Elsevier

Science & Sports

Volume 26, Issue 2, April 2011, Pages 72-82
Science & Sports

Original article
Preschool outdoor play environment may combine promotion of children's physical activity and sun protection. Further evidence from Southern Sweden and North CarolinaLes aires de jeux extérieures en école maternelle peuvent associer promotion de l’activité physique et protection solaire. Nouveaux arguments de Suède du Sud et de Caroline du Nord

https://doi.org/10.1016/j.scispo.2011.01.007Get rights and content

Summary

Objective

To study the impact of preschool outdoor environments on children's physical activity and solar ultraviolet (UV) exposure at different latitudes and countries.

Methods. Outdoor environments of 11 preschools (two in Raleigh NC, USA, Lat.36̊N, nine in Malmö, Sweden, Lat.55̊N) were scored (OPEC) regarding space, vegetation, hilly terrain and level of integration between open spaces, vegetation and play structures. Free sky (%) was determined by imaging. Physical activity was measured by pedometers and solar UV-exposure by polysulphone dosimeters during 5 days in spring 2009, and individual background data gathered by questionnaires and anthropometric measurements. Global UV radiation was measured and available individual UV radiation (%) computed.

Results

In Malmö, mean step count/minute was 21.2 in preschools with high-scored environment vs. 17.6 in low-scored environments, and UV-exposure lower, 26% vs. 43% of available UV during outdoor stay. In Raleigh, step count/minute was 12.3 and UV-exposure of available UV 27% during outdoor stay.

Conclusions

Step count/minute was lower in Raleigh than in Malmö, but in Malmö children at low-scored environments ran a higher risk of sunburn than in Raleigh. Trees and shrubbery integrated in children's playscape trigger both physical activity and sun-protective behaviour in Sweden, and previous measurements in Stockholm were confirmed. Such outdoor environment should be recommended, but the role of season and climate needs to be further explored.

Résumé

Objectifs

Étudier l’impact de l’environnement extérieur d’écoles maternelles sur l’activité physique et l’exposition au rayonnement solaire ultraviolet (UV) à deux latitudes et dans deux pays.

Méthodes

Les éléments extérieurs de 11 écoles maternelles (deux à Raleigh NC, États-Unis, Lat. 36̊N et neuf à Malmö, Suède, Lat. 55̊N) ont été combinés par le score OPEC : espace, végétation, relief du terrain et degré d’intégration entre l’espace, la végétation et les structures de jeu. L’activité physique a été mesurée par podomètres et l’exposition solaire par dosimètres à film de polysulfone pendant cinq jours au printemps 2009. Les données individuelles ont été recueillies par questionnaires et anthropométrie.

Résultats

À Malmö, le nombre moyen de coups/minute était de 21,2 chez les enfants évoluant dans un environnement à score élevé et de 17,6 dans les environnements à score bas. Les expositions solaires étaient respectivement de 26 et 43 % lors des séjours en extérieur. À Raleigh, les coups/minutes ne différaient pas selon l’environnement : 12,3 et l’exposition solaire non plus : 27 %.

Conclusions

L’activité physique est moindre à Raleigh, mais à Malmö, les enfants qui évoluent dans un environnement extérieur à score peu élevé courent un plus haut risque d’érythème solaire qu’à Raleigh. Les arbres et arbustes intégrés dans les aires de jeu des enfants augmentent l’activité physique et les comportements de protection solaire. Le rôle des saisons et du climat doit être précisé.

Introduction

Outdoor preschool environment is important for health promotion in Western societies as a rising number of preschool children spend most of their waking hours at preschool. Immediate access to varied preschool environment with proximity to vegetation in play areas may serve several targets of health promotion: physical activity, sun-protective behaviour and general health and well-being [1], [2]. A lack of physical activity and overexposure to solar ultraviolet radiation (UVR) with its consequences are global health concerns [2], [3], [4], [5] with short- and long-term implications for health as part of a developing lifestyle. Too little self-triggered physical activity in daily life may cause “physical activity deficiency” i.e. affect physical activity below levels required to maintain health [6], [7], [8]. Further, 80–90% of skin cancers in Western societies are caused by overexposure to solar UVR [4], [5], [9], in preschool children commonly occurring inadvertently during outdoor stay and play. Indoor stay protects from harmful overexposure on sunny days but restrains physical activity. Studies at preschools indicate the relevance of active intervention policies to increase physical activity [10], and to reduce sun exposure [7]. However, by environmental change it is possible to achieve long-term positive impact on both physical activity and sun exposure without recurrent intervention. Green outdoor environments facilitate physically active play [1], [3], [11] and shelter from excessive UVR due to a substantial cut in UV-exposure during free play [1], [12]. Abundant, low-reflectant greenery yields sun protection [13], [14] as part of a play behaviour typical of outdoor settings in which children tend to move in between different places surrounded by vegetation [2], [15]. In Stockholm County children with access to green outdoor environments with high such play potential increased their physical activity and had a low risk of sunburn in spite of long outdoor stay [1]. It was unknown if these findings would also apply to other climates and latitudes than those of Stockholm County (Lat. 59̊–60̊N) which is a segmented coastal metropolitan area, characterized by rocky topography and pine forests in a continental climate zone between the mid-latitude and subarctic regions [16].

In spring 2009 preschool children's physical activity and sun exposure was studied at nine public preschools in Malmö (Lat. 55̊N), an urban area with parks and surrounded by agricultural land in a coastal climate. Six preschools were situated in downtown medium-high income districts, and three preschools in a low-income district 5 km from the city center (Fig. 1).

Variation in the play potential of outdoor environments within socio-economic areas was considered taking into account the size, layout and content of nature and if popular play locations were shaded or sun-exposed. The selection of sites was based on the examination of aerial/satellite photography (e.g. Google Earth) and inspection in situ. A pilot study (convenience sample) was also carried out in subtropical Raleigh, (Lat.36̊N) and run at two corporate preschools attended by children from affluent society. In both studied areas the prevalence of preschool attendance is high [17], [18]. In NC 80% of the children aged 3–5 years are enrolled in child care, usually in private/corporate preschools [18]. In Sweden 96% of their peers attend preschool, of which 82%are run by the local authorities [17]. The prevalence of overweight and obesity among preschool children is 15–20% in both locations [19], [20]. Lifetime prevalence rates of sunburn in young white children in Sweden and US range between 28 and 53% [21], [22]. The aim was to explore the generalizability of the salutogenic potential in outdoor preschool environment across different regions.

Section snippets

Methods

Permissions for study were granted by the Stockholm Regional Ethics Committee, the local authorities and preschools (Malmö) and the Internal Review Board at North Carolina State University (Raleigh), and by parental written informed consent. In Malmö 172/253 (68%) of eligible children aged 3–5,9 years participated (non-response, n = 76, declined participation = 5). All children with parental consent except one wanted to participate. Two children were absent during fieldwork, leaving 169 children

Malmö

After assessment of the participating preschools’ outdoor play areas according to the OPEC-tool, six out of nine were classified as low-score and three as high-score environments (Table 1A, Table B).

Discussion

The main finding of this study was that high-OPEC preschools trigger children's physical activity and sun protection, confirming previous observations from Stockholm County further north that, promotion of physical activity and sun protection did not conflict. Green outdoor environments with high play potential during 7 h/day add 1500–2000 steps, combined with 35–40% lower UV-exposure, enabling long outdoor stay without sunburn, compared with preschools without these qualities. OPEC and outdoor

Conclusion

The same findings were made at two different latitudinal and climatological locations in Sweden, i.e. vegetation integrated in play space at preschool mediated by play behaviour yields physical activity and sun protection by automation. Handy tools for inexpensive assessment as part of upgrading and selecting preschool land should be further elaborated and adapted to mid-high latitudes. In Raleigh, children's step count/minute was lower than at comparable sites in Malmö. However, at

Conflict of interest statement

None.

Acknowledgments

The study was funded by the Swedish Council for Environment, Agricultural Sciences and Spatial Planning. We also want to acknowledge Bertil Forsberg and Chris Jordan for giving access to rooftops at estate Kronprinsen in central Malmö and NCSU campus for global UV measurement, Jill Sindholt and Sarah Andersson for assistance in behaviour mapping, Fredrik Olsson for assistance in processing sky view images, and Thomas Carlund at SMHI for supplying pyranometer data from Lund. Above all, we want

References (43)

  • B.K. Armstrong et al.

    How much melanoma is caused by sun exposure?

    Melanoma Res

    (1993)
  • M. Dowda et al.

    Influences of preschool policies and practices on children's physical activity

    J Community Health

    (2004)
  • I. Fjörtoft

    Landscape as playscape. Learning effects from playing in a natural environment on motor development in children

    (2000)
  • C. Boldeman et al.

    Swedish pre-school children's UVR exposure - a comparison between two outdoor environments

    Photodermatol Photoimmunol Photomed

    (2004)
  • B.L. Diffey et al.

    Clinical climatology

    Photodermatol

    (1984)
  • P.G. Parsons et al.

    The shady side of solar protection

    Med J Aust

    (1998)
  • F. Mårtensson

    The landscape in children's play. A study of outdoor play in preschools

    (2004)
  • KGWCC. Koeppen-Geiger World Climate Classification map....
  • NAE

    Follow-Up Systems

    (2007)
  • Capizzano JM, Main R. Many young children spend long hours in child care (Snapshot of America's Families III No. 22)....
  • U.S.N.C. North Carolina- NPAS.S. http://www.eatsmartmovemorenc.com....
  • Cited by (0)

    Présenté au 1er congrès européen sur l’activité physique et la santé des tout-petits (0–6 ans), Épinal, 28–29 mai 2010.

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