Family-based interventions to increase physical activity in children: a systematic review, meta-analysis and realist synthesis

Efficacy of lifestyle interventions to treat pediatric obesity: A systematic review and multivariate meta-analysis of randomized controlled trials

The aim of this study was to provide a quantitative synthesis of the effects of randomized controlled pediatric lifestyle interventions in treating obesity among 11-17-year-old children. We conducted a systematic review and meta-analysis on the randomized controlled trials, consisting of actual exercise training and nutrition education, published between January 2000 and August 2022. The initial search yielded 2598 articles, with eight articles meeting the inclusion criteria. The articles were analyzed using a multivariate random effects model. The primary outcome variables were body mass index (BMI), standardized BMI (BMIz), and waist circumference (WC). Our analyses showed that lifestyle interventions were efficacious in improving BMI (-1.77 kg/m2, 95% CI [-2.70, -0.83], p < 0.001), BMIz (-0.30, 95% CI [-0.45, -0.16], p < 0.001), and WC (-3.32 cm, 95% CI [-5.35, -1.29], p < 0.001) in children with overweight and obesity. In addition, moderation analyses suggested that the efficacy of the lifestyle interventions correlated positively with participants' weight status and was enhanced when an intervention was boosted with a longer intervention duration and higher frequency. In conclusion, the current evidence suggests that lifestyle interventions are efficacious in treating children with obesity. The available evidence further indicates that duration, frequency, along weight status, were moderating the effectiveness of these lifestyle interventions.

A Comprehensive Planning Framework for Designing Effective Physical Activity Interventions in Youth

BACKGROUND

Effective physical activity (PA) interventions are needed to counter the insufficient and declining levels of PA in youth. These require an updated, comprehensive planning framework that consolidates recent decades of progress in promoting PA in young children, children, and adolescents. Effective PA interventions require program planning and conceptual model development that target a coordinated and multilevel set of age-specific PA determinants. Accordingly, this paper presents a comprehensive planning framework that researchers can use to design intervention research to promote PA in youth.

METHODS

The first author conducted targeted searches through Google Scholar to compile PA models/frameworks/guides applicable to youth, a comprehensive set of PA determinants, and determinant-linked strategies to promote PA focusing on review articles. The information was summarized in tables, synthesized, and used to create a planning framework, all of which were reviewed by coauthors.

RESULTS

The APPLE Framework for Planning PA Opportunities for Youth (APPLE = Age, PA focus, Place and time, Leverage relevant influences and strategies, and ensure Enjoyable PA opportunities) incorporated all core elements from targeted reviews to create a comprehensive planning framework. The APPLE Planning Framework has a set of questions/prompts that guide the intervention planning process and conceptual model templates to organize planning efforts for designing intervention research.

CONCLUSIONS

The APPLE Framework for Planning PA Opportunities for Youth will enable researchers to develop comprehensive conceptual models to guide the design of PA interventions for youth. Future research should refine the model and its components to enable PA intervention research in youth to move forward.

Feasibility and potential efficacy of a family-based intervention on promoting physical activity levels and fundamental movement skills in preschoolers: A cluster randomised controlled trial

Physical activity (PA) is crucial for preschool-aged children's health and development. However, limited evidence exists regarding the feasibility of implementing home-based interventions and how program components influence parent cognitions and practices and child PA. This study evaluated the feasibility and potential efficacy of a family-based PA intervention on objectively measured PA, fundamental movement skills (FMS), parental efficacy, support, goal setting and parent-child co-activity. Guided by social cognitive theory, an 8-week cluster randomised controlled trial was conducted in Hong Kong. The trial included parental workshops, FMS training, PA homework, social media activity sharing and exercise equipment provision. Data were collected at baseline (Time 1; April 2019) and at the end of the intervention period (Time 2; approximately 2 months later) from 108 parent-child pairs in five preschools. The intervention led to increased moderate-to-vigorous PA and FMS in children, along with improved parental self-efficacy, goal setting, supportiveness and co-participation. However, parental PA did not show significant changes. Parents expressed high satisfaction, supporting the need for tailoring interventions to address the unique needs and preferences of young children and their parents. Reinforcing the parental role and providing informative materials and training can promote healthy lifestyles in early childhood.

Replicability, adaptability and long-term impact of the 'Healthy Youngsters, Healthy Dads' program in Newcastle, Australia

'Healthy Youngsters, Healthy Dads' (HYHD) targets fathers to improve the health of their preschool-aged children. In a previous randomized trial, fathers and children experienced meaningful improvements in physical activity and eating behaviours. The next phase is to test the replicability and adaptability of HYHD when delivered in the community by trained facilitators. Fathers/father-figures and children aged 3-5 years were recruited from Newcastle, Australia into a 9-week, non-randomized trial with assessments at baseline, 10 weeks, and 12 months. The primary outcome was achievement of pre-registered targets for recruitment (≥ 96 dyads), attendance (≥ 70%), compliance (completing ≥ 70% of home-based tasks), fidelity (≥ 80% of content delivered as intended) and program satisfaction (≥ 4/5). Secondary outcomes included physical activity, nutrition, screen time and parenting measures. Process targets were surpassed for recruitment (140 fathers, 141 children), attendance (79% for fathers-only workshops, 81% for father-child sessions), compliance (80% of home-tasks completed), fidelity (99% for education, ≥ 97% for practical) and program satisfaction (4.8/5). Mixed effects regression models revealed significant effects in fathers for moderate-to-vigorous physical activity, co-physical activity, dietary intake and parenting practises, which were maintained at 12 months. Significant effects were also established for screen time at 10 weeks only. For children, significant effects were observed for screen time and dietary intake at 10 weeks, while effects on energy-dense, nutrient-poor foods and healthy, nutrient-dense core food intake were maintained at 12 months. Findings demonstrate the replicability and adaptability of HYHD when delivered in the community by local trained facilitators. Further investigation into how to optimally scale-up HYHD is warranted.

National trends and ecological factors of physical activity engagement among U.S youth before and during the COVID-19 pandemic: A cohort study from 2019 to 2021

BACKGROUND

This study aims to investigate the trends and ecological determinants of physical activity among U.S. children and adolescents during the 2019-2021 period, encompassing the COVID-19 pandemic's onset and subsequent years.

METHODS

Utilizing data from the National Survey of Children's Health over three years, this cohort study analyzed physical activity levels and ecological determinants among 82,068 participants aged 6-17. The sample included 36,133 children (44%) and 45,935 adolescents (56%), with variables assessed by caregiver reports.

RESULTS

The analysis revealed a significant decline in physical activity among children from 2019 to 2020, followed by a recovery in 2021, whereas adolescents showed a continued decrease without recovery. Over the study period, children were consistently more active than adolescents. Better health status, normal weight, less screen time, stronger peer relationships, higher parental involvement, better family resilience and greater school participation were consistently correlated with increased physical activity in both age groups. Sleep duration was a predictor of activity only in children, while mental health status was solely a predictor in adolescents. Neighborhood environment consistently predicted children's activity levels but was a significant factor for adolescents only in 2020.

CONCLUSIONS

These findings highlight the differing impacts of the pandemic on physical activity between children and adolescents, emphasizing the need for targeted public health interventions, particularly for adolescents whose activity levels have not recovered from the pandemic period. Age-specific physical activity interventions should consider sleep duration and neighborhood environmental factors when targeting children and mental health factors when focused on adolescents.

Effects of Universal School-Based Parental Support for Children's Healthy Diet and Physical Activity-the Healthy School Start Plus Cluster-Randomised Controlled Trial

Health promotion from an early age is key to preventing unhealthy weight development in childhood, and parental involvement is essential. The school-based Healthy School Start intervention aims to promote healthy dietary and activity habits in the home environment and prevent child obesity through parental support. This study evaluated the effectiveness of the third iteration of the programme on children's dietary and activity behaviours, and body composition through a cluster-randomised controlled trial. The trial included 17 schools (8 intervention) in disadvantaged areas in mid-Sweden with 353 families with 5- to 7-year-old children. The primary outcomes were intake of selected healthy and unhealthy foods and beverages measured using photography. Secondary outcomes were physical activity and sedentary time measured by accelerometry, and measured weight and height. All outcomes were assessed at baseline and post-intervention (8 months). Linear multi-level regression showed significant favourable effects of the intervention for intake of sweet beverages (b =  - 0.17, p = 0.04), intake of healthy foods (b = 0.11, p = 0.04), and more time in moderate to vigorous physical activity during weekdays (b = 5.68, p = 0.02). An unfavourable sub-group effect of the intervention was found for children from families with low education regarding sedentary time on weekends (b = 23.04, p = 0.05). The results align with the previous two trials of the programme, indicating that school-based parental support is a useful approach for health promotion in young children in disadvantaged areas. Trial registration: ClinicalTrials.gov: No. NCT03390725, retrospectively registered on January 4, 2018, https://clinicaltrials.gov/ct2/show/NCT03390725 .

Comparison of Cardiovascular Health Between Parents and Non-Parents in NHANES 2011-2018

BACKGROUND AND OBJECTIVES

We compared cardiovascular health for parents and non-parents using the American Heart Association's Life's Essential 8 (LE8).

METHODS

This cross-sectional cohort analyzed 2011-2018 NHANES participants aged 20 to 54. The exposure was parenting, defined as living with a child. Logistic regression assessed whether parenting was associated with odds of ideal LE8 total or sub-scores. Regression adjusted for age, sex, race and ethnicity, educational attainment, marital status, and income. Subgroups included female sex, male sex, income <150% federal poverty levels, and parents of younger children.

RESULTS

6847 participants represented a weighted population of 79 120 285 (57% parents). Parenting was not associated with adjusted odds of ideal total LE8 (OR 0.91, 95% CI 0.76-1.09). Parenting was associated with decreased odds of ideal body mass index (BMI) (OR 0.81, 95% CI 0.72-0.91) and increased odds of smoking avoidance (OR 1.22, 95% CI 1.09-1.38). Associations varied by subgroup. Only the subgroup with lower incomes demonstrated reduced odds of ideal total LE8 for parents (OR 0.58, 95% CI 0.41-0.82).

CONCLUSIONS

Parents and non-parents differed in smoking and BMI, though not in LE8 total. Families with low incomes may particularly benefit from dual generation cardiovascular risk reduction.

Parental physical activity, parental mental health, children's physical activity, and children's mental health

Introduction

The benefits of physical activity for mental health and well-being and the associations between parental mental health and children's mental health have been well established. These important issues tend to be examined separately however, and there is limited research on the associations between parent and child physical activity and mental health when all considered together. While family focused practice is recommended to provide support for parents who have mental health problems and their families and includes various components (such as psychoeducation, support for mental health and parenting), promoting physical activity for parents and children is not usually a core component of these interventions.

Methods

The Northern Ireland Youth Wellbeing Survey aimed to provide estimates of the prevalence of mental health problems among children and young people. The survey also included questions about parental physical activity, parental mental health, and children's physical activity (for those aged 11-19 years). The main aim of the analysis reported in this article was to explore possible bivariate associations between parent and child physical activity and mental health and also explore these associations when all considered together. Participants were included in the analysis where there were completed interviews for the young person and one of their parents, and both young person and parent provided responses in relation to questions on weekly physical activity (n = 882).

Results

The findings highlight the positive associations between parental physical activity and parental mental health, and between children's physical activity and children's mental health. They also explore some of the more complex interactions between these four variables, which suggest that gender may also be an important consideration. There were significant associations between father's physical activity and son's mental health, and son's physical activity and father's mental health.

Discussions

These findings suggest that including support for parental physical activity and children's physical activity should be a routine component of family focused mental health interventions. It is important to acknowledge that there may be additional barriers to engaging in physical activity for families where a parent is experiencing mental health problems, and these should also be explored and addressed.

Virtual fitness buddy ecosystem: a mixed reality precision health physical activity intervention for children

6-11-year-old children provide a critical window for physical activity (PA) interventions. The Virtual Fitness Buddy ecosystem is a precision health PA intervention for children integrating mixed reality technology to connect people and devices. A cluster randomized, controlled trial was conducted across 19 afterschool sites over two 6-month cohorts to test its efficacy in increasing PA and decreasing sedentary behavior. In the treatment group, a custom virtual dog via a mixed reality kiosk helped children set PA goals while sharing progress with parents to receive feedback and support. Children in the control group set PA goals using a computer without support from the virtual dog or parents. 303 children had 8+ hours of PA data on at least one day of each of the 3 intervention time intervals. Conversion of sedentary time was primarily to light-intensity PA and was strongest for children with low baseline moderate-to-vigorous PA than children above 45 min of baseline moderate-to-vigorous PA. Findings suggest that the VFB ecosystem can promote sustainable PA in children and may be rapidly diffused for widespread public health impact.

Efficacy of physical activity shared between parents and children to improve sports initiation in the M.A.M.I.deporte® program

Objective

To determine if the active methodology for improving sports initiation (M.A.M.I.deporte®) shared between children and parents successfully promotes children in sports activities, maintains their activity and improves long-term adherence.

Participants

The study involved 118 participants aged between 2 and 11 years (6.3 ± 2.3). In the first season, 34 participated (16 girls; 18 boys); in the second season, 46 participated (22 girls; 24 boys) and in the third season, 38 participated (19 girls; 19 boys).

Methodology

It was carried out from October to June over three academic years for two hours a week. Every 4 sessions a different sporting activity was carried out, planned so that parents and children could practise them, simultaneously.

Analysis

At the beginning and end of each period, a survey was carried out on the sports activities in which the participants had started. If participants remained in the activity, the survey was face-to-face and if participants no longer attended the activity, they were contacted by telephone. Descriptive values were obtained for the variables in absolute and percentage form and a repeated measures anova was performed.

Results

Vigorous physical activity performed was 3.82 ± 1.16 h/week in the first year, 3.38 ± 1.59 in the second year and 2.99 ± 1.46 in the third year with no significant differences between any of the years. 32.20% joined other sporting activities and only 6.78% gave up vigorous physical activity.

Conclusion

Joint activity of parents and children contributed to maintaining vigorous physical activity at the recommended levels in the child population with only 6.78% (n = 8) of the participants dropping out.

Effects of eHealth Interventions on 24-Hour Movement Behaviors Among Preschoolers: Systematic Review and Meta-Analysis

BACKGROUND

The high prevalence of unhealthy movement behaviors among young children remains a global public health issue. eHealth is considered a cost-effective approach that holds great promise for enhancing health and related behaviors. However, previous research on eHealth interventions aimed at promoting behavior change has primarily focused on adolescents and adults, leaving a limited body of evidence specifically pertaining to preschoolers.

OBJECTIVE

This review aims to examine the effectiveness of eHealth interventions in promoting 24-hour movement behaviors, specifically focusing on improving physical activity (PA) and sleep duration and reducing sedentary behavior among preschoolers. In addition, we assessed the moderating effects of various study characteristics on intervention effectiveness.

METHODS

We searched 6 electronic databases (PubMed, Ovid, SPORTDiscus, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) for experimental studies with a randomization procedure that examined the effectiveness of eHealth interventions on 24-hour movement behaviors among preschoolers aged 2 to 6 years in February 2023. The study outcomes included PA, sleep duration, and sedentary time. A meta-analysis was conducted to assess the pooled effect using a random-effects model, and subgroup analyses were conducted to explore the potential effects of moderating factors such as intervention duration, intervention type, and risk of bias (ROB). The included studies underwent a rigorous ROB assessment using the Cochrane ROB tool. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment.

RESULTS

Of the 7191 identified records, 19 (0.26%) were included in the systematic review. The meta-analysis comprised a sample of 2971 preschoolers, which was derived from 13 included studies. Compared with the control group, eHealth interventions significantly increased moderate to vigorous PA (Hedges g=0.16, 95% CI 0.03-0.30; P=.02) and total PA (Hedges g=0.37, 95% CI 0.02-0.72; P=.04). In addition, eHealth interventions significantly reduced sedentary time (Hedges g=-0.15, 95% CI -0.27 to -0.02; P=.02) and increased sleep duration (Hedges g=0.47, 95% CI 0.18-0.75; P=.002) immediately after the intervention. However, no significant moderating effects were observed for any of the variables assessed (P>.05). The quality of evidence was rated as "moderate" for moderate to vigorous intensity PA and sedentary time outcomes and "low" for sleep outcomes.

CONCLUSIONS

eHealth interventions may be a promising strategy to increase PA, improve sleep, and reduce sedentary time among preschoolers. To effectively promote healthy behaviors in early childhood, it is imperative for future studies to prioritize the development of rigorous comparative trials with larger sample sizes. In addition, researchers should thoroughly examine the effects of potential moderators. There is also a pressing need to comprehensively explore the long-term effects resulting from these interventions.

TRIAL REGISTRATION

PROSPERO CRD42022365003; http://tinyurl.com/3nnfdwh3.

Barriers and facilitators to older adult participation in intergenerational physical activity program: a systematic review

BACKGROUND

The intergenerational physical activity program aims to promote the health, social engagement, and well-being of older adults. It is essential to comprehend the barriers and facilitators that affect their involvement to develop successful intervention strategies. This systematic review critically examines available research to identify the factors that impact the participation of older adults in intergenerational physical activity programs.

METHODS

This study retrieved 13 electronic databases (from January 2000 to March 2023) and used a social-ecological model to classify and analyze the identified facilitators and barriers.

RESULTS

A total of 12 articles were included, which identified 73 facilitators and 37 barriers. These factors were condensed into 7 primary themes and 14 sub-themes in total.

CONCLUSIONS

The factors influencing the participation of older adults in intergenerational physical activities are multifaceted. These factors guide project developers, policymakers, and practitioners in developing and implementing intergenerational physical activity programs to help address global aging issues and promote intergenerational connections.

TRIAL REGISTRY

PROSPERO ID: CRD42023420758.

Understanding how therapeutic exercise prescription changes outcomes important to patients with persistent non-specific low back pain: a realist review protocol

INTRODUCTION

Persistent low back pain (LBP) is the leading cause of disability worldwide, and therapeutic exercise is recommended as a first-line treatment in international guidelines. The effects of exercise on clinical outcomes of pain and physical function are small to moderate, despite broader impacts on cardiovascular systems, biological health, mood, and emotional well-being. Therapeutic exercise prescription is defined as exercise that is prescribed by a clinician for a health-related treatment. It is unknown how therapeutic exercise prescription creates effects on outcomes of importance. Realist reviews explore how underlying mechanisms (M) may be active in the context (C) of certain situations, settings, or populations to create an intended or unintended outcome (O). Our objective is to explore and understand the mechanisms by which therapeutic exercise prescription changes outcomes for people with persistent LBP.

METHODS

We will develop initial programme theories based on preliminary data from a previous systematic review and consensus workshop. These theories will be modified with input from a steering group (experts), a stakeholder group (people with lived experience of exercise for persistent LBP and clinicians), and a scoping search of the published literature. An information specialist will design and undertake an iterative search strategy. These will be used to create CMO configurations, which will be refined and tested using the literature. The realist review will be reported following RAMESES guidance.

DISCUSSION

Realist reviews are uncommon in LBP research to date, yet those offer an opportunity to contrast with traditional methods of randomised controlled trials and systematic reviews and provide additional information regarding the contexts and mechanisms that may trigger certain outcomes. This can aid our understanding of the contextual features that may influence exercise prescription, such as for whom they are most effective, in what setting, how they are implemented and why. This realist synthesis will enhance our understanding of therapeutic exercise prescription to improve adherence and engagement and ultimately will provide clinically relevant recommendations regarding exercise prescription for those with persistent LBP.

SYSTEMATIC REVIEW REGISTRATION

The review has been registered with PROSPERO (CRD42017072023).

The feasibility, acceptability and potential efficacy of a parental text message and social media program on children's vegetable consumption and movement behaviours: A pilot randomised controlled trial

ISSUE ADDRESSED

Australian children fall short of meeting the dietary, physical activity and sedentary behaviour guidelines. This study aimed to test the feasibility, acceptability and potential efficacy of a parental text message and social media program on, primarily, their school-aged children's vegetable consumption and movement behaviours, and, secondarily, their own.

METHODS

Between August and November 2022, we conducted a two-armed randomised controlled trial with 242 parents/caregivers of primary school-aged children in New South Wales. The 'Adventure & Veg' intervention ran for 8 weeks, promoting vegetable eating behaviours, local outdoor physical activity opportunities and ideas for reducing screen time. Feasibility and acceptability were assessed via recruitment and retention data, intervention metrics and self-reported participant data. Vegetable intake and movement behaviour data were collected via online-surveys and effect sizes were examined.

RESULTS

Most participants reported that they enjoyed receiving the text messages (88%) and the delivery frequency was acceptable (94%). Limitations to Facebook as a delivery platform were reported. The majority of participants used the text messages to influence the vegetable eating (65%) and movement (77%) behaviours of their child. Significant effects were observed among intervention child participants compared with control for mean daily vegetable consumption (0.45 serves, CI: .19; .71, p = .001, d = .5); weekly vegetable variety (1.85, CI: .25; 3.45, p < .001, d = .6); and weekly physical activity variety (.64 CI: .09; 1.19, p = .022, d = .3). Parents in the intervention group increased their daily vegetable intake by .44 serves (CI: .11; .78, p = .01, d = .4).

CONCLUSIONS

A parental text message and social media program has potential to support children's vegetable intake and movement behaviours. Further research is required to explore different online delivery methods to promote local outdoor activity options. SO WHAT?: The Adventure & Veg program holds promise as a stand-alone health promotion intervention or as a useful adjunct to current family or school-based healthy lifestyle programs.

Parental and familial factors related to participation in a home-based physical activity intervention in children with obesity or Prader-Willi syndrome

Background

Increasing physical activity (PA) participation is vital to promote the development of health behaviors in childhood. This study examined which parental and familial factors predicted completion of and compliance with a home-based family PA program in a cohort of families with a child with Prader-Willi syndrome (PWS; a rare disorder with obesity and developmental disability) or with obesity but with neurotypical development.

Methods

Participants (n = 105) were parents of children with PWS (n = 41) and parents of children with obesity but without PWS (n = 64). Parents completed a series of questionnaires documenting their demographic characteristics, self-efficacy, social support, and family environment (active-recreational orientation and cohesion). Relationships between these factors and intervention completion and compliance were evaluated using bivariate correlations and logistic regression (compliance) and multiple regression (completion) analyses with groups together and then separately if the child group was a significant predictor.

Results

None of the variables of interest (marital status, employment, employed hours per week, self-efficacy, social support, and family environment) were significant predictors of intervention completion. Intervention compliance was negatively associated with parents working part-time and working full-time and positively associated with family cohesion (Model R2 = 0.107, F(3,100) = 4.011, p = .010). Child group was not a factor.

Conclusions

Compliance with a 24-week family home-based PA intervention was related to fewer employment hours of the primary caregiver and family environment factors. Future interventions should consider how to reduce the intervention's burden in working parents along with strategies to foster family cohesion.

Preventing diabetes in Latino families: A protocol for a randomized control trial

BACKGROUND

Latino families are disproportionately affected by type 2 diabetes (T2D) and lifestyle intervention is the first-line approach for preventing T2D. The purpose of this study is to test the efficacy of a culturally-grounded lifestyle intervention that prioritizes health promotion and diabetes prevention for Latino families. The intervention is guided by a novel Family Diabetes Prevention Model, leveraging the family processes of engagement, empowerment, resilience, and cohesion to orient the family system towards health.

METHOD

Latino families (N = 132) will be recruited and assessed for glucose tolerance as measured by an Oral Glucose Tolerance Test (OGTT) and General and Weight-Specific Quality of Life (QoL) at baseline, four months, and 12 months. All members of the household age 10 and over will be invited to participate. Families will be randomized to the intervention group or a control group (2:1). The 16-week intervention includes weekly nutrition and wellness classes delivered by bilingual, bicultural Registered Dietitians and community health educators at a local YMCA along with two days/week of supervised physical activity classes and a third day of unsupervised physical activity. Control families will meet with a physician and a Registered Dietitian to discuss the results of their metabolic testing and recommend lifestyle changes. We will test the efficacy of a family-focused diabetes prevention intervention for improving glucose tolerance and increasing QoL and test for mediators and moderators of long-term changes.

CONCLUSION

This study will provide much needed data on the efficacy of a family-focused Diabetes Prevention Program among high-risk Latino families.

Parents' attitudes regarding their children's play during COVID-19: Impact of socioeconomic status and urbanicity

Objectives

The COVID-19 pandemic has had a profound impact on the daily routines of parents and children. This study explored the influence of socioeconomic status (SES) and urbanicity on parents' attitudes toward their children's active play opportunities 6 months and 1.5 years into COVID-19.

Methods

A sample of 239 Ontario parents of children aged 12 and younger completed two online surveys (August-December 2020; 2021) to assess parents' intentions, beliefs, and comforts concerning their child's eventual return to play, in addition to various sociodemographic and physical activity variables. Descriptive analyses were run as well as an exploratory factor analysis (EFA) was conducted to group the 14 attitude items into subscales for analysis, to ensure reliability and validity of attitude measures.

Results

In general, parents in communities with more urban features (e.g., densely populated areas), single-parents, full-time employed parents, and parents with lower-incomes were more hesitant to return their children to active play during the pandemic.

Conclusion

Findings from this work highlight SES and urbanicity disparities that continue to exist during COVID-19.

Changes in fitness and fatness in Australian schoolchildren during the summer holidays: fitness lost, fatness regained? A cohort study

BACKGROUND

Emerging evidence suggests that children's fatness increases and fitness declines at a greater rate during the summer holiday period, compared with the school year. The aim of this study was to compare rates of change in fitness and fatness over the in-term and summer holiday periods among Australian schoolchildren. A secondary aim was to explore whether rates of change differed according to the child's sex, socio-economic status (SES), pubertal status and weight status.

METHODS

Children (n = 381) initially in Grade 4 (age 9) were recruited for this 2-year longitudinal study. Fatness (% body fat, BMI z-score, waist-to-height ratio) and fitness (20-m shuttle run and standing broad jump) were measured at the start and end of two consecutive years. Rates of change were calculated for the two in-school periods (Grades 4 and 5) and for the summer holiday period. Rates of change in fatness and fitness between in-school and holiday periods were compared, and differences in rates of change according to sex, socio-economic status, and weight status were explored.

RESULTS

During the holidays, percentage body fat increased at a greater rate (annualised rate of change [RoC]: +3.9 vs. Grade 4 and + 4.7 vs. Grade 5), and aerobic fitness declined at a greater rate (RoC - 4.7 vs. Grade 4 and - 4.4 vs. Grade 5), than during the in-school periods. There were no differences in rates of change for BMI z-score, waist-to-height ratio or standing broad jump. Body fatness increased faster in the holidays (relative to the in-school period) in children who are overweight and from low-SES families. Aerobic fitness declined more rapidly in the holidays in children who are overweight.

CONCLUSION

This study highlights that during the summer holiday period, children experience greater increases in fatness and declines in fitness, with children who live with low-SES families and are overweight being more affected. The findings suggest the need for targeted interventions during this period to address these negative health trends.

TRIAL REGISTRATION

Australia New Zealand Clinical Trials Registry, identifier ACTRN12618002008202. Retrospectively registered on 14 December 2018.

Cultivating an Active Living Plan Through a Social-Ecological Evaluation

Physical activity (PA) social-ecological model (SEM) posits the importance of several levels of influence critical for PA promotion within communities. The purpose of this study was to examine an SEM evaluation informing a county-wide active living plan in McLennan County, Texas in the United States. Mixed-methods evaluation occurred in 4 stages: (1) county policies (n = 15) were evaluated for PA promoting strategies; (2) PA resource assessments (PARAs) were conducted via Google Maps (n = 171); (3) surveys (n = 244) included the International Physical Activity Questionnaire and interpersonal and intrapersonal factors related to PA; and (4) focus groups (n = 5) were conducted with residents (n = 30), discussing barriers and facilitators to being active. Logistic regression determined significant associations between SEM factors and meeting PA recommendations. Policy scans and PARAs identified strengths and areas of improvement (eg, equitable project selection and disparities in resource quality). Residents reporting fewer barriers (OR = 0.89, P =.01), more perceived behavioral control (odds ratio [OR] = 1.38, P = .01), more social co-participation in PA (OR = 1.20, P = .03), and living in zip codes with higher mean PARA score (OR = 1.22, P = .04) were significantly more likely to meet PA recommendations (Nagelkerke R2 = 0.32). Focus groups also discussed safety and disparities in access and quality. This study suggests the utility of the SEM when evaluating and promoting community PA.

Facilitators and barriers of physical activity participation in children with a single ventricle physiology: a mixed-methods study

BACKGROUND

The present study focuses on assessing the physical activity level of children with Fontan circulation for Hypoplastic Left Heart Syndrome and identifying potential barriers and facilitators toward their participation in physical activity.

PATIENTS AND METHODS

Seven children aged 5-16 years (mean (SD) 8.8 (3.7) years) with a Fontan procedure for hypoplastic left heart syndrome, their parents (n = 7), and siblings (n = 1) were recruited. Data were collected using a mixed-methods approach: (i) children wore an activity monitor for 7 days to record physical activity, with sedentary time and level of activity calculated from accelerometer data; (ii) children completed a bespoke questionnaire recording limitations in physical activity; (iii) parents completed a semi-structured interview discussing perceptions about their child's physical activity participation. Qualitative data were analysed using thematic analysis.

RESULTS

Activity monitors data recorded highly active children with a mean (SD) of 153(36) minutes/day spent in moderate-to-vigorous physical activity. Time spent in sedentary behaviour was also high (57.5% of total accelerometer wearing-time). Four key themes relating to parental perceptions of physical activity were identified: (i) A new lease of life -post-Fontan; (ii) Setting limits - managing limitations; (iii) The wider world - how others set limits; and (iv) "I fear the future" - parental concerns.

CONCLUSION

Following completion of the Fontan circulation, children engaged in higher levels of physical activity in comparison to the national average. However, more than half their time was spent in sedentary behaviour. Fears and anxiety from parents and teachers may act as a barrier toward physical activity participation.

A self-management app to improve asthma control in adults with limited health literacy: a mixed-method feasibility study

BACKGROUND

Digital technology tailored for those with limited health literacy has the potential to reduce health inequalities. Although mobile apps can support self-management in chronic diseases, there is little evidence that this approach applies to people with limited health literacy. We aimed to determine the acceptability of a self-management app in adults living with asthma and have limited health literacy and the feasibility of delivering the intervention and assessing outcomes.

METHODS

We recruited eligible adults from the Klang Asthma Cohort registry in primary care for a 3-month mixed-method study plus a 2-month extended observation. We collected baseline data on socio-demography, health literacy and asthma control level. The outcomes of the intervention were assessed at 1- and 3-month: i) adoption (app download and usage), ii) adherence (app usage), iii) retention (app usage in the observation period), iv) health outcomes (e.g., severe asthma attacks) and v) process outcomes (e.g., ownership and use of action plans). At 1-month, participants were purposively sampled for in-depth interviews, which were audio-recorded, transcribed verbatim, and analysed deductively.

RESULTS

We recruited 48 participants; 35 participants (23 Female; median age = 43 years; median HLS score = 28) completed the 3 months study. Of these, 14 participants (10 Female; median age = 48 years; median HLS score = 28) provided interviews. Thirty-seven (77%) participants adopted the app (downloaded and used it in the first month of the study). The main factor reported as influencing adoption was the ease of using the app. A total of 950 app usage were captured during the 3-month feasibility study. App usage increased gradually, peaking at month 2 (355 total log-ins) accounting for 78% of users. In month 5, 51.4% of the participants used the app at least once. The main factors influencing continued use included adherence features (e.g., prompts and reminders), familiarity with app function and support from family members.

CONCLUSIONS

An asthma self-management app intervention was acceptable for adults with limited health literacy and it was feasible to collect the desired outcomes at different time points during the study. A future trial is warranted to estimate the clinical and cost-effectiveness of the intervention and to explore implementation strategies.

Ecological correlates of sport and exercise participation among Thai adolescents: A hierarchical examination of a cross-sectional population survey

BACKGROUND

Understanding factors influencing adolescents' sport/exercise participation (S/EP) is vital to developing effective interventions, but currently, evidence from less developed countries is limited. The purpose of this study was to examine correlates of S/EP across individual, interpersonal, and environmental levels in a nationally representative sample of Thai adolescents.

METHODS

Data from 4617 Thai adolescents aged 14-17 years old were obtained from recruited schools across Thailand. Data on S/EP (outcome variable), and psychosocial, home, and community environment covariates were collected from individual adolescents using the Thailand Physical Activity Children Survey, Student Questionnaire. School environmental data were collected at the school level using a School Built Environment Audit. Hierarchical regressions taking into account school clustering effects were applied for data analysis.

RESULTS

At the individual level, age and body mass index were independently and strongly correlated with S/EP. Adolescents with high preference for physical activity (PA) (odd ratio (OR) = 1.71, p < 0.001) and at least a moderate level of self-efficacy (OR = 1.33, p = 0.001) were more likely to have high S/EP. At the interpersonal level, adolescents whose parents joined their sports/exercise at least 1-2 times/week (OR = 1.36, p = 0.003) received ≥3 types of parental support (OR = 1.43, p = 0.005) and who received siblings' (OR = 1.26, p = 0.004) and friends' (OR = 1.99, p < 0.001) support had a greater chance of high S/EP. At the environmental level, adolescents' S/EP was greater when there were at least 3-4 pieces of home sport/exercise equipment (OR = 2.77, p = 0.003), grass areas at school (OR = 1.56, p < 0.001), and at least 1-2 PA facilities in the community (OR = 1.30, p = 0.009).

CONCLUSION

Multiple factors at different levels within an ecological framework influencing Thai adolescents' S/EP were generally similar to those found in developed countries, despite some differences. For those interested in promoting and supporting Thai adolescents' engagement in sports/exercise, further exploration of the influence of self-efficacy and attitude toward PA is required at the individual level; parental and peer support at the interpersonal level; and home sport equipment, school grass areas, and neighborhood PA facilities at the environment level.

Decreasing Sedentary Behaviors in Youth to Prevent and Manage Childhood Obesity: Is It Realistic?

PURPOSE OF REVIEW

Decreasing sedentary behaviors has been proposed as one approach to reduce the rate of obesity in youth. This review summarizes the contemporary literature examining the efficacy of these interventions in the school and community along with an additional focus on the role of socioeconomic status in these interventions.

RECENT FINDINGS

Studies that focus on decreasing sedentary behavior have utilized a wide variety of strategies in a number of settings. The effects of these interventions are often hindered by non-standard outcome measures, study infidelity, and subjective measures of sedentary time. However, interventions that incorporate engaged stakeholders and include younger subjects appear to be the most likely to succeed. Promising interventions to decrease sedentary behaviors have been shown in recent clinical trials; however, replicating and sustaining these results is challenging. From the available literature, school-based interventions have the potential of reaching the largest group of children. In contrast, interventions in younger children, particularly those with invested parents, seem to be the most effective.

Physical activity maintenance and increase in Chinese children and adolescents: the role of intrinsic motivation and parental support

Objective

This longitudinal study aimed to examine the association of intrinsic motivation, parental physical activity, and parental support with physical activity maintenance and increase among children and adolescents.

Methods

A sample of 2,424 children and adolescents in Shanghai, China participated in the two-wave survey before and during the COVID-19 pandemic. The questionnaire measured children and adolescents' physical activity and intrinsic motivation, as well as their parental physical activity and support (concern for their child and co-activity with their child). Multivariable logistic regressions were performed by groups to examine the associations between these factors and physical activity change.

Results

Most children and adolescents exhibited a decline in physical activity participation during the pandemic, as indicated by a mere 15.0 and 8.0% of individuals maintaining and increasing their pre-pandemic levels, respectively. Among the initially active participants, perceived self-choice [OR = 1.341 (95%CI: 1.173-1.533)] and parental concern [OR = 1.922 (95%CI: 1.204-3.068)] predicted maintained physical activity. Increased physical activity was predicted by perceived enjoyment [OR = 1.193 (95%CI: 1.046-1.362)] and parental co-activity (OR = 1.995 [95%CI: 1.095-3.633]).

Conclusion

This study provides longitudinal evidence that intrinsic motivation and parental support can have a positive impact when physical activity levels change significantly. Effective interventions targeting multilevel factors are needed to maintain or increase children and adolescents' physical activity.

Child perceived motor competence as a moderator between physical activity parenting and child objectively measured physical activity

This longitudinal study aimed to examine how physical activity parenting (PAP) directly predicted objectively measured children's moderate-to-vigorous physical activity (MVPA) and sedentariness over a three-year transitional period from early to middle childhood, and second, whether the children's perception of motor competence (PMC) mediated or moderated the influence of PAP to children's MVPA or sedentariness. At time 1 (T1), PAP and children's (N = 396, mean age 5.80, SD 1.04) PA were assessed by parental questionnaire. Three years later, at time 2 (T2), children's (N = 396, mean age 8.80, SD 1.04) PMC was measured by a validated pictorial scale, and MVPA and sedentariness were measured by accelerometers. All the analyses were conducted using the Mplus statistical package (Version 8.4). The models were adjusted for the following covariates: children's PA (T1), gender (T1), age (T1), mean accelerometer measurement in hours per day (T2), and parents' education level (T1). Results showed that PAP at T1 did not significantly predict level of MVPA or sedentary time at T2 and, therefore, PMC did not mediate the PAP-children's MVPA or sedentary time relationship either. However, PMC significantly moderated the relationship between PAP and MVPA but not between PAP and sedentary time. The results suggested that parental support positively predicts children's MVPA among children with low PMC but not among children with high PMC. This unique finding proposes that family-based PA interventions could benefit from screening of children with low PMC and provision of PA counselling to their parents.

The Association between Adult Sport, Fitness, and Recreational Physical Activity and Number and Age of Children Present in the Household: A Secondary Analysis Using NHANES

Only one in three adults in the United States meets the weekly recommendation for physical activity (PA). The presence of children in the home may restrict adult PA. The purpose of this study was to examine the association between adult moderate and vigorous sport, fitness, and recreational physical activities and the number and age (0-5 and 6-17) of children in their household. Secondary data were drawn from the National Health and Nutrition Examination Survey (NHANES) from 2007-2016. Adults with complete survey data for self-reported moderate (MPA) and vigorous physical activities (VPA), number of children in the home, and other sociodemographic variables were included. The final sample included 2034 adults from 22-65 years of age. Analyses included ANOVAs and separate multivariable regression analyses to determine if the number of children in the household aged 0-5 and 6-17 were significant predictors of weekly moderate-to-vigorous physical activity (MVPA) after controlling for covariates. For MPA, no differences were found between adult PA regardless of the number and age of children in the home. For VPA, adults with two or more children aged 0-5 reported 80 fewer minutes of weekly VPA (p < 0.05) compared to those with no children or just one child in this age group after controlling for all covariates. Finally, adults with three or more children in the household aged 6-17 reported fifty fewer minutes of weekly VPA (p < 0.05) compared to those with no children, one, or just two in the household. These findings highlight a need to support the vigorous PA behaviors of this population, as the majority of the family-based PA intervention studies to date have primarily focused on family dyads.

Validating the Perceived Active School Travel Enablers and Barriers-Parent (PASTEB-P) Questionnaire to Support Intervention Programming and Research

A child's ability to participate in active school travel (AST) is complicated by several factors. Of particular note are parental controls, which are informed by their perceptions of the local built and social environments, assessments of their child's skills, and convenience preferences, among other considerations. However, there is currently a lack of AST-specific scales that include validated parental perception measures related to such notable barriers and enablers, or those that tend to frame their AST decision-making processes. Framed within the social-ecological model of health behaviour, the aims of the present paper were thus threefold, specifically to (1) outline and test the construct validity of measures delineating parental perceptions of barriers and enablers to AST, (2) evaluate the reliability and consistency of the developed measures, and (3) connect these measures to develop broader constructs for use in the Perceived Active School Travel Enablers and Barriers-Parent (PASTEB-P) questionnaire. To achieve these aims, a mixed-methods approach featuring cognitive interviews and surveys, along with qualitative (thematic analysis) and quantitative (Cohen's Kappa, McDonald's Omega, and confirmatory factor analysis) analyses, was applied across two studies. The validation processes of the two studies resulted in the development of fifteen items comprising seven distinct constructs (barriers: AST Skills, Convenience, Road Safety, Social Safety, and Equipment Storage; enablers: Supportive Environment and Safe Environment) related to parental perceptions of AST. The developed PASTEB-P questionnaire can be used to inform and evaluate AST intervention programming and can be applied for AST research purposes.

Piloting the Virtual PLAYshop Program: A Parent-Focused Physical Literacy Intervention for Early Childhood

The PLAYshop program is a parent-focused physical literacy intervention for early childhood. This single-group mixed-methods pilot study aimed to explore the feasibility of virtually delivering and assessing the PLAYshop program. The virtual PLAYshop program included a virtual workshop, resources/basic equipment, and two booster emails (3-week and 6-week follow-up). Data on 34 preschool-aged children (3-5 years) and their parents from Edmonton and Victoria, Canada, were collected via an online questionnaire, virtual assessment session, and interview at single or multiple time points (baseline, post-workshop, 2-month follow-up). Intraclass correlation coefficients (ICCs), paired t-tests, repeated measures ANOVAs, and thematic analyses were conducted. Regarding feasibility, most parents (≥94%) were satisfied/extremely satisfied with the virtual workshop and planned to continue physical literacy activities post-workshop. The virtual assessment protocol for children's fundamental movement skills (FMS; overhand throw, underhand throw, horizontal jump, hop, one-leg balance) was feasible, with high completion rates (>90%) and reliable scoring (ICC = 0.79-0.99). For positive changes in potential outcomes, a medium effect size was observed for children's hopping skills (d = 0.54), and large effect sizes were observed for several parental outcomes (partial η² = 0.20-0.54). The findings support the feasibility and potential positive outcomes of the virtual PLAYshop program. A larger randomized controlled efficacy trial is recommended.

The development of a family-based wearable intervention using behaviour change and co-design approaches: move and connect

BACKGROUND

Previous research has explored the effectiveness of wearable activity trackers (wearables) for increasing child physical activity (PA) levels, but there have been mixed results. The use of theoretical frameworks and co-design techniques are recognised ways of increasing an intervention's acceptability and effectiveness.

AIMS

This study aims to use co-design workshops and an evidence-based theoretical framework (the Behaviour Change Wheel) to develop a family-based PA intervention using wearables.

METHODS

Three stages of intervention development outlined by the Behaviour Change Wheel were used. Co-design workshops with seven families (11 parents and 12 children) and seven PA experts were conducted where stakeholders discussed how to overcome previously identified barriers to families being active and using wearables. This resulted in the intervention's components being developed, with each component's mechanisms of action (e.g. intervention functions and behaviour change techniques) being retrospectively identified.

RESULTS

The 'Move & Connect' intervention was developed, which targets family PA and wearable use. The intervention takes a flexible approach and includes eight components, including wearable devices (Fitbit Alta HR), support resources, an introductory workshop, collective challenges, goal setting and reviewing, engagement prompts, social support and health-related resources (e.g. educational videos). The intervention incorporates six intervention functions targeting PA and wearable use: education, training, modelling, persuasion, incentivisation and environmental restructuring and 24 behaviour change techniques, including goal setting, social comparison, feedback on behaviour and graded task.

CONCLUSIONS

This is the first known study to use an evidence-based framework and co-design to develop a family-based wearable intervention. The identification of the intervention's mechanisms of action will prove useful when implementing and evaluating the 'Move & Connect' intervention and allow researchers to replicate its components.

Child and family experiences of a whole-systems approach to physical activity in a multiethnic UK city: a citizen science evaluation protocol

INTRODUCTION

Whole-systems approaches are being adopted to tackle physical inactivity. The mechanisms contributing to changes resulting from whole-systems approaches are not fully understood. The voices of children and families that these approaches are designed for need to be heard to understand what is working, for whom, where and in what context. This paper describes the protocol for the children and families' citizen science evaluation of the Join Us: Move, Play (JU:MP) programme, a whole-systems approach to increasing physical activity in children and young people aged 5-14 years in Bradford, UK.

METHODS AND ANALYSIS

The evaluation aims to understand the lived experiences of children and families' relationship with physical activity and participation in the JU:MP programme. The study takes a collaborative and contributory citizen science approach, including focus groups, parent-child dyad interviews and participatory research. Feedback and data will guide changes within this study and the JU:MP programme. We also aim to examine participant experience of citizen science and the suitability of a citizen science approach to evaluate a whole-systems approach. Data will be analysed using framework approach alongside iterative analysis with and by citizen scientists in the collaborative citizen science study.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the University of Bradford: study one (E891-focus groups as part of the control trial, E982-parent-child dyad interviews) and study two (E992). Results will be published in peer-reviewed journals and summaries will be provided to the participants, through schools or directly. The citizen scientists will provide input to create further dissemination opportunities.

Influence of pilot and small trials in meta-analyses of behavioral interventions: a meta-epidemiological study

BACKGROUND

Pilot/feasibility or studies with small sample sizes may be associated with inflated effects. This study explores the vibration of effect sizes (VoE) in meta-analyses when considering different inclusion criteria based upon sample size or pilot/feasibility status.

METHODS

Searches were to identify systematic reviews that conducted meta-analyses of behavioral interventions on topics related to the prevention/treatment of childhood obesity from January 2016 to October 2019. The computed summary effect sizes (ES) were extracted from each meta-analysis. Individual studies included in the meta-analyses were classified into one of the following four categories: self-identified pilot/feasibility studies or based upon sample size but not a pilot/feasibility study (N ≤ 100, N > 100, and N > 370 the upper 75th of sample size). The VoE was defined as the absolute difference (ABS) between the re-estimations of summary ES restricted to study classifications compared to the originally reported summary ES. Concordance (kappa) of statistical significance of summary ES between the four categories of studies was assessed. Fixed and random effects models and meta-regressions were estimated. Three case studies are presented to illustrate the impact of including pilot/feasibility and N ≤ 100 studies on the estimated summary ES.

RESULTS

A total of 1602 effect sizes, representing 145 reported summary ES, were extracted from 48 meta-analyses containing 603 unique studies (avg. 22 studies per meta-analysis, range 2-108) and included 227,217 participants. Pilot/feasibility and N ≤ 100 studies comprised 22% (0-58%) and 21% (0-83%) of studies included in the meta-analyses. Meta-regression indicated the ABS between the re-estimated and original summary ES where summary ES ranged from 0.20 to 0.46 depending on the proportion of studies comprising the original ES were either mostly small (e.g., N ≤ 100) or mostly large (N > 370). Concordance was low when removing both pilot/feasibility and N ≤ 100 studies (kappa = 0.53) and restricting analyses only to the largest studies (N > 370, kappa = 0.35), with 20% and 26% of the originally reported statistically significant ES rendered non-significant. Reanalysis of the three case study meta-analyses resulted in the re-estimated ES rendered either non-significant or half of the originally reported ES.

CONCLUSIONS

When meta-analyses of behavioral interventions include a substantial proportion of both pilot/feasibility and N ≤ 100 studies, summary ES can be affected markedly and should be interpreted with caution.

Experience and Satisfaction with a Family-Based Physical Activity Intervention Using Activity Trackers and Apps: A Qualitative Study

Wearable activity trackers and smartphone apps have been shown to increase physical activity in children and adults. However, interventions using activity trackers and apps have rarely been tested in whole families. This study examined the experience and satisfaction with an activity tracker and app intervention (Step it Up Family) to increase physical activity in whole families. Telephone interviews were conducted with Queensland-based families (n = 19) who participated in the Step it Up Family intervention (N = 40, single-arm, pre/post feasibility study) in 2017/2018. Using commercial activity trackers combined with apps, the intervention included an introductory session, individual and family-level goal setting, self-monitoring, family step challenges, and weekly motivational text messages. Qualitative content analysis was conducted to identify themes, categories and sub-categories. In summary, parents reported that children were engaged with the activity tracker and app features to reach their daily step goals. Some technical difficulties were experienced with app navigation, syncing of activity tracker data, and tracker band discomfort. Although families liked that the weekly text messages reminded them to be active, they did not find them very motivating. Using text messages for physical activity motivation in families requires further testing. Overall, the intervention was well-received by families for increasing physical activity motivation.

Barriers to physical activity for father's living in marginalising conditions

Physical activity can be a conduit for improving men's social connectedness as well as physical gains for well-being. However, marginalised men, and fathers in particular, can be challenged to engage in leisure time physical activity. This qualitative study reports how fathers, who experience complex and significant social and health inequities, conceptualise and experience barriers to physical activity. Drawing from focus groups with 17 fathers, and semi-structured interviews with seven service providers about their perspectives on men's physical activity in Vancouver's Downtown Eastside (DTES), a highly marginalised neighbourhood. A masculinities framework was used to describe and contextualise physical activity in fathers' lives. Three themes were inductively derived through the analyses: (1) 'they're busy surviving' a finding referencing the work and limits invoked by poverty wherein survival was triaged ahead of leisure time physical activity; (2) 'there is no activity centre' chronicling the lack of physical activity spaces, programmes and resources available to fathers; and (3) 'lifestyle affects our capability to exercise' a theme detailing how social isolation amplified by factors including housing and opioid crises, and being a father in a resource poor setting imposed significant barriers to physical activity. The findings support reconceptualising physical activity programmes with men who are living in marginalising conditions to address behavioural and structural health inequities in tailoring father-centred programmes and resources.

The role of the family in health promotion: a scoping review of models and mechanisms

The family is an important contributor to the cultural conditions that support health. Current challenges in family health promotion interventions include programme design that is not always guided by theory and change mechanisms. Multifaceted programmes also make it hard to examine what works for whom, given different family roles and the range of lifestyle behaviour and mechanisms examined within diverse conceptual frameworks and cultures. We performed a scoping review on the heterogeneous literature to map and categorize the models and mechanisms by which a family may promote health behaviours among its members. We searched five electronic databases and grey literature up to 2020. Publications were included if they examined health-promoting behaviours, influences at the family level, and outlined the behavioural mechanisms involved. Two hundred and forty studies were identified. Ecological systems theory, social cognitive theory, family systems theory and the theory of planned behaviour were the frameworks most widely used in explaining either study context and/or mechanism. The most frequently studied family mechanisms involved aspects of family support, supervision and modelling, while some studies also included individual-level mechanisms. Majority of the studies investigated parental influence on the child, while few studies assessed the elderly family member as a recipient or actor of the influences. Studies on African, Asian and Middle Eastern populations were also in the minority, highlighting room for further research. Improving the understanding of context and behavioural mechanisms for family health promotion will aid the development of public health policy and chronic disease prevention programmes, complementing efforts targeted at individuals.

The association between number and ages of children and the physical activity of mothers: Cross-sectional analyses from the Southampton Women's Survey

BACKGROUND

Physical activity (PA) has many health benefits, but motherhood is often associated with reduced PA. Considering that ages and number of children may be associated with maternal PA, and that PA patterns may change as children transition to formal schooling, we aimed to investigate the associations between ages and number of children and device-measured maternal PA.

METHODS

Cross-sectional analyses were conducted using data from 848 mothers from the Southampton Women's Survey at two different timepoints. Two-level random intercept linear models were used to investigate associations between ages (≤4y(ears) ("younger"), school-aged, both age groups) and number (1, 2, ≥3) of children, and their interaction, and accelerometer-assessed minutes of maternal moderate or vigorous PA (log-transformed MVPA) and light, moderate or vigorous PA (LMVPA).

RESULTS

Women with any school-aged children engaged in more MVPA than those with only ≤4y (e.g. % difference in minutes of MVPA [95% confidence interval]: 46.9% [22.0;77.0] for mothers with only school-aged vs only ≤4y). Mothers with multiple children did less MVPA than those with 1 child (e.g. 12.5% [-1.1;24.3] less MVPA for those with 2 children). For mothers with multiple children, those with any school-aged children did less LMVPA than those with only ≤4y (e.g. amongst mothers with 2 children, those with only school-aged children did 34.0 [3.9;64.1] mins/day less LMVPA). For mothers with any ≤4y, those with more children did more LMVPA (e.g. amongst mothers with only ≤4y, those with 2 children did 42.6 [16.4;68.8] mins/day more LMVPA than those with 1 child).

CONCLUSIONS

Mothers with multiple children and only children aged ≤4y did less MVPA. Considering that many of these women also did more LMVPA than mothers with fewer or older children, interventions and policies are needed to increase their opportunities for higher intensity PA to maximise health benefits.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04715945.

Children's Physical Activity during COVID-19 in Ontario, Canada: Parents' Perspectives

The COVID-19 pandemic has had a large influence on children's physical activity (i.e., play and sport) opportunities. The purpose of this study was to describe parents' perspectives of their children's (ages 0-12) physical activity experiences during the pandemic (i.e., since the onset in March 2020 until follow-up survey completion date [between August to December 2021]). As part of the 'Return to Play' study conducted in Ontario, Canada, two-parent report surveys were completed online via Qualtrics. Surveys measured parents' perspectives regarding their children's physical activity since the onset of the pandemic (n = 17 items) and collected demographic information (n = 16 items). Open-ended questions were included to gather a rich understanding of parents' experiences (i.e., supports, challenges) with facilitating their children's physical activity. Descriptive statistics were calculated to describe parents' perspectives of their children's physical activity experiences and to determine parent demographics. Open-ended questions were analyzed via deductive content analysis. Parents (n = 382) reported that they noticed behavior changes in their children because of the pandemic (65.9%), and most (73.7%) reported challenges with supporting their children's activity during periods when public health measures were in place. Many parents (44.5%) stated that their children asked about returning to play/sport more than three times per week during periods when play/sport facilities were closed in Ontario. Qualitative data identified common supports parents used (e.g., getting active outdoors, forming mini social 'bubbles'), and challenges they faced (e.g., work, children's increased screen time, and home schooling), pertaining to their children's physical activity.

Rapid cycle adaptation of a classroom-based intervention to promote equity in access to youth physical activity

Our objective was to systematically adapt Interrupting Prolonged sitting with ACTivity (InPACT), a classroom-based physical activity intervention, for home delivery to equitably increase access to structured youth physical activity opportunities during the COVID-19 pandemic. Key steps in the rapid-cycle research adaptation process included: (Step 1) identifying partner organizations; (Steps 2 and 3) engaging in problem and knowledge exploration to examine the problem from different perspectives; (Steps 4 and 5) initiating solution development and testing by selecting an intervention and adapting the format and content for home delivery. Using Rapid RE-AIM to guide online assessment and refinement of InPACT at Home; and (Step 6) utilizing dissemination strategies to extend the reach of the program. Core elements of the InPACT program that were retained included: the use of exercise videos, maintenance of the intervention dose, and teacher-led physical activities. Key adaptations included: utilization of physical education specialists to develop the exercise videos, incorporation of health messaging in videos, and utilization of dissemination strategies (intervention website) to reach K-12 students across the state. Intervention website reach included all 83 counties in Michigan, but goals were not met for website pageviews (5,147; 85% of goal) and video view duration (7 min 19 sec; 37% of goal). Accordingly, dissemination was expanded to include public television broadcasting (monthly viewers: 500,000) and videos were shortened to 8 minutes. Dissemination and implementation science frameworks guided the rapid adaptation of an existing intervention, InPACT, to equitably increase access to structured youth physical activity opportunities at home during the pandemic.

Feasibility of using activity trackers and apps to increase physical activity in whole families: The Step it Up Family intervention

Objective

This study examined the feasibility of an activity tracker and app intervention to increase physical activity in whole families.

Methods

This was a single-arm feasibility study with pre-post-intervention measures. Between 2017 and 2018, 40 families (58 children aged 6-10 years, 39 mothers, 33 fathers) participated in the 6-week Step it Up Family programme in Queensland, Australia. It was delivered using Garmin activity trackers and apps, weekly motivational text messages and an introductory session. Online surveys and semi-structured interviews conducted with parents assessed intervention usage, acceptability, usability, perceived usefulness, use of physical activity self-management strategies and programme influence. Analyses included descriptive statistics, Wilcoxon signed-rank test and qualitative content analysis.

Results

Overall, 38 families completed the post-intervention survey (95% family retention; 90% children, 95% mothers, 88% fathers). Garmin activity tracker usage was high (i.e. nearly 24/7 during the 6 weeks intervention). Families also used the Garmin apps regularly (i.e. mostly 2-6 times per week). Further, 80% of mothers and 52% of fathers read the motivational mobile text messages. Usability and perceived usefulness of the Garmin activity trackers and apps were rated high. Both parents significantly increased their use of physical activity self-management strategies from pre to post-intervention. Parents expressed that the intervention had increased awareness of physical (in)activity in the family, encouraged to be active and promoted outdoor family activities.

Conclusions

Using activity trackers and apps to increase physical activity in the whole family was well received by children and parents which suggests that this intervention approach is feasible. However, further testing is needed amongst more diverse family populations. These early findings support the implementation of a randomised controlled trial to examine intervention efficacy.

Home- and Community-Based Interventions for Physical Activity and Early Child Development: A Systematic Review of Effective Strategies

This systematic review examined the effects of home/family and community-based interventions on physical activity (PA) and developmental outcomes in early childhood. A search strategy was employed using four electronic databases (Academic Search Complete, CINAHL Complete, MEDLINE, and SPORTDiscus). Interventions investigating weight status (i.e., BMI), physical activity, sedentary behavior, and/or motor proficiency that took place in home, family, or community settings were assessed. Studies were eligible if they were peer-reviewed, available in English, published between 2011 and 2021, and if samples consisted of healthy young children (2-5 years old). There were 24 studies retained (8351 participants) spanning from the United States (n = 12), Australia (n = 3), Canada (n = 2), Switzerland (n = 2), Finland (n = 2), Netherlands (n = 1), and other Eastern European countries (n = 2). There were 19 studies that incorporated home/family-based approaches and 14 studies that incorporated community-based approaches. Studies ranged in intervention duration from 6 weeks to 24 months. It suggests that improving PA participation in young children was especially challenging to solicit improvement (only 25% of all studies found significant improvement in PA after intervention). Distributing educational material to parents/families, consistent, direct contact with parents, and encouraging community engagement were identified as effective strategies to promote physical activity, healthy weight status, and motor skills in young children.

Acceptability of a parent-focused program for physical literacy development among parents and children during the COVID-19 pandemic: A qualitative study

Background

A 3-month parent education program was designed and implemented in Hong Kong to improve physical literacy (PL) among primary school children and their parents during the COVID-19 pandemic. This study aims to probe into the acceptability of the intervention from parental perspectives, providing more insights for future implementation.

Methods

Following the 3-month parent-focused PL program, 16 parents (mean age = 43.73 years, 15 mothers) were recruited to participate in semi-structured individual interviews in June 2021. Interviews were analyzed using thematic analysis in NVivo 12. Two coders analyzed interview transcripts deductively based on the interview guide and social cognitive theory (SCT).

Results

Three themes were identified that captured the acceptability of the program: (1) Addressing needs through appropriate delivery enhances acceptability of intervention; (2) Positive behavioral and psychological changes to families; (3) Appropriate support of environmental factors can enhance the sustainability of program effects. The high levels of acceptability were attributable to the fact that parents were able to learn and be a gatekeeper to impact their children positively. Moreover, the design and contents of the program were appropriate for the participating parents because the program provided adequate learning resources and interactive learning support without being overly rigid, and the online learning mode was feasible and convenient. Consequent to their participation in the program, parents expressed that they became more aware of the importance of PL, established physical activity routines with their children, and modified their parenting styles which resulted in improved parent-child relationships.

Conclusions

The current study provided evidence that engaging parents in the intervention was feasible and acceptable approach in supporting both parents and children to establish physically active routines in the family setting. The insights gained regarding the appropriateness and acceptability of the program in this specific context may be used to inform the design, implementation and sustainability of other parent-focused PL programs.

Family sports interventions for the treatment of obesity in childhood: a meta-analysis

Background

Obesity in children has become one of the key concerns of the World Health Organization, and the incidence of related non-communicable diseases is also rising. This study evaluates the effect of family sports participation on the treatment and prevention of obesity in children aged 0–14 years by systematic analysis.

Method

A literature review from 2000 to 2020 was conducted. According to PRISMA-IPD (Preferred Reporting Items for MetaAnalyses of individual participant data) guidelines. The two researchers independently assessed the risk and bias of the articles, obtained a comprehensive, high-quality result, and extracted the data based on the Cochrane intervention system review manual. Randomized controlled trials (RCTs) were selected from the searches that used family sports interventions or family sports combined with dietary adjustments and behavioral habits change. Only studies targeting overweight or obese children aged 0–14 years were included.

Results

The search resulted in a total of 16 studies. Across all 16 studies, there were a total of 1680 participants in the experimental groups and 1701 participants in the control groups. The results are as follows: body mass index (BMI) (SMD-RE = − 4.10, 95% CI (− 0.84 to 0.02), Z = 1.88, p = 0.06); Body weight (SMD-RE = − 0.77, 95% CI (− 1.53 to − 0.01), Z = 2.00, p = 0.05); Waist circumference (SMD-RE = − 0.45, 95% CI (− 1.36 to 0.47), Z = 0.96, p = 0.34); and Body fat rate (SMD-FE = − 0.06, 95% CI (− 0.22 to 0.11), Z = 0.69, p = 0.49). Hence, through family sports intervention among obese children, juvenile and obese body composition—BMI, body weight, waist circumference, and body fat rate—are all reduced. But only body weight was statistically significant.

Conclusions

Compared with the samples without family sports, the weight of obese children participating in family sports decreased, but there were no significant differences in other relevant physical indicators. Follow-up research should examine large-scale clinical trials with family sports as a single factor intervention, which are needed to provide stronger evidence of the intervention effect. However, family activities can help obese children grow and develop by improving their exercise capacity, enhancing their lifestyles, and facilitating communication and relationships with their parents. In the future, long-term sports training plans for children with obesity should be implemented.

Comportements de mouvement et santé des enfants et des jeunes handicapés : impact de la pandémie de COVID-19 en 2020

Objectifs

Cette étude s’est penchée sur l’impact ponctuel et prolongé de la pandémie de COVID-19 sur les comportements de mouvement et la santé des enfants et jeunes handicapés du Canada.

Méthode

Quatre-vingt-six parents d’enfants et jeunes handicapés ont répondu deux fois à un questionnaire en ligne (en mai et en novembre 2020). Des entrevues ont eu lieu en mars 2021 auprès de sept familles.

Résultats

Lors des deux évaluations, < 20 % des enfants et jeunes handicapés atteignaient les cibles d’activité physique et de comportement sédentaire préconisées dans les directives, et > 50 % des enfants et jeunes handicapés atteignaient les cibles de sommeil. Aucun enfant et jeune handicapé n’atteignait les trois cibles de mouvement préconisées dans les directives. Près du quart des enfants et jeunes handicapés ont rapporté un déclin par rapport au niveau d’avant la pandémie. Les thèmes de l’entrevue ont révélé que le changement de la routine, le temps libre, les occasions moins fréquentes de physiothérapie, la capacité parentale et l’environnement social et aménagé ont tous contribué aux comportements de mouvement des enfants et jeunes handicapés.

Conclusions

Les efforts de relance après la pandémie de COVID-19 doivent donner la priorité aux comportements de mouvement et à la santé des enfants et jeunes handicapés par l’entremise de programmes de bonne qualité, d’instructeurs bien formés, d’infrastructure accessible et inclusive, et de santé axée sur la famille.

Location-specific psychosocial and environmental correlates of physical activity and sedentary time in young adolescents: preliminary evidence for location-specific approaches from a cross-sectional observational study

BACKGROUND

A better understanding of the extent to which psychosocial and environmental correlates of physical activity are specific to locations would inform intervention optimization.

PURPOSE

To investigate cross-sectional associations of location-general and location-specific variables with physical activity and sedentary time in three common locations adolescents spend time.

METHODS

Adolescents (N = 472,Mage = 14.1,SD = 1.5) wore an accelerometer and global positioning systems (GPS) tracker and self-reported on psychosocial (e.g., self-efficacy) and environmental (e.g., equipment) factors relevant to physical activity and sedentary time. We categorized each survey item based on whether it was specific to a location to generate psychosocial and environmental indices that were location-general or specific to either school, non-school, or home location. Physical activity (MVPA) and sedentary time were based on time/location match to home, school, or all "other" locations. Mixed-effects models investigated the relation of each index with location-specific activity.

RESULTS

The location-general and non-school physical activity psychosocial indices were related to greater MVPA at school and "other" locations. The school physical activity environment index was related to greater MVPA and less sedentary time at school. The home activity environment index was related to greater MVPA at home. The non-school sedentary psychosocial index was related to less sedentary time at home. Interactions among indices revealed adolescents with low support on one index benefited (i.e., exhibited more optimal behavior) from high support on another index (e.g., higher scores on the location-general PA psychosocial index moderated lower scores on the home PA environment index). Concurrent high support on two indices did not provide additional benefit.

CONCLUSIONS

No psychosocial or environment indices, including location-general indices, were related to activity in all locations. Most of the location-specific indices were associated with activity in the matching location(s). These findings provide preliminary evidence that psychosocial and environmental correlates of activity are location specific. Future studies should further develop location-specific measures and evaluate these constructs and whether interventions may be optimized by targeting location-specific psychosocial and environmental variables across multiple locations.

The Effects of a Multicomponent Social Support Intervention on Physical Fitness and Exercise Attitude in Children: A 12-Week Randomized Controlled Trial

Purpose: The current study is intended to assess the effects of a multicomponent social support intervention program on grip strength, sprinting, jumping, agility, flexibility, core strength and exercise attitude among children over a period of twelve weeks. Method: This study followed a randomized parallel design in which 366 children (age: 9.35 ± 1.12 years) in the 3rd−5th grade at an elementary school in China were allocated to an intervention group (n = 183) or a control group (n = 183). Participants were assessed twice (baseline and postintervention) for the following tests: (i) grip strength, (ii) 50 m dash, (iii) rope skipping, (iv) sit-ups, (v) sit-and-reach, and (vi) exercise attitude. The intervention group received the “Exercise Methods and Wellness Knowledge Guide (EMWKG)” leaflet three times a week. The control group was not required to make any changes. Results: Significant increases in pre−post left-hand grip strength (Cohen’s d = 0.10, p < 0.001), right-hand grip strength (Cohen’s d = 0.09, p < 0.001), and behavioral intention (Cohen’s d = 0.17, p < 0.01) were observed in the intervention group. Students in the control group showed significant decreases in three indicators: both 50 m (Cohen’s d = 0.19, p < 0.01) and sit-ups (Cohen’s d = 0.14, p < 0.05) as well as sit-and-reach (Cohen’s d = 0.46, p < 0.001). Significant differences (p < 0.001) were found between the two groups in right-hand grip strength (F = 7.109, ηp2 = 0.020), sit-and-reach (F = 11.255, ηp2 = 0.031), and subjective standards (F = 15.461, ηp2 = 0.043). A comparison of the post hoc test results showed that the intervention group scored 0.519 kg (95% CI: 0.136−0.901, Cohen’s d = 0.27), 0.944 cm (95% CI: 0.0391−1.497, Cohen’s d = 0.35), and 2.535 points (95% CI: 1.267−3.803, Cohen’s d = 0.41) higher than the control group in right-hand grip strength, sit-and-reach, and subjective standards, respectively. Conclusion: This combined social support theory-based intervention was effective in improving exercise attitude and fitness among children in 12 weeks.

Establishing Effectiveness of a Community-based, Physical Activity Program for Fathers and Daughters: A Randomized Controlled Trial

BACKGROUND

The 'Dads And Daughters Exercising and Empowered' (DADEE) program significantly improved physical activity levels of fathers and their daughters in an efficacy trial. However, the effectiveness of interventions when delivered in real-world settings needs to be established.

PURPOSE

To evaluate the effectiveness of the DADEE intervention when delivered in community settings by trained facilitators.

METHODS

We conducted a two-arm RCT, (baseline and 3-months post-intervention assessments), in Newcastle, Australia. In 2016, 155 fathers (27-60 years) and 189 primary-school-aged daughters (4-12 years) (n = 344) were randomly allocated to the intervention (78 fathers, 95 daughters) or waitlist-control (77 fathers, 94 daughters) groups. Trained facilitators delivered the 9-week DADEE program (weekly sessions plus home-based tasks). Primary outcomes were fathers' and daughters' physical activity (steps/day). Secondary outcomes included screen-time, weight status, daughters' fundamental movement skill (FMS) proficiency, perceived sports competence, and fathers' parenting practices. Effects were assessed using linear mixed models.

RESULTS

Primary outcome follow-up data were collected from 88% of fathers and 89% of daughters. Significant group-by-time differences in mean daily steps were found for fathers' (adjusted difference = +1,638; 95% CI: 833, 2,443, d = 0.7) and daughters' (adjusted difference = +1,023 steps/day; 95% CI: 259, 1,787; d = 0.4) physical activity. Significant effects were observed for daughters' screen-time, FMS, and some parenting practices. No significant effects were identified for weight status, or fathers'screen-time or self-reported MVPA. Program attendance, satisfaction and fidelity were very high.

CONCLUSION

This study established the effectiveness of the DADEE intervention when delivered in community settings by trained facilitators. Importantly, the findings were comparable to those of the efficacy RCT delivered by the research team. To maximize public health benefits, a larger-scale dissemination of the program appears warranted.Trial Registration Australian New Zealand Clinical Trial Registry: ACTRN12616001270404 Human Research Ethics Committee: H-2014-0330.

Parent-focused online intervention to promote parents' physical literacy and support children's physical activity: results from a quasi-experimental trial

Background

The development of physical literacy (PL) early in life may influence children's subsequent physical activity (PA) participation and consequent health benefits across the life course. Interventions designed for parents are lacking, but such efforts can potentially enhance the PL of parents and their children’s PA participation. Additionally, there is insufficient evidence to support the feasibility of delivering a PL intervention using an online format. Therefore, the purpose of this study was to examine the feasibility and effectiveness of a parent-focused, theory-driven, online-delivered intervention designed to improve the parents’ PL and children’s PA behaviors.

Methods

A non-randomized trial was conducted to evaluate the effects of the program. 224 Hong Kong families (primary school-aged children and their parents) registered to the program were considered the experimental group and were exposed to an online intervention over three months. Another 220 families in Hong Kong were considered the comparison group and did not receive any intervention. Outcome measures included PA behaviors (daily steps and moderate-to-vigorous PA), parent–child co-activity behaviors, family PA routines, and parent perceived PL. Linear mixed models were used to analyze the differences in terms of changes in measured outcomes between groups over time.

Results

No significant group-by-time effects were found for children’s or parents’ PA behaviors. In terms of the family Co-PA routines, a small positive effect size in favor of the experimental group was found (p = .44, d = 0.2). Group-by-time effects favorable to the experimental group was detected for parent–child co-activity (p < .001, d = 0.7) and parental PL (p < .001, d = 0.9) at post-intervention. The results demonstrated that the intervention was acceptable and that there was potential for scale up.

Conclusions

Findings indicated that the intervention was effective in increasing parent–child co-activity and parent perceived PL. During the pandemic, online intervention delivery was found to be feasible. Using this mode of delivery, the intervention has the potential to reach a wide population in the local context.

Trial registration

The study was prospectively registered at the Chinese Clinical Trial Registry, Registration number: ChiCTR2100041903, Registered 09 January 2021.

Design and Validation of a Virtual Physical Education and Sport Science-Related Course: A Learner's Engagement Approach

Learners’ engagement is shown to be a major predictor of learning, performance, and course completion as well as course satisfaction. It is easier to engage learners in a face-to-face teaching and learning format since the teacher can observe and interpret the learner’s facial expression and body language. However, in a virtual setting with the students sitting behind cameras, it is difficult to ascertain engagement as the students might be absent-mindedly attending the class. Henceforth, with the rapid transition to online learning, designing course content that could actively engage the students towards achieving the said elements is, therefore, necessary. We applied a data-driven approach in designing a virtual physical education and sport science−related course via a learner engagement model. A fully online course catering to 132 students that runs for a total of 14 weeks was used as a case study to develop the course. The study was conducted during the 2020/2021 academic year, which was the period of the peak COVID-19 pandemic in Malaysia. The delivery of the course content was implemented in stages to achieve three essential educational outcomes namely, skill and knowledge acquisition, and personal development as well as course satisfaction. We hypothesised that the developed learners’ engagement approach will promote the students’ acquisition of skills and knowledge and foster the personal development of the students through fitness improvement. It is also hypothesised that the students will be satisfied with the course developed upon successful completion. A chi-square analysis projected a statistically significant difference in the skill and knowledge acquisition before and after the programme (p < 0.001). A Wilcoxon rank-sum test demonstrated personal improvement in the overall fitness of the student upon completing the prescribed activity of the course content. Moreover, a total of 96.2%, 95.5% and 93.2% of students expressed their satisfaction with the clarity of the learning objectives, good organisational and course content plan, and appropriate workload of the course designed, respectively. There is sufficient evidence to accept all hypotheses formulated, and hence, we postulated that, since students spend more time outside the classroom, out-of-class learners’ engagement activity should be considered when designing a virtual course to promote lifelong learning, experience, and higher-order thinking. The techniques presented herein could be useful to academics, professionals, and other relevant stakeholders in developing virtual course content within a specific domain of interest.

Impact of the 'Healthy Youngsters, Healthy Dads' program on physical activity and other health behaviours: a randomised controlled trial involving fathers and their preschool-aged children

Background

Targeting fathers may be a key strategy to increase physical activity among their preschool-aged children, but limited research exists in this area. The primary study aim was to examine the impact of a lifestyle program for fathers and their preschool-aged children on child physical activity levels.

Methods

A total of 125 fathers (aged: 38 ± 5.4 years, BMI: 28.1 ± 4.9 kg/m²) and 125 preschool-aged children (aged: 3.9 ± 0.8 years, BMI z-score: 0.3 ± 0.9, 39.2% girls) recruited from Newcastle, Australia, NSW were randomised to (i) the Healthy Youngsters, Healthy Dads (HYHD) program, or (ii) wait-list control group. The program included two fathers-only workshops (2 h each) and eight father-child weekly educational and practical sessions (75 min each), plus home-based activities targeting family physical activity and nutrition. Assessments took place at baseline, 10-weeks (post-intervention) and 9-months follow-up. The primary outcome was the children’s mean steps/day at 10-weeks. Secondary outcomes included: co-physical activity, fathers’ physical activity levels and parenting practices for physical activity and screen time behaviours, children’s fundamental movement skill (FMS) proficiency, plus accelerometer based light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), screen time and adiposity for fathers and children. Process measures included; attendance, satisfaction, fidelity and retention. Linear mixed models estimated the treatment effect at all time-points for all outcomes.

Results

Intention-to-treat analyses revealed a significant group-by-time effect for steps per day at 10-weeks (+ 1417, 95%CI: 449, 2384) and 9-months follow-up (+ 1480, 95%CI: 493, 2467) in intervention children compared to control. There were also favourable group-by-time effects for numerous secondary outcomes including fathers’ physical activity levels, children’s FMS proficiency, and several parenting constructs. No effects were observed for both fathers’ and children’s accelerometer based LPA or MVPA, co-physical activity, screen-time and adiposity measures. Process evaluation data revealed very high levels of satisfaction, attendance, retention, and intervention fidelity.

Conclusion

Engaging fathers in a lifestyle program is a promising strategy to increase physical activity among preschool-aged children. Additional benefits to fathers’ physical activity levels, children’s FMS proficiency and parenting practices further support the importance of engaging fathers to improve family health outcomes.

Trial Registration

Australian New Zealand Clinical Trials Registry: ACTRN12619000105145. Registered 24/01/2019.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-13424-1.