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Brief: More Movement Program in Early Child Care Settings in Boston, MA

The information in this brief is intended only to provide educational information.

A version of this brief was published in September 2021. This brief was updated in January 2023 to reflect revised projections for Boston’s population.

This brief summarizes a CHOICES Learning Collaborative Partnership model examining the More Movement program in early child care settings in Boston. This strategy provides training opportunities and resources for early child care educators to implement actions in their programs to encourage physical activity.

The Issue

Every child should have opportunities to grow up at a healthy weight. Early child care programs are key settings that can provide physical activity opportunities that support child development and lay the foundation for a healthy lifestyle. National guidelines recommend preschool-aged children engage daily in 60 to 90 minutes of moderate-to-vigorous physical activity while in early child care settings.1 However, many children do not meet these recommended levels of activity.2

In 2017, about three in 10 first graders in Boston had overweight or obesity.3 If trends continue, over half of today’s children will have obesity as adults.4 Increasing physical activity in child care settings is a national health priority.5 Therefore, identifying strategies that help young children move more is important for ensuring children develop healthy habits and grow up at a healthy weight.

About the More Movement Program in Early Child Care Settings

The More Movement program could support Boston’s efforts to improve early child care quality through the Boston Healthy Child Care Initiative. It would include training opportunities for early child care educators in physical activity curricula, provide resources and instructional materials, and support technical assistance opportunities that may lead to higher physical activity levels among young children.6,7 Helping educators implement practices shown to be effective in increasing physical activity can help the children in Boston’s early education and care settings to move more.

NOTE: The data that informed these estimates were collected after the program closures prompted by the COVID-19 pandemic. As programs reopen and demand continues to increase, this strategy could reach more children.

Comparing Costs and Outcomes

CHOICES cost-effectiveness analysis compared the costs and outcomes of implementing the More Movement program in Boston early child care settings with the costs and outcomes associated with not implementing the strategy over 10 years (2020-2030).

Implementing the More Movement program in early child care settings is an investment in the future. By the end of 2030:

18,200 children would be reached over 10 years; 94 cases of childhood obesity would be prevented in 2030; this strategy would cost $30 per child to implement; children reached would get 7.4 additional minutes of moderate-to-vigorous physical activity per child per day

Conclusions and Implications

If the More Movement program were implemented, we project that over 10 years, 18,200 children ages 3-5 would attend early child care programs that promote and encourage more physical activity (based on the number of programs open during the COVID-19 pandemic). This strategy would prevent 94 cases of obesity in 2030 alone, saving $104,000 in obesity-related health care costs over 10 years. The average annual cost to implement these activities would be $293 per program, or $30 per child.

Expanding training opportunities for early child care educators will also help support quality care. Ensuring access to quality care is essential for families and employers.8 In the initial training series, the More Movement program would provide additional skills training and professional development for 1,380 educators and more physical activity promotion opportunities in 570 (100%) child care programs serving 3-5 year olds.

Besides promoting a healthy weight, engaging in physical activity benefits children in other ways. Increased physical activity is linked to improved bone and muscular health and better gross motor skills in young children.9-11 We estimate that, on average, each child attending a More Movement program would increase daily moderate-to-vigorous physical activity by seven minutes. This can help to form a strong foundation for overall health and well-being.

The More Movement program is a strategy for training and providing technical assistance in early child care. As programs reopen post-pandemic and demand for child care continues to increase, the strategy could reach even more children. The More Movement program would enable early child care programs in Boston to support healthy growth because every child deserves a healthy start.


  1. American Academy of Pediatrics, American Public Health Association, National Resource Center for Health and Safety in Child Care and Early Education. Caring for our Children: National Health and Safety Performance Standards Guidelines for Early Care and Education Programs. 2019. https://nrckids.org/files/CFOC4%20pdf-%20FINAL.pdf

  2. Tassitano RM, Weaver RG, Tenório MCM, Brazendale K, Beets MW. Physical activity and sedentary time of youth in structured settings: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity. 2020;17(1):160. Published 2020 Dec 4. doi:10.1186/s12966-020-01054-y

  3. School Health Services, Dept of Public Health. Results from the Body Mass Index Screening in Massachusetts Public School Districts, 2017. School Health Services, Dept of Public Health; 2020. Accessed July 23, 2021. https://www.mass.gov/doc/the-status-of-childhood-weight-in-massachusetts-2017  

  4. Ward Z, Long M, Resch S, Giles C, Cradock A, Gortmaker S. Simulation of Growth Trajectories of Childhood Obesity into Adulthood. New England Journal of Medicine. 2017; 377(22): 2145-2153. 

  5. Healthy People 2030. Increase the proportion of child care centers where children aged 3 to 5 years do at least 60 minutes of physical activity a day — PA-R01. Office of Disease Prevention and Health Promotion, Office of the Assistant Secretary for Health. Accessed Nov 16, 2020. https://health.gov/healthypeople/objectives-and-data/browse-objectives/physical-activity/increase-proportion-child-care-centers-where-children-aged-3-5-years-do-least-60-minutes-physical-activity-day-pa-r01

  6. Fitzgibbon ML, Stolley MR, Schiffer LA, et al. Hip-Hop to Health Jr. Obesity Prevention Effectiveness Trial: Postintervention Results. Obesity (Silver Spring). 2011;19(5):994-1003. 

  7. Kong A, Buscemi J, Stolley MR, Schiffer LA, Kim Y, Braunschweig CL, Gomez-Perez SL, Blumstein LB, Van Horn L, Dyer AR, Fitzgibbon ML. Hip-Hop to Health Jr. Randomized Effectiveness Trial: 1-Year Follow-up Results. American Journal of Preventive Medicine. 2016 Feb;50(2):136-44.

  8. Campbell F, Patil P, McSwain K. Boston’s Child-Care Supply Crisis: What a Pandemic Reveals. Boston Opportunity Agenda; 2020. Accessed July 23, 2021. https://www.bostonopportunityagenda.org/-/media/boa/early-ed-census-2020-pt-1-202011.pdf

  9. U.S. Dept of Health and Human Services. Physical Activity Guidelines for Americans, 2nd edition. U.S. Dept of Health and Human Services; 2018. Accessed Jul 23, 2021. https://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf

  10. Pate RR, Hillman CH, Janz KF, et al. Physical Activity and Health in Children Younger than 6 Years: A Systematic Review. Medicine & Science in Sports & Exercise. 06 2019;51(6):1282-1291.

  11. Timmons BW, Leblanc AG, Carson V, et al. Systematic review of physical activity and health in the early years (aged 0-4 years). Applied Physiology, Nutrition, and Metabolism. Aug 2012;37(4):773-92.

Suggested Citation:

Bovenzi M, Carter S, Sabir M, Bolton A, Barrett J, Reiner J, Cradock AL. Boston, MA: More Movement Program in Early Child Care Settings {Issue Brief}. Boston Public Health Commission and the CHOICES Learning Collaborative Partnership at the Harvard T.H. Chan School of Public Health, Boston, MA; January 2023. For more information, please visit www.choicesproject.org 

A version of this brief was published in September 2021. This brief was updated in January 2023 to reflect revised projections for Boston’s population.

The design for this brief and its graphics were developed by Molly Garrone, MA and partners at Burness.

This issue brief was developed at the Harvard T.H. Chan School of Public Health in collaboration with the Boston Public Health Commission through participation in the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES) Learning Collaborative Partnership. This brief is intended for educational use only. This work is supported by The JPB Foundation and the Centers for Disease Control and Prevention (U48DP006376). The findings and conclusions are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention or other funders.