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. 2022 Dec 16;22:2364. doi: 10.1186/s12889-022-14675-8

Correlates of physical activity and sedentary behaviour in children attending before and after school care: a systematic review

Andrew J Woods 1,2,, Yasmine C Probst 3,4, Jennifer Norman 1,4,5, Karen Wardle 6, Sarah T Ryan 1,2, Linda Patel 1,2, Ruth K Crowe 2,3, Anthony D Okely 1,2,4
PMCID: PMC9758811  PMID: 36527045

Abstract

Background

Out of School Hours Care (OSHC) offers structured care to elementary/primary-aged children before and after school, and during school holidays. The promotion of physical activity in OSHC is important for childhood obesity prevention. The aim of this systematic review was to identify correlates of objectively measured physical activity and sedentary behaviour in before and after school care.

Methods

A systematic search was conducted in Scopus, ERIC, MEDLINE (EBSCO), PsycINFO and Web of Science databases up to December 2021. Study inclusion criteria were: written in English; from a peer-reviewed journal; data from a centre-based before and/or after school care service; children with a mean age < 13 years; an objective measure of physical activity or sedentary behaviour; reported correlations and significance levels; and if an intervention study design these correlates were reported at baseline. Study quality was assessed using the Office of Health Assessment and Translation Risk of Bias Rating Tool for Human and Animal Studies. The PRISMA guidelines informed the reporting, and data were synthesised according to shared correlations and a social ecological framework.

Results

Database searches identified 4559 papers, with 18 cross-sectional studies meeting the inclusion criteria.There were a total of 116 physical activity correlates and 64 sedentary behaviour correlates identified. The most frequently reported correlates of physical activity were child sex (males more active), staff engaging in physical activity, an absence of elimination games, and scheduling physical activity in daily programming (all more positively associated). The most frequently reported correlates of sedentary behaviour were child sex (females more sedentary) and age (older children more sedentary).

Conclusions

Encouraging physical activity engagement of female children, promoting positive staff behaviours, removing elimination elements from games, and scheduling more time for physical activity should be priorities for service providers. Additional research is needed in before school care services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14675-8.

Keywords: Out of school hours care, After school program, Before school care, Physical activity, Sedentary behaviour, Review

Background

Childhood overweight and obesity is a critical public health issue [1]. Recent global estimates indicate that over 18% of children and adolescents aged 5–19 years have overweight or obesity, compared with just 4% in 1975 [2]. The World Health Organization [3] attributes the increased prevalence of childhood obesity to a global shift in diets towards energy-dense, nutrient-poor foods; and a trend towards less physical activity (PA) due to increasingly sedentary lifestyles. Managing childhood overweight and obesity will require population-based, multi-sectoral and multi-disciplinary approaches [3].

A setting which provides an opportunity for an environmental level approach to childhood overweight and obesity is Out of School Hours Care (OSHC). OSHC offers care to elementary/primary-aged children before and after school, and during school holidays, with an average of 29% of children aged 6 to 11 years across Organisation for Economic Co-operation and Development (OECD) countries attending centre-based before and/or after school care services [4].

While OSHC services can have a positive impact on the PA and healthy eating of children through active play and the provision of healthy snacks [5, 6], childhood obesity interventions in OSHC settings have been mixed and generally ineffective in reducing child obesity (e.g. body mass index (BMI), body composition, cardiovascular fitness) [7]. A review of obesity interventions in after school care services found many interventions were focussed on increasing PA but not on reducing sedentary activities [7]. Reducing sedentary behaviour is important given its association with several adverse health outcomes [8]. To the authors’ knowledge, no reviews have systematically looked at factors that are associated with child PA and sedentary behaviour while attending OSHC services. Understanding the influences on and thus, potential, causes of PA behaviours has been widely identified as important for evidence-based planning of public health interventions [9].

The aim of this systematic review was to identify correlates of objectively measured PA and sedentary behaviour in before and after school care. While vacation care, such as summer camps, is considered an OSHC service, this review included only before and after school care, given the differences in programming and delivery compared with vacation care. Consistent with other reviews of PA and sedentary behaviour in children [1012] a social ecological framework was used in correlate categorisation to provide an organised multilevel approach to help inform future interventions in the OSHC setting [13].

Methods

The reporting of this review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) statement [14]. The review was registered with the International Prospective Register of Systematic Reviews (PROSPERO) in April 2020 (CRD42020135814). A systematic review was conducted as a meta-analysis was not feasible due to the considerable heterogeneity among study outcome measures.

Search strategy

A systematic search was conducted with five scientific databases- Scopus, ERIC, MEDLINE (EBSCO), PsycINFO and Web of Science. Databases were searched from their inception to December 2021. Search terms were developed to capture all variations of the terminology related to before and after school programs as countries globally have varying names for the services. The initial search terms used were “out of school hours care” OR “outside school hours care” OR “out of school time program*” OR “after school care” OR “after school program*” OR “before school care” OR “before school program*” OR “breakfast club*” OR “after school club*” OR “wrap around care”; AND “healthy eating” OR food* OR nutrit* OR diet* OR “physical activity” OR movement OR exercise* OR sedentary OR sitting. These terms were tested for feasibility with Scopus before they were used in all databases. Nutrition related search terms were included as initially this review was also looking at healthy eating behaviours in OSHC services, however, only one study met the inclusion criteria. Consequently, we focused solely on PA and sedentary behaviours and excluded the healthy eating study.

Search records were extracted from the databases and imported into Endnote referencing software [15], where duplicate records were removed. Screening was conducted by multiple authors to reduce the risk of rejecting relevant articles [14]. Four independent reviewers screened the titles and abstracts of records against the eligibility criteria (AW, RC, LP, SR). Full text versions of studies meeting the criteria in initial screening were retrieved and assessed for final inclusion by three independent reviewers (AW, SR, LP), and their reference lists were manually searched to identify any additional relevant literature (AW). References found from the manual search also had the inclusion and exclusion criteria applied to determine relevance. Any discrepancies were resolved by discussion between reviewers, with an independent reviewer available for consultation if necessary (AO).

Inclusion and exclusion criteria

Articles were included if they were: (1) written in the English language; (2) from a peer-reviewed academic journal; (3) contained data from a centre-based before and/or after school care service; (4) had a sample population of children with a mean age under 13 years (elementary/primary school age); (5) contained an objective measure of physical activity or sedentary behaviour; and (6) reported correlations or associations between the objective measure and other demographic, environmental, contextual or behavioural variables; and reported statistical significance (p value) of these correlations. Intervention studies reporting correlates at baseline would be eligible, however none did so they were excluded. Reviews, conference proceedings, dissertations and non-scholarly sources were also excluded from the review.

Consistent with other reviews of PA and sedentary behaviour correlates in children [8, 11], studies were required to have an objective measure of PA or sedentary behaviour. Physical activity is a complex behaviour, and research has demonstrated objective measures as more precise compared to subjective measures [16], particularly among children where issues with recall accuracy can arise [17]. Commonly used objective measurement tools reviewers were looking for were wearable monitors, indirect calorimetry and direct observation. Variables associated with the objective measure could be reported with both subjective or objective measures; in this way any contextual information captured by the subjective methods was included.

Study risk of bias assessment

Individual study risk of bias was assessed by two independent authors (AW, SR) using the Office of Health Assessment and Translation (OHAT) Risk of Bias Rating Tool for Human and Animal Studies [18]. This tool assesses the risk of bias at the outcome level and rates cross-sectional studies using seven questions covering six types of bias: selection, confounding, attrition/exclusion, detection, selective reporting, and other. The risk of bias for each question was considered as definitely low, probably low, probably high and definitely high risk of bias. Initial review agreement between the two authors was low, at an agreement score of 47%. Most of the differences were between whether a criterion was ‘definitely low’ or ‘probably low’, and following a mutual discussion clarifying the definition of direct versus indirect evidence, these differences were resolved with an agreement score of 100%.

Data extraction and synthesis

Data were extracted from each eligible study by one review author in a tabular format including: the country of study; the sample size; objective physical activity/sedentary behaviour data collection method/s; and any identified correlates (Table 1). A variety of techniques were used in the selected papers to report variables including univariate, bivariate and multilevel analyses. Similar to other reviews [1012], for analyses focused on correlates where multiple analytic models were reported, findings from the final or fully adjusted models were extracted.

Table 1.

Summary of included articles

Author/date Location Sample Assessment and Outcome Correlates of PA observed Correlates of sedentary behaviour observed
Outcome Measurement tool Variable SEF Domain Variable SEF Domain
Ajja et al., 2014 [19] United States 20 ASPs; 1302 children (5–12 years old); 53.6% boys; 56.1% White Minutes of MVPA (indoor/outdoor) Actigraph accelerometer % local pop. in poverty Community % local pop. in poverty Community
Minutes of sedentary behaviour Actigraph accelerometer Free play Institutional Age of child Individual
PA policy characteristics HAPI-PA Scale Ethnicity Individual BMI Individual
BMI Individual Ethnicity (non-white) Individual
Age of child Individual Size of used PA space Institutional
Size of used PA space Institutional Free play Institutional
Supportive PA policy characteristics Institutional Supportive PA policy characteristics Institutional
Beets et al., 2012 [20] United States 3 ASPs; 245 children (mean age 8.2 years old); 48% boys; 60% White Minutes of MVPA Actigraph accelerometer Minutes in attendance Individual
Steps Walk4Life MVPA pedometer Meeting 30 min MVPA guideline Individual
Beets et al., 2013 [21] United States 18 ASPs; 1241 children (5–12 years old); 50% boys; 59% White Minutes of MVPA Actigraph accelerometer PA evaluation (limited with nonvalid methods) Institutional Activities appealing to both genders Institutional
Minutes of sedentary behaviour Actigraph accelerometer PA policy (non-specific language) Institutional Scheduled PA time (< 25% schedule) Institutional
PA policy environment characteristics Scheduled PA time (50% or more) Institutional Child feedback (formal collection) Institutional
Staff PA training (< 1 h) Institutional Child feedback (informal collection) Institutional
Staff PA training (1 to 4 h) Institutional Scheduled PA time (25–49% schedule) Institutional
Scheduled activities (limited) Institutional Scheduled PA time (50% or more) Institutional
Scheduled PA time (< 25% schedule) Institutional Staff PA training (< 1 h) Institutional
Child feedback (informal collection) Institutional PA curriculum (non-evidence based) Institutional
PA curriculum (non-evidence based) Institutional PA evaluation (limited with nonvalid methods) Institutional
Activities appealing to both genders Institutional PA policy (non-specific language) Institutional
Child feedback (formal collection) Institutional PA training delivered by noncertified personnel Institutional
Scheduled activities (diverse) Institutional Scheduled activities (diverse) Institutional
PA training delivered by noncertified personnel Institutional Scheduled activities (limited) Institutional
Scheduled PA time (25–49% schedule) Institutional Staff PA training (1 to 4 h) Institutional
Beets et al., 2015 [22] United States 19 ASPs; 812 children (6–12 years old); 53% boys; 61% White non-Hispanic Minutes of total PA Actigraph accelerometer BMI Individual
Minutes of MVPA Actigraph accelerometer School-based ASP Institutional
Meeting PA policy benchmarks Ethnicity (non-white) Individual
Age of child Individual
Attended faith-based ASP Institutional
Sex Individual
Beets et al., 2016 [23] United States 20 ASPs; 1408 children (5–12 years old); 56% boys Minutes of MVPA Actigraph accelerometer % PA opportunities dedicated for free play (45–74%) Institutional % PA opportunities dedicated for free play (45–74%) Institutional
Minutes of sedentary behaviour Actigraph accelerometer Scheduled PA time (110–160 min) Institutional % PA opportunities dedicated for free play (75–100%) Institutional
Program characteristics Review of schedules; direct observation Scheduled PA time (90–105 min) Institutional Annual organisation revenue (approx $2–4 million) Institutional
Sedentary option during PA time (60 min) Institutional Annual organisation revenue (approx $5–20 million) Institutional
Sedentary option during PA time (75–120 min) Institutional Attending YMCA ASP Institutional
Annual organisation revenue (approx $2–4 million) Institutional Scheduled PA time (110–160 min) Institutional
Annual organisation revenue (approx $5–20 million) Institutional Scheduled PA time (90–105 min) Institutional
Attending YMCA ASP Institutional Sedentary option during PA time (60 min) Institutional
Outdoor PA space (approx 231 k-281 k ft2) Institutional Sedentary option during PA time (75–120 min) Institutional
Outdoor PA space (approx 85 k-200 k ft2) Institutional Indoor PA space (4461–6009 ft2) Institutional
% PA opportunities dedicated for free play (75–100%) Institutional Indoor PA space (7344–15,056 ft2) Institutional
Indoor PA space (4461–6009 ft2) Institutional Outdoor PA space (approx 231 k-281 k ft2) Institutional
Indoor PA space (7344–15,056 ft2) Institutional Outdoor PA space (approx 85 k-200 k ft2) Institutional
Staff PA training (1 or more hours) Institutional Staff PA training (1 or more hours) Institutional
Brazendale et al., 2015 [24] United States 20 ASPs; 1248 children (5–12 years old); 53% boys Scheduled PA time Schedule review Scheduled PA time (< 60 min) Institutional
Minutes of MVPA Actigraph accelerometer Scheduled PA time (> 60 min) Institutional
Scheduled PA time (≈ 45 min) Institutional
Scheduled PA time (≤ 30 min) Institutional
Scheduled PA time (≥ 105 min) Institutional
Scheduled PA time (60 min) Institutional
Scheduled PA time (75 min) Institutional
Burrows et al., 2014 [25] Canada 2 ASPs; 40 children (6–10 years old); 42% boys FMS proficiency Test of Gross Motor Development 2 Attended sport-based ASP Institutional
Low-organised game ASP Institutional
Crowe et al., 2021 [26] Australia 89 ASPs; 4408 children (5–12 years old); 42% boys Child physical activity Actigraph accelerometer Sex Individual Sex Individual
Physical activity policies HAAND Grade Individual Grade Individual
Physical activity promotion practices SOSPAN PA policy Institutional
Type and structure of physical activity SOSPAN Staff PA training Institutional
Available PA space Craftright measuring wheel PA promotion material Institutional
Screen time availability Institutional
Handheld device availability Institutional
Children input in daily programming Institutional
Scheduled free play Institutional
Organised PA Institutional
Children engaged in PA Individual
Children stand and wait during PA games Interpersonal
Elimination games Institutional
Staff engaged in PA Interpersonal
Domazet et al., 2015 [27] Denmark 10 ASPs; 475 children (5–11 years old); 41% boys MVPA minutes Actigraph accelerometer Attended regular ASP Institutional Attended non sport-based ASP Institutional
Cardiovascular fitness Attended sport-based ASP Institutional Attended sport-based ASP Institutional
Huberty et al., 2013 [28] United States 12 ASPs; 888 children (mean age 8.7 years old); 44% boys; 77% White non-Hispanic Staff behaviour SOPLAY Minutes of scheduled PA Institutional
Scans observed sedentary SOPLAY Organised PA Institutional
Scans observed walking SOPLAY PA equipment available Institutional
Scans observed vigorous SOPLAY Staff engaged in PA Interpersonal
Staff off task during PA Interpersonal
Staff other duties during PA Interpersonal
Staff promoting PA Interpersonal
Total number of boys/girls Institutional
Kuritz et al., 2020 [29] Germany ASPs; 198 children % of time in sedentary, LPA & MVPA Actigraph accelerometer Minutes in attendance Individual Sex Individual
Socio-demographic data Motorik-Modul activity questionnaire Sex Individual Grade (year 1 only) Individual
Age of child Individual Minutes in attendance Individual
Londal et al., 2020 [30] Norway 14 ASPs; 42 children (Grade 1); 52% boys Time in sedentary behaviour, total PA and MVPA Actigraph accelerometer Outdoor PA (comparison indoor) Institutional Sex Individual
PA periods Observation form Sex Individual
Maher et al., 2019 [31] Australia 23 ASPs; 1068 children Service contexual information and policies HAAND Number of active play zones available Institutional % of session in MVPA Institutional
Sedentary, LPA, MVPA SOPLAY Outdoor play duration Institutional Availability of screen before 5 pm Institutional
Staff PA and nutrition promotion behaviours SOSPAN Screen availability Institutional Screen availability Institutional
Total number of screen devices Institutional Service size Institutional
Availability of screens before 5 pm Institutional Number of active play zones available Institutional
Service size Institutional Outdoor play duration Institutional
Staff promoting PA Interpersonal Staff promoting PA Interpersonal
Staff witholding PA Interpersonal Staff witholding PA Interpersonal
Total number of screen devices Institutional
Riiser et al., 2019 [32] Norway 14 ASPs; 426 children (Grade 1); 52% boys Physical activity Actigraph accelerometer BMI Individual BMI Individual
Child biometrics Sex Individual Sex Individual
Rosenkranz et al., 2011 [33] United States 7 ASPs 230 children (grade 3 and 4) Physical activity Actigraph accelerometer Child self-efficacy Individual
PA enjoyment Individual
Sex Individual
BMI Individual
Parent PA social support Interpersonal
Child socioeconomic status Individual
Ethnicity (non-white) Individual
Trost et al., 2008 [34] United States 7 ASPs; 147 children (mean age 10.1 years old); 54% male Physical activity Actigraph accelerometer BMI Individual BMI Individual
Height and weight Anthropometric measures Sex Individual Sex Individual
Indoor free play (comparison academic time) Institutional
Indoor free play (comparison indoor organised PA) Institutional
Indoor free play (comparison outdoor free play) Institutional
Indoor free play (comparison outdoor organised PA) Institutional
Indoor free play (comparison snack time) Institutional
Indoor organised PA (comparison academic time) Institutional
Indoor organised PA (comparison outdoor free play) Institutional
Indoor organised PA (comparison outdoor organised PA) Institutional
Indoor organised PA (comparison snack time) Institutional
Outdoor free play (comparison academic time) Institutional
Outdoor free play (comparison outdoor organised PA) Institutional
Outdoor free play (comparison snack time) Institutional
Outdoor organised PA (comparison academic time) Institutional
Outdoor organised PA (comparison snack time) Institutional
Snack time (comparison academic time) Institutional
Weaver et al., 2014 [35] United States 4 ASPs; Undisclosed Staff PA and nutrition promotion behaviours SOSPAN Children stand and wait during PA games Institutional Scheduled enrichment Institutional
Scans observed sedentary SOPLAY Elimination PA games Institutional Children stand and wait during PA games Institutional
Scans observed walking SOPLAY Idle time Institutional Elimination PA games Institutional
Scans observed vigorous SOPLAY Scheduled academics Institutional Scheduled snack Institutional
Scheduled activity rotation Institutional Idle time Institutional
Scheduled bathroom Institutional Scheduled academics Institutional
Scheduled enrichment Institutional Scheduled activity rotation Institutional
Scheduled snack Institutional Scheduled bathroom Institutional
Staff discipline children Interpersonal Staff discipline children Interpersonal
Staff discouraging PA Interpersonal Staff discouraging PA Interpersonal
Staff engaged in PA Interpersonal Staff engaged in PA Interpersonal
Staff giving instructions during PA Interpersonal Staff giving instructions during PA Interpersonal
Staff leading PA Interpersonal Staff leading PA Interpersonal
Staff off task during PA Interpersonal Staff off task during PA Interpersonal
Staff other duties during PA Interpersonal Staff other task during PA Interpersonal
Staff promoting PA Interpersonal Staff promoting PA Interpersonal
Staff witholding PA Interpersonal Staff witholding PA Interpersonal
Zarrett et al., 2015 [36] United States 7 ASPs; Undisclosed (7–12 years old); 56% male PA levels in METS SOPLAY Average temperature Community
Social and environment context of PA SOPLAY Children appear engaged Individual
Social-motivational climate of ASPs MCOT-PA Clear PA rules Institutional
Free play Institutional
Organised PA Institutional
PA activity includes most children Institutional
PA equipment available Institutional
Staff encouraging out-of-program PA Interpersonal
Staff engaged in PA Interpersonal
Staff leading PA Interpersonal
Staff promoting PA Interpersonal
Staff supervision Interpersonal
Staff supervising PA Interpersonal
Usable environment Institutional
Youth interacting positively with one another Interpersonal

Abbreviations: ASPs after school programs, BMI body mass index, HAAND Healthy Afterschool Activity and Nutrition Documentation, HAPI-PA Healthy Afterschool Program Index-Physical Activity scale, LPA light physical activity, MCOT-PA Motivational Climate Observation Tool for Physical Activity, MPA moderate physical activity, MVPA moderate to vigorous physical activity, PA physical activity, SEF social ecological framework, SOPLAY System for Observing Play and Leisure in Youth, SOSPAN System for Observing Staff Promotion of Physical Activity and Nutrition

The correlates were categorised by one review author (AW) into their associated social ecological framework domain: individual, interpersonal, institutional, community and public policy [13]. A second review author (JN) reviewed the categorisation and any discrepancies were discussed and consensus reached. Consistent with other reviews of PA and sedentary behaviour in children [1012] the social ecological framework was used to allow for the investigation of multidimensional factors that influence PA and sedentary behaviour; and provide an organised approach to inform future interventions in the OSHC setting [13]. In the context of this review, the institutional domain refers to correlates at the individual OSHC service provider level, whereas the community domain refers to correlates that are external to the service and from the wider society.

Correlates were summarised to determine shared associations (see Additional files 1 and 2). Correlates which reported a statistically significant (p < 0.05) association with a PA or sedentary behaviour outcome measure were coded as + or – depending on the association (Column 4, Additional files 1 and 2). Those reporting no significant association were recorded in Column 5. The number of times a correlate was associated with an outcome variable was tallied against the total number of times the association was observed (including studies with no significant association). The tally was converted into a percentage (Column 7, Additional files 1 and 2) and analysed using a summary code to represent the association (Table 2). This was similar to a previously published extraction and synthesis process [11] and method of coding [10, 12]. This summary code for the overall association was then recorded (Column 8, Additional files 1 and 2) and used for discussion of the results.

Table 2.

Rules for classifying variables regarding strength of association

Outcome measures supporting association (%) Summary code Explanation of code
0–33 0 Non-significant association
34–59 ? Inconclusive association
60–100  +  Positive association
60–100 - Negative association

Note: When a correlation was observed in three or more studies, it was coded as: 00 (non-significant association for three or more studies); ?? (inconclusive for three or more studies); +  + (positive association for three or more studies); – (negative association for three or more studies). This assists visually with correlations that were more widely studied

Reporting of outcome findings

The reporting of outcome findings in the results is presented using the summary coding for each correlate (Column 7, Additional files 1 and 2). Accordingly, (n/N) refers to the number of significant associations found with outcome measures / total number of associations studied (for that particular correlate). The literature cited refers to the studies which reported the summary code relationship for that correlate (i.e. no association, indeterminate association, positive association, negative association).

Results

A total of 4559 papers were retrieved with 3514 remaining after duplicates were removed (Fig. 1). Following the title and abstract screening, 75 studies were retrieved for full-text review. Of these, 18 studies met the inclusion criteria and were included in this review (Table 1). Publication years of included studies ranged from 2008 – 2021, with all but two studies [33, 34] published in the last 10 years. Most studies (61%) were conducted in the United States (n = 11) [1924, 28, 3336]. The remainder were from Australia (n = 2) [26, 31], Norway (n = 2) [30, 32], Canada (n = 1) [25], Denmark (n = 1) [27] and Germany (n = 1) [29]. All studies were conducted in after school programs (n = 18) with no studies in before school care settings. As the decision to remove healthy eating from this review was made after the screening was completed, the numbers indicated in the PRISMA flow diagram (Fig. 1) include studies which met the healthy eating search terms indicated in the search strategy of the methods section.

Fig. 1.

Fig. 1

PRISMA flow diagram for the search results and inclusions process for identification of articles

Risk of bias in studies

All included studies had an overall ‘definitely low’ or ‘probably low’ risk of bias (Fig. 2). No studies had any criteria which were ‘definitely high’ risk of bias, and only six studies had one ‘probably high’ risk of bias criterion [21, 22, 25, 33, 35, 36]. The most common ‘probably high’ risk of bias was related to the exposure characterisation, with four studies using invalidated methods to measure the exposure(s) [21, 22, 33, 35]. Due to these exposure measures being indirect, the tool called for ‘(NR)’ to be recorded which indicates there was insufficient information to assess risk.

Fig. 2.

Fig. 2

Risk of bias in individual studies, assessed using the OHAT Risk of Bias Rating Tool [18]

Summarising the studies

PA and sedentary behaviour were assessed using a range of measurement methods. Thirteen studies used accelerometers [1924, 26, 27, 29, 30, 3234], one study used pedometers [20], and six studies used direct observations via three tools—System for Observing Play and Leisure Activity in Youth (SOPLAY) (n = 4) [28, 31, 35, 36], Test of Gross Motor Development 2 (n = 1) [25], and one other unnamed observation tool (n = 1) [30]. Correlational information on the PA and sedentary behaviour environments was collected from policy reviews using five tools: System for Observing Staff Promotion of Activity and Nutrition (SOSPAN) (n = 3) [26, 31, 35], Healthy Afterschool Program Index-Physical Activity (HAPI-PA) scale (n = 1) [19], Healthy Afterschool Activity and Nutrition Documentation (HAAND) (n = 2) [26, 31], a PA policy environment framework (n = 1) [21] and policy benchmarks (n = 1) [22]. Other correlational information was collected from a review of the service schedule (n = 2) [23, 24], an unnamed psychosocial questionnaire (n = 1) [33], Motivational Climate Observation Tool for Physical Activity (MCOT-PA) (n = 1) [36], and administrative records (n = 1) [33].

A total of 116 correlates of PA were identified (Additional file 1), of which 10 were classified as individual, 14 as interpersonal, 90 as institutional and two as community variables. There were 64 correlates of sedentary behaviour identified (Additional file 2), of which six were classified as individual variables, nine as interpersonal, 48 as institutional and one as a community variable. Identified associations reflected the relationship between the correlate and PA or sedentary behaviour outcome stated in Column 3 (Additional files 1 and 2).

Summarising the outcome findings

Individual variables

Ten individual level correlates relating to PA were identified (Additional file 1). The most frequently observed individual correlates were sex and BMI. Seven studies [22, 26, 29, 30, 3234] reported 30 associations between sex and varying PA outcomes, six of which found 20 significantly positive associations (n = 20/30) [22, 26, 29, 3234]. This indicates a positive association between sex and PA, with males more physically active than females. Five studies [19, 22, 3234] reported 26 associations with BMI, of which only four studies found five which were significantly negative (n = 5/26) [19, 22, 32, 34] indicating an overall null association. An inconclusive association was also found between PA and age, with three studies reporting eight significant negative associations out of 16 total (n = 8/16) [19, 22, 26].

Six individual level correlates relating to sedentary behaviour were also identified (Additional file 2), with the most frequently observed being sex, BMI and age. Five studies reported eight associations between sex and sedentary behaviour, six of which were significantly negative indicating an overall negative association and showing that females were more sedentary than males (n = 6/8) [26, 29, 30, 32]. An overall inconclusive association was found between BMI and sedentary behaviour, with three studies reporting seven non-significant associations (n = 0/7) [19, 32, 34]. Two studies revealed an overall positive association between age and sedentary behaviour (n = 4/6) [19, 26], finding older children more sedentary.

Interpersonal variables

There were 14 interpersonal level correlates relating to PA (Additional file 1). The most commonly reported was staff verbally promoting PA with four studies [28, 31, 35, 36] reporting 13 correlates, of which only two were significant (n = 2/13) [28, 36] revealing an overall non-significant association. Staff being engaged in PA was found to have an overall positive association with PA outcomes, as two studies reported seven significantly positive associations (n = 7/10) [35, 36]. One study also found that staff supervision of PA (n = 3/3) and children interacting positively with each other (n = 2/3) had positive associations on PA [36].

Nine interpersonal correlates relating to sedentary behaviour were reported (Additional file 2). One study found positive associations between staff disciplining children during PA (n = 2/2), staff discouraging PA (n = 2/2) and staff giving instructions during PA (n = 2/2) with sedentary behaviour outcomes [35]. The same study also reported a negative association between staff engaged in PA and sedentary behaviour (n = 2/2) [35].

Institutional variables

Ninety institutional correlates of PA were identified (Additional file 1). The most frequently studied related to the associations between activity structure (organised PA and free play) and PA outcomes. The results were inconclusive. Two studies reported seven associations between free play and PA, with only two being significant (n = 2/7) [19, 36] revealing an overall non-significant association. Two studies [28, 36] also reported eight associations between organised PA and PA outcomes, and only one was reported as significant (n = 1/8) [36] indicating another non-significant association. PA games with an elimination component were found to be associated with reduced PA levels, as two studies reported five negative associations between elimination PA games and PA (n = 5/5) [26, 35]. PA equipment availability is associated with increased PA, with two studies reporting four positive associations (n = 4/5) [28, 36]. Scheduling PA time in OSHC was also found associated with increased PA, with one study finding a positive association between scheduled PA time of 60 and 75 min with PA (n = 2/2) [24], another study finding a positive association with scheduled PA time between 90–105 min and PA (n = 4/4) [23], and one more finding a positive association with scheduling 50% or more of the session for PA and PA outcomes (n = 2/2) [21]. Another study also found that scheduling 30 min or more of free play (n = 1/1) [26] and organised PA (n = 1/1) [26] was found positively associated with PA.

Forty-eight institutional correlates of sedentary behaviour were identified (Additional file 2). One study found two positive associations between elimination-based PA games and sedentary behaviour (n = 2/2) [35], however conversely found two positive associations between children standing and waiting during PA games and sedentary behaviour (n = 2/2) [35]. Scheduling 50% or more of the OSHC session for PA time was found to have an overall negative association on sedentary behaviour, with one study finding two negative associations (n = 2/2) [21]. Screen time was also found to be associated with increased sedentary behaviour, with a study finding that screen availability and the total number of screen devices in a service both increase the percentage of the session children spend in screen time (n = 1/1) [31].

Community variables

There were two community level correlates of PA identified (Additional file 1). One study found a non-significant association between percentages of the local population living in poverty and PA (n = 0/4) [19] and another found a non-significant association between the average temperature and PA (n = 0/3) [36].

One community correlate of sedentary behaviour was identified (Additional file 2). This consisted of one study reporting four associations between percentage of the local population in poverty and sedentary behaviour, of which only one was significantly positive resulting in an overall non-significant association (n = 1/4) [19].

Public policy variables

No extracted correlates were categorised into the public policy domain.

Discussion

To the best of our knowledge, this is the first systematic review that reports the correlates of objectively measured physical activity and sedentary behaviour in OSHC services. This review demonstrated the varying social ecological domains which were associated with physical activity and sedentary behaviour, similar to other reviews [11, 12]. Physical activity correlates were most frequently reported, however, sedentary behaviour was often addressed in conjunction. The majority of the extracted correlates were categorised into the institutional domain, followed by the interpersonal, individual and community domains respectively. This demonstrates the priority areas interventions within the OSHC setting should target.

The individual domain demonstrated an association that males engage in more PA and are less sedentary than females, which is consistent with reviews of children in other settings [10, 11]. This highlights a need for OSHC services to better engage female children in physical activity, possibly through programming activities which appeal to both sexes. This idea is consistent with a correlate found in the institutional domain, which found programming activities which appeal to both sexes is associated with increased PA among females [20]. This relationship between correlates is an example of the interactions which exist between the social ecological domains, and how looking at PA and sedentary behaviour in the OSHC setting through this framework offers an insightful approach for future interventions.

The interpersonal domain revealed correlates of PA and sedentary behaviour which was anticipated. Staff engaging in and supervising PA was associated with increased physical activity levels [35, 36], and staff discouraging PA and disciplining children was significantly associated with increased sedentary behaviour [35]. The discouragement of PA and discipline of children being associated with more time spent sedentary is an implied relationship, which makes it concerning that staff are actively engaging in this behaviour. Staff training and service policies to promote staff engaging in and supervising PA and educating staff not to discourage children while they are physically active should be an approach for all OSHC services.

In this review, the institutional domain provided most insight into the correlates of PA and sedentary behaviour in OSHC. PA games which involve elimination were associated with reduced PA and increased sedentary behaviour [26, 35], something commonly seen and a game element studies recommend against using [37]. Increased PA equipment availability was also associated with higher PA levels [28, 36]. While availability of equipment is dependent upon finances, services should explore their options around acquiring and providing additional PA equipment through fundraising and other means. OSHC services also need to prioritise scheduling dedicated PA time into their daily programming, as several studies found associations between higher levels of scheduled PA and reduced sedentary behaviour and increased PA levels [21, 23, 24].

Findings around activity structure through the impact of free play and organised PA were mixed, with several studies exploring these factors and finding no significant associations or conflicting results [19, 28, 34, 36]. Further research should be conducted to determine more definitively the association between activity structure and PA and sedentary behaviour in OSHC services. One institutional correlate which was unexpected was children standing and waiting during PA games being associated with higher levels of PA and lower levels of sedentary behaviour [35]. It is, however, important to note that this was only found in one study and was attributed to the complex nature of the OSHC program setting with many events happening simultaneously possibly causing this contradictory relationship [35].

All studies were based in the after school care setting, with no studies included from the before school care setting. This was not unexpected, as preliminary literature searches found most of the research conducted in the OSHC setting was from the United States, and searches for before school care in the United States revealed very little information, suggesting that it is not a prominent setting in that country. Before school care is, however, common in countries such as Australia where there are 4258 registered services who offer this care [38], and New Zealand where 8% of children 6–12 years attend before school care [39]. This reveals another gap in the literature and a need for more studies in OSHC based outside of the United States.

It is important to note that this review initially included correlates of healthy eating in the OSHC setting, though was modified when only one study met the inclusion criteria [40]. While there were a few studies on the food environment of OSHC identified, an inclusion criteria for this review was an objective measure, and most of the studies either did not look at the consumption of food or the measures were subjective in nature. While the screening criteria of this study may have been too stringent to explore the healthy eating environments of the OSHC setting, it does reveal a gap in the literature of a lack of objective healthy eating studies in OSHC services.

Limitations

The results of this review should be considered in light of a number of limitations, including: 1) there were only a small number of studies for most variables; 2) most of the studies were from the United States and may limit the generalisability of the results; 3) none of the included studies observed the before school care setting, meaning the findings may not be representative of that sector; 4) the studies reviewed varied in sample size, outcome measures, and methodologies (although all used an objective measure of PA or sedentary behaviour), which may impact the heterogeneity of the estimates and likelihood of biases in conclusions made; 5) only studies which used an objective measure of PA or sedentary behaviour were included in this review, therefore findings from studies using subjective measures were not accounted for and could vary some of the conclusions made in this study; 6) there was only one author responsible for extracting data from included studies and, though this process was undertaken with extreme diligence, there is potential for error.

Conclusions

This review is important as a large number of children aged 5–13 years attend before and/or after school care services [4], and the sector has been identified as having the potential to positively influence the physical activity, sedentary behaviour and heathy eating of children [5, 6, 41]. This review provides an understanding of the diverse range of influences in participation in physical activity and sedentary behaviour among children while attending OSHC services. It reinforces that females are often less physically active and more sedentary than males in these environments, with service providers and staff needing to explore ways to further engage female children in PA. Service providers also need to monitor staff behaviours around PA through means such as training and policy, as it has the potential to both positively and negatively influence how active children are. They should also look towards removing elimination elements from their PA games, try to schedule more time for PA and also provide more PA equipment for children to use. Health researchers need to look further into how activity structure impacts on child PA, as current studies report mixed findings. This review addresses a knowledge gap and will contribute to future research in both the OSHC setting and childhood overweight and obesity prevention.

Supplementary Information

12889_2022_14675_MOESM1_ESM.xlsx (33.7KB, xlsx)

Additional file 1. Summary of reported physical activity correlates.

12889_2022_14675_MOESM2_ESM.xlsx (23.7KB, xlsx)

Additional file 2. Summary of reported sedentary behaviour correlates.

Acknowledgements

Not applicable.

Abbreviations

BMI

Body mass index

HAAND

Healthy Afterschool Activity and Nutrition Document

HAPI-PA

Healthy Afterschool Program Index-Physical Activity

MCOT-PA

Motivational Climate Observation Tool for Physical Activity

MVPA

Moderate-to-vigorous physical activity

OECD

Organisation for Economic Co-operation and Development

OHAT

Office of Health Assessment and Translation

OSHC

Out of school hours care

PA

Physical activity

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-analysis

PROSPERO

International Prospective Register of Systematic Reviews

SOPLAY

System for Observing Play and Leisure Activity in Youth

SOSPAN

System for Observing Staff Promotion of Physical Activity and Nutrition

Authors’ contributions

AW is a PhD candidate within this study and has worked with the research team to develop the study design and methodology; screened literature for review inclusion; and led data extraction, analysis, interpretation and write up of this manuscript. YP, KW and JN are PhD supervisors and co-investigators on this project. They have contributed to the funding support, study design and revised the manuscript. SR, LP and RC were involved in screening literature for review inclusion and revised the manuscript. AO is the chief investigator of this study, contributing to the funding support, study design, methodologies and is a PhD supervisor on this project. All authors have read and approved the final manuscript. This manuscript has not been submitted or published in any other journal.

Funding

This research has been conducted with the support of the Australian Government Research Training Program Scholarship. This work was supported by the Prevention Research Support Program, funded by the New South Wales Ministry of Health. We declare the funding body has had no influence on the study design, data collection, analysis, interpretations of the findings or writing of this manuscript.

Availability of data and materials

The datasets supporting the conclusions of this article are included within the article (and its additional files).

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors have declared there is no competing interests.

Footnotes

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Contributor Information

Andrew J. Woods, Email: ajw989@uowmail.edu.au

Yasmine C. Probst, Email: yasmine@uow.edu.au

Jennifer Norman, Email: jennifer.norman@health.nsw.gov.au.

Karen Wardle, Email: karen.wardle@health.nsw.gov.au.

Sarah T. Ryan, Email: sr139@uowmail.edu.au

Linda Patel, Email: le092@uowmail.edu.au.

Ruth K. Crowe, Email: ruth.crowe@health.nsw.gov.au

Anthony D. Okely, Email: tokely@uow.edu.au

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

12889_2022_14675_MOESM1_ESM.xlsx (33.7KB, xlsx)

Additional file 1. Summary of reported physical activity correlates.

12889_2022_14675_MOESM2_ESM.xlsx (23.7KB, xlsx)

Additional file 2. Summary of reported sedentary behaviour correlates.

Data Availability Statement

The datasets supporting the conclusions of this article are included within the article (and its additional files).


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