Perspectives and Impact of a Parent-Child Intervention on Dietary Intake and Physical Activity Behaviours, Parental Motivation, and Parental Body Composition: A Randomized Controlled Trial.

Adults and children in Canada are not meeting physical activity guidelines nor consuming sufficient nutrient-rich foods. High engagement in these unhealthy behaviours can lead to obesity and its associated diseases. Parent-child interventions aimed at obesity prevention/treatment have assisted families with making positive changes to their nutrition and physical activity behaviours. Given that the home environment shapes early health behaviours, it is important to target both parents and children when addressing diet and physical activity. One method that has been shown to improve health outcomes is co-active coaching. The current study explored the impact of a three-month co-active coaching and/or health education intervention on the dietary intake and physical activity behaviours of parents with overweight/obesity and their children (ages 2.5-10; of any weight). Body composition (i.e., body mass index [BMI] and waist circumference), changes in parental motivation with respect to physical activity and dietary behaviours, and parental perceptions of program improvements were collected. A concurrent mixed methods study comprised of a randomized controlled trial and a descriptive qualitative design was utilized. Fifty parent-child dyads were recruited and randomly assigned to the control (n = 25) or intervention (n = 25) group. Assessments were completed at baseline, mid-intervention (six weeks), post-intervention (three months), and six-month follow-up. A linear mixed effects model was utilized for quantitative analysis. Inductive content analysis was used to extract themes from parent interviews. No significant results were observed over time for the dependent measures. Parents in both control and intervention groups reported varied program experiences, including developing changes in perspective, increased awareness of habits, and heightened accountability for making positive changes in themselves, and consequently, their families. Parents also shared barriers they faced when implementing changes (e.g., time, weather, stress). Qualitatively, both groups reported benefitting from this program, with the intervention group describing salient benefits from engaging in coaching. This research expands on the utility of coaching as a method for behaviour change, when compared to education only, in parents with overweight/obesity and their children.

Coaching and/or education intervention for parents with overweight/obesity and their children: study protocol of a single-centre randomized controlled trial.

BACKGROUND: In Canada, a majority of children and adults are insufficiently active for health gains, and about one in seven children and over 20% of adults are overweight or obese. Overweight and obesity are risk factors for many chronic diseases in both adults and children and can result in lower quality and quantity of life. Children whose parents are overweight or obese are more likely to become overweight themselves. Thus, parent/child interventions are important for reducing obesity and promoting long-term healthy weights among members of the family unit. Programs using Co-Active coaching have resulted in positive behaviour changes among adults with overweight/obesity; however, little research has explored the effects of Co-Active coaching on parents, and the consequent impact on the family unit (i.e. all parents and children in the same household). This protocol paper provides a detailed methodological account of a coaching-based program targeting parent and child dyads, in hopes of enhancing health behaviours within the family unit. METHODS: Using a randomized controlled trial design, the researchers aim to identify the impact of coaching plus education (intervention) compared to education only (control) on parents with overweight/obesity and their children (ages 2.5-10, of any weight). A total of 50 dyads are being recruited and randomly assigned using a 1:1 ratio into the control or intervention group. The control group receive 6 webinar-based education sessions focused on physical activity and nutrition. The intervention group receive the same education sessions and nine, 20-min telephone-based sessions with a certified coach. Coaching and health education sessions are conducted with the parent/guardian of the dyad. This paper provides a detailed methodological account of this program. DISCUSSION: The expected findings from this research will advance coaching literature, research, and practice on this topic by determining whether coaching and education are more effective than education alone at producing behaviour changes among a family unit. If proven effective, this approach may be applied more broadly through public health interventionists to parent and child populations in hopes of affecting change with both individuals and their families. TRIAL REGISTRATION: ISRCTN ISRCTN69091372 . Retrospectively registered 24 September 2018.

Prenatal Education: Program Content and Preferred Delivery Method From the Perspective of the Expectant Parents.

The purpose of this research is to better understand expectant parents' perception of importance regarding a wide range of prenatal education topics and their information delivery method preferences. One hundred and eighty-one expectant parents completed the investigator-developed survey tools. Most of the participants rated each item on the Perceived Importance of Topics survey as "important" or "very important." Overall, the topics of Newborn Safety, Birth, and Breastfeeding had the highest percentage of participants who indicated the topic was "very important." Most of the respondents (47.5%, n = 86) indicated that their preference was to attend face-to-face-prenatal education sessions. Additional delivery method preferences are discussed. Findings from this study provide valuable information to inform future prenatal education program content and delivery.

The effects of acute exercise on tobacco cravings and withdrawal symptoms in temporary abstinent pregnant smokers.

INTRODUCTION: Smoking during pregnancy is common, and quitting at any point during pregnancy can yield benefits to both the fetus and mother. Smoking cessation is typically followed by withdrawal symptoms and a strong desire to smoke, both of which are likely to contribute to relapse. Research has shown that a bout of exercise minimizes cravings and tobacco withdrawal symptoms (TWS) after temporary abstinence in smokers, but these findings have not been replicated in pregnant smokers. This study examined the effect of 20min of exercise on cravings (primary outcome) and TWS (secondary outcomes) among temporary abstinent, inactive pregnant smokers. METHODS: Thirty female smokers (Mean(M) age=25.7years, Standard Deviation(SD)=5.5; M weeks pregnant=18.2, SD=5.3; Fagerstrom Test for Cigarette Dependence=3.3, SD=2.2; M 9.3 cigarettes/day, SD=4.7; M hours abstained=17.2, SD=2.8) were randomized to 20 min of mild-to-moderate intensity exercise (EC; n=14) or passive (PC; n=16) condition. Cravings and TWS were assessed immediately before, during (at 10 min), immediately post, and at 10, 20, and 30 min post-condition. RESULTS: A 2 (condition)×6 (time) repeated measures ANOVA revealed that the EC significantly (p<0.05) reduced cravings (ή(2)=0.46) compared with the PC, across time. Non-significant, but nevertheless, large effects were evident favouring the EC over time for TWS restlessness (ή(2)=0.34), stress (ή(2)=0.24), irritability (ή(2)=0.21), tension (ή(2)=0.15), and depression (ή(2)=0.14). CONCLUSIONS: Consistent with previous research, this study reveals that in pregnant smokers, a bout of exercise is associated with a reduction in cravings and similar patterns exist for TWS. Therefore, exercise may have the potential to assist in the initial stages of smoking cessation attempts during pregnancy.

Pregnancy--should women put up their feet or lace up their running shoes?: Self-presentation and the exercise stereotype phenomenon during pregnancy.

Little is known about how women who exercise during pregnancy are perceived. The purpose of this study was to investigate whether the positive exercise stereotype (i.e., the general tendency for exercisers to be evaluated more positively than nonexercisers) extends to pregnancy. Adult women (N = 202, mean age = 38.55 years, SD = 13.46) were randomly assigned to read a description of one of the following pregnant female targets: regular exerciser, active living, excessive exerciser, nonexerciser, or control. Participants then rated the target on 12 personality and 8 physical dimensions. MANOVAs revealed a significant main effect for both physical and personality attributes (p < .05). The regular exerciser and active living target received the most positive ratings on both physical and personality dimensions. Whereas the excessive exerciser received high ratings on most physical characteristics, this target was also perceived as meaner and sadder, and having fewer friends than all other targets.

Effects of a group-based exercise and self-regulatory intervention on obese adolescents' physical activity, social cognitions, body composition and strength: a randomized feasibility study.

This feasibility study assessed the effects of an exercise plus group-based self-regulatory skills intervention on obese youths' physical activity, social cognitions, body composition and strength. Forty-three obese youth (male = 13, BMI > 95th percentile; 10-16 yrs) completed this 12-week intervention. Assessments were taken at baseline, week 6, 13 and 12 weeks post-intervention (week 24). Although no attention control group (i.e. exercise only) was included in this study, participants engaged in significantly more self-reported physical activity at weeks 13 and 24 as compared to baseline. Social cognitions, body composition and strength were also positively impacted suggesting this intervention technique may be feasible for treating obese adolescents.

Exercise during pregnancy: a review of patterns and determinants.

The mental and physical health benefits of exercise during pregnancy highlight the importance of understanding the determinants of pregnant women's physical activity. This paper presents a review of the existing research on pregnancy and physical activity, in order to (a) summarize the existing body of literature since 1986 examining changes in physical activity during pregnancy, (b) summarize correlates and predictors of physical activity during pregnancy, and (c) present directions for future research. A literature search yielded 25 articles published from 1986 to 2009 in English peer-reviewed journals. The major findings were categorized into the following: (a) exercise patterns, (b) demographic correlates/predictors, (c) the influence of pre-pregnancy exercise on pregnancy exercise, (d) theory-based predictors and (f) other correlates of exercise (e.g. general health and safety concerns). Results indicated that pregnant women are less active than non-pregnant women and that pregnancy leads to a decrease in physical activity. Consistent demographic predictors of higher exercise participation during pregnancy include higher education and income, not having other children in the home, being white, and being more active prior to becoming pregnancy. Only a few studies used theoretical models to understand physical activity during pregnancy with varied results. The review outlines demographic and theory-based correlates/predictors that should be taken into consideration when developing interventions to increase physical activity among pregnant women.

Understanding exercise self-efficacy and barriers to leisure-time physical activity among postnatal women.

Studies have demonstrated that postnatal women are at high risk for physical inactivity and generally show lower levels of leisure-time physical activity (LTPA) compared to prepregnancy. The overall purpose of the current study was to investigate social cognitive correlates of LTPA among postnatal women during a 6-month period following childbirth. A total of 230 women (mean age = 30.9) provided descriptive data regarding barriers to LTPA and completed measures of LTPA and self-efficacy (exercise and barrier) for at least one of the study data collection periods. A total of 1,520 barriers were content analyzed. Both exercise and barrier self-efficacy were positively associated with subsequent LTPA. Exercise self-efficacy at postnatal week 12 predicted LTPA from postnatal weeks 12 to 18 (ß = .40, R (2) = .18) and exercise self-efficacy at postnatal week 24 predicted LTPA during weeks 24-30 (ß = .49, R (2) = .30). Barrier self-efficacy at week 18 predicted LTPA from weeks 18 to 24 (ß = .33, R (2) = .13). The results of the study identify a number of barriers to LTPA at multiple time points closely following childbirth which may hinder initiation, resumption or maintenance of LTPA. The results also suggest that higher levels of exercise and barrier self-efficacy are prospectively associated with higher levels of LTPA in the early postnatal period. Future interventions should be designed to investigate causal effects of developing participants' exercise and barrier self-efficacy for promoting and maintaining LTPA during the postnatal period.

Postnatal women's feeling state responses to exercise with and without baby.

OBJECTIVE: Health research has demonstrated that physical activity during the postnatal period may play a crucial role in managing the physical and psychological challenges that women face during these times of transition. To promote physical activity during the postnatal period, mother-and-baby exercise classes are offered through several health and fitness organizations. The purpose of this study was to examine the effect of a moderate aerobic exercise session on feeling states when women exercised with their baby present compared to without their baby present. METHODS: Postnatal women (N = 23) participated in two 45-min exercise sessions: one with baby present and one without baby present. Exercise sessions were counterbalanced. The State Scale of the State-trait Anxiety Inventory and the Exercise-induced Feeling Inventory were used to assess feeling states pre- and post-exercise. To examine changes in feeling states during the exercise sessions and whether the changes differed between conditions, five separate mixed model ANCOVAs were conducted. RESULTS: There were no differences (P > .05) in feeling states when women exercised with or without their babies. However, both exercise conditions, showed significant improvements in feeling states from pre- to post-exercise session (P < or = .001) on the Exercise-induced Feeling Inventory subscales and the State Scale of the State-trait Anxiety Inventory. CONCLUSION: Exercising with baby present may be an effective option that allows mothers to balance care duties and a physically active lifestyle, while achieving psychological benefits associated with exercise participation.

Lifestyle modification and metformin as long-term treatment options for obese adolescents: study protocol.

BACKGROUND: Childhood obesity is a serious health concern affecting over 155 million children in developed countries worldwide. Childhood obesity is associated with significantly increased risk for development of type 2 diabetes, cardiovascular disease and psychosocial functioning problems (i.e., depression and decreased quality of life). The two major strategies for management of obesity and associated metabolic abnormalities are lifestyle modification and pharmacologic therapy. This paper will provide the background rationale and methods of the REACH childhood obesity treatment program. METHODS/DESIGN: The REACH study is a 2-year multidisciplinary, family-based, childhood obesity treatment program. Seventy-two obese adolescents (aged 10-16 years) and their parents are being recruited to participate in this randomized placebo controlled trial. Participants are randomized to receive either metformin or placebo, and are then randomized to a moderate or a vigorous intensity supervised exercise program for the first 12-weeks. After the 12-week exercise program, participants engage in weekly exercise sessions with an exercise facilitator at a local community center. Participants engage in treatment sessions with a dietitian and social worker monthly for the first year, and then every three months for the second year. The primary outcome measure is change in body mass index and the secondary outcome measures are changes in body composition, risk factors for type 2 diabetes and cardiovascular disease, changes in diet, physical activity, and psychosocial well-being (e.g., quality of life). It is hypothesized that participants who take metformin and engage in vigorous intensity exercise will show the greatest improvements in body mass index. In addition, it is hypothesized that participants who adhere to the REACH program will show improvements in body composition, physical activity, diet, psychosocial functioning and risk factor profiles for type 2 diabetes and cardiovascular disease. These improvements are expected to be maintained over the 2-year program. DISCUSSION: The findings from this study will advance the knowledge regarding the long-term efficacy and sustainability of interventions for childhood obesity. TRIAL REGISTRATION: ClinicalTrials.gov number NCT00934570.

Pre- and postnatal women's leisure time physical activity patterns: a multilevel longitudinal analysis.

The purpose of this study was to examine women's leisure time physical activity (LTPA) before pregnancy, during pregnancy, and through the first 7 months postnatal. Pre- and postnatal women (n = 309) completed the 12-month Modifiable Activity Questionnaire and demographic information. Multilevel modeling was used to estimate a growth curve representing the average change in LTPA over time and intraindividual variations in the average growth curve over time. Growth curve estimates for the linear quadratic, and cubic trends were significant (p < .05), indicating that LTPA declined during pregnancy but then increased following birth. The results also demonstrated that the individual trajectories of LTPA varied substantially from the average growth curve. One demographic predictor variable (having other children at home) was significant (p < .05).

A prospective examination of exercise and barrier self-efficacy to engage in leisure-time physical activity during pregnancy.

BACKGROUND: Pregnant women without medical contraindications should accumulate 30 min of moderate exercise on most days of the week, yet many pregnant women do not exercise at recommended levels. PURPOSE: The purpose the study was to examine barriers to leisure-time physical activity (LTPA) and investigate barrier and exercise self-efficacy as predictors of self-reported LTPA during pregnancy. METHODS: Pregnant women (n = 160) completed questionnaires eliciting barriers to LTPA, measures of exercise and barrier self-efficacy, and 6-week LTPA recall at gestational weeks 18, 24, 30, and 36. RESULTS: A total of 1,168 barriers were content-analyzed, yielding nine major themes including fatigue, time constraints, and physical limitations. Exercise self-efficacy predicted LTPA from gestational weeks 18 to 24 (beta = 0.32, R(2) = 0.26) and weeks 30 to 36 (beta = 0.41, R(2) = 0.37), while barrier self-efficacy predicted LTPA from weeks 24 to 30 (beta = 0.40, R(2) = 0.32). CONCLUSIONS: Pregnant women face numerous barriers to LTPA during pregnancy, the nature of which may change substantially over the course of pregnancy. Higher levels of self-efficacy to exercise and to overcome exercise barriers are associated with greater LTPA during pregnancy. Research and interventions to understand and promote LTPA during pregnancy should explore the dynamic nature of exercise barriers and foster women's confidence to overcome physical activity barriers.

Moms in motion: a group-mediated cognitive-behavioral physical activity intervention.

BACKGROUND: When examining the prevalence of physical inactivity by gender and age, women over the age of 25 are at an increased risk for sedentary behavior. Childbearing and motherhood have been explored as one possible explanation for this increased risk. Post natal exercise studies to date demonstrate promising physical and psychological outcomes, however few physical activity interventions have been theory-driven and tailored to post natal exercise initiates. The purpose of this study was to compare the effects of a group-mediated cognitive behavioral intervention based upon social-cognitive theory and group dynamics (GMCB) to a standard care postnatal exercise program (SE). METHOD: A randomized, two-arm intervention design was used. Fifty-seven post natal women were randomized to one of two conditions: (1) a standard exercise treatment (SE) and (2) a standard exercise treatment plus group-mediated cognitive behavioral intervention (GMCB). Participants in both conditions participated in a four-week intensive phase where participants received standard exercise training. In addition, GMCB participants received self-regulatory behavioral skills training via six group-mediated counseling sessions. Following the intensive phase, participants engaged in a four-week home-based phase of self-structured exercise. Measures of physical activity, barrier efficacy, and proximal outcome expectations were administered and data were analyzed using ANCOVA procedures. RESULTS AND DISCUSSION: ANCOVA of change scores for frequency, minutes, and volume of physical activity revealed significant treatment effects over the intensive and home-based phases (p's < 0.01). In addition, ANCOVA of change in mean barrier efficacy and proximal outcome expectations at the conclusion of the intensive phase demonstrated that GMCB participants increased their initial level of barrier efficacy and outcome expectations while SE participants decreased (p < 0.05). CONCLUSION: While both exercise programs resulted in improvements to exercise participation, the GMCB intervention produced greater improvement in overall physical activity, barrier efficacy and proximal outcome expectations.