A Policy-Based Intervention for Physical Activity and Screen Time in Childcare Outside School Hours: A Cluster Randomized Clinical Trial

Importance: Extended education programs reach tens of millions of children globally during discretionary hours when physical activity competes with screen use, yet scalable strategies to improve movement behaviors are limited.

Objective

To evaluate the effectiveness of Activated Outside School Hours Care (OSHC), a policy-based intervention to improve physical activity and screen time practices in extended education settings. Design, setting, and participants: This cluster randomized clinical trial was conducted in Australia's system of organized before- and after-school care in 3 Australian states (South Australia, New South Wales, and Western Australia) between August 1, 2022, and December 31, 2024, with assessments at baseline, 3 months, and 12 months.