Experts agree that physical activity is critical to the health and well-being of children (19,23), more specifically, as a means to combat the recent and dramatic rise in obesity in the United States (9), other developed nations (24), and countries undergoing nutrition transition (12). This increase in obesity has been observed in children of all ages, including the very young (16). In the United States, nationwide prevalence data indicate that the number of children age 2-5 yr who are classified as obese (body mass index ≥ 95th percentile for age and gender) increased threefold during the past 20 yr (8). More than 25% of preschool-aged children in the United States are considered overweight or obese (9), and more than 8% of 2- to 5-yr-olds are significantly obese (body mass index ≥ 97th percentile) (10). Accumulation of excess body fat creates risk for several chronic health conditions, such as diabetes, hypertension, and hyperlipidemia (5), and also results in unfortunate social and behavioral problems during these important early developmental years (14,18). Moreover, obesity seems to track from childhood to adulthood, creating even more serious health risks (3,6,15). On the basis of the seriousness of these issues, prevention-oriented strategies are needed.
Early childhood physical activity is important not only to prevent excess weight gain and avoid chronic health problems but also for other aspects of a young child's physical, social, and psychological development (21). From the earliest age, physical activity experiences allow a young child to explore and interact with the surrounding environment and, through this interaction, learn to crawl, stand, and ultimately, walk. As children proceed from toddlers to preschoolers, physical activities continue to play an important role in the development of gross and fine motor skills as well as social skills, therefore care should be taken to ensure that children have generous amounts of active experiences (7).
Nationally, 60% of mothers with preschool-aged children are in the workforce (2), which, in turn, necessitates their use of out-of-home child care. (For this series, we use the term "child care" to refer to any type of organized out-of-home care for children between the ages of 0 and 5 yr, including preschool, nursery school, day care, child care center, and family child care home.) Whether that child care is provided by a center, home, or other arrangement, out-of-home child care settings can make important contributions to the welfare and health of young children because of the many children who are enrolled and spend considerable time at such sites. Overall, 56% of 3- to 6-yr-olds are cared for in a center-based setting (2). Further, there is some indication that the amount of time children spend in care seems to be increasing (17). A 2005 report from the Department of Education noted that children aged 3-5 yr who attend center-based child care at least once per week spend an average of 22.5 h·wk−1 there (4). Moreover, recent evidence suggests that an inverse relationship may exist between time spent in child care and time spent in active play (20).
Despite the recognized value of regular physical activity to the health and development of children, experts fear children may not be receiving adequate experiences. Previous evidence of a sharp decline in physical activity in school-aged children (13) was recently validated by objectively monitored physical activity data collected for the National Health and Nutrition Examination Survey (22). Although preschool-aged children were not assessed for this component of the National Health and Nutrition Examination Survey, other studies suggest that physical activity levels are very low even among young children during their time at child care settings (1,11).
Because of the many children they enroll, child care settings offer a unique opportunity to help younger children obtain the necessary amount of physical activity and to reinforce adoption of a physically active lifestyle that could mitigate the decline in activity often seen in child-to-adolescent transition. In 2002, the National Association for Sport and Physical Education (NASPE) published recommendations for physical activity for infants, toddlers, and preschoolers (7). For preschool children, NASPE recommends at least 60 min, and up to several hours per day, of unstructured play time. In addition, their guidelines address structured physical activity, sedentary time, movement skill, environment, and the role of adult supervision. For a more complete listing of the NASPE standards, see Table 1.
Although the NASPE standards do not specifically address child care settings, physical activity provided at child care can contribute to the accumulation of recommended levels of activity, provide important time out-of-doors, develop motor skills, and provide interaction with staff that can facilitate physical activity. Research studies that address these issues, however, are limited.
At the 2008 American College of Sports Medicine Annual Meeting, a symposium titled, "Role of Child Care in the Young Child's Physical Activity," included five presentations describing several issues critical to the role child care plays in the development of physical activity in young children. In this special series, we present four review articles that address these physical activity-related topics that are relevant for the child care setting. Reilly updates the literature in this area by reviewing available studies of physical activity at preschool, nursery school, or other child care settings. Pate et al. share strategies for measuring physical activity in this age group and make recommendations for obtaining quality assessments. Integrating strategies from landscape architecture and planning, Cosco and associates describe methods for determining how outdoor spaces, or "behavior settings," afford physical activity to children in the outdoor settings provided at organized child care. The role of environment and policy in promotion of physical activity at child care is reviewed by Trost et al. Specifically, they explore the environmental and policy characteristics at child care that have been found to increase physical activity. Finally, Ward et al. critically review physical activity interventions implemented in child care and make recommendations regarding their potential to change young children's physical activity levels through programs, policies, or practices. Collectively, these five articles provide a compilation of the most up-to-date research findings available about key aspects of the physical activity development of young children at child care settings.
Funding disclosure: None.
Results presented in this article do not constitute endorsement by American College of Sports Medicine.
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