title: A cluster randomized trial of a multi-level intervention, delivered by service staff, to increase physical activity of children attending center-based childcare.
abstract: OBJECTIVE
  To evaluate the impact of a multi-level intervention on the physical activity levels of 3-5 year old children attending center-based childcare services.
  
  
  METHODS
  The trial was conducted in New South Wales Australia in 2010 in 20 centers with 459 children. The intervention, included: fundamental movement skill sessions; structured activities; staff role modelling; limiting small screen recreation and sedentary time; and anactivity promoting physical environment. Control services continued with usual routines. Physical activity during care was assessed using pedometers at baseline and at six months after baseline. Intervention implementation was assessed via observation of staff physical activity practices and audits of service environment and policy.
  
  
  RESULTS
  Mean step counts at baseline and follow-up were 17.20 (CI 15.94-18.46) and 16.12 (CI 14.86-17.30) in the intervention group and 13.78 (CI 12.76-14.80) and 13.87 (CI 12.57-15.17) in the control group (p=0.12). Intervention services showed significantly greater increases in the total minutes that teachers led structured activities, relative to control group services (p=0.02).
  
  
  CONCLUSIONS
  The intervention showed no significant effect on child step counts per minute despite increasing time that staff delivered structured activity which is likely to be attributable to difficulties experienced by service staff in delivering a number of intervention components.
authors.affiliation: Hunter New England Population Health, Newcastle, NSW, Australia; School of Medicine and Public Health University of Newcastle, Newcastle, NSW, Australia. Electronic address: meghan.finch@hnehealth.nsw.gov.au.
authors.forename: Meghan
authors.initials: M
authors.lastname: Finch
authors.affiliation: School of Medicine and Public Health University of Newcastle, Newcastle, NSW, Australia.
authors.forename: Luke
authors.initials: L
authors.lastname: Wolfenden
authors.affiliation: School of Education, University of Newcastle, Newcastle, NSW, Australia; Priority Research Center in Physical Activity and Nutrition, University of Newcastle, Newcastle, NSW, Australia.
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Morgan
authors.affiliation: Hunter New England Population Health, Newcastle, NSW, Australia; School of Medicine and Public Health University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia.
authors.forename: Megan
authors.initials: M
authors.lastname: Freund
authors.affiliation: Hunter New England Population Health, Newcastle, NSW, Australia.
authors.forename: Jannah
authors.initials: J
authors.lastname: Jones
authors.affiliation: Hunter New England Population Health, Newcastle, NSW, Australia; School of Medicine and Public Health University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Wiggers
mesh_terms: D061725:Accelerometry; D001831:Body Temperature / Q000502:physiology; D002656:Child Day Care Centers; D002675:Child, Preschool; D016000:Cluster Analysis; D003695:Delivery of Health Care; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008297:Male; D008503:Medical Staff / Q000592:standards*; D009043:Motor Activity / Q000502:physiology*; D009517:New South Wales; D010342:Patient Acceptance of Health Care; D015397:Program Evaluation; D016896:Treatment Outcome
keywords: Child day-care centers; Childcare; Physical activity; Preschool; Young children