Subjectively and objectively assessed social and physical environmental correlates of preschoolers’ accelerometer-based physical activity
Eichinger et al. International Journal of Behavioral Nutrition and Physical Activity
Subjectively and objectively assessed social and physical environmental correlates of preschoolers' accelerometer-based physical activity
Michael Eichinger 0 1
Sven Schneider 1
Freia De Bock 0 1
0 Department of Pediatrics, University Medicine Mannheim, Heidelberg University , Theodor-Kutzer-Ufer 1-3, 68167 Mannheim , Germany
1 Mannheim Institute of Public Health, Social and Preventive Medicine, Medical Faculty Mannheim, Heidelberg University , Ludolf-Krehl-Strasse 7-11, 68167 Mannheim , Germany
Background: Overweight and low levels of physical activity (PA) in preschoolers are major public health concerns. However, to date only few studies have investigated subjective and objective correlates of PA across different socioecological domains in preschoolers. We therefore simultaneously investigate associations between preschoolers' objectively measured leisure-time PA and a comprehensive set of subjective and objective potential PA correlates across the behavioral, social and physical environmental domains on both family- and community-level. Methods: In this cross-sectional study time spent in moderate-to-vigorous PA (MVPA) and total PA (TPA) were measured by combined accelerometry and heart rate monitoring in 735 3-6 year-old children from 52 preschools in Southern Germany. Family- and community-level potential correlates of PA from different domains (behavioral, social and physical environmental) were subjectively (i.e. by parent proxy-report) and objectively assessed. Their associations with PA on weekend days and weekday afternoons were tested by covariate-adjusted multilevel regression models. Results: While none of the objective social and physical environmental factors showed associations with PA, subjective parental traffic safety perceptions were positively associated with MVPA and TPA on weekends. Also, preschoolers' participation in organized sports was positively correlated with MVPA (on weekends) and TPA (both on weekends and weekday afternoons). Conclusion: Subjective traffic safety perceptions and participation in organized sports, an indicator and a result of parental support towards PA - i.e. subjective parental perceptions of environmental factors and family-level correlates which are more proximal to preschoolers - might be more central to PA in preschool age than objectively assessed community-level environmental features which tend to be more distal correlates. If replicable, targeting parental perceptions of environmental factors and parental support for PA in preschool age might be powerful leverages for public health policy.
Physical activity; Family-level correlates; Community-level correlates; Physical environment; Built environment; Social environment; Preschoolers; Accelerometry; Heart rate monitoring
Childhood overweight is a major public health concern
that affects approximately 20% of children in Europe [
]. Adverse health effects of childhood overweight and
obesity include cardiovascular, metabolic and
psychosocial health problems [
]. In the past, efforts to
prevent childhood obesity have mainly focused on
individual-level behavior change, with limited effects [
Therefore, child health promotion has recently
broadened its focus to social and physical environmental
potential correlates of obesity [
Insufficient physical activity (PA), a key determinant of
childhood obesity, is widespread among preschoolers
], with adverse PA behaviors tracking from early
childhood to adulthood [
evidenceinformed PA promotion based on detailed knowledge
about PA correlates in preschool age is paramount.
While there is a large body of literature on correlates
of PA in older children and adolescents [
], only a
limited number of predominantly cross-sectional studies
with often small sample sizes is available for preschool
] (with [
] (n = 2173) [
] (n = 1248) being
notable exceptions). To date systematic reviews have only
been able to identify a very limited number of consistent
associations between PA and its correlates in this age
group (e.g. obese parents, preschool location) [
20, 23, 24
In addition, only a few longitudinal studies have
investigated determinants of PA in preschoolers so far [
These studies mainly used small convenience samples
restricting external validity and predominantely assessed a
limited number of potential PA correlates (e.g. gender,
age, season, parental behaviors) [
Taken together, our understanding of the complex
associations between preschoolers’ PA and its potential
correlates is still hampered. Three analytical approaches
have been called for that might move the field ahead:
Firstly, the socioecological framework emphasizing the
multidimensionality of PA correlates has become a well
established theoretical model guiding PA research [
Recent studies started to concurrently investigate
multiple relevant variables across the social as well as
physical environmental domains [
21, 22, 30
]. But more
studies that deliberately include potential correlates
across the whole spectrum of domains in the
socioecological model (i.e. demographic and biological, cognitive
and emotional, behavioral, social and cultural, and
physical environmental) have been called for in a recent
]. Secondly, both the socioecological
framework and empirical research emphasize that correlates
of preschoolers’ PA operate at different (hierarchical) levels,
such as the family-level (e.g. parental PA [
28, 31, 32
the community-level (e.g. community-level socioeconomic
status (SES) [
]). Therefore, including potential correlates
pertaining to different levels in a simultaneous analysis
seems important. Thirdly, given the widely found
divergence between subjective perceptions and objective
environmental measurements (e.g. regarding traffic
]), supplementing survey-based parental
environmental perceptions with objective administrative
routine data presents a unique opportunity to increase
our understanding of PA correlates in preschool age.
The aim of this study was thus to investigate
associations between preschoolers’ accelerometry/heart rate
monitoring-based leisure-time PA and a comprehensive
set of subjective and objective potential PA correlates
across the behavioral, social and physical environmental
domains on both family- and community-level in a large
sample of German preschoolers.
Setting and participants
In this cross-sectional study (i) family-level (ii)
preschool-level (iii) village/city-level as well as (iv)
county-level data were used, i.e. the data were clustered
at 3 levels. All preschoolers attending the same
preschool, that lived in the same village/city or the same
county had the same data on all preschool, village/city
and county-level potential correlates, respectively (mean
numbers of preschoolers with the same data for
community-level potential correlates range from 13.9–
29.6, lower bound of ranges: 3, upper bound: 128). A
county in Germany (Kreis) comprises several cities and/
or villages. On average 1.4 preschools were nested in
one village/city (median: 1, range: 1–4) and 3.5 were
nested in a county (median: 2, range: 1–15). Table 1
gives an overview of the levels of measurement of all
Family–level and preschool-level data were based on the
baseline measurements of two concurrently implemented
cluster-randomized controlled trials in 52 preschools in the
German federal state of Baden-Württemberg [
a preschool attendance rate of >90% [
] and study
preschools being representative for the German preschool
], the recruited sample was representative of the
population of preschoolers in Germany. Moreover, 80% of
all eligible children were recruited further strengthening
All children aged 3–6 years who were enrolled in one
of the 52 preschools were eligible. 1134 were recruited
and participated in the baseline measurements of the
two intervention studies. Informed written consent was
obtained in advance from the parents of all recruited
children. The research was approved by the Ethics
Committee of the Medical Faculty Mannheim, Heidelberg
University (2008-275 N-MA).
The mean age of the preschoolers in our study was
slightly higher than in comparable studies due to
differences in the German preschool system. After daycare
Domain classification was adapted from Sallis et al. [
]. No potential correlates belonging to the domain psychological, cognitive and emotional potential correlates
were assessed in this study. We assessed both family-level (white) and community-level potential correlates (grey) that were measured subjectively (i.e. by parent
proxy-report) or objectively (marked with an asterisk *). Among the community-level potential correlates variables were measured at preschool1, village/city2 or
county-level3. As the results of 4-level mixed models did not change qualitatively, we collapsed the preschool, village/city and county-levels into one level, called
community-level in the entire paper. Only 2-level models distinguishing family-level from community-level potential correlates are presented in this paper. Latent
variables are marked with a °.
BMI body mass index, ISCED International Standard Classification of Education, MVPA moderate-to-vigorous physical activity, PA physical activity, SES socioeconomic
status, TPA total physical activity
(0–3 years) which is attended by approximately a quarter
of children only, kindergarten (3–6 years) is the main
educational facility in Germany during the early years.
Preschool in the German context is defined as the last
year of kindergarten. It is characterized by exercises
integrated into everyday kindergarten practices with only a
minor focus on math and reading compared to other
countries. While our sample was drawn from
kindergartens, we used the term preschool in order to comply with
the predominant nomenclature in the PA literature.
Data collection was conducted between September
2008 and March 2009 and comprised individual and
family-level (accelerometry/heart rate data and data on
potential correlates assessed by parent proxy-reports)
as well as preschool-level data (e.g. preschool location).
These data were merged with data on village/city-level
and county-level socioeconomic and built environmental
factors based on official statistics of the federal
government and provided by the Federal Institute for Research
on Building, Urban Affairs and Spatial Development
(INKAR dataset 2013, http://www.bbsr.bund.de).
When merging child-level data with community-level
potential correlates, the private addresses of children
were approximated by preschool addresses due to the
unavailability of addresses for a majority of preschoolers.
In a subsample of 370 preschoolers for whom individual
addresses were available, the ZIP codes of the
preschoolers’ addresses and those of the preschools agreed in
95% of cases. As sensitivity analyses showed qualitatively
comparable results using 4-level models (i.e. taking into
account the clustering of the data at 3 levels; results not
shown), we used 2-level models for our analyses,
collapsing the preschool, village/city and county-levels into one
level, henceforth called community-level.
Outcomes: Objective moderate-to-vigorous and total physical activity
Outcomes of the study were time spent in
moderate-tovigorous PA (MVPA) and total PA (TPA) outside of
preschool. As previous studies in preschoolers documented
different levels of PA on weekend days versus weekdays
] with potentially different factors influencing
preschoolers’ PA, we analyzed separate models for
weekends and weekday afternoons. Preschool characteristics
were shown to be associated with PA during preschool
time  suggesting different PA correlates for
leisuretime PA versus PA at preschool. As we specifically
wanted to investigate correlates of leisure-time PA, i.e.
PA outside of the preschool context, we used PA during
weekday afternoons and during weekends as outcomes.
Accordingly, only children that exclusively attended
preschool during mornings (9 am – 1 pm) were included in
the weekday afternoon sample, comprising the time
between 1 and 9 pm. The weekend sample included
Saturdays and Sundays from 7 am – 9 pm for all children,
as in Germany children only attend preschools during the
week. Actiheart devices (Actiheart software version
13.1.4., CamNtech, Cambridge, UK) were used for
accelerometry and heart rate monitoring for up to six
consecutive days including two weekend days (epoch length 15 s,
continuous 24 h recording). Time spent in MVPA was
assessed by combined accelerometry and heart rate
monitoring using previously validated cut-offs (boys:
accelerometry >118 counts/15 s and heart rate > 134 beats/min;
girls: accelerometry >105 counts/15 s and heart rate > 138
]. TPA was assessed by mean accelerometry
counts per 15 s from 1 to 9 pm and 7 am – 9 pm,
respectively. Recordings had to last at least 4 h/day to be
considered valid and children had to have recordings for
Saturday and Sunday and at least three weekday
afternoons to be included in the final analyses, respectively.
Potential correlates of physical activity behaviors
Potential correlates of PA (Fig. 1) were identified from
comprehensive literature reviews [
20, 23, 44, 45
then grouped into four domains of the socioecological
framework presented by Sallis et al. : (1)
demographic and biological, (2) behavioral, (3) social and
cultural as well as (4) physical environmental potential
correlates. Psychological, cognitive and emotional
potential correlates (i.e. the fifth domain in the framework of
Sallis et al.) were not available. Potential correlates were
assessed at the family- and community-level and
deliberately included both subjectively (parent proxy-report,
e.g. parental perceptions) as well as objectively measured
(i.e. data from routine administrative datasets) potential
correlates (Table 1). Potential correlates were included
in the multilevel models if previous studies had shown
them to be associated with preschoolers’ PA (references
are presented in Table 1). Details (measurement,
operationalization and scale level) on all potential correlates
included in the final models are provided in Table 1. To
reduce the number of potential correlates in the models,
underlying latent variables were identified by
correspondence (ordinal variables) and factor analyses using
principal component analysis and applying an
orthogonal rotation (continuous variables). The
operationalization of the latent variables was based on previous
research (Table 1). Cronbach’s alpha was calculated to
assess the internal consistency of the extracted
continuous latent variable.
After descriptive and bivariate analyses, associations
between potential correlates and objectively assessed MVPA
and TPA on weekdays and weekends were tested by a
single covariate-adjusted multilevel regression model each.
The four models included all potential correlates and a
random intercept to account for the clustered data
structure (ICC = 0.05 and ICC = 0.07 for MVPA and TPA,
Point estimates for the regression models were
expressed in minutes/weekend day and minutes/weekday
afternoon for MVPA and mean counts/15 s for TPA,
respectively. Only cases with complete data were considered
in the analyses. Introducing quadratic terms into the
models for the variables age and BMI (to reach an
approximately Gaussian distribution of the residuals) did not
change the results qualitatively (except for BMI being
additionally associated with MVPA and TPA on weekday
afternoons compared to the compact specifications).
Therefore, only models without quadratic terms are
presented in the results section. All statistical analyses were
conducted in 2016 using STATA (version 13, StataCorp,
College Station, United States).
In our study, 735 and 783 preschoolers (see flow
diagram in Fig. 2) from 52 and 50 preschools had complete
data for weekends and weekday afternoons, respectively,
and hence could be included in the multilevel models.
Preschoolers with complete data attending preschool
both during mornings and afternoons (39%) were
excluded from further analyses in the weekday models,
leaving 474 preschoolers in the weekday afternoon
models (Fig. 2). Child and community-level sample
characteristics are presented in Table 2. Mean daily
recording times were 12.68 ± 3.01 and 7.42 ± 1.29 h for
weekend days and weekdays, respectively. On average,
children spent 3.9% of the weekend waking time and 4.3%
of weekday afternoons in MVPA. We observed differences
in the mean time spent in MVPA during weekends between
preschoolers included in the final models and those
excluded due to incomplete data (subsample in final models:
32.55 ± 20.55 min/weekend day, subsample excluded due
to incomplete data: 26.00 ± 21.53 min/weekend day,
respectively; p < 0.001). Moreover, differences in the
distribution of several potential correlates were observed between
preschoolers included in the final models and those with
incomplete data (Additional file 1: Table S1).
Multilevel models for moderate-to-vigorous and total physical activity
The covariate-adjusted multilevel linear regression
models for both weekends and weekday afternoons
showed significant associations between the outcome
variables (MVPA and TPA) and family-level behavioral
correlates as well as subjective parental physical
environmental perceptions (Table 3). While certain differences
in relations are evident, the overall pattern of
associations was comparable across MVPA and TPA (Table 3).
In contrast, none of the objective social and physical
environmental variables from the community-level routine
administrative dataset (community-level socioeconomic
status (SES), proportions of forest, recreational area as
well as settlement area) or the preschool location (rural
versus urban) were associated with any of the outcomes
In the behavioral domain, a child’s participation in
organized sports was positively associated with MVPA on
weekends (β = 1.99 min/weekend day [95% CI 0.10–3.87]). For
TPA a positive association was documented for both the
weekend (β = 1.68 mean counts/15 s [0.28–3.07]) and the
weekday afternoon sample (β = 2.25 mean counts/15 s
[0.02–4.48]). In addition, MVPA during weekday
afternoons was positively associated with subjective (i.e. parent
proxy-report) screen time (β = 1.57 min/weekday afternoon
[0.24–2.89]), but no such association was found for any of
the other outcomes (Table 3).
Within the group of family-level social correlates,
subjective parental leisure-time PA showed a trend towards
significance for MVPA in the weekend sample
(β = 1.74 min/weekend day [−0.06–3.55]), but no such
finding was documented for the other models.
Within the family-level physical environmental
domain, subjective parental perceptions of traffic safety in
the neighborhoods were consistently associated with the
PA outcomes. For weekends, parental perceptions were
positively associated with both MVPA (β = 3.37 min/
weekend day [0.01–6.73]) and TPA (β = 2.44 mean
Domain classification was adapted from Sallis et al. [
]. For the domain psychological, cognitive and emotional potential correlates in the framework of Sallis et al.
no factors were assessed in this study. We assessed both family-level (white) and community-level potential correlates (grey) that were measured subjectively (i.e.
by parent proxy-report) or objectively (marked with an asterisk *). Values are an (%) and bmean ± SD. For ease of display, categories of ordinal variables were
merged (if available, based on national recommendations [
]) and hence do not match with the categories as used in the multilevel models (Table 3). Due to
rounding errors percentages do not always add up to 100%. MVPA was measured in minutes/weekend day and minutes/weekday afternoon, respectively. TPA
was measured in mean accelerometer counts/15 s during weekend days and weekday afternoons, respectively. A weekend day and a weekday afternoon
comprised the period between 7 am - 9 pm and 1–9 pm, respectively.
BMI body mass index, MVPA moderate-to-vigorous physical activity, n number of children in the respective sample, N number of preschools in the respective
sample, PA physical activity, SES socioeconomic status, TPA total physical activity.
The subjectively (i.e. by parent proxy-report) or objectively (marked with a hashtag #) assessed variables in the four domains were concurrently tested in the
multilevel regression models. Both family- (white) and community-level potential correlates (grey) were included in the analyses. Domain classification was
adapted from Sallis et al. [
]. No potential correlates belonging to the domain psychological, cognitive and emotional potential correlates were assessed in this
study. MVPA and TPA were measured in minutes/weekend day or minutes/weekday afternoon and mean accelerometer counts/15 s, respectively. A weekend day
and a weekday afternoon comprised the period between 7 am - 9 pm and 1–9 pm, respectively. If units of independent variables are not otherwise specified they
are measured on an ordinal scale (details on measurement, scale levels and operationalization are provided in Table 1).
BMI body mass index, CI confidence interval, MVPA moderate-to-vigorous physical activity, n number of children included in the respective analysis, N number of
preschools included in the respective analysis, PA physical activity; SES, socioeconomic status, TPA total physical activity.
*P < 0,1, **P < 0,05.
counts/15 s [0.48–4.39]). Within the group of objective
community-level physical environmental correlates, season
was significantly associated with MVPA in the weekday
sample only (β = 3.32 min/weekday afternoon [0.21–6.42]).
In addition, demographic and biological covariates such
as gender and migration background showed significant
associations with preschoolers’ MVPA and TPA (see Table
3 for details).
This study assessed associations between preschoolers’
objectively measured leisure-time PA and a comprehensive
set of subjective (i.e. by parent proxy-report) and objective
potential PA correlates across the behavioral, social and
physical environmental domains on both family- and
community-level (Fig. 1) in a large sample of German
None of the objective community-level social and
physical environmental potential correlates were associated
with objectively assessed leisure-time PA. In contrast, for
the family-level behavioral domain (child participation in
organized sports) as well as the subjective (i.e. by parent
proxy-report) family-level physical environmental domain
(parental perception of neighborhood traffic safety)
significant associations with MVPA and TPA were observed.
These main findings were consistently seen in both the
weekend and weekday afternoon samples.
No associations between PA and the objective
community-level social and physical environmental factors
from routine administrative datasets (community-level SES
and proportions of forest, recreational as well as settlement
area) – i.e. distal potential correlates - were observed. To
date only few studies have investigated associations
between objective community-level potential correlates and
PA in preschool age [
]. Our results are in line
with a study in Dutch preschoolers showing fewer
associations between subjectively assessed outdoor play and
distal physical environmental correlates (i.e. correlates
that are less central to a person, e.g. greenness of the
neighborhood) than proximal correlates (e.g. presence
of a private garden) .
The lack of associations observed in our study might
partly be due to the measurement of objective
environmental correlates at the community-level, i.e. all
preschoolers attending preschools in one community had
the same data on the objective community-level
potential correlates. As the area in which a substantial
proportion of preschoolers’ PA happens tends to be quite small
], our assessment might not have been detailed
enough to capture relevant yet subtle differences in the
PA environment. An objective assessment of the
environment at the level of the individual child (e.g. by
creating and analyzing child-level buffers in GIS), possibly
compared to community-level measures, might move
the field ahead.
In our study none of the subjective (i.e. parent
proxyreported) family-level physical environmental correlates
apart from parental perceptions of the neighborhood
traffic safety were associated with PA. In contrast, a
small number of North-American and Australian studies
identified several physical environmental correlates of
PA in preschoolers (predominantly assessed by parent
proxy-report, e.g. number of playgrounds within walking
], distance to the next park [
], presence of
public open spaces and the number of recreational
facilities in public open spaces [
]). In contrast to these
results distance to infrastructure (i.e. to formal play areas
like the next playground) were not associated with PA in
our study. This might be explained by differences
between North-American and European land-use planning
traditions (e.g. increased availability of informal play
areas like sidewalks in European settings) [
Moreover, the variables playability and access to private
garden, mainly capturing informal opportunities to play,
were not associated with PA in our study either. This is
in contrast to a recent study in Dutch preschoolers that
showed a positive association between the presence of
sidewalks, i.e. one type of informal opportunity to play,
and outdoor play [
]. The result of the Dutch study
highlights the potential beneficial effect of informal play
areas already in preschool age which should be further
investigated in future studies.
Subjectively assessed regular participation in organized
sports was positively associated with all PA outcomes in
our study. The literature however remains inconclusive:
A study on children aged 5–12 years (n = 518)
documented a positive association between participation in
organized sports and parent proxy-report leisure-time
], while a recent review including two smaller
studies (n = 214; n = 347) reported no association
between formal sports participation and PA [
explanations for these divergent results might be
different methods of PA assessment (objective measurement
by accelerometry/heart rate monitoring versus direct
observation), different settings (overall leisure-time PA
versus PA during time spent in childcare versus PA at
home) or differing degrees of control for potential
There is a growing body of literature documenting a
consistent positive association between parental PA and PA
behaviors in preschool age [
]. In the present study,
however, we only found a non-significant association
between subjectively assessed (i.e. parent reported) parental
leisure-time PA, a family-level social environmental
correlate, and MVPA on weekends with no significant
associations for any of the other outcomes. One reason could be
our joint assessment of leisure-time PA for mothers and
fathers: One study in preschoolers  as well as a review
including studies in older children [
] showed that only PA
levels of fathers were a correlate of children’s PA whereas
the mothers’ PA was mostly unrelated. For studies that did
not separate PA of parents no associations were observed
Alternatively, participation in organized sports as a
potential proxy-measure for parental support might
mediate the relationship between parental PA and their
children’s PA levels as shown by Loprinzi et al. [
effect estimates were not affected by excluding
participation in organized sports from our models (data not
shown), substantial mediating effects seem unlikely but
can not be precluded. Future studies might want to
further assess potential indirect and direct effects in the
relationship between parental and offspring PA.
The positive association between preschoolers’
leisuretime PA and subjective parental perceptions of
neighborhood traffic safety, a family-level physical environmental
correlate, is in line with Timperio et al. [
documenting that children whose parents perceived neither lights
nor crossings within the neighborhood were less likely
to actively commute to school. In contrast, other
empirical evidence did not show an association between
subjective perceptions of neighborhood safety and PA
]. These mixed results might be due to the
assessment of different dimensions of safety (traffic
versus crime) and different types of PA (overall leisure-time
PA versus active transportation versus outdoor play).
Recent evidence shows that negative impacts of parental
safety concerns on offspring PA are not confined to
preschool age but are also observed in older children’s
independent mobility (10 to 12 year-olds) [
]. This might be
due to a persistent negative association between parental
safety concerns and offspring unstructured PA and play
across different periods of childhood. Interventions
already during the preschool period might therefore yield
the largest benefits and should be prioritized in future
While some studies identified road safety as a valid
parental concern substantiated by child pedestrian
accident statistics [
], others showed no correlation
between objective road insecurity and subjective parental
]. Future studies should aim at elucidating
which dimensions of neighborhood safety (traffic and/or
crime) are most important for which type of PA and
whether objectively measured and subjectively perceived
traffic safety concur.
Surprisingly, we found that subjectively assessed (i.e.
by parent proxy-report) screen time, one of the
familylevel behavioral correlates, was positively associated with
MVPA on weekday afternoons, but not with any other
outcome. However, also previous literature on screen
time and its association with PA remains inconclusive
], with lack of sedentary behavior during
screenbased activities in young children being one potential
The lack of association between most PA outcomes and
age, BMI, migration status and SES is in line with a
majority of studies included in recent reviews [
20, 23, 24
results for these demographic and biological correlates did
not change once all community-level potential correlates
had been excluded from the models in sensitivity analyses
(results not shown).
Estimated mean magnitudes of associations between
MVPA and its correlates, particularly parental perceptions
of neighborhood traffic safety and participation in
organized sports, ranged from approximately 1.5–3.5 minutes
per weekend day and weekday afternoon, respectively.
While small in absolute terms, the coefficients represent a
relative increase of time spent in MVPA per weekend day
and weekday afternoon of 7–10%, respectively. Given
increasing evidence that particularly MVPA (vs. lower
intensity PA) is associated with health gains in children and
], the magnitude of associations observed in our
study might well be relevant in public health terms.
Strengths and limitations
Strengths of our study are the objective PA
measurement by combined accelerometry and heart rate
monitoring and the deliberate use of linear mixed models to
account for the clustered data structure. In contrast,
many studies on potential correlates of PA relied on
proxy-report measures of PA and disregarded the
clustered data structure in statistical analyses [
Our study adds to the limited number of recent studies
simultaneously investigating multiple potential correlates
of preschoolers’ PA from different domains of the
socioecological model (e.g. [
] (outcome: subjectively
assessed outdoor play)  (outome: PA counts per
minute)). In contrast, older studies often reported only
bivariate results or confined themselves to investigating a
few correlates (mean 3.9 correlates/study, range: 1–14)
]. By concurrently assessing a multidimensional set of
potential correlates, the complexity of factors influencing
preschoolers’ PA is approached in a much more
comprehensive way and the most effective intervention leverages
might be better isolated.
Moreover, the present paper adds to the limited body
of literature on social and physical environmental
potential correlates of preschoolers’ PA in European countries
]. The majority of studies to date have reported
findings from North-American and Australian samples
] – countries with clearly distinct land-use
planning traditions and built environments [
Despite these strengths, the study has several limitations.
Firstly, like most studies investigating potential correlates of
20, 23, 24
], the present study uses a cross-sectional
design precluding any causal inferences. Future studies should
select longitudinal study designs to advance our
understanding of the correlates of PA. Secondly, we observed
significant differences with regards to mean time spent in
MVPA during weekends and the distribution of several
potential PA correlates between preschoolers included in the
final models and those excluded due to incomplete data. A
larger proportion of preschoolers excluded from the
analyses due to incomplete data had migration background
and was from a low SES background and spent less time in
MVPA during weekends. While 80% of eligible children
were recruited, this presumably non-random pattern of
missing data might have biased our results and might
therefore limit the generalizability of our findings. The
observed pattern of missing data and non-response is
common in many studies that rely on parental consent and
proxy-report. Using administrative routine data at the level
of the preschoolers (e.g. objectively assessed BMI from
school entrance examinations) and objective measures of
PA correlates might minimize this source of selection bias
in future studies. Thirdly, despite the objective assessment
of a limited number of potential PA correlates, a substantial
subset of potential PA correlates was still measured via
parent proxy-report. Future research might benefit from
supplementing or even substituting these subjective measures
with objective approaches to minimize measurement error
(e.g. assessment of distances to playgrounds and preschools
by GPS/GIS-based approaches) [
]. Fourthly, we were
only able to assess parental perceptions with regards to
neighborhood traffic safety. As parental perceptions might
shape preschoolers’ PA behaviors beyond this narrow area,
future studies should assess parental perceptions of a
broader set of neighborhood characteristics (e.g.
neighborhood greenness, insecurity due to crime). Fifthly, we were
only able to include a limited set of family-level physical
environmental potential correlates (e.g. access to private
garden, presence of a dog in families). Future studies
investigating the association between both indoor (e.g. indoor
PA equipment) and outdoor (e.g. size of garden) home
physical environmental correlates and objectively measured
PA should use novel technologies to objectively assess the
home environment (e.g. wearable cameras) where possible
. Lastly, the present dataset only included limited
information on parental characteristics (e.g. parental modeling,
support). With accumulating evidence that parental
characteristics might be key correlates of PA in preschool age [
31, 54–56, 58, 59
], gathering detailed information on
parents in future studies seems necessary.
This paper investigated associations between preschoolers’
objectively measured leisure-time PA and a
comprehensive set of subjective (e.g. parental perceptions) and
objective potential PA correlates across the behavioral, social
and physical environmental domains on both family- and
community-level in a large representative sample of
preschoolers in a German context. While none of the
objective social and physical environmental factors showed
significant associations with PA, subjective parental
perceptions of neighborhood traffic safety as well as
participation in organized sports, possibly mirroring parental
support towards PA, were positively associated with
MVPA and TPA. Family-level correlates and subjective
parental perceptions of environmental factors – i.e.
correlates that are more proximal to preschoolers – might be
more central to PA in preschool age than objectively
assessed community-level environmental features, i.e.
more distal correlates. Future longitudinal and
intervention studies should therefore include these correlates to
further strengthen the evidence base. If our findings can
be replicated, targeting parental perceptions of
environmental factors and parental support for PA in preschool
age might be powerful leverages for future public health
policy at the municipal and district level.
Additional file 1: Table S1. Sample characteristics of the subsample
included in the final models and the subsample excluded from the final
models due to incomplete data. (XLSX 35 kb)
BMI: Body mass index; ISCED: International Standard Classification of
Education; MVPA: Moderate-to-vigorous physical activity; PA: Physical activity;
SES: Socioeconomic status; TPA: Total physical activity
Assistance with data management by Marc N. Jarczok and statistical
consulting by Bernd Genser is gratefully acknowledged.
Data collection for the cluster-randomized controlled trials was supported by a
grant from the Baden-Wuerttemberg Stiftung. FDB was supported by the European
Social Fund and the Ministry for Arts and Sciences Baden-Wuerttemberg during
the trial implementation. No external or internal funding was received for the
preparation of this manuscript. We acknowledge financial support by Deutsche
Forschungsgemeinschaft and Heidelberg University within the funding program
Open Access Publishing. Neither the funding bodies nor any company played a
role in the design of the study, collection, analysis or interpretation of the data
collected, the decision to publish, or the contents of the report.
Availability of data and materials
The dataset analyzed for this paper is available from the corresponding
author on request.
ME conceptualized the study, operationalized hypotheses, conducted the
statistical analyses and drafted and revised the manuscript. SS contributed to
the idea of the study and reviewed the manuscript for important intellectual
content. FDB conceptualized the study and statistical analysis and revised
the manuscript. All authors read and approved the final manuscript as
Ethics approval and consent to participate
The studies were approved by the Ethics Committee of the Medical Faculty
Mannheim, Heidelberg University (2008-275 N-MA). Informed written consent
was obtained from the parents of all participating children in advance.
Consent for publication
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in
published maps and institutional affiliations.
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