Preschool Physical Activity Policy and Children's Physical Activity: A Pragmatic Cluster Randomized Clinical Trial
In brief
Preschool activity policy adds no measurable activity for children after six months
In 124 Stockholm preschools, children's moderate-to-vigorous activity rose by about 6 minutes per day in both groups, with the new policy adding just 0.3 minutes compared with usual practice. Total activity and steps also showed no added gain, suggesting that adopting a policy alone may not change children's activity; how to translate preschool rules into measurable behavior remains unclear.
- Journal
- JAMA network open (Q1)
- Published
- 1 October 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Chu Chen, Jairo H Migueles, Viktor H Ahlqvist, Pablo Campos-Garzón, Pontus Henriksson, Martin Neovius, et al.
- PMID
- 42944688
- DOI
- 10.1001/jamanetworkopen.2026.40617
Why clinicians should know about it
- Picked for Pediatrics and Child Health (top studies of the week, 1 November 2026): Cluster trial evaluates preschool physical activity and prevention
Abstract
IMPORTANCE: Evidence regarding the effectiveness of physical activity (PA) policies within preschool settings remains limited. OBJECTIVE: To evaluate the effectiveness of a cocreated preschool-level PA policy on children's accelerometer-measured PA during preschool hours. DESIGN, SETTING, AND PARTICIPANTS: This single-blind, parallel-group, cluster randomized clinical trial was performed at public preschools in Stockholm, Sweden. Of 156 randomly sampled preschools invited, 124 were randomized. Children aged 3 to 5 years with parental consent were recruited from September 14 to December 11, 2020, baseline measurements from September 23, 2020, to January 22, 2021, and 6-month follow-up from March 8 to June 11, 2021. Statistical analyses were performed from March 6, 2023, to October 25, 2024. INTERVENTION: A cocreated preschool-level PA policy implemented for 6 months vs usual practice. MAIN OUTCOMES AND MEASURES: Prespecified primary outcomes were between-group differences in change in moderate to vigorous PA, total PA, and steps during preschool hours, measured using wearable accelerometers. RESULTS: Among 3751 children (mean [SD] age, 4.44 [0.86] years; 1934 male [51.6%]), 1960 attended intervention preschools and 1791 attended control preschools. All 124 preschools completed follow-up; data were available for 1530 children (78.1%) in intervention schools at baseline and 1435 (73.2%) at follow-up and 1430 children (79.8%) in control schools at baseline and 1356 (75.7%) at follow-up. Intention-to-treat analyses included 3417 children (1770 intervention and 1647 control). Moderate to vigorous PA increased from 27.4 to 33.0 minutes per day in the intervention group and from 27.6 to 33.0 minutes per day in the control group (difference in change, 0.3 [95% CI, -0.7 to 1.3] minutes per day; P = .57). Total PA increased from 177.7 to 185.3 minutes per day in the intervention group and from 176.5 to 184.5 minutes per day in the control group (difference, -0.3 [95% CI, -3.3 to 2.7] minutes per day; P = .84). Steps increased from 5415 to 5953 per day in the intervention and from 5549 to 6078 per day in the control groups (difference, 8 [95% CI, -118 to 133] steps per day; P = .90). No participants withdrew because of adverse events. CONCLUSIONS AND RELEVANCE: In this cluster randomized clinical trial, a cocreated preschool PA policy did not increase children's PA beyond usual practice after 6 months. These findings highlight the complexity of translating policy adoption into measurable behavioral change and of detecting such change in preschool settings. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04569578.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.