Pate RR, Brown WH, Pfeiffer KA, Howie EK, Saunders RP, Addy CL, Dowda M. (2016). An Intervention to Increase Physical Activity in Children: A Randomized Controlled Trial With 4-Year-Olds in Preschools. American Journal of Preventive Medicine, 51 (1), 12-22.
Designed to increase physical activity to reduce obesity among preschool children, this school-based intervention changes instructional practices and the school environment through four daily components: (1) 10 minutes of indoor physical activity, (2) two 20-minute sessions of recess, (3) two 5-minute sessions incorporating physical activity into classroom lessons, and (4) enhanced social support (e.g., verbal encouragement) and physical environment (e.g., equipment, space). The study showed an increase in physical activity.
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Currently in the United States, 12.7 million children and adolescents are obese. Many health-related conditions are linked to obesity, including heart disease, stroke, type 2 diabetes, and certain types of cancer. Obesity can be prevented through increased physical activity. Children and adolescents should do 60 minutes or more of moderate to vigorous physical activity (MVPA) each day. The Institute of Medicine has recommended that providers of childcare be required to provide children with opportunities to be physically active throughout the day. A recommended action is that children be provided with opportunities for light, moderate and vigorous intensity physical activity for at least 15 minutes per hour when children are in care. Examples of these activities are bike riding, walking, running, dancing, and playing tag, soccer, and basketball. Physical activity is vital for health, and schools are a prime setting in which to teach youth about exercise and encourage an active lifestyle. Although prevalence of obesity among preschool-aged children (2 to 5 years old) is decreasing, interventions that encourage physical activity among children are vital to continue the reduction of obesity.
Supporting Health and Activity in Preschool Environments (SHAPES) aims to increase moderate to vigorous physical activity among preschool children by changing instructional practices and the school environment. SHAPES is based on the social ecological model, which suggests that an individual's behavior can be influenced at the individual, institutional, social, and physical environmental levels. The intervention has four essential components:
-- Move Inside: Each day, teachers lead at least 10 minutes of indoor MVPA not part of recess or academic lessons. Activities may include theme-based obstacle courses, dancing to music, or activities that focus on development of particular motor skills (e.g., hopscotch).
-- Move Outside: Teachers provide at least two 20-minute sessions of recess per day, with at least one 5-minute structured physical activity. Sample activities include running games, follow the leader, or "buzzing bees" (where children "buzz" around while flapping their elbows and searching for nectar).
-- Move To Learn: For two 5-minute sessions each day, teachers incorporate physical activity into pre-academic classroom lessons to support children's learning (e.g., reciting while moving, counting motor movements such as jumping jacks, acting out stories).
-- Enhanced social support for physical activity: Elements enhancing the social environment include the teacher's verbal encouragement of physical activity, participation in physical activity, and use of activities that encourage the children to engage in MVPA (e.g., dancing, chase games, ball games). Elements enhancing the physical environment include the availability of equipment and other materials (e.g., balls, music, scarves) and ample space for physical activity.
Teachers are encouraged to use these four components to modify their practices and environment in ways that fit their teaching style, classroom, and children's needs and capabilities. Teachers choose how and when to implement the components to best improve the children's physical activity. Prior to implementation, teachers complete six online training modules that address topics on physical activity, key elements of the SHAPES program, and self-assessment. Other online resources include workshops, newsletters, and self-monitoring activities, as well as supplies and examples of all intervention components.
-- 90-120 minutes for teachers to complete the six training modules
-- 1 hour each day for teachers to provide opportunities for physical activity
SHAPES is intended for preschool children aged 3‒5 years.
This intervention can be implemented in any school-based facility.
Required resources to implement the program include the following:
-- SHAPES website
For costs associated with this program, please contact the developer, Dale Murrie. (See products page on the RTIPs website for developer contact information.)
About the Study
A randomized wait-list controlled trial compared children attending implementation preschools with those attending preschools that continued their usual physical activity practices. Researchers recruited public and private preschools in Columbia, South Carolina, that met three eligibility criteria: (1) focus on developmental and pre-academic skills, (2) adherence to state curriculum standards, and (3) program length of at least 3 hours per day and 180 instructional days per year. From 62 eligible preschools, a stratified random sample of 16 were invited to participate. The schools were pair matched by type of school (public or private), number of enrolled students, number of classrooms for 4-year-old children, and number of children per classroom. Data collection occurred in waves over 2 academic years, 2008‒2009 (n=264) and 2009‒2010 (n=224), with children in the 4-year-olds' classrooms.
Parents of children in the 4-year-olds' classrooms were invited to enroll their children in the study. Children who were not aged 3‒5 or who had a disability that would interfere with the measure of physical activity (accelerometry) were excluded from the study. The intervention group (n=188) was 48.9% males, and the control group (n=191) was 51.8% males. The average age of students in both groups was 4.5 years.
The main outcome, MVPA, was assessed while children were in preschool over a 5-day period (Monday through Friday), once in the fall (baseline) and once in the spring (follow-up). Physical activity was measured using ActiGraph GT1M and GT3X accelerometers. Minutes/hour of observation of sedentary, light, MVPA, and total physical activity were then calculated, using children's wear time during the school day as the divisor. (MVPA was defined as at least 420 counts/15 seconds.) Participants wore the monitors on an elastic belt on their right hip and were allowed to remove the monitor during water-related activities. Data were collected and recorded in 15-second intervals to capture sporadic activity patterns that happen among children between 3 to 5 years.
The baseline assessment showed that children in the intervention and control schools were similar in sex, age, body mass index, total physical activity, MVPA, time spent sedentary, and estimated physical activity energy expenditure. A few variables- parent education, distribution of races, and amount of time in light physical activity were significantly different between groups at baseline. The final analysis compared groups at follow-up and controlled for baseline physical activity as well as sex, race, parent education, and length of school day.
- Preschool children in the intervention schools engaged in significantly more MVPA than children in control schools (7.3 vs. 6.7 minutes per hour; p=.01).
Pfeiffer KA, Saunders RP, Brown WH, Dowda M, Addy CL, Pate RR. (2013). Study of Health and Activity in Preschool Environments (SHAPES): study protocol for a randomized trial evaluating a multi-component physical activity intervention in preschool children. BMC Public Health, 13 (728), 1-8.
Pate RR, Almeida MJ, McIver KL, Pfeiffer KA, Dowda M. (2006). Validation and Calibration of an Accelerometer in Preschool Children. Obesity, 14 (11), 2000-2006.
Saunders RP, Pfeiffer K, Brown WH, Howie EK, Dowda M, O'Neill JR, McIver K, Pate RR. (2017). Evaluating and Refining the Conceptual Model Used in the Study of Health and Activity in Preschool Environments (SHAPES) Intervention. Health Education & Behavior, 1-9.