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Table 1 Characteristics of experimental studies (n = 13) and effects of (pre)school playgrounds on children’s health

From: The value of (pre)school playgrounds for children’s physical activity level: a systematic review

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

  1. 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.