Increasing physical activity and healthy behaviours at nursery and at home: ToyBox Scotland

INTERVENTION: The ToyBox Scotland intervention has been adapted from the original European Toybox study (http://www.toybox‐study.eu/) for use in Scottish nurseries. Six nurseries are selected from a list of 11 nurseries which expressed an interest in participating after a call was sent out by Glasgow City council to all nurseries in the Greater Glasgow area. Nurseries are selected based on location, size, deprivation score (as defined by the Scottish Index of Multiple Deprivation; from the 3 most deprived quintiles 1‐3), and if they are not currently involved in any similar programmes to ToyBox Scotland which could contaminate results. Nurseries are then be matched by size, ethnic diversity and deprivation score before each matched pair of nurseries is randomised to either intervention (n=3) or control (n=3) following baseline measurement. The intervention is delivered by nursery teachers, who are given appropriate training and materials regarding the ToyBox Scotland programme of activities prior to the study commencing. The intervention involves distinct home and nursery‐based elements. Teachers deliver a programme of activities in the form of semi‐structured active play/physical activity sessions. The activities are initiated by the teachers, however the children are given the freedom to lead the sessions in their own direction, in keeping with the ethos of the Scottish Curriculum for Excellence which promotes child‐led learning. teachers will focus on physical activity for 4 weeks, followed by sedentary behaviour for 4 weeks. This cycle is repeated for the duration of the intervention period (18 weeks). Timing and duration of each session is at the teacher's discretion, however they are asked to aim for at least two sessions per week. One session should total one hour in duration however this can be split up and spread throughout the nursery day in smaller time slots. Environmental changes are also made to the classroom to promote physical activity and interrupt sedentary be CONDITION: Obesity, sedentary behaviour (at nursery and at home), physical activity (at nursery and at home), sleep (at home), eating/snacking. ; Nutritional, Metabolic, Endocrine ; Obesity INCLUSION CRITERIA: 1. Male or female 2. Pre‐school year/final year children aged 3‐5 years old 3. Able to participate in nursery activities 4. Parental consent provided PRIMARY OUTCOME: 1. BMI z‐score is measured using standardised methodology at baseline and follow‐up (week 14); 2. Nursery and home physical activity are measured using the activPAL accelerometer to be worn at baseline for seven consecutive days and in week 14 of the study again for 7 consecutive days; 3. Nursery and home sedentary behaviou are measured using using the activPAL accelerometer to be worn at baseline for seven consecutive days and in week 14 of the study again for 7 consecutive days; ; A process evaluation will also be conducted throughout intervention implementation and after final data collection to assess intervention fidelity and acceptability, in addition to the identification of any issues which would need to be addressed before any possible effectiveness trial in the future. SECONDARY OUTCOME: Current secondary outcome measures as of 23/04/2018; 1. Sleep is measured using the activPAL accelerometer at baseline and follow‐up; 2. Body composition (bio‐electrical impedance) is measured using the Bodyst at 1500 at baseline and follow‐up; 3. Eating and snacking is measured by parental questionnaire at baseline and follow‐up; 4. Water consumption is measured by parental questionnaire at baseline and follow‐up; 5. Screen‐time is measured by parental questionnaire at baseline and follow‐up; 6. Feasibility parameters (including participant recruitment rates, participant attrition rates, questionnaire response rates, standard deviations of outcome measures and intracluster correlation coefficients which will inform the design of a fully‐powered cluster RCT) ; 7. Intervention fidelity will be assessed using practitioner logbooks completed monthly and observation of intervention delivery, involving two sessions of physical activity and sedentary behavior being observed during intervention delivery at each pre‐school midway through the intervention; ; Outcomes 1‐6 will be measured at baseline then again 14‐17 weeks later at follow up. ; ; Previous secondary outcome measures; 1. Sleep is measured using the activPAL accelerometer at baseline and follow‐up; 2. Body composition (bio‐electrical impedance) is measured using the Bodyst at 1500 at baseline and follow‐up; 3. Eating and snacking is measured by parental questionnaire at baseline and follow‐up; 4. Water consumption is measured by parental questionnaire at baseline and follow‐up; 5. Screen‐time is measured by parental questionnaire at baseline and follow‐up