Review and special articleEngaging Parents to Increase Youth Physical Activity: A Systematic Review
Introduction
Physical activity among youth has been associated with lower prevalence of several chronic disease risk factors including increased body mass,1 elevated lipids,2 higher insulin levels,3 and higher blood pressure,2 as well as lower self-esteem.4 Change in physical activity from age 9 to 15 years predicted insulin and HOMA-Insulin Resistance levels at age 15, suggesting that change in physical activity during youth was important for the prevention of insulin resistance.5 Regular physical activity among youth also had social benefits, such as learning new social skills6 and enhancing personal development.7 Physical activity played a central role in the development of children's friendship groups, particularly among boys.8 These findings suggest that ensuring that youth are physically active is important for children's physical and emotional development.
It has been suggested that attempts to increase children's physical activity should target the whole family.9, 10, 11 Parents can strongly influence children's physical activity behaviors through role-modeling and direct involvement, and these influences may last beyond adolescence.11 Parental support, direct help from parents, and opportunities to exercise have consistently been associated with adolescent physical activity.12
Previous reviews of physical activity and obesity prevention interventions have attempted to evaluate the effects of involving parents in physical activity interventions for children only as subsections of broader reviews. Two reviews claimed that the evidence for involving families was insufficient or not consistent enough to draw conclusions, including a systematic review of both child and adult physical activity interventions13 and a review of obesity prevention interventions in the school setting.14 Alternatively, others concluded that strategies to involve the family appeared to be the most promising. A systematic review of school-based physical activity interventions found strong evidence for involving families with adolescents, but insufficient evidence for children.15 Narrative reviews of physical activity interventions for youth concluded that interventions that involved families,10 or more specifically involved families in the school setting with additional child components, were most effective.16, 17
Although involving parents and families in interventions to increase children's physical activity appears to be a reasonable approach, to date, attention has been focused primarily on how interventions target children in order to change their behaviors. Interventions have used multiple channels to reach parents and various methods to involve parents in physical activity interventions for children, with no clear understanding of which is the best approach. This review seeks to answer the question: What is the best method to involve parents in interventions for children to increase their children's physical activity?
Section snippets
Evidence Acquisition
PubMed, MEDLINE, PsycINFO, and Cochrane Library databases were searched in Spring 2008 to identify intervention studies whose aim (primary or secondary) was to increase physical activity among otherwise healthy children or adolescents and that included a family intervention component. The search terms included: (1) preschool child, child, adolescent, teen; (2) physical activity, motor activity, exercise; (3) obesity, weight, overweight; (4) family, parent(s); and (5) prevention, intervention,
Evidence Synthesis
Thirty-five family-based intervention studies were identified that targeted increases in physical activity (see Appendixes A and B, available online at www.ajpm-online.net). A summary of study characteristics (Table 1) shows that the primary aim of nine (28.6%) of the studies24, 25, 26, 27, 28, 29, 30, 31, 32 was to increase physical activity. Four studies9, 33, 34, 35 (8.6%) were designed to improve physical activity and diet behaviors, eight21, 36, 37, 38, 39, 40, 41, 42 (22.9%) to prevent
Discussion
There was no obvious pattern to identify which family involvement methods resulted in physical activity behavior change. Given the large number of pilot studies reported; the large variability in study design and outcome variables reported; the measures used to assess the outcome variables; and the lack of reporting of intervention fidelity, dose, and exposure, it is not possible to draw any conclusions as to how best to involve parents to yield the most promising outcomes for increasing
Conclusion
There is little evidence from the current review for the effectiveness of family involvement methods or parental components in promoting physical activity in children, as a result of the heterogeneity of study design, study quality, and the outcome measures employed. Face-to-face interactions and/or telephone contact with parents that provide parent training, family counseling, or preventive messages appear to offer some promise that needs to be evaluated in larger, well-designed studies.
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