The association between outdoor environmental factors in kindergartens and children's moderate-to-vigorous physical activity: A systematic review and meta-analysis.

Abstract

The kindergarten outdoor environment is considered a key factor influencing children's moderate-to-vigorous physical activity (MVPA). However, existing findings remain inconsistent, with varying criteria and no synthesis. Associations came from studies employing two common measurement methods: accelerometry and direct observation. Fixed- or random-effects models were applied to calculate pooled correlation coefficients. A systematic search of six databases for studies published 2000-2024 identified 17 articles, and 9 met the inclusion criteria for meta-analysis. All outdoor environmental factors were standardized and categorized using validated observational systems, enabling consistent evaluation of their associations with children's MVPA and facilitating data integration across methods. Open spaces, natural elements, and "ball and object play" were moderately positively associated with children's MVPA. Fixed equipment showed weak positive association, while sedentary environments showed very weak negative association. Direct observation appeared slightly more sensitive than accelerometry in detecting these associations. Open spaces, natural elements, and "ball and object play" are associated with higher levels of children's MVPA, while sedentary environments are linked to reduced activity. These findings highlight the importance of designing kindergarten outdoor environments that promote children's physical activity and healthy development. Future studies should consider the influence of measurement tool differences on results.