Physical Activity: Family-Based Interventions

The CPSTF uses recently published systematic reviews to conduct accelerated assessments of interventions that could provide program planners and decision-makers with additional, effective options. The following published review was selected and evaluated by a team of specialists in systematic review methods, and in research, practice, and policy related to increasing physical activity.

Brown HE, Atkin AJ, Panter J, Wong G, Chinapaw MJM, van Sluijs EMF. Family-based interventions to increase physical activity in children: a systematic review, meta-analysis and realist synthesis. Obesity Review 2016;17(4):345-60.

The systematic review included 47 studies (search period through September 2015). The review included a meta-analysis and a realist synthesis. The CPSTF finding is based on the 19 studies used for the meta-analysis.

The CPSTF finding is based on results from the published review, additional information from the meta-analysis, and expert input from team members and the CPSTF.

This review updates and replaces the 2001 CPSTF finding on Family-Based Social Support to Increase Physical Activity.

The U.S. Department of Health and Human Services recommends that young people ages 6 17 years participate in at least 60 minutes of physical activity daily (HHS, 2008).

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement.

The meta-analysis used as the basis for the CPSTF finding included 19 studies.

• Physical activity among children in the intervention groups increased by a small but statistically significant amount (19 studies).
• Studies that directly measured physical activity with accelerometers, pedometers, or direct observation (16 studies) showed slightly greater increases than studies that used self-reported data (3 studies).

A systematic review of economic evidence has not been conducted.

Based on results from the Brown et al. systematic review, findings should be applicable to U.S. families with girls and boys ages 5 12 years.

The CPSTF identified several areas that have limited information. Additional research and evaluation could help answer the following questions and fill remaining gaps in the evidence base. (What are evidence gaps?)

• How effective are interventions targeted to certain groups based on demographic characteristics (i.e., single-sex interventions)?
• Which combination of intervention components are most effective?
• Does the duration of the intervention have an effect?

• Included studies addressed physical activity only (8 studies) or physical activity plus additional behaviors such as dietary habits (11 studies).
• Intervention strategies included education (19 studies), goal-setting (7 studies), reinforcement of positive health behaviors (4 studies), and role modeling (4 studies). Interventions may have included more than one strategy.
• Included studies were conducted in the United States (11 studies), the United Kingdom (3 studies), Australia (3 studies), Singapore (1 study), and New Zealand (1 study).
• Interventions lasted from 8 days to 12 months, and follow-up ranged from 1 to 36 months.
• Interventions were delivered by community leaders (often selected for their cultural connection to participants), healthcare providers, researchers, or teachers.
• Settings included schools, afterschool programs, homes, community centers, churches, universities, or research institutes.
• Programs targeted families with healthy children aged 5 12 years.
• Five studies included girls only, and the remaining studies included roughly equal numbers of boys and girls.
• Study populations included children who were all considered to be healthy weight (4 studies), children who were mostly overweight or obese (3 studies), or children whose weight was not reported (12 studies).

Effectiveness Review

No content is available for this section.

Effectiveness Review

A summary evidence table for this Community Guide review is not available because the CPSTF finding is based on the following published systematic review:

Brown HE, Atkin AJ, Panter J, Wong G, Chinapaw MJM, van Sluijs EMF. Family-based interventions to increase physical activity in children: a systematic review, meta-analysis and realist synthesis. Obesity Review 2016;17(4):345-60.

The number of studies and publications do not always correspond (e.g., a publication may include several studies or one study may be explained in several publications).

Effectiveness Review

Studies Included in the Meta-Analysis (Brown et al., 2016)

Beech B, Klesges R. Child-and parent-targeted interventions: the Memphis GEMS pilot study. Ethn Dis 2003;13(1 Suppl 1):S40-53.

Chen JL, Weiss S, Heyman MB, Lustig RH. Efficacy of a child-centred and family-based program in promoting healthy weight and healthy behaviors in Chinese American children: a randomized controlled study. J Public Heal 2010;32(2):219 29.

Chen JL, Weiss S, Heyman MB, Cooper B, Lustig RH. The efficacy of the web-based childhood obesity prevention program in Chinese American adolescents (Web ABC study). J Adolesc Health 2011;49(2):148 54.

Crespo NC, Elder JP, Ayala GX, Slymen DJ, Campbell NR, Sallis JF, et al. Results of a multi-level intervention to prevent and control childhood obesity among Latino children: the Aventuras Para Ninos Study. Ann Behav Med 2012;43(1):84 100.

Duncan S, McPhee JC, Schluter PJ, Zinn C, Smith R, Schofield G. Efficacy of a compulsory homework programme for increasing physical activity and healthy eating in children: the healthy homework pilot study. Int J Behav Nutr Phys Act 2011;8:127.

Eather N, Morgan PJ, Lubans DR. Feasibility and preliminary efficacy of the Fit4Fun intervention for improving physical fitness in a sample of primary school children: a pilot study. Phys Educ Sport Pedagog 2013;18(4):389 411.

Finkelstein EA, Tan YT, Malhotra R, Lee CF, Goh SS, Saw SM. A cluster randomized controlled trial of an incentive-based outdoor physical activity program. J Pediatr 2013; 163(1):167-72.

Hardman CAC, Horne PPJ, Lowe CF. A home-based intervention to increase physical activity in girls: the “fit n fun” dudes program. J Exerc Sci Fit 2009;7(1):1 8.

Hovell MF, Nichols JF, Irvin VL, Schmitz KE, Rock CL, Hofstetter CR, et al. Parent/child training to increase preteens’ calcium, physical activity, and bone density: a controlled trial. Am J Heal Promot 2009;24(2):118 28.

Jago R, Sebire SJ, Turner KM, Bentley GF, Goodred JK, Fox KR, et al. Feasibility trial evaluation of a physical activity and screen-viewing course for parents of 6 to 8 year-old children: Teamplay. Int J Behav Nutr Phys Act 2013;10:31.

Morgan PJ, Collins CE, Plotnikoff RC, Callister R, Burrows T, Fletcher R, et al. The `Healthy Dads, Healthy Kids’ community randomized controlled trial: a community-based healthy lifestyle program for fathers and their children. Prev Med 2014 Apr;61:90 9.

Morrison R, Reilly JJ, Penpraze V, Westgarth C, Ward DS, Mutrie N, et al. Children, parents and pets exercising together (CPET): exploratory randomised controlled trial. BMC Public Health; 2013;13:1096.

Nyberg G, Sundblom E, Norman , Bohman B, Hagberg J, Elinder LS. Effectiveness of a universal parental support programme to promote healthy dietary habits and physical activity and to prevent overweight and obesity in 6-year-old children: the Healthy School Start Study, a cluster-randomised controlled trial. PLoS One 2015;10: e0116876.

Olvera N, Bush J a, Sharma S V, Knox BB, Scherer RL, Butte NF. BOUNCE: a community-based mother-daughter healthy lifestyle intervention for low-income Latino families. Obes 2010;18 Suppl 1(n1s):S102 4.

Patterson TL, Sallis JF, Nader PR, Rupp JW, McKenzie TL, Roppe B, et al. Direct observation of physical activity and dietary behaviors in a structured environment: effects of a family-based health promotion program. J Behav Med 1988;11(5):447 58.

Ransdell LB, Robertson L, Ornes L, Moyer-Mileur L. Generations Exercising Together to Improve Fitness (GET FIT): a pilot study designed to increase physical activity and improve health-related fitness in three generations of women. Women Health 2004;40(3):77 94.

Shelton D, Le Gros K, Norton L, Stanton-Cook S, Morgan J, Masterman P. Randomised controlled trial: a parent-based group education programme for overweight children. J Paediatr Child Heal 2007;43(12):799 805.

Story M, Sherwood NE, Himes JH, Davis M, Jacobs DR, Cartwright Y, et al. An after-school obesity prevention program for African-American girls: the Minnesota GEMS pilot study. Ethnicity and Disease 2003;13(1 Suppl 1):S54 64.

Trost SG, Tang R, Loprinzi PD. Feasibility and efficacy of a church-based intervention to promote physical activity in children. J Phys Act Heal 2009;6(6):741 9.

Refer to the existing systematic review for information about the search strategy:

Brown HE, Atkin AJ, Panter J, Wong G, Chinapaw MJM, van Sluijs EMF. Family-based interventions to increase physical activity in children: a systematic review, meta-analysis and realist synthesis. Obesity Review 2016;17(4):345-60.

Brown HE, Atkin AJ, Panter J, Wong G, Chinapaw MJM, van Sluijs EMF. Family-based interventions to increase physical activity in children: a systematic review, meta-analysis and realist synthesis. Obesity Review 2016;17(4):345-60. Available at URL: http://onlinelibrary.wiley.com/doi/10.1111/obr.12362/full.

U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans. Washington (DC): U.S. Department of Health and Human Services; 2008.

The following considerations are drawn from studies included in the evidence review, the broader literature, and expert opinion.

The Brown et al. systematic review recommends the following for practitioners and policy-makers, based on studies included in both the meta-analysis and realist synthesis.

• Family-based interventions should be tailored to consider the ethnicity of the family, how motivated parents are to increase children’s physical activity, and time constraints due to work and school responsibilities.
• Combining goal-setting and reinforcement techniques improves physical activity by increasing motivation.
• The family psychosocial environment should be considered when designing interventions to increase physical activity among both children and their families. These efforts should focus on the child as the agent of change.

Evidence-Based Cancer Control Programs (EBCCP)

Find programs from the EBCCP website that align with this systematic review. (What is EBCCP?)

Healthy People 2030

Healthy People 2030 includes the following objectives related to this CPSTF recommendation.

• • Reduce the proportion of adults who do no physical activity in their free time — PA‑01
  • Increase the proportion of adults who do enough aerobic physical activity for substantial health benefits — PA‑02
  • Increase the proportion of adults who do enough aerobic physical activity for extensive health benefits — PA‑03
  • Increase the proportion of adults who do enough aerobic and muscle-strengthening activity — PA‑05
  • Increase the proportion of adolescents who do enough aerobic physical activity — PA‑06
  • Increase the proportion of adolescents who do enough muscle-strengthening activity — PA‑07
  • Increase the proportion of adolescents who do enough aerobic and muscle-strengthening activity — PA‑08
  • Increase the proportion of children who do enough aerobic physical activity — PA‑09
  • Increase the proportion of adults who walk or bike to get places — PA‑10
  • Increase the proportion of adolescents who walk or bike to get places — PA‑11