Table 1.

ECEC-based intervention studies that examine cardiovascular fitness outcomes in preschool children.

Author, year	Intervention setting; length	Population	Country	PA intervention components	Fitness measurement	Findings	Follow-up findings
Alpert et al. 1990 (Alpert et al., 1990)	During school; 8 weeks	n = 24 children 3- to 5-years-old (mean age 44 months)	USA	30 min daily designed to increase HR to 60–80% HR max. Children exercised with music and imagery. HR was monitored every 10-min. Stickers were given for achieving HR goals.	Cycle ergometer test at three workloads (12.5, 25, and 37.5 watts). Change in exercise HR.	HRs were significantly lower at post-test compared to pretest for all workloads in the X group compared to the O group. Workload 1: O (+9 bpm) vs. X (−17 bpm). Workload 2: O (+7 bpm) vs. X (−16 bpm). Workload 3: O (+5 bpm) vs. X (−20 bpm).	N/A
Eliakim et al., 2007	During school; 14 weeks	n = 101 upper-middle SES 5–6-year-old	Israel	2 parent orientation sessions. Teachers implemented sessions 4× per week and youth coaches implemented sessions 2× per week for 45 min/session (80% running games; 20% sports activities).	600-m run	O group significantly increased endurance run time by 6 s, while X group decreased by 14 s. Overweight and obese O increased by 7 s, while X decreased by 7 s.	N/A
Nemet et al., 2011a; Nemet et al., 2013	During school; one school year	n = 342 low SES 4.2–6.5-year-old	Israel	2 parent orientation sessions. Teachers implemented sessions 5× per week and youth coaches implemented sessions 1× per week for 45 min/session (80% running games; 20% sports activities).	10-m shuttle run test	O group decreased total number of laps by 10.2 ± 1.6 (males −7; females −14), while X group increased by 11.6 ± 1.4 laps (males +11; females +13); overweight and obese O decreased by 12 and 2 laps respectively, while overweight and obese X participants increased by 7 and 18 laps respectively.a	Nemet et al. (2014) n = 203 (59%); Both O and X had more laps 1 year later. The X remained significantly higher than the O.
Nemet et al., 2011b	During school; one school year	n = 795 low SES 3.8–6.8-year-old	Israel	2 parent orientation sessions. Teachers implemented sessions 5× per week and youth coaches implemented sessions 1× per week for 45 min/session (80% running games; 20% sports activities)	10-m shuttle run test	O group decreased total number of laps by 3 (males 0; females −5), while X group increased by 18 laps (males +20; females +17); overweight and obese O decreased by 2 and 3 laps respectively, while overweight and obese X participants increased by 17 and 18 laps respectively.a	N/A
Niederer et al., 2013b						Normal weight X group improved shuttle run (+1.8 stages) compared to O (+1.5 stages). Overweight X children did not significantly improve shuttle run (+1.7 stages) compared to O (+1.3 stages). Low fit X group did not improve shuttle run (+1.8 stages) compared to O (+1.6 stages). Normal fit X group improved shuttle run (+1.7 stages) compared to O (+1.4 stages). Neither weight nor fitness level were not found to modify intervention effects for the shuttle run.	N/A
Puder et al., 2011	During school; 1 academic year	n = 652 migrant 5.2 ± 0.6-years-old preschool children	Switzerland	Four 45-min PA sessions/wk. Implementers gave 1 PA session/wk. Reduced to 2×/month after 4 months. Other sessions ran by teachers after two workshops. Every 2nd wk. children took home a PA card. Parents joined 3 discussions. Play equipment installed/provided to classrooms.	20-m shuttle run test	X group significantly increased shuttle run (1.7 stages) compared to O group shuttle run (1.4 stages).	N/A
Latorre-Román et al., 2018	During school; 10 weeks	n = 111 children aged 4.28 ± 0.61-years-old	Spain	Three 30 min training sessions/wk. Sessions included aerobic games that increased from a total of 15–18 min in duration over the 10 weeks.	10 × 20 m shuttle run	Time decreased by 8.5 s in the X group and decreased by 3.6 s in the O group. Group by time interactions were not statistically significant.	N/A
Tan et al., 2017	During school; 10 weeks	n = 104 children 5-year-old	China	5 one hour supervised sessions/wk. 10 min warm-up and cool down. 40 min of moderate PA (walking, running, jumping, rope skipping, semisquatting, crawling) in 4 min intervals followed by 1 min rest. Exercise occurred at 50% of HR max (monitored by HR monitor).	20-m shuttle run test; HR Index-HR response to a workload (30 squats in 30 s). Formula: resting HR + end exercise HR + recovery HR at 1 min–200) ÷ 10	Obese X group increased their 20-m shuttle 1.05 laps compared to a 0.33 lap increase in obese O. Lean X group increased by 1.06 laps compared to a 0.32 increased in lean O. Results not significant. Obese X group decreased HR index by −0.96, while obese O HR index decreased −0.24. Lean X group decreased HR index −1.17, while lean O decreased by −0.12. Results were significant (p < 0.001) for both groups.	N/A
Zhou et al., 2014	12 months	n = 357 children ages 3–5-years-old	China	New outdoor play policy (60–90 min with 10-min exercise session). Teacher received bi-weekly training (20 h total). Outdoor play curriculum developed and monitored daily. New outdoor play equipment. Monthly education webinars and newsletters for families. Internet resource website. Family events and new play equipment for families. Renovation of neighborhood playgrounds, including new equipment. Neighborhood events.	20-m agility run	Children at the intervention center significantly decreased their 20 m agility run time (−1.22 s) compared to control (−0.59 s).	N/A

Review conducted in June 2018.

Bpm-beats per minute; HR-heart rate; O-control; PA-physical activity; SES-socioeconomic status; X- experimental.

^aLap changes are estimated from a graph where a standard deviation is not reported. Exact values are not reported in the manuscript.

^bSame Study as Puder et al. 2011. Analysis of intervention effects by weight (overweight vs. normal weight) and fitness (low fitness vs. normal fitness).