Where are preschoolers active in childcare centers? A hot-spot analysis using GIS, GPS and accelerometry data

This study investigated where preschool children were more or less active in outdoor play areas in Early Childhood Education and Care (ECEC) centers using a novel method of combined device-measured physical activity, spatial data and on-site audit data. Preschool children (n_=_237) aged 2-5 years from 30 ECEC centers wore accelerometer (Actigraph GT3X+) and Global Positioning System device (Qstarz Q-1000XT) for 7 days. Optimized hot spot analysis was performed to identify physical activity hot and cold spots in ECEC outdoor play areas. Preschoolers’ mean daily minutes of physical activity per ECEC day were significantly higher in large-very large ECEC centers compared to small-medium sized ECEC centers (all p_<_.01). Physical activity hot spots were frequently found in open areas and sometimes also found in their adjacent outdoor play areas if children can freely move between these areas. The amount of running space in ECEC outdoor play area and its location in relation to open areas are important for facilitating physical activity in preschool children. The findings provide objective behavioral and spatial information of ECEC outdoor play area designs that promote physical activity behavior in preschoolers, which can be used to inform the planning and design of physical activity promoting ECEC outdoor environments.