Welcome to this month’s Research Roundup, a recurring overview of recent studies published by researchers at BC Children’s Hospital Research Institute (BCCHR) and the University of British Columbia, and their collaborators.

research roundup

Effects of mandatory Active Play Standards on physical activity policies and practices in B.C. childcare centres

BCCHR theme: Evidence to Innovation

Active play is defined as moderate to intense physical activity, such as running or jumping, that significantly raises children’s heart rates. Active play is important because it improves balance and coordination, helps build strong bones and muscles, and increases children’s concentration and learning skills.

The Canadian 24-Hour Movement Guidelines for the Early Years (0-4 years) states that toddlers and preschoolers should get a minimum of three hours of physical activity each day and, for preschoolers, one out of three of those hours should be active play. In addition, sedentary screen time — such as sitting while watching TV — should take up no more than one hour per day for kids aged one to four.

Recent studies show that preschoolers are only getting an average of 15 minutes of active play per day. To help ensure adequate physical activity in young children attending licensed childcare centres, the Government of British Columbia implemented mandatory Active Play Standards that went into effect in 2017.

Dr. Louise Mâsse, Dr. Claire Tugault-Lafleur, Dr. Guy Faulkner, Dr. Erica Lau and their collaborators measured the effects of the Active Play Standards on related written policies and practices in childcare centres throughout B.C. To do this, they surveyed a total of 1,459 managers and staff from 970 licensed childcare facilities serving children aged two to five years. The team also looked at policies related to healthy eating.

“Before the Active Play Standards went into effect, eight to 43 per cent of childcare centres had written physical activity and sedentary behaviours policies — such as amount of daily outdoor active play or amount of screen time,” says Dr. Mâsse. “These numbers rose to 17 to 77 per cent after the standards were implemented and enforced.”

While B.C. childcare centres substantially increased their written policies involving physical activity and sedentary behaviours, the same could not be said for actual practices.

“The childcare centres in our study reported modest changes in practices related to physical activity levels and sedentary behaviours,” says Dr. Mâsse. “This could be explained by the relatively high levels of self-reported practices at baseline, meaning many of the centres in our study claimed they were already performing quite well in this area even before the standards went into effect. The extent to which current physical activity practices impact outcomes for children will be the subject of future studies, as well as examining how the COVID-19 pandemic has impacted the practices of childcare providers.”

Read more in “Does an Active Play Standard Change Childcare Physical Activity and Healthy Eating Policies? A Natural Policy Experiment,” BMC Public Health.


Family centred lifestyle intervention: A positive, supportive way to decrease BMI and maintain bone health

BCCHR theme: Healthy Starts

One in three Canadian children aged five to 17 live with an overweight condition or obesity, leaving them at risk for a wide range of physical and mental health consequences. These include heart disease and stroke, diabetes, osteoarthritis, some cancers, sleep disorders, low self-esteem, anxiety and depression.

Additionally, the location of fat on the body can be associated with specific health risks. For example, fat that is predominantly accumulated around the upper body, in areas such as the abdomen and chest, has been shown to be inversely associated with bone mineral content in adolescents. In other words, as the percentage of upper body fat increases, whole body bone mineral content may decrease. This has been linked with higher risk of fractures in teens with obesity compared with their peers living in normal weight bodies, and can increase risk of osteoporosis later in life. To further complicate bone health in this population, some weight-loss interventions have been associated with reductions in bone mineral density in young adults with obesity, though the data on children are limited.

Family centred lifestyle interventions (FCLIs) are evidence-based programs that help increase physical activity and other healthy behaviours in children living with overweight or obesity. To do this, these interventions enlist parent involvement every step of the way in setting, tracking and maintaining lifestyle changes related to diet and physical activity. FCLIs lead to more sustainable changes in lifestyle behaviours compared to other methods, meaning kids who participate in these programs are more likely to maintain healthy habits into adulthood.

Dr. Tamara Cohen and her collaborators assessed changes in body mass index (BMI), fat location and bone health in nine- to 12-year-old children with overweight or obesity who participated in an FCLI for one year. Canadian dietary and physical activity guidelines formed the theoretical basis of the FCLI.

“The family centred lifestyle intervention in our study was unique in that it provided a safe, non-judgemental environment for the participants and allowed them to fit the intervention to their own preferences,” says Dr. Cohen. “This resulted in a very high retention rate.”

Out of 60 children enrolled in the study, 55 completed their final visit at 12 months after starting the FCLI.

“After one year, participants in the control group — those who did not receive the FCLI — experienced significantly increased waist circumference and upper body fat, whereas participants in the FCLI experienced significant reductions in BMI,” says Dr. Cohen. “We were pleased that changes in BMI were not associated with decreased bone health.”

Read more in “Changes in Adiposity Without Impacting Bone Health in Nine- to Twelve-Year-Old Children With Overweight and Obesity After a One-Year Family-Centered Lifestyle Behavior Intervention,” Childhood Obesity.

british columbia research

Supporting kids with neurodisability by integrating labels assigned to patient navigation and related services

BCCHR theme: Brain, Behaviour & Development

Neurodisability is defined as a group of long-term conditions caused by impairments of the brain or neuromuscular system, which lead to difficulties in performing routine activities of daily life. Neurodisability may manifest as challenges related to thinking and learning, movement, hearing and vision, communication, emotion and behaviour.

Children with neurodisability require health-related supports from various sources, including education, social services and health-care providers. The burden of identifying, accessing and coordinating these supports usually falls on the family.

“Caregivers encounter a lack of communication across health, social services and rehabilitation agencies, and are often quite overwhelmed with the responsibility of coordinating their child’s access to services,” says Dr. Emily Gardiner. “Their ongoing experiences with a fragmented system negatively impact quality of life for families and health outcomes for patients.”

Dr. Gardiner, Dr. Anton Miller, Vivian Wong and their team found problems even in the terminology related to services available to assist families. The team conducted a scoping review and found 33 research papers that referenced 20 different terms to describe what is essentially patient navigation or care coordination services for children with neurodisability.

Patient navigators, care coordinators, key workers and others facilitate access to and connection amongst fragmented systems, reduce family specific barriers, help identify patient needs, and provide education and emotional support to patients and their families. They often serve as a family’s single point of contact — connecting the patient and family to all necessary supports.

“The diversity of titles applied to these services is confusing for families, who are unlikely to understand the subtle differences between terms such as ‘patient navigator,’ ‘care coordinator,’ and ‘case manager,’” says Dr. Gardiner. “Health-care providers may experience similar confusion and may not know how to direct or advise patients and families who need these kinds of supports.”

The result may be that patients and their families do not learn about navigation services available to them, or do not know whether they qualify for such services.

“We have proposed an integrated and streamlined way to conceptualize these roles to provide clarity to researchers, policy-makers, health-care providers, and patients and families regarding navigation or coordination services,” says Dr. Gardiner. “In this model, ‘family support’ is the umbrella term, under which ‘coordination,’ ‘coaching,’ ‘navigation’ and ‘key working’ reside. We have also developed a model for understanding patient navigation that sets out key components of the role, what these practices aim to provide, and overarching principles or values by which they are guided.”

The team hopes that, with the adoption of this model, more children with neurodisability and their families can learn about these assistance services in a timely manner and be able to make use of them throughout their care journeys.

Read more in “Terminology and Descriptions of Navigation and Related Practices for Children With Neurodisability and Their Families: A Scoping Review,” BMC Health Services Research.


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