Family-based interventions to increase physical activity in children: a systematic review, meta-analysis and realist synthesis.

OBJECTIVE: Family-based interventions represent a potentially valuable route to increasing child physical activity (PA) in children. A dual meta-analysis and realist synthesis approach examined existing interventions to assist those developing programmes to encourage uptake and maintenance of PA in children. DESIGN: Studies were screened for inclusion based on including participants aged 5-12 years, having a substantive aim of increasing PA by engaging the family and reporting on PA outcome. Duplicate data extraction and quality assessment were conducted. Meta-analysis was conducted in STATA. Realist synthesis included theory development and evidence mapping. RESULTS: Forty-seven studies were included, of which three received a 'strong' quality rating, 21 'moderate' and 23 'weak'. The meta-analysis (19 studies) demonstrated a significant small effect in favour of the experimental group (standardized mean difference: 0.41; 95%CI 0.15-0.67). Sensitivity analysis, removing one outlier, reduced this to 0.29 (95%CI 0.14-0.45). Realist synthesis (28 studies) provided insight into intervention context (particularly, family constraints, ethnicity and parental motivation), and strategies to change PA (notably, goal-setting and reinforcement combined). CONCLUSION: This review provides key recommendations to inform policy makers and other practitioners in developing evidence-based interventions aimed at engaging the family to increase PA in children, and identifies avenues for future research.This research received no specific grant from any funding agency in the public, commercial or not-for- profit sectors. This work was supported by the Medical Research Council [Unit Programme number: MC_UU_12015/7], and undertaken under the auspices of the Centre for Diet and Activity Research, a UKCRC Public Health Research Centre of Excellence which is funded by the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, and the Wellcome Trust (RES-590-28-0002). JP is supported by an NIHR post-doctoral fellowship (NIHR-PDF-2012-05-157). This article presents independent research in which the funders had no involvement in the study design; the collection, analysis, and interpretation of data; the writing of the article; or the decision to submit the article for publication. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, the Department of Health or the other funders.This is the final version of the article. It first appeared from Wiley via http://dx.doi.org/10.1111/obr.1236