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Interventions to Promote Healthy Movement Behaviours in Early Childhood Education and Care Settings

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (31 December 2019) | Viewed by 52174

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Special Issue Editors

Dr. Hayley Christian

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Guest Editor

PLAYCE Research Group, School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Crawley, WA 6009, Australia
Interests: physical activity (adult and child); obesity; health and the built environment; health benefits of pet ownership; health promotion

Prof. Stewart Trost

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Guest Editor

Institute of Health and Biomedical Innovation (IHBI),QLD Centre for Children’s Health Research (CCHR), Queensland University of Technology, Brisbane QLD 4000, Australia

Prof. Dr. Dianne S. Ward

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Guest Editor

1. Department of Nutrition, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
2. Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
Interests: behavior science; nutrition; physical activity; children’s health; obesity
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Special Issue Information

Dear Colleagues,

Countries such as Canada and Australia have recently released 24-hour Movement Guidelines for the early years and national physical literacy standards highlighting the importance of early movement behaviours and physical development on later health (i.e., chronic diseases such as obesity) and developmental trajectories (e.g., academic achievement). Young children spend a significant amount of time in early childhood education and care (ECEC) services. ECEC is thus an important setting to promote early child movement behaviours related to physical activity, sedentary behaviour, and sleep, as well as development-related outcomes such as physical literacy. There is a need for effective intervention strategies that target multiple movement-based behaviours and developmental outcomes for children attending ECEC. To support the implementation of these intervention strategies, they should align with country-specific early years learning frameworks, regulatory requirements, and standards.

This Special issue seeks papers on early childhood education and care interventions focused on movement behaviours such as physical activity, sedentary behaviour, and sleep, as well as related developmental outcomes such as physical literacy. Intervention studies with a focus on the scale up and implementation of strategies at a population level are a priority.

Assoc. Prof. Hayley Christian
Prof. Stewart Trost
Prof. Dianne Stanton Ward
Guest Editors

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Keywords

early childhood education and care
childcare
preschool
early years
early child development
physical activity
sedentary behaviour
screen time
sleep
physical literacy
fundamental movement skills
intervention studies
implementation
scale up

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Published Papers (12 papers)

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15 pages, 341 KiB

Open AccessArticle

Preschoolers Build Fundamental Motor Skills Critical to an Active Lifestyle: The All 4 Kids^© Intervention Study

by Anne R. Lindsay, Angela Starrett, Ali Brian, Teresa A. Byington, Jennifer Lucas and Madeleine Sigman-Grant

Int. J. Environ. Res. Public Health 2020, 17(9), 3098; https://doi.org/10.3390/ijerph17093098 - 29 Apr 2020

Cited by 15 | Viewed by 4605

Abstract

This pragmatic, real world study examined the effects of the All 4 Kids^© intervention on preschoolers’ mastery of movement skills and determined whether the instruction had greater impact than natural development. Methods included a quasi-experimental intervention-comparison subsample of 379 children (COMPARISON) and a pretest-posttest design with convenience scale-up sampling of 2817 preschoolers (SCALE-UP). Children receiving education and dance instruction 3 times/week for 8 weeks were assessed using the Preschool Movement Assessment to evaluate skills pre and post intervention. Using repeated measures ANOVA, McNemar and Wilcoxon signed ranks tests, preschooler’s participation in the intervention resulted in greater improvement in 12 movement skills (F = 83.451, df = 1, p < 0.001,

η_{p}^{2}

= 0.555), balance (p = 0.028), hopping (t = −3.545, df = 112, p = 0.001) and crossing the midline (p < 0.001) than natural development (COMPARISON). In the SCALE-UP study, children significantly improved in all measures based on post-intervention scores. Significant differences were observed between Hispanic and non-Hispanic children for the 12-skills (b = −0.758, se = 0.161, p < 0.001) using hierarchical linear models; boys’ and girls’ scores were not differentially impacted by the intervention. Therefore, implementation of interventions focused on fundamental movement skill development have the potential to remediate secular motor skill decline in young children. Full article

(This article belongs to the Special Issue Interventions to Promote Healthy Movement Behaviours in Early Childhood Education and Care Settings )

17 pages, 390 KiB

Open AccessArticle

Implementing Appetite to Play at scale in British Columbia: Evaluation of a Capacity-Building Intervention to Promote Physical Activity in the Early Years

by Kasra Hassani, E. Jean Buckler, Jennifer McConnell-Nzunga, Sana Fakih, Jennifer Scarr, Louise C. Mâsse and Patti-Jean Naylor

Int. J. Environ. Res. Public Health 2020, 17(4), 1132; https://doi.org/10.3390/ijerph17041132 - 11 Feb 2020

Cited by 30 | Viewed by 4047

Abstract

Childcare is a critical target for promoting children’s physical activity (PA) and physical literacy (PL). With emerging evidence about the efficacy of policy and capacity-building strategies, more information about how to bring these strategies to scale is needed. This paper describes implementation at scale of Appetite to Play (ATP), a capacity-building intervention for childcare providers, and examines the implementation and impact on early years providers’ capacity to address PA. The ATP implementation evaluation was a natural experiment that utilized a mixed methods concurrent parallel design framed within the Reach, Effectiveness, Adoption, Implementation, Maintenance framework (RE-AIM). Workshop and website tracking assessed reach and adoption. Surveys and interviews with workshop participants and stakeholders assessed satisfaction, implementation, and maintenance. Training reached 60% of British Columbia municipalities and 2700 early years providers. Significant changes in participants’ knowledge and confidence to promote PA and PL were achieved (p > 0.01–0.001). Childcare level implementation facilitators as reported by early years providers included appropriate resources, planning, indoor space, and equipment, whereas weather and space were reported barriers. The stakeholder advisory group viewed the stakeholder network and Active Play policy as facilitators and adjustments to recent shifts in childcare funding and previous initiatives as barriers to implementation. ATP was scalable and impacted provider knowledge, confidence, and intentions. The impact on actual policies and practices, and children’s PA needs to be assessed along with sustainability. Full article

(This article belongs to the Special Issue Interventions to Promote Healthy Movement Behaviours in Early Childhood Education and Care Settings )

14 pages, 667 KiB

Open AccessArticle

Prevalence and Relationships among Physical Activity Policy, Environment, and Practices in Licensed Childcare Centers from a Manager and Staff Perspective

by Jennifer McConnell-Nzunga, Louise C. Mâsse, E. Jean Buckler, Valerie Carson, Guy E. Faulkner, Erica Y. Lau, Heather A. McKay, Viviene A. Temple, Luke Wolfenden and Patti-Jean Naylor

Int. J. Environ. Res. Public Health 2020, 17(3), 1064; https://doi.org/10.3390/ijerph17031064 - 7 Feb 2020

Cited by 4 | Viewed by 3167

Abstract

Physical activity (PA) is critical to early childhood health and development, and childcare is a key setting for establishing physically active play. In British Columbia (BC), a provincial standard for active play in childcare was enacted, identified here as the Active Play (AP) standard. Pragmatic constraints limit real-world data collection for evaluating policy impact. We explored whether information about policies, practices, and the environment varied when it was collected from managers or staff. Surveys were distributed to BC childcare centers before AP standard enactment to ascertain current PA and fundamental movement skill policies and practices. The full sample (n = 1037 from 625 facilities) and a subsample of paired managers and staff (n = 261 centers) were used to explore agreement across managers and staff in reported prevalence and relationships among indicators. The policy prevalence and relationships for active play and outdoor play variables were relatively similar for manager and staff data, although the matched data had modest agreement and less than optimal intraclass correlations. The prevalence of manager-reported PA policies ranged from 47% for screen-time limits to 77% for fundamental movement skill activities. The manager and staff data highlighted indoor and outdoor space as a primary factor in AP standard adherence. With reliance on sampling staff unfeasible, it appears that the manager data may adequately describe the policies and practices of childcare providers with some notable issues. Full article

(This article belongs to the Special Issue Interventions to Promote Healthy Movement Behaviours in Early Childhood Education and Care Settings )

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10 pages, 303 KiB

Open AccessArticle

Patterns and Correlates of Sedentary Behavior in Children Attending Family Child Care

by Li Kheng Chai, Kelly Rice-McNeil and Stewart G. Trost

Int. J. Environ. Res. Public Health 2020, 17(2), 549; https://doi.org/10.3390/ijerph17020549 - 15 Jan 2020

Cited by 6 | Viewed by 2929

Abstract

Public health authorities recommend young children should not be sedentary for more than one hour at a time. This study assessed the frequency and duration of sedentary bouts in children attending family child care homes (FCCHs); and examined associations with FCCH provider practices related to sedentary behaviors. Overall, 127 children (aged 3.5 ± 1.1 years) from 41 FCCHs participated in the study. Sedentary bouts were measured using an accelerometer worn for the duration of FCCHs attendance over a randomly selected week. Provider practices were assessed using the Nutrition and Physical Activity Self-Assessment for Child Care self-assessment instrument. Children attending FCCHs mostly accumulated short sedentary bouts (<5 min) with very few lasting more than 10 min. Boys exhibited significantly fewer sedentary bouts, and significantly less sedentary time in bouts than girls. Children attending FCCHs that met or exceeded childcare standards for outdoor active play, had portable play equipment, offered a variety of fixed play equipment, and/or adequate indoor play space exhibited significantly fewer sedentary bouts and significantly less sedentary time accumulated in short and medium length bouts. Programs encouraging FCCHs to adopt physical activity promoting practices could potentially reduce child sedentary time while in care. Full article

(This article belongs to the Special Issue Interventions to Promote Healthy Movement Behaviours in Early Childhood Education and Care Settings )

17 pages, 447 KiB

Open AccessArticle

The Effect of Upgrades to Childcare Outdoor Spaces on Preschoolers’ Physical Activity: Findings from a Natural Experiment

by Michelle Ng, Michael Rosenberg, Ashleigh Thornton, Leanne Lester, Stewart G. Trost, Pulan Bai and Hayley Christian

Int. J. Environ. Res. Public Health 2020, 17(2), 468; https://doi.org/10.3390/ijerph17020468 - 10 Jan 2020

Cited by 17 | Viewed by 4694

Abstract

Physical inactivity is a significant risk factor for childhood obesity. Preventing obesity in the early years reduces the risk of developing chronic health conditions later. Early childhood education and care (ECEC) services are important settings to establish good preschooler physical activity behaviors. This natural experiment investigated the influence of ECEC outdoor physical environment upgrade on preschoolers’ physical activity (aged 2–5 years). Centers implemented upgrades without researcher input. Physical activity was measured by 7-day accelerometry for intervention (n = 159; 6 centers) and control (n = 138; 5 centers) groups. ECEC outdoor space was assessed using a modified Environment and Policy Assessment and Observation (EPAO) Instrument. Key outcomes were measured at baseline and 6–12 months follow-up. Fixed sandboxes, balls, portable slides, portable floor play equipment (e.g., tumbling mats), and natural grassed areas were positively associated with activity levels; fixed tunnels and twirling equipment were negatively associated with activity levels (all p < 0.05). Post-upgrade portable play equipment (balls, twirling equipment, slides, floor play equipment) increased intervention preschoolers’ moderate-vigorous physical activity (MVPA) levels compared to control (p < 0.05). Intervention preschoolers were more active than control at follow-up (58.09 vs. 42.13 min/day increase in total physical activity; 30.46 vs. 19.16 min/day increase in MVPA (all p < 0.001)). Since few preschoolers meet daily activity recommendations while at ECEC, the findings may help ECEC providers to optimize outdoor physical environments and encourage more active play among preschoolers. Full article

(This article belongs to the Special Issue Interventions to Promote Healthy Movement Behaviours in Early Childhood Education and Care Settings )

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16 pages, 621 KiB

Open AccessFeature PaperArticle

Nature Play and Fundamental Movement Skills Training Programs Improve Childcare Educator Supportive Physical Activity Behavior

by Pulan Bai, Ashleigh Thornton, Leanne Lester, Jasper Schipperijn, Gina Trapp, Bryan Boruff, Michelle Ng, Elizabeth Wenden and Hayley Christian

Int. J. Environ. Res. Public Health 2020, 17(1), 223; https://doi.org/10.3390/ijerph17010223 - 27 Dec 2019

Cited by 22 | Viewed by 5671

Abstract

Background: Physical activity professional development programs for Early Childhood Education and Care (ECEC) educators are a viable strategy for improving preschool children’s physical activity behavior. This pilot intervention evaluated the effectiveness of ‘nature play’ and ‘fundamental movement skills’ (FMS) professional development programs on ECEC educators’ practices on physical activity. Methods: 148 ECEC educators from 20 ECEC centers took part in either the Nature play or FMS professional development programs in Perth, Western Australia. Educators self-reported their physical activity related practices at baseline and three months post-professional development training, using established items. Wilcoxon’s test and adjusted models using Mann–Whitney U tests were run at the individual educator level to examine the change between baseline and post-professional development educator physical activity behavior. Results: Educators’ self-efficacy to engage children to be active significantly increased in both the Nature play and FMS professional development programs (p < 0.05). In the Nature play professional development program, ECEC educators’ perceived time set aside for children to participate in nature-based play increased by 9.2%, and their perceived behavioral control for supporting general and nature-based play activities for preschool children increased by 5% and 10.3%, respectively (p < 0.05). However, these results were no longer significant after adjusting for educator socio-demographics. Conclusion: Both the Nature play and FMS professional development programs were effective in improving educators’ self-efficacy to engage children to be active in Nature play or FMS activities. Larger pragmatic trials are required to confirm the impact of these professional development programs on educator perceived physical activity behavior. Full article

(This article belongs to the Special Issue Interventions to Promote Healthy Movement Behaviours in Early Childhood Education and Care Settings )

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12 pages, 1371 KiB

Open AccessArticle

Childcare Center Characteristics Moderate the Effects of a Physical Activity Intervention

by Ruth P. Saunders, Marsha Dowda, Karin A. Pfeiffer, William H. Brown and Russell R. Pate

Int. J. Environ. Res. Public Health 2020, 17(1), 101; https://doi.org/10.3390/ijerph17010101 - 22 Dec 2019

Cited by 2 | Viewed by 2853

Abstract

Center-based early childhood education and care (ECEC) programs are well-positioned to create positive impacts on the health and development of large numbers of young children by promoting physical activity using evidence-based programs. Studies testing physical activity programs for young children should examine the circumstances under which programs are most effective by assessing the role of contextual factors on program outcomes. The purpose of this study was to examine the moderating effects of baseline ECEC center characteristics on the relationship between the Study of Health and Activity in Preschool Environments (SHAPES) intervention and moderate-to-vigorous physical activity (MVPA). MVPA was assessed via accelerometry; center characteristics, practices, and social and physical environments were assessed by director interview and observation; and center quality was assessed using the Early Childhood Environment Rating Scale-Revised Edition. Mixed-model analyses of covariance (ANCOVAs) examined intervention effects on MVPA during the school day; interactions between baseline center variables and group assignment (intervention vs. control) tested for moderation. Two center instructional practices, two social environment characteristics, and one physical environment characteristic at baseline moderated the effects of SHAPES on MVPA outcomes. Assessing baseline practices and center characteristics may aid efforts to match centers with interventions likely to increase physical activity as well as suggest additional intervention strategies to test. Full article

(This article belongs to the Special Issue Interventions to Promote Healthy Movement Behaviours in Early Childhood Education and Care Settings )

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15 pages, 319 KiB

Open AccessArticle

The Effects of a Comprehensive, Integrated Obesity Prevention Intervention Approach (SuperFIT) on Children’s Physical Activity, Sedentary Behavior, and BMI Z-Score

by Ilona van de Kolk, Sanne M. P. L. Gerards, Lisa S. E. Harms, Stef P. J. Kremers and Jessica S. Gubbels

Int. J. Environ. Res. Public Health 2019, 16(24), 5016; https://doi.org/10.3390/ijerph16245016 - 10 Dec 2019

Cited by 14 | Viewed by 4367

Abstract

SuperFIT is a comprehensive, integrated intervention approach aimed at promoting healthy energy balance-related behaviors in 2- to 4-year-old children in the preschool and home settings. A quasi-experimental research design was adopted to evaluate the effects of SuperFIT on physical activity (PA), sedentary behavior (SB) and Body Mass Index (BMI) z-score. Children could participate in the preschool-based and family-based component (full intervention) or only in the preschool-based component (partial intervention). Children’s PA levels and SB were assessed with accelerometers and observations, and height and weight were measured for the BMI z-score. Measurements were performed at baseline and two follow-up time points. Effectiveness was evaluated using linear mixed-model analyses, correcting for relevant covariates. Healthy changes in PA levels occurred within all study groups over time. No significant differences were found in overall PA levels between the intervention groups and control group at both follow-ups. Nevertheless, sedentary behavior decreased more in the full intervention group (effect size (ES): −0.62), and moderate-to-vigorous PA (ES: 0.85) and counts per minute (ES: 0.45) increased more compared to the control group on preschool days at the first follow-up. No effects were found for BMI z-score. The integrated approach of SuperFIT may induce changes in PA of young children, although the effects were small. Full article

(This article belongs to the Special Issue Interventions to Promote Healthy Movement Behaviours in Early Childhood Education and Care Settings )

14 pages, 508 KiB

Open AccessArticle

The Impact of Shorter, More Frequent Outdoor Play Periods on Preschoolers’ Physical Activity during Childcare: A Cluster Randomized Controlled Trial

by Molly Driediger, Stephanie Truelove, Andrew M. Johnson, Leigh M. Vanderloo, Brian W. Timmons, Shauna M. Burke, Jennifer D. Irwin and Patricia Tucker

Int. J. Environ. Res. Public Health 2019, 16(21), 4126; https://doi.org/10.3390/ijerph16214126 - 26 Oct 2019

Cited by 14 | Viewed by 5663

Abstract

Children’s physical activity levels are higher at the start of outdoor playtime, which suggests that shorter, more frequent play periods might result in greater amounts of daily physical activity. In this extension of the Supporting Physical Activity in the Childcare Environment (SPACE) cluster randomized controlled trial, we explored the impact of four 30-min daily outdoor unstructured play periods on preschoolers’ moderate-to-vigorous-intensity physical activity (MVPA). Experimental childcare centres (n = 6) implemented four 30-min daily outdoor playtimes for 8 weeks, while control centres (n = 6) maintained their two 60-min outdoor sessions. Actical™ accelerometers were used to measure preschoolers’ physical activity pre- and post-intervention for 5 days during childcare hours. Linear mixed effects models were used to determine the impact of the intervention on preschoolers’ MVPA. Of the 185 preschoolers enrolled (54.20% female; mean age = 39.90 months, SD = 7.24), 127 (65 experimental and 62 control) were included in the analysis (30% and 9% loss to follow-up for experimental and control group preschoolers, respectively). No significant differences in MVPA were observed between groups over time (p = 0.36). Preschoolers’ MVPA did not improve after the introduction of shorter outdoor play periods. The loss of data due to wear time noncompliance and participant attrition may have influenced these findings. Trial registration: ISRCTN70604107 (October 8, 2014). Full article

(This article belongs to the Special Issue Interventions to Promote Healthy Movement Behaviours in Early Childhood Education and Care Settings )

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Review

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13 pages, 318 KiB

Open AccessReview

Childcare Physical Activity Interventions: A Discussion of Similarities and Differences and Trends, Issues, and Recommendations

by Rachel A. Jones, Eduarda Sousa-Sá, Michele Peden and Anthony D. Okely

Int. J. Environ. Res. Public Health 2019, 16(23), 4836; https://doi.org/10.3390/ijerph16234836 - 2 Dec 2019

Cited by 27 | Viewed by 4991

Abstract

Early childhood education and care (ECEC) settings have a pivotal role in the promotion of physical activity for young children, and thus, the number of ECEC-based physical activity interventions has exponentially increased in the last two decades. The aim of this study was three-fold: (1) to discuss some of the similarities and differences in ECEC-based physical activity interventions, (2) to highlight current trends and issues in the ECEC sector relating to such interventions, and (3) to provide recommendations for future interventions. Twenty-four individual studies are discussed. Most studies have targeted children aged between 3 and 5 years and involved children participating in additional physical activity opportunities while at childcare. In all studies, educators participated in some professional development either prior or during the intervention. Less the half of the studies discussed reported significant positive changes in physical activity outcomes. Those involved in developing future interventions will need to consider current national and international trends in the ECEC sector (e.g., over-crowded curriculum, administrative requirements, and more highly-qualified educators devoting time for business development), as well as creative and unique ways of delivering ECEC-based physical activity interventions. Full article

(This article belongs to the Special Issue Interventions to Promote Healthy Movement Behaviours in Early Childhood Education and Care Settings )

Other

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15 pages, 667 KiB

Open AccessProtocol

Study Protocol for the Evaluation of “SuperFIT”, a Multicomponent Nutrition and Physical Activity Intervention Approach for Preschools and Families

by Ilona van de Kolk, Sanne M. P. L. Gerards, Lisa S. E. Harms, Stef P. J. Kremers, Angela M. H. S. van Dinther-Erkens, Monique Snellings and Jessica S. Gubbels

Int. J. Environ. Res. Public Health 2020, 17(2), 603; https://doi.org/10.3390/ijerph17020603 - 17 Jan 2020

Cited by 9 | Viewed by 4064

Abstract

The promotion of healthy energy balance-related behaviours (EBRB) is already important for children at a young age. Different settings, for example childcare and home, play an important role in the EBRB of young children. Further, factors in different types of environment (e.g., physical, sociocultural and political) influence their behaviours. SuperFIT (Systems of Underprivileged Preschoolers in their home and preschool EnviRonment: Family Intervention Trial) is a comprehensive, integrated intervention approach for 2–4 year old children. This paper describes the development and design of the evaluation of SuperFIT. The SuperFIT intervention approach consists of preschool-based, family-based, and community-based components. Intervention activities aimed at changing the physical, sociocultural and political environments in each setting and establishing an increased alignment between the settings. A quasi-experimental design was adopted with twelve intervention and nine control preschools to evaluate effectiveness. The primary outcomes were Body Mass Index (BMI) z-scores (objectively assessed height and weight), dietary intake (24 h recall), and physical activity (accelerometer) of the children. Further, the effects on the nutrition- and physical activity-related practices of preschool teachers and parents were evaluated (questionnaires). Intervention effectiveness was evaluated using linear mixed models. Process evaluation was performed using mixed methods; both quantitative (questionnaires) and qualitative (observations and in-depth interviews) measures were used. The comprehensive, integrated approach of SuperFIT is expected to support healthy EBRB in young children. Full article

(This article belongs to the Special Issue Interventions to Promote Healthy Movement Behaviours in Early Childhood Education and Care Settings )

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14 pages, 300 KiB

Open AccessProtocol

A Cluster Randomised Controlled Trial of an Intervention to Increase Physical Activity of Preschool-Aged Children Attending Early Childhood Education and Care: Study Protocol for the ‘Everybody Energise’ Trial

by Tessa Delaney, Jacklyn K. Jackson, Jannah Jones, Alix Hall, Ashleigh Dives, Taya Wedesweiler, Libby Campbell, Nicole Nathan, Maria Romiti, Stewart G. Trost, Melanie Lum, Yeshe Colliver, Lara Hernandez and Sze Lin Yoong

Int. J. Environ. Res. Public Health 2019, 16(21), 4275; https://doi.org/10.3390/ijerph16214275 - 4 Nov 2019

Cited by 4 | Viewed by 4278

Abstract

The use of ‘Energisers,’ short bouts of moderate-to-vigorous physical activity (MVPA), have been shown to significantly increase children’s physical activity within the school setting but not within Early Childhood Education and Care (ECEC) centres. The aim of this study is to assess the efficacy of an intervention involving the provision of educator-led daily Energisers to increase the time children spend in MVPA while attending ECEC. Fourteen ECEC centres in the Hunter region of New South Wales, Australia, will be randomised to either an intervention or control group. The intervention group will be supported by the research team to implement three brief (5-min) educator-led Energisers each day for children aged three to six years between the hours of 9:00 a.m. to 3.00 p.m. Control ECEC centres will continue to provide ‘normal practice’ to children. The primary trial outcome is child minutes of MVPA whilst in ECEC, assessed objectively via accelerometery over three days. Outcome assessment will occur at baseline and 6 months post-baseline. Linear mixed models under an intention-to-treat framework will be used to compare differences between groups in MVPA at follow-up. This will be the first cluster randomised controlled trial to test the efficacy of Energisers in isolation on increasing the time children spend in MVPA. Full article

(This article belongs to the Special Issue Interventions to Promote Healthy Movement Behaviours in Early Childhood Education and Care Settings )

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