Relationship between youth cardiometabolic health and physical activity in medical records.

BACKGROUND: Thers is limited research examining modifiable cardiometabolic risk factors with a single-item health behavior question obtained during a clinic visit. Such information could support clinicians in identifying patients at risk for adverse cardiometabolic health. We investigated if children meeting physical activity or screen time recommendations, collected during clinic visits, have better cardiometabolic health than children not meeting recommendations. We hypothesized that children meeting either recommendation would have fewer cardiometabolic risk factors. METHODS AND FINDINGS: This cross-sectional study used data from electronic medical records (EMRs) between January 1, 2013 through December 30, 2017 from children (2-18 years) with a well child visits and data for ≥1 cardiometabolic risk factor (i.e., systolic and diastolic blood pressure, glycated hemoglobin, alanine transaminase, high-density and low-density lipoprotein, total cholesterol, and/or triglycerides). Physical activity and screen time were patient/caregiver-reported. Analyses included EMRs from 63,676 well child visits by 30,698 unique patients (49.3% female; 41.7% Black, 31.5% Hispanic). Models that included data from all visits indicated children meeting physical activity recommendations had reduced risk for abnormal blood pressure (odds ratio [OR] = 0.91, 95%CI 0.86, 0.97; p = 0.002), glycated hemoglobin (OR = 0.83, 95%CI 0.75, 0.91; p = 0.00006), alanine transaminase (OR = 0.85, 95%CI 0.79, 0.92; p = 0.00001), high-density lipoprotein (OR = 0.88, 95%CI 0.82, 0.95; p = 0.0009), and triglyceride values (OR = 0.89, 95%CI 0.83, 0.96; p = 0.002). Meeting screen time recommendations was not associated with abnormal cardiometabolic risk factors. CONCLUSION: Collecting information on reported adherence to meeting physical activity recommendations can provide clinicians with additional information to identify patients with a higher risk of adverse cardiometabolic health.

Barriers to Participation in a Telemedicine-based, Family-based Behavioral Group Treatment Program for Pediatric Obesity: Qualitative findings from Rural Caregivers.

This study examined factors influencing rural caregivers' decision to decline participation in a healthy lifestyle intervention. Eligible caregivers of rural children who declined participation in a healthy lifestyle intervention were interviewed regarding reasons for declining. Inductive thematic analyses were conducted for responses. Caregiver interviews (n=16) resulted in 5 saturated themes: (1) rural families' household schedules prohibit participation, (2) preference for diverse treatment approaches, (3) desire for information across multimedia platforms, and more communication with a point-of-contact, (4) support for an inclusive approach integrated with existing school practices, and (5) caregivers had an understanding of behaviors that promote health.

Effectiveness of a paediatric weight management intervention for rural youth (iAmHealthy): Primary outcomes of a cluster randomised control trial.

BACKGROUND: Youth in rural areas are disproportionally affected by obesity. Given the unique barriers rural populations face, tailoring and increasing access to obesity interventions is necessary. OBJECTIVE: This paper evaluates the effectiveness of iAmHealthy, a family-based paediatric obesity intervention delivered to rural children, compared to a Newsletter Control. METHODS: Participating schools (n = 18) were randomly assigned to iAmHealthy or Newsletter Control. iAmHealthy consists of individual health coaching and group sessions delivered via televideo to a participant's home. The child and parent's body mass index (BMI), child physical activity and child dietary intake were assessed at baseline, post-treatment (8 months) and follow-up (20 months). Multilevel modeling estimated the effect of treatment at both time points. RESULTS: Parent and child dyads were recruited (n = 148) and randomised to iAmHealthy (n = 64) or the Control group (n = 84). The Control group had significant increases in child BMIz from baseline to follow-up. iAmHealthy youth had no significant changes in BMIz from baseline to post or follow-up. Child dietary intake, physical activity and parent BMI results are also discussed. CONCLUSIONS: This trial extends previous paediatric obesity work by simultaneously increasing convenience and dose of treatment. Results suggest iAmHealthy resulted in a change in BMIz trajectories and long-term health behaviour for youth.

Sedentary Bout Patterns and Metabolic Health in the Hispanic Community Health Study/Study of Latino Youth (SOL Youth).

Background There is limited evidence on the potential negative metabolic health impacts of prolonged and uninterrupted sedentary bouts in structurally disadvantaged youth. This study investigated associations between sedentary bout variables and metabolic health markers in the Hispanic Community Health Study/SOL Youth (Study of Latino Youth). Methods and Results SOL Youth was a population-based cohort of 1466 youth (age range, 8-16 years; 48.5% female); 957 youth were included in the analytic sample based on complete data. Accelerometers measured moderate-to-vigorous physical activity (MVPA), total sedentary time, and sedentary bout patterns (daily time spent in sedentary bouts ≥30 minutes, median sedentary bout duration, and number of daily breaks from sedentary time). Clinical measures included body mass index, waist circumference, fasting glucose, glycated hemoglobin, fasting insulin, and the homeostasis model assessment of insulin resistance. After adjusting for sociodemographics, total sedentary time, and MVPA, longer median bout durations and fewer sedentary breaks were associated with a greater body mass index percentile (bbouts=0.09 and bbreaks=-0.18), waist circumference (bbouts=0.12 and bbreaks=-0.20), and fasting insulin (bbouts=0.09 and bbreaks=-0.21). Fewer breaks were also associated with a greater homeostasis model assessment of insulin resistance (b=-0.21). More time in bouts lasting ≥30 minutes was associated with a greater fasting glucose (b=0.18) and glycated hemoglobin (b=0.19). Conclusions Greater accumulation of sedentary time in prolonged and uninterrupted bouts had adverse associations with adiposity and glycemic control over and above total sedentary time and MVPA. Findings suggest interventions in Hispanic/Latino youth targeting both ends of the activity spectrum (more MVPA and less prolonged/uninterrupted sedentary patterns) may provide greater health benefits than those targeting only MVPA.

Prospective associations of neighborhood healthy food access and walkability with weight status in a regional pediatric health system.

BACKGROUND: Most neighborhood food and activity related environment research in children has been cross-sectional. A better understanding of prospective associations between these neighborhood environment factors and children's weight status can provide stronger evidence for informing interventions and policy. This study examined associations of baseline and changes in neighborhood healthy food access and walkability with changes in children's weight status over 5 years. METHODS: Height, weight, and home address were obtained for 4,493 children (> 75% were Black or Latinx) from primary care visits within a large pediatric health system. Eligible participants were those who had measures collected during two time periods (2012-2014 [Time 1] and 2017-2019 [Time 2]). Data were integrated with census tract-level healthy food access and walkability data. Children who moved residences between the time periods were considered 'movers' (N = 1052; 23.4%). Mixed-effects models, accounting for nesting of children within census tracts, were conducted to model associations of baseline and changes in the neighborhood environment variables with Time 2 weight status (BMIz and overweight or obese vs. healthy weight). Models adjusted for weight status and child and neighborhood sociodemographics at baseline. RESULTS: Children living in a neighborhood with [ample] healthy food access at Time 1 had a lower BMIz at Time 2, regardless of mover status. A decrease in healthy food access was not significantly associated with children's weight status at Time 2. Baseline walkability and improvements in walkability were associated with a lower BMIz at Time 2, regardless of mover status. CONCLUSIONS: Findings provide evidence that residing in a neighborhood with healthy food access and walkability may support a healthy weight trajectory in children. Findings on changes in the neighborhood environment suggested that improved walkability in the neighborhood may support children's healthy weight. The greater and more consistent findings among movers may be due to movers experiencing greater changes in neighborhood features than the changes that typically occur within a neighborhood over a short period of time. Future research is needed to investigate more robust environmental changes to neighborhoods.

Hot Yoga During Pregnancy: A Mixed-Methods Study Examining Perspectives of Studio Management.

Research provides evidence on the benefits and safety of prenatal yoga as well as hot yoga among nonpregnant individuals. However, limited literature on hot yoga during pregnancy exists. The present study aims to (1) describe knowledge, attitudes, and beliefs of hot yoga studio management regarding hot yoga during pregnancy; and (2) examine how management teams rank the credibility of information sources (e.g., obstetricians) regarding the safety of hot yoga during pregnancy. Inclusion criteria included being at least 18 years of age and on the management team at a U.S. hot yoga studio. Studios were recruited via emails from publicly accessible websites of major hot yoga studio communities. Thirty-five participants completed a cross-sectional online survey addressing the study aims, and 10 (28.57%) participants reported trying hot yoga themselves while pregnant. Participants reported a median of 4 (interquartile range 1.5-8.5) pregnant individuals at their studio in the past year. All participants reported at least one hot yoga class type that they would recommend to pregnant individuals. Three qualitative themes emerged regarding deciding whether a pregnant individual may practice hot yoga: (1) integration of healthcare and individual knowledge, (2) emphasis on prior practice, and (3) individual bodily intuition and choice. Obstetricians were ranked the highest for credibility, although inferential tests suggested that their rankings were equivalent to those for academic journals, one's own knowledge/experiences, and a friend/acquaintance who had practiced hot yoga during pregnancy. These findings suggest recommendations for future yoga teacher trainings to include specific needs and considerations for pregnant individuals who choose to practice hot yoga.

Parent factors associated with BMI, diet, and physical activity of adolescents with intellectual and developmental disabilities.

BACKGROUND: Adolescents with intellectual and developmental disabilities (IDD) experience overweight and obesity (OW/OB) up to 1.8 times the rate of their typically developing peers. Parents may influence adolescent weight management behaviors in this population, but the association between parent factors and adolescent weight management behaviors is unclear. OBJECTIVE: To examine the associations between parent BMI and sociodemographic characteristics with adolescents' BMI, diet quality, daily energy intake, moderate to vigorous physical activity (MVPA), and sedentary behavior. METHODS: This study analyzed baseline data from an 18-month randomized controlled weight loss trial for adolescents with IDD. We assessed parent BMI (kg/m2) and sociodemographic factors, and adolescent BMI z-score, MVPA, sedentary time, daily energy intake, and diet quality. Associations between parent and adolescent factors were assessed with Pearson, Spearman or Kendall Tau-b correlations; mean differences for categorical outcomes were assessed with independent samples t-tests/Mann-Whitney U tests or ANOVA/Kruskall-Wallis tests. RESULTS: Ninety-five adolescent and parent dyads were included. Parent BMI was positively correlated with adolescent BMI z-score (n = 94: rs = 0.37, p < 0.01). Household income was inversely correlated with adolescent BMI z-score (n = 95: Tb = -0.18, p = 0.02). Parents with less than a bachelor's degree had adolescents with higher BMI z-scores than those with bachelor's or higher (2.1 ± 0.5 vs. 1.8 ± 0.5, p = 0.02) as well as higher sedentary behavior (n = 28, 515.2 ± 102.6 min/day vs. n = 40, 463.9 ± 148.1 min/day, p = 0.02). CONCLUSION: We found parent BMI, income, and education associated with adolescent BMI z-score. These findings contribute to the sparse literature on parental factors associated with OW/OB in this population. CLINICAL TRIALS NUMBER: NCT02561754.

Recruitment and reach in a school-based pediatric obesity intervention trial in rural areas.

Introduction: The purpose of this study is to evaluate two recruitment strategies on schools and participant participation rates and representativeness (reach) within a pediatric obesity treatment trial tailored for families who live in rural areas. Methods: Recruitment of schools was evaluated based on their progress toward enrolling participants. Recruitment and reach of participants were evaluated using (1) participation rates and (2) representativeness of demographics and weight status of participants compared to eligible participants (who did not consent and enroll) and all students (regardless of eligibility). School recruitment, as well as participant recruitment and reach, were evaluated across recruitment methods comparing opt-in (i.e., caregivers agreed to allow their child to be screened for eligibility) vs. screen-first (i.e., all children screened for eligibility). Results: Of the 395 schools contacted, 34 schools (8.6%) expressed initial interest; of these, 27 (79%) proceeded to recruit participants, and 18 (53%) ultimately participated in the program. Of schools who initiated recruitment, 75% of schools using the opt-in method and 60% of schools using the screen-first method continued participation and were able to recruit a sufficient number of participants. The average participation rate (number of enrolled individuals divided by those who were eligible) from all 18 schools was 21.6%. This percentage was higher in schools using the screen-first method (average of 29.7%) compared to schools using the opt-in method (13.5%). Study participants were representative of the student population based on sex (female), race (White), and eligibility for free and reduced-price lunch. Study participants had higher body mass index (BMI) metrics (BMI, BMIz, and BMI%) than eligible non-participants. Conclusions: Schools using the opt-in recruitment were more likely to enroll at least 5 families and administer the intervention. However, the participation rate was higher in screen-first schools. The overall study sample was representative of the school demographics.

The Impact of the COVID-19 Pandemic on Healthy Lifestyles in Rural Families.

The purpose of the current study is to understand how the early portion of COVID-19 pandemic impacted the health behaviors of rural families participating in a healthy lifestyles intervention. Caregivers of rural children participating in a healthy lifestyles intervention were invited to participate in a structured interview regarding how the COVID-19 pandemic affected their family and family health behaviors. Interviews were transcribed and the research team conducted a rigorous inductive thematic analysis. Structured qualitative interviews with caregivers (n=30) resulted in 5 saturated themes: (a) caregivers reported new or exacerbated mental health concerns and stress among family members, largely due to social isolation and external stressors, (b) caregivers reported feeling out of control of positive health behaviors for themselves and their children, (c) families reported variability in how they handled reductions in schedule demands, ranging from filling time with positive activities to negative behaviors such as snacking, (d) families continuously re-adjusted their approach to parenting, routines, and health behaviors due to internal and external factors, (e) families ate foods that were accessible and convenient, which impacted the health of the family diet. Despite being asked primarily about lifestyle behavior changes, families reported concerns around mental health. Implications are that professionals working with rural children and families, even those without mental health training, may be called upon to help address these concerns especially in these underserved, rural families.

The impact of COVID-19 on rural treatment-seeking families with children with overweight or obesity.

To examine the early impact of the COVID-19 pandemic on rural parental stress and family behaviors, parents who participated in a 2nd-4th grade pediatric obesity intervention completed a survey in May 2020. Parents (N=77) experienced 7.8±2.7 events on the COVID-19 Exposure and Family Impact Scales (CEFIS) with an average impact of 2.5±0.5, with many parents reporting moderate stress (73%). Parental stress was predictive of personal well-being getting 'worse' while loss of income events were predictive of family routines getting 'better.' Professionals working with rural families may want to assess for these factors when promoting positive changes in family health behaviors.

Validation of remote height and weight assessment in a rural randomized clinical trial.

BACKGROUND: The purpose of this study is to describe and assess a remote height and weight protocol that was developed for an ongoing trial conducted during the SARS COV-2 pandemic. METHODS: Thirty-eight rural families (children 8.3 ± 0.7 years; 68% female; and caregivers 38.2 ± 6.1 years) were provided detailed instructions on how to measure height and weight. Families obtained measures via remote data collection (caregiver weight, child height and weight) and also by trained staff. Differences between data collection methods were examined. RESULTS: Per absolute mean difference analyses, slightly larger differences were found for child weight (0.21 ± 0.21 kg), child height (1.53 ± 1.29 cm), and caregiver weight (0.48 ± 0.42 kg) between school and home measurements. Both analyses indicate differences had only minor impact on child BMI percentile (- 0.12, 0.68) and parent BMI (0.05, 0.13). Intraclass coefficients ranged from 0.98 to 1.00 indicating that almost all of the variance was due to between person differences and not measurement differences within a person. CONCLUSION: Results suggest that remote height and weight collection is feasible for caregivers and children and that there are minimal differences in the various measurement methods studied here when assessing group differences. These differences did not have clinically meaningful impacts on BMI. This is promising for the use of remote height and weight measurement in clinical trials, especially for hard-to reach-populations. TRIAL REGISTRATION: Clinical. Registered in clinicaltrials.gov ( NCT03304249 ) on 06/10/2017.

Adherence to and changes in mental and physiological health during an 8-week yoga intervention: A pilot study.

BACKGROUND: Participating in yoga may be ideal for college students to increase physical activity and improve mental health. PURPOSE: To investigate the feasibility and impact of an 8-week yoga intervention within a university setting on mental and physiologic heath. METHODS: This 8-week yoga intervention included twelve yoga-naïve adults, (23.8 ± 4.6 years; 71% female). Participants attended two 60-min yoga classes/week in addition to baseline, mid- and post-lab visits. RESULTS: 83% of participants attended ≥75% of yoga classes. Stress and depression symptoms decreased by 11% and 25%, respectively and erythrocyte sedimentation rate (ESR) reduced by 28%. Participants who did not meet physical activity recommendations observed greater improvements in stress, depression symptoms, ESR, and C-reactive protein compared to participants who met recommendations. CONCLUSION: The majority of participants attended ≥12 of 16 yoga classes. Exploratory analyses provide preliminary support for the impact of yoga on reducing stress, symptoms of depression, and ESR. Participants who were not meeting physical activity guidelines prior to starting the intervention received greater benefits.

Feasibility and applicability of Evenson sedentary behavior cut points applied to children with and without intellectual and developmental disabilities.

AIM: Sedentary behavior (SB) is widely studied as it is associated with cardiometabolic health and obesity issues. However, children with Intellectual and Developmental Disabilities (IDD) have been understudied. Accelerometers are commonly used to measure SB in typically developing populations but may be inappropriate for IDD populations due to differences in body movement and physiologic responses to the activity. The use of Evenson sedentary cut-points, created based on typically developing children, has yet to be applied and/or examined in children with IDD. PURPOSE: A descriptive cross-sectional study was conducted to (1) Assess the feasibility of applying Evenson sedentary cut-points in children with IDD (2) Describe SB over a two-week period between diagnosis groups. METHODS: The SB of 22 participants (8 children with Down syndrome, 6 children with spina bifida, 8 children with no chronic illness) was assessed on two separate occasions: (1) during a 7-minute sedentary protocol, and (2) over a two-week period. RESULTS: The study supports the preliminary efficacy of using Evenson cut-points for this population, with 100% of participants being within the Evenson counts per minute (0-100 cpm) during the 7-minute sedentary protocol. The total volume of SB over a two-week period was not significantly different between diagnosis groups (8.8 h, 8.6 h, and 7.1 h of SB for children with Down syndrome, spina bifida, or those with no chronic illness, respectively; p = 0.36). CONCLUSIONS: Evenson sedentary cut-points can be used for children with IDD. Preliminary data suggest that children with IDD do not engage in significantly different SB than children without a chronic illness. Further study is warranted.Implications for rehabilitationObjective measures of physical activity and sedentary behavior for children with Down syndrome or spina bifida are rarely used due to potential differences in body movement (e.g., gait) during ambulation compared to typically developing peers that may influence the accuracy of cut-points.This study supports that Evenson sedentary cut-points can be used in children with Down syndrome or spina bifida to assess sedentary activity.Preliminary findings from this study demonstrate similarities in patterns of sedentary behaviors exhibited by our sample of children with Down syndrome, spina bifida, or no chronic illness.

Incorporating Yoga into a Pediatric Weight Management Program: A Pilot Study.

Purpose: To assess the feasibility and acceptability of yoga incorporated into a pediatric weight management program (promoting health in teens; PHIT Yoga) to racially diverse caregivers and youth and to compare this program with a cohort that received a program that did not include yoga (PHIT Kids). Methods: Thirty children with obesity were enrolled in a 12-week pediatric weight management intervention (PHIT Kids, n = 17; PHIT Yoga, n = 13). Weight, BMI z-score (BMIz), BMI percent of the 95th percentile, and health habits assessment were obtained from both cohorts pre- and post intervention. Acceptability was assessed in the yoga cohort. Results: Fifty-four percent of children in the PHIT Yoga cohort and 65% of children in the PHIT Kids cohort attended ≥75% of the intervention sessions. Survey results support that the PHIT Yoga was acceptable to both caregivers and children. Improvements in BMIz were observed in 50% of children in each cohort and both groups improved on five of seven health habits; cohorts overlapped on three habits (breakfast, screen time, and sugar-sweetened drinks). Conclusion: Findings support that yoga classes added to a pediatric weight management program are feasible and acceptable in racially diverse children with severe obesity and their caregivers.

A comparison of accelerometer cut-points for measuring physical activity and sedentary time in adolescents with Down syndrome.

BACKGROUND: No cut-points have been developed for youth with Down syndrome; there is concern that altered gait patterns, decreased energy expenditure and exercise capacity of individuals with Down syndrome may produce inaccurate physical activity data if accelerometer data are analyzed using cut-points from populations with typical development and other IDD diagnoses. AIM: To compare physical activity and sedentary time across existing accelerometer cut-point methods in adolescents with Down syndrome. METHODS: In this cross-sectional analysis, participants diagnosed with Down syndrome (n = 37; 15.5 ± 1.9 years; 57 % female) wore an accelerometer on their non-dominant hip for seven-days. Data were analyzed and compared across four physical activity intensity cut-points: Evenson, Freedson 4-MET, McGarty, and Romanizi. OUTCOMES & RESULTS: Differences in time spent in each intensity across cut-point methods were evident for sedentary (448-615 min/day), light (72-303 min/day) and moderate-to-vigorous (12-77 min/day) activities. Between 0.0-67.6 % of the sample met the physical activity guidelines, depending on the cut-point method selected. CONCLUSIONS & IMPLICATIONS: This study presents the wide variation of accumulated physical activity minutes when different cut-points are applied to individuals with Down syndrome. There is a critical need to establish Down syndrome-specific measures of physical activity assessment rather than applying methods developed for their peers with typical development. WHAT THIS PAPER ADDS: This paper highlights concerns over the application of objective measurements of physical activity in youth with Down syndrome from measurement methods derived from populations with typical development. This is the first manuscript to examine this issue in a sample comprised solely of youth with Down syndrome. Results demonstrate the large variation in time spent in each activity intensity that arise due to the application of different cut-point methods.

Quality of Dietary Intake in Children With Developmental Disabilities: A Pilot Study.

BACKGROUND: Children with developmental disabilities have a high prevalence of overweight and obesity. The role and contribution of their diet to weight status is poorly understood. OBJECTIVES: This pilot study describes the dietary quality of children with spina bifida and Down syndrome compared with typically developing peers. METHODS: Dietary intakes of 8 children with spina bifida or Down syndrome and 4 children without developmental disabilities, aged 8 to 18 years, were collected using six 24-hour dietary recalls through Facetime. Dietary quality was assessed by application of the Healthy Eating Index (HEI). RESULTS: Children with spina bifida and Down syndrome had higher HEI scores when compared to typically developing peers (48.3, 52.9, and 46.2, respectively) and vegetable consumption (1.9, 2.6, and 1.4, respectively). All groups had undesirable intakes of saturated fat, added sugar, and sodium. Within this small sample, children with spina bifida and Down Syndrome had similar diet quality to their typically developing peers. CONCLUSIONS: Further investigation in a larger sample is recommended to support the development of methods to optimize weight management in children with developmental disabilities.

Accuracy of body mass index in categorizing weight status in children with intellectual and developmental disabilities.

PURPOSE: To identify the accuracy of Body Mass Index (BMI) to categorize body weight in a sample of children with spina bifida and Down syndrome as compared to typically developing peers. METHODS: A secondary analysis of 32 children with spina bifida, Down syndrome or no chronic illness. A calculated BMI was plotted on the Centers for Disease Control and Prevention age- and sex-specific BMI growth charts to determine each child's weight status. Percentage of body fat, obtained by labeled water, was plotted on two different body fat percentile reference curves, one derived from a whole body measure (DXA) of body fat and one by skin-fold measure. Differences in weight categories between calculated BMI and body fat percentile curves were reported. RESULTS: The calculated BMI for children with a disability had significant misclassifications as a screening tool for body fat when compared to children without a disability. Misclassifications were increased with the body fat percentile reference curve derived from skin-fold measures and for children who primarily used a wheelchair. CONCLUSION: The current recommendation to use BMI to categorize weight status is not useful for many children with disabilities. Further research to identify an alternative pragmatic strategy is necessary.

Association between yoga, physiologic and psychologic health: A cross sectional study.

PURPOSE: To compare markers of health associated with chronic diseases between yoga and non-yoga participants. METHODS: 30 participants were categorized as either: 1) "Yoga" engaging in yoga ≥2 times/week for ≥6 months, or 2) "Non-yoga" not engaging in yoga. RESULTS: Perceived Stress Scale (PSS) and Beck Depression Inventory-II (BDI-II) scores were significantly different between the yoga and non-yoga groups (PSS: 8.0 vs. 17.5, respectively, p < 0.05; BDI-II: 1.0 vs. 5.5, respectively, p < 0.05). No significant differences were evident between groups for inflammatory markers nor Complex V of the mitochondrial electron transport chain. The erythrocyte sedimentation rate values differed between groups based on clinical cutoffs, with yoga participants categorized as normal (11.0 mm) and non-yoga above normal (21.5 mm). CONCLUSION: This research supports that yoga participation is associated with lower PSS and BDI-II scores but does not support a relationship with markers of inflammation. Further research is warranted.

Adding Family Digital Supports to Classroom-Based Physical Activity Interventions to Target In- and Out-of-School Activity: An Evaluation of the Stay Active Intervention during the COVID-19 Pandemic.

Remotely delivered interventions are promising for reaching large numbers of people, though few have targeted multiple levels of influence such as schools and families. This study evaluated two versions (arms) of a remotely delivered classroom-based physical activity (CBPA) intervention. One arm solely included remote CBPA; the other included remote CBPA and mobile health (mHealth) family supports. Six schools were randomized to CBPA or CBPA+Family. Both arms were remotely delivered for seven weeks. CBPA+Family added behavior change tools delivered via text messages and newsletters to caregiver/child dyads. Garmin devices measured moderate-to-vigorous activity (MVPA) in both arms and were used for goal setting/monitoring in the CBPA+Family arm (integrated with the text messages). Caregivers completed surveys evaluating intervention acceptability. 53 participants (CBPA n=35; CBPA+Family n=18; 9.7±0.7 years) were included. Increases in MVPA were similar between arms, showing a pre-post effect of the CBPA but no additional effect of family supports. MVPA was low at baseline and during the first 3 weeks (CBPA 7.5±3.1 minutes/day; CBPA+Family 7.9±2.7 minutes/day) and increased by Weeks 6-8 (CBPA 56.8±34.2 minutes/day; CBPA+Family 49.2±18.7 minutes/day). Approximately 90% of caregivers reported high satisfaction with the added family support content. CBPA+Family participants wore the Garmin later into the study period. Remote delivery of CBPA appears feasible and effective for supporting increases in children's MVPA. Adding family supports to school-based interventions appears acceptable and may support engagement, demonstrating promise for more multilevel/multi-setting interventions, though the multilevel intervention was not more effective than the single-level intervention in increasing children's MVPA.