Date of Award

5-2014

Degree Name

Doctor of Philosophy in Nursing (PhD)

Advisor(s)

Janet C. Meininger

Second Advisor

Cathy Rozmus

Third Advisor

Martina Gallagher

Fourth Advisor

Barbara Hernandez

Abstract

Background: Reversing obesity is an urgent public health need for children: worldwide, in 2011 more than 40 million children under the age of five were either overweight or obese. Increasing intensity and duration of physical activity is a strategy to aid in preventing and reducing obesity. A minimum of 60 minutes per day of moderate to vigorous physical activity is recommended for children. School settings, such as full-day kindergarten, where 74% of children in the United States are enrolled, provide opportunities for population-based interventions to increase physical activity, yet little objective data exist on current levels of physical activity in kindergarten settings. The aims of this study were to 1) describe the patterns and duration of daily physical activity of kindergarten children at different levels of intensity (sedentary, light, moderate-to-vigorous, and vigorous) during school hours; and 2) identify the most predictive factors that enable and support physical activity in kindergarten children at recommended intensity levels.

Methods: A cross-sectional observational study with a sample of 38 children was conducted in a full day, public kindergarten. Accelerometers measured the duration and intensity of physical activity for three 6-hour school days in 15-second epochs. Parent and teacher questionnaires and other factor-specific tools were used to measure enabling (body mass index, motor skills, and duration of access to play equipment) and supporting vi (mother social support, mother and teacher behavior related to physical activity, mother’s perception of the child’s competence and enjoyment of physical activity) factors.

Results: The 38 children had a mean age of 6.12 ±0.14 years, 60% Females, 93% African American, 16% were overweight, and 16% were obese. Physical activity of the children was sedentary/light for 91% of the school day and the mean duration of moderately vigorous/and vigorous physical activity was 32.2 (SD 11.6) minutes/day. Pattern analyses indicated slight increases in moderate to vigorous and vigorous physical activity from 10 a.m. to 11 a.m. (outdoor free play) and from 1 p.m. to 2:30 p.m. (classroom guided physical activity, free play, and dismissal preparation). In multiple regression analysis, motor skills scores (enabling factor) and teacher physical activity (supporting factor) were identified as predictor variables, but not in the direction expected. These variables explained 21% of the variance in moderate to vigorous and vigorous physical activity (p = 0.001). The statistical significance of teacher physical activity and the unexplained direction of the associations prompted further analysis of differences among the five participating classrooms. The classroom variable alone explained 36% of the variance in the dependent variable and none of the other predictor variables was statistically significant.

Conclusions: During school hours, this sample of kindergarten children met about half of the recommended 60 minutes of moderate to vigorous and vigorous physical activity per day. Patterns across the school day identified slight increases in physical activity intensity during brief periods of scheduled playtime, highlighting the need to incorporate increases of higher intensity level physical activity at other times during the school day. Further study is needed with larger, more diverse samples of kindergarten children to investigate specific factors at the classroom and school levels that influence physical activity, in addition to further research on characteristics of the individual child and familial influences.

Keywords

obesity, exercise, physical activity, kindergarten, cross-sectional observational study

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