Rationale and design of active play @ home: a parent-led physical activity program for children with and without disability

Daniela A Rubin, Kathleen S Wilson, Lenny D Wiersma, Jie W Weiss, Debra J Rose, Daniela A Rubin, Kathleen S Wilson, Lenny D Wiersma, Jie W Weiss, Debra J Rose

Abstract

Background: Compared to other children, those with disability have additional challenges to being physically active. Prader-Willi Syndrome is a genetic form of childhood obesity that is characterized by hypotonia, growth hormone deficiency, behavioral, and cognitive disability. In children, the low prevalence of this syndrome (1 in 10,000 to 15,000 live births) makes group-based physical activity interventions difficult. In contrast, the home environment presents a natural venue to establish a physical activity routine for this population. This manuscript describes the design of a parent-led physical activity intervention incorporating playground and interactive console-based games to increase physical activity participation in youth with and without Prader-Willi Syndrome.

Methods/design: The study participants will be 115 youth ages 8-15 y (45 with the syndrome and 70 without the syndrome but categorized as obese). The study will use a parallel design with the control group receiving the intervention after serving as control. Participants will be expected to complete a physical activity curriculum 4 days a week for 6 months including playground games 2 days a week and interactive console games 2 days a week. Parents will be trained at baseline and then provided with a curriculum and equipment to guide their implementation of the program. Tips related to scheduling and coping with barriers to daily program implementation will be provided. Throughout, parents will be contacted by phone once a week (weeks 1-4) and then every other week to receive support in between visits. Measurements of children and parents will be obtained at baseline, 12 weeks, and at the end (week 24) of the intervention. Children main outcomes include physical activity (accelerometry), body composition (dual x-ray absorptiometry), motor proficiency (Bruininks-Oseretsky Test of Motor Proficiency), quality of life and physical activity self-efficacy (questionnaires). Intervention compliance will be monitored using mail-in daily self-report checklists.

Discussion: This parent-guided physical activity intervention aims to increase physical activity by using a curriculum that builds physical activity related self-confidence through the development and/or enhancement of motor skill competency. Ultimately, helping children develop these skills as well as joy in being physically active will translate into sustained behavior change.

Trial registration: Current Controlled Trial: NCT02058342.

Figures

Figure 1
Figure 1
Study timeline for the Active Play @ Home (APAH) intervention.
Figure 2
Figure 2
Sample playground game from the Active Play @ Home curriculum (Wiersma LD, Rubin DA, Rose DJ, Schroeder L, and M Junior, 2011).

References

    1. Haskell WL, Lee IM, Pate RR, Powell KE, Blair SN, Franklin BA, Macera CA, Heath GW, Thompson PD, Bauman A. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423–1434. doi: 10.1249/mss.0b013e3180616b27.
    1. Services USDHHS, editor. Services USDHHS. Physical activity guidelines for American midcourse report: strategies to increase physical activity among youth. Washington, DC: US Department of Health and Human Service Services; 2012.
    1. Murphy N, Carbone P. Promoting the participation of children with disabilities in sports, recreation, and physical activities. Pediatrics. 2008;121:1057–1061. doi: 10.1542/peds.2008-0566.
    1. American Academy of Pediatrics. Active healthy living: prevention of childhood obesity through increased physical activity. Pediatrics. 2006;117(5):1834–1842.
    1. Strong WB, Malina RM, Blimkie CJ, Daniels SR, Dishman RK, Gutin B, Hergenroeder AC, Must A, Nixon PA, Pivarnik JM. et al.Evidence based physical activity for school-age youth. J Pediatr. 2005;146(6):732–737. doi: 10.1016/j.jpeds.2005.01.055.
    1. Troiano RP, Berrigan D, Dodd KW, Masse LC, Tilert T, McDowell M. Physical activity in the United States measured by accelerometer. Med Sci Sports Exerc. 2008;40(1):181–188. doi: 10.1249/mss.0b013e31815a51b3.
    1. Rimmer JA, Rowland JL. Physical activity for youth with disabilities: a critical need in an underserved population. Dev Neurorehabil. 2008;11(2):141–148. doi: 10.1080/17518420701688649.
    1. Law M, King G, King S, Kertoy M, Hurley P, Rosenbaum P. Patterns of participation in recreational and leisure activities among children with complex physical disabilities. Dev Med Child Neurol. 2006;48:337–342. doi: 10.1017/S0012162206000740.
    1. King G, Law M, Hurley P, Petrenchik T, Schwellnus H. A developmental comparison of the out-of-school recreation and leisure activity participation of boys and girls with and without disability. Int J Disabil Dev Educ. 2010;57(1):77–107. doi: 10.1080/10349120903537988.
    1. Majnemer A, Shevell M, Law M, Birbaum R, Chilingaryan G, Rosembaum P. Participation and enjoyment of leisure activities in school aged children with cerebral palsy. Dev Med Child Neurol. 2008;50(10):751–758. doi: 10.1111/j.1469-8749.2008.03068.x.
    1. Phillips AC, Holland AJ. Assessment of objectively measured physical activity levels in individuals with intellectual disabilities with and without Down’s syndrome. PLoS ONE. 2011;6(12):e28618. doi: 10.1371/journal.pone.0028618.
    1. Rubin DA, Cano-Sokoloff N, Castner DM, Judelson DA, Wright P, Duran A, Haqq AM. Update on body composition and bone density in children with Prader-Willi Syndrome. Horm Res Paediatr. 2013;79(5):271–276. doi: 10.1159/000350525.
    1. Cassidy SB, Schwartz S, Miller JL, Driscoll DJ. Prader-Willi syndrome. Genet Med. 2012;14(1):10–26. doi: 10.1038/gim.0b013e31822bead0.
    1. Butler MG, Theodoro MF, Bittel DC, Donnelly JE. Energy expenditure and physical activity in Prader-Willi syndrome: comparison with obese subjects. Am J Med Genet A. 2007;143(5):449–459.
    1. van den Berg-Emons R, Festen D, Hokken-Koelega A, Bussmann J, Stam H. Everyday physical activity and adiposity in Prader-Willi syndrome. J Pediatr Endocrinol Metab. 2008;21(11):1041–1048.
    1. Rubin DA, Weiss JW, Mouttapa M, Barrera-Ng A. Physical activity in children with Prader-Willi syndrome: a parents' perspective. Calif J Health Promotion. 2012;10(Special):57–66.
    1. Dykens EM. Leisure Activities in Prader-Wlli Syndrome: implications for health, cognition and adaptive functioning. J Autism Dev Disord. 2014;44(2):294–302. doi: 10.1007/s10803-012-1462-7.
    1. Eiholzer U, Nordmann Y, l’Allemand D, Schlumpf M, Schmid S, Kromeyer-Hauschild K. Improving body composition and physical activity in Prader-Willi Syndrome. J Pediatr. 2003;142(1):73–78. doi: 10.1067/mpd.2003.mpd0334.
    1. Schlumpf M, Eiholzer U, Gygax M, Schmid S, van der Sluis I, l’Allemand D. A daily comprehensive muscle training programme increases lean mass and spontaneous physical activity in children with Prader-Willi syndrome after 6 months. J Pediatr Endocrinol Metab. 2006;19:65–74.
    1. Silverthorn KH, Hornak JE. Beneficial effects of exercise on aerobic capacity and body composition in adults with Prader-Willi syndrome. Am J Ment Retard. 1993;97(6):654–658.
    1. Vismara L, Cimolin V, Grugni G, Galli M, Parisio C, Sibilia O, Capodaglio P. Effectiveness of a 6-month home-based training program in Prader-Willi patients. Res Dev Disabil. 2010;31(6):1373–1379. doi: 10.1016/j.ridd.2010.07.001.
    1. Bandura A. Social cognitive theory: an agentic perspective. Annu Rev Psychol. 2001;52:1–26. doi: 10.1146/annurev.psych.52.1.1.
    1. Williams SL, French DP. What are the most effective intervention techniques for changing physical activity self-efficacy and physical activity behaviour—and are they the same? Health Educ Res. 2011;26:308–322. doi: 10.1093/her/cyr005.
    1. Bandura A. The primacy of self-regulation in health promotion. Appl Psychol. 2005;54(2):245–254. doi: 10.1111/j.1464-0597.2005.00208.x.
    1. Anshel MH, Seipel SJ. Self-monitoring and selected measures of aerobic and strength fitness and short-term exercise attendence. J Sport Behavior. 2009;32(2):125–151.
    1. Baranowski T, Anderson C, Carmack C. Mediating variable framework in physical activity interventions: How are we doing? How might we do better? Am J Prev Med. 1998;15:266–297. doi: 10.1016/S0749-3797(98)00080-4.
    1. Bandura A. Toward a psychology of human agency. Perspect Psychol Sci. 2006;1:164–180. doi: 10.1111/j.1745-6916.2006.00011.x.
    1. Bandura A. Social foundations of thought and action: A social cognitive theory . Englewood Cliffs, N. J.: Prentice-Hall; 1986.
    1. Pugliese J, Tinsley B. Parental socialization of child and adolescent physical activity: a meta-analysis. J Fam Psychol. 2007;21:331–343.
    1. Cliff DP, Okely AD, Morgan PJ, Steele JR, Jones RA, Colyvas K, Baur LA. Movement skills and physical activity in obese children: randomized controlled trial. Med Sci Sports Exerc. 2011;43(1):90–100. doi: 10.1249/MSS.0b013e3181e741e8.
    1. Salmon J, Ball K, Hume C, Booth M, Crawford D. Outcomes of a group-randomized trial to prevent excess weight gain, reduce screen behaviours and promote physical activity in 10-year-old children: switch-play. Int J Obes (Lond) 2008;32(4):601–612. doi: 10.1038/sj.ijo.0803805.
    1. Fisher A, Reilly JJ, Kelly LA, Montgomery C, Williamson A, Paton JY, Grant S. Fundamental movement skills and habitual physical activity in young children. Med Sci Sports Exerc. 2005;37(4):684–688. doi: 10.1249/01.MSS.0000159138.48107.7D.
    1. Morgan PJ, Okely AD, Cliff DP, Jones RA, Baur LA. Correlates of objectively measured physical activity in obese children. Obesity (Silver Spring) 2008;16(12):2634–2641. doi: 10.1038/oby.2008.463.
    1. Duncan MJ, Stanley M. Functional movement is negatively associated with weight status and positively associated with physical activity in British primary school children. J Obes. 2012;2012:697563.
    1. Sallis JF, McKenzie TL, Alcaraz JE, Kolody B, Faucette N, Hovell MF. The effects of a 2-year physical education program (SPARK) on physical activity and fitness in elementary school students. Sports, play and active recreation for kids. Am J Public Health. 1997;87(8):1328–1334. doi: 10.2105/AJPH.87.8.1328.
    1. Luepker RV, Perry CL, McKinlay SM, Nader PR, Parcel GS, Stone EJ, Webber LS, Elder JP, Feldman HA, Johnson CC. et al.Outcomes of a field trial to improve children's dietary patterns and physical activity. The child and adolescent trial for cardiovascular health. CATCH collaborative group. JAMA. 1996;275(10):768–776. doi: 10.1001/jama.1996.03530340032026.
    1. O'Loughlin EK, Dugas EN, Sabiston CM, O'Loughlin JL. Prevalence and correlates of exergaming in youth. Pediatrics. 2012;130:806–814. doi: 10.1542/peds.2012-0391.
    1. Maloney AE, Carter Bethea T, Kelsey KS, Marks JT, Paez S, Rosenberg AM, Catellier DJ, Hamer RM, Sikich L. A pilot of a video game (DDR) to promote physical activity and decrease sedentary screen time. Obesity. 2008;16:2074–2080. doi: 10.1038/oby.2008.295.
    1. Maddison R, Foley L, Ni Mhurchu C, Jiang Y, Jull A, Prapavessis H, Hohepa M, Rodgers A. Effects of active video games on body composition: a randomized controlled trial. Am J Clin Nutr. 2011;94(1):156–163. doi: 10.3945/ajcn.110.009142.
    1. Sandlund M, Waterworth EL, Hager C. Using motion interactive games to promote physical activity and enhance motor performance in children with cerebral palsy. Dev Neurorehabil. 2011;14(1):15–21. doi: 10.3109/17518423.2010.533329.
    1. Jelsma J, Pronk M, Ferguson G, Jelsma-Smit D. The effect of the Nintendo Wii Fit on balance control and gross motor function of children with spastic hemiplegic cerebral palsy. Dev Neurorehabil. 2013;16(1):27–37. doi: 10.3109/17518423.2012.711781.
    1. Lin H-C, Wuang Y-P. Strength and agility training in adolescents with Down syndrome: a randomized controlled trial. Res Dev Disabil. 2012;33:2236–2244. doi: 10.1016/j.ridd.2012.06.017.
    1. Ho M, Garnett SP, Baur L, Burrows T, Stewart L, Neve M, Collins C. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analyses. Pediatrics. 2012;130:e1647–e1671. doi: 10.1542/peds.2012-1176.
    1. Epstein LH, Wing RR, Koeske R, Valoski A. Effects of diet plus exercise on weight change in parents and children. J Consult Clin Psychol. 1984;52(3):429–437.
    1. Rooney BL, Gritt LR, Havens SJ, Mathiason MA, Clough EA. Growing healthy families: family use of pedometers to increase physical activity and slow the rate of obesity. WMJ. 2005;104(5):54–60.
    1. Barkin SL, Gesell SB, Poe EK, Ip EH. Changing overweight Latino preadolescent body mass index: the effect of the parent-child dyad. Clin Pediatr (Phila) 2011;50(1):29–36. doi: 10.1177/0009922810379039.
    1. Golley RK, Magarey AM, Baur LA, Steinbeck KS, Daniels LA. Twelve-month effectiveness of a parent-led, family-focused weight-management program for prepubertal children: a randomized, controlled trial. Pediatrics. 2007;119(3):517–525. doi: 10.1542/peds.2006-1746.
    1. Harvey-Berino J, Rourke J. Obesity prevention in preschool native-american children: a pilot study using home visiting. Obes Res. 2003;11(5):606–611. doi: 10.1038/oby.2003.87.
    1. Janicke DM, Sallinen BJ, Perri MG, Lutes LD, Huerta M, Silverstein JH, Brumback B. Comparison of parent-only vs family-based interventions for overweight children in underserved rural settings: outcomes from project STORY. Arch Pediatr Adolesc Med. 2008;162(12):1119–1125. doi: 10.1001/archpedi.162.12.1119.
    1. Hardman CA, Pauline HJ, Lowe CF. A home-based intervention to increase physical activity in girls: the Fit 'n' Fun Dudes program. J Exerc Sci Fit. 2009;7(1):1–8. doi: 10.1016/S1728-869X(09)60001-0.
    1. Ransdell LB, Taylor A, Oakland D, Schmidt J, Moyer-Mileur L, Shultz B. Daughters and mothers exercising together: effects of home- and community-based programs. Med Sci Sports Exerc. 2003;35(2):286–296. doi: 10.1249/01.MSS.0000048836.67270.1F.
    1. Lee SM, Nihiser A, Strouse D, Das B, Michael S, Huhman M. Correlates of children and parents being physically active together. J Phys Act Health. 2010;7(6):776–783.
    1. Hanggi JM, Phillips LR, Rowlands AV. Validation of the GT3X ActiGraph in children and comparison with the GT1M ActiGraph. J Sci Med Sport. 2013;16(1):40–44. doi: 10.1016/j.jsams.2012.05.012.
    1. Evenson KR, Catellier DJ, Gill K, Ondrak KS, McMurray RG. Calibration of two objective measures of physical activity for children. J Sports Sci. 2008;26(14):1557–1565. doi: 10.1080/02640410802334196.
    1. Trost SG, Loprinzi PD, Moore R, Pfeiffer KA. Comparison of accelerometer cut points for predicting activity intensity in youth. Med Sci Sports Exerc. 2011;43(7):1360–1368. doi: 10.1249/MSS.0b013e318206476e.
    1. Bruininks R, Bruininks B. Bruininks-Oseretsky test of motor proficiency Second edn. Minneapolis, MN: NCS: Pearson; 2005.
    1. Cherng RJ, Su FC, Chen JJ, Kuan TS. Performance of static standing balance in children with spastic diplegic cerebral palsy under altered sensory environments. Am J Phys Med Rehabil. 1999;78(4):336–343. doi: 10.1097/00002060-199907000-00008.
    1. Centers for Disease Control and Prevention, National Center for Health Statistics. CDC growth charts: United States. May 30, 2000 ( )
    1. Margulies L, Horlick M, Thornton JC, Wang J, Ioannidou E, Heymsfield SB. Reproducibility of pediatric whole body bone and body composition measures by dual-energy X-ray absorptiometry using the GE lunar prodigy. J Clin Densitom. 2005;8(3):298–304. doi: 10.1385/JCD:8:3:298.
    1. Varni JW, Seid M, Kurtin PS. PedsQL™ 4.0: reliability and validity of the pediatric quality of life inventory™ version 4.0 generic core scales in healthy and patient populations. Med Care. 2001;39(8):800–812. doi: 10.1097/00005650-200108000-00006.
    1. Saunders RP, Pate RR, Felton G, Dowda M, Weinrich MC, Ward DS, Parsons MA, Baranowski T. Development of questionnaires to measure psychosocial influences on children's physical activity. Prev Med. 1997;26(2):241–247. doi: 10.1006/pmed.1996.0134.
    1. Dishman RK, Saunders RP, McIver KL, Dowda M, Pate RR. Construct validity of selected measures of physical activity beliefs and motives in fifth and sixth grade boys and girls. J Pediatr Psychol. 2013;38(5):563–576. doi: 10.1093/jpepsy/jst013.
    1. Dishman RK, Motl RW, Sallis JF, Dunn AL, Birnbaum AS, Welk GJ, Bedimo-Rung AL, Voorhees CC, Jobe JB. Self-management strategies mediate self-efficacy and physical activity. Am J Prev Med. 2005;29(1):10–18. doi: 10.1016/j.amepre.2005.03.012.
    1. Motl RW, Dishman RK, Saunders RP, Dowda M, Pate RR. Perceptions of physical and social environment variables and self-efficacy as correlates of self-reported physical activity among adolescent girls. J Pediatr Psychol. 2007;32(1):6–12.
    1. Shields CA, Brawley LR. Preferring proxy-agency: impact on self-efficacy for exercise. J Health Psychol. 2006;11:904–914. doi: 10.1177/1359105306069092.
    1. Kraft LA, Wilson KS, Nelson MM. North American Society for the Psychology of Sport and Physical Activity. Hawaii; 2012. Parents pressuring their kids to be active: Parent self-efficacy, other-efficacy and negative social control.
    1. Wilson KS, Spink KS. Perceived parental social control following a recalled physical activity lapse: impact on adolescents' reported behavior. Psychology of Sport and Exercise. 2010;11(6):602–608. doi: 10.1016/j.psychsport.2010.06.012.
    1. Wilson KS, Spink KS, Priebe CS. Parental social control in reaction to a hypothetical lapse in their child's activity: the role of parental activity and importance. Psychology of Sport and Exercise. 2010;11:231–237. doi: 10.1016/j.psychsport.2010.01.003.

Source: PubMed

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