Anita Nelson Niehues

Increasing physical activity in young primary school children - it's child's play: a cluster randomised controlled trial.

OBJECTIVE To explore the effects of an innovative school-based intervention for increasing physical activity. METHODS 226 children (5-7 years old) randomly selected from 12 Australian primary schools were recruited to a cluster randomised trial with schools randomly allocated to intervention or control conditions. The 13-week intervention comprised: (1) altering the school playground by introducing loose materials and (2) a teacher-parent intervention exploring perceptions of risk associated with childrens free play. The primary outcomes were total accelerometer counts and moderate-vigorous physical activity during break times. Testing took place in Sydney, 2009-2010. RESULTS 221 participants were tested at baseline. Mixed-effect multilevel regression revealed a small but significant increase from the intervention on total counts (9400 counts, 95% CI 3.5-15.2, p=0.002) and minutes of MVPA (1.8 min, 95% CI 0.5-3.1, p=0.006); and a decrease in sedentary activity (2.1 min, 95% CI 0.5-3.8, p=0.01) during break times. We retested children in one intervention school after 2 years; they maintained the gains. CONCLUSIONS Capturing childrens intrinsic motivations to play while simultaneously helping adults reconsider views of free play as risky provided increases in physical activity during break times. Using accelerometry as the sole measure of physical activity may underestimate the effect. TRIAL REGISTRATION ACTRN12611000089932.

The sydney playground project: popping the bubblewrap - unleashing the power of play: a cluster randomized controlled trial of a primary school playground-based intervention aiming to increase children's physical activity and social skills

BackgroundIn the Westernised world, numerous children are overweight and have problems with bullying and mental health. One of the underlying causes for all three is postulated to be a decrease in outdoor free play. The aim of the Sydney Playground Project is to demonstrate the effectiveness of two simple interventions aimed to increase childrens physical activity and social skills.Methods/DesignThis study protocol describes the design of a 3-year cluster randomised controlled trial (CRCT), in which schools are the clusters. The study consists of a 13-week intervention and 1 week each of pre-and post-testing. We are recruiting 12 schools (6 control; 6 intervention), with 18 randomly chosen participants aged 5 to 7 years in each school. The two intervention strategies are: (1) Child-based intervention: Unstructured materials with no obvious play value introduced to the playground; and (2) Adult-based intervention: Risk reframing sessions held with parents and teachers with the aim of exploring the benefits of allowing children to engage in activities with uncertain outcomes. The primary outcome of the study, physical activity as measured by accelerometer counts, is assessed at baseline and post-intervention. Additional assessments include social skills and interactions, self-concept, after school time use and anthropometric data. Qualitative data (i.e., transcriptions of audio recordings from the risk reframing sessions and of interviews with selected teacher and parent volunteers) are analysed to understand their perceptions of risk in play. The control schools have recess as usual. In addition to outcome evaluation, regular process evaluation sessions are held to monitor fidelity to the treatment.DiscussionThese simple interventions, which could be adopted in every primary school, have the potential of initiating a self-sustaining cycle of prevention for childhood obesity, bullying and mental ill health.Trial registrationAustralian and New Zealand Clinical Trials Registration Number ACTRN12611000089932.

Everyday uncertainties: reframing perceptions of risk in outdoor free play

This paper reports the results of risk reframing, an intervention to offer parents and educators a context for building new and complex perceptions of risk in children’s outdoor free play. Our objective was to alter these adults’ perceptions of risk to increase the sustainability of an innovative child-centred playground intervention. Qualitative data in the form of audio-recordings of risk-reframing sessions, brief participant evaluations and field notes kept by project staff were collected and either transcribed in their entirety or summarised in brief written reports. These data were subjected to constant comparative analysis to identify emergent themes. Results suggest that educators and parents benefit from opportunities to share risk perceptions and discuss the costs and benefits for offering outdoor free play to children to achieve their common goals for children: health, happiness and resilience.

Sydney Playground Project: A Cluster-Randomized Trial to Increase Physical Activity, Play, and Social Skills.

BACKGROUND We assessed the effectiveness of a simple intervention for increasing childrens physical activity, play, perceived competence/social acceptance, and social skills. METHODS A cluster-randomized controlled trial was conducted, in which schools were the clusters. Twelve Sydney (Australia) primary schools were randomly allocated to intervention or control conditions, with 226 children (5-7 years old) selected randomly to participate. Data were collected at baseline and after 13 weeks. The intervention consisted of introducing recycled materials without an obvious play purpose into school playgrounds and a risk-reframing workshop for parents and teachers. RESULTS Children from the intervention schools increased physical activity and reduced sedentary time while control schools decreased physical activity and increased sedentary time. The intervention yielded increases in total accelerometer counts (β = 9350 counts, 95% CI 3490-1522, p = .002), minutes of moderate/vigorous physical activity (MVPA) (β = 1.8 min, 95% CI 0.52-3.12, p = .006), and reductions in sedentary time (β = -2.1 min, 95% CI -3.77-(-0.51), p = .01). Although the changes in time spent in play and nonplay were not statistically different (p = .08) the effect size (d = .27) indicates clinical significance. CONCLUSIONS This intervention was effective for increasing MVPA during recess and demonstrated capacity to improve play opportunities in school playgrounds.

Reframing healthy risk taking: Parents’ dilemmas and strategies to promote children’s well-being

ABSTRACT This paper reports findings of a qualitative study regarding dilemmas adults experience in balancing protecting children and offering age-appropriate risk taking opportunities. It outlines strategies adults used to manage their own uncertainties as they supported children to become autonomous. Twenty seven parents of typically developing children and 10 parents of children living with social or physical disabilities engaged in a card sort; they identified and prioritized attributes for their children as a prelude to semi-structured, in-depth interviews about how risk helps children reach these goals. Eight teachers of the typically-developing children also participated in interviews about risk in everyday life and their observations of parents’ views about children’s risk taking. We took a hermeneutic interpretive approach to analyzing interview transcripts to gain an understanding of these adults’ dilemmas and strategies they used to offer children age-appropriate occupations with gradually increasing challenge and responsibility. This study provides unique insights into ways adults manage uncertainties and employ strategies to offer children practice in managing risks in everyday life. These practices supported children in developing qualities and characteristics that contributed both to children’s own well-being and to collective well-being of families, schools and communities.