Vol.3, No.1, 141-147 (2013) Open Journal of Preventiv e Me dic ine
http://dx.doi.org/10.4236/ojpm.2013.31018
Evaluation of a teacher-led physical activity
curriculum to increase preschooler physical activity
Margaret Dunn-Carver1, Lizzy Pope1*, Gregory Dana2, Anne Dorwald t3, Brian Flynn3,
Janice Bunn4, Jean Harvey-Berino1
1Department of Nutrition and Food Sciences, University of Vermont, Burlington, USA;
*Corresponding Author:
2Vermont Child Health Improvement Program, University of Vermont, Burlington, USA
3Office of Health Promotion Research, University of Vermont, Burlington, USA
4Department University Mathematics & Statistics, University of Vermont, Burlington, USA
Received 12 January 2013; revised 12 February 2013; accepted 19 February 2013
ABSTRACT
Preschool students are generally sedentary at
school, and few interventions have addressed
whether teacher-led activities can increase physi-
cal activity at pr eschools. The cur rent study aimed
to increase physical activity in preschool chil-
dren enrolled in childcare centers by training
childcare providers to deliver a physical activity
curriculum. A within-group pre-test/post-test de-
sign was used including 32 children at 4 pre-
schools. A teacher-led physical activity curricu-
lum, the Coordinated Approach to Child Health
Early Childhood Education Curriculum (CEC)
was implemented in each childcare center for
six weeks. Activity levels of participants were
monitored through the use of accelerometers
and direct observation for approximatel y five hours
pre- and post-intervention. Time spent in mod-
erate/vigorous physical activity in preschoolers
in three of th e four pres chools sugg ested a posi -
tive trend increasing from 34.5% ± 13.2% base-
line to 39.3% ± 15.4% at follow-up (p = 0.10).
Teachers from all four centers reported spend-
ing 24.6 ± 13.0 minutes per activity session with
up to two activity sessions completed per day.
These results justify larger trials to determine
the impact of a teacher-led physical activity cur-
riculum on the intensity and duration of pre-
school students’ physical activity at school.
Keywords: Component; Formatting; Style; Styling
1. INTRODUCTION
In 2007-2008 10.4% of 2 - 5 years olds were estimated
to be obese and 10.8% overweight [1,2]. This trend sig-
nifies a national shift toward positive energy balance
even in young children [3]. Physical activity is an im-
portant contributor to energy balance, and several longi-
tudinal studies have demonstrated that physical activity
levels are related to weight status in children [4,5]. Addi-
tionally, adequate physical activity promotes other posi-
tive health outcomes including increased self-esteem,
cognitive health, bone formation, overall fitness, and
reduced cardiovascular risk factors [6-8]. Furthermore,
physical activity behaviors formed during childhood
likely persist into adulthood [9-11].
In 2007-2008, 60% or 4.2 million children ages 3 - 5
attended preschools. These environments may play a
pivotal role in helping children attain adequate physical
activity levels [12,13]. Despite the perception that pre-
schoolers are constantly moving during the preschool day,
evidence suggests that children in this age group are not
getting the recommended amounts of physical activity
(PA). Recent studies have revealed that preschoolers
typically spend a substantial amount of time (70% - 90%
of their day) in sedentary behavior [14-17]. These find-
ings suggest that the current level of PA that preschoolers
engage in may not meet the recently published Institute
of Medicine (IOM) preschool physical activity recom-
mendations to prevent early childhood obesity, which
suggest providing opportunities for light, moderate, and
vigorous physical activity for at least 15 minutes per
hour in childcare [18].
Studies have investigated the effectiveness of several
physical activity promotion interventions for younger
children. These studies employed approaches includ-
ing increased recess time, health promotion programs,
weight control programs, play equipment, and teacher-
guided physical activities in classrooms or on play-
grounds [13,19-27]. Several of these studies found posi-
tive intervention effects including increased physical
activity levels, higher mean heart rate, and more time

M. Dunn-Carver et al. / Open Journal of Preventive Medicine 3 (201 3) 141-147
142
spent in vigorous and moderate to vigorous physical ac-
tivity (MVPA).
Key physical activity promotion targets include
physical environment, center policies, staff training, and
opportunities for increasing physical activity throughout
preschool curricula [28]. Few studies have focused on
the association between teacher-guided physical activity
and the intensity, duration, and contextual aspects of
physical activity [20,21]. Several cross-sectional studies
have shown that staff training in physical education is
positively associated with children’s physical activity
[20,29]. However, to our knowledge, intervention studies
have not succeeded in showing a positive effect of a fo-
cused teacher training, and subsequent curriculum im-
plementation on physical activity of preschool students
[28,30]. This study sought to increase physical activity in
preschool children enrolled in childcare centers by train-
ing childcare providers to deliver a widely available pre-
school physical activity curriculum. We hypothesized
that a teacher-led, physical activity intervention would
increase the time and intensity of preschool children’s
physical activity.
2. METHODS
2.1. Participants
The study was conducted within preschool classrooms
at four licensed childcare centers in Vermont. Potential
centers were selected with consideration of the number
of children available in the targeted 4 - 5 years age group,
the amount of space available to feasibly implement the
intervention program activities, absence of a significant
physical activity asset such as a gym at the facility, and
diversity of the populations served. Enrollment of centers
occurred from December 2009 to January 2010.
All children ages 4 - 5 attending the enrolled centers
were eligible for the study. Center staff provided consent
forms and letters describing the study and data collection
procedures to parents of 4 - 5 year-old children. Centers
were offered an incentive of $400 for participation, in
addition to staff training and equipment needed to im-
plement the curriculum. Thirty-two children participated
in the study.
2.2. Instruments
Measures used to document impact, implementation,
and acceptability of the CEC program included objective
measures of physical activity, observer reports, and logs
and surveys provided by participating teachers.
Physical Activity Measurement. Children’s physical
activity was measured with a SenseWear®Pro 3 armband
(BodyMedia, Pittsburgh, PA) (SWA) during the baseline
and follow-up periods. SWA assessed physical activity
levels over time as average metabolic equivalent of task
(MET) per minute. The device is worn on the triceps of
the upper right arm and held in place by a Velcro arm-
band strap. It uses a combination of five sensors, includ-
ing a two-axis accelerometer, plus participant’s height,
weight, and age to calculate total energy expenditure,
active energy expenditure, average MET levels, number
of steps, and sleep and lying down duration for each
minute of use. The SWA has been tested in a variety of
adult populations and has been validated in resting state,
during exercise, and in obese individuals [31]. Further-
more, recent studies by Calabro et al. showed that SWAs
validly assess physical activity in children [32,33]. The
output of interest for this study was physical activity by
MET levels: sedentary (≤1.4 METs), light (1.5 - 2.9),
moderate (>3 to 5.9 METs), and vigorous (≥6 METs)
[34].
Direct Observation of Children’s Activities. Trained
study staff conducted direct observations recording a
sequence of activity categories for individual children
delimited by specific times that could be linked with
minute-by-minute accelerometer measures of activity
levels for the same children over these time periods. Ob-
servers recorded a brief description of each of the 4-5
children they were following on a structured form. Ob-
servers then recorded the time each new type of activity
began throughout the observation period. Observers also
indicated whether the activity was indoors or outdoors,
and whether the activity was a teacher-guided activity or
free-play activity. After the observation session, each
activity was further categorized by additional codes in-
dicating whether the activity was free play with a gross
motor emphasis (FGM), teacher-led gross motor (TGM)
play, or manipulative, sedentary, sedentary with limb
movement, transitional, or unique activity. These catego-
ries were adapted from Brown et al [35]. A review by
Pate et al. indicated that both direct observation systems
and accelerometry are well established, valid, reliable,
and complimentary measures of physical activity in
young children [36].
Height and Weight. Anthropometric measures were
taken on the first day of baseline measurements with
children wearing street clothes and without shoes. Re-
search staff used a calibrated floor scale (Tanita, BWB-
800A) to measure weight; height was measured using a
wall-mounted tape measure with square on head. Body
Mass Index (BMI) was calculated as weight (kg)/height
(m2) and BMI-for-age percentile was calculated using
standard growth charts [37].
Teacher Logs and Post-Intervention Surveys. Partici-
pating teachers completed daily logs of CEC lessons
used and lesson duration during the 6-week curriculum
implementation. They indicated how closely the activi-
ties were followed using a scale where 1 = not at all and
4 = completely. Children’s level of enthusiasm in re-

M. Dunn-Carver et al. / Open Journal of Preventive Medicine 3 (201 3) 141-147 143
sponse to the activities was recorded using a scale where
1 = not at all enthusiastic and 5 = extremely enthusiastic.
Teachers also were asked to complete a semi-structured
post-intervention survey regarding the acceptability and
ease of implementation of the CEC curriculum.
Observer Reports. A physical education teacher and a
research staff member visited participating classrooms 2 -
3 weeks into the intervention period to observe whether
the CEC activities were being implemented as intended.
Observations occurred for one half day in each center,
and observer reports were filled out using a form adapted
from CEC evaluation materials.
2.3. Procedure
This 10-week study used a pre-test/post-test design.
Baseline measures were conducted in February/March
2010, a six-week intervention occurred, and follow-up
measures were conducted in April/May 2010. In both the
baseline and follow-up periods assessments of partici-
pating children’s physical activity levels were completed
over two consecutive mornings at the childcare center.
Teachers attended a one-day training on the Coordinated
Approach to Child Health (CATCH) elementary educa-
tion program and then implemented the curriculum for
six weeks, keeping logs of the components implement-
ed.
The CATCH Early Childhood Curriculum (CEC) is
based on the grades 3 - 5 Coordinated Approach to Child
Health (CATCH) elementary education program [38].
The CATCH program uses Social Cognitive Theory as a
foundation for the design of activities to promote posi-
tive changes in multiple health behaviors, including
physical activity. Preliminary evaluations of the CEC
program demonstrated feasibility and acceptability among
children, teachers and parents [39]. This study focused
on the CEC physical activity components aimed at in-
creasing moderate to vigorous physical activity (MVPA)
through classroom activities enhanced with play equip-
ment, and stimulated by music and group games. Table 1
provides a description of activity categories and example
activities.
Seven teachers from the four centers participated in a
one-day CEC curriculum training conducted by a CATCH/
CEC National Training Staff member. Each center re-
ceived the CEC physical education curriculum kit and
accompanying equipment. Participating teachers were
asked to implement at least two CEC curriculum activity
sessions per day during the six-week intervention period
(~60 minutes per day). There was no additional supervi-
sion during this period.
2.4. Data Analysis
Data from the SWAs were downloaded into individual
Table 1. CATCH early childhood activity categories.
I. Warm-up Short 3 - 5 minutes activities designed to prepare
for more vigorous movement
II. Go Fitness Intended to promote muscular strength, muscular
endurance, and cardiovascular endurance
III. Go Activity Activities that develop fundamental motor skills
and rhythm
IV. Limber Limbs Purposeful movement to improve muscular range
of motion such as stretching and twisting
V. Cool Down Cool down students' bodies and help with
transition back to the classroom
files for each participant for each observation session.
Data were analyzed using Inner View Research Software
(version 6.1) provided by the SWA manufacturer. Ob-
servation data (e.g., indoor/outdoor, guided/free play)
was hand coded and linked by time stamp to SWA data.
Continuous variables are reported as means ± standard
deviations; categorical variables are reported as frequen-
cies and percentages. The analytic approach was a sin-
gle-group repeated measures analysis of variance. For
analysis of baseline-to-follow up intervention changes,
time point was considered a fixed effect, with random
variables included to account for the correlation among
repeated measures taken on the same child as well as the
correlation among children clustered within a preschool
program. These analyses included only those children
with data collected in both time points. All analyses were
performed using SAS, version 9.2 (SAS Institute Inc.,
2002).
3. RESULTS
3.1. Participant Descriptors
Of 46 children with signed parental consent forms, 42
(91%) participated in the study. Among these children,
32 (76%) completed both baseline and follow-up meas-
ures. The mean age of participating children was 4.3 ±
1.5 (range: 4 - 5) years; 46.3% were male. Participants
had an average BMI of 15.9 kg/m2 ± 1.1; 2.4% were
obese, and 12.2% were overweight. A completer versus
non-completer analysis revealed no significant differ-
ences in age, gender, BMI, or baseline activity levels
between children who completed all measures and those
who did not. Therefore, analysis focused on children
completing both baseline and follow-up measures (n =
32). Reasons why consented children did not complete
the assessments included temporary absence and leaving
the preschool program. Seven preschool teachers from
the four centers participated in the CEC training, imple-
mented the program in their classrooms, and completed a
survey assessment of the curriculum at the end of the
follow-up period. Five of these teachers logged the fre-
quency, duration, and type of each CEC activity imple-
mented.

M. Dunn-Carver et al. / Open Journal of Preventive Medicine 3 (201 3) 141-147
144
3.2. Baseline Phys ical Activity Measurement
Children in all four centers wore the SWA for an av-
erage of 332 ± 91 minutes at baseline (about 5.5 hours)
over two mornings and 339 ± 72 minutes at follow-up (n
= 32). Among children participating in both assessments
an average of 57% ± 17% of time was sedentary at base-
line. The average MET level per minute at baseline was
3.00 ± 0.62. The average MET levels for FGM was 3.76
± 0.83 (n = 31) and for TGM 4.21 ± 1.03 (n = 17).
3.3. Physical Activity Level Changes at All
Four Centers
The percentage of time spent in MVPA MET levels
among participating children (n = 32) at baseline was
43.3% ± 16.9% and at follow-up was 41.8% ± 13.4% (p
= 0.57) suggesting that there was no significant differ-
ence in time spent in MVPA before and after the inter-
vention. However, examination of MET levels for each
center at baseline and follow-up suggested that three of
the centers may have experienced an increase in MET
levels (Table 2).
Closer examination of center 3 data indicated that this
center had relatively high physical activity levels at base-
line and the intervention may have had no impact on
overall physical activity intensity for these children. We
observed that this program highly valued physical activ-
ity based on research staff interactions, teacher surveys,
and the center’s written mission. Therefore, center 3 was
removed from further analyses to examine the effect of
the intervention on preschool programs with a more
typical management of physical activity.
3.4. Physical Activity Level Changes for
Centers 1, 2, and 4
In the three remaining programs, 21 children partici-
pated at both baseline and follow-up assessments.
At baseline, these children spent 34.5% ± 13.2% of
their time in MVPA and at follow-up spent 39.3% ±
15.4% of their time in MVPA (p = 0.10). This difference
suggests a trend toward increasing MET levels from
baseline to follow-up among children in these classrooms.
At baseline, these children spent an average of 30.6% of
time sedentary, 34.9% in light activity and 31.8% in
moderate activity; negligible amounts of time were spent
in vigorous or very vigorous activity (2.6%). Favorable
changes in percent of time spent in various MET levels
were noted at follow-up as shown in Figure 1, with a
lesser proportion of time in sedentary behavior, and a
greater proportion of time spent more active (sedentary
decreased to 23.5%, light increased to 37.2%, moderate
increased to 34.7%, vigorous and very vigorous in-
creased to 4.6%). Further evaluation of activity types
indicated that the average time spent in specific activity
categories changed in these three centers between the
two assessment points. Teacher-led gross motor (TGM)
play increased by 44.0 minutes and sedentary time de-
creased by 27.1 minutes as shown in Figure 2.
Ta ble 2. Percent of time spent in Moderate to Vigorous Physi-
cal Activity (MVPA) MET levels and time spent in MVPA per
center for all children (42).
Ctr nPercent of time spent in
MVPA MET level
Time in MVPA
mean ± SD
Baseline
1 937.5  12.4 125.7 ± 64.8
2 424.5  10.8 66.5 ± 25.5
3 1160.2  7.7 194.8 ± 57.0
4 836.0  14.2 133.9 ± 55.4
Follow-Up
1 944.1  17.6 150.1 ± 61.0
2 424.4  9.7 75.5 ± 13.0
3 1146.6  6.8 149.6 ± 34.7
4 941.3  10.9 149.3 ± 53.4
Figure 1. Percent of time spent in MET levels in three child-
care centers at baseline and follow-up (n = 21).
Figure 2. Average time in minutes spent in activity type at
baseline and follow-up (n = 21).

M. Dunn-Carver et al. / Open Journal of Preventive Medicine 3 (201 3) 141-147 145
3.5. Teacher and Observer Reports
Teachers from all four centers reported spending 24.6
± 13.0 minutes per CEC session with up to two sessions
completed per day. Center 2 reported at least one CEC
session over all 30 days; center 1 and 4 missed one day
of CEC sessions; center 3 did not complete any sessions
on 11 days. Teachers reported following the curriculum
closely (3.15 where 1 = not at all and 4 = completely)
and indicated that the children were generally enthusias-
tic (3.94 where 1 = not enthusiastic and 5 = very enthu-
siastic) about the program. Two independent observers
also reported that children actively participated in the
activities, which were conducted as designed.
4. DISCUSSION
The overall findings suggest that using a physical ac-
tivity curriculum may be a feasible and effective ap-
proach to increasing physical activity among preschool
students. During six weeks of implementing CEC, teach-
ers logged at least 25 minutes of recommended activities
per day and reported high levels of enthusiasm by the
students. Independent observers reported high levels of
participation by the children and the staff. In three child-
care centers with lower baseline levels of physical activ-
ity, positive trends towards greater amounts of time in
MVPA were observed. More specifically, child participa-
tion in teacher-led gross motor activities appeared to in-
crease following implementation of the curriculum in
these three centers, as intended by the CEC design. As-
sessments of children in one center that had higher base-
line levels of MVPA did not reflect these positive trends,
however.
On average during the baseline period, all four centers
were sedentary or engaged in light activity for more than
50% of the observation time, and less than one percent of
the time was spent in vigorous or very vigorous activity.
When center three was removed from the analyses, we
discovered that the centers spent on average almost 70%
of the preschool day in sedentary or light behavior. In
order to meet IOM guidelines recommending that chil-
dren get at least 15 minutes of physical activity per hour,
we requested that teachers incorporate at least two ses-
sions of CEC per day. Unfortunately, most teachers did
not meet this goal. This deficit may be explained by the
challenge that teachers faced in engaging the children for
the recommended structured physical activity time. Also,
decreased ability to engage in active play may have re-
sulted from space limitations in the childcare centers, an
important environmental determinant of physical activity
for children attending childcare [13,20].
This study adds to the small amount of research fo-
cused on physical activity curriculum interventions for
preschoolers. Use of multiple methods of evaluation to
assess the context, duration, acceptability, feasibility, and
intensity of physical activity during the school day is a
strength of the study. This is the first study to use a
multi-sensor armband accelerometer to quantify the im-
pact of a physical activity curriculum on physical activity
levels attained during the preschool day. The physical
activity program was delivered by the usual preschool
teaching staff rather than research staff or outside profes-
sionals, highlighting the potential of a one-day teacher
training as a means to increase physical activity in pre-
school students.
Limitations
There were several limitations to this study. The study
employed a within-group design, and therefore did not
have a control group to account for the influence of
secular or seasonal trends in activity. The sample size
was small, limiting our ability to detect differences be-
tween baseline and follow-up measurements as statisti-
cally significant. Loss during follow up contributed to
this limitation although it may be typical for this popula-
tion. Another limitation was the short duration, as an
average of five hours of observation per child over a lim-
ited time frame may not be sufficient to observe other
factors that influence preschool physical activity. This
study drew from a convenience sample population that
may limit generalizability. Finally, although we did not
collect ethnic or racial information, we are aware that
overall the Vermont ethnic/race distribution is largely
homogeneous which could also limit generalizability; it
should be noted, however, that the CEC was developed
in settings with more diverse populations.
5. CONCLUSION
Considering the detrimental health implications of a
sedentary lifestyle for children and the rise in childhood
obesity, activity at childcare centers remains a critical
area of research. In fact, this area of research has been
recognized as being increasingly important by the June
2011 IOM report suggesting that childcare regulatory
agencies require that childcare providers engage pre-
school children in physical activity throughout the day
[18]. The positive trends in MVPA among 4 - 5 years old
at childcare centers found in this study suggest that a
focused physical activity curriculum may be an effective
way to increase activity during the preschool day. Addi-
tionally, preschool teachers reported a high level of sat-
isfaction and efficacy in implementing the CEC program
and perceived their students to be enthusiastic about the
program. These results suggest that larger trials may be
justified to provide stronger evidence for the impact of a
CEC curriculum on the intensity and duration of pre-
school students’ physical activity in childcare settings.

M. Dunn-Carver et al. / Open Journal of Preventive Medicine 3 (201 3) 141-147
146
6. ACKNOWLEDGEMENTS
The authors are grateful to the participating preschools, directors,
providers, children and their parents who invested their time in the
study. We would also like to acknowledge all members of the project
team not listed as authors and Dr. David Brock for his valuable input.
This work was supported by grant NIFA #2008-04099 from the US
Department of Agriculture awarded to Jean Harvey-Berino, R.D., Ph.D.
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