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

Abstract

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.

Keywords: mHealth; mobile health; pediatric; school; short messaging system (SMS); wearables.

Figure 1

Physical Activity Metrics across Study Weeks for each Intervention Arm (n = 28) Note. Circles show observed means and vertical lines show standard deviations across participants. Slopes for the CBPA arm shown using solid regression lines and slopes for the CBPA+Family arm shown using dashed regression lines. Orange regression lines are from standard mixed effects models, blue regression lines are from models with last value carried forward and back-fill, and green regression lines are from joint modeling. CBPA = classroom-based physical activity; MVPA = moderate to vigorous physical activity.

Figure 2

Physical Activity Metrics Grouped by Early and Late Intervention and Intervention Arm (n = 21) Note. Jittered dots are participant means for each time point, and error bars represent ±1 standard deviation across days within participants. Bars are observed grand means. CBPA = classroom-based physical activity; MVPA = moderate to vigorous physical activity; Early intervention = Week 0 (baseline) and Weeks 1 to 3 (first 3 weeks of the intervention); Late intervention = Weeks 5 to 8 (final 3 weeks of the intervention and 1-week post-intervention).

Figure 3

Week-Level Garmin Wear Adherence for Participants Who Provided at Least One Valid Day of Data over the Study Period (n = 32). Note. Participant included in the two-time-point analysis.