title: Active Early: one-year policy intervention to increase physical activity among early care and education programs in Wisconsin.
abstract: Early childcare and education (ECE) is a prime setting for obesity prevention and the establishment of healthy behaviors. The objective of this quasi-experimental study was to examine the efficacy of the Active Early guide, which includes evidenced-based approaches, provider resources, and training, to improve physical activity opportunities through structured (i.e. teacher-led) activity and environmental changes thereby increasing physical activity among children, ages 2-5 years, in the ECE setting.
  
  
  
  Twenty ECE programs in Wisconsin, 7 family and 13 group, were included. An 80-page guide, Active Early, was developed by experts and statewide partners in the fields of ECE, public health, and physical activity and was revised by ECE providers prior to implementation. Over 12 months, ECE programs received on-site training and technical assistance to implement the strategies and resources provided in the Active Early guide. Main outcome measures included observed minutes of teacher-led physical activity, physical activity environment measured by the Environment and Policy Assessment and Observation (EPAO) instrument, and child physical activity levels via accelerometry. All measures were collected at baseline, 6 months, and 12 months and were analyzed for changes over time.
  
  
  
  Observed teacher-led physical activity significantly increased from 30.9 ± 22.7 min at baseline to 82.3 ± 41.3 min at 12 months. The change in percent time children spent in sedentary activity decreased significantly after 12 months (-4.4 ± 14.2 % time, -29.2 ± 2.6 min, p < 0.02). Additionally, as teacher led-activity increased, percent time children were sedentary decreased (r = -0.37, p < 0.05) and percent time spent in light physical activity increased (r = 0.35, p < 0.05). Among all ECE programs, the physical activity environment improved significantly as indicated by multiple sub-scales of the EPAO; scores showing the greatest increases were the Training and Education (14.5 ± 6.5 at 12-months vs. 2.4 ± 3.8 at baseline, p < 0.01) and Physical Activity Policy (18.6 ± 4.6 at 12-months vs. 2.0 ± 4.1 at baseline, p < 0.01).
  
  
  
  Active Early promoted improvements in providing structured (i.e. teacher-led) physical activity beyond the recommended 60 daily minutes using low- to no-cost strategies along with training and environmental changes. Furthermore, it was observed that Active Early positively impacted child physical activity levels by the end of the intervention. However, resources, training, and technical assistance may be necessary for ECE programs to be successful beyond the use of the Active Early guide. Implementing local-level physical activity policies combined with support from local and statewide partners has the potential to influence higher standards for regulated ECE programs.
authors.affiliation: Department of Dietetics, School of Natural and Health Sciences, Mount Mary University, 2900 North Menomonee River Parkway, Milwaukee, WI, 53222, USA. larowet@mtmary.edu.
authors.forename: Tara L
authors.initials: TL
authors.lastname: LaRowe
authors.affiliation: College of Public Health & Human Sciences, School of Biological & Population Health Sciences, Oregon State University, 118D Milam Hall, Corvallis, OR, 97331, USA.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Tomayko
authors.affiliation: Department of Family Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, 610 Walnut Street, Madison, WI, 53726, USA.
authors.forename: Amy M
authors.initials: AM
authors.lastname: Meinen
authors.affiliation: Supporting Families Together Association, 700 Rayovac Drive, Suite 6, Madison, WI, 53711, USA.
authors.forename: Jill
authors.initials: J
authors.lastname: Hoiting
authors.affiliation: School of Medicine and Public Health, Area Health Education Centers System, University of Wisconsin-Madison, 750 Highland Avenue, Madison, WI, 53705, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Saxler
authors.affiliation: State of Wisconsin, Department of Children and Families, 201 East Washington Avenue, Madison, WI, 53708, USA.
authors.forename: Bridget
authors.initials: B
authors.lastname: Cullen
mesh_terms: D061725:Accelerometry; D002648:Child; D002654:Child Care / Q000331:legislation & jurisprudence* / Q000379:methods; D002675:Child, Preschool; D004777:Environment; D015444:Exercise; D005260:Female; D006284:Health Plan Implementation; D006291:Health Policy; D006293:Health Promotion / Q000331:legislation & jurisprudence* / Q000379:methods; D006801:Humans; D008297:Male; D063766:Pediatric Obesity / Q000517:prevention & control; D015397:Program Evaluation / Q000706:statistics & numerical data*; D014922:Wisconsin
keywords: Accelerometry; Early care and education; Environment and policy assessment and observation; Obesity prevention; Physical activity