Advertisement

More children more active: Tailored playgrounds positively affect physical activity levels amongst youth

      Abstract

      Objectives

      Overall physical activity (PA) of children is low, and the physical inactivity problem is highest in deprived neighborhoods. The overall goal of the Richard Krajicek Foundation is to provide children in deprived neighborhoods with safe public playgrounds that stimulate daily PA. This study investigates whether Krajicek playgrounds are associated with higher usage and intensity of PA compared to control playgrounds during playground use amongst children.

      Design

      Cross-sectional observational study.

      Methods

      Ten Krajicek and ten control playgrounds in The Netherlands were matched for neighborhood and playground characteristics. Usage and intensity of PA at the playgrounds were measured using direct observation (SOPLAY). Trained observers collected PA data after-school time on weekdays and weekend days. Multilevel regression analyses were performed to analyze the difference in usage and intensity of PA between control and Krajicek playgrounds.

      Results

      Krajicek playgrounds were significantly less often empty compared to control playgrounds (12% vs. 29%). In addition, there was a statistically significant difference in the number of boys observed on the Krajicek playgrounds (14 vs. 9, OR 1.8). Across all categories differences in playground PA were found with an average of 13% of the children on Krajicek playgrounds engaged in moderate-to-vigorous physical activity (MVPA) compared to 10% on control playgrounds. Energy-expenditure (EE) per child was higher on Krajicek playgrounds across all groups (B.006).

      Conclusions

      Krajicek playgrounds are positively associated with higher usage and PA intensity compared to control playgrounds. Our results indicate that Krajicek playgrounds can benefit PA of children living in deprived neighborhoods during playground play.

      Keywords

      1. Introduction

      Physical inactivity is the fourth leading risk factor for global mortality, with a population attributable risk (PAR) of 6%.
      • World Health Organization
      Global recommendations on physical activity for health.
      Especially at a younger age physical inactivity has been associated with higher risks of being overweight or obese and with the increased risk to suffer from the resulting short and long-term negative health consequences.
      • Biro F.M.
      • Wien M.
      Childhood obesity and adult morbidities.
      • Carlson J.A.
      • Crespo N.C.
      • Sallis J.F.
      • et al.
      Dietary-related and physical activity-related predictors of obesity in children: a 2-year prospective study.
      Moreover, in children and adolescents regular physical activity (PA) is associated with both physical
      • Janssen I.
      • LeBlanc A.G.
      Systematic review of the health benefits of physical activity and fitness in school-aged children and youth.
      and psychological health benefits,
      • Eime R.M.
      • Young J.A.
      • Harvey J.T.
      • et al.
      A systematic review of the psychological and social benefits of participation in sport for children and adolescents: informing development of a conceptual model of health through sport.
      amongst which are increased cardiorespiratory fitness and muscular strength, reduced body fatness, favorable cardio-metabolic disease risk profiles, improved self-esteem, and fewer depressive symptoms. This shows the importance of PA for a healthy childhood and associated benefits later in life. Yet, recent figures have shown that less than 20% of children in the Netherlands aged 12–16 years, are engaged in the recommended daily intensity of PA of 60 min of moderate intensity PA.
      • World Health Organization
      Global recommendations on physical activity for health.
      • Hildebrandt V.H.
      • Bernaards C.M.
      • Stubbe J.H.
      Trend report: exercise and health (Trendrapport Bewegen en Gezondheid) 2010/2011.
      As such, improving the levels of PA in children is a public health priority.
      Studies have suggested that the physical environment has a great effect on the intensity of PA of children, and that physical inactivity is most prevalent in deprived neighborhoods,
      • De Vries S.I.
      • Bakker I.
      • Van Overbeek K.
      • et al.
      Children in prioritised neighbourhoods: physical (in)activity and overweight (Kinderen in prioriteitswijken: lichamelijke (in) activiteit en overgewicht).
      • Galvez M.P.
      • McGovern K.
      • Knuff C.
      • et al.
      Associations between neighborhood resources and physical activity in inner-city minority children.
      i.e. urban neighborhoods with a relatively high percentage of non-western immigrants. In general in such neighborhoods the socioeconomic status of inhabitants is lower than the national mean.
      • CBS StatLine
      Kerncijfers wijken en buurten.
      Various environmental factors have been found to affect children's PA behavior,
      • Ding D.
      • Sallis J.F.
      • Kerr J.
      • et al.
      Neighborhood environment and physical activity among youth.
      such as perceived neighborhood safety,
      • Cohen D.A.
      • Han B.
      • Derose K.P.
      • et al.
      Neighborhood poverty, park use, and park-based physical activity in a Southern California city.
      perceived playground safety,
      • Cohen D.A.
      • Han B.
      • Derose K.P.
      • et al.
      Neighborhood poverty, park use, and park-based physical activity in a Southern California city.
      playground supervision,
      • Cohen D.A.
      • Han B.
      • Derose K.P.
      • et al.
      Neighborhood poverty, park use, and park-based physical activity in a Southern California city.
      and the proximity or access to recreational facilities.
      • Ding D.
      • Sallis J.F.
      • Kerr J.
      • et al.
      Neighborhood environment and physical activity among youth.
      • Cohen D.A.
      • Marsh T.
      • Williamson S.
      • et al.
      The potential for pocket parks to increase physical activity.
      In deprived neighborhoods these critical neighborhood characteristics are usually poorly represented.
      • Lovasi G.S.
      • Hutson M.A.
      • Guerra M.
      • et al.
      Built environments and obesity in disadvantaged populations.
      Based on such insights, interventions have been evaluated to promote PA through alterations of school playgrounds
      • Anthamatten P.
      • Brink L.
      • Lampe S.
      • et al.
      An assessment of schoolyard renovation strategies to encourage children's physical activity.
      • Janssen M.
      • Twisk J.W.R.
      • Toussaint H.M.
      • et al.
      Effectiveness of the PLAYgrounds programme on PA levels during recess in 6-year-old to 12-year-old children.
      or public parks.
      • Cohen D.A.
      • Han B.
      • Derose K.P.
      • et al.
      Neighborhood poverty, park use, and park-based physical activity in a Southern California city.
      • Cohen D.A.
      • Marsh T.
      • Williamson S.
      • et al.
      The potential for pocket parks to increase physical activity.
      • Tester J.
      • Baker R.
      Making the playfields even: evaluating the impact of an environmental intervention on park use and physical activity.
      Interventions explicitly aimed at the use of non-school, public playgrounds for PA promotion have not been evaluated to date.
      In the Netherlands, the Richard Krajicek Foundation (RKF) creates public playgrounds (further referred to as Krajicek playgrounds) in deprived neighborhoods. The external factors that influence PA behavior, which are mentioned above, are taken into account in the design of the Krajicek playground. For instance, every Krajicek playground is supervised daily during peak usage times, and a designated sports coach is responsible for the organization of activities. Furthermore, loose equipment, e.g. soccer balls or jump ropes, is provided. The overall goal of the RKF is to provide public playgrounds (further referred to as Krajicek playgrounds) that stimulate daily playground PA in a socially and physically safe environment, for children of all ages in deprived neighborhoods where PA possibilities are limited. A Krajicek playground is a modified public playground with at least one, but preferably multiple, areas for children to engage in different sports or other physical free-play activities. However it remains unknown, how effective this approach is in increasing levels of playground PA as compared to regular playgrounds in comparable neighborhoods. Therefore, the aim of this study was to evaluate the children's usage and Intensity of PA at Krajicek playgrounds as compared to regular playgrounds.

      2. Methods

      The RKF combines public playground placements or renovations with lendable sports equipment and sports guidance to children in deprived neighborhoods. As Krajicek playgrounds are designed in reaction to calls from, and in concordance with, local government, school administrations, and local residents. All playgrounds are specifically tailored to the possibilities and needs of the specific location where a Krajicek playground is situated. For example, if a playground is located in the neighborhood with elementary schools there could be demand for a larger free-play area with swing sets and climbing apparatus for younger children. This opposed to a playground located in the neighborhood of a secondary school were sports areas could be of greater interest. Furthermore, local parties are also involved in the management, maintenance and organization of activities. Local community (sports) organizations must arrange supervision for the playground and organize events at least once a week. It is necessary that daily management is centralized and aimed at creating a (socially) safe environment. On the one hand, a safe environment constitutes of protection against, for instance, traffic by placing a fence around the playground if needed. On the other hand, a safe environment constitutes also a social benign situation in order to give all children the chance to participate in joyful PA and sports. The Medical Ethics Committee of the VU University Medical Centre, the Netherlands, approved the study design, procedures and informed consent procedure.
      At the time of the study (April to July 2013) there were 99 Krajicek playgrounds throughout the Netherlands. A sample of 10 Krajicek playgrounds was randomly selected from all playgrounds that had existed at least for one year (n = 84) to account for the novelty effect. A selection of comparative regular playgrounds (hereafter referred as control playgrounds) were matched with Krajicek playgrounds based on neighborhood and playground characteristics; i.e. the number of neighborhood inhabitants, percentage non-Western (NW) immigrants, residential density, percentage of children (0–15) living in the neighborhood, the number of households, the percentage of households with children, the average size of households, the percentage of low-income households, the mean income of households, playground size, the number of play areas, and area purposes. All neighborhood characteristics were derived from data from CBS Statistics Netherlands.
      • CBS StatLine
      Kerncijfers wijken en buurten.
      The SOPLAY (System for Observing Play and Leisure Activity in Youth) mapping tool was used to describe the playground characteristics.
      • McKenzie T.L.
      • Marshall S.J.
      • Sallis J.F.
      • et al.
      Leisure-time physical activity in school environments: an observational study using SOPLAY.
      Paired playgrounds were simultaneously observed to control for factors like weather and religious events (e.g. Ramadan). Observations were not conducted when weather conditions would not allow normal playground use or when the playground was not freely accessible.
      Utilization and intensity of PA were directly observed using SOPLAY.
      • McKenzie T.L.
      • Marshall S.J.
      • Sallis J.F.
      • et al.
      Leisure-time physical activity in school environments: an observational study using SOPLAY.
      SOPLAY is a standardized observation method used to determine the number of children on a playground and their intensity of PA. Intensity of PA is categorized by SOPLAY as sedentary (i.e., lying down, sitting, or standing), moderate (i.e., walking or light activity), or vigorous intensity by validated codes. These activity codes have been validated by heart rate monitoring
      • McKenzie T.L.
      • Marshall S.J.
      • Sallis J.F.
      • et al.
      Leisure-time physical activity in school environments: an observational study using SOPLAY.
      and permit EE to be estimated. It also documents playground characteristics, e.g. the presence of playground supervision, the possibility to borrow (sports) equipment and whether there are organized activities going on. Before the start of the observation period each playground was divided for observation purposes into target areas; i.e. observable areas for PA. For all observations two observers scanned each target area at set time intervals of 5 min. A second team of observers was added if the playground contained more than two target areas. Temperature, playground characteristics, activity type (e.g., soccer, basketball, tennis) and the categories of PA intensity of each child (i.e. sedentary, moderate or vigorous intensity activity) were reported. All playground pairs were observed for four days, three weekdays after school hours and one weekend day. A scan of all designated target areas was completed every 5 min during a two-hour period per day, resulting in 96 unique scans for each playground in total. Children of all ages were included during the scan; parents and adults other than the supervisor or sports coach were excluded from the observations.
      Fifteen undergraduate University students were trained in using the SOPLAY protocol. All observations were conducted by one of the researchers together with a trained student. Training consisted of a lecture and practice observations on different playgrounds to get familiar with the SOPLAY protocol. Observers learned how to use the coding on the observation form and how to discriminate between different categories of PA intensity. Pre-recorded videos of children being physically active were used to explain the discrimination between the different categories of PA intensity and to explain the practice observation methods. Additionally, field observations were done to practice the SOPLAY method. After the practice field observations, feedback and inter-observer agreement were reported back to the observers. Inter-observer agreement was calculated separately for each observation day. Inter-observer agreement percentage ranged from 70 to 100% (mean 92%, CI 95% 90–94). Sample size: 1777 observations needed with correction for the clustered data.
      Playground use is presented as: (1) the number of scans with no children present on the playground (i.e. no children during an observation); and (2) the average number of children during the scans when children were present. Additionally, mean EE per child and proportion of children participating in MVPA was calculated as a measure of PA. Following the SOPLAY protocol the estimate of EE (kcal/kg/min) was calculated by multiplying the number children with a constant for each category (sedentary; 0.051 kcal/kg/min, moderate; 0.096 kcal/kg/min and vigorous; 0.144 kcal/kg/min).
      • McKenzie T.L.
      • Marshall S.J.
      • Sallis J.F.
      • et al.
      Leisure-time physical activity in school environments: an observational study using SOPLAY.
      The average number of children on the playground was calculated by summing all the counts of children divided by the number of scans. The same was done for EE. The proportion of children participating in MVPA was calculated by dividing the number of very active children by the total number of children on the playground.
      • Saint-Maurice P.F.
      • Welk G.
      • Ihmels M.A.
      • et al.
      Validation of the SOPLAY direct observation tool with an accelerometry-based physical activity monitor.
      Due to the small number of playground pairs (10 matched pairs) a Mann–Whitney-U-test was used to compare neighborhood and playground characteristics between pairs. The difference between Krajicek and control playgrounds in playground scans with no children present was estimated using multilevel generalized linear mixed models (ordinal logistic regression) accounting for the three levels of data clustering; observation scans were clustered within days, and clustered within playground. Second, the average number of children (girls and boys) per m2 within the scans with at least one child present was compared between playgrounds. Due to skewed distribution logarithmic transformation was performed after which multilevel linear regression analyses were conducted to account for the clustered nature of the data. In the analysis with EE as outcome, observations with no children present were excluded. Following the SOPLAY protocol the estimate of EE was calculated as described before. Subsequently to calculate the mean EE per child, the total EE was divided by the number of children. Outcome variables were skewed and therefore logarithmically transformed. Beside a crude analysis, analysis was preformed adjusted for playground size, number of target areas and gender. All data was investigated whether size, target areas and gender were either confounders of effect modifiers. The difference was analyzed using multilevel regression analyses using the same levels as described before. All multilevel analyses were performed using MLwiN v 2.22. No informed consent was required because only de-identified data was collected in this observational study.

      3. Results

      Descriptive characteristics of the playgrounds and surrounding neighborhoods are presented in Table 1. The average size of all of playgrounds (n = 20) was 3785 (CI 95% 2290–5280) square meters. Most of the playgrounds (n = 14) consisted of at least one soccer area or a multi-court and a free-play area. The playgrounds had an average of three (CI 95% 2.5–3.4) predefined target areas for different forms of PA. Neighborhood and playground characteristics were not significantly different between Krajicek and control playgrounds, except for the percentage supervision, organized events and lendable equipment. Since Krajicek playgrounds distinguish themselves from regular playgrounds on these variables, these differences were to be expected.
      Table 1Characteristics of playgrounds and surrounding neighborhoods.
      KrajicekControl
      Mean95% CIMean95% CIp-Value
      Group differences were tested using the Mann–Whitney U test.
      Neighborhood
       No. of inhabitants69413611–10,27162592915–96030.52
       % NW immigrants4730–654829–670.88
       % children1714–211916–220.50
       % households with children3124–383426–410.47
       % low income households4944–555043–570.82
      Playground
       Size in m241441661–662934251256–55940.65
       No. of target areas3.02.1–3.92.92.4–3.40.55
       No. of playgrounds with a multi-court5/100.12–0.884/100.03–0.770.66
       No. of playgrounds with a soccer area6/100.23–0.977/100.35–1.050.65
       No. of playgrounds with a basketball area4/100.03–0.774/100.03–0.771.0
       No. of playgrounds with a skate park3/10−0.05–0.651/10−0.13–0.330.28
       No. of playgrounds with a free-play area
      A free-play area consists of a variety of play structures, e.g. swing sets or climbing apparatus.
      7/100.35–1.057/100.35–1.051.0
       No. of playgrounds with a tennis court4/100.03–0.771/10−0.13–0.330.13
       No. of playgrounds with a panna-field
      Soccer game played in two versus two setting on a small field.
      3/10−0.05–0.651/10−0.13–0.330.28
       % of time supervised0.400.25–0.550.120.02–0.210.01
       % of time organized events0.180.09–0.270.030.00–0.060.00
       % of time loose equipment lendable0.380.23–0.520.110.01–0.210.01
      No.: number.
      NW: non-western.
      a Group differences were tested using the Mann–Whitney U test.
      b A free-play area consists of a variety of play structures, e.g. swing sets or climbing apparatus.
      c Soccer game played in two versus two setting on a small field.
      Krajicek playgrounds were significantly less often empty (12%) compared to control playgrounds (29%) in the total group. After stratifying for gender, no difference in absence was found for girls (Table 2). The difference in absence between Krajicek playgrounds and control playgrounds was the largest for boys.
      Table 2Percentage of empty playgrounds.
      Percentage of observations with 0 childrenOdds of absence of children on control compared to Krajicek playgrounds
      Krajicek (n = 912) (%)Control (n = 912) (%)Crude modelAdjusted model
      Adjusted for number of target areas.
      OR (95% CI)OR (95% CI)
      Children12293.1 (1.2–7.8)5.2 (2.0–13.7)
      Girls30381.4 (0.6–3.2)1.6 (0.6–4.0)
      Boys13343.4 (1.4–8.4)4.2 (1.5–11.3)
      a Adjusted for number of target areas.
      Krajicek playgrounds had a slightly higher child density than control playgrounds (Table 3). Although not significant, on average, 20 children per scan were present at Krajicek playgrounds compared to 14 at control playgrounds. The density of boys was significantly higher on Krajicek playgrounds: with a mean of 14 versus 9 boys on control playgrounds.
      Table 3Difference in number of children on playgrounds and EE per child.
      NMean no. childrenDifference in no. of children
      Adjusted for playground size.
      Mean EE per child (kcal/kg/min)Difference in EE
      Calculated per child.
      KrajicekControlKrajicekControlOR (95% CI)KrajicekControlB (95% CI)
      Children80764920141.6 (0.9–2.8)0.0840.0780.006 (0.004–0.008)
      Girls6375631071.3 (0.1–2.2)0.0810.0750.006 (0.002–0.010)
      Boys7946041491.8 (1.1–3.1)0.0840.0800.005 (0.001–.009)
      EE: energy expenditure (kcal/kg/min). N: sample size. No.: number.
      a Adjusted for playground size.
      b Calculated per child.
      EE was greater at Krajicek playgrounds than at control playgrounds for all children (Table 3). For a child weighing 50 kg, that is a small difference of 18 kcal/h. While boys generally showed a higher EE compared to girls on both Krajicek and control playgrounds (mean 0.084 versus 0.081 and 0.080 versus 0.075, respectively), the difference in EE between Krajicek playgrounds and control playgrounds was slightly larger for girls. On average 13.2% of the children playing on the Krajicek playgrounds was engaged in vigorous intensity PA compared to 10.4% of children on control playgrounds (B (95% CI); 2.7% (0.7–4.7%)).

      4. Discussion

      This study examined the difference in utilization and physical activity levels of children playing on neighborhood tailored Krajicek playgrounds compared to matched regular control playgrounds. Indeed Krajicek playgrounds had a significantly higher utility rate as well as higher physical activity levels during playground play (both EE and proportion engaged in MVPA).
      Previous playground studies looking at playground renovation or equipment provision have reported comparable findings where factors like playground renovations,
      • Anthamatten P.
      • Brink L.
      • Lampe S.
      • et al.
      An assessment of schoolyard renovation strategies to encourage children's physical activity.
      • Janssen M.
      • Twisk J.W.R.
      • Toussaint H.M.
      • et al.
      Effectiveness of the PLAYgrounds programme on PA levels during recess in 6-year-old to 12-year-old children.
      • Willenberg L.J.
      • Ashbolt R.
      • Holland D.
      • et al.
      Increasing school playground physical activity: a mixed methods study combining environmental measures and children's perspectives.
      provision of sports equipment,
      • Willenberg L.J.
      • Ashbolt R.
      • Holland D.
      • et al.
      Increasing school playground physical activity: a mixed methods study combining environmental measures and children's perspectives.
      • McKenzie T.L.
      • Crespo N.C.
      • Baquero B.
      • et al.
      Leisure-time physical activity in elementary schools: analysis of contextual conditions.
      and adult supervision
      • Cohen D.A.
      • Han B.
      • Derose K.P.
      • et al.
      Neighborhood poverty, park use, and park-based physical activity in a Southern California city.
      • McKenzie T.L.
      • Crespo N.C.
      • Baquero B.
      • et al.
      Leisure-time physical activity in elementary schools: analysis of contextual conditions.
      have proven to be effective towards improving PA on school playgrounds. However, other studies did not report a significant effect of such factors on physical activity.
      • Bohn-Goldbaum E.E.
      • Cohen D.A.
      • Phongsavan P.
      • et al.
      Does playground improvement increase physical activity among children? A quasi-experimental study of a natural experiment.
      • Bocarro J.N.
      • Kanters M.A.
      • Cerin E.
      • et al.
      School sport policy and school-based physical activity environments and their association with observed physical activity in middle school children.
      To our knowledge, no studies have examined the effects of these factors on physical activity levels at public playgrounds. Our results indicate that providing these factors in a non-school, public neighborhood setting benefit the PA of children living in these neighborhoods. By locating playgrounds independent of school settings they could have a larger outreach.
      • Cohen D.A.
      • Marsh T.
      • Williamson S.
      • et al.
      The potential for pocket parks to increase physical activity.
      Krajicek playgrounds seem to attract more boys than girls, which is consistent with the literature on gendered playground use.
      • Anthamatten P.
      • Brink L.
      • Lampe S.
      • et al.
      An assessment of schoolyard renovation strategies to encourage children's physical activity.
      • McKenzie T.L.
      • Crespo N.C.
      • Baquero B.
      • et al.
      Leisure-time physical activity in elementary schools: analysis of contextual conditions.
      Lower presence of girls may be explained by the general design of the playgrounds. Krajicek playgrounds are primarily aimed at offering play areas for team sports like soccer and basketball. Girls are generally more attracted to free-play areas and individual activities instead of areas for team sports.
      • Eime R.M.
      • Payne W.R.
      • Casey M.M.
      • et al.
      Transition in participation in sport and unstructured physical activity for rural living adolescent girls.
      • Liu J.
      • Sun H.
      • Beets M.W.
      • et al.
      Assessing natural groupings of common leisure-time physical activities and its correlates among US adolescents.
      Another possible explanation could be that girls feel chased away by boys.
      • Saint-Maurice P.F.
      • Welk G.J.
      • Silva P.
      • et al.
      Assessing children's physical activity behaviors at recess: a multi-method approach.
      Boys generally play more aggressive and more competitive in sports what could make girls feel unwanted and incompetent.
      • Slater A.
      • Tiggemann M.
      Gender differences in adolescent sport participation, teasing, self-objectification and body image concerns.
      Playground use by girls might be improved by allocation of dedicated playground time for girls, a feature that is being provided by RKF. However, further research has to be done to evaluate the validity of this hypothesis. Lower playground use by girls may also be explained by certain ethical/religious beliefs that do not support girls to play sports like soccer and basketball which are mostly targeted at playgrounds.
      • Walseth K.
      Young Muslim women and sport: the impact of identity work.
      Girls feel that they have to act a certain way according to their background and feel tension between their believes and PA participation.
      • Dagkas S.
      • Benn T.
      Young Muslim women's experiences of Islam and physical education in Greece and Britain: a comparative study.
      • Benn T.
      • Pfister G.
      Meeting needs of Muslim girls in school sport: case studies exploring cultural and religious diversity.
      These cultural beliefs may have influenced girlś public playground use negatively.
      Boys had higher EE levels than girls. This finding is similar to other studies on PA at playgrounds.
      • McKenzie T.L.
      • Crespo N.C.
      • Baquero B.
      • et al.
      Leisure-time physical activity in elementary schools: analysis of contextual conditions.
      • Kaczynski A.T.
      • Stanis S.A.W.
      • Besenyi G.M.
      • et al.
      Differences in youth and adult physical activity in park settings by sex and race/ethnicity.
      What is surprising is that girls showed a slightly larger difference in EE on Krajicek playgrounds when compared to control playgrounds. Translating that difference into a child weighing 50 kg, which is a difference of 18 kcal/h for girls, which corresponds to 2 g of fat intake. Although statistically significant, the clinical relevance of this difference needs further study.
      Although our findings suggest that the RKF concept increases intensity of PA, there are several limitations. First, all playgrounds are located in different neighborhoods which makes it possible that unobserved or unconsidered factors could have affected playground use. However, we succeeded in matching playgrounds on both playground and neighborhood characteristics to control for such factors. Further research is needed to assess which factors of a Krajicek playground exactly influence the playground use. Second, the SOPLAY method provides no information on the time spent on the playground of an individual child. Thus we cannot calculate the contribution of Krajicek playgrounds to the daily PA recommendations of a single child. Furthermore, overall usage of the playgrounds was low (mean of 20 and 14 children on Krajicek and control playgrounds, respectively). Looking at the estimated number of children living in the neighborhoods (around 1200 children per neighborhood), this seems an extremely low number. Further research is needed on strategies to improve overall usage of playgrounds. Finally, it is possible that the RKF concept mostly attracts children who are already active to begin with and not the inactive target group.
      Despite the mentioned drawbacks this study also contains some strengths. By only including playgrounds that have been in place for over a year, we believe the novelty effect does not influence the attractiveness of the playground. However, there is a possibility that the novelty effect still exists after one year, which may have resulted in biased data. Other studies often only look at the immediate effect after implementation, by which outcomes may be biased. The second strength is the simultaneous observations of the matched playgrounds, eliminating external factors that might influence playground use.

      5. Conclusion

      This study shows that playground use and physical activity levels of children in deprived neighborhoods are higher at Krajicek playgrounds, using the concept of offering public playgrounds tailored to the neighborhood, lendable sports material and sports guidance in a social safe environment than control playgrounds. Our results suggest that Krajicek playgrounds can benefit the Intensity of PA of children living in deprived neighborhoods.

      6. Practical implications

      • Regular playgrounds are underused and often left deserted. Increasing the attractiveness of these existing playgrounds to enhance their usage should be a primary aim.
      • When playgrounds offer a combination of supervision, lendable equipment and organized events, more children make use of the playground than when these facilities are absent.
      • The rationale behind and characteristics of RKF playgrounds could be implemented in existing and future playgrounds to increase the activity level of children attending the playground.

      Source of funding

      ZonMw—the Netherlands Organization for Health Research and Development.

      Acknowledgement

      The results of the present study do not constitute endorsement by ACSM.

      References

        • World Health Organization
        Global recommendations on physical activity for health.
        WHO, Geneva2010
        • Biro F.M.
        • Wien M.
        Childhood obesity and adult morbidities.
        Am J Clin Nutr. 2010; 91: 1499S-1505S
        • Carlson J.A.
        • Crespo N.C.
        • Sallis J.F.
        • et al.
        Dietary-related and physical activity-related predictors of obesity in children: a 2-year prospective study.
        Child Obes. 2012; 8: 110-115
        • Janssen I.
        • LeBlanc A.G.
        Systematic review of the health benefits of physical activity and fitness in school-aged children and youth.
        Int J Behav Nutr Phys Act. 2010; 7: 40-56
        • Eime R.M.
        • Young J.A.
        • Harvey J.T.
        • et al.
        A systematic review of the psychological and social benefits of participation in sport for children and adolescents: informing development of a conceptual model of health through sport.
        Int J Behav Nutr Phys Act. 2013; 10: 98-119
        • Hildebrandt V.H.
        • Bernaards C.M.
        • Stubbe J.H.
        Trend report: exercise and health (Trendrapport Bewegen en Gezondheid) 2010/2011.
        TNO Kwaliteit van Leven, Leiden2013
        • De Vries S.I.
        • Bakker I.
        • Van Overbeek K.
        • et al.
        Children in prioritised neighbourhoods: physical (in)activity and overweight (Kinderen in prioriteitswijken: lichamelijke (in) activiteit en overgewicht).
        TNO Kwaliteit van Leven, Leiden2005
        • Galvez M.P.
        • McGovern K.
        • Knuff C.
        • et al.
        Associations between neighborhood resources and physical activity in inner-city minority children.
        Acad Pediatr. 2013; 13: 20-26
        • CBS StatLine
        Kerncijfers wijken en buurten.
        Statline.Cbs.Nl, 2009–2012 (Available at 〈http://statline.cbs.nl/〉 (accessed May 26, 2013))
        • Ding D.
        • Sallis J.F.
        • Kerr J.
        • et al.
        Neighborhood environment and physical activity among youth.
        Am J Prev Med. 2011; 41: 442-455
        • Cohen D.A.
        • Han B.
        • Derose K.P.
        • et al.
        Neighborhood poverty, park use, and park-based physical activity in a Southern California city.
        Soc Sci Med. 2012; 75: 2317-2325
        • Cohen D.A.
        • Marsh T.
        • Williamson S.
        • et al.
        The potential for pocket parks to increase physical activity.
        Am J Health Promot. 2014; 28: S19-S26
        • Lovasi G.S.
        • Hutson M.A.
        • Guerra M.
        • et al.
        Built environments and obesity in disadvantaged populations.
        Epidemiol Rev. 2009; 31: 7-20
        • Anthamatten P.
        • Brink L.
        • Lampe S.
        • et al.
        An assessment of schoolyard renovation strategies to encourage children's physical activity.
        Int J Behav Nutr Phys Act. 2011; 8: 9
        • Janssen M.
        • Twisk J.W.R.
        • Toussaint H.M.
        • et al.
        Effectiveness of the PLAYgrounds programme on PA levels during recess in 6-year-old to 12-year-old children.
        Br J Sports Med. 2015; 49: 259-264
        • Tester J.
        • Baker R.
        Making the playfields even: evaluating the impact of an environmental intervention on park use and physical activity.
        Prev Med. 2009; 48: 316-320
        • McKenzie T.L.
        • Marshall S.J.
        • Sallis J.F.
        • et al.
        Leisure-time physical activity in school environments: an observational study using SOPLAY.
        Prev Med. 2000; 30: 70-77
        • Saint-Maurice P.F.
        • Welk G.
        • Ihmels M.A.
        • et al.
        Validation of the SOPLAY direct observation tool with an accelerometry-based physical activity monitor.
        J Phys Act Health. 2011; 8: 1108-1116
        • Willenberg L.J.
        • Ashbolt R.
        • Holland D.
        • et al.
        Increasing school playground physical activity: a mixed methods study combining environmental measures and children's perspectives.
        J Sci Med Sport. 2010; 13: 210-216
        • McKenzie T.L.
        • Crespo N.C.
        • Baquero B.
        • et al.
        Leisure-time physical activity in elementary schools: analysis of contextual conditions.
        J Sch Health. 2010; 80: 470-477
        • Bohn-Goldbaum E.E.
        • Cohen D.A.
        • Phongsavan P.
        • et al.
        Does playground improvement increase physical activity among children? A quasi-experimental study of a natural experiment.
        J Environ Public Health. 2013; 2013: 109841
        • Bocarro J.N.
        • Kanters M.A.
        • Cerin E.
        • et al.
        School sport policy and school-based physical activity environments and their association with observed physical activity in middle school children.
        Health Place. 2012; 18: 31-38
        • Eime R.M.
        • Payne W.R.
        • Casey M.M.
        • et al.
        Transition in participation in sport and unstructured physical activity for rural living adolescent girls.
        Health Educ Res. 2010; 25: 282-293
        • Liu J.
        • Sun H.
        • Beets M.W.
        • et al.
        Assessing natural groupings of common leisure-time physical activities and its correlates among US adolescents.
        J Phys Act Health. 2013; 10: 470-479
        • Saint-Maurice P.F.
        • Welk G.J.
        • Silva P.
        • et al.
        Assessing children's physical activity behaviors at recess: a multi-method approach.
        Pediatr Exerc Sci. 2011; 23: 585-599
        • Slater A.
        • Tiggemann M.
        Gender differences in adolescent sport participation, teasing, self-objectification and body image concerns.
        J Adolesc. 2011; 34: 455-463
        • Walseth K.
        Young Muslim women and sport: the impact of identity work.
        Leis Stud. 2006; 25: 75-94
        • Dagkas S.
        • Benn T.
        Young Muslim women's experiences of Islam and physical education in Greece and Britain: a comparative study.
        Sport Educ Soc. 2006; 11: 21-38
        • Benn T.
        • Pfister G.
        Meeting needs of Muslim girls in school sport: case studies exploring cultural and religious diversity.
        Eur J Sport Sci. 2013; 13: 567-574
        • Kaczynski A.T.
        • Stanis S.A.W.
        • Besenyi G.M.
        • et al.
        Differences in youth and adult physical activity in park settings by sex and race/ethnicity.
        Prev Chronic Dis. 2013; 10: E42-E46