Title: The impact of a family-based physical activity promotion programme on child physical activity: feasibility and pilot of the Families Reporting Every Step to Health (FRESH) intervention
Funder: Department of Health and Social Care

Abstract: BACKGROUND: Despite the known health and social benefits of physical activity (PA), many children are insufficiently active. Family-based interventions may be a promising strategy to increase PA, and wider family functioning. However, the evidence for ‘whole-family’ strategies is limited, with most interventions targeting child PA rather that the PA of the family unit. DESIGN: 1) Intervention optimisation and feasibility study (N=20 families); 2) Pilot randomised controlled trial (N=60 families) SETTING: Norfolk (rural) TARGET POPULATION: Families with at least 1 child aged 8-10 years INTERVENTION: The Families Reporting Every Step to Health (FRESH) intervention is evidence-based, developed for families by families, and theoretically underpinned. FRESH aims to increase PA by improving PA awareness, parenting behaviour and family functioning. Participants wear pedometers to self-monitor PA and upload step counts online, allowing them to virtually ‘travel’ across the world. The web-based platform enables goal setting and provides reinforcement, rewards and information, and encourages the child to act as agent of change. Two conditions will be tested; ‘Family’: all family members wear pedometer and contribute to goal; ‘Child-only’: only the 8-10yr-old wears pedometer. EVALUATION: All family members will be invited to take part in the evaluation, irrespective of randomisation. Mixed-methods process evaluation will inform intervention optimisation and evaluation procedures. In pilot evaluation, outcomes will be assessed at baseline, 8wk and 1yr post-baseline [main outcome]. PRIMARY OUTCOME: The primary outcome of the current project will be the development of a definitive trial of the FRESH interventions. The proposed primary outcome of a definitive trial will be child average daily accelerometer-assessed moderate-to-vigorous PA (MVPA). SECONDARY OUTCOMES: • Parameters to inform sample size calculation; intervention feasibility and acceptability; feasibility and acceptability of study procedures; sample representativeness; modelled intervention costs; calculated trial costs. • Proposed secondary outcomes for the definitive evaluation include: total daily accelerometer-assessed MVPA of all family members; accelerometer-assessed sedentary, light and overall PA at specific times of the week; health outcomes (waist circumference, blood pressure, aerobic fitness); cognitive performance; self-reported PA (and family co-participation); psychosocial mediators (e.g. family functioning; parenting behaviours; social support and norms, self-efficacy); expenditure of PA-related activities incurred by families; cost-effectiveness; mixed methods process evaluation (e.g. programme acceptability, uptake, maintenance, dose). OUTPUTS: In addition to refining/testing FRESH in preparation for a definitive trial and preparing a grant application, this programme will result in several interim publications: 1) intervention development and feasibility process evaluation, 2) pilot evaluation outcomes, 3) defining and assessing family PA co-participation, 4) insights into PA in the family context. IMPACT: This project will help us understand how to change family PA and inform the development of a definitive evaluation of a novel family-based PA promotion intervention. FRESH has the potential to be a sustainable intervention to impact on the health and wellbeing of families across the UK.

Lay abstract: PROJECT AIM This project aims to refine and pilot test the FRESH programme, developed to increase physical activity in 8-10 year old children and their families. BACKGROUND • A low level of physical activity raises the risk of obesity, mental health problems and poor bone development. • Children’s physical activity levels are low and decline as they get older, particularly in rural areas. • Youth physical activity declines mostly outside of school, yet physical activity promotion continues to use the school settings. • Family-based physical activity promotion is potentially effective, but rarely targets the whole family. FRESH PROGRAMME • FRESH (Families Reporting Every Step to Health) was developed with families. This web-based pedometer-based programme includes goal setting and rewards, and encourages family relations by getting families to be active together. • Children (and their families) travel across the world virtually by accumulating activity throughout the week. They get rewards for achieving goals, and have access to a website to help them set goals, which also includes fun facts about the places they visit and other activity challenges. • We will test a child-only and a whole-family version of the website, to explore whether family involvement helps to increase effectiveness. PROJECT DESIGN During the first phase, we will refine FRESH with families. We will recruit 20 families; 10 will trial the family intervention with the remaining 10 trialling the child-only version. Verbal and written feedback from families will help us to further develop the website and our measurement protocols. The second phase will be a pilot randomised controlled trial with 60 families (20 whole-family, 20 child-only, 20 no programme), in which we will test our recruitment and evaluation plans. We will compare the physical activity level of children (and their families) in the 3 different groups, using a waist-worn device similar to a pedometer. We will measure waist circumference, blood pressure, fitness and cognitive performance, and questionnaires will ask families about the types of activity they do together, family support and motivation, plus how they see their quality of life. We will measure the outcomes in all participating family members at project start, and 8 weeks and 1 year later. We will also review how many family members took part and how often, and whether they liked FRESH and how they would improve it. INVOLVING FAMILIES • Involving the people who will be working with FRESH is important to the success of the project. Therefore, throughout the project, we will meet with parents, teachers, children, and other agency staff regularly working with families to get their input. • These sessions will focus on making sure that this research will provide answers to the questions that matter and that the FRESH programme is attractive to families. Further contributions will focus on improving the study materials and identifying ways of recruiting families. GETTING THE WORD OUT • The results of this project will form the basis for a larger evaluation. The final results will be presented to children in schools, parents, and teachers as well as those in local and national government. This will help to get the FRESH programme delivered to more families across the country. • We will also present the work to other academics, through journal publications and presentation at conferences.

Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE