Purpose: Evidence links tummy time to infants’ health outcomes. However, the associations between tummy time and other movement and sleep behaviours remains unknown. The purpose of this study is to examine associations of tummy time with active playtime, screen time, and nocturnal sleep time of children aged 12- and 24 months old.

Methods: A longitudinal analysis was conducted using data extracted from an Australian trial. Telephone interviews were conducted to collect data from 1,155 women at baseline (3rd trimester of pregnancy) and when their children reached 6-, 12- and 24-months old.

Results: Children who started tummy time within 4 weeks of age were more likely to have > 10 hours sleep at night at 12 months (AOR 1.54, 95% CI 1.08 – 2.19). They were more likely to have >3 hours per day of outdoor play and have <1 hour per day of screen time at 24 months. Children who practised tummy time every day were more likely to have >2 hours per day of active play at 12 months and have <1 hour per day of screen time at 24 months.

Conclusions: Starting tummy time earlier and more frequently was associated with favourable movement and sleep behaviours of young children at 12- and 24 months old.

Purpose: Parents play a key role in young children's physical activity, including the development of physical literacy via fundamental movement skills. To date, little research has explored parent-focused interventions to improve young children's physical literacy. The primary objective of this study was to determine if a potentially scalable physical literacy training workshop called PLAYshop could increase parental knowledge and confidence related to engaging in play with their preschool-aged child (3-5 years) to facilitate physical literacy.

Methods: We conducted a pragmatic, systematic controlled trial in two Canadian cities from December 2019 – March 2020. The PLAYshop was designed using the Behaviour Change Wheel and Bandura’s social cognitive theory. Participants assigned to the intervention group received a 75-minute workshop inclusive of interactive activities and educational messages derived from physical literacy concepts. To support physical literacy development at-home, parents were provided with educational materials, a ‘goody bag’ of resources, and booster emails sent at two time points after the workshop. Participants assigned to the control group received the workshop and equipment at a later date. Parents’ knowledge and confidence of key physical literacy constructs were measured via baseline and follow-up surveys. Parent’s application of workshop learnings at-home were qualitatively explored using semi-structured telephone interviews. Repeated measures ANOVAs and thematic analyses were completed.

Results/findings: A total of 89/143 eligible parents provided complete data from the intervention (n=39) and control group (n=50); 33 parents from the intervention group participated in telephone interviews.  Parents’ knowledge and confidence relating to all physical literacy constructs improved significantly over time across both groups, but the changes in the intervention group were significantly greater than those in the control group. Additionally, parents applied key concepts of physical literacy at-home (e.g. child-led play, making activities fun, and promoting child manipulative and locomotor skills).

Conclusions: Parents’ self-reported knowledge and confidence to assist their child in developing physical literacy significantly increased after participating in the PLAYshop. The key concepts of physical literacy were also translated to parents’ purposeful play with their child at-home. The findings from this real-world trial address an important evidence gap and highlight a feasible intervention that warrants further testing.

Purpose: The COVID-19 pandemic has altered children’s daily lives via the transition to virtual schooling, cancellation of extracurricular activities, and implementation of physical distancing among other mitigation strategies. Previous cross-sectional and retrospective longitudinal studies suggest children’s sleep timing has shifted later, while findings regarding sleep duration have been mixed. To date, it is unknown how the pandemic has impacted the day-to-day consistency in children’s sleep duration or timing. This interrupted time series design examined children’s sleep duration and midpoint consistency during the COVID-19 pandemic compared to previous data from the same children during the same time periods in each of the two years prior.

Methods: As part of a larger cohort, 209 children (7-12 years, 52% female) wore a Fitbit Charge-2 on their non-dominant wrist for 6-week measurement periods during the spring (April/May) and summer (June/July) from 2018-2020. Consistency of sleep duration (minutes asleep between sleep onset and offset) and timing (sleep midpoint, time halfway between onset and offset) were calculated. Child-level individual standard deviation for duration and timing were calculated within each 6-week measurement period. Multilevel mixed models compared changes in consistency before the pandemic (2018-2019) to changes after the pandemic onset (2019-2020). Covariates included mean sleep duration, age, sex, and race.

Results: Prior to the pandemic (difference between 2018 and 2019), there were no changes in the consistency of children’s sleep duration (spring: -4.8 minutes, 95%CI=-12.2, 2.5; summer: -2.6 minutes, 95%CI=-11.8, 6.6) or timing (spring: -8.0 minutes, 95%CI=-19.9, 3.9; summer: -9.1, 95%CI=-24.2, 6.0). During the pandemic spring, both sleep duration and timing became more inconsistent by 20 minutes (95% CI=6.4, 34.4) and 33 minutes (95% CI=10.5, 56.4), respectively. During the pandemic summer, sleep timing became more inconsistent (+46 minutes, 95% CI=19.2, 74.8), while there was no change in duration consistency.

Implications: Inconsistent sleep duration and timing during the pandemic is concerning given their link to poor health behaviors, which may ultimately lead to unhealthy weight gain. Future intervention strategies should consider consistency of sleep duration and timing to alleviate long-term effects on children’s health.

Purpose: The School Wellness Integration Targeting Child Health (SWITCH) has demonstrated feasibility as a promising implementation process designed to help schools facilitate changes in students’ physical activity (PA), sedentary screen time (SST), and dietary intake (DI). This study evaluated the comparative effectiveness of an intensive individualized implementation approach with a group implementation approach, and whether effectiveness differed by student gender.

Methods: Iowa elementary schools (N=22) participated in the 2017‒2018 iteration of SWITCH. The schools were predominantly rural with heterogeneous total enrollment (N=57‒521), and free/reduced lunch status (8.5‒59.4%). All schools received standardized training (school wellness conference and preparatory webinars). Schools were matched within region and randomized to receive either enhanced (individualized monthly webinars with motivational interviewing) or standard (group) implementation support during 12 weeks of SWITCH intervention programming. PA, SST, and DI outcomes of 1,097 students were assessed at pre- and post-intervention periods via Youth Activity Profile (YAP), a validated and calibrated online self-report instrument. A series of mixed models were used to evaluate differential change in outcomes by condition (adjusting for school region and gender) to determine comparative effectiveness, and to test for differential change by condition by gender. Alpha was set at 0.01.

Results: Both conditions showed significant improvements in PA and SST over time (p<0.01), but change was not significant for DI (p=0.023‒0.054). There were no differential changes between the standard and enhanced implementation conditions for PA (p=0.507), SB (p=0.190), and DI (p=0.725). There were no significantly differential changes by condition by gender for PA (p=0.861), SST (p=0.455, or DI (p=0.150). Effect size for both implementation conditions equated to approximately 6 minutes of improvement in moderate-to-vigorous physical activity per day.

Conclusion: The results indicate that enhanced individualized implementation support was not more effective than standard group implementation support for improving PA, SST, or DI. Given that the standard group support is less demanding than individualized support for both intervention staff and school personnel, this lack of difference is a welcome finding. Similarly, the lack of interaction by gender suggests that SWITCH can be effective for both boys and girls.  Future studies will evaluate SWITCH at scale.

Purpose: The Physically Active Children in Education (PACE) intervention is a proven-effective multicomponent implementation strategy to increase teacher’s delivery of physical activity, consistent with a state-level policy mandate. The dissemination of PACE is necessary for population level benefit, but this may not be feasible for public health and/or school departments with limited resources. This study assessed whether an adapted variation of PACE (hypothesized to be more amenable to scale-up) was noninferior compared to the original PACE.

Methods: We employed a noninferiority cluster randomised controlled trial with 48 schools in the Hunter New England region of NSW, Australia. Schools were randomised to receive the original PACE intervention or an adapted PACE intervention. A rigorous process was used to determine adaptations, including literature reviews, mediation analysis, cost-effectiveness comparison, stakeholder input and consensus among the research team. The final modifications were: (A) teacher training delivered by an internal school champion instead of an external public health officer, and (B) school support provided via distance communication instead of face-to-face. The primary outcome of interest was teachers’ scheduled minutes of weekly physical activity assessed at baseline (Oct 2018- Feb 2019) and 12-month follow-up (Oct- Dec 2019). The noninferiority margin was set at 17.9 minutes based on data from previous trials of PACE. Linear mixed models analyzed within a Bayesian framework were used to assess non-inferiority between the two versions of PACE.

Results/findings: The posterior estimate for the difference in the average minutes of weekly physical activity delivered by teachers at follow-up receiving the adapted PACE, compared to teachers receiving the original PACE is -2.3 minutes; with a 95% probability that the true difference lies between -18.02 and 14.45 minutes. There was an estimated 97.4% probability of the adapted PACE being considered non-inferior to the original PACE (i.e. adapted PACE no more than 17.9 minutes less than original PACE).

Conclusions: Adapted PACE is suitable for scaled-up service delivery. Further evaluation of implementation and cost-effectiveness will supplement these findings and corroborate evidence of its scalability.