Preschool Physical Activity Policy and Children’s Physical Activity
10 affiliations
- 1Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- 2Centre for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
- 3PROFITH (Promoting Fitness and Health Through Physical Activity) Research Group, Sport and Health University Research Institute, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
- 4Department of Biomedicine, Aarhus University, Aarhus, Denmark
- 5Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- 6Faculty of Health Sciences, University of Lethbridge, Lethbridge, Alberta, Canada
- 7Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- 8Department of Medicine, Division of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
- 9Department of Public Health Sciences, Thompson School of Social Work & Public Health, University of Hawaii at Mānoa, Mānoa
- 10Center for Wellbeing, Welfare and Happiness, Stockholm School of Economics, Stockholm, Sweden.
Abstract
Importance: Evidence regarding the effectiveness of physical activity (PA) policies within preschool settings remains limited.
Objective: To evaluate the effectiveness of a cocreated preschool-level PA policy on children’s accelerometer-measured PA during preschool hours.
Design, Setting, and Participants: This single-blind, parallel-group, cluster randomized clinical trial was performed at public preschools in Stockholm, Sweden. Of 156 randomly sampled preschools invited, 124 were randomized. Children aged 3 to 5 years with parental consent were recruited from September 14 to December 11, 2020, baseline measurements from September 23, 2020, to January 22, 2021, and 6-month follow-up from March 8 to June 11, 2021. Statistical analyses were performed from March 6, 2023, to October 25, 2024.
Intervention: A cocreated preschool-level PA policy implemented for 6 months vs usual practice.
Main Outcomes and Measures: Prespecified primary outcomes were between-group differences in change in moderate to vigorous PA, total PA, and steps during preschool hours, measured using wearable accelerometers.
Results: Among 3751 children (mean [SD] age, 4.44 [0.86] years; 1934 male [51.6%]), 1960 attended intervention preschools and 1791 attended control preschools. All 124 preschools completed follow-up; data were available for 1530 children (78.1%) in intervention schools at baseline and 1435 (73.2%) at follow-up and 1430 children (79.8%) in control schools at baseline and 1356 (75.7%) at follow-up. Intention-to-treat analyses included 3417 children (1770 intervention and 1647 control). Moderate to vigorous PA increased from 27.4 to 33.0 minutes per day in the intervention group and from 27.6 to 33.0 minutes per day in the control group (difference in change, 0.3 [95% CI, −0.7 to 1.3] minutes per day; P = .57). Total PA increased from 177.7 to 185.3 minutes per day in the intervention group and from 176.5 to 184.5 minutes per day in the control group (difference, −0.3 [95% CI, −3.3 to 2.7] minutes per day; P = .84). Steps increased from 5415 to 5953 per day in the intervention and from 5549 to 6078 per day in the control groups (difference, 8 [95% CI, −118 to 133] steps per day; P = .90). No participants withdrew because of adverse events.
Conclusions and Relevance: In this cluster randomized clinical trial, a cocreated preschool PA policy did not increase children’s PA beyond usual practice after 6 months. These findings highlight the complexity of translating policy adoption into measurable behavioral change and of detecting such change in preschool settings.
Trial Registration: ClinicalTrials.gov Identifier: NCT04569578
Related
- Long-term regular aerobic activity and its effects on physical fitness and self-concept in preschool children aged 4–6 years: a quasi-experimental study
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- Boosting Children’s Physical Activity in Outside School Hours Care
- Physical activity, entertainment screen time, and dietary fat profiles and concurrent weight status among school-attending Chinese children and adolescents: CHNS 2004–2011
BibTeX
@article{chen2026preschool,
title = {{Preschool Physical Activity Policy and Children’s Physical Activity}},
author = {Chu Chen and Jairo H. Migueles and Viktor H. Ahlqvist and Pablo Campos-Garzón and Pontus Henriksson and Martin Neovius and Maria Rosaria Galanti and Kyriaki Kosidou and Nicola Orsini and Anton Lager and Daniel Berglind},
journal = {JAMA Network Open},
year = {2026},
month = oct,
doi = {10.1001/jamanetworkopen.2026.40617},
url = {https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855864},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Preschool Physical Activity Policy and Children’s Physical Activity
AU - Chu Chen
AU - Jairo H. Migueles
AU - Viktor H. Ahlqvist
AU - Pablo Campos-Garzón
AU - Pontus Henriksson
AU - Martin Neovius
AU - Maria Rosaria Galanti
AU - Kyriaki Kosidou
AU - Nicola Orsini
AU - Anton Lager
AU - Daniel Berglind
PY - 2026
DA - 2026/10/27
JO - JAMA Network Open
DO - 10.1001/jamanetworkopen.2026.40617
UR - https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2855864
AB - Importance: Evidence regarding the effectiveness of physical activity (PA) policies within preschool settings remains limited. Objective: To evaluate the effectiveness of a cocreated preschool-level PA policy on children’s accelerometer-measured PA during preschool hours. Design, Setting, and Participants: This single-blind, parallel-group, cluster randomized clinical trial was performed at public preschools in Stockholm, Sweden. Of 156 randomly sampled preschools invited, 124 were randomized. Children aged 3 to 5 years with parental consent were recruited from September 14 to December 11, 2020, baseline measurements from September 23, 2020, to January 22, 2021, and 6-month follow-up from March 8 to June 11, 2021. Statistical analyses were performed from March 6, 2023, to October 25, 2024. Intervention: A cocreated preschool-level PA policy implemented for 6 months vs usual practice. Main Outcomes and Measures: Prespecified primary outcomes were between-group differences in change in moderate to vigorous PA, total PA, and steps during preschool hours, measured using wearable accelerometers. Results: Among 3751 children (mean [SD] age, 4.44 [0.86] years; 1934 male [51.6%]), 1960 attended intervention preschools and 1791 attended control preschools. All 124 preschools completed follow-up; data were available for 1530 children (78.1%) in intervention schools at baseline and 1435 (73.2%) at follow-up and 1430 children (79.8%) in control schools at baseline and 1356 (75.7%) at follow-up. Intention-to-treat analyses included 3417 children (1770 intervention and 1647 control). Moderate to vigorous PA increased from 27.4 to 33.0 minutes per day in the intervention group and from 27.6 to 33.0 minutes per day in the control group (difference in change, 0.3 [95% CI, −0.7 to 1.3] minutes per day; P = .57). Total PA increased from 177.7 to 185.3 minutes per day in the intervention group and from 176.5 to 184.5 minutes per day in the control group (difference, −0.3 [95% CI, −3.3 to 2.7] minutes per day; P = .84). Steps increased from 5415 to 5953 per day in the intervention and from 5549 to 6078 per day in the control groups (difference, 8 [95% CI, −118 to 133] steps per day; P = .90). No participants withdrew because of adverse events. Conclusions and Relevance: In this cluster randomized clinical trial, a cocreated preschool PA policy did not increase children’s PA beyond usual practice after 6 months. These findings highlight the complexity of translating policy adoption into measurable behavioral change and of detecting such change in preschool settings. Trial Registration: ClinicalTrials.gov Identifier: NCT04569578
SN - 2574-3805
ER -