Table 1

Characteristics of experimental studies (n = 13) and effects of (pre)school playgrounds on children’s health
Study; Study design; School(s) (type) Outcome (unit) [measurement] Intervention effects
Country; Level of randomization; Intervention mode(s)
Methodological quality Study population (mean age/range; % girls)
PRESCHOOL INTERVENTIONS
Brown, 2009 [37,47] Non-randomized controlled trial 2 preschools MVPA (% of intervals in which MVPA is performed) [OSRAP]1 No significant difference on intervention days compared to no-intervention days
US 5 children (80% girls) Teacher-implemented promotion of MVPA (3 children)
5.5 Teacher-implemented promotion of MVPA + guided discussions, initial pep talks on the playground, teacher participation, brief review and acknowledgement after the activity, and stickers for child participation (2 children)
No-intervention days (5 children)
Cardon, 2009 [33] RCT 40 preschools I. % in sedentary activity during recess I-V. No significant differences in intervention schools compared to control schools
Belgium Randomization: school-level Provision of play equipment (10 schools) II. % in LPA during recess
10 583 children (mean age 5.3; 47% girls) Painting of playground markings (10 schools) III. % in MPA during recess
Provision of play equipment and painting of playground markings (10 schools) IV. % in VPA during recess
No intervention (10 schools) V. % in average PA during recess[accelerometer]
Hannon, 2008 [36] Non-randomized trial 64 children (age 3–5; 53% girls) 1 preschool I. % time spent in sedentary activity I. Significant decrease after the intervention compared to pre-intervention (F(1,61) = 243.90)a
US Provision of play equipment: hurdles to jump over and hoops to jump through, tunnels to crawl through, balance beams, target toss/throw sets, bean bags, various sized playground balls II. % time spent in LPA II. Significant increase after the intervention compared to pre-intervention (F(1,61) = 16.30)a
9 III. % time spent in MPA III. Significant increase after the intervention compared to pre-intervention (F(1,61) = 212.43)a
IV. % time spent in VPA [accelerometer] IV. Significant increase after the intervention compared to pre-intervention (F(1,61) = 50.35)a
Secondary analyses:
Younger children showed significantly more moderate activity after the intervention compared to pre-intervention than older children (F(2,61) = 9.64)a
Older children showed more vigorous activity after the intervention compared to pre-intervention than younger children (F(2,61) = 2.83)a
Holmes, 2006 [38] Non-randomized trial 1 preschool Post-recess attention (% attentive) [observations] Significant increase in post-recess attention as recess duration increased (F(2,24) = 13.08)
US 27 children (age 50–63 months; 70% girls) Recess duration of 10, 20 and 30 min Secondary analyses:
4.5 Intervention effect was strongest following the 20 min recess and for girls
Van Cauwenberghe, 2012 [42] Non-randomized trial 4 preschools During recess During recess
Belgium 128 children (age 4–6; 46% girls) Decrease of playground density I. min and % spent in sedentary time I. Significant decrease after the intervention compared to pre-intervention 2(2,N = 128) = 26.0, p < 0.001; χ2(2,N = 128) = 19.5, p < 0.001)b
6.5 II. min and % spent in LMVPA II. Significant increase after the intervention compared to pre-intervention ((χ2(2,N = 128) = 26.0, p < 0.001; χ2(2,N = 128) = 19.5, p < 0.001)b
III. min and % spent in MVPA III. Significant increase after the intervention compared to pre-intervention ((χ2(2,N = 128) = 15.3, p < 0.001; χ2(2,N = 128) = 27.2, p < 0.001)b
During preschool time During preschool time
IV. min and % spent in sedentary time IV. No significant difference after the intervention compared to pre-intervention
V. min and % spent in LMVPA V. No significant difference after the intervention compared to pre-intervention
VI. min and % spent in MVPA VI. No significant difference after the intervention compared to pre-intervention
During the entire day During the entire day
VII. min and % spent in sedentary time VII. No significant difference after the intervention compared to pre-intervention
VIII. min and % spent in LMVPA VIII. No significant difference after the intervention compared to pre-intervention
IX. min and % spent in MVPA [accelerometer] IX. Significant increase 2(2,N = 107) = 5.8, p < 0.05)b
Secondary analyses:
Intervention effect was stronger for girls compared to boys for the% spent in sedentary time and LMVPA
PRIMARY SCHOOL INTERVENTIONS
Brink, 2010 [41] Non-randomized controlled trial 9 primary schools I. % active boys/girls on school grounds [SOPLAY]2 I. Significantly more active boys and girls in established and recently rebuilt schools compared to in control schools
US 5488 children (age 4–11; 48% girls) Schoolyard renovations (installation of play equipment, asphalt areas for structured games, and a grassed multipurpose playfield) within the past year (3 schools=’recently rebuilt schools’) II. % sedentary boys/girls on school grounds [SOPLAY]2 II. No significant differences in established and recently rebuilt schools compared to in control schools
8.5 Schoolyard renovations in place for at least 2 years (3 schools=’established schools’) III. Energy expenditure rate (EER) on school grounds [calculated] III. Significant higher EER in boys and girls in established and recently rebuilt schools compared to in control schools
No renovations/minimal improvements over the years (3 schools=’control schools’) Secondary analyses:
Significantly more active boys when there was an unstructured hard surface
Significant less sedentary behavior among girls in established and recently rebuilt schools compared to in control schools
Significantly more active girls when there was a soft structured surface
Bundy, 2008 [43] Non-randomized trial 1 primary school Playfulness (score 0–3; 30 items) [ToP]3 Significant increase after the intervention (ES = 0.55; 95% CI = −0.08,1.19) compared to pre-intervention
Australia 20 children (age 5–7; 70% girls) Introduction of play materials
7.5
Colabianchi, 2009 [40,46] Non-randomized controlled trial 20 primary schools I. % active children on school grounds I. No significant differences in intervention schools compared to control schools
US 136 children Renovation of playground (new play equipment, safety and site improvements) (10 schools) II. % moderately active children on school grounds II. No significant difference in intervention schools compared to control schools
8.5 No intervention (10 schools) III. % vigorously active children on school grounds [SOPLAY]2 III. No significant difference in intervention schools compared to control schools
Huberty, 2011 [39] Non-randomized trial 2 primary schools (public and parochial) During recess During recess
US Public school: Staff training, recreational equipment and playground markings (2 schools) I. MPA (counts/min) I. Significant increase after the intervention compared to pre-intervention
8.5 45 children (age 9.6; 42% girls) II. VPA (counts/min) II. Significant increase after the intervention compared to pre-intervention
Parochial school: During the school day During the school day
48 children (age 9.6; 50% girls) III. MPA (counts/min) III. Significant increase after the intervention compared to pre-intervention
IV. VPA (counts/min) [accelerometer] IV. Significant increase after the intervention compared to pre-intervention
Loucaides, 2009 [34] RCT Randomization: school-level 3 primary schools (innercity) I. Steps/min during recess I. Significant increase in the intervention schools compared to the control school (F(2,222) = 3.08)
Cyprus 228 children (age 11.2; 50% girls) Allocating play space for team games, playground markings and ropes for jumping (school 1) II. Steps/min after school [pedometer] II. No significant difference in the intervention schools compared to the control school
9 Allocating play space for team games (school 2)
No intervention (school 3)
Ridgers, 2007 [28,29] Non-randomized controlled trial 297 children (age 5–10; 50% girls) 26 primary schools I. % time spent in MVPA during recess I. Significant increase in intervention schools compared to control schools (β = 5.95; 95% CI = 0.14,11.77)
UK Incentive for change of playground with use of playground markings and physical structures (15 schools) II. % time spent in VPA during recess [accelerometer] II. Significant increase in intervention schools compared to control schools (β = 1.07; 95% CI = 0.01,3.39)
8.5 No intervention (11 schools) No significant effects when analyses were adjustedc
Secondary analyses:
Intervention effect was stronger for younger children and when recess duration increased
Ridgers, 2007 [28,29] Non-randomized controlled trial 26 primary schools I. % time spent in MVPA during recess I. Significant increase in intervention schools compared to control schoolsa(heart rate: β = 4.03; 95% CI = 0.15, 7.91), accelerometer: β = 4.53; 95% CI = 0.59, 8.47)
UK 470 children (age 8.1-10.1; 51% girls) Incentive for change of playground with use of playground markings and physical structures (15 schools) II. % time spent in VPA during recess [heart rate telemetry, accelerometer] II. Significant increase in intervention schools compared to control schoolsa(heart rate: β = 2.34; 95% CI = 0.06, 4.80, accelerometer: β = 2.32; 95% CI = 0.71,3.93)
7 No intervention (11 schools)
Ridgers, 2010 [30,49] Non-randomized controlled trial 26 primary schools Morning recess I-IV. No significant increase in intervention schools compared to control schools
UK 470 children (age 8.1-10.1; 51% girls) Incentive for change of playground with use of playground I. % time spent in MVPA
8 markings and physical structures (15 schools) II. % time spent in VPA
No intervention (11 schools) Lunch recess
III. % time spent in MVPA
IV. % time spent in VPA [heart rate telemetry, accelerometer]
Stratton, 2005 [32] Non-randomized controlled trial 8 primary schools (4 early primary; 4 late primary) I.% time spent in MVPA during recess I. Significant increase in intervention schools compared to control schools (F(1,204) = 13.7)
UK 99 children (age 4–11; 49% girls) Painting of playground markings (2 early primary and 2 late primary schools) II. % time spent in VPA during recess [heart rate telemetry] II. Significant increase in intervention schools compared to control schools (F(1,204 = 4.05
9 No intervention (2 early primary and 2 late primary schools) cSecondary analyses:
Increase in MVPA in late primary schools was more than double than that found in early primary schools
Stratton, 2000 [31] Non-randomized controlled trial 2 early primary schools I. % of playtime in MVPA I-II. No significant differences in intervention schools compared to control schools
UK 47 children (age 5–7; 51% girls) Playground markings and no play equipment allowed on playground (except for a single football) (1 school) II. % of playtime in VPA [heart rate telemetry]
8.5 No playground markings and limited play equipment allowed (1 school)
Verstraete, 2006 [35] RCT 7 primary schools Morning recess Morning recess
Belgium Randomization: school-level Presentation and provision of game equipment (two jump ropes, two double Dutch ropes, two scoop sets, two I. % time spent in LPA I. No significant difference in intervention schools compared to control schools
9 235 children (age ±10.8; 49% girls) scoop sets, two flying discs, two catch balls, one poco ball, one II. % time spent in MPA II. Significantly higher in intervention schools compared to control schools (F(4) = 10.6)d
plastic ball, two plastic hoops, two super grips, three juggling III. % time spent in VPA III. No significant difference in intervention schools compared to control schools
scarves, six juggling rings, six juggling bean balls, one diabolo, IV. % time spent in MVPA IV. No significant difference in intervention schools compared to control schools
one angel-stick, four spinning plates, two sets of badminton Lunch break Lunch break
racquets and two sets of oversized beach paddles) and activity cards with examples of games and activities that can be performed with the equipment (4 schools) V. % time spent in LPA V. No significant difference in intervention schools compared to control schools
VI. % time spent in MPA VI. Significantly higher in intervention schools compared to control schools (F(4) = 28.3)d
No intervention (3 schools) VII. % time spent in VPA VII. Significantly higher in intervention schools compared to control schools (F(4) = 13.1)d
VIII. % time spent in MVPA [accelerometer] VIII. Significantly higher in intervention schools compared to control schools (F(4) = 44.2)d
Secondary analyses:
Girls spent significantly more time in LPA F(4) = 2.4)d, MPA (F(4) = 2.2)d, VPA (F(4) = 0.5)d and MVPA (F(4) = 2.9)d during morning recess

PA = physical activity; LPA = light intensity physical activity; MPA = moderate intensity physical activity; VPA = vigorous intensity physical activity; MVPA = moderate-to-vigorous physical activity; Methodological quality was assessed on a scale 0–14; 1OSRAP = Observational System for Recording Physical Activity in Preschoolers; 2SOPLAY = System for Observing Play and Leisure Activity in Youth; 3ToP = Test of Playfulness, an observational assessment of playfulness. Analyses were adjusted for aage, gender, baseline physical activity levels and recess time; bplay duration and body mass index; csex, age, body mass index and recess duration; dsex, age and accelerometer wear time; egender, day of accelerometry; fgender and baseline MVPA. If no superscript number, the results of analyses were unadjusted.

Broekhuizen et al.

Broekhuizen et al. International Journal of Behavioral Nutrition and Physical Activity 2014 11:59   doi:10.1186/1479-5868-11-59

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