2. Materials and Methods
2.1. Data Protection and Ethical Approval
2.2. The Process of Designing Alternative Work Tasks—The Goldilocks-Games
- Step 1:
- We retrieved evidence from two childcare institutions participating in a previous study by our research group . Based on this knowledge and a dialogue with childcare workers and managers, we identified what constituted a regular workday, including identifying main work tasks, and where different activities occurred. This gave an overview of childcare work and an idea of the potential to achieve a ‘just right’ balance of exertion and recovery.
- Step 2:
- We collected additional data on 15 childcare workers (age, M 38 years, SD 11; 60% female) at the two institutions engaged in step 1. Data was collected regarding BMI (M 26 kg/m2, SD 4), self-reported physical activity level, and heart rate for five consecutive days, the latter using ambulatory sensors. This provided a basis to assess the workers’ health status, and physical behavior(s) that could influence health.
- Step 3:
- Based on our understanding of the childcare workers’ (i) work tasks, (ii) physical activity behavior during work hours, and (iii) health status, we determined that a relevant health-related goal would be to improve their cardiorespiratory fitness. To achieve this goal, we focused on promoting HIPA behavior when the childcare workers play pedagogical games with the children.
- Step 4:
- The process of modifying pedagogical games in childcare began by identifying initiatives that could increase HIPA in childcare, based on scientific literature [34,35], field observations and feedback from childcare workers. Then, an iterative process (shown by circulating arrows, Figure 1) was used to develop pedagogical games (i.e., modify a work task) and test them in daily childcare work (i.e., assessing their potential to change work behaviors). The field tests were performed on four childcare workers at two separate institutions, none of which were included in the main study. The field tests included observations, questionnaires and measurements using ambulatory sensors to assess the extent to which the games lead to HIPA, and whether it was feasible for the childcare workers to perform the games in the context of acting as active role models for the children. In this process, we developed and tested six games. Three of the six games did not show a potential to increase HIPA, and were therefore excluded. Finally, we presented the three remaining games to an expert panel comprising members from childcare organizations, union representatives, employers associations’ representatives and government occupational health consultants, which added specific suggestions on how to tailor the games to the needs, context, and work conditions in childcare. This included adapting the games to better incorporate the new and improved educational curriculum (i.e., six politically determined objectives) for childcare work in Denmark .
2.3. Study Design
- Day 1:
- Began with anthropometric measurements and a questionnaire-based interview with the childcare workers. After that, we instructed the children to play the Goldilocks-games with the childcare workers joining in together with the children, thus introducing the childcare workers to the games.
- Day 2:
- A regular workday, where the childcare workers were told to perform their work as usual.
- Day 3:
- Began with the childcare workers conducting the Goldilocks-games with the children without assistance from the research team. A member of the research team observed the Goldilocks-games and noted information on participation by the childcare workers, and contextual factors of relevance. Also, the childcare workers were asked to rate their perceived exertion while performing the games. After having performed the games, the childcare workers were asked about the feasibility of the games, and had their cardiorespiratory fitness assessed. Heart rate was monitored during day (2) and (3).
2.5. Worker Perceptions of Feasibility and Exertion
2.6. Participation and Contextual Factors
2.7. Heart Rate
2.8. Sample Size
2.9. Statistical Methods
3.1. Participants Flow
3.2. Demographics and Fitness
3.3. Worker Perceptions of Goldilocks-Games Feasibility and Exertion
3.4. Researcher Observations of Contextual Factors during the Goldilocks-Games
3.5. Heart Rate Measurements (HIPA during Goldilocks-Games and Regular Workday)
4.1. Strengths and Limitations
4.2. Practical Implications
Conflicts of Interest
|Original Game||Description||Re-Designed Game||Modifications|
|Catching tails||Two children are randomly announced as catchers. The remaining children each attach one tail.|
The catchers countdown from ten and then run to collect all the tails from the children.
The childcare workers assist in attaching tails and start and stop the game.
|Egg hunt 1,2,3,4,5||The childcare workers are announced as catchers 1. All the children attach eggs to their shirts/pants.|
The childcare workers draw an activity card and countdown by performing 1–9 repetitions of the drawn activity (e.g., burpees, air boxing or air squats), while the children runs away 2,3.
The childcare workers then have to collect all the eggs by chasing and catching each child 1. The game is restarts for several rounds 4.
|Circle run||Two equal sized teams of children starts at opposing sides of a circle of cones.|
The objective is to catch the opposing team by running in the same direction around the circle.
The childcare workers set up the circle, judge who is caught and restarts the game.
|Rabbit hunt 1,2,3,4,5||The childcare workers and a group of children starts at opposing sides of a circle of cones.|
The childcare workers have to catch the children running in the same direction as the children around the circle 1.
When a child is caught, the childcare workers perform an activity (e.g., burpee, air boxing, air squats), giving the remaining children the opportunity to run forward 2,3.
When all children are caught the game restarts 4.
|Train||All children are paired and walks hand-in-hand in a straight line.|
The childcare workers walks at the front and the end of the line.
|Goldilocks train 1,3,4,5||All children are paired and walks hand-in-hand in a straight line. The childcare workers walks in the front.|
The childcare workers walk to the back of the line, and collects one child each from their side of the line 1,3.
The childcare worker and the child (holding hands) run together to the front of the line 1.
This process is continued until a predetermined destination is reached 4.
Appendix B.1. Game 1: Egg hunt
- Exercises: Burpees, squat jumps, jumping jacks, air boxing with high knees.
- Materials: Laminated eggs, clamps, exercise and number cards.
- Duration: 10–15 min.
Appendix B.2. Game 2: The Rabbit Hunt
- Exercise: Burpees, squats, jumping jacks.
- Materials: Cones.
- Duration: 10–15 min.
Appendix B.3. Game 3: The Goldilocks Train
- Materials: None.
- Duration: 10–15 min.
|Fitness Level||Workers (n)||Feasible (%)||Partially feasible (%)||Unfeasible (%)|
|Fitness level||Workers (n)||Feasible (%)||Partially feasible (%)||Unfeasible (%)|
|Smoker||Workers (n)||Feasible (%)||Partially feasible (%)||Unfeasible (%)|
|Smoker||Workers (n)||Feasible (%)||Partially feasible (%)||Unfeasible (%)|
|Smoker||Workers (n)||Borg (SD)|
|Fitness Level||Workers (n)||Borg (SD)|
|Above average||4||4.6 (1.7)|
|Below average||3||6.3 (1.2)|
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|Age (years)||35.3 (11.5)|
|Length of service in current job|
|Self-rated time spent in MVPA|
during work and leisure combined (hours/week)
|Self-rated time spent in MVPA|
during work (hours/week)
|Self-rated time spent performing VPA|
during work and leisure (hours/week)
|Current smoker (yes)||7||36.8|
|BMI (kg/m2)||25.0 (3.6)|
|Blood pressure (mmHg)|
|Cardiorespiratory fitness (ml/kg·min)||41.9 (7.9)|
|Pedagogic feasibility a|
|Future implementation b|
|Perceived physical exertion c||5 (1.4)|
|Contextual Factors||N||%||Mean (SD)|
|Area size c|
|On institutions facilities||3||27.3|
|On other facilities||8||72.7|
|Easy access e|
|Duration (min)||32.5 (8.1)|
|Children participating||13 (4.4)|
|Children leaving||1.5 (2.1)|
|Workers’ leaving g|
|Adjustments i||1.3 (0.8)|
|Area limitations j|
|Physical activity among the children k|
|High or very high||3||27.3|
|Low or very low||0||0.0|
|Physical activity among the workers l|
|High or very high||7||63.6|
|Low or very low||0||0.0|
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