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Child care centers differ systematically with respect to the quality and quantity of physical activity they provide, suggesting that center-level policies and practices, as well as the center's physical environment, are important influences on children's physical activity behavior.To summarize and critically evaluate the extant peer-reviewed literature on the influence of child care policy and environment on physical activity in preschool-aged children.A computer database search identified seven relevant studies that were categorized into three broad areas: cross-sectional studies investigating the impact of selected center-level policies and practices on moderate-to-vigorous physical activity (MVPA), studies correlating specific attributes of the outdoor play environment with the level and intensity of MVPA, and studies in which a specific center-level policy or environmental attribute was experimentally manipulated and evaluated for changes in MVPA.Staff education and training, as well as staff behavior on the playground, seem to be salient influences on MVPA in preschoolers. Lower playground density (less children per square meter) and the presence of vegetation and open play areas also seem to be positive influences on MVPA. However, not all studies found these attributes to be significant. The availability and quality of portable play equipment, not the amount or type of fixed play equipment, significantly influenced MVPA levels.Emerging evidence suggests that several policy and environmental factors contribute to the marked between-center variability in physical activity and sedentary behavior. Intervention studies targeting these factors are thus warranted.