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Background Several systematic reviews have reviewed the evidence relating to nature on aspects of children and adolescent’s health and wellbeing; however, none have looked at the associations or effectiveness of attending nature-based early childhood education (ECE). The main objective is to systematically review and synthesise the evidence to determine if nature-based ECE enhances children’s health, wellbeing and development. Methods We will search the following electronic databases (from inception onwards): MEDLINE, Scopus, PsycINFO, ERIC, SportDiscus, Australian Education Index, British Education Index, Child Development and Adolescent studies, and Applied Social Sciences Index and Abstracts. Grey literature will be identified searching dissertations and reports (e.g. Open Grey, Dissertations Theses Database [ProQuest], and Google Scholar). All types of studies (quantitative and qualitative) conducted in children (aged 2–7 years old) attending ECE who had not started education at primary or elementary school will be included. The exposure of interest will be nature-based ECE settings that integrate nature into their philosophy and/or curriculum and environment. The outcomes of interest will be all aspects of the child’s physical, cognitive, social and emotional health wellbeing and development. Two reviewers will independently screen full-text articles. The study methodological quality (or bias) will be appraised using appropriate tools. If feasible, a meta-analysis will be conducted using a random-effect model for studies similar in exposure and outcome. Where studies cannot be included in a meta-analysis, findings will be summarised based on the effect directions and a thematic analysis will be conducted for qualitative studies. Discussion This systematic review will capture the state of the current literature on nature-based ECE for child health, wellbeing and development. The results of this study will be of interest to multiple audiences (including researchers and policy makers). Results will be published in a peer-reviewed journal. Gaps for future research will be identified and discussed. Systematic review registration PROSPERO CRD42019152582

The main goal of Physical Activity (PA) guidelines is to provide a structured and systematic set of evidence-based statements/recommendations that guide the public to improve their health through PA. A child is often referred to as physically inactive if they do not meet the PA guidelines. However, an active child can at the same time be a sedentary child; e.g., the child engages in 70 minutes of moderate to vigorous PA per day but spends the rest of the day seated behind his/her computer. Sedentary activities can include but are not limited to reading, sitting in a stroller/buggy, and watching a movie. The dose-response relationship can have different forms: for example, a dose-response relationship can be linear, which means that every added unit of something results in a consistent added health benefit. Sedentary behavior is defined as any waking behavior with an energy expenditure of less than 1.5 metabolic equivalents.

Background Living in urban or rural environments may influence children’s levels of physical activity and sedentary behaviours. We know little about variations in device-measured physical activity and sedentary levels of urban and rural children using nationally representative samples, or if these differences are moderated by socioeconomic factors or seasonal variation. Moreover, little is known about the influence of ‘walkability’ in the UK context. A greater understanding of these can better inform intervention strategies or policy initiatives at the population level. Methods Country-wide cross-sectional study in Scotland in which 774 children (427 girls, 357 boys), aged 10/11 years, wore an accelerometer on one occasion for at least four weekdays and one weekend day. Mean total physical activity, time spent in sedentary, light, and moderate-to-vigorous physical activity (MVPA), per day were extracted for weekdays, weekend days, and all days combined. Regression analyses explored associations between physical activity outcomes, urban/rural residence, and a modified walkability index (dwelling density and intersection density); with interactions fitted for household equivalised income and season of data collection. Sensitivity analyses assessed variation in findings by socioeconomic factors and urbanicity. Results Rural children spent an average of 14 min less sedentary (95% CI of difference: 2.23, 26.32) and 13 min more in light intensity activity (95% CI of difference, 2.81, 24.09) per day than those from urban settlements. No urban-rural differences were found for time spent in MVPA or in total levels of activity. Our walkability index was not associated with any outcome measure. We found no interactions with household equivalised income, but there were urban/rural differences in seasonal variation; urban children engaged in higher levels of MVPA in the spring months (difference: 10 mins, p = 0.06, n.s) and significantly lower levels in winter (difference: 8.7 mins, p = 0.036). Conclusions Extrapolated across one-year, rural children would accumulate approximately 79 h (or just over 3 days) less sedentary time than urban children, replacing this for light intensity activity. With both outcomes having known implications for health, this finding is particularly important. Future work should prioritise exploring the patterns and context in which these differences occur to allow for more targeted intervention/policy strategies.

ObjectivesTo study the extent to which home-to-school distance and neighbourhood walkability were associated with self-reported active travel to school (ATS) (eg, walking, cycling), and to explore how distance moderates the effect of walkability on ATS, among 10–11 years old.DesignCross-sectional study.SettingData were collected between May 2015 and May 2016 in partnership with the Growing Up in Scotland Study, a nationally representative longitudinal cohort study.Participants713 children (male (n=330) and female (n=383) 10–11 years old) from Studying Physical Activity in Children’s Environments across Scotland.Primary and secondary outcome measuresChildren who actively travelled to/from school categorised as active all (100% of ATS) and active 60%+ (at least 60% of ATS); home-to-school road/path network distance (ResultsDistance and walkability were both associated with ATS. The likelihood of ATS for all or most journeys decreased with increasing distance. Compared with ‘most’ walkable areas (Q1), the odds of active all were significantly lower within least walkable areas (Q5 OR 0.45, 95% CI 0.21 to 0.99), and odds of active 60%+ were significantly less in Q2–Q5 (lowest odds Q5 OR 0.20, 95% CI 0.07 to 0.47). Regarding walkability and distance interactions, for all distance categories, higher walkability increased the probability of ATS (for most school journeys).ConclusionWalkability was positively associated with ATS within all distance categories, with the relationship between walkability and ATS more complex than the clear-cut association between distance and ATS. A more walkable environment had a larger effect on the probability of reaching the 60% threshold of school journeys using ATS than the probability of always travelling in an active manner. Investment is needed in existing less walkable neighbourhoods to provide infrastructure to support opportunities for children’s ATS.

Background The environment in which we live, travel and socialise has a profound influence on health. Existing literature typically uses a fixed ‘neighbourhood’ as the unit of analysis – assuming often that people conduct their lives within that spatially defined unit. The aim of this study is to describe urban mobility and environmental exposure across an entire urban landscape. Methods Using the ‘Studying Physical Activity in Children’s Environments across Scotland’ (SPACES) study, we developed a novel concept to construct a model of the entire urban landscape within the Central Belt of Scotland. The model used a 25 m2 grid system (∼3 million GRID squares). For each cell, there was detailed built-environment information, including characteristics of the road network, retail outlets, greenspace, and walkability measures. SPACES used GPS to collect individual-level mobility information for 100 10-year-old children over the course of one week. Each child’s location was recorded every 10 seconds during waking hours and that data was joined to the urban landscape model. The result was a comprehensive dataset describing of whether and when each child visited each grid cell, how long they spent there, and what the location comprised. Using negative binomial regression, we explored which features of the built environment were associated with the child visiting that space at all, and with time spent there, and examined whether this differed by the sociodemographic characteristics of the child. Results We found land-uses across the urban landscape that were predictive of children spending time, such as: libraries ((coef) 2.0, 95% CI 1.0 to 3.0) and places of worship (1.8, 95% CI 1.2 to 2.5), and a linear relationship between increased walkability of a cell and a greater time spent there. Cells containing playing fields, public parks and play parks were predictive of children spending time, independently of proximity to their home. For most land-uses there were no differences by gender, except for leisure centres where girls spent more time than boys (4.0, 95% CI 1.0 to 7.0). Conclusion We created ‘personalised activity spaces’ which simultaneously assessed all the types of environment children could and did visit. The study found features of the urban landscape that, regardless of distance from home, children were more or less likely to spend time in. The ability to consider how children use their urban area, and the multiple environments they are exposed to, is a significant step towards understanding the urban environment as a complex system.

Objectives To describe the objectively measured levels of physical activity (PA) and sedentary time in a nationally representative sample of 10–11-year-old children, and compare adherence estimates to the UK PA guidelines using two approaches to assessing prevalence.\ud \ud Design Nationally representative longitudinal cohort study.\ud \ud Setting Scotland wide in partnership with the Growing up in Scotland (GUS) study. Data collection took place between May 2015 and May 2016.\ud \ud Participants The parents of 2402 GUS children were approached and 2162 consented to contact. Consenting children (n=1096) wore accelerometers for 8 consecutive days and 774 participants (427 girls, 357 boys) met inclusion criteria.\ud \ud Primary and secondary outcome measures Total PA (counts per minute, cpm); time spent sedentary and in moderate-to-vigorous PA (MVPA); proportion of children with ≥60 min MVPA on each day of wear (daily approach); proportion of children with ≥60 min of MVPA on average across days of wear (average approach)—presented across boys and girls, index of multiple deprivation and season.\ud \ud Results: Mean PA level was 648 cpm (95% CI, 627 to 670). Children spent 7.5 hours (7.4–7.6) sedentary/day and 72.6 min (70.0–75.3) in MVPA/day. 11% (daily) and 68% (average) of children achieved the recommended levels of PA (P

Background: Large-scale primary data collections are complex, costly, and time-consuming. Study protocols for trial-based research are now commonplace, with a growing number of similar pieces of work being published on observational research. However, useful additions to the literature base are publications that describe the issues and challenges faced while conducting observational studies. These can provide researchers with insightful knowledge that can inform funding proposals or project development work. Objectives: In this study, we identify and reflectively discuss the unforeseen or often unpublished issues associated with organizing and implementing a large-scale objectively measured physical activity and global positioning system (GPS) data collection. Methods: The SPACES (Studying Physical Activity in Children’s Environments across Scotland) study was designed to collect objectively measured physical activity and GPS data from 10- to 11-year-old children across Scotland, using a postal delivery method. The 3 main phases of the project (recruitment, delivery of project materials, and data collection and processing) are described within a 2-stage framework: (1) intended design and (2) implementation of the intended design. Results: Unanticipated challenges arose, which influenced the data collection process; these encompass four main impact categories: (1) cost, budget, and funding; (2) project timeline; (3) participation and engagement; and (4) data challenges. The main unforeseen issues that impacted our timeline included the informed consent process for children under the age of 18 years; the use of, and coordination with, the postal service to deliver study information and equipment; and the variability associated with when participants began data collection and the time taken to send devices and consent forms back (1-12 months). Unanticipated budgetary issues included the identification of some study materials (AC power adapter) not fitting through letterboxes, as well as the employment of fieldworkers to increase recruitment and the return of consent forms. Finally, we encountered data issues when processing physical activity and GPS data that had been initiated across daylight saving time. Conclusions: We present learning points and recommendations that may benefit future studies of similar methodology in their early stages of development. [JMIR Res Protoc 2018;7(4):e110]

Background:\ud A number of studies based in the US, Canada, and Australia, have found evidence of associations between the built environment (BE) and mode of transport to school, and links between active travel and deprivation. Limited research in the UK compares potential BE supports for walking to school by area deprivation. Within this study, we gathered data on BE attributes previously linked to active travel, i.e., street/path connectivity, and dwelling density, created a composite ‘walkability score’ (WS) for areas around primary schools across urban Scotland, and explored whether poorer areas exhibit lower scores than more affluent areas, or vice versa. We consider this to be a novel approach as few studies have compared BE features by deprivation across a whole country.\ud \ud Methods:\ud Address and road/path maps were obtained and primary schools (N = 937) across mainland Scotland were mapped. Schools were attributed income deprivation scores (scores divided into quintiles (Q1: least deprived, Q5: most deprived)). Catchment area (CA) boundaries, i.e., the geographic area representing eligibility for local school attendance, were drawn around schools, and WS calculated for each CA. We compared mean WS by income quintile (ANOVA), for all local authorities (LAs) combined (N = 29), and separately for the four LAs with the greatest number of schools included in the analysis.\ud \ud Results:\ud For all LAs combined, the least deprived quintile (Q1) showed a significantly lower WS (−0.61), than quintiles 3, 4 and 5 (Q2: −0.04 (non-sig), Q3: 0.38, Q4: 0.09, Q5: 0.18); while for Glasgow the second least deprived quintile (Q2) showed significantly higher WS (Q1: 1.35, Q2: 1.73), than middling (Q3: 0.18) and most deprived quintiles (Q4: 0.06, Q5: −0.10).\ud \ud Conclusion:\ud WS differ by deprivation with patterns varying depending on the spatial scale of the analysis. It is essential that less walkable areas are provided with the resources to improve opportunities to engage in active travel.

Evidence suggests that behaviours such as standing are beneficial for our health. Unfortunately, little is known of the prevalence of this state, its importance in relation to time spent stepping or variation across seasons. The aim of this study was to quantify, in young adolescents, the prevalence and seasonal changes in time spent upright and not stepping (UNSt(time)) as well as time spent upright and stepping (USt(time)), and their contribution to overall upright time (U(time)). Thirty-three adolescents (12.2 ± 0.3 y) wore the activPAL activity monitor during four school days on two occasions: November/December (winter) and May/June (summer). UNSt(time) contributed 60% of daily U(time) at winter (Mean = 196 min) and 53% at summer (Mean = 171 min); a significant seasonal effect, p0.001. USt(time) was significantly greater in summer compared to winter (153 min versus 131 min, p0.001). The effects in UNSt(time) could be explained through significant seasonal differences during the school hours (09:00-16:00), whereas the effects in USt(time) could be explained through significant seasonal differences in the evening period (16:00-22:00). Adolescents spent a greater amount of time upright and not stepping than they did stepping, in both winter and summer. The observed seasonal effects for both UNSt(time) and USt(time) provide important information for behaviour change intervention programs.