Sedentary LifestylePlay&GrowNCT02715544
Promoting Healthy Eating and Active Playtime by Connecting Preschool Children to Nature
A study testing Healthy lifestyle and physical activity and dietary guidelines in people with Sedentary Lifestyle and Overweight, run by The University of Hong Kong at 1 site in Hong Kong.
Trial summary
Recent research suggests a majority of Hong Kong's toddlers (aged 2 to 4) are much less active than is recommended and are increasingly engaged in sedentary behaviour, which places them at risk of becoming overweight or obese. Read more about this study
- Who is it for?
- Ages 2 to 6 yearsHealthy volunteers can take part
- Conditions the study is for
- Sedentary Lifestyle, Overweight, Eating Disorders
- What is being tested?
- Healthy lifestyle and physical activity and dietary guidelines
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 240 participants
- Where
- 1 siteHong Kong
- Study dates
- Jan 2015to Dec 2020
- Phase
- Interventional
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 2 to 6 years
- All sexes
- Healthy volunteers accepted
- Child
Who may be able to join
- 2-4 year old children
- With English-speaking parents
Who cannot join
- Children with chronic health conditions
- Families who have recently taken part in a healthy lifestyle promotion programme
Trial locations and contacts
1 site in 1 country.
Hong Kong1 site, 1 recruiting
- Recruiting
The University of Hong Kong
Hong Kong, 000
Tanja Sobko, +85251816160, tanja.sobko@gmail.com
About this study
Recent research suggests a majority of Hong Kong's toddlers (aged 2 to 4) are much less active than is recommended and are increasingly engaged in sedentary behaviour, which places them at risk of becoming overweight or obese. The proposed project will test whether connecting families to nature positively influences physical activity (that is, active playtime) and healthy eating routines in children aged 2 to 4. The investigators have recently conducted a pilot study Play \& Grow (P\&G), a programme based on the most successful international preschool interventions described in the literature. In addition to adopting healthy eating and physical activity intervention elements, the programme was enhanced by including a novel third element: connectedness to nature (CN). To test the effectiveness of this enhanced intervention, the plan is to run a family-based randomised controlled trial (RCT). The intervention will include 240 families with children aged 2 to 4, will take the form of one-hour activity sessions for parents and children held once a week for 10 weeks. The investigators will assess lifestyle-related habits before, immediately after the completion the intervention, at 6 months and one year after the intervention. Created for this purpose, a novel measuring tool for connectedness to nature, Nature Relatedness Scale (NRS), will be validated and tested for reliability prior to the RTC. The results of RCT are intended to be used to understand which components of the intervention were most effective. The objectives of this project will be achieved over a 36-month period, and it is expected to contribute to a close examination of key components of successful healthy lifestyle promotion programme during early childhood. The investigators predict that is that the new element CN will significantly improve the intervention. Finally, the overall aim is that connecting families to nature will result in sustainable lifestyle changes that remain with them for a lifetime.
Read the detailed description
Proper nutrition and physical activity are essential for a healthy life. Time spent in nature has also been proven beneficial. Systematic reviews have shown that nature-related activities enhance general well-being as reflected in increased physical activity, a healthier diet, reduced stress and better sleep. However, existing programmes promoting healthy lifestyles in children focus almost exclusively on diet and physical activity. None, to the inestigators's awareness, taken into consideration interactions, or connectedness with nature. Connectedness to nature/nature relatedness is a relatively new concept that, to date, has been investigated primarily in adults.The concept suggests, for example, that engaging in activities in a natural environment can induce a feeling of connectedness to nature. Exposing preschool children to nature and to thinking about nature in different ways could stimulate nature relatedness as a measurable construct. When children are placed in a natural setting, they are more likely to be physically active. Natuxral products such as fruits and vegetables are widely acknowledged to improve health. As noted above, parents are children's role models, and the investigators therefore believe that connecting parents with nature will have benefits for their children. Many habits and attitudes are developed early in life, and those related to the natural world are no exception. In fact, children are inherently interested in their environment and in nature in general. The hypothesis is that both indoor and outdoor nature-related activities may induce connectedness and bring about positive changes in both eating and activity habits (short-term outcomes) in preschool children, in turn leading to a healthier lifestyle (long-term outcomes).The aim of P\&G is to encourage healthy eating habits and active play in children from an early age, and to bring about healthy behavioural changes in families. The programme also includes a CN element designed to equip parents with environmental knowledge and skills. The generated re- and post-test comparison data indicated the effectiveness of the programme (not presented here). A detailed manual and full resource kit were created, and each session consisted of: (i) a 15-minute theoretical education component (food, activity, CN), and (ii) a 30-minute component on indoor and outdoor nature-related activities, such as playing with nature objects and searching for natural treasures. Some nature activities were food-related (e.g. growing plants, creating miniature indoor gardens, and healthy cooking). The control group received an information folder containing government-recommended physical activity and dietary guidelines for children. To enhance participation, the sessions were scheduled for weekends. The outcome data was collected using a number of scales and questionnaires addressed eating, active play and nature-related habits before and after the program, and focus group discussions were held at the beginning and end of the programme. The programme proved popular amongst participants and the results demonstrated significant positive changes on number of health-related outcomes, such as food habits and caregiver physical activity levels.
- Conditions
- Sedentary Lifestyle, Overweight, Eating Disorders
- Being tested
- Healthy lifestyle, physical activity and dietary guidelines
- Keywords
- Intervention, Physical activity, Eating habit, Connectedness to nature
- Medical subject headings
- Sedentary Behavior, Overweight, Feeding and Eating Disorders, Motor Activity, Feeding Behavior
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Healthy lifestyleOther
The families will receive a designed for these purposes intervention
physical activity and dietary guidelinesOther
The families will receive a designed for these purposes intervention
| Study group | Role | What they receive |
|---|---|---|
| Intervention group | Experimental | The group will receive healthy lifestyle intervention Receives: Other: Healthy lifestyle |
| control group | Active comparator | Other: physical activity and dietary guidelines Receives: Other: physical activity and dietary guidelines |
What is being measured
The primary outcome is the main question the study is designed to answer.
Eating habits
A short validated Eating and Physical Activity Questionnaire (EPAQ)
Measured: 3 years
Physical activity
Physical Activity Questionnaire for Preschool-aged Children (Pre-PAQ®)
Measured: 3 years
Nature relatedness
a short, age-adjusted NRS scale
Measured: 3 years
Secondary outcomes (5)
Parental knowledge of nutrition
Nutrition Knowledge Questionnaire (NKQ)
Measured: 3 years
Parental feeding behaviours
The Preschool Child Feeding Questionnaire (PCFQ)
Measured: 3 years
weight
weight in kilograms
Measured: 3 years
height
height in meters
Measured: 3 years
child neophobia
Pliner's Child Neophobia Scale (PCNS)
Measured: 3 years
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted22 Mar 2016 (estimated)
- Study startJan 2015
- Primary completionDec 2019 (estimated)
- Study completionDec 2020 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Publications (13)Papers the sponsor has linked to this study.
- Other trials for Sedentary LifestyleStudies of the same condition, open and under way.
- More trials run by The University of Hong KongThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Enrolment
- 240 participants (estimated)
Sponsor and investigators
- Lead sponsor
- The University of Hong Kong
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Dr. Tanja Sobko, The University of Hong Kong
- Investigators
- Tanja sobko, Principal investigator, The University of Hong Kong
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT02715544
- Sponsor's protocol ID
- P&G 2015
- Acronym
- Play&Grow
- Status last verified
- Aug 2018
- First submitted
- 8 Mar 2016
- Last updated
- 27 Aug 2018
- Results posted
- No
- Data monitoring committee
- Yes
- Individual data sharing
- No: Hong Kong Ethics Committee
Publications
Nisbet EK, Zelenski JM. The NR-6: a new brief measure of nature relatedness. Front Psychol. 2013 Nov 1;4:813. doi: 10.3389/fpsyg.2013.00813. eCollection 2013.
PubMed 24198806Cleland V, Crawford D, Baur LA, Hume C, Timperio A, Salmon J. A prospective examination of children's time spent outdoors, objectively measured physical activity and overweight. Int J Obes (Lond). 2008 Nov;32(11):1685-93. doi: 10.1038/ijo.2008.171. Epub 2008 Oct 14.
PubMed 18852701Dyment JE, Bell AC. Grounds for movement: green school grounds as sites for promoting physical activity. Health Educ Res. 2008 Dec;23(6):952-62. doi: 10.1093/her/cym059. Epub 2007 Oct 22.
PubMed 17956885Bell JF, Wilson JS, Liu GC. Neighborhood greenness and 2-year changes in body mass index of children and youth. Am J Prev Med. 2008 Dec;35(6):547-53. doi: 10.1016/j.amepre.2008.07.006.
PubMed 19000844Veselinovska SS, Osogovska TL: Engagement of Students in Environmental Activities in School. Procedia - Social and Behavioral Sciences 2012, 46:5015-5020.
Barratt Hacking E, Barratt R, Scott W: Engaging children: research issues around participation and environmental learning. Environmental Education Research 2007, 13:529-544.
Mullis F: Active parenting: an evaluation of two Adlerian parent education programs. Journal of Individual Psychology 1999, 55:225-232.
Liefländer AK, Fröhlich G, Bogner FX, Schultz PW: Promoting connectedness with nature through environmental education. Environmental Education Research 2013, 19(3):370-384
Cutter-Mackenzie A, Edwards S: Toward a Model for Early Childhood Environmental Education: Foregrounding, Developing, and Connecting Knowledge Through Play-Based Learning. The Journal of Environmental Education 2013, 44(3):195-213.
The Biophilia Hypothesis [http://books.google.com/books?hl=nl&lr=&id=qOg3-J0BoGoC&pgis=1]
Sobko T, Brown GTL, Cheng WHG. Does connectedness to nature improve the eating behaviours of pre-schoolers? Emerging evidence from the Play&Grow randomised controlled trial in Hong Kong. Appetite. 2020 Nov 1;154:104781. doi: 10.1016/j.appet.2020.104781. Epub 2020 Jun 30.
PubMed 32615145Sobko T, Jia Z, Brown G. Measuring connectedness to nature in preschool children in an urban setting and its relation to psychological functioning. PLoS One. 2018 Nov 29;13(11):e0207057. doi: 10.1371/journal.pone.0207057. eCollection 2018.
PubMed 30496300Sobko T, Tse M, Kaplan M. A randomized controlled trial for families with preschool children - promoting healthy eating and active playtime by connecting to nature. BMC Public Health. 2016 Jun 13;16:505. doi: 10.1186/s12889-016-3111-0.
PubMed 27296723
Study at a glance
From the registry record, last updated by the sponsor on 27 Aug 2018. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Promoting Healthy Eating and Active Playtime by Connecting Preschool Children to Nature
- ClinicalTrials.gov ID
- NCT02715544
- Acronym / sponsor ID
- Play&Grow / P&G 2015
- Conditions
- Sedentary Lifestyle, Overweight, Eating Disorders
- Keywords
- Intervention, Physical activity, Eating habit, Connectedness to nature
- Study type
- Interventional
- Recruitment status
- Unknown status
- Enrolment
- 240 participants (estimated)
- Lead sponsor
- The University of Hong KongUniversity, hospital or other
- Study start
- Jan 2015 (actual)
- Primary completion
- Dec 2019 (estimated)
- Study completion
- Dec 2020 (estimated)
- First posted
- 22 Mar 2016 (estimated)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Recent research suggests a majority of Hong Kong's toddlers (aged 2 to 4) are much less active than is recommended and are increasingly engaged in sedentary behaviour, which places them at risk of becoming overweight or obese. The proposed project will test whether connecting families to nature positively influences physical activity (that is, active playtime) and healthy eating routines in children aged 2 to 4. The investigators have recently conducted a pilot study Play \& Grow (P\&G), a programme based on the most successful international preschool interventions described in the literature. In addition to adopting healthy eating and physical activity intervention elements, the programme was enhanced by including a novel third element: connectedness to nature (CN). To test the effectiveness of this enhanced intervention, the plan is to run a family-based randomised controlled trial (RCT). The intervention will include 240 families with children aged 2 to 4, will take the form of one-hour activity sessions for parents and children held once a week for 10 weeks. The investigators will assess lifestyle-related habits before, immediately after the completion the intervention, at 6 months and one year after the intervention. Created for this purpose, a novel measuring tool for connectedness to nature, Nature Relatedness Scale (NRS), will be validated and tested for reliability prior to the RTC. The results of RCT are intended to be used to understand which components of the intervention were most effective. The objectives of this project will be achieved over a 36-month period, and it is expected to contribute to a close examination of key components of successful healthy lifestyle promotion programme during early childhood. The investigators predict that is that the new element CN will significantly improve the intervention. Finally, the overall aim is that connecting families to nature will result in sustainable lifestyle changes that remain with them for a lifetime.
Detailed description
Proper nutrition and physical activity are essential for a healthy life. Time spent in nature has also been proven beneficial. Systematic reviews have shown that nature-related activities enhance general well-being as reflected in increased physical activity, a healthier diet, reduced stress and better sleep. However, existing programmes promoting healthy lifestyles in children focus almost exclusively on diet and physical activity. None, to the inestigators's awareness, taken into consideration interactions, or connectedness with nature. Connectedness to nature/nature relatedness is a relatively new concept that, to date, has been investigated primarily in adults.The concept suggests, for example, that engaging in activities in a natural environment can induce a feeling of connectedness to nature. Exposing preschool children to nature and to thinking about nature in different ways could stimulate nature relatedness as a measurable construct. When children are placed in a natural setting, they are more likely to be physically active. Natuxral products such as fruits and vegetables are widely acknowledged to improve health. As noted above, parents are children's role models, and the investigators therefore believe that connecting parents with nature will have benefits for their children. Many habits and attitudes are developed early in life, and those related to the natural world are no exception. In fact, children are inherently interested in their environment and in nature in general. The hypothesis is that both indoor and outdoor nature-related activities may induce connectedness and bring about positive changes in both eating and activity habits (short-term outcomes) in preschool children, in turn leading to a healthier lifestyle (long-term outcomes).The aim of P\&G is to encourage healthy eating habits and active play in children from an early age, and to bring about healthy behavioural changes in families. The programme also includes a CN element designed to equip parents with environmental knowledge and skills. The generated re- and post-test comparison data indicated the effectiveness of the programme (not presented here). A detailed manual and full resource kit were created, and each session consisted of: (i) a 15-minute theoretical education component (food, activity, CN), and (ii) a 30-minute component on indoor and outdoor nature-related activities, such as playing with nature objects and searching for natural treasures. Some nature activities were food-related (e.g. growing plants, creating miniature indoor gardens, and healthy cooking). The control group received an information folder containing government-recommended physical activity and dietary guidelines for children. To enhance participation, the sessions were scheduled for weekends. The outcome data was collected using a number of scales and questionnaires addressed eating, active play and nature-related habits before and after the program, and focus group discussions were held at the beginning and end of the programme. The programme proved popular amongst participants and the results demonstrated significant positive changes on number of health-related outcomes, such as food habits and caregiver physical activity levels.
Study design
- Primary purpose
- Prevention
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- None (open label)
- Number of arms
- 2
| Arm | Type | Receives |
|---|---|---|
| Intervention group | Experimental | Other: Healthy lifestyleThe group will receive healthy lifestyle intervention |
| control group | Active comparator | Other: physical activity and dietary guidelinesOther: physical activity and dietary guidelines |
Who may qualify
- Ages
- 2 to 6 years
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child
Key inclusion criteria (2 listed)
- 2-4 year old children
- With English-speaking parents
Key exclusion criteria (2 listed)
- Children with chronic health conditions
- Families who have recently taken part in a healthy lifestyle promotion programme
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Healthy lifestyleThe families will receive a designed for these purposes intervention | Other | Intervention group |
| physical activity and dietary guidelinesThe families will receive a designed for these purposes intervention | Other | control group |
Primary outcome
Eating habits
Time frame: 3 years
A short validated Eating and Physical Activity Questionnaire (EPAQ)
Physical activity
Time frame: 3 years
Physical Activity Questionnaire for Preschool-aged Children (Pre-PAQ®)
Nature relatedness
Time frame: 3 years
a short, age-adjusted NRS scale
5 secondary outcomes
Parental knowledge of nutrition
Time frame: 3 years
Parental feeding behaviours
Time frame: 3 years
weight
Time frame: 3 years
height
Time frame: 3 years
child neophobia
Time frame: 3 years
Results and safety
Results are not available in the source record.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 27 Aug 2018.
- Background: PubMed 24198806Nisbet EK, Zelenski JM. The NR-6: a new brief measure of nature relatedness. Front Psychol. 2013 Nov 1;4:813. doi: 10.3389/fpsyg.2013.00813. eCollection 2013.
- Background: PubMed 18852701Cleland V, Crawford D, Baur LA, Hume C, Timperio A, Salmon J. A prospective examination of children's time spent outdoors, objectively measured physical activity and overweight. Int J Obes (Lond). 2008 Nov;32(11):1685-93. doi: 10.1038/ijo.2008.171. Epub 2008 Oct 14.
- Background: PubMed 17956885Dyment JE, Bell AC. Grounds for movement: green school grounds as sites for promoting physical activity. Health Educ Res. 2008 Dec;23(6):952-62. doi: 10.1093/her/cym059. Epub 2007 Oct 22.
- Background: PubMed 19000844Bell JF, Wilson JS, Liu GC. Neighborhood greenness and 2-year changes in body mass index of children and youth. Am J Prev Med. 2008 Dec;35(6):547-53. doi: 10.1016/j.amepre.2008.07.006.
- BackgroundVeselinovska SS, Osogovska TL: Engagement of Students in Environmental Activities in School. Procedia - Social and Behavioral Sciences 2012, 46:5015-5020.
- BackgroundBarratt Hacking E, Barratt R, Scott W: Engaging children: research issues around participation and environmental learning. Environmental Education Research 2007, 13:529-544.
- BackgroundMullis F: Active parenting: an evaluation of two Adlerian parent education programs. Journal of Individual Psychology 1999, 55:225-232.
- BackgroundLiefländer AK, Fröhlich G, Bogner FX, Schultz PW: Promoting connectedness with nature through environmental education. Environmental Education Research 2013, 19(3):370-384
- BackgroundCutter-Mackenzie A, Edwards S: Toward a Model for Early Childhood Environmental Education: Foregrounding, Developing, and Connecting Knowledge Through Play-Based Learning. The Journal of Environmental Education 2013, 44(3):195-213.
- BackgroundThe Biophilia Hypothesis [http://books.google.com/books?hl=nl&lr=&id=qOg3-J0BoGoC&pgis=1]
- Derived from this study: PubMed 32615145Sobko T, Brown GTL, Cheng WHG. Does connectedness to nature improve the eating behaviours of pre-schoolers? Emerging evidence from the Play&Grow randomised controlled trial in Hong Kong. Appetite. 2020 Nov 1;154:104781. doi: 10.1016/j.appet.2020.104781. Epub 2020 Jun 30.
- Derived from this study: PubMed 30496300Sobko T, Jia Z, Brown G. Measuring connectedness to nature in preschool children in an urban setting and its relation to psychological functioning. PLoS One. 2018 Nov 29;13(11):e0207057. doi: 10.1371/journal.pone.0207057. eCollection 2018.
- Programme promotion videoLink provided by the sponsor.
- Individual participant dataSharing planned: No. Hong Kong Ethics Committee
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Tanja sobko principal investigator
The University of Hong Kong
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Healthy lifestyle and physical activity and dietary guidelines in people with Sedentary Lifestyle and Overweight, run by The University of Hong Kong at 1 site in Hong Kong.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: status not confirmed, as of the sponsor's last update on 27 Aug 2018. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Hong Kong. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
Results are not available in the source record.
How can a doctor refer a patient or contact the research team?
Contact Tanja Sobko, PhD (+85251816160, tanja.sobko@gmail.com), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Eating habits (time frame: 3 years). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
On the ClinicalTrials.gov record for NCT02715544, which also lists 13 linked publications.
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 27 Aug 2018.