@article{b54134d8c0314004a4ed517562d9293d,
title = "Effectiveness of early care and education center-based interventions for improving cardiovascular fitness in early childhood: A systematic review and meta-analysis",
abstract = "This systematic review and meta-analysis examined the literature on early care and education center (ECEC)-based physical activity interventions to identify ecologic environmental factors that improve cardiovascular fitness (CVF) in preschool-aged children. Data sources included PubMed, Web of Science, Cochrane Library Trials, CINHAL, Science Direct, PsychINFO and SPORTDiscus. Peer-reviewed publications of studies that met the following criteria were eligible for inclusion: (1) mean age of participants between two and a half and five and a half years old enrolled in a pre-primary school; (2) randomized controlled trials or quasi-experimental interventions with a control group; (3) interventions occurring before, during, or immediately after school; (4) use of an objective measure or field-based estimate of CVF; (5) enrolled apparently healthy children. In June of 2018, titles (n = 1197) were reviewed for inclusion into the study and 74 abstracts/full texts were assessed for eligibility. Ten articles met all eligibility criteria and were included in the final review. A random effects meta-analysis suggested a moderate-to-large effect size for ECEC-based interventions to increase CVF (g = 0.75; 95%CI [0.40–1.11]). Interventions that included three or more ecologic environments (g = 0.79 [0.34–1.25]) were more effective than interventions occurring at the individual level (g = 0.67 [0.12–1.22]). Study quality was moderate, and (mean ± SD) 17.9 ± 4.3 (63.9%) of 28 checklist items were reported. Preliminary evidence suggests that ECEC-based interventions to increase CVF are highly effective at improving preschool children's exercise test scores. Although ECEC-based interventions show promise, the small number of studies included in this review limits confidence in these findings. Review registered at PROSPERO CRD42018099115.",
keywords = "Cardiorespiratory fitness, Child, Physical activity, Preschool, Social ecology, Systematic review",
author = "Jacob Szeszulski and Elizabeth Lorenzo and Shaibi, {Gabriel Q.} and Buman, {Matthew P.} and Sonia Vega-L{\'o}pez and Hooker, {Steven P.} and Lee, {Rebecca E.}",
note = "Funding Information: Overall, this study found that interventions focused on improving the CVF profiles of young children impart a moderate-to-large effect on CVF. Interpersonal and institutional factors included in these studies focused on training and incorporation of teachers into intervention delivery, whereas parents were included through newsletters, discussions, orientation sessions, webinars, and family homework. In addition, PA equipment (e.g., posters, climbing walls, PA games, portable toys) was installed into classrooms and play areas of ECECs. The one intervention that included both community and policy level intervention components focused on center-level play policies, improved curricula and curricular monitoring, improvement of neighborhood play equipment, and neighborhood events for families (Zhou et al., 2014). Strategies implemented by these studies are consistent with the literature on improving PA and supported by the EMPA, which posits that interventions that occur within multiple environments have linkages that allow transfer effects (Spence and Lee, 2003).This research was supported by the National Institutes of Health through the National Institute on Minority Health and Health Disparities cooperative agreement 5U01MD010667-03 awarded to Dr. Rebecca E. Lee, the National Institute of Nursing Research grant 1F31NR017560-01 awarded to Elizabeth Lorenzo, the National Cancer Institute/NIH Grant Grant 2T32CA057712-26 awarded to the University of Texas Health Science Center at Houston School of Public Health Cancer Education and Career Development Program. Partial funding by the Michael Susan Dell Center for Healthy Living for Jacob Szeszulski, the Jonas Scholar Nurse Leader 2016–2018 Cohort awarded to Elizabeth Lorenzo, and a dissertation completion fellowship awarded by Arizona State University's Graduate College to Jacob Szeszulski. Not applicable. Funding Information: This research was supported by the National Institutes of Health through the National Institute on Minority Health and Health Disparities cooperative agreement 5U01MD010667-03 awarded to Dr. Rebecca E. Lee, the National Institute of Nursing Research grant 1F31NR017560-01 awarded to Elizabeth Lorenzo, the National Cancer Institute/NIH Grant Grant 2T32CA057712-26 awarded to the University of Texas Health Science Center at Houston School of Public Health Cancer Education and Career Development Program. Partial funding by the Michael Susan Dell Center for Healthy Living for Jacob Szeszulski, the Jonas Scholar Nurse Leader 2016–2018 Cohort awarded to Elizabeth Lorenzo, and a dissertation completion fellowship awarded by Arizona State University's Graduate College to Jacob Szeszulski. Publisher Copyright: {\textcopyright} 2019 The Authors",
year = "2019",
month = sep,
doi = "10.1016/j.pmedr.2019.100915",
language = "English (US)",
volume = "15",
journal = "Preventive Medicine Reports",
issn = "2211-3355",
publisher = "Elsevier BV",
}