio-economic preschools and preschoolers with the highest levels of total sedentary time at baseline in the intervention group compared to the control group. Results of this intervention indicated that the school environment can be used as a setting to implement sedentary behavior interventions in preschoolers and that this intervention is promising to change preschoolers’ sedentary behavior in at-risk groups

The translation of preschoolers' physical activity guidelines into a daily step count target

This study aimed at translating the physical activity (PA) guideline (180min of total PA per day) into a step count target in preschoolers. 535 Flemish preschoolers (mean age: 4.41 +/- 0.58) wore an ActiGraph accelerometer (GT1M, GT3X and GT3X+) - with activated step count function - for four consecutive days. The step count target was calculated from the accelerometer output using a regression equation, applying four different cut-points for light-to-vigorous PA: Pate, Evenson, Reilly, and Van Cauwenberghe. The present analysis showed that 180min of total PA per day is equivalent to the following step count targets: 5,274 steps/day using the Pate cut-point, 4,653 steps/day using the Evenson cut-point, 11,379 steps/day using the Reilly cut-point and 13,326 steps/day using the Van Cauwenberghe cut-point. Future studies should focus on achieving consensus on which cut-points to use in preschoolers before a definite step count target in preschoolers can be proposed. Until then, we propose to use a provisional step count target of 11,500 steps/day as this step count target is attainable, realistic and helpful in promoting preschoolers' PA

The effect of a cluster randomised control trial on objectively measured sedentary time and parental reports of time spent in sedentary activities in Belgian preschoolers : the ToyBox-study

Background: In preschoolers, high levels of sedentary behaviour are associated with several adverse health outcomes. The purpose of this study is to report the effects of the ToyBox-intervention (a European 24-week cluster randomised controlled trial) on sedentary behaviour in preschoolers. Methods: In Belgium, 859 preschoolers from 27 kindergartens (15 intervention and 12 control) wore an accelerometer to objectively measure their sedentary time and 1715 parents/caregivers completed a questionnaire to assess sedentary activities in which preschoolers participate at home. Main outcomes were objectively measured sedentary time, time spent watching TV, using the computer and time spent in quiet play. Multilevel repeated measures analyses were conducted to take clustering into account. Intention to treat analysis was used to handle missing data. Results: A sample of 859 (29.5% of all contacted children) preschoolers (4.4 ± 0.6 years, 54.4% boys) provided valid accelerometer data at either baseline or follow-up and parents of 1715 (58.9% of all contacted children) preschoolers (4.4 ± 0.5 years, 52.5% boys) completed a questionnaire at either baseline or follow-up. No intervention effects were found on objectively and subjectively measured total sedentary time in the total sample. However, some effects on objectively and subjectively measured sedentary time were found in specific subgroups. Preschoolers from the intervention group from high SES kindergartens and preschoolers with high levels of sedentary time at baseline decreased their sedentary time, while preschoolers from the control group increased their sedentary time. Girls in the intervention group decreased their TV viewing time during weekend days (-5.83 min/day), while girls' &TV viewing in the control group increased (+4.15 min/day). In low SES kindergartens, a smaller increase for computer time during weekend days was found in preschoolers in intervention kindergartens (+6.06 min/day) than in control kindergartens (+12.49 min/day). Conclusion: While some small positive effects were found in some sub-groups, the ToyBox-intervention had no effect on objectively and subjectively measured sedentary time in the total sample. A longer period to implement the intervention and a more active involvement of parents/caregivers might enhance intervention effects. The ToyBox-study is registered with the clinical trials registry clinicaltrials.gov, ID: NCT02116296.Toy Bo