title: Effectiveness of centre-based childcare interventions in increasing child physical activity: a systematic review and meta-analysis for policymakers and practitioners.
abstract: BACKGROUND
  The review describes the effectiveness of physical activity interventions implemented in centre-based childcare services and (i) examines characteristics of interventions that may influence intervention effects; (ii) describes the effects of pragmatic interventions and non-pragmatic interventions; (iii) assesses adverse effects; and (iv) describes cost-effectiveness of interventions
  
  
  METHODS
  Data sources were Cochrane Central Register of Controlled trials, MEDLINE, EMBASE, PsycINFO, ERIC, CINAHL, SCOPUS and SPORTDISCUS. Studies selected included randomized controlled trials conducted in centre-based childcare including an intervention to increase objectively measured physical activity in children aged less than 6 years. Data were converted into standardized mean difference (SMD) and analysed using a random effects model.
  
  
  RESULTS
  Overall interventions significantly improved child physical activity (SMD 0.44; 95% confidence interval [CI]: 0.12-0.76). Significant effects were found for interventions that included structured activity (SMD 0.53; 95% CI: 0.12-0.94), delivery by experts (SMD 1.26; 95% CI: 0.20-2.32) and used theory (SMD 0.76; 95% CI: 0.08-1.44). Non-pragmatic (SMD 0.80; 95% CI: 0.12-1.48) but not pragmatic interventions (SMD 0.10; 95% CI:-0.13-0.33) improved child physical activity. One trial reported adverse events, and no trials reported cost data.
  
  
  CONCLUSIONS
  Intervention effectiveness varied according to intervention and trial design characteristics. Pragmatic trials were not effective, and information on cost and adverse effects was lacking. Evidence gaps remain for policymakers and practitioners regarding the effectiveness and feasibility of childcare-based physical activity interventions.
authors.affiliation: Hunter New England Population Health, Wallsend, NSW, Australia.|School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
authors.forename: M
authors.initials: M
authors.lastname: Finch
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Jones
authors.affiliation: School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Yoong
authors.affiliation: Hunter New England Population Health, Wallsend, NSW, Australia.|School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.|Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
authors.forename: J
authors.initials: J
authors.lastname: Wiggers
authors.affiliation: Hunter New England Population Health, Wallsend, NSW, Australia.|School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.|Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
authors.forename: L
authors.initials: L
authors.lastname: Wolfenden
mesh_terms: D015982:Bias; D002648:Child; D015444:Exercise; D006801:Humans; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D012307:Risk Factors
keywords: Childcare; intervention; physical activity; pragmatic; systematic review