Effectiveness of a Parent-Led Physical Activity Intervention in Youth With Obesity

Daniela A. Rubin; Kathleen S. Wilson; Marilyn Dumont-Driscoll; Debra J. Rose

Disclosures

Med Sci Sports Exerc. 2019;51(4):805-813. 

In This Article

Abstract and Introduction

Abstract

Purpose: Prader–Willi syndrome (PWS) is a complex, rare neurobehavioral syndrome characterized by excessive fat, hypotonia, poor motor skills, and behavioral and cognitive disabilities. We tested the effectiveness of a home-based physical activity (PA) intervention led by parents in youth with obesity with and without PWS to increase moderate-to-vigorous PA (MVPA) and gross motor proficiency.

Methods: Participants were 111 youth age 8 to 16 yr (45 with PWS and 66 without PWS, but categorized as obese). A parallel design was used with the control group (C) receiving the intervention after serving as control. Intervention participants (I) completed a PA curriculum 4 d·wk−1 for 24 wk including warm-up exercises, strengthening exercises, and playground games 2 d·wk−1 and interactive console games 2 d·wk−1 guided by their parents. Pre–post outcomes (baseline to 24 wk) included MVPA (7-d accelerometry) and motor proficiency including upper limb coordination, bilateral coordination, balance, running speed and agility, and muscle strength (Bruininks–Oseretsky Test of Motor Proficiency).

Results: The intervention led to no change in MVPA (I group, 39.6 vs 38.9 min·d−1; C group, 40.6 vs 38.3 min·d−1). The intervention led to improvements in body coordination (22.3%; P < 0.05), as well as strength and agility (13.7%; P < 0.05). Specifically, the I group showed increases in upper limb coordination (19.1%), bilateral coordination (27.8%), and muscle strength (12.9%; P < 0.05 for all) not observed in the C group: −0.2%, 2.5%, and −3.2%, respectively.

Conclusions: This parent-guided PA intervention did not increase PA. However, the intervention led to improvements in gross motor skill competency. Providing families with tools and support can lead to implementation of PA routines that contribute to motor skill proficiency in youth with and without PWS.

Introduction

Children and youth are encouraged to participate in 60 min·d−1 of enjoyable and developmentally appropriate moderate-to-vigorous physical activity (MVPA).[1] However, in the United States, approximately 58% of children age 6 to 11 yr do not meet these recommendations,[2] with higher inactivity rates in those with physical and/or cognitive disabilities.[3] The low participation in PA has been linked to the increasing prevalence of obesity in youth with disability.[3]

Multiple studies have demonstrated that obesity in childhood is associated with poor motor competency.[4,5] Motor competence refers to the ability to execute different motor acts including coordination of gross and fine motor skills. Gross motor competence encompasses proficiency in different fundamental movement skills (e.g., throwing, balancing, and running) typically learned during childhood, as well as body coordination.[5]

In typically developing children, interventions targeting fundamental motor skills have mostly been conducted in school or community settings and delivered by physical education specialists or trained classroom teachers.[6] Some of these interventions have used curricula that included games.[7,8] For example, Cliff and associates[9] successfully combined the use of a skill-building curriculum at school with activities performed at home in youth with obesity. In youth with disability, approaches have included clinic-based interventions including active (movement-based) video games.[10,11] Because the movements executed while playing active video games may not exactly simulate the "real" game, this intervention strategy may be appealing as it provides the opportunity for repetitive practice of motor skills without judgment from peers if the games are played in the home environment.

Prader–Willi syndrome (PWS) is a rare congenital neurodevelopmental disorder stemming from an alteration or the lack of expression of the paternal chromosome 15 in the locus 13–15q. Youth with PWS have high body fat percentage and low lean mass, display poor motor skill competencies, and pose behavioral challenges, with most individuals presenting with physical and intellectual disabilities.[12] As a group, individuals with PWS exhibit low levels of PA.[13] To date, the only interventions that have been successful in increasing PA in children with PWS have been strength-training programs delivered at home.[14,15] Although these two studies have increased spontaneous PA, neither addressed the development and improvement of motor skill competencies.

Parents and children being active together correlate with PA participation in youth.[16] However, only a handful of studies have included the coparticipation of parents and children age 8 to 15 yr in PA.[17,18] Interventions carried out at home have the advantage of removing structural/logistical barriers (i.e., transportation or a fixed schedule) and providing a nonthreatening environment for those youth with poor perceived competence or self-efficacy for PA.[19] Using the framework of the Social Cognitive Theory in which parents may serve as a proxy and aid in the management and regulation of their child's behavior by scheduling and facilitating opportunities for PA,[20] we examined the efficacy of a parent-led home-based PA intervention.[21] Using a quasi-experimental design, this study evaluated whether a 24-wk parent-led PA curriculum increased PA levels and motor proficiency in youth with PWS and in youth without the syndrome, but with obesity.

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