[Playground marking for contrasting sedentary lifestyle: systematic literature review]

Background: promoting physical activity and reducing sedentary behaviour are public health priorities aimed at ensuring health and well-being at all stages of life. Physical activity should be encouraged from early childhood, with play being a key component, including interactive 'floor-based' activities in safe spaces. The introduction of colourful markings in playgrounds and public spaces (such as 'playground markings') may offer a cost-effective and feasible way to promote physical activity, also providing structured opportunities for teachers to support motor skill development. Objectives: to provide evidence of the benefits of playground markings interventions in schools on increasing physical activity levels and enhancing the physical and psychological well-being in pre-school and school-aged children. Design: a systematic literature search was conducted in Cochrane Library, MedLine, Embase, PsycInfo, and Epistemonikos databases up to 13.02.2024. The primary focus was to identify systematic reviews (SRs) or, in their absence, randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs). Study quality was assessed using validated tools according to study design, and meta-analyses were conducted where feasible. The GRADE approach was used to evaluate the certainty of evidence and results were presented in Summary of Findings (SoF) tables. Studies not included in the meta-analyses due to data unavailability or heterogeneity in outcome measures or interventions were narratively reported. Setting and participants: students aged 3 to 10 years attending preschool and primary school. Main outcome measures: increased physical activity (including light, moderate vigorous and reduction of sedentary lifestyle); reduced obesity, overweight, Body Mass Index; well-being (quality of life, psychological aspect); cognitive level; school performance. Results: a total of 557 records were screened and 35 potentially eligible full-text assessed publications. The review included 14 publications corresponding to 11 studies: 6 RCTs and 5 NRCTs. No systematic reviews were included. Meta-analyses were conducted using data from 2 RCTs, examining outcomes related to reduced sedentary behaviour and increased light, moderate, and vigorous physical activity. No statistically significant differences between comparison groups. The certainty of evidence was very low for all outcomes. Four of the 9 studies that were not included in the meta-analysis were RCT studies and 5 non-randomized studies reported heterogeneous results with respect to the physical activity outcome with some outcomes showing an effect in favour of the intervention while others reported no effect. Conclusions: multi-coloured playground markings consist of a low-cost approach to promote physical activity in children. However, the results reported by the few available studies in both pre-school and school-age children are inconclusive.