title: A participatory physical activity intervention in preschools: a cluster randomized controlled trial.
abstract: BACKGROUND
  Previous studies on physical activity interventions in preschools have reported limited effectiveness. Participatory community-based approaches hold promise for increasing intervention effectiveness and involving parents as key stakeholders in a sustainable way.
  
  
  OBJECTIVE
  To assess whether a participatory parent-focused approach using parents as agents of behavioral change enhances the efficacy of a preschool physical activity (PA) intervention.
  
  
  METHODS
  Two-armed, cluster-RCT with preschool as unit of randomization and children as unit of analysis.
  
  
  METHODS
  39 South German preschools applying for an existing state-sponsored PA program with 826 children (52% boys, aged 5.0±0.2 years), with 441 allocated to the intervention arm.
  
  
  METHODS
  Control preschools received a state-sponsored program consisting of twice-weekly gym classes over 6 months. In intervention preschools, this program was augmented by motivating parents to develop and implement their own project ideas for promoting children's PA.
  
  
  METHODS
  Primary outcomes included mean accelerometry counts and time spent in moderate- to vigorous-intensity PA or sedentary behavior. Secondary outcomes were BMI, percentage body fat, quality of life, sleep quality, and general health. Outcomes were measured at baseline and at 6 and 12 months in both study arms (time period: 2008-2010). Using an intention-to-treat-analysis, linear multilevel regression models assessed change over time and across study arms, adjusted for age, gender, season, and preschool location. Analysis was conducted in 2011.
  
  
  RESULTS
  In 15 intervention preschools, parents implemented 25 PA projects. Compared with controls, intervention arm children were 11 minutes less sedentary per day (95% CI=5.39, 17.01, p=0.014); had significantly more mean accelerometry counts (1.4 counts/15 seconds [95% CI=0.22, 2.54], p=0.019); and showed benefits in perceived general health and quality of life. All other outcomes showed no difference between study arms.
  
  
  CONCLUSIONS
  A participatory preschool intervention focusing on parents as agents of behavioral change may be able to promote PA and reduce sedentary behavior in preschoolers. These benefits may go beyond the effects of existing nonparticipatory interventions.
  
  
  BACKGROUND
  This study is registered at clinicaltrials.gov NCT00987532.
authors.affiliation: Mannheim Institute of Public Health, Medical Faculty Mannheim, Social and Preventive Medicine, Mannheim, Germany; Department of Pediatrics, University Medicine Mannheim Heidelberg University, Mannheim, Germany. Electronic address: freia.debock@medma.uni-heidelberg.de.
authors.forename: Freia
authors.initials: F
authors.lastname: De Bock
authors.affiliation: Mannheim Institute of Public Health, Medical Faculty Mannheim, Social and Preventive Medicine, Mannheim, Germany; Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Brazil.
authors.forename: Bernd
authors.initials: B
authors.lastname: Genser
authors.affiliation: Netherlands Institute of Health Sciences, Institute for Public Health, Erasmus Medical Center, Rotterdam, the Netherlands.
authors.forename: Hein
authors.initials: H
authors.lastname: Raat
authors.affiliation: Mannheim Institute of Public Health, Medical Faculty Mannheim, Social and Preventive Medicine, Mannheim, Germany.
authors.forename: Joachim E
authors.initials: JE
authors.lastname: Fischer
authors.affiliation: Mannheim Institute of Public Health, Medical Faculty Mannheim, Social and Preventive Medicine, Mannheim, Germany.
authors.forename: Herbert
authors.initials: H
authors.lastname: Renz-Polster
mesh_terms: D061725:Accelerometry; D002675:Child, Preschool; D016000:Cluster Analysis; D055812:Community-Based Participatory Research / Q000458:organization & administration; D005260:Female; D005858:Germany; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods*; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008297:Male; D009042:Motivation; D009043:Motor Activity; D017063:Outcome Assessment, Health Care; D010290:Parents; D010806:Physical Education and Training / Q000458:organization & administration*; D011788:Quality of Life; D012574:Schools; D013997:Time Factors