Table 4.
Association between risky play supportive environments and health in children and youth.
| Quality Assessment | No. of Participants | Absolute Effect (95% CI, SE) | Quality | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| No. of Studies | Design | Risk of Bias | Inconsistency | Indirectness | Imprecision | Other Considerations | ||||
| Acute physical activity (age range between 3 and 9.99 years, data collected over a single session up to a 2 year follow-up, acute physical activity measured through direct observation with observer behaviour mapping and accelerometry) | ||||||||||
| 1 | RCT | Low risk of bias a | No serious inconsistency | No serious indirectness | Serious imprecision b | None | 221 | 11.2 ± 0.9 min/day MVPA, 10.0 ± 0.9 min/day MVPA | MODERATE | |
| Coefficient = 1.82 | ||||||||||
| CI: 0.5–3.1, p = 0.006 | ||||||||||
| 72,100 ± 14,700 counts, 7200 ± 13,800 counts | ||||||||||
| Coefficient = 9.35 | ||||||||||
| CI: 3.5–15.2, p = 0.002 c | ||||||||||
| 4 | Observational studies d | Serious risk of bias e | No serious inconsistency f | No serious indirectness | Serious imprecision g | None | 552 | 1612 CPM (SD = 491), p = 0.014 | VERY LOW | |
| es = 0.9 SD h | ||||||||||
| 39%, p < 0.05 i | ||||||||||
| 75 min; H = 26.6, p < 0.01 j | ||||||||||
| Habitual physical activity (age range between 4.7 and 7.3 years, data collected at baseline, 13 weeks, and 2 years follow-up, habitual physical activity measured through accelerometry) | ||||||||||
| 1 | RCT | No serious risk of bias a | No serious inconsistency k | No serious indirectness | Serious imprecision b | None | 221 | MODERATE | ||
| Habitual sedentary behaviour (age range between 4.7 and 7.3 years, data collected at baseline, 13 weeks, and 2 years follow-up, habitual sedentary behaviour measured through accelerometry) | ||||||||||
| 1 | RCT | No serious risk of bias a | No serious inconsistency l | No serious indirectness | Serious imprecision b | None | 221 | MODERATE | ||
| Acute sedentary behaviour (age range between 4.7 and 7.3 years, data collected at baseline, 13 weeks, and 2 years follow-up, habitual physical activity measured through accelerometry) | ||||||||||
| 1 | RCT | No serious risk of bias a | No serious inconsistency | No serious indirectness | Serious imprecision b | None | 221 | 22.7 ± 9.9 min/day, 23.2 ± 10.3 min/day; | MODERATE | |
| coefficient = −2.13; CI: −3.8–(−0.5), p = 0.01 m | ||||||||||
| Antisocial behaviour (age range between 5 and 9.99 years, distance between pre- and post-measures not reported, aggression measured through direct observation with observer behaviour mapping) | ||||||||||
| 1 | Observational study n | Serious risk of bias a | No serious inconsistency p | No serious indirectness q | No serious imprecision r | None | ~400 | VERY LOW | ||
Notes: CI, 95% confidence interval; CPM, counts per minute; LPA, light physical activity; MVPA, moderate to vigorous physical activity; PA, physical activity; RCT, randomized controlled trial; Acute physical activity: 1 Randomized trial [15]; 4 Observational studies [85,86,87,88]; a The comparison condition was “usual care”. Following baseline testing outcome assessors were no longer blinded to group assignment [15]; b The magnitude of the median sample size is intermediate. The magnitude of the number of included studies is small (N = 1); c Children in the 13-week loose parts/adult risk reframing intervention had a larger increase in minutes/day of MVPA during break times than children in the comparison group at 13 weeks (pre-intervention minutes/day MVPA = 10.8 ± 0.9 and 11.4 ± 0.9, respectively). No difference between groups for LPA; Intervention children had a larger increase in total counts during break times than comparison group (pre-intervention counts = 69,700 ± 14,400 and 74,100 ± 15,200, respectively) [15]; d Includes 3 pre- and post-test studies [85,86,88] and 1 longitudinal study [87]; e Two studies assessed acute PA subjectively using observers to record “active play” occurrences [86,88]; f There was no difference in mean CPM when children played on a traditional playground in the spring, a traditional playground in the winter, or a nature setting in the spring. The traditional playground used for comparison included many built and natural elements that afford components of risky play and thus may not have allowed a true less risky comparison [87]; g The magnitude of the median sample size is intermediate. The magnitude of the number of included studies is small (N = 3); h Children had higher mean CPM after an 11 week loose parts playground intervention compared to baseline (Mean CPM = 1028, SD = 770) [85]; i The proportion of time children spent engaged in active play at post-test was significantly higher than at pre-test, 16%. Active play time was significantly higher following construction of a risky play affording playground environment than at pre-test. It is not clear how long after playground construction post-testing was conducted [86]; j Median length of stay on an adventure playground was higher than traditional playground and contemporary playground (21 and 32 min, respectively. Kruskal-Wallis one-way analysis of variance by ranks determined differences were significant at the 0.001 level [88]; Habitual physical activity: 1 Randomized trial [15]; 0 Observational studies; k No difference in whole day minutes of PA between children who participated in a 13 week playground based intervention with a 2 h risk-reframing intervention administered to parents and teachers compared with control group [15]; Habitual sedentary behaviour: 1 Randomized trial [15]; 0 Observational studies; l No difference between children who participated in a 13-week playground-based intervention with a 2-h risk-reframing adult intervention when compared to children in the control group for minutes per day sedentary [15]; Acute sedentary behaviour: 1 Randomized trial [15]; 0 Observational studies; m Post intervention time spent sedentary during break times in loose parts intervention and control group, respectively. Children in the 13 week loose parts intervention had a larger decrease in minutes/day of sedentary time during break times than the comparison group, whose sedentary time increased over the intervention period (pre-intervention min/day sedentary time = 23.8 ± 10.4 and 22.2 ± 9.9, respectively) [15]; Antisocial behaviour: 0 Randomized trials; 1 Observational study [86]; n Includes 1 pre-post test study; ° Aggression was rated subjectively using direct observation [86]; p No change in aggression from pre- to post-risky play supportive playground construction [86]; q It is likely that the time frame (2 weeks, immediately after the new playground was built) was not sufficient to detect a difference in aggression from pre- to post-test [86]; r The magnitude of the number of included studies is small (N = 1).