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Play is an essential part of childhood, and growing attention has focused on the potential health benefits of 'risky' or 'thrill-seeking' play. Such play behavior is readily observed on any playground, where it can sometimes lead to injuries--most often from fall impacts--that require medical attention. Monkey bars account for ~7% of childhood arm fractures in the USA, an alarming statistic that raises difficult questions over its costs and benefits. Many authors view monkey bars as a public health hazard, but it is plausible that our childhood impulse toward thrill-seeking play is a result of selective pressures throughout our primate evolutionary history. Indeed, emerging evidence suggests that the developmental benefits of thrill-seeking play extend into adulthood, outweighing the occasional costs of injury. Disparate and consequential, these dueling perspectives have fueled debate among health professionals and policymakers, but with little attention to the work of biological anthropologists. Here we call attention to the hominin fossil record and play behaviors of non-human primates, providing a novel perspective that bolsters arguments for the adaptive significance of thrill-seeking play. The moment for such a review is timely, for it commemorates the centennial anniversaries of two playground icons: the jungle gym and monkey bars.

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Heavy metals pose significant threats to human health, particularly children. This study aimed to assess heavy metal pollution in children's playgrounds using surface dust as an indicator and to ascertain the associated exposure levels and health risks. A total of one hundred twenty dust samples were collected from the surface of playground toys in areas surrounding the cement factory in Bursa, Türkiye, on precipitation-free days. The heavy metal content of the samples was analyzed using ICP-MS. The average total concentration of heavy metals ranged from 2401 to 6832 mg/kg across the sampling sites, with the highest values observed at PG4, PG3, PG2, and PG1, respectively. The most commonly detected heavy metals in the samples included Cr, Mn, Fe, Co, Cu, Zn, Pb, Cd, As, and Ni. Statistical analysis revealed significant positive correlations (p < 0.01) among Cr, Mn, Fe, Co, Cu, Pb, As, and Ni, with Cu and Pb also showing correlation (p < 0.05). PCA analysis identified three principal components explaining 79.905% of the total variance. The Hazard Quotient (HQ) and Hazard Index values for heavy metals were found to be below the safe threshold (HQ < 1). Quantitative techniques such as the geoaccumulation index and enrichment factor are used to determine pollution levels at the sampling sites. Overall, the results indicate that cement factories significantly contribute to heavy metal pollution, with observed values varying based on proximity to the emission source.

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Staphylococcus aureus is one of the most important human pathogenic bacteria and environmental surfaces play an important role in the spread of the bacterium. Presence of S. aureus on children's playgrounds and on toys was described in international studies, however, little is known about the prevalence and characteristics of S. aureus at playgrounds in Europe. In this study, 355 samples were collected from playgrounds from 16 cities in Hungary. Antibiotic susceptibility of the isolates was tested for nine antibiotics. Presence of virulence factors was detected by PCR. Clonal diversity of the isolates was tested by PFGE and MLST. The overall prevalence of S. aureus was 2.81% (10/355) and no MRSA isolates were found. Presence of spa (10), fnbA (10), fnbB (5), icaA (8), cna (7), sea (2), hla (10), hlb (2) and hlg (6) virulence genes were detected. The isolates had diverse PFGE pulsotypes. With MLST, we have detected isolates belonging to ST8 (CC8), ST22 (CC22), ST944 and ST182 (CC182), ST398 (CC398), ST6609 (CC45), ST3029 and ST2816. We have identified a new sequence type, ST6609 of CC45. S. aureus isolates are present on Hungarian playgrounds, especially on plastic surfaces. The isolates were clonally diverse and showed resistance to commonly used antibiotics. These data reinforce the importance of the outdoor environment in the spread for S. aureus in the community.

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BACKGROUND: There is ample evidence that most children do not perform enough physical activity (PA). To address this major public health problem, the French government implemented 30 minutes of daily PA (DPA) at schools but did not provide any supplemental resources or concrete guidance. Considering both children's interest in video games and the need for teachers to complete their curriculum, the use of a learning-based exergame that combines PA and learning appears particularly relevant. OBJECTIVE: The first objective of this study was to evaluate the feasibility of implementing 30 minutes of DPA through exergaming among school-age children. The second objective was to examine the effects of an exergaming program on physical literacy, academic learning, and soft skills (motivation, self-efficacy, and concentration). METHODS: This interventional study had a pre-post design and used the Play LÜ exergame platform. The study included 79 children with a mean age of 8.9 (SD 1.2) years from grade 2 (7 years old) to grade 5 (11 years old). Play LÜ requires players to throw balls against a wall to reach a target or to activate an object and provides an interactive game area for educational activities linked to specific learning themes. After a 4-session familiarization phase during which the teachers chose to prioritize mathematics learning in 30-minute DPA sessions, students took part in DPA sessions over a period of 3 weeks with Play LÜ and a motor skills circuit behind the LÜ setup to keep them continuously active. All sessions were carried out by PA specialists. Each session started with a warm-up using the Grööve application, continued with main activities promoting mathematics learning adapted to each grade level, and ended with a 3-minute meditation for returning to a calm and serene state using the Gaïa application. Before (T0) and after (T1) the program, students completed a self-evaluation booklet to assess their levels of physical literacy, academic performance, and soft skills. RESULTS: The implementation of this exergaming program was welcomed by the school's administration, teaching staff, and parents. After the program, we observed increased scores for physical literacy (difference +2.6, percentage change +3.6%; W=933.0; P=.002; rrb=-0.39, 95% CI -0.58 to -0.16) and motivation in mathematics (+0.7, +9.8%; W=381.5; P=.005; rrb=-0.44, 95% CI -0.66 to -0.16). In addition, it is important to note that some measures progressed differently across learning levels and age groups. CONCLUSIONS: The study results indicate positive impacts of learning-based exergaming on physical literacy and motivation in mathematics among school-age children.

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OBJECTIVE: Unintentional injury is the leading cause of death to children worldwide, and playgrounds pose a significant risk of injury. Those aged 5 and 6 years are particularly vulnerable to playground injuries. Previous interventions have typically targeted environmental modifications or increased supervision to reduce playground injuries; however, minimal research has focused on implementing behavioral interventions that seek to change children's safety knowledge and risk-taking behaviors on the playground. The current randomized trial addressed these gaps in the literature and sought to increase preschool children's hazard awareness skills and knowledge of unsafe playground behaviors and decrease their intentions to engage in risk-taking behaviors on the playground. METHOD: A total of 77 children aged 5 and 6 years were tested at a laboratory on a university campus, using a parallel group design, with 38 randomized to the playground intervention group and 39 randomly assigned to a control group. The intervention was manualized and delivered to small groups of children (3-5) over several sessions. RESULTS: Statistical analyses revealed significant group differences. Intervention experience led to significant increases in hazard awareness skills and knowledge of unsafe playground behaviors, and significant decreases in children's risk-taking behavioral intentions, whereas those in the control group showed no significant changes in these scores. Attention scores for those in the intervention group highlighted that the program content was successful in maintaining children's attention and engagement, and memory scores indicated excellent retention of lesson content. CONCLUSION: The program shows promise in addressing the issue of unintentional playground injuries in young children.

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BACKGROUND: Outdoor social participation in the school playground is crucial for children's socio-emotional and cognitive development. Yet, many children with disabilities in mainstream educational settings are not socially included within their peer group. We examined whether loose-parts-play (LPP), a common and cost-effective intervention that changes the playground play environment to enhance child-led free play, can promote social participation for children with and without disabilities. METHOD: Forty-two primary school children, out of whom three had hearing loss or autism, were assessed for two baseline and four intervention sessions. We applied a mixed-method design, combining advanced sensors methodology, observations, peer nominations, self-reports, qualitative field notes and an interview with the playground teachers. RESULTS: Findings indicated for all children a decrease during the intervention in social interactions and social play and no change in network centrality. Children without disabilities displayed also an increase in solitude play and in the diversity of interacting partners. Enjoyment of LPP was high for all children, yet children with disabilities did not benefit socially from the intervention and became even more isolated compared with baseline level. CONCLUSIONS: Social participation in the schoolyard of children with and without disabilities did not improve during LPP in a mainstream setting. Findings emphasize the need to consider the social needs of children with disabilities when designing playground interventions and to re-think about LPP philosophy and practices to adapt them to inclusive settings and goals.

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Childhood obesity is highly prevalent among certain populations of New York. This cross-sectional pilot study examined the associations between parental attitudes about outdoor activities and body mass index (BMI). A questionnaire was distributed among parents of 1 to 13 aged children at ambulatory pediatric clinics. Of 104 children included in the study 57 were of normal weight and 47 were overweight or obese. Most parents of children with BMI <85% reported frequent playground utilization, considered longer hours to spend outside on weekdays, reported a larger total temperature range for outdoor playground utilization and a lower tolerable minimum temperature compared to parents of children with BMI ≥85%, p < .05. Only having a parent born outside of the United States remained a significant predictor of overweight and obesity in the final model. Parents of children with BMI < 85% are more willing to spend time outdoors, regardless of weather. Immigrant parents are protective against overweight.

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Reports of children's play-related injuries have remained stagnant according to epidemiology studies of the past 3 decades. This article provides a unique look into the context of playground injuries within an entire school district, demonstrating the prevalence of these injuries. This study reports that playgrounds are the leading location of school injury, comprising one-third of all elementary school injuries. This study found that while head/neck injuries were the most commonly injured body region within the playground environment, the proportion of head/neck injuries decreased with age, whereas the proportion of extremity injuries increased with age. At least 1 upper extremity injury required outside medical attention for every 4 that were treated on-site, making upper extremity injuries roughly twice as likely to require outside medical attention as injuries to other body regions. The data in this study are useful for interpreting injury patterns in the context and evaluation of existing safety standards for playgrounds.

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Investment in outdoor parks is proposed as a promising large-scale strategy to promote physical activity (PA). This study aimed to systematically review the impact of park renovations or installing new ones in increasing PA. Searches were conducted using predefined terms in three databases (PubMed, Scopus, and Web of Science) in March 2022. Studies examining the effectiveness of park renovations or developing new ones in increasing PA and having control or comparison were eligible for inclusion. Study quality was assessed using the Quality Assessment Tool for Quantitative Studies. Data were extracted from the included records using a predefined extraction table. The database search yielded 959 records, and 26 were included. For park renovations (n = 17), 11 (65%) studies presented findings supporting a positive effect on PA. The other six (35%) studies found no PA benefits when compared to control or pre-renovations/improvement levels. Regarding new installations (n = 9), five (56%) studies presented improvements in PA, and four (44%) did not. A promising positive impact of park renovations and new installations on park use and PA was observed. The review findings reflect the need to understand the context, daily routines, and interests of the surrounding population before renovating or installing new outdoor parks.

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Brisk walking is a simple exercise for older adults. We aimed to assess the cardiovascular response to a short bout of brisk walking on walking loops in an innovative senior playground in Thailand. Twenty older adults were randomly assigned to brisk walking on artificial turf (AT group, n = 10) or an uneven surface (US group, n = 10). We assessed cardiovascular parameters, average walking speed, and rate of perceived exertion. Blood pressure, heart rate, rate-pressure product, and rate perceived exertion were significantly increased, while the mean RR interval of heart rate variability was significantly decreased in both AT and US groups after exercise compared with pre-exercise (p < 0.05). A greater change in systolic blood pressure was observed in the US group than in the AT group (p < 0.05). These data indicated that brisk walking on AT and US increases cardiovascular response. Our findings provide information on planning exercise programs for older adults.

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BACKGROUND: Preschool children are not meeting recommended levels of physical activity (PA) nor are they proficient in fundamental motor skills (FMS), which are the foundation for PA. As such, interventions are needed to increase PA and FMS in young children. This trial examined the effects of an environmental ("painted playgrounds") and capacity-building (written toolkit) intervention on child FMS, PA, and sedentary behavior at early childhood education (ECE) centers and examined feasibility. METHODS: In a randomized controlled trial, four ECE centers were randomly assigned to an intervention group or wait-list control. For intervention centers, stencils were spray painted adjacent to playgrounds and teachers were provided material for using stencils for FMS practice. Follow-up assessments were conducted six to eight weeks after baseline. Time spent in PA and sedentary behavior was assessed via accelerometry and FMS were evaluated using the Test of Gross Motor Development (TGMD-3) at baseline and follow-up. A repeated measures linear model was performed to test the effects of the painted playgrounds on the primary outcomes of interest. Feasibility was measured by stencil engagement via direct observation and satisfaction surveys. RESULTS: A total of 51 preschoolers completed baseline assessments (4.3±0.6 years; 43.1% male). There were no significant changes in PA or sedentary behavior (all confidence intervals contain 0) between control and intervention groups. Intervention children significantly improved ball skill, locomotor, and overall TGMD-3 percentile scores at follow-up (all (all confidence intervals contain 0), which was not observed in control group. However, there was no significant change in FMS between the control and intervention groups (confidence intervals contain 0). For stencil use, boys and girls interacted with different stencils during their free play. Directors and teachers reported children incorporated academic concepts and initiated games, and teachers prompted more PA opportunities on the playground. CONCLUSIONS: This intervention did not show statistically significant changes in children's PA, FMS, or sedentary behavior compared to a control group; however, small FMS improvements for the intervention group were found from baseline to follow-up. Further work should examine intervention fidelity as well as inexpensive supplies, teacher training, or other strategies to increase preschool children's PA and improve FMS at ECE centers.

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Every child, irrespective of socioeconomic status, ethnicity, or ability, deserves the fundamental right to experience play, which is a powerful and enriching activity that fosters their physical and mental health. Regrettably, most public play spaces hinder the complete inclusion of children with disabilities, with the main reason being a lack of universal accessibility. This study identified existing international and Canadian policies and community best practices related to inclusive playgrounds, and gathered stakeholders' opinions on the present condition of playgrounds, including challenges faced by children with disabilities and recommendations to make playgrounds inclusive. The questionnaires were completed by 97 participants. In addition, 10 individual interviews and three focus groups were performed. Ten policy documents and five community best practices were found. Our investigation identified factors that influence the design and implementation of inclusive playgrounds, categorized into three main areas: physical, social, and political environments. The results indicate that children with disabilities lack opportunities to engage fully in the physical and social aspects of playgrounds and spontaneous play activities with their peers. Notably, children with multiple disabilities may not feel welcomed or included in existing public play spaces.

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INTRODUCTION: Injuries are a major public health concern and one of the leading causes of death and disability worldwide. Childhood injuries contribute to a major proportion of this burden. OBJECTIVE: To identify injury hazards within school premises and playgrounds in Karachi, Pakistan. METHODS: This observational cross-sectional study took place in 107 public and private schools of Karachi, Pakistan using a self-structured standard injury risk assessment tool. This tool was developed after an extensive literature review, expert consultation, and field visits to a few local schools. Data related to school demographics, administrative data and injury hazards within the school boundaries were collected in schools offering education from nursery to secondary grades (through 10th grade, matriculation). Descriptive analysis were calculated. RESULTS: Out of 107 schools, only 12 were recording school-related injuries. A quarter (25%) of schools had some type of disaster drill exercises and built-in fire exits. Fire alarms were placed in 10 schools (9%), all of which were private. In 16 schools (15%), students had access to rooftop doors. There were multiple injury hazards in the school playgrounds. More than half of the schools had hazardous playground surfaces, such as slippery, concrete and uneven ground. Over 80% of schools were not supervising the children during playtime and did not have a separate play area for children under 6 years old. In 38 schools (22%), there were multiple injury hazards in the play rides, such as broken equipment, rusted parts, and sharp edges. Moreover, nine schools (7%) had loose nuts, bolts, edges, belts, steps, or rails in their play rides. Inside, almost a quarter (24%, n = 76) of schools did not have proper insulation of electric wires. Protruded metal nails, which could be high risk for prick and cut injuries, were observed in 20% of the observed furniture. CONCLUSION: In conclusion, there are multiple injury hazards in the private and public schools of Karachi, Pakistan.

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Social connectedness at school is crucial to children's development, yet very little is known about the way it has been affected by school closures during COVID-19 pandemic. We compared pre-post lockdown levels of social connectedness at a school playground in forty-three primary school-aged children, using wearable sensors, observations, peer nominations and self-reports. Upon school reopening, findings from sensors and peer nominations indicated increases in children's interaction time, network diversity and network centrality. Group observations indicated a decrease in no-play social interactions and an increase in children's involvement in social play. Explorative analyses did not reveal relations between changes in peer connectedness and pre-lockdown levels of peer connectedness or social contact during the lockdown period. Findings pointed at the role of recess in contributing to children's social well-being and the importance of attending to their social needs upon reopening.

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BACKGROUND: Unintentional injuries are a leading cause of children's hospitalisations and death globally and are thus a pressing public health concern. Fortunately, they are largely preventable, and understanding children's perspectives on safe and dangerous outdoor play can help educators and researchers identify ways to mitigate the likelihood of their occurrence. Problematically, children's perspectives are rarely included in injury prevention scholarship. In this study, we acknowledge children's right to have their voices heard by exploring the perspectives on safe and dangerous play and injury of 13 children in Metro Vancouver, Canada. METHODS: We employed tenets of risk and sociocultural theory and a child-centred community-based participatory research approach to injury prevention. We conducted unstructured interviews with children aged 9-13 years old. RESULTS: Through our thematic analysis, we identified two themes: (1) 'little' and 'big' injuries and (2) risk and danger. CONCLUSION: Our results suggest children differentiate between 'little' and 'big' injuries by reflecting on the potential loss of opportunities for play with friends. Further, they suggest children avoid play they perceive as dangerous, but enjoy 'risk-seeking' because it is thrilling and provides them with opportunities to push their physical and mental capabilities. Child educators and injury prevention researchers can use our findings to inform their communications with children and make play spaces more accessible to, fun and safe for children.

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Developing physical fitness (PF) behaviors early in life enhances physical development and facilitates sustained participation in physical activity and sports across childhood. This study addressed the effect of different teaching approaches on precursors of PF in kindergarten children. A total of 178 children (5.45 ± 0.40 years, female = 92) from 11 classes were organized into three groups. Group 1 (structured activity + free play) and Group 2 (only free play) attended the same playground (PrimoSport0246) for one hour/week for 10 weeks. Group 3 (structured activity + free play in kindergarten) followed their standard physical education curriculum at school. PF tests (standing long jump, medicine ball throw, and 20 m running speed) were administered pre- and post-intervention. Factorial ANOVA was implemented using a percentage change in PF performance (PFC) as the dependent variable, and teaching approaches, gender, and age as factors. Group 1 demonstrated significant improvements in fitness performance compared with Groups 2 and 3. Moderate to large effect sizes (Cohen's d range: 0.68-1.40) were noted in both males and females. Six-year-old demonstrated the greatest improvement in composite PFC compared to Groups 2 and 3. A structured teaching plan, even with a limited dose of once per week, supported the development of PF attributes in kindergarteners.

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Introduction: Children with disabilities may be unable engage playground spaces due to barriers exacerbating exclusion. Therefore, clarity on how to evaluate existing playgrounds for inclusivity of children with disabilities is required. Methods: A scoping review was undertaken to explore auditing tools. Results: Fourteen white and grey literature resources were identified. The term "inclusion" was operationalized differently across tools, primarily focusing on physical accessibility. Characteristics of the tools were synthesized into 13 inclusive design recommendations for playgrounds. Two tools showed promise, evaluating 12/13 recommendations. Discussion: The results of this review provide guidance on existing tools for evaluating playgrounds for inclusion for community stakeholders and researchers. Systematic Review Registration: https://osf.io/rycmj.

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For children, playgrounds are important environments. However, children's perspectives are often not acknowledged in playground provision, design, and evaluation. This scoping review aimed to summarize the users' (children with and without disabilities) perspectives on environmental qualities that enhance their play experiences in community playgrounds. Published peer-reviewed studies were systematically searched in seven databases from disciplines of architecture, education, health, and social sciences; 2905 studies were screened, and the last search was performed in January 2023. Included studies (N = 51) were charted, and a qualitative content analysis was conducted. Five themes were formed which provided insights into how both physical and social environmental qualities combined provide for maximum play value in outdoor play experiences. These multifaceted play experiences included the desire for fun, challenge, and intense play, the wish to self-direct play, and the value of playing alone as well as with known people and animals. Fundamentally, children wished for playgrounds to be children's places that were welcoming, safe, and aesthetically pleasing. The results are discussed in respect to social, physical, and atmospheric environmental affordances and the adult's role in playground provision. This scoping review represents the valuable insights of children regardless of abilities and informs about how to maximise outdoor play experiences for all children.

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School recess is a daily opportunity for school-age students to be physically active. However, in some territories teachers often use recess for other purposes (e.g., children's poor classroom behavior might be punished with reduced time for recess). This study aimed to examine the impact of such practices on children's physical activity (PA) and the relationships between PA, gender, body mass index (BMI), and academic achievement. Forty-six first-grade students from two natural classrooms wore an accelerometer over the course of 6 weeks to measure their metabolic equivalent of task (METs) and sedentary behavior during school recess. Gender, age, BMI, the classroom to which students belonged, and academic achievement were also analyzed in two Generalized Estimating Equations models. Results revealed that boys achieved more METs and spent less time participating in sedentary behavior than girls during recess. Children within a healthy weight range of BMI yielded more METs than underweight and overweight/obese children. Academic achievement was positively associated with the METS and negatively with the sedentary behavior. Finally, withholding all or part of school recess significantly reduced children's PA and extended their sedentary behavior. The literature indicates that school recess plays an important role in promoting numerous children's health outcomes. Therefore, students should not be excluded from participation in all or part of recess.