***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: This pilot study examined the effects of a teacher-taught , locomotor skill (LMS)-based physical activity ( PA ) program on the LMS and PA levels of minority preschooler-aged children . Eight low-socioeconomic status preschool classrooms were r and omized into LMS-PA ( LMS-oriented lesson plans ) or control group ( supervised free playtime ) . Interventions were delivered for 30 min/day , five days/week for six months . Changes in PA ( accelerometer ) and LMS variables were assessed with MANCOVA .  LMS-PA group exhibited a significant reduction in during-preschool ( F ( 1,16 ) = 6.34 , p = .02 , d = 0.02 ) and total daily ( F ( 1,16 ) = 9.78 , p = .01 , d = 0.30 ) percent time spent in sedentary activity .  LMS-PA  group also exhibited significant improvement in leaping skills , F ( 1 , 51 ) = 7.18 , p = .01 , d = 0.80 ) . No other , significant changes were observed . The implementation of a teacher-taught , LMS-based PA program could potentially improve LMS and reduce sedentary time of minority preschoolers Introduction Childcare educators may be role models for healthy eating and physical activity ( PA ) behaviours among young children . This study aim ed to identify which childcare educators ’ practice s are associated with preschoolers ’ dietary intake and PA levels . Methods This cross-sectional analysis included 723 preschoolers from 50 r and omly selected childcare centres in two Canadian provinces . All data were collected in the fall of 2013 and 2014 and analysed in the fall of 2015 .  PA was assessed using Actical accelerometers during childcare hours for 5 consecutive days .  Children ’s dietary intake  was measured at lunch on 2 consecutive days using weighed plate waste and digital photography . Childcare educators ’ nutrition practice s ( modelling , nutrition education , satiety recognition , verbal encouragement and not using food as rewards ) and PA practice s ( informal and formal PA promotion ) were assessed by direct observation over the course of 2 days , using the Nutrition and Physical Activity Self- Assessment for Child Care tool . Associations between educators ’ practice s and preschoolers ’ PA and dietary intake were examined using multilevel linear regressions . Results Overall , modelling of healthy eating was positively associated with children ’s intake of sugar ( β=0.141 , 95 % CI 0.03 to 0.27 ) , while calorie ( β=−0.456 , 95 % CI −1.46 to –0.02 ) and fibre intake ( β=−0.066 , 95 % CI −0.12 to –0.01 ) were negatively associated with providing nutrition education . Not using food as rewards was also negatively associated with fat intake ( β=−0.144 , 95 % CI −0.52 to –0.002 ) . None of the educators ’ PA practice s were associated with children ’s participation in PA  . Conclusions Modelling healthy eating , providing nutrition education and not using food as rewards are associated with children ’s dietary intake at lunch in childcare centres , highlighting the role that educators play in shaping preschoolers ’ eating behaviours . Although PA practice s were not associated with  children ’s PA levels , there is a need to reduce sedentary time in childcare centres Aim To determine whether levels of daytime physical activity are associated with  sleep duration and night waking in children assessed using accelerometry , and if these associations change over time . Methods 24-hour accelerometry data were obtained from 234 children at 3 , 5 and 7 years of age for at least 5 days at each time .  Sleep duration was estimated using the Sadeh algorithm . Time spent in sedentary , light and moderate-vigorous ( MVPA ) activity was established using published cut-points . Appropriate statistical techniques were utilised to account for the closed nature of the data ( 24-hour periods ) . Results Time spent asleep was related more to sedentary or light activity and not to MVPA . The most active ( 95th percentile ) children spent 55–84 fewer minutes asleep and 16–19 more minutes awake at night compared to the least active ( 5th percentile ) children . Children with later bedtimes slept less at night ( 30–40 minutes ) and undertook more sedentary ( 10–15 minutes ) but also more light ( 18–23 minutes ) activity during the day . However , no differences in MVPA were apparent according to bedtime . Children slept slightly less on weekend nights ( 11 minutes ) compared with week-nights , but only at 3 years of age . Most relationships were broadly similar at 3 , 5 and 7 years of age . Conclusion Children who are more physically active during the day have shorter total sleep time and are more awake at night than less active children . The protective effect of sleep on obesity does not appear to be mediated by increased physical activity Objective To investigate the effect of a  preschool physical activity intervention program delivered in licensed childcare setting s , with or without a parent‐facilitated home component , on  children 's daily physical activity , sedentary time , and body composition . Study design For this cluster r and omized controlled trial , 18 childcare centers were r and omly allocated in equal numbers to the typical curriculum comparison group , childcare intervention alone ( CC ) , or childcare intervention with parental involvement . Accelerometers  were used to asses physical activity and sedentary time , and body composition was measured by bioelectrical impedance . Results Linear mixed model regression analyses showed no differences between the CC , the childcare intervention with parental involvement , and the comparison groups in changes from baseline to 6 months in total physical activity ( P for time × group interaction = .665 ) or moderate‐to‐vigorous physical activity ( P for time × group interaction = .164 ) when adjusted for baseline physical activity levels . Furthermore , no group differences were found for changes in light physical activity , sedentary time , or anthropometric variables . Conclusions An affordable and easily scalable preschool intervention program delivered in licensed childcare setting s , with or without the addition of a parent‐driven home physical activity promotion , seems to have no significant effect on physical activity , sedentary time , or body composition . Trial registration IS RCT N : IS RCT N94022291 OBJECTIVE To calibrate the Actigraph GT3X+ accelerometer for wrist-worn placement in young preschoolers by developing intensity thresholds for sedentary , low- and high-intensity physical activity . Furthermore , to cross-vali date the developed thresholds in young preschoolers . METHODS Actigraph GT3X+ was used to measure physical activity during structured activities and free play in 38 children ( 15 - 36 months ) . Activity was video recorded and scored into  sedentary  , low- and  high-intensity  physical activity based on Children 's Activity Rating Scale ( CARS ) and combined with accelerometer data using a 5 s epoch . Receiver operating characteristic analysis was used to develop intensity thresholds in 26 r and omly selected children . The remaining 12 children were used for cross-validation . RESULTS Intensity thresholds for sedentary were ≤89 vertical counts ( Y ) and ≤221 vector magnitude ( VM ) counts per 5 s and ≥440 Y counts and ≥730 VM counts per 5 s for high-intensity physical activity . Sensitivity and specificity were 60 - 100 % for the developed intensity thresholds . Strong correlations ( Spearman rank correlation 0.69 - 0.91 ) were found in the cross-validation sample between the developed thresholds for the accelerometer and CARS scoring time in all intensity categories . CONCLUSION The developed intensity thresholds appear valid to categorize sedentary behaviour and physical activity intensity categories in children 2 years of age Objectives Evaluate the predictive validity of ActiGraph energy expenditure equations and the classification accuracy of physical activity intensity cut-points in preschoolers . Methods Forty children aged 4–6 years ( 5.3±1.0 years ) completed a ∼150-min room calorimeter protocol involving age-appropriate sedentary , light and moderate-to vigorous-intensity physical activities . Children wore an ActiGraph GT3X on the right mid-axillary line of the hip . Energy expenditure measured by room calorimetry and physical activity intensity classified using direct observation were the criterion methods . Energy expenditure was predicted using Pate and Puyau equations . Physical activity intensity was classified using Evenson , Sirard , Van Cauwenberghe , Pate , Puyau , and Reilly , ActiGraph cut-points . Results The Pate equation significantly overestimated VO2 during sedentary behaviors , light physical activities and total VO2 ( P<0.001 ) . No difference was found between measured and predicted VO2 during moderate-to vigorous-intensity physical activities ( P = 0.072 ) . The Puyau equation significantly underestimated activity energy expenditure during moderate-to vigorous-intensity physical activities , light-intensity physical activities and total activity energy expenditure ( P<0.0125 ) . However , no overestimation of activity energy expenditure during sedentary behavior was found . The Evenson cut-point demonstrated significantly higher accuracy for classifying sedentary behaviors and light-intensity physical activities than others . Classification accuracy for moderate-to vigorous-intensity physical activities was significantly higher for Pate than others . Conclusion Available ActiGraph equations do not provide accurate estimates of energy expenditure across physical activity intensities in preschoolers . Cut-points of ≤25counts⋅15 s−1 and ≥420 counts⋅15 s−1 for classifying sedentary behaviors and moderate-to vigorous-intensity physical activities , respectively , are recommended Objective Routine moderate-to-vigorous physical activity ( MVPA ) is associated with better health outcomes ; the purpose of this work was to evaluate healthy preschooler physical activity patterns with objective measurement . Methods and Procedures An objective prospect i ve study of fifty normally-developing children 3–5 years old who were ≥50th and < 95th BMI percentile and enrolled in a family-based healthy lifestyle study in 2011–2012 . Participants wore a tri-axial accelerometer for 7 continuous days . Outcome measures consisted of wear time examining four common MVPA patterns : isolated spurt ( IS ) , isolated sustained activity ( ISA ) , clustered spurt ( CS ) , and clustered sustained activity ( CSA ) . Results Participants were 4.3 years , 56 % female , 52 % African-American , and 26 % overweight . Forty-five children met wear time criteria . On average , children spent 14.5 % of wake-wear time in MVPA , requiring 11.3 hours to complete 90 % of their daily MVPA . Children spent the majority of MVPA in CS ( 62.1 % , followed by CSA ( 20.1 % ) . Remaining MVPA was spent in IS ( 15.5 % ) and ISA ( 2.3 % ) . Conclusion It takes most of the waking day for preschoolers to attain their PA . They engage in short spurts of small duration , in four common MVPA patterns . Utilizing this method could better characterize preschooler physical activity needs in practice and policy guidelines Although many studies have reported on  physical activity ( PA ) levels using accelerometers , a thorough description of the PA pattern in preschool children during their stay in the preschool , is lacking in the current literature . Furthermore , there remains a lack of underst and ing of the PA level and pattern in children in the lower end of the PA continuum . The first aim of this study was therefore to describe the PA pattern during a week-long stay in a preschool in all children born in 2011 ( either three or four-year-olds ) attending public preschools in a municipality in Norway . The second aim was to describe the PA level and pattern of the children who are the least physically active . This cross-sectional study included baseline data from 95 % of children ( N = 111 ) participating in a r and omized controlled physical activity intervention ( Active Kindergarten – Active Children study ) . The participants wore an Actigraph accelerometer , in week 39 in 2015 , from when they arrived at the preschool on Monday morning and throughout their stay of five consecutive days . The amount of moderate- to vigorous-intensity PA ( MVPA ) per day ranged from 16 min to 116 min , and sedentary time ranged from 2.7 h to 6.5 h per day in the least and most sedentary child , respectively . The least physically active 25 % of children were less active throughout the entire day , and only a few of them managed to achieve the recommended level of MVPA on any weekday . The physical activity levels and patterns among the least active children described in this study may help to inform interventions targeting this group BACKGROUND Young children depend on  adult caregivers  to provide opportunities for physical activity . Research has focused on barriers and facilitators to children 's physical activity while in childcare , but parental influences remain largely unknown . This study examines parent 's attitudes about preschoolers ' physical activity and outdoor time , compares them with those of childcare providers and determines the association between parental attitudes and preschoolers ' measured activity . METHODS Parents and childcare providers from 30 childcare centres were surveyed regarding attitudes towards  preschoolers ' physical activity and outdoor time . Children 's moderate-to-vigorous physical activity was determined by using 24-h accelerometry . Parent and childcare providers ' responses were compared . Mixed-effect linear regression examined moderate-to-vigorous physical activity and sedentary time as outcomes with parental attitudes as predictors , family demographics as covariates and centre as a r and om effect . RESULTS Three hundred eighty-eight parents and 151 childcare prov 
    Output:
    
Our results suggest that young children spend a significant portion of their waking hours in sedentary behaviors .
While at childcare , young children accumulated more sedentary behavior indoors than outdoors .
Girls were more likely to be more sedentary than boys .
No significant differences were found between weekdays and weekends , or between childcare and nonchildcare hours .