Review and special article
Engaging Parents to Increase Youth Physical Activity: A Systematic Review

https://doi.org/10.1016/j.amepre.2009.04.020Get rights and content

Background

Parents are often involved in interventions to engage youth in physical activity, but it is not clear which methods for involving parents are effective.

Purpose

A systematic review was conducted of interventions with physical activity and parental components among healthy youth to identify how best to involve parents in physical activity interventions for children.

Evidence acquisition

Identified intervention studies were reviewed in 2008 for study design, description of family components, and physical activity outcomes. The quality of reporting was assessed using the CONSORT checklist for reporting on trials of nonpharmacologic treatments.

Evidence synthesis

The literature search identified 1227 articles, 35 of which met review criteria. Five of the 14 RCTs met ≥70% of CONSORT checklist items. Five general procedures for involving parents were identified: (1) face-to-face educational programs or parent training, (2) family participatory exercise programs, (3) telephone communication, (4) organized activities, and (5) educational materials sent home. Lack of uniformity in reporting trials, multiple pilot studies, and varied measurements of physical activity outcomes prohibited systematic conclusions. Interventions with educational or training programs during family visits or via telephone communication with parents appear to offer some promise.

Conclusions

There is little evidence for effectiveness of family involvement methods in programs for promoting physical activity in children, because of the heterogeneity of study design, study quality, and outcome measures used. There is a need to build an evidence base of more-predictive models of child physical activity that include parent and child mediating variables and procedures that can effect changes in these variables for future family-based physical activity interventions.

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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