title: Supporting Physical Activity in the Childcare Environment (SPACE): rationale and study protocol for a cluster randomized controlled trial.
abstract: BACKGROUND
  Young children are prone to low levels of physical activity in childcare. Researchers have identified that preschoolers tend to be more active outdoors than indoors, with higher activity levels occurring during the first 10 minutes of outdoor playtime. Additionally, interventions incorporating either staff training or the inclusion of play equipment have been effective at increasing children's activity in this setting. As such, the overarching objective of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention is to improve the physical activity levels of preschoolers during childcare hours, utilizing a combination of the above components. The purpose of this manuscript is to provide a detailed account of the protocol, innovative methods, and evaluation plans used in the implementation of the SPACE study; in an effort to support the development of further research in this field.
  
  
  METHODS
  The SPACE study, a cluster randomized controlled trial, involves 22 childcare centres randomly allocated to either the experimental (n = 11) or the control (n = 11) group. Childcare centres receiving the intervention will adopt an 8-week physical activity intervention with the following components: 1. shorter, more frequent bouts of outdoor playtime (4 × 30 min periods rather than 2 × 60 min periods); 2. new portable play equipment (e.g., obstacle course, balls); and, 3. staff training (1 × 4 hr workshop). Actical accelerometers will be used to assess total physical activity with measurements taken at baseline (i.e., week 0), immediately post-intervention (i.e., week 8), and at 6- and 12-month follow-up. As secondary objectives, we aim to evaluate the effectiveness of the intervention on preschoolers': a) sedentary time; b) standardized body mass index scores (percentiles); c) health-related quality of life; and childcare providers' physical activity-related knowledge and self-efficacy to implement physical activity.
  
  
  CONCLUSIONS
  The SPACE study aims to increase the low levels of physical activity observed within childcare centres. The findings of this work may be useful to policy makers and childcare providers to consider modifications to the current childcare curriculum and associated outdoor play time.
  
  
  BACKGROUND
  ISRCTN70604107 (October 8, 2014).
authors: School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada. ttucker2@uwo.ca.
authors: Patricia
authors: P
authors: Tucker
authors: School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada. sburke9@uwo.ca.
authors: Shauna M
authors: SM
authors: Burke
authors: School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada. ancagaston@gmail.com.
authors: Anca
authors: A
authors: Gaston
authors: School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada. jenirwin@uwo.ca.
authors: Jennifer D
authors: JD
authors: Irwin
authors: School of Health Studies, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada. ajohnson@uwo.ca.
authors: Andrew M
authors: AM
authors: Johnson
authors: Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada. timmonbw@mcmaster.ca.
authors: Brian W
authors: BW
authors: Timmons
authors: Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada. lvande32@uwo.ca.
authors: Leigh M
authors: LM
authors: Vanderloo
authors: School of Occupational Therapy, Faculty of Health Sciences, University of Western Ontario, 1201 Western Road, Elborn College, Room 2547, London, ON, N6G 1H1, Canada. mdriedig@uwo.ca.
authors: Molly
authors: M
authors: Driediger
mesh_terms: D061725:Accelerometry; D015992:Body Mass Index; D002654:Child Care / Q000458:organization & administration*; D000067576:Child Health; D002675:Child, Preschool; D015444:Exercise; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006293:Health Promotion / Q000458:organization & administration*; D006304:Health Status; D006801:Humans; D008297:Male; D010988:Play and Playthings; D011788:Quality of Life; D012107:Research Design; D057185:Sedentary Behavior; D020377:Self Efficacy; D013997:Time Factors