Evidence on the Effectiveness of Public Policies for Physical Activity Promotion in the Early Childcare Education and Care Setting: A Systematic Review.

Only three countries were represented (the United States, Canada and Australia), so the findings may not transfer to other health systems or cultural contexts. The 11 studies used different designs and measured activity in different ways, so their results could not be combined into a single estimate. Only three studies had a control group, and those showed that changes in children's activity could not be attributed to the policy alone. Most studies were rated only fair or poor quality, which is why the authors say the results should be treated with caution. Adherence was often judged by asking centre staff, and the one study that checked both ways found staff greatly overestimated how much activity children were offered. The search ended in August 2023 and used activity-specific search terms, so relevant studies may have been missed. There is little evidence on whether these policies affect boys and girls differently or reduce inequalities.

The authors declare no conflicts of interest. No funder is named in the article.

Do not read the 74% to 94% adherence rates as evidence that children became more active. Adherence describes what centres reported offering, and in the one study that measured both ways, 78.5% of centres reported providing 30 minutes of structured activity a day while observation found 29.9%, and for 60 minutes of total activity the figures were 87.2% and 25.7%. Across the review, children's activity levels did not change consistently.