Impact of the 'Healthy Youngsters, Healthy Dads' program on physical activity and other health behaviours: a randomised controlled trial involving fathers and their preschool-aged children.

BACKGROUND: Targeting fathers may be a key strategy to increase physical activity among their preschool-aged children, but limited research exists in this area. The primary study aim was to examine the impact of a lifestyle program for fathers and their preschool-aged children on child physical activity levels. METHODS: A total of 125 fathers (aged: 38 ± 5.4 years, BMI: 28.1 ± 4.9 kg/m2) and 125 preschool-aged children (aged: 3.9 ± 0.8 years, BMI z-score: 0.3 ± 0.9, 39.2% girls) recruited from Newcastle, Australia, NSW were randomised to (i) the Healthy Youngsters, Healthy Dads (HYHD) program, or (ii) wait-list control group. The program included two fathers-only workshops (2 h each) and eight father-child weekly educational and practical sessions (75 min each), plus home-based activities targeting family physical activity and nutrition. Assessments took place at baseline, 10-weeks (post-intervention) and 9-months follow-up. The primary outcome was the children's mean steps/day at 10-weeks. Secondary outcomes included: co-physical activity, fathers' physical activity levels and parenting practices for physical activity and screen time behaviours, children's fundamental movement skill (FMS) proficiency, plus accelerometer based light physical activity (LPA) and moderate-to-vigorous physical activity (MVPA), screen time and adiposity for fathers and children. Process measures included; attendance, satisfaction, fidelity and retention. Linear mixed models estimated the treatment effect at all time-points for all outcomes. RESULTS: Intention-to-treat analyses revealed a significant group-by-time effect for steps per day at 10-weeks (+ 1417, 95%CI: 449, 2384) and 9-months follow-up (+ 1480, 95%CI: 493, 2467) in intervention children compared to control. There were also favourable group-by-time effects for numerous secondary outcomes including fathers' physical activity levels, children's FMS proficiency, and several parenting constructs. No effects were observed for both fathers' and children's accelerometer based LPA or MVPA, co-physical activity, screen-time and adiposity measures. Process evaluation data revealed very high levels of satisfaction, attendance, retention, and intervention fidelity. CONCLUSION: Engaging fathers in a lifestyle program is a promising strategy to increase physical activity among preschool-aged children. Additional benefits to fathers' physical activity levels, children's FMS proficiency and parenting practices further support the importance of engaging fathers to improve family health outcomes. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry: ACTRN12619000105145 . Registered 24/01/2019.

Establishing Effectiveness of a Community-based, Physical Activity Program for Fathers and Daughters: A Randomized Controlled Trial.

BACKGROUND: The 'Dads And Daughters Exercising and Empowered' (DADEE) program significantly improved physical activity levels of fathers and their daughters in an efficacy trial. However, the effectiveness of interventions when delivered in real-world settings needs to be established. PURPOSE: To evaluate the effectiveness of the DADEE intervention when delivered in community settings by trained facilitators. METHODS: We conducted a two-arm RCT, (baseline and 3-months post-intervention assessments), in Newcastle, Australia. In 2016, 155 fathers (27-60 years) and 189 primary-school-aged daughters (4-12 years) (n = 344) were randomly allocated to the intervention (78 fathers, 95 daughters) or waitlist-control (77 fathers, 94 daughters) groups. Trained facilitators delivered the 9-week DADEE program (weekly sessions plus home-based tasks). Primary outcomes were fathers' and daughters' physical activity (steps/day). Secondary outcomes included screen-time, weight status, daughters' fundamental movement skill (FMS) proficiency, perceived sports competence, and fathers' parenting practices. Effects were assessed using linear mixed models. RESULTS: Primary outcome follow-up data were collected from 88% of fathers and 89% of daughters. Significant group-by-time differences in mean daily steps were found for fathers' (adjusted difference = +1,638; 95% CI: 833, 2,443, d = 0.7) and daughters' (adjusted difference = +1,023 steps/day; 95% CI: 259, 1,787; d = 0.4) physical activity. Significant effects were observed for daughters' screen-time, FMS, and some parenting practices. No significant effects were identified for weight status, or fathers'screen-time or self-reported MVPA. Program attendance, satisfaction and fidelity were very high. CONCLUSION: This study established the effectiveness of the DADEE intervention when delivered in community settings by trained facilitators. Importantly, the findings were comparable to those of the efficacy RCT delivered by the research team. To maximize public health benefits, a larger-scale dissemination of the program appears warranted.Trial Registration Australian New Zealand Clinical Trial Registry: ACTRN12616001270404 Human Research Ethics Committee: H-2014-0330.

Dietary Outcomes of the 'Healthy Youngsters, Healthy Dads' Randomised Controlled Trial.

(1) Background: The effect of fathers on dietary intake in preschool-aged children is under-explored. The aims were to: (i) evaluate the efficacy of a family-based lifestyle intervention, Healthy Youngsters, Healthy Dads, on change in dietary intake in fathers and their preschool-aged children post-intervention (10 weeks) and at 9 months follow-up compared to a waitlist control group and (ii) investigate associations in father-child dietary intakes. (2) Methods: Linear mixed models estimated group-by-time effects for all dietary outcomes, measured by food frequency questionnaires. Cohen's d determined effect sizes, while correlation tests determined associations in father-child dietary intakes. (3) Results: For children, medium group-by-time effects sizes were identified at 10 weeks for sodium intake (d = 0.38) and percentage energy from core foods (d = 0.43), energy-dense, nutrient-poor (EDNP) foods (d = 0.43) and prepacked snacks (d = 0.45). These findings were sustained at 9 months follow-up. For fathers, medium to large, group-by-time effect sizes were identified at 10 weeks for energy intake (d = 0.55), sodium intake (d = 0.64) and percentage energy from core foods (d = 0.49), EDNP foods (d = 0.49), and confectionary (d = 0.36). For all of these dietary variables, except sodium, effects were sustained at 9 months. Moderate to strong associations existed in father-child dietary intakes for some of the dietary variables. (4) Conclusions: Although further research is required, this study provides preliminary support for targeting fathers as agents of change to improve dietary intakes in their preschool-aged children.

Engaging Fathers to Improve Physical Activity and Nutrition in Themselves and in Their Preschool-Aged Children: The "Healthy Youngsters, Healthy Dads" Feasibility Trial.

BACKGROUND: Few lifestyle programs for young children have targeted fathers. This study examined the feasibility of a lifestyle intervention for fathers and their preschool-aged children. METHOD: A total of 24 father/preschool child dyads were recruited from Newcastle, Australia, into a single-arm, feasibility trial (baseline and 3-mo postbaseline assessments). The 9-session program aimed to improve physical activity and dietary habits of fathers and children. A priori feasibility benchmarks targeted recruitment (15 dyads), eligibility rate (>60%), attendance (80%), retention (≥85%), and program acceptability (≥4 out of 5). Acceptability of data collection procedures, research team program/resource management, home-program compliance, and preliminary intervention outcomes were also assessed. RESULTS: Feasibility benchmarks were surpassed for recruitment (24 dyads), eligibility rate (61.5%), attendance (89%), retention (100%), and program acceptability (4.6 out of 5). Data collection procedures were acceptable. Challenges included mothers reporting their own dietary intake rather than their child's, children moving during body composition measurement, and resetting pedometers. Resource and program management were excellent. Most families met home-program requirements (83%). Preliminary intervention outcomes were encouraging for fathers and children. CONCLUSION: Program feasibility was demonstrated by excellent recruitment, attendance, acceptability, retention, program administration, and promising preliminary intervention outcomes. A few data collection difficulties were identified. A larger scale efficacy trial is warranted.

Twelve-month outcomes of a father-child lifestyle intervention delivered by trained local facilitators in underserved communities: The Healthy Dads Healthy Kids dissemination trial.

Healthy Dads Healthy Kids (HDHK) was the first program internationally to specifically target overweight and obese fathers to improve their children's health. In previous randomized controlled trials, HDHK generated meaningful short-term improvements in the adiposity, physical activity, and eating behaviors of both fathers and children. The aim of this dissemination trial was to evaluate the 12-month impact of HDHK when delivered by trained facilitators across four low socioeconomic and regional communities in the Hunter Region, Australia. The study was a nonrandomized, prospective trial with minimal eligibility criteria (i.e., father body mass index [BMI] ≥ 25 kg/m2 and children aged 4-12 years). HDHK included eight weekly practical and theoretical sessions. Assessments were baseline, 3 months (post-intervention), 6-months, and 12-months. The primary outcome was fathers' weight. Secondary outcomes included child BMI z-score and validated lifestyle behavior measures (e.g., physical activity, diet). Overall, 189 fathers (mean age: 40.2 years, BMI: 32.6 kg/m2) and 306 children (mean age: 8.1 years) participated in one of 10 HDHK programs in four areas. Intention-to-treat linear mixed models revealed a significant mean reduction in fathers' weight at post-intervention (-3.6 kg, 95% confidence interval: -4.3, -2.9), which was maintained at 12 months (71% retention). Corresponding improvements were also detected in children's BMI z-score and a range of lifestyle behaviors for both fathers and children. Attendance and satisfaction levels were high. Positive intervention effects observed in previous randomized controlled trials were largely replicated and sustained for 12 months when HDHK was delivered by trained local facilitators in underserved communities. Further investigation into the key systems, processes, and contextual factors required to deliver HDHK at scale appears warranted.

Impact of a father-daughter physical activity program on girls' social-emotional well-being: A randomized controlled trial.

OBJECTIVE: To increase girls' well-being, strategies are needed to optimize their social-emotional competence during childhood. Although positive fathering is important for girls, many fathers discount their unique influence and few participate in interventions. The Dads And Daughters Exercising and Empowered (DADEE) program was developed to engage fathers and their daughters through shared physical activity experiences. This study examined the program's impact on girls' well-being and the father-daughter relationship. METHOD: Overall, 115 fathers (age range: 29-53 years) and 153 daughters (age range: 4-12 years) were randomized to (1) the DADEE program (9 weekly educational and practical sessions plus home-based challenges) or (2) a wait-list control. Assessments were baseline, 2 months (postintervention), and 9 months (94% retention). Daughters' social-emotional well-being was measured with the Devereux Student Strengths Assessment composite. Secondary outcomes included additional well-being indicators (e.g., global self-perception) plus validated measures of father involvement and father-daughter relationship quality. RESULTS: At 2 months, intervention daughters showed a medium-to-large improvement in overall well-being (+24.9 units, 95% CI [8.6, 41.1], d = 0.6), when compared with controls. Intervention daughters were also more likely to show clinically meaningful improvements in well-being (54%) than controls (18%). Medium-to-large effects were observed for: seven of eight social-emotional competencies (e.g., personal responsibility, d = 0.4-0.9), father-daughter relationship quality (d = 0.8, father-report; d = 0.5, daughter-report), daughters' prosocial behavior (d = 0.3) and several indicators of father involvement. Most outcomes had improved by 9 months. No effects were observed for daughters' emotional difficulties or global self-perception. CONCLUSIONS: This study provided the first experimental evidence that father-daughter physical activity programs may improve girls' well-being and the father-daughter relationship. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Engaging Fathers to Increase Physical Activity in Girls: The "Dads And Daughters Exercising and Empowered" (DADEE) Randomized Controlled Trial.

Background: Existing strategies to increase girls' physical activity levels have seen limited success. Fathers may influence their children's physical activity, but often spend more time with their sons and rarely participate in family-based programs. Purpose: To test a novel program designed to increase the physical activity levels of fathers and their daughters. Methods: In a two-arm RCT, 115 fathers (29-53 years) and 153 daughters (4-12 years) were randomized to (i) the "Dads And Daughters Exercising and Empowered" (DADEE) program, or (ii) a wait-list control. The 8-week program included weekly educational and practical sessions plus home tasks. Assessments were at baseline, 2 months (postintervention), and 9 months. The primary outcomes were father-daughter physical activity levels (pedometry). Secondary outcomes included screen-time, daughters' fundamental movement skill proficiency (FMS: perceived and objective), and fathers' physical activity parenting practices. Results: Primary outcome data were obtained from 88% of daughters and 90% of fathers at 9 months. Intention-to-treat analyses revealed favorable group-by-time effects for physical activity in daughters (p = .02, d = 0.4) and fathers (p < .001, d = 0.7) at postintervention, which were maintained at 9 months. At postintervention and follow-up, significant effects (p < .05) were also identified for daughters' FMS competence (objective: d = 1.1-1.2; perceived: d = 0.4-0.6), a range of fathers' physical activity parenting practices (d = 0.3-0.8), and screen-time for daughters (d = 0.5-0.8) and fathers (d = 0.4-0.6, postintervention only). Program satisfaction and attendance were very high. Conclusions: This study provided the first experimental evidence that efforts to increase physical activity behavior in preadolescent girls would benefit from a meaningful engagement of fathers. Clinical Trial information: Australian New Zealand Clinical Trials Registry: ACTRN12615000022561.

Fundamental movement skills: Where do girls fall short? A novel investigation of object-control skill execution in primary-school aged girls.

Fundamental movement skill (FMS) proficiency is positively associated with a range of health outcomes, and is a predictor of lifelong participation in physical activities and sport. Yet low FMS proficiency levels in children prevail, particularly among girls performing object-control skills (e.g., kicking, catching). To identify where girls require the most support and inform future teaching resources and interventions, this cross-sectional study investigated proficiency levels of object-control skills and their specific performance components (subskills) in girls; and aimed to determine whether patterns in subskill mastery were evident in girls from two different developmental stages. This study included 153 girls (aged 4-12 years; mean age = 7.7, SD = 1.8) from the Hunter Region, Australia. Six object-control skills were video-assessed using the Test of Gross Motor Development (TGMD-2, TGMD-3); overall skill proficiency levels and mastery levels of subskills were determined. In summary, <5% (of the total group, 4-8 years or 9-12 years) demonstrated mastery or advanced skill level in the strike, stationary dribble, overhand throw or kick. Mastery levels were also poor for the majority of the 24 subskills, with mastery levels below 40% for the total group for 17 of the 24 subskills. Deficiencies in specific subskills were evident in the preparation, action and recovery phases of the six object-control skills. Only 6 of the 24 subskills mastery levels were significantly higher in the older age-group. Our investigation provides new evidence that may be useful for practitioners and researchers looking to support the optimal development of FMS proficiency among girls. Australian New Zealand Clinical Trials Registry: ACTRN12615000022561.

Effectiveness of mother and daughter interventions targeting physical activity, fitness, nutrition and adiposity: A systematic review.

BACKGROUND: Physical inactivity and poor dietary habits in women pose a clear public health burden. Mothers are generally the main female role model for daughters, therefore, targeting intergenerational females simultaneously may be a novel approach. However, the effectiveness of this approach to improve physical activity, fitness, nutrition and adiposity has not been systematically examined. OBJECTIVES: To assess the effectiveness of physical activity, fitness and nutrition interventions targeting mothers and their daughters. DATA SOURCES: PubMed, Psychinfo, EMBASE, Ovid Medline, SCOPUS, CINAHL, Sportdiscus and Informit were searched for English language studies (1980-2015). STUDY SELECTION: Randomized controlled trials (RCTS), non-randomized experimental trials and pre-post studies of physical activity, fitness, nutrition and adiposity interventions targeting mothers and daughters were eligible if they reported changes in physical activity, fitness, dietary intake or adiposity. DATA EXTRACTION: Data were extracted using a standardized template and checked by a second author. DATA SYNTHESIS: 3577 articles were screened and 14 unique studies (7 RCTs, 1 pseudo-randomized, 1 non-randomized, 5 pre-post) met the inclusion criteria. The majority of studies were conducted in the US (n=11) and most were limited by methodological concerns. Of the RCTs that targeted each outcome exclusively, ≤20%, ≤20% ≤21% and 0% were successful for improving physical activity, fitness, nutrition and adiposity respectively. CONCLUSIONS: Overall, evidence for the effectiveness of mother-daughter interventions to improve physical activity, fitness, nutrition and adiposity is inconclusive. The diversity of study designs, exposures and outcomes used, along with methodological weaknesses means that well-designed and reported RCTs are warranted.

Involvement of Fathers in Pediatric Obesity Treatment and Prevention Trials: A Systematic Review.

CONTEXT: Despite their important influence on child health, it is assumed that fathers are less likely than mothers to participate in pediatric obesity treatment and prevention research. OBJECTIVE: This review investigated the involvement of fathers in obesity treatment and prevention programs targeting children and adolescents (0-18 years). DATA SOURCES: A systematic review of English, peer-reviewed articles across 7 databases. Retrieved records included at least 1 search term from 2 groups: "participants" (eg, child*, parent*) and "outcomes": (eg, obes*, diet*). STUDY SELECTION: Randomized controlled trials (RCTs) assessing behavioral interventions to prevent or treat obesity in pediatric samples were eligible. Parents must have "actively participated" in the study. DATA EXTRACTION: Two authors independently extracted data using a predefined template. RESULTS: The search retrieved 213 eligible RCTs. Of the RCTs that limited participation to 1 parent only (n = 80), fathers represented only 6% of parents. In RCTs in which participation was open to both parents (n = 133), 92% did not report objective data on father involvement. No study characteristics moderated the level of father involvement, with fathers underrepresented across all study types. Only 4 studies (2%) suggested that a lack of fathers was a possible limitation. Two studies (1%) reported explicit attempts to increase father involvement. LIMITATIONS: The review was limited to RCTs published in English peer-reviewed journals over a 10-year period. CONCLUSIONS: Existing pediatric obesity treatment or prevention programs with parent involvement have not engaged fathers. Innovative strategies are needed to make participation more accessible and engaging for fathers.

Maternal Correlates of Objectively Measured Physical Activity in Girls.

OBJECTIVES: Given the low levels of physical activity in girls, improving our understanding of the factors associated with girls' physical activity is important. In particular, exploring maternal correlates of girls' physical activity for both generations is important, given the paucity of research in this area. The primary aim of this study was to assess maternal correlates of objectively-measured physical activity in girls. METHODS: A cross-sectional design was used to assess 40 girls [mean age 8.8 years; mean body mass index (BMI) z-score = 0.7] and their mothers (mean age 39.1 years; mean BMI = 27.6) prior to an intervention. Maternal correlates of daughters' accelerometer-assessed physical activity were evaluated. Daughters' outcomes included: % moderate-to-vigorous physical activity (MVPA), counts per minute (CPM) and % sedentary behavior (SED), screen time (mother-proxy) and BMI z-score (objectively measured). Maternal correlates included demographic, anthropometric, behavioral, activity-related parenting practices, and physical activity cognitions. Correlates were examined using regression models. RESULTS: For daughters' % MVPA, mothers' beliefs was significant in the final model (R(2) = 0.14; P = 0.01). For daughters' CPM, mothers' logistic support (P = 0.03), mothers' CPM (P = 0.02) and outcome expectations (P = 0.01) were all significant (R(2) = 0.24). For daughters' % SED, mothers' logistic support (P = 0.02) was significant (R(2) = 0.11). CONCLUSIONS FOR PRACTICE: A number of maternal behaviors, social-cognitive and parenting correlates were found to be significantly associated with daughters' physical activity. Experimental studies are warranted, targeting mothers as the primary agents of change to increase physical activity among girls.

Feasibility and Preliminary Efficacy of the MADE4Life Program: A Pilot Randomized Controlled Trial.

BACKGROUND: The aim was to assess the feasibility and preliminary efficacy of a community-based physical activity (PA) intervention targeting mothers and daughters. METHODS: A randomized controlled trial of 48 primary school-aged girls and their 40 mothers were randomized to (i) Mothers And Daughters Exercising for Life (MADE4Life) (n = 21 mothers, n = 25 daughters) or (ii) wait-list control (n = 19 mothers, n = 23 daughters). The 8-week program involved 8 sessions; 25-minute separate mothers and daughters education sessions and 60-minutes PA together. Assessments were at baseline, postintervention and 3-month postintervention. Primary outcome measure was daughters' moderate-to- vigorous physical activity (MVPA) (accelerometer). Secondary outcomes included accelerometer-assessed light/moderate/vigorous PA, BMI, waist circumference, body composition, blood pressure, resting heart rate, sedentary behaviors and mothers' self-reported PA, parenting measures, and cognitions. Intention-to-treat analysis used linear mixed models. RESULTS: Recruitment and retention goals were exceeded. Attendance rates, program acceptability and satisfaction were high. There was no significant group-by-time effect for daughters' %MVPA (-0.08; 95%CI -1.49, 1.33, d = -0.03) or other secondary outcomes for girls (postintervention range d = 0.01 to -0.46). Significant intervention effects were found for mothers' %VPA (P = .04, d = 0.25) and role modeling (P = .02, d = 0.66). CONCLUSION: MADE4Life was both feasible and acceptable. Although very small effect sizes were found for the daughters, significant changes were seen for mothers (d = 0.25 to 0.66). Future fully powered trials targeting PA in mothers and daughters is warranted.