Brian W Timmons

• PhD
• Professor at McMaster University

Background While exercise training and metformin treatment have demonstrated preliminary cognitive improvements in pediatric brain tumor (PBT) survivors, the neuronal mechanisms underlying their cognitive improvements are unclear. Diffusion‐weighted metrics (e.g., fractional anisotropy [FA]) are commonly used to evaluate remyelination, but magnetiz...

Objective: (1) develop and test a novel, open-source, supervised machine learning model to detect toddlers’ physical activity (PA) and sedentary time (SED); (2) compare this novel machine learning model to existing cut-point methods to analyse toddlers’ PA (independent sample cross-validation of existing methods). Methods: We recruited 111 healthy...

Purpose: Developmental Coordination Disorder (DCD) is a common neurodevelopmental disorder characterized by motor impairments and subsequent physical activity (PA) deficits in middle childhood. It is not well understood when this gap in PA emerges. The purpose of the current study was to examine the longitudinal trajectories of device-assessed PA i...

Improving cognitive sequelae in children treated for brain tumours (CTBT) requires accessible interventions. While instructor-led exercise in a hospital setting is efficacious, it is not extended to communities. Objectives We aimed to (i) develop a website with educational resources/tools for community health and fitness professionals (HFP) to del...

Background Early childhood educators play a critical role in promoting physical activity and reducing sedentary time in childcare centres. However, early childhood educators receive limited specialised pre- and in-service learning opportunities relating to these behaviours and may lack the capacity to effectively engage children in healthy movement...

BACKGROUND Exercise training and metformin treatment may improve cognition after cranial irradiation in pediatric brain tumors (PBT), but the neuronal mechanisms underlying the effect of these interventions remains unknown. Magnetization transfer imaging (MTI) is an imaging technique that may be sensitive to white matter microstructure – including...

Background Recent scientific evidence has challenged the traditional “rest-is-best” approach for concussion management. It is now thought that “exercise-is-medicine” for concussion, owing to dozens of studies which demonstrate that sub-maximal, graded aerobic exercise can reduce symptom burden and time to symptom resolution. However, the primary ne...

Background Recent scientific evidence has challenged the traditional “rest-is-best” approach for concussion management. It is now thought that “exercise-is-medicine” for concussion, owing to dozens of studies which demonstrate that sub-maximal, graded aerobic exercise can reduce symptom burden and time to symptom resolution. However, the primary ne...

Purpose: The purpose of this study was to compare the gross motor skills of children with a chronic physical illness with those of their healthy peers. Methods: Data for children with a chronic physical illness come from the Multimorbidity in Children and Youth Across the Life Course study, and data from children without a physical illness come...

Background Inflammatory bowel disease (IBD) poses significant challenges to pediatric patients, affecting their physical and psychological well-being. Physical activity can be an essential component of managing IBD, yet its adoption among this population remains suboptimal. Understanding the factors that influence physical activity levels in youth...

BACKGROUND Our research team developed evidence-based Return to Activity and Return to School protocols for youths with concussion which are based on the Sports Concussion Consensus statements and the main management strategy for concussion recovery. OBJECTIVE It is important to determine if youth with concussion adhere to these protocols before e...

Background Concussion, or mild traumatic brain injury, is a growing public health concern, affecting approximately 1.2% of the population annually. Among children aged 1‐17 years, concussion had the highest weighted prevalence compared to other injury types, highlighting the importance of addressing this issue among the youth population. Objective...

Objectives Reliable measurements of health‐related fitness—cardiorespiratory endurance, muscular endurance, muscular strength, body composition, and flexibility—are imperative for understanding and tracking health‐related fitness from the preschool age. This study aimed to examine the test–retest reliability of field‐based (i.e., sit and reach [sta...

Background While exercise training (ET) programs show positive outcomes in cognition, motor function, and physical fitness in pediatric brain tumor (PBT) survivors, little is known about the optimal timing of intervention. The aim of this work was to explore the feasibility and benefits of ET based on its timing after radiotherapy. Methods This re...

Purpose: Concussion management is shifting away from a rest-is-best approach, as data now suggest that exercise-is-medicine for this mild brain injury. Despite this, we have limited data on habitual physical activity following concussion. Therefore, our objective was to quantify accelerometer-measured physical activity and sedentary time in childr...

Background: Inflammatory bowel disease (IBD) is a chronic, systemic condition affecting the gastrointestinal tract. IBD can be severe and are associated with impairment in growth, school absences, abdominal pain, and fatigue. Physical activity (PA) could have an anti-inflammatory effect in addition to other benefits. It is important to address the...

Background: Children with inflammatory bowel disease (IBD) experience extraintestinal side effects including altered body composition, impaired muscle strength, and aerobic capacity. Exercise training may remedy these issues. Purpose: To assess the feasibility, safety, participant satisfaction, and efficacy of a training program for youth with I...

BACKGROUND It is crucial to develop effective and accessible interventions to improve cognitive sequelae in children treated for brain tumours (CTBT), as their impact on functional outcomes is significant. Instructor-led exercise training in a hospital setting is safe, feasible and efficacious to promote cognitive improvements in patients, however,...

Background: Recent work has shown that individuals with chronic health conditions and disabilities (CCD) meet the 24-h movement guidelines at lower rates than population norms; however, the evidence base remains limited across different stages of the lifespan and very few studies have examined associations with mental health outcomes. Objective:...

Abstract Pediatric concussion has a rising incidence and can lead to long-term symptoms in nearly 30% of children. Resting state functional magnetic resonance imaging (rs-fMRI) disturbances are a common pathological feature of pediatric concussion, though no studies have explicitly examined sex-differences with respect to this outcome, precluding a...

Introduction/purpose: To determine personal, environmental, and participation factors that predict children's physical activity (PA) trajectories from preschool through to school years. Methods: 279 children (4.5 ± 0.9 years old, 52% boys) were included in this study. PA was collected via accelerometry at 6 different timepoints over 6.3 ± 0.6 ye...

Children with physical illnesses often experience co-occurring mental illness (known as multimorbidity; MM) and it is currently unknown if MM is associated with physical activity (PA) and if the association differs between internalizing and externalizing disorders. Therefore, the aim of this study was to examine the association between MM and PA. B...

Background: Children with inflammatory bowel disease (IBD) experience extra-intestinal side effects including altered body composition, impaired muscle strength and aerobic capacity. Exercise training may remedy these issues. Purpose: To assess the feasibility, safety, participant satisfaction and efficacy of a training program for youth with IBD....

Little is known about how wake-time movement behaviour compositions while in childcare relate to children's health and development. This study aimed to use compositional analysis to examine how childcare movement behaviour compositions were associated with standardised body mass index (zBMI) and physical and psychosocial functioning among children...

Background The measurement of physical fitness has a history that dates back nearly 200 years. Recently, there has been an increase in international research and surveillance on physical fitness creating a need for setting international priorities that could help guide future efforts. Objective This study aimed to produce a list of the top 10 inte...

Developmental coordination disorder (DCD) is often comorbid with attention-deficit/hyperactivity disorder (ADHD). While children with DCD engage in less moderate-to-vigorous physical activity (MVPA) compared to typically developing (TD) children, research pertaining to how ADHD affects this relationship is limited. We investigated the effect of ADH...

Our objective was to explore the association between resting-state functional connectivity and accelerometer-measured physical activity in pediatric concussion. Fourteen children with concussion (aged 14.54 ± 2.39 years, 8 female) were included in this secondary data analysis of a larger study. Participants had neuroimaging at 15.3 ± 6.7 days posti...

This study measured physical activity (PA) and explored its correlates among children with multimorbidity (co-occurring chronic physical and mental illness; MM) versus those with chronic physical illness only (PI). This study used baseline data from the Multimorbidity in Children and Youth Across the Life Course (MY LIFE) study, an on-going cohort...

Purpose Increased adiposity in children confers a higher risk of cardiovascular disease in later life, with low cardiorespiratory fitness strongly linked to poorer metabolic health. Children with motor coordination problems are likely to be less physically fit and at a higher risk of obesity. In this study, we examined the associations between aero...

Background: Early childhood educators (ECEs) influence young children's early uptake of positive health behaviours in childcare settings and serve as important daytime role models. As such, it is imperative that post-secondary early childhood education programs provide students with the foundational knowledge and professional training required to...

Background Childcare-based physical activity (PA) and sedentary behavior (SB) interventions have traditionally used in-person training to supplement early childhood educators’ (ECEs) knowledge and confidence to facilitate physically active programming for the children in their care. However, this method of delivery is resource-intensive and unable...

Purpose: The associations between longitudinal physical activity (PA) patterns across childhood and physical literacy have not been studied. The purpose of this study was to identify PA trajectories from preschool to school-age, and to determine if trajectory group membership was associated with school-age physical literacy. Methods: Participant...

Background: Early childhood educators (ECEs) are the primary daytime role models for many young children, and are responsible for facilitating physical activity (PA) opportunities and minimizing sedentary behaviour (SB) in childcare. However, they have reportedly received little related education in their pre-service training. The purpose of the T...

Objective The aim of this study was to estimate the six-month prevalence of mental illness in children with chronic physical illness (multimorbidity), examine agreement between parent and child reports of multimorbidity, and identify factors associated with child multimorbidity. Method The sample included 263 children aged 2–16 years with a physic...

Background: The fitness levels of Canadian adults declined substantially between 1981 and the years 2007 to 2009, suggesting a reduction in population health. This paper updates the fitness trends of Canadians aged 20 to 69 years by extending the time period to 2017. Data and methods: The Canadian Health Measures Survey is a repeated cross-secti...

The Pediatric Collections: Sports Medicine Playbook will increase pediatric providers’ understanding of the injuries that young athletes may incur – including their history, treatment, and prevention. Each section includes a unique expert introduction and they cover such topics as the benefits of physical activity, injuries, and concerns including...

Background: Research has established beneficial associations between 24-hour movement guideline adherence and several health outcomes in typically developing (TD) children, but these relationships are poorly understood in children with neurodevelopmental disorders (NDD). This study examined (1) 24-hour movement guideline adherence, (2) the influen...

Background This study preliminarily examined the relationship between physical activity, sedentary time, and social emotional functioning in children aged 4–6 years. Methods Eighty children attending kindergarden classes in Ottawa, Canada wore Actical accelerometers for 1-week to directly assess their physical activity and sedentary time. Physical...

Background: Sedentary lifestyle morbidities are common among children with congenital heart disease (CHD). Understanding the physical activity trajectory from early childhood could enhance intervention timing/effectiveness. Methods: 154 children (56% male) were recruited at 12-47 months of age for this prospective, longitudinal, observational st...

PURPOSE To explore the operationalization and measurement of sedentary behavior (SB) in individuals with cerebral palsy (CP). MATERIALS AND METHODS We searched five databases from 2011 to 2020 for primary studies of experimental, qualitative, longitudinal, or observational designs measuring SB or postures typically characterized as sedentary (sitt...

Objectives To explore the association between resting state functional connectivity and accelerometer-measured physical activity in pediatric concussion. Methods Fourteen children with concussion (aged 14.54 ± 2.39 years, 8 female) were included in this secondary data-analysis. Participants had neuroimaging at 15.3 ± 6.7 days post-injury and subse...

Objectives: To characterize and quantify differences in accelerometer-measured physical activity and sedentary time between children with concussion (within the first month of injury) and 1:1 matched healthy controls. Methods: Secondary analysis of accelerometer data collected on 60 children with concussion and 60 healthy controls matched for age,...

Importance: Pediatric concussion has a rising incidence and can lead to long-term symptoms in nearly 30% of children. Resting state functional magnetic resonance imaging (rs-fMRI) disturbances are a common pathological feature of concussion, though no studies have examined sex-differences with respect to this outcome. Despite known sex-differences...

Background: The importance of daily physical activity is crucial for healthy development during the early years. Currently, a formal written physical activity policy is lacking in Canadian childcare centers, but holds promise for offering consistent physical activity opportunities. With eight recommendations, the Childcare PLAY policy is an evidenc...

Background: Moderate-to-vigorous physical activity (MVPA) offers many health benefits for preschoolers (2.5-5 y). In childcare, MVPA is predominantly accumulated outdoors, with higher rates purported among children within the first few minutes outside. The Supporting Physical Activity in the Childcare Environment intervention included shorter, mor...

Background: Research has established beneficial associations between 24-hour movement guideline adherence and several health outcomes in typically developing (TD) children, but these relationships are poorly understood in children with neurodevelopmental disorders (NDD). This study examined: (1) 24-hour movement guideline adherence; (2) the influen...

Objective: This manuscript serves to provide an overview of the methods of the Multimorbidity in Children and Youth across the Life-course (MY LIFE) study, profile sample characteristics of the cohort, and provide baseline estimates of multimorbidity to foster collaboration with clinical and research colleagues across Canada. Method: MY LIFE is...

Purpose: In girls and women, the authors studied the effects of an acute bout of low-impact, moderate-intensity exercise serum on myoblast and osteoblast proliferation in vitro. Methods: A total of 12 pre/early pubertal girls (8-10 y old) and 12 women (20-30 y old) cycled at 60% VO2max for 1 hour followed by 1-hour recovery. Blood samples were c...

The Childcare PhysicaL ActivitY (PLAY) policy was an evidence-informed, eight-item institutional-level policy document targeting children’s physical activity, outdoor play, and sedentary time. Nine childcare centers in London, Ontario, participated in this cluster, randomized controlled trial. Early Childhood Educators allocated to the experimental...

Background: Physical fitness is an important indicator of current and future health status. This analysis examines the relationships among child-parent dyads in physical fitness measures. Data and methods: The analysis is based on biological child-parent dyads from three cycles of the Canadian Health Measures Survey (Cycle 1: 2007 to 2009, Cycle...

The Physical Literacy Assessment for Youth (PLAY) Tools are a suite of tools to assess an individual’s physical literacy. The purpose of this study is to examine the psychometric properties of the PLAY Tools, including inter-rater reliability, internal consistency, validity and the associations between the tools. In this study, 218 children and you...

Educators strongly influence young children's behaviors, and their perspectives regarding physical activity (PA) and screen-viewing (SV) may influence their provision in childcare. This study gathered early childhood education (ECE) candidates' perspectives regarding: 1. the importance of their role(s) in promoting PA/reducing SV; 2. how their ECE...

It has been theorized that physical literacy is associated with physical activity and health. The purpose of this study is to investigate the associations between physical literacy and health, and if this relationship is mediated by moderate-to-vigorous physical activity (MVPA). Two hundred and twenty-two children (113 girls, 10.7 ± 1.0 years old)...

In pediatric brain tumor patients, treatment advances have increased survival rates to nearly 70%, while consequently shifting the burden of disease to long-term management. Exercise has demonstrated potential in improving multiple health impairments secondary to brain tumor treatment. However, these effects have not been consolidated through revie...

Purpose: To assess the systemic effects of an acute bout of moderate-intensity exercise on factors that are known to regulate muscle and bone growth in prepubertal girls and women. Methods: A total of 12 prepubertal girls (8-10 y) and 12 women (20-30 y) cycled at 60% maximal oxygen uptake for 1 hour followed by 1 hour recovery. Blood samples wer...

Background: Impaired metabolic flexibility (MetFlex) could contribute to ectopic fat accumulation and pathological conditions, such as type 2 diabetes. MetFlex refers to the ability to adapt substrate oxidation to availability. To the best of our knowledge, no studies have examined MetFlex under exercise conditions in children with obesity (OB) co...

Objectives: To examine if the associations between motor competence and physical activity and musculoskeletal fitness change over time, whether motor competence is associated with longitudinal trajectories of physical activity and fitness and to examine mediating pathways among these constructs across early childhood. Methods: Four hundred and e...

Objective To assess the efficacy of aerobic exercise training to improve controlled attention, information processing speed and neural communication during increasing task load and rest in pediatric brain tumor survivors (PBTS) treated with cranial radiation. Methods Participants completed visual-motor Go and Go/No-Go tasks during magnetoencephalo...

The utility of animation videos in teaching science to students has yielded mixed results, with some studies showing success in student engagement and performance, and others a lack thereof. While these discrepancies can be intrinsic to the type of video intervention, they may also be a result of the diverse learning perceptions within a given clas...

Physical literacy is becoming increasingly popular in sport, recreation, physical education and physical activity settings and programming. We developed an environmental assessment tool to evaluate the extent child and youth activity programs implement physical literacy across four domains: environment, programming, leaders and staff, and values an...

The purpose of this study was to investigate parent reports of quality of life for their very young children with congenital heart defects (CHD) and to compare their scores to previously published data. Parents of children 1–3 years old with CHD or innocent heart murmurs completed the Pediatric Quality of Life Inventory (PedsQL) core, cardiac, and...

Background: An increased prevalence of psychological and behavioral conditions has been observed in youth and adolescents with DCD. The majority of research examining the relationship between motor skill proficiency and psychological problems has focused on older children and adolescents. The aim of the present study was to examine the relationship...

Objective: Sub-maximal aerobic exercise can alleviate brain injury-related symptom burden. There is substantial data from animal studies and a growing clinical evidence base to suggest that exercise may also improve cognitive and neural outcomes following brain injury. We performed this systematic review to consolidate evidence from randomized and...

Background: Young children are prone to low levels of physical activity in childcare. This environment, inclusive of equipment, policies, and staff, has been identified as influencing young children’s activity behaviours. To date, no study has examined the feasibility and effectiveness of such policies in Canadian childcare centres, while the provi...

Introduction Multimorbidity, the co-occurrence of a chronic physical condition and mental disorder, affects a substantial number of children and youth and can lead to compromised quality of life, hardship for families, and an increased burden on the healthcare system. We are conducting a study to document the course of mental disorder in children a...

Abstract Background Accurate measurement of physical behaviour is paramount to better understand lifestyle, health, and functioning, particularly in adults with physical disability as they may be at higher risk of sedentary lifestyle and subsequent negative health consequences. This study aimed: 1) to evaluate the criterion validity of a novel and...

Children’s physical activity levels are higher at the start of outdoor playtime, which suggests that shorter, more frequent play periods might result in greater amounts of daily physical activity. In this extension of the Supporting Physical Activity in the Childcare Environment (SPACE) cluster randomized controlled trial, we explored the impact of...

Background: Physical fitness during childhood is an important indicator of current and future health. This paper provides an overview of the fitness of Canadian children and youth aged 6 to 19 years. Data and methods: Data are from three cycles of the Canadian Health Measures Survey (CHMS) spanning a 10-year period: 2007 to 2009 (n = 2,081), 200...

Purpose Developmental coordination disorder (DCD) is a prevalent, neurodevelopmental disorder affecting 2% to 5% of children, which is characterised by fine and gross motor problems. Children with DCD have been shown to be less fit and physically active than other children; however, the direction of causality is unknown as previous studies have typ...

Aim To describe active and sedentary time in children with spina bifida and to compare their physical activity on weekdays versus weekends. Method In this exploratory cross‐sectional study, data from 13 Canadian and 22 Dutch children with spina bifida (14 females, 21 males; mean age 10y 11mo, standard deviation [SD] 3y 6mo, range 5y 6mo–18y; Hoffe...

Background and aims: Cross-sectional studies suggest that arterial stiffness increases during childhood; however, this evidence stems from pressure-dependent arterial distension, while longitudinal movement of the arterial wall has not been explored. Carotid artery longitudinal wall motion (CALM) has been identified as a novel biomarker of vascula...

Objectives: Cardiovascular disease prevention should begin in childhood. However, the influence of physical activity on cardiovascular health in early childhood is unknown. Our purpose in this study was to determine the effect of physical activity on trajectories of cardiovascular health indicators during early childhood. Methods: This prospecti...

Background and aims Carotid artery longitudinal wall motion (CALM) is associated with established indicators of arterial stiffness in healthy adults and in adults with cardiovascular disease risk factors. CALM assessment may be more feasible for incorporation into routine clinical examination than traditional assessments of arterial stiffness; howe...

Purpose: This study examined whether increasing physical activity (PA) through 6 months of behavioral counseling positively influenced depressive symptoms and quality of life (QoL) over 12 months among children with epilepsy (CWE). Methods: A longitudinal multisite randomized controlled trial (RCT) was conducted with 8-14-year-old children with...

Objectives Children spend substantial time in childcare, and the reasons parents choose a particular childcare type may differ by family. However, little is known about how childcare type influences habitual (full day) activity levels among children. Therefore, exploring patterns between childcare type and habitual physical activity (PA) (i.e., lig...

Background: Studies evaluating the efficacy of anti-inflammatory treatment strategies for major depressive disorder (MDD) commonly include participants who do not demonstrate elevated concentrations of baseline inflammatory mediators, or simply fail to assess baseline inflammation. This may result in an underestimation of the efficacy of such trea...

The burden of morbidities affecting cardiovascular and musculoskeletal systems, metabolism, and psychosocial health in young patients with cancer is high. It is alarming that patients and survivors of childhood cancer are less physically active than their healthy peers, since exercise may improve many of these conditions significantly and is associ...

Aim To examine cross‐sectional differences in patterns of daily physical activity accumulation between preschool children at risk for developmental coordination disorder (DCD) compared to typically developing children. Method In total, 514 children (292 males, 222 females; 4–5y) were recruited as part of the Coordination and Activity Tracking in C...

The multidisciplinary field of pediatric traumatic brain injury (TBI) and exercise medicine is of growing importance. There is active study into the diagnostic and therapeutic potential of exercise in pediatric TBI as well as the effects of TBI on postinjury fitness. With the evidence-based growing, a literature review can help establish the state...

Background: Early childhood educators greatly influence young children's physical activity and screen-viewing behaviours in childcare. However, educators have requested additional training in physical activity programming, and one logical place to provide this education is during their pre-service schooling. This study explored the physical activi...

Objective: To compare cardiovascular health variables and physical activity levels of adolescents and adults with cerebral palsy who are Gross Motor Func-tion Classification System (GMFCS) levels I and II. Methods: Eleven adolescents (mean age 13.1 (standard deviation (SD) 2.1) years) and 14 adults (mean age 31.7 (SD 10.4) years)) with cerebral pa...

This study describes the process evaluation of the Supporting Physical Activity in the Childcare Environment (SPACE) intervention, consisting of educator physical activity training, provision of portable play equipment, and a modified outdoor schedule (i.e., 4 × 30-minute periods). Educators (N = 49) from 11 childcare centers in London, Ontario, Ca...

Many commercial ultrasound systems are now including automated analysis packages for the determination of carotid intima-media thickness (cIMT); however, details regarding their algorithms and methodology are not published. Few studies have compared their accuracy and reliability with previously established automated software, and those that have w...

Introduction: While High Intensity Interval Training is praised in many populations for its beneficial effects on body composition and cardiometabolic health, its use among obese youth remain uncertain. This study aimed at determining whether HIIT is effective to improve aerobic fitness and reduce cardiometabolic risk factors in overweight and obe...

There is growing evidence that exercise induced experience dependent plasticity may foster structural and functional recovery following brain injury. We examined the efficacy of exercise training for neural and cognitive recovery in long-term pediatric brain tumor survivors treated with radiation. We conducted a controlled clinical trial with cross...

The capacity to match carbohydrate (CHO) oxidation with CHO availability (deemed metabolic flexibility (MetFlex)) may be important for type 2 diabetes prevention. In adults, impaired MetFlex is associated with insulin resistance (IR), which can be improved with as little as 7 days of exercise. Whether this occurs similarly in children is unknown. W...

Purpose: School-age children with Developmental Coordination Disorder (DCD) have poor health-related fitness (HRF), but little is known about when these deficits emerge. The purpose of this study was to determine if 4- and 5-year old children who meet the criteria for DCD exhibit poorer HRF than typically developing (TD) children, and if this rela...

There is a high prevalence of children with obesity who are participating in sports. Appropriate nutritional considerations are important to optimize health and training adaptations. This review focuses on macronutrient recommendations and their effect on weight management and/or benefits for athletic training for children ages 5 to 18 years. Equal...

Correction: After publication of the article [1], it has been brought to our attention that an incorrect reference has been used in this article, both in the main body and additional file 2. The reference in question is #105 in the main body and #74 in additional file 2. Here it is cited as "Lindsay H, Brussoni M. Injuries and helmet use related t...

Purpose: Existing methods for diagnosing diabetes and for identifying risk of diabetes development are completed under resting conditions and based on adult data. Studying additional methods to identify metabolic risk in children is warranted. Our objective was to examine the validity and reliability of a metabolic flexibility (MetFlex) test for s...

This study examines accelerometer-based and self-report assessment of sleep disturbance from a larger prospective cohort of youth 5 to 18 years of age with postconcussive injury. Twenty-one participants with self-reported sleep disturbance were evaluated using accelerometers. Participants completed the Pittsburgh Sleep Quality Index (PSQI) every 48...

Being active offers many physical and emotional benefits contributing to a higher health-related quality of life (HRQoL); however, this relationship remains unexplored among preschoolers (aged 2.5–5 years). This study examined the impact of the Supporting Physical Activity in the Childcare Environment (SPACE), which was an intervention implemented...