Adding family digital supports to classroom-based physical activity interventions to target in- and out-of-school activity: An evaluation of the Stay Active intervention during the COVID-19 pandemic
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Keywords

mHealth
mobile health
short messaging system (SMS)
pediatric
school
wearables

Abstract

Introduction: Interventions targeting multiple levels of influence and settings may have a greater impact on children’s total daily physical activity than those targeting a single setting. This study evaluated the addition of family supports to a classroom-based physical activity intervention.

Methods: 6 schools were randomized to a remotely delivered classroom-based physical activity only (CBPA) or classroom-based physical activity plus family (CBPA+) arm. The latter added behavior change tools (e.g., self-regulation) delivered via text messages and newsletters to caregiver/child dyads. The intervention lasted for 7 weeks with a 1-week baseline and 1-week post-intervention assessment (9 weeks total). Children who enrolled in the evaluation study received a Garmin activity monitor, which was used to tailor the text messages and evaluate changes in moderate to vigorous physical activity (MVPA). Caregivers completed surveys evaluating intervention acceptability.

Results: The 53 child participants (CBPA n=35; CBPA+ n=18) were 9.7±0.7 years old, 64% were female, 59% were Black, and 23% were Hispanic/Latinx. Almost 90% of caregivers reported high satisfaction with the added family-based intervention content. Adherence to wearing the Garmin was higher in the CBPA+ arm. MVPA was low at baseline and during the first 3 weeks of the intervention (CBPA 7.5±3.1 minutes/day; CBPA+ 7.9±2.7 minutes/day) and increased by ~45 min/day by weeks 6-8 (CBPA 56.8±34.2 minutes/day; CBPA+ 49.2±18.7minutes/day). Changes in MVPA were similar between arms.

Conclusion: The high acceptability and intervention engagement in the CBPA+ arm show promise for integrating mHealth tools to provide additional family support in multilevel multiapproach interventions targeting children’s physical activity.

https://doi.org/10.51250/jheal.v1i4.31
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References

Böhm B, Karwiese SD, Böhm H, Oberhoffer R. (2019). Effects of Mobile Health Including Wearable Activity Trackers to Increase Physical Activity Outcomes Among Healthy Children and Adolescents: Systematic Review. JMIR Mhealth Uhealth. 7(4):e8298 doi: 10.2196/mhealth.8298

Brazendale, K., Beets, M. W., Weaver, R. G., Pate, R. R., Turner-McGrievy, G. M., Kaczynski, A. T., ... & von Hippel, P. T. (2017). Understanding differences between summer vs. school obesogenic behaviors of children: the structured days hypothesis. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 1-14.

Bronikowski M, Bronikowska M, Glapa A. (2016). Do they need goals or support? A report from a goal-setting intervention using physical activity monitors in youth. Int J Environ Res Public Health. 13(13),9.

Carlson, J. A., Sallis, J.F., Norman, G.J., McKenzie, T.L., Kerr, J., Arredondo, E.M., Madanat, H., Mignano, A.M., Cain, K.L., Elder, J.P., & Saelens, B.E. (2013). Elementary school practices and children's objectively measured physical activity during school. Preventive Medicine, 57(5), 591-595. PMC3904859

Carlson, J. A., Engelberg, J. K., Cain, K. L., Conway, T. L., Mignano, A. M., Bonilla, E. A., & Sallis, J. F. (2015). Implementing classroom physical activity breaks: Associations with student physical activity and classroom behavior. Preventive medicine, 81, 67-72.

Carlson, J. A., Schipperijn, J., Kerr, J., Saelens, B. E., Natarajan, L., Frank, L. D., ... & Sallis, J. F. (2016). Locations of physical activity as assessed by GPS in young adolescents. Pediatrics, 137(1).

Chi, D. L., Luu, M., & Chu, F. (2017). A scoping review of epidemiologic risk factors for pediatric obesity: implications for future childhood obesity and dental caries prevention research. Journal of Public Health Dentistry, 77, S8-S31.

Christodoulos AD, Douda HT, Polykratis M, et al. Attitudes towards exercise and physical activity behaviours in Greek schoolchildren after a year long health education intervention. Br J Sports Med 2006;40:367–71.

Collins, L. M., Murphy, S. A., & Strecher, V. (2007). The multiphase optimization strategy (MOST) and the sequential multiple assignment randomized trial (SMART): new methods for more potent eHealth interventions. American journal of preventive medicine, 32(5), S112-S118.

Cushing, C. C., Bejarano, C. M., Ortega, A., Sayre, N., Fedele, D. A., & Smyth, J. M. (2021). Adaptive mHealth Intervention for Adolescent Physical Activity Promotion. Journal of Pediatric Psychology.

Dale, L. P., Vanderloo, L., Moore, S., & Faulkner, G. (2019). Physical activity and depression, anxiety, and self-esteem in children and youth: an umbrella systematic review. Mental Health and Physical Activity, 16, 66-79.

Direito, A., Carraça, E., Rawstorn, J., Whittaker, R., & Maddison, R. (2017). mHealth Technologies to Influence Physical Activity and Sedentary Behaviors: Behavior Change Techniques, Systematic Review and Meta-Analysis of Randomized Controlled Trials. Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 51(2), 226–239. https://doi.org/10.1007/s12160-016-9846-0

Dunton, G.F., Do, B. & Wang, S.D. (2020). Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S.. BMC Public Health 20, 1351. https://doi.org/10.1186/s12889-020-09429-3

Eisenmann, J. C., Gentile, D. A., Welk, G. J., Callahan, R., Strickland, S., Walsh, M., & Walsh, D. A. (2008). SWITCH: rationale, design, and implementation of a community, school, and family-based intervention to modify behaviors related to childhood obesity. BMC Public health, 8(1), 1-10.

Elementary and Secondary Information System, National Center for Education Statistics, nces.ed.gov/ccd/elsi/default.aspx?agree=0. Accessed on May 2, 2021.

Fedele, D. A., Cushing, C. C., Fritz, A., Amaro, C. M., & Ortega, A. (2017). Mobile health interventions for improving health outcomes in youth: a meta-analysis. JAMA pediatrics, 171(5), 461-469.

Friel, C. P., Duran, A. T., Shechter, A., & Diaz, K. M. (2020). US Children Meeting Physical Activity, Screen Time, and Sleep Guidelines. American Journal of Preventive Medicine, 59(4), 513-521.

Garmin Ltd. (2018). vívosmart 4 - Step Goal. Retrieved June 2, 2021, from https://www8.garmin.com/manuals/webhelp/vivosmart4/EN-US/GUID-5AC1A1BC-EFB3-40EC-9C18-2BF1D6218E69.html

GoNoodle (2015, July 24). Rock Out - Fresh Start Fitness [Video]. YouTube. https://www.youtube.com/watch?v=3KReaoKLA-4&list=PLAwOTEJXH-cN4YyNnBR19QBdcM7Kn79Qs&index=1 .

Head, K. J., Noar, S. M., Iannarino, N. T., & Harrington, N. G. (2013). Efficacy of text messaging-based interventions for health promotion: a meta-analysis. Social science & medicine, 97, 41-48.

Janssen I, Leblanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act 2010;7:40

Klinker, C.D., Schipperijn, J., Christian, H., Kerr, J., Ersbøll, A.K., Troelsen, J. (2014). Using accelerometers and global positioning system devices to assess gender and age differences in children’s school, transport, leisure and home based physical activity. Int J Behav Nutr Phys Act, 11(1):8. https://doi.org/10.1186/1479-5868-11-8.

Luepker RV, Perry CL, McKinlay SM, et al. Outcomes of a field trial to improve children’s dietary patterns and physical activity. The Child and Adolescent Trial for Cardiovascular Health (CATCH). JAMA 1996;275:768–76.

Mclaughlin, M., Delaney, T., Hall, A., Byaruhanga, J., Mackie, P., Grady, A., Reilly, K., Campbell, E., Sutherland, R., Wiggers, J., & Wolfenden, L. (2021). Associations Between Digital Health Intervention Engagement, Physical Activity, and Sedentary Behavior: Systematic Review and Meta-analysis. Journal of medical Internet research, 23(2), e23180. https://doi.org/10.2196/23180

Messing, S., Rütten, A., Abu-Omar, K., Ungerer-Röhrich, U., Goodwin, L., Burlacu, I., & Gediga, G. (2019). How can physical activity be promoted among children and adolescents? A systematic review of reviews across settings. Frontiers in public health, 7, 55.

Metcalf B, Henley W, Wilkin T. Effectiveness of intervention on physical activity of children: systematic review and meta-analysis of controlled trials with objectively measured outcomes (EarlyBird 54). BMJ. 2012;345:e5888

Michie, S., Abraham, C., Whittington, C., McAteer, J., & Gupta, S. (2009). Effective techniques in healthy eating and physical activity interventions: a meta-regression. Health Psychology, 28(6), 690.

Norton DE, Froelicher ES, Waters CM, Carrieri-Kohlman V. Parental influence on models of primary prevention of cardiovascular disease in children. Eur J Cardiovasc Nurs 2003;2:311–22.

Ortega, A., Cushing, C.C. (2020). Developing Empirical Decision Points to Improve the Timing of Adaptive Digital Health Physical Activity Interventions in Youth: Survival Analysis JMIR Mhealth Uhealth, 8(6):e17450

Ortega, A., Bejarano, C. M., Cushing, C. C., Staggs, V. S., Papa, A. E., Steel, C., & Carlson, J. A. (2020). Differences in adolescent activity and dietary behaviors across home, school, and other locations warrant location-specific intervention approaches. International Journal of Behavioral Nutrition and Physical Activity, 17(1), 1-12.

Poitras VJ, Gray CE, Borghese MM, Carson V, Chaput J-P, Janssen I, Katzmarzyk PT, Pate RR, Connor Gorber S, Kho ME, Sampson M, Tremblay MS. Systematic review of the relationships between objectively measured physical activity and health indicators in school-aged children and youth. Appl Physiol Nutr Metab. 2016;41(6 (Suppl. 3):S197–239. https://doi.org/10.1139/apnm-2015-0663

R Core Team (2021). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. URL https://www.R-project.org/.

Rhodes, R. E., Guerrero, M. D., Vanderloo, L. M., Barbeau, K., Birken, C. S., Chaput, J. P., ... & Tremblay, M. S. (2020). Development of a consensus statement on the role of the family in the physical activity, sedentary, and sleep behaviours of children and youth. International Journal of Behavioral Nutrition and Physical Activity, 17(1), 1-31..

Rizopoulos, D. (2010). JM: An R package for the joint modelling of longitudinal and time-to-event data. Journal of Statistical Software (Online), 35(9), 1-33.

Sallis J, Prochaska J, Taylor W. A review of correlates of physical activity of children and adolescents. (2000). Med Sci Sports Exerc 5 :963–75.

Salmon, J., Booth, M. L., Phongsavan, P., Murphy, N., & Timperio, A. (2007). Promoting physical activity participation among children and adolescents. Epidemiologic reviews, 29(1), 144-159.

Sanford Health (2021). fitFLow. Website. https://fit.sanfordhealth.org/resources/fitflow-activity.

Shapiro J.R., Bauer S., Hamer R.M., Kordy H., Ward D. & Bulik C.M. (2008). Use of text messaging for monitoring sugar-sweetened beverages, physical activity, and screen time in children: A pilot study. Journal of Nutrition Education & Behavior, 40(6), 385–391.

Spinelli M, Lionetti F, Setti A, Fasolo M. Parenting Stress During the COVID-19 Outbreak: Socioeconomic and Environmental Risk Factors and Implications for Children Emotion Regulation. Fam Process. 2020 Sep 28. doi: 10.1111/famp.12601. Epub ahead of print. PMID: 32985703.

Stevens, J., Story, M., Ring, K., Murray, D. M., Cornell, C. E., & Gittelsohn, J. (2003). The impact of the Pathways intervention on psychosocial variables related to diet and physical activity in American Indian schoolchildren. Preventive medicine, 37, S70-S79.

Tassitano, R. M., Weaver, R. G., Tenório, M. C. M., Brazendale, K., & Beets, M. W. (2020). Physical activity and sedentary time of youth in structured settings: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 17(1), 1-17.

Van Sluijs, E. M., McMinn, A. M., & Griffin, S. J. (2007). Effectiveness of interventions to promote physical activity in children and adolescents: systematic review of controlled trials. Bmj, 335(7622), 703.

Warren JM, Henry CJK, Lightowler HJ, et al. (2003). Evaluation of a pilot school programme aimed at the prevention of obesity in children. Health Promot Int. 18:287–96.

Walton, A., Nahum‐Shani, I., Crosby, L., Klasnja, P., & Murphy, S. (2018). Optimizing digital integrated care via micro‐randomized trials. Clinical Pharmacology & Therapeutics, 104(1), 53-58.

Watson, A., Timperio, A., Brown, H., Best, K., & Hesketh, K. D. (2017). Effect of classroom-based physical activity interventions on academic and physical activity outcomes: a systematic review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 14(1), 1-24.

World Health Organization. (2020) WHO announces COVID-19 outbreak a pandemic [Available from: http://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/news/news/2020/3/whoannounces-covid-19-outbreak-a-pandemic.

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