Calculation and Comparison of Step Guidelines for Preschooler Physical Activity While Indoors.

Objectives: Preschooler physical activity (PA) is vital for growth and development. The World Health Organization PA guidelines state preschoolers should achieve ≥ 180 min/day of Total PA (TPA) of which ≥ 60 min is moderate-to-vigorous PA (MVPA). A step/day recommendation to match these guidelines may be a more practical metric for caregivers to promote PA. The purpose of our investigation is to improve upon existing step recommendations by creating one for indoor-based activities, acknowledging where preschoolers spend most of their time, and various cut-points for PA.

Methods: In a laboratory study (Aim 1), a validated direct observation protocol was used to quantify preschooler PA intensity while performing indoor activities (n = 35). Actigraph GT3x accelerometers were placed on the waist, wrist, and ankle to measure step count. In a field study (Aim 2), habitual PA of 881 preschoolers (7113 valid days) via waist-worn accelerometers was used to assess the agreement between created guidelines (Aim 1) and other step recommendations with PA guidelines using Receiver Operating Characteristic and Area Under the Curve (ROC-AUC).

Results: In the laboratory study, calculated indoor step ranges were 6960-7440 (waist), 7200-8640 (wrist), and 7680-9120 (ankle) to align with existing PA guidance. In the field, the higher step guidelines (> 12 000) achieved very limited agreement, due to few preschoolers achieving this metric. The 6000 step/day guidelines had the highest agreement (AUCs: TPA: 0.637; MVPA: 0.751; TPA + MVPA: 0.761) with PA guideline.

Conclusions: When preschoolers are indoors, 6000 steps may be the minimum for adequate PA.