ArticleBMJ open2026
Can an active outdoor living initiative in kindergartens in two disadvantaged neighbourhoods increase physical activity among children? Findings from a within-subject design of the Happy Healthy Active Children initiative.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo investigate whether the Happy Healthy Active Children (HHAC) initiative increased children's time spent in different physical activity (PA) intensities in kindergartens located in disadvantaged neighbourhoods.
designA within-subject design, nested within the HHAC initiative, with children acting as their own controls.
settingSeven kindergartens in the adjacent disadvantaged neighbourhoods of Tingbjerg and Husum located in Copenhagen, Denmark.
participantsChildren aged 3-5 years attending participating kindergartens. A total of n=51 children provided valid accelerometer data from at least one HHAC activity day and one regular kindergarten day.
interventionHHAC is a partnership-based initiative promoting active outdoor living through co-created activities centred around play, nature and cooking. In the kindergarten setting, activities were implemented one day per week over 10 weeks from the second half of 2023 to the first half of 2024. OUTCOME MEASURES: PA was measured using thigh-worn Axivity AX3 accelerometers over two 10-day periods during the initiative. Time spent in moderate-to-vigorous PA (MVPA), light PA and sedentary behaviour (SB) was compared between HHAC activity days and regular kindergarten days.
resultsCompared with regular days, children spent significantly more time in MVPA (8.6 min, p=0.002) and significantly less time in SB (9.2 min, p=0.007) on HHAC activity days. Play activity days showed the largest effects, with increased time spent in MVPA (13.2 min, p=0.002) and significantly less time spent in SB (19.2 min, p<0.001). No significant differences were observed for nature or cooking activities.
conclusionThe HHAC initiative, particularly its play-based activities, increased MVPA and reduced SB among children in kindergartens located in disadvantaged neighbourhoods.
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