Physical Activity: Family-Based Interventions

Findings and Recommendations

The Community Preventive Services Task Force (CPSTF) recommends family-based interventions to increase physical activity among children.

The full CPSTF Finding and Rationale Statement and supporting documents for Physical Activity: Family-Based Interventions are available in The Community Guide Collection on CDC Stacks.

Intervention

Family-based interventions combine activities to build family support with health education to increase physical activity among children. Interventions include one or more of the following:

Goal-setting tools and skills to monitor progress, such as a website to enter information
Reinforcement of positive health behaviors, such as reward charts or role modeling of physical activity by parents or instructors
Organized physical activity sessions, such as instructor-led opportunities for active games

Interventions also may provide information about other lifestyle behaviors, such as choosing healthier foods or reducing screen time.

About The Systematic Review

The CPSTF uses recently published systematic reviews to conduct accelerated assessments. 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.

Study Characteristics

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
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)

Summary of Results

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)

Summary of Economic Evidence

A systematic review of economic evidence has not been conducted.

Applicability

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.

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?

General Research Issues

The following outlines evidence gaps for reviews of the following interventions to increase physical activity:

Effectiveness

Several crosscutting research issues about the effectiveness of all of the reviewed interventions remain.

What behavioral changes that do not involve physical activity can be shown to be associated with changes in physical activity?
- For example, does a decrease in time spent watching television mean an increase in physical activity or will another sedentary activity be substituted?
- Does an increase in the use of public transportation mean an increase in physical activity or will users drive to the transit stop?
Physical activity is difficult to measure consistently across studies and populations. Although several good measures have been developed, several issues remain to be addressed.
- Reliable and valid measures are needed for the spectrum of physical activity. Rationale: Current measures are better for vigorous activity than for moderate or light activity.
- Sedentary people are more likely to begin activity at a light level; this activity is often not captured by current measurement techniques.
- Increased consensus about “best measures” for physical activity would help to increase comparability between studies and would facilitate assessment of effectiveness.
Note: This is not intended to preclude researchers’ latitude in choosing what aspects of physical activity to measure and to decide which measures are most appropriate for a particular study population. Perhaps a useful middle ground position would be the establishment of selected core measures that most researchers should use which could then be supplemented by additional measures. The duration of an intervention’s effect was often difficult to determine.

Applicability

Each recommended and strongly recommended intervention should be applicable in most relevant target populations and settings, assuming that appropriate attention is paid to tailoring. However, possible differences in the effectiveness of each intervention for specific subgroups of the population often could not be determined. Several questions about the applicability of these interventions in settings and populations other than those studied remain.

Are there significant differences in the effectiveness of these interventions, based on the level or scale of an intervention?
What are the effects of each intervention in various sociodemographic subgroups, such as age, sex, race, or ethnicity?

Other Positive or Negative Effects

The studies included in this review did not report on other positive and negative effects of these interventions. Research on the following questions would be useful:

Do informational approaches to increasing physical activity help to increase health knowledge? Is it necessary to increase knowledge or improve attitudes toward physical activity to increase physical activity levels?
Do these approaches to increasing physical activity increase awareness of opportunities for and benefits of physical activity?
What are the most effective ways to maintain physical activity levels after the initial behavior change has occurred?
Are there other benefits from an intervention that might enhance its acceptability? For example, does increasing social support for physical activity carry over into an overall greater sense of community?
Are there any key harms?
Is anything known about whether or how approaches to physical activity could reduce potential harms (e.g., injuries or other problems associated with doing too much too fast)?

Economic Evidence

The available economic data were limited. Therefore, considerable research is warranted on the following questions:

What is the cost-effectiveness of each of these interventions?
How can effectiveness in terms of health outcomes or quality-adjusted health outcomes be better measured, estimated, or modeled?
How can the cost benefit of these programs be estimated?
How do specific characteristics of each of these approaches contribute to economic efficiency?
What combinations of components in multicomponent interventions are most cost-effective?

Barriers

Research questions generated in this review include the following:

What are the physical or structural (environmental) barriers to implementing these interventions?
What resource (time and money) constraints prevent or hinder the implementation of these interventions?

Implementation Considerations and Resources

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

Crosswalks