A Dyadic Action Control Trial in Overweight and Obese Couples (DYACTIC) Parent-focused change to prevent obesity in preschoolers: results from the KAN-DO study. The influence of partner's behavior on health behavior change: the English Longitudinal Study of Ageing. The use of TeleMedicine in the treatment of paediatric obesity: feasibility and acceptability. The partners for life program: a couples approach to cardiac risk reduction. Aerobic Exercise Is Promoted when Individual Performance Affects the Group: A Test of the Kohler Motivation Gain Effect Family PArtners in Lifestyle Support (PALS): Family-Based Weight Loss for African American Adults with Type 2 Diabetes Testing the Efficacy of OurSpace, a Brief, Group Dynamics-Based Physical Activity Intervention: A Randomized Controlled Trial Effects of a web-based stroke education program on recurrence prevention behaviors among stroke patients: a pilot study. Screen-Time Weight-loss Intervention Targeting Children at Home (SWITCH): a randomized controlled trial A self-regulation-based intervention to increase physical activity in cancer patients Guided Self-Help for the Treatment of Pediatric Obesity Benefits of partnered strength training for prostate cancer survivors and spouses: results from a randomized controlled trial of the Exercising Together project Latino families, primary care, and childhood obesity: a randomized controlled trial. Children, parents and pets exercising together (CPET): exploratory randomised controlled trial Feasibility and impact of Creciendo Sanos, a clinic-based pilot intervention to prevent obesity among preschool children in Mexico City The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Buddy up: the Köhler effect applied to health games. A kindergarten cardiovascular risk surveillance study: CARDIAC-Kinder. 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Two-Player Partnered Exergame for Obesity Prevention: Using Discrepancy in Players' Abilities as a Strategy to Motivate Physical Activity Physical activity program delivery by professionals versus volunteers: the TEAM randomized trial. Effects of spouse-assisted coping skills training and exercise training in patients with osteoarthritic knee pain: a randomized controlled study Randomized controlled trial of collaborative implementation intentions targeting working adults' physical activity. Spouse health behavior outcomes from a randomized controlled trial of a spouse-assisted lifestyle change intervention to improve patient low-density lipoprotein cholesterol Efficacy of an internet-based behavioral weight loss program for overweight adolescent African-American girls A dance intervention for cancer survivors and their partners (RHYTHM) Parent/Child Training to Increase Preteens' Calcium, Physical Activity, and Bone Density: A Controlled Trial The effect of reinforcement or stimulus control to reduce sedentary behavior in the treatment of pediatric obesity. Feasibility of enlisting social network members to promote weight loss among Latinas. Exercise plus behavioral management in patients with Alzheimer disease: a randomized controlled trial. Children's food and activity patterns following a six-month child weight management program. 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Background Enhancing physical activity in overweight and obese individuals is an important means to promote health in this target population . The Health Action Process Approach ( HAPA ) , which was the theoretical framework of this study , focuses on individual self-regulation variables for successful health behavior change . One key self-regulation variable of this model is action control with its three subfacets awareness of intentions , self-monitoring and regulatory effort . The social context of individuals , however , is usually neglected in common health behavior change theories . In order to integrate social influences into the HAPA , this r and omized controlled trial investigated the effectiveness of a dyadic conceptualization of action control for promoting physical activity . Methods / Design This protocol describes the design of a single-blind r and omized controlled trial , which comprises four experimental groups : a dyadic action control group , an individual action control group and two control groups .  Participants of this study are overweight or obese , heterosexual adult couples who intend to increase their physical activity . Blocking as means of a gender-balanced r and omization is used to allocate couples to conditions and partners to either being the target person of the intervention or to the partner condition . The ecological momentary intervention takes place in the first 14 days after baseline assessment and is followed by another 14 days diary phase without intervention . Follow-ups are one month and six months later . Subsequent to the six-months follow-up another 14 days diary phase takes place . The main outcome measures are self-reported and accelerometer-assessed physical activity . Secondary outcome measures are Body Mass Index ( BMI ) , aerobic fitness and habitual physical activity . Discussion This is the first study examining a dyadic action control intervention in comparison to an individual action control condition and two control groups applying a single-blind r and omized control trial . Challenges with running couples studies as well as advantages and disadvantages of certain design -related decisions are discussed . This RCT was funded by the Swiss National Science Foundation ( PP00P1_133632/1 ) and was registered on 27/04/2012 at http://www.is rct n.com/IS RCT N15705531 OBJECTIVE The study presents the immediate post-intervention results of Kids and Adults Now - Defeat Obesity ! , a r and omized controlled trial to enhance healthy lifestyle behaviors in mother-preschooler ( 2 - 5 years old ) dyads in North Carolina ( 2007 - 2011 ) . The outcomes include change from baseline in the child 's diet , physical activity and weight , and in the mother 's parenting behaviors , diet , physical activity , and weight . METHOD The intervention targeted parenting through maternal emotion regulation , home environment , feeding practice s , and modeling of healthy behaviors .  400 mother-child dyads were r and omized . RESULTS Mothers in the intervention arm , compared to the control arm , reduced  instrumental feeding  ( -0.24 vs. 0.01 , p<0.001 ) and TV snacks ( -.069 vs. -0.24 , p=0.001 ) . There were also improvements in emotional feeding ( p=0.03 ) , mother 's sugary beverage ( p=0.03 ) and fruit/vegetable ( p=0.04 ) intake , and dinners eaten in front of TV ( p=0.01 ) ; these differences were not significant after adjustment for multiple comparisons . CONCLUSION KAN-DO , design ed to maximize the capacity of mothers as agents of change , improved several channels of maternal influence . There were no group differences in the primary outcomes , but differences were observed in the parenting and maternal outcomes and there were trends toward improvement in the preschoolers ' diets . Long-term follow-up will address whether these short-term trends ultimately improve weight status IMPORTANCE Couples are highly concordant for unhealthy behaviors , and a change in one partner 's health behavior is often associated with a change in the other partner 's behavior . However , no studies have explicitly compared the influence of having a partner who takes up healthy behavior ( eg , quits smoking ) with one whose behavior is consistently healthy ( eg , never smokes ) . OBJECTIVE To examine the influence of partner 's behavior on making positive health behavior changes . DESIGN , SETTING , AND PARTICIPANTS We used prospect i ve data from married and cohabiting couples ( n , 3722 ) participating in the English Longitudinal Study of Ageing , a large population -based cohort of older adults ( ≥50 years ) . Study ing men and women who had unhealthy behaviors in 3 domains at baseline ( ie , smoking , physically inactive , or overweight/obese ) , we used logistic regression analysis to examine the influence of the partner 's behavior in the same domain on the odds of positive health behavior change over time . MAIN OUTCOMES AND MEASURES Smoking cessation , increased physical activity , and 5 % weight loss or greater . RESULTS Across all domains , we found that when one partner changed to a healthier behavior ( newly healthy ) , the other partner was more likely to make a positive health behavior change than if their partner remained unhealthy ( smoking : men 48 % vs 8 % , adjusted odds ratio [ OR ] , 11.82 [ 95 % CI , 4.84 - 28.90 ] ; women 50 % vs 8 % , OR , 11.23 [ 4.58 - 27.52 ] ) ( physical activity : men 67 % vs 26 % , OR , 5.28 [ 3.70 - 7.54 ] ; women 66 % vs 24 % , OR , 5.36 [ 3.74 - 7.68 ] ) ( weight loss : men 26 % vs 10 % , OR , 3.05 [ 1.96 - 4.74 ] ; women 36 % vs 15 % , OR , 3.08 [ 1.98 - 4.80 ] ) . For smoking and physical activity , having a consistently healthy partner also predicted positive change , but for each domain , the odds were significantly higher in individuals with a newly healthy partner than those with a consistently healthy partner ( smoking : men OR , 3.08 [ 1.43 - 6.62 ] ; women OR , 5.45 [ 2.44 - 12.16 ] ) ( physical activity : men OR , 1.92 [ 1.37 - 2.70 ] ; women OR , 1.84 [ 1.33 - 2.53 ] ) ( weight loss : men OR , 2.28 [ 1.36 - 3.84 ] ; women OR , 2.86 [ 1.55 - 5.26 ] ) . CONCLUSIONS AND RELEVANCE Men and women are more likely to make a positive health behavior change if their partner does too , and with a stronger effect than if the partner had been consistently healthy in that domain . Involving partners in behavior change interventions may therefore help improve outcomes To assess the feasibility of conducting empirically supported family-based paediatric obesity group treatment via TeleMedicine .  Seventeen families were r and omly assigned to one of two conditions ( physician visit , TeleMedicine ) . Measures included feasibility , satisfaction and intervention outcome measures such as BMI percentile , and nutrition and activity behaviours . Measures were completed at baseline , post-treatment and at 1-year follow-up . Analyses indicate that both feasibility and satisfaction data regarding the TeleMedicine intervention were positive . Intervention outcome indicates no change in BMI percentile or nutrition and activity behaviours for either treatment group . A behavioural family-based weight loss intervention delivered via TeleMedicine was well received by both parents and providers . Due to the small sample size , null findings regarding intervention outcome should be interpreted with caution . Future research should focus on methods to increase the impact of this intervention on key outcome variables Morbidity and mortality are reliably lower for the married compared with the unmarried across a variety of illnesses . What is less well understood is how a couple uses their relationship for recommended lifestyle changes associated with decreased risk for illness . Partners for Life compared a patient and partner approach to behavior change with a patient only approach on such factors as exercise , nutrition , and medication adherence . Ninety-three patients and their spouses/partners consented to participate ( 26 % of those eligible ) and were r and omized into either the individual or couples condition . However , only 80 couples , distributed across conditions , contributed data to the analyses , due to missing data and missing data points . For exercise , there was a significant effect of couples treatment on the increase in activity and a significant effect of couples treatment on the acceleration of treatment over time . In addition , there was an interaction between marital satisfaction and treatment condition such that patients who reported higher levels of marital distress in the individuals condition did not maintain their physical activity gains by the end of treatment , while both distressed and nondistressed patients in the couples treatment exhibited accelerating gains throughout treatment . In terms of medication adherence , patients in the couples treatment exhibited virtually no change in medication adherence over time , while patients in the individuals treatment showed a 9 % relative decrease across time . There were no condition or time effects for nutritional outcomes . Finally , there was an interaction between baseline marital satisfaction and treatment condition such that patients in the individuals condition who reported lower levels of initial marital satisfaction showed deterioration in marital satisfaction , while non satisfied patients in the couples treatment showed improvement over time Background A key barrier to achieving recommended intensity and duration of physical activity is motivation . Purpose We investigated whether a virtually present partner would influence participants ’ motivation ( duration ) during aerobic exercise . Method Fifty-eight females ( Mage = 20.54 ± 1.86 ) were r and omly assigned to either a coactive condition ( exercising alongside another person , independently ) , a conjunctive condition ( performance determined by whichever partner stops exercising first ) where they exercised with a superior partner , or to an individual condition . Participants exercised on a stationary bike at 65 % of heart rate reserve on six separate days . Results Across sessions , conjunctive condition participants exercised significantly longer ( M = 21.89 min , SD = ±10.08 min ) than those in coactive ( M = 19.77 min , SD = ± 9.00 min ) and individual ( M = 10.6 min , SD = ±5.84 min ) conditions ( p < 0.05 ) . Conclusion Exercising with a virtually present partner can improve performance on an aerobic exercise task across multiple sessions Objective To develop and test a family-centered behavioral weight loss intervention for African American adults with type 2 diabetes . Methods In this r and omized trial , dyads consisting of African American adult with overweight or obesity and type 2 diabetes ( index participant ) paired with a family partner with overweight or obesity , but not diagnosed with diabetes , were assigned in a 2:1 ratio to a 20-week special intervention ( SI ) or delayed intervention ( DI ) control group . The primary outcome was weight loss among index participants at 20 weeks follow-up . Results One hundred-eight participants ( 54 dyads – 36 ( SI ) and 18 ( DI ) dyads ) were enrolled : 81 % females ; mean age , 51 years ; mean weight,103 kg ; and mean BMI , 37 kg/m2 . At post-intervention , 96 participants ( 89 % ) returned for follow-up measures . Among index participants , mean difference in weight loss between groups was −5.0 kg , p<.0001 ( −3.6 kg loss among SI ; 1.4 kg gain in DI ) . SI index participants showed significantly greater improvements in hemoglobin A1c , depressive symptoms , family interactions , and dietary , physical activity , and diabetes self-care behaviors . SI family partners also had significant weight loss ( −3.9 kg ( SI ) vs. −1.0 kg ( DI ) p=0.02 ) . Conclusions A family-centered , behavioral weight loss intervention led to clinical ly significant short-term weight loss among family dyads Background Emerging technologies ( ie , mobile phones , Internet ) may be effective tools for promoting  physical activity ( PA ) . However , few interventions have provided effective means to enhance social support through these platforms . Face-to-face programs that use group dynamics-based principles of behavior change have been shown to be highly effective in enhancing social support through promoting group cohesion and PA , but to date , no studies have examined their effects in Web-based programs . Objective The aim was to explore proof of concept and test the efficacy of a brief , online group dynamics-based intervention on PA  in a controlled experiment . We expected that the impact of the intervention on PA would be moderated by perceptions of cohesion and the partner ’s degree of presence in the online media . Methods Participants ( n=135 ) were r and omized into same-sex dyads and r and omly assigned to one of four experimental conditions : st and ard social support ( st and ard ) , group dynamics-based – high presence , group dynamics-based – low presence , or individual control . Participants performed two sets of planking exercises ( pre-post ) . Between sets , participants in partnered conditions interacted with a virtual partner using either a st and ard social support app or a group dynamics-based app ( group dynamics-based – low presence and group dynamics-based – high presence ) , the latter of which they participated in a series of online team-building exercises . Individual participants were given an equivalent rest period between sets . To increase presence during the second set , participants in the group dynamics-based – high presence group saw a live video stream of their partner exercising . Perceptions of cohesion were measured using a modified PA Group Environment Question naire . Physical activity was calculated as the time persisted during set 2 after controlling for persistence in set 1 . Results Perceptions of cohesion were higher in the group dynamics-based – low presence ( overall mean 5.81 , SD 1.04 ) condition compared to the st and ard ( overall mean 5.04 , SD 0.81 ) conditions ( P=.006 ) , but did not differ between group dynamics-based – low presence and group dynamics-based – high presence ( overall mean 5.42 , SD 1.07 ) conditions ( P=.25 ) . Physical activity was higher in the high presence condition ( mean 64.48 , SD 20.19 , P=.01 ) than all other conditions ( mean 53.3 , SD 17.35 ) . Conclusions A brief , online group dynamics-based intervention may be an effective method of improving group cohesion in virtual PA groups . However , it may be insufficient on its own to improve PA The effectiveness of methods to prevent stroke recurrence and of education focusing on learners ' needs has not been fully explored . The aims of this study were to assess the effects of such interventions among stroke patients and their primary caregivers and to evaluate the feasibility of a web-based stroke education program . The participants were 36 patients with a clinical diagnosis of ischemic stroke within 12 months post-stroke and their primary caregivers . The participants were r and omly assigned to either an experimental or a control group . The primary measures included blood chemistry , self-reported health behaviors , sense of control , and health motivation for stroke patients , and caregiver mastery for caregivers . To test the feasibility of the intervention program , the rates of participation and occurrence of technical problems were calculated . The experimental group tended to improve significantly more than the control group in terms of exercise , diet , sense of control and health motivation for the stroke patients and in terms of caregiver mastery for the primary caregivers . The rate of participation in the web-based program was 63.1 % . This program , which focuses on recurrence prevention in stroke patients and caregivers , has the potential to improve health behaviors for stroke patients Background Screen-based activities , such as watching television ( TV ) , playing video games , and using computers , are common sedentary behaviors among young people and have been linked with increased energy intake and overweight . Previous home-based sedentary behaviour interventions have been limited by focusing primarily on the child , small sample sizes , and short follow-up periods . The SWITCH ( Screen-Time Weight-loss Intervention Targeting Children at Home ) study aim ed to determine the effect of a home-based , family-delivered intervention to reduce screen-based sedentary behaviour on body composition , sedentary behaviour , physical activity , and diet over 24 weeks in overweight and obese children . Methods A two-arm , parallel , r and omized controlled trial was conducted . Children and their primary caregiver living in Auckl and , New Zeal and were recruited via schools , community centres , and word of mouth . The intervention , delivered over 20 weeks , consisted of a face-to-face meeting with the parent/caregiver and the child to deliver intervention content , which focused on training and educating them to use a wide range of strategies design ed to reduce their child ’s screen time . Families were given Time Machine TV monitoring devices to assist with allocating screen time , activity packages to promote alternative activities , online support via a website , and monthly newsletters . Control participants were given the intervention material on completion of follow-up . The primary outcome was change in children ’s BMI z-score from baseline to 24 weeks . Results Children ( n = 251 ) aged 9 - 12 years and their primary caregiver were r and omized to receive the SWITCH intervention ( n = 127 ) or no intervention ( controls ; n = 124 ) . There was no significant difference in change of z BMI between the intervention and control groups , although a favorable trend was observed ( -0.016 ; 95 % CI : -0.084 , 0.051 ; p = 0.64 ) . There were also no significant differences on secondary outcomes , except for a trend towards increased children ’s moderate intensity physical activity in the intervention group ( 24.3 min/d ; 95 % CI : -0.94 , 49.51 ; p = 0.06 ) . Conclusions A home-based , family-delivered intervention to reduce all leisure-time screen use had no significant effect on screen-time or on BMI at 24 weeks in overweight and obese children aged 9 - 12 years . Trial registration Australian New Zeal and Clinical Trials RegistryWebsite : http://www.anzctr.org.auTrial registration number : The study examined whether a behavior-change intervention focusing on self-regulatory strategies and emphasizing role model support increases physical activity ( PA ) among insufficiently active ( not meeting PA guidelines of 150 min/week ) cancer patients . Ambulatory cancer patients [ N = 72 ; 54 % female ; M = 56 years , SD = 12.34 ; most with breast or colon cancer ( 34 , 15 % ) ] were enrolled in the MOTIVACTION- study , a 4-week intervention ( 1-hr counseling , followed by weekly phone calls ) , with pretest ( T1 ) , posttest ( T2 ) and a 10-week follow-up ( T3 ) . Participants were r and omized to either an exercise or to a stress management intervention ( active control ) . The exercise intervention emphasized self-regulatory strategies ( e.g. action- and coping planning and self-monitoring ) ; patients were also encouraged to contact a physically active same-sex role model as a potential exercise partner . The active control condition consisted of coping and relaxation techniques .  Sixty-seven patients remained in the study and completed the SQUASH assessment of PA and a measure of perceived stress . PA was vali date d by Actigraph accelerometry . At T2 , 46 % of the patients in the exercise group and 19 % of stress management patients increased their activity levels to meet PA guidelines ( > 150 min/week ; χ2(1 ) = 5.51 , p = .019 ) . At T3 , participants in the exercise intervention maintained their exercise level ( 46 % ) , but also 31 % of the stress management patients met the guidelines . All patients reported reductions in perceived stress . Additional analyses comparing patients in the exercise group by role model contact ( 63 % realized contact ) revealed that those who had contact with their role model were significantly more likely to adhere to the recommended guidelines ( T2:50 % ; T3:64 % ) compared to those who did not have contact with a role model ( T2:39 % ; T3:15 % ) , suggesting the potential of mobilizing role model support to facilitate PA . In sum , cancer patients may not only benefit from an exercise intervention emphasizing self-regulation , but also from stress management , regarding both reducing stress and increasing PA BACKGROUND AND OBJECTIVE : Clinic-based programs for childhood obesity are not available to a large proportion of the population . The purpose of this study was to evaluate the efficacy of a guided self-help treatment of pediatric obesity ( GSH-PO ) compared with a delayed treatment control and to evaluate the impact of GSH-PO 6-months posttreatment . METHODS : Fifty overweight or obese 8- to 12-year-old children and their parents were r and omly assigned to immediate treatment or to delayed treatment . The GSH-PO includes 12 visits over 5 months and addresses key components included in more intensive clinic-based programs . Children and parents in the immediate treatment arm were assessed at time 1 ( T1 ) , participated in GSH-PO between T1 and T2 , and completed their 6-month posttreatment assessment at T3 . Children and parents in the delayed treatment arm were assessed at T1 , participated in GSH-PO between T2 and T3 , and completed their 6-month posttreatment assessment at T4 . The main outcome measures were BMI , BMI z score , and percentage overweight ( % OW ) . RESULTS : Children in the immediate treatment GSH-PO arm decreased their BMI significantly more than did the delayed treatment arm ( BMI group × time = −1.39 ; P < .001 ) . Similar results were found for BMI z score and % OW . At the 6-month posttreatment assessment , changes result ing from GSH-PO were maintained for BMI z score and % OW but not BMI ( BMI time effect = −0.06 , not significant ; BMI z score time effect = −0.10 , P < .001 ; % OW time effect = −4.86 , P < .05 ) . CONCLUSIONS : The GSH-PO showed initial efficacy in decreasing BMI for children in this study . Additional efficacy and translational studies are needed to additionally evaluate GSH-PO Background Prostate cancer can negatively impact quality of life of the patient and his spouse caregiver , but interventions rarely target the health of both partners simultaneously . We tested the feasibility and preliminary efficacy of a partnered strength training program on the physical and mental health of prostate cancer survivors ( PCS ) and spouse caregivers . Methods Sixty-four couples were r and omly assigned to 6 months of partnered strength training ( Exercising Together , N = 32 ) or usual care ( UC , N = 32 ) . Objective measures included body composition ( lean , fat and trunk fat mass ( kg ) , and % body fat ) by DXA , upper and lower body muscle strength by 1-repetition maximum , and physical function by the physical performance battery ( PPB ) . Self-reported measures included the physical and mental health summary scales and physical function and fatigue subscales of the SF-36 and physical activity with the CHAMPS question naire . Results Couple retention rates were 100 % for Exercising Together and 84 % for UC . Median attendance of couples to Exercising Together sessions was 75 % . Men in Exercising Together became stronger in the upper body ( p < 0.01 ) and more physically active ( p < 0.01 ) than UC . Women in Exercising Together increased muscle mass ( p = 0.05 ) and improved upper ( p < 0.01 ) and lower body ( p < 0.01 ) strength and PPB scores ( p = 0.01 ) more than UC . Conclusions Exercising Together is a novel couples-based approach to exercise that was feasible and improved several health outcomes for both PCS and their spouses . Implication s for cancer survivorsA couples-based approach should be considered in cancer survivorship programs so that outcomes can mutually benefit both partners . Trial registration Clinical Trials.gov BACKGROUND Few successful treatment modalities exist to address childhood obesity . Given Latinos ' strong identity with family , a family-focused intervention may be able to control Latino childhood obesity . PURPOSE To assess the feasibility and effectiveness of a family-centered , primary care-based approach to control childhood obesity through lifestyle choices . DESIGN R and omized waitlist controlled trial in which control participants received the intervention 6 months after the intervention group . SETTING / PARTICIPANTS Forty-one Latino children with BMI > 85 % , aged 9 - 12 years , and their caregivers were recruited from an urban community health center located in a predominantly low-income community . INTERVENTION Children and their caregivers received 6 weeks of interactive group classes followed by 6 months of culturally sensitive monthly in-person or phone coaching to empower families to incorporate learned lifestyles and to address both family and social barriers to making changes . MAIN OUTCOMES MEASURES Caregiver report on child and child self-reported health-related quality of life ( HRQoL ) ; metabolic markers of obesity ; BMI ; and accelerometer-based physical activity were measured July 2010-November 2011 and compared with post-intervention assessment s conducted at 6 months and as a function of condition assignment . Data were analyzed in 2012 . RESULTS Average attendance rate to each group class was 79 % . Socio-environmental and family factors , along with knowledge , were cited as barriers to changing lifestyles to control obesity . Caregiver proxy and child self-reported HRQoL improved for both groups with a larger but not nonsignificant difference among intervention vs control group children ( p=0.33 ) . No differences were found between intervention and control children for metabolic markers of obesity , BMI , or physical activity .  CONCLUSIONS Latino families are willing to participate in group classes and health coaching to control childhood obesity . It may be necessary for primary care to partner with community initiatives to address childhood obesity in a more intense manner . TRIAL REGISTRATION This study is registered at Clinical trials.partners.org 2009P001721 Background Levels of physical activity ( PA ) in UK children are much lower than recommended and novel approaches to its promotion are needed . The Children , Parents and Pets Exercising Together ( CPET ) study is the first exploratory r and omised controlled trial ( RCT ) to develop and evaluate an intervention aim ed at dog-based PA promotion in families . CPET aim ed to assess the feasibility , acceptability and potential efficacy of a theory-driven , family-based , dog walking intervention for 9–11 year olds . Methods Twenty-eight families were allocated r and omly to either receive a 10-week dog based PA intervention or to a control group . Families in the intervention group were motivated and supported to increase the frequency , intensity and duration of dog walking using a number of behaviour change techniques . Parents in the intervention group were asked to complete a short study exit question naire . In addition , focus groups with parents and children in the intervention group , and with key stakeholders were undertaken . The primary outcome measure was 10 week change in total volume of PA using the mean accelerometer count per minute ( cpm ) . Intervention and control groups were compared using analysis of covariance . Analysis was performed on an intention to treat basis . Results Twenty five families were retained at follow up ( 89 % ) and 97 % of all outcome data were collected at baseline and follow up . Thirteen of 14 ( 93 % ) intervention group parents available at follow up completed the study exit question naire and noted that study outcome measures were acceptable . There was a mean difference in child total volume of PA of 27 cpm ( 95 % CI -70 , 123 ) and -3 cpm ( 95 % CI -60 , 54 ) for intervention and control group children , respectively . This was not statistically significant . Approximately 21 % of dog walking time for parents and 39 % of dog walking time for children was moderate-vigorous PA . Conclusions The acceptability of the CPET intervention and outcome measures was high . Using pet dogs as the agent of lifestyle change in PA interventions in children and their parents is both feasible and acceptable , but did not result in a significant increase in child PA in this exploratory trial . Trial registration IS RCT Background Mexico has the highest adult overweight and obesity prevalence in the Americas ; 23.8 % of children < 5 years old are at risk for overweight and 9.7 % are already overweight or obese . Creciendo Sanos was a pilot intervention to prevent obesity among preschoolers in Instituto Mexicano del Seguro Social ( IMSS ) clinics . Methods We r and omized 4 IMSS primary care clinics to either 6 weekly educational sessions promoting healthful nutrition and physical activity or usual care . We recruited 306 parent-child pairs : 168 intervention , 138 usual care . Children were 2 - 5 years old with WHO body mass index ( BMI ) z-score 0 - 3 . We measured children ’s height and weight and parents reported children ’s diet and physical activity at baseline and 3 and 6-month follow-up . We analyzed behavioral and BMI outcomes with generalized mixed models incorporating multiple imputation for missing values . Results 93 ( 55 % ) intervention and 96 ( 70 % ) usual care families completed 3 and 6-month follow-up . At 3 months , intervention v. usual care children  increased vegetables by 6.3 servings/week ( 95 % CI , 1.8 , 10.8 ) . In stratified analyses , intervention participants with high program adherence ( 5 - 6 sessions ) decreased snacks and screen time and increased vegetables v. usual care .  No further effects on behavioral outcomes or BMI were observed . Transportation time and expenses were barriers to adherence . 90 % of parents who completed the post-intervention survey were satisfied with the program . Conclusions Although satisfaction was high among participants , barriers to participation and retention included transportation cost and time . In intention to treat analyses , we found intervention effects on vegetable intake , but not other behaviors or BMI .Trial registration Clinical Trials.gov NCT01539070.Comisión Nacional de Investigación Científica del IMSS : 2009 - 785 - 120 Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more The present investigation examined the Köhler motivation gain effect in a health game using an absent partner , presented virtually . The Köhler effect occurs when an inferior team member performs a difficult task better in a team or coaction situation than one would expect from knowledge of his or her individual performance . The effect has been strongest in conjunctive task conditions in which the group 's potential productivity is equal to the productivity of its least capable member . Participants were r and omly assigned to one of four conditions ( individual control , coaction , additive , and conjunctive ) in a 4 ( conditions ) • 2 ( gender ) factorial design and performed a series of isometric plank exercises within an exercise game . They performed the first series of five exercises alone holding each position for as long as they could , and , after a rest period , those in the partner conditions were told they would do remaining trials with a same-sex virtual partner whom they could observe during their performance . The partner 's performance was manipulated to be always superior to the participant 's . Results showed that task persistence was significantly greater in all experimental conditions than in the individual control condition . The conjunctive condition was no more motivating than either the additive or coactive conditions . Results suggest that working out with virtually present , superior partners can improve persistence motivation on exercise game tasks OBJECTIVE To evaluate an intervention aim ed at increasing family physical activity and parent education about diet and activity for kindergarten students and issues related to their children 's BMI . METHODS A r and omized , controlled trial design was used to assess intervention impact in parental report of child diet and physical activity  , and step logs over a 4-week period . RESULTS Participants in the intervention group reported that their children obtained more steps by the end of the program period , were more active , and had consumed fewer sweets than the comparison group . CONCLUSION The proposed intervention for parents and their young children does produce awareness and behavior change Objective : Action planning can help translate physical activity intentions into action by linking situational cues with behavioral responses . Dyadic planning extends action planning and refers to target persons forming plans for their own behavior change together with partners . This study investigated whether a dyadic planning intervention could increase physical activity in target persons and their partners , whether these effects were moderated by relationship quality and mediated by action control , activity-specific received partner support , and control . Method : Couples ( n = 338 ; target persons r and omized ) were r and omly assigned to ( a ) a dyadic planning condition ( DPC ) ; ( b ) an individual planning condition ( IPC ) , in which target persons planned and partners worked on a distractor task ; or ( c ) a control condition ( CC ) , in which couples worked on a distractor task . During 3 assessment s up to 6 weeks postintervention , moderate ( primary outcome ) and vigorous activity were objective ly measured ; other variables were self-reported . Multilevel and path models were fit . Results : There were no beneficial direct effects of the intervention for DPC target persons . Over time , DPC partners ’ vigorous activity increased , but decreased again . At lower relationship quality , DPC target persons ’ activity decreased , whereas IPC target persons ’ vigorous activity increased . Mediation hypotheses were not supported . Mutual influence models indicated positive effects of partners ’ on target persons ’ moderate activity in DPC and CC , whereas for IPC , negative effects of target persons ’ on partners ’ moderate activity emerged . Conclusions : Findings revealed the complexity of effects of dyadic planning on behavior change . Adding relationship quality to the equation clarified effects of DPC and IPC on physical activity Background The diets , physical activity and sedentary behavior levels of both children and adults in Australia are suboptimal . The family environment , as the first ecological niche of children , exerts an important influence on the onset of children ’s habits . Parent modeling is one part of this environment and a logical focus for child obesity prevention initiatives . The focus on parent ’s own behaviors provides a potential opportunity to decrease obesity risk behaviors in parents as well . Objective To assess the effect of a parent-focused  early childhood obesity prevention  intervention on  first-time mothers ’ diets , physical activity and TV viewing time .  Methods The Melbourne InFANT Program is a cluster-r and omized controlled trial which involved 542 mothers over their newborn ’s first 18 months of life . The intervention focused on parenting skills and strategies , including parental modeling , and aim ed to promote development of healthy child and parent behaviors from birth , including healthy diet , increased physical activity and reduced TV viewing time . Data regarding mothers ’ diet ( food frequency question naire ) , physical activity and TV viewing times ( self-reported question naire ) were collected using vali date d tools at both baseline and post-intervention . Four dietary patterns were derived at baseline using principal components analyses including frequencies of 55 food groups . Analysis of covariance was used to measure the impact of the intervention . Results The scores of both the " High-energy snack and processed foods " and the " High-fat foods " dietary patterns decreased more in the intervention group : -0.22 ( −0.42;-0.02 ) and −0.25 ( −0.50;-0.01 ) , respectively . No other significant intervention vs. control effects were observed regarding total physical activity , TV viewing time , and the two other dietary patterns , i.e. “ Fruits and vegetables ” and “ Cereals and sweet foods ” . Conclusions These findings suggest that supporting first-time mothers to promote healthy lifestyle behaviors in their infants impacts maternal dietary intakes positively . Further research needs to assess ways in which we might further enhance those lifestyle behaviors not impacted by the InFANT intervention Diet and physical activity habits may deteriorate after cohabitation , leading to weight gain and increased risk of lifestyle diseases . We carried out a 4-month , r and omized controlled trial of a diet and physical activity program for couples with a 1-year follow-up , comparing two methods of delivery . The program used six modules , which , after an initial group session , were mailed to the low-level intervention group .  In the high-level intervention group , half of the modules were mailed , and the others were delivered at interactive group sessions . A control group received no intervention . Postintervention and at follow-up , physical fitness improved in the high-level group , saturated fat intake decreased in both intervention groups , and low-density lipoprotein cholesterol fell in the high-level group . Fewer participants in the high-level group became overweight or obese . Health promotion for couples can improve health behaviors and potentially lower the risk of lifestyle diseases in participants and their future families ABSTRACT This study tested the efficacy of brief image-based print-mediated parent/caregiver and adolescent messages integrating physical activity with alcohol use avoidance .  A total of 684 high school students were r and omly assigned to either the parent postcard or adolescent flyer arm , with baseline and four-month postintervention data collection s. A significant repeated measures interaction ( group × time ) was found ( F(4,344 ) = 2.48 , p = .04 ) , with univariate tests showing less alcohol use frequency and problems ( ps < .05 ) among adolescents exposed to parent material s. Repeated measures factorial MANOVAs for group × time × prior current drug use were significant , with drug using adolescents receiving parent print messages showing less alcohol initiation and frequency and marijuana initiation and frequency ( ps < .05 ) . Very brief print material s sent to parents/caregivers may hold some promise for influencing substance use among adolescents , particularly those already using drugs Background and Purpose — The Stroke Health and Risk Education Project was a cluster-r and omized , faith-based , culturally sensitive , theory-based multicomponent behavioral intervention trial to reduce key stroke risk factor behaviors in Hispanics/Latinos and European Americans . Methods — Ten Catholic churches were r and omized to intervention or control group . The intervention group received a 1-year multicomponent intervention ( with poor adherence ) that included self-help material s , tailored newsletters , and motivational interviewing counseling calls . Multilevel modeling , accounting for clustering within subject pairs and parishes , was used to test treatment differences in the average change since baseline ( ascertained at 6 and 12 months ) in dietary sodium , fruit and vegetable intake , and physical activity , measured using st and ardized question naires . A priori , the trial was considered successful if any one of the 3 outcomes was significant at the 0.05/3 level . Results — Of 801 subjects who consented , 760 completed baseline data assessment s , and of these , 86 % completed at least one outcome assessment . The median age was 53 years ; 84 % subjects were Hispanic/Latino ; and 64 % subjects were women . The intervention group had a greater increase in fruit and vegetable intake than the control group ( 0.25 cups per day [ 95 % confidence interval : 0.08 , 0.42 ] , P=0.002 ) , a greater decrease in sodium intake ( −123.17 mg/d [ −194.76 , −51.59 ] , P=0.04 ) , but no difference in change in moderate- or greater-intensity physical activity ( −27 metabolic equivalent – minutes per week [ −526 , 471 ] , P=0.56 ) . Conclusions — This multicomponent behavioral intervention targeting stroke risk factors in predominantly Hispanics/Latinos was effective in increasing fruit and vegetable intake , reaching its primary end point . The intervention also seemed to lower sodium intake . Church-based health promotions can be successful in primary stroke prevention efforts . Clinical Trial Registration — URL : http://www . clinical trials.gov . Unique identifier : NCT01378780 BACKGROUND AND OBJECTIVE : Motivational interviewing ( MI ) has been shown to be an effective strategy for targeting obesity in adolescents , and parental involvement is associated with increased effectiveness . The aim of this study was to evaluate and compare the role of parental involvement in MI interventions for obese adolescents . METHODS : A total of 357 Iranian adolescents ( aged 14–18 years ) were r and omized to receive an MI intervention or an MI intervention with parental involvement ( MI + PI ) or assessment s only ( passive control ) . Data regarding anthropometric , biochemical , psychosocial , and behavioral measures were collected at baseline and 12 months later . A series of intention-to-treat , 2-way repeated- measures analysis of covariance were performed to examine group differences in change in outcomes measures over the 12-month follow-up period . RESULTS : Results revealed significant effects on most of the outcome parameters for MI + PI ( eg , mean ± SD BMI z score : 2.58 ± 0.61 ) compared with the passive control group ( 2.76 ± 0.70 ; post hoc test , P = .02 ) , as well as an additional superiority of MI + PI compared with MI only ( 2.81 ± 0.76 ; post hoc test , P = .05 ) . This pattern was also shown for most of the anthropometric , biochemical , psychometric , and behavioral outcome variables . CONCLUSIONS : MI with parental involvement is an effective strategy in changing obesity-related outcomes and has additional effects beyond MI with adolescents only . These findings might be important when administering MI interventions in school setting Background School health promotion has been shown to improve the lifestyle of students , but it remains unclear whether school-based programs can influence family health . We developed an innovative program that enables school children to act as change agents in promoting healthy lifestyles of their mothers . The objective of this study was to examine the effect of the child-initiated intervention on weight , physical activity and dietary habit of their mothers . Methods A 12-month cluster r and omized trial was conducted , with school as a cluster . Participants were mothers with grade 8 students , aged around 13 years , of 20 schools in Homagama , Sri Lanka . Students of the intervention group were trained by facilitators to acquire the ability to assess noncommunicable disease risk factors in their homes and take action to address them , whereas those of the comparison group received no intervention .  Body weight , step count and lifestyle of their mothers were assessed at baseline and post-intervention . Multi-level multivariable linear regression and logistic regression were used to assess the effects of intervention on continuous and binary outcomes , respectively . Results Of 308 study participants , 261 completed the final assessment at 12 month . There was a significantly greater decrease of weight and increase of physical activity in the intervention group . The mean ( 95 % confidence interval ) difference comparing the intervention group with the control group was −2.49 ( −3.38 to −1.60 ) kg for weight and −0.99 ( −1.40 to −0.58 ) kg/m2 for body mass index . The intervention group had a 3.25 ( 95 % confidence interval 1.87–5.62 ) times higher odds of engaging in adequate physical activity than the control group , and the former showed a greater number of steps than the latter after intervention . The intervention group showed a greater reduction of household purchase of biscuits and ice cream . Conclusions A program to motivate students to act as change agents of family ’s lifestyle was effective in decreasing weight and increasing physical activity of their mothers . Trial registration Sri Lanka Clinical Trials Registry SLCTR/2013/011 Objective To assess the effectiveness of 2 interventions in improving the physical activity and well-being of secondary school children . Design A clustered r and omised controlled trial ; classes , 1 per school , were assigned to 1 of 3 intervention arms or a control group based on a 2 × 2 factorial design . The interventions were peer-mentoring and participative learning .  Year 7 children ( aged 11–12 ) in the peer-mentoring intervention were paired with year 9 children for 6 weekly mentoring meetings . Year 7 children in the participative learning arm took part in 6 weekly geography lessons using personalised physical activity and Global Positioning System ( GPS ) data . Year 7 children in the combined intervention received both interventions , with the year 9 children only participating in the mentoring sessions . Participants 1494 year 7 students from 60 schools in the North of Engl and took part in the trial . Of these , 43 students opted out of taking part in the evaluation measurements , 2 moved teaching group and 58 changed school . Valid accelerometry outcome data were collected for 892 students from 53 schools ;  and well-being outcome data were available for 927 students from 52 schools . Main outcome measures The primary outcomes were mean minutes of accelerometer-measured moderate-to-vigorous intensity physical activity per day , and well-being as evaluated by the KIDSCREEN-27 question naire . These data were collected 6 weeks after the intervention ; a 12-month follow-up is planned . Results No significant effects ( main or interaction ) were observed for the outcomes . However , small positive differences were found for both outcomes for the participative learning intervention . Conclusions These findings suggest that the 2 school-based interventions did not modify levels of physical activity or well-being within the period monitored . Change in physical activity may require more comprehensive individual behavioural intervention , and /or more system-based efforts to address wider environmental influences such as family , peers , physical environment , transport and educational policy . Trial registration number IS RCT N82956355 Background Despite the physical and mental health benefits , few adults meet US Department of Health and Human Services physical activity guidelines for exercise frequency , intensity , and duration . One strategy that may increase physical activity duration is exercising with an Internet partner ( ie , someone who is virtually present , as in video chat ) . Internet partners help people overcome many barriers associated with face-to-face exercise groups ( eg , time , coordinating schedules , social physique anxiety ) . Past research examining individual performance in groups suggests that an increase in effort occurs when performing a task conjunctively , ie , when a participant is ( 1 ) less capable than fellow group members , and ( 2 ) participants efforts are particularly indispensable for group success ( ie , where the group ’s potential productivity is equal to the productivity of its least capable member ) . This boost in effort is more commonly known as the Köhler effect , named after the German psychologist who first observed the effect . While encouragement between group members is common practice in face-to-face group exercise , the effect of encouragement between partners exercising conjunctively across the Internet is unknown . Objective To examine the impact of exercising alone , compared to exercising conjunctively with an Internet partner , both with and without encouragement , on exercise persistence ( primary outcomes ) and secondary psychosocial outcomes ( self-efficacy , enjoyment , exercise intention ) . Methods Participants were recruited online and face-to-face from the campus of Michigan State University . With the assistance of the experimenter , participants ( n=115 ) played an exercise video game in a laboratory , performing a series of five abdominal plank exercises where they were asked to hold the plank for as long as possible ( Time 1 ) . They were then r and omized to a condition ( Individual , Partner-without-encouragement , or Partner-with-encouragement ) , where they performed the exercises again ( Time 2 ) . The impact of condition on the primary outcome measures and secondary outcome measures were evaluated using a 2 ( Gender ) x 3 ( Condition ) ANOVA on change scores ( Time 2-Time 1 ) . Results Those who exercised in online teams ( n=80 ) exercised significantly longer ( time=78.8s , P<.001 ) than those who worked individually ( n=35 ) . However , exercise duration was shorter when one ’s more capable partner gave verbal encouragement ( n=55 ) than when s/he did not ( n=25 ) ( a mean difference of 31.14s ) . These increases in effort were not accompanied by altered task self-efficacy , enjoyment of the task , or intention to exercise in the future . Conclusions Exercising conjunctively with an Internet partner can boost one ’s duration of exercise . However , encouragement from the stronger to the weaker member can mitigate these gains , especially if one perceives such comments being directed at someone other than themselves . To boost exercise duration , Internet-based physical activity interventions involving group interaction should make relative abilities of participants known and communication clear Background There is evidence that physical activity ( PA ) is of cognitive benefit to the ageing brain , but little is known on the effect in patients with Alzheimer ’s disease ( AD ) . The present pilot study assessed the effect of a home-based PA training on clinical symptoms , functional abilities , and caregiver burden after 12 and 24 weeks . Methods In an RCT thirty patients ( aged 72.4±4.3 years ) with AD ( MMSE : 20.6±6.5 points ) and their family caregivers were allocated to a home-based 12-week PA intervention program or the usual care group . The program changed between passive , motor-assisted or active resistive leg training and changes in direction on a movement trainer in order to combine physical and cognitive stimuli . Results Analysis of activities of daily living in the patients ( ADCS ADL total score ) revealed a significant group × time interaction effect ( 95 % CI of the difference between both groups at T2 : 5.01–10.51 ) . The control group experienced decreases in ADL performance at week 12 and 24 whereas patients in the intervention group remained stable . Analyses of executive function and language ability revealed considerable effects for semantic word fluency with a group × time interaction ( 95 % CI of the difference between both groups at T2 : 0.18–4.02 ) . Patients in the intervention group improved during the intervention and returned to initial performance at week 12 whereas the controls revealed continuous worsening . Analyses of reaction time , h and -eye quickness and attention revealed improvement only in the intervention group . Caregiver burden remained stable in the intervention group but worsened in the control group . Conclusions This study suggests that PA in a home-based setting might be an effective and intrinsically attractive way to promote PA training in AD and modulate caregiver burden . The results demonstrate transfer benefits to ADL , cognitive and physical skill in patients with AD . Trial Registration Clinical Trials.gov Background People with dementia have a disproportionately high rate of falls and fractures and poorer outcomes , yet there is currently no evidence to guide falls prevention in this population . Methods A r and omised trial design was used to test feasibility of study components and acceptability of a home hazard reduction and balance and strength exercise fall prevention program . The program was tailored to participant ’s individual cognitive levels and implemented as a carer-supported intervention .  Feasibility of recruitment , retention and implementation of intervention were recorded through observation and documented in field notes . Adherence , carer burden and use of task simplification strategies were also monitored . Outcome measures , collected at 12 weeks included physiological , fear of falling , cognitive and functional measures . Results Recruitment was achievable but may be more challenging in a multisite trial . Twenty two dyads of persons with mild dementia and their carers were r and omised to intervention or usual care control  group . Of 38 dyads referred to the study , there was a high rate of willingness to participate , with 6 ( 16 % ) declining and 10 ( 26 % ) not meeting inclusion criteria . The intervention was well received by participants and carers and adherence to both program components was very good . All participants implemented some home safety recommendations ( range 19 - 80 % ) with half implementing 50 % or more . At the end of 12 weeks , 72 % of the intervention group were  exercising .  Both the rate of falling and the risk of a fall were lower in the intervention group but these findings were not significant ( RR= 0.50 ( 95 % CI 0.11 - 2.19 ) . There were no differences in physiological outcome measures between the control and intervention groups . However results were influenced by the small study size and incomplete data primarily in the intervention group at follow up . Conclusions The pilot study was feasible and acceptable to people with mild dementia and their carers . The lessons learnt included : recruitment for a larger trial will require multiple approaches ; home safety recommendations should provide a greater emphasis on environmental use compared with behavioural change ; strategies to ensure an adequate dosage of exercise should be further explored . We recommend that intervention delivery incorporate an integrated occupational therapy and physiotherapy approach and that carers be provided with an individualised session to enhance dementia-specific skills in management and communication . A refined intervention should be tested in a r and omised trial with an adequately powered sample size . Trial registration Australia and New Zeal and Clinical Trials Registry Background Many children spend too much time screen-viewing ( watching TV , surfing the internet and playing video games ) and do not meet physical activity ( PA ) guidelines . Parents are important influences on children ’s PA and screen-viewing ( SV ) . There is a shortage of parent-focused interventions to change children ’s PA and SV . Methods Teamplay was a two arm individualized r and omized controlled feasibility trial . Participants were parents of 6–8 year old children . Intervention participants were invited to attend an eight week parenting program with each session lasting 2 hours . Children and parents wore an accelerometer for seven days and minutes of moderate-to-vigorous intensity PA ( MVPA )  were derived . Parents were also asked to report the average number of hours per day that both they and the target child spent watching TV . Measures were assessed at baseline ( time 0 ) at the end of the intervention ( week 8) and 2 months after the intervention had ended ( week 16 ) . Results There were 75 participants who provided consent and were r and omized but 27 participants withdrew post-r and omization . Children in the intervention group engaged in 2.6 fewer minutes of weekday MVPA  at Time 1 but engaged in 11 more minutes of weekend MVPA . At Time 1 the intervention parents engaged in 9 more minutes of  weekday MVPA  and 13 more minutes of weekend MVPA  . The proportion of children in the intervention group watching ≥ 2 hours per day of TV on weekend days decreased after the intervention ( time 0 = 76 % , time 1 = 39 % , time 2 = 50 % ) , while the control group proportion increased slightly ( 79 % , 86 % and 87 % ) . Parental weekday TV watching decreased in both groups . In post- study interviews many mothers reported problems associated with wearing the accelerometers . In terms of a future full-scale trial , a sample of between 80 and 340 families would be needed to detect a mean difference of 10-minutes of weekend MVPA . Conclusions Teamplay is a promising parenting program in an under- research ed area . The intervention was acceptable to parents , and all elements of the study protocol were successfully completed . Simple changes to the trial protocol could result in more complete data collection and study engagement In a pilot health promotion program for couples , we aim ed to build on re-evaluation of attitudes to health occurring early in marriage , and social support provided by partners , to address the weight gain and physical inactivity which may follow marriage . A r and omized controlled trial lasting 16 weeks used six modules focusing on nutrition and physical activity but including information about alcohol and smoking . Thirty-four of 39 couples enrolled completed the study .  Self-efficacy for diet and physical activity increased significantly in the program group while ranking of barriers to healthy behaviours decreased and ranking of beliefs about the benefits of health behaviours increased relative to controls . Intake of fat , take-away foods and alcohol decreased , and consumption of fruit , vegetables and reduced-fat foods increased significantly in the program group .  Physical activity  in the program group increased by the equivalent of 50 min of brisk walking weekly but did not differ significantly from controls . Cholesterol fell significantly by 6 % more in the program group than controls . In focus groups , participants unanimously found the program valuable . Health promotion programs design ed for couples can achieve short-term changes in behaviour and risk factors . Larger trials with longer-term monitoring , incorporating feedback from focus groups and cost-benefit analysis , are in progress OBJECTIVE : To assess the effectiveness of a  parent-focused intervention on  infants ’ obesity-risk behaviors and BMI . METHODS : This cluster r and omized controlled trial recruited 542 parents and their infants ( mean age 3.8 months at baseline ) from 62 first-time parent groups . Parents were offered six 2-hour dietitian-delivered sessions over 15 months focusing on parental knowledge , skills , and social support around infant feeding , diet , physical activity , and television viewing . Control group parents received 6 newsletters on nonobesity-focused themes ; all parents received usual care from child health nurses . The primary outcomes of interest were child diet ( 3 × 24-hour diet recalls ) , child physical activity ( accelerometry ) , and child TV viewing ( parent report ) . Secondary outcomes included BMI z-scores ( measured ) . Data were collected when children were 4 , 9 , and 20 months of age . RESULTS : Unadjusted analyses showed that , compared with controls , intervention group children consumed fewer grams of noncore drinks ( mean difference = –4.45 ; 95 % confidence interval [ CI ] : –7.92 to –0.99 ; P = .01 ) and were less likely to consume any noncore drinks ( odds ratio = 0.48 ; 95 % CI : 0.24 to 0.95 ; P = .034 ) midintervention ( mean age 9 months ) . At intervention conclusion ( mean age 19.8 months ) , intervention group children consumed fewer grams of sweet snacks ( mean difference = –3.69 ; 95 % CI : –6.41 to –0.96 ; P = .008 ) and viewed fewer daily minutes of television ( mean difference = –15.97 : 95 % CI : –25.97 to –5.96 ; P = .002 ) . There was little statistical evidence of differences in fruit , vegetable , savory snack , or water consumption or in BMI z-scores or physical activity . CONCLUSIONS : This intervention result ed in reductions in sweet snack consumption and television viewing in 20-month-old children OBJECTIVE To evaluate the effectiveness of a psychological , family-based intervention to improve diabetes-related outcomes in patients with poorly controlled type 2 diabetes . METHODS This study was a r and omized controlled trial of a psychological family-based intervention targeted at individuals with poorly controlled type 2 diabetes . Recruitment and follow-up occurred at specialist diabetes clinics . Patients were r and omly allocated to an  intervention group ( n=60 ) or a control group ( n=61 ) . Poor control was defined as at least 2 of the patient 's last 3 glycated hemoglobin (  A1C  )  readings at > 8.0 % . The intervention consisted of 2 sessions delivered by a health psychologist to the patient and a family member in the patient 's home , with a third session involving a 15-minute follow-up telephone call . RESULTS At 6-month follow-up , the intervention group reported significantly lower mean A1C levels than the control group ( 8.4 % [ SD=0.99 % ] vs 8.8 % [ SD=1.36 % ] ; P=.04 ) . The intervention was most effective in those with the poorest control at baseline ( A1C>9.5 % ) ( intervention 8.7 % [ SD=1.16 % , n=15 ] vs control 9.9 % [ SD=1.31 % , n=15 ] ; P=.01 ) . The intervention group also reported statistically significant improvements in beliefs about diabetes , psychological well-being , diet , exercise , and family support . CONCLUSIONS After participating in a family-based intervention targeting negative and /or inaccurate illness perceptions , patients with poorly controlled type 2 diabetes showed improvements in A1C levels and other outcomes . Our results suggest that adding a psychological , family-based component to usual diabetes care may help improve diabetes management Parent-only ( PO ) treatments for childhood obesity are feasible , more cost-effective and potentially easier to disseminate . The objective of this study was to determine whether a PO treatment is not inferior to a parent + child ( PC ) treatment for childhood obesity . Eighty parent-child dyads with an 8 - 12 year old overweight or obese child ( > 85th BMI -P ) were recruited and r and omized into  PO or PC treatment for childhood obesity . Parents or parent-child dyads attended 5-month treatment groups . Child and parent body size , child caloric intake , and child physical activity were assessed at baseline , post-treatment , and 6-months follow-up . Noninferiority testing using mixed linear models was used to compare PO treatment with PC treatment . Results showed that the PO group was not inferior to the PC group in terms of child weight loss . Results also showed that the PO group was not inferior to the PC group in terms of parent weight loss and child physical activity , but not child caloric intake . This study suggests that a PO treatment could provide similar results to PC in child weight loss and other relevant outcomes , and potentially could be more cost-effective and easier to disseminate . Although further research is needed , this study suggests that PO groups are a viable method for providing childhood obesity treatment Regular physical activity ( PA ) and the avoidance of prolonged sitting are essential for children ’s healthy growth , and for the physical and mental wellbeing of both children and adults . In the context of exercise , music may promote behavioral change through increased exercise adherence and participation . The purpose of this study was to determine whether a movement-to-music video program could reduce sedentary behavior ( SB ) and increase PA in mother-child pairs in the home environment . A r and omized controlled trial was conducted in the Pirkanmaa region , Finl and , in 2014–2016 . The participants consisted of 228 mother-child pairs ( child age 5–7 years ) . The primary outcomes of interest were tri-axial accelerometer-derived SB and PA , which were measured in weeks one ( baseline ) , two , and eight in both the intervention and control groups . Further , the mothers and children in the intervention group used a movement-to-music video program from the beginning of week two to the end of week eight . Secondary outcomes included self-reported screen time . The statistical methods employed comprised an intention-to-treat and linear mixed effects model design . No statistically significant differences between groups were found in primary or secondary outcomes . Among the children in the control group  , light PA  decreased significantly over time and screen time increased from 89 ( st and ard deviation , SD 37 ) to 99 ( SD 41 ) min/d . Among mothers and children in the intervention group , no statistical differences were found . In supplementary analysis , the children who stayed at home instead of attending daycare/preschool had on average 25 ( 95 % confidence interval , CI 19–30 ) min/d more sedentary time and 11 ( 95 % CI 8–14 ) min/d less moderate-to-vigorous PA than those who were at daycare/preschool . The higher body mass index of mothers was related with 5 ( 95 % CI 2–7 ) min/d more sedentary time and 1 ( 95 % CI 0–2 ) min/d less moderate-to-vigorous PA . The movement-to-music video program did not change the objective ly measured SB or PA of the mother-child pairs . However , mothers and children seemed to be more sedentary at home , and therefore interventions for decreasing SB and increasing PA should be targeted in the home environment OBJECTIVE To determine whether maternal participation in an obesity prevention plus parenting support ( OPPS ) intervention would reduce the prevalence of obesity in high-risk Native-American children when compared with a parenting support (PS)-only intervention . RESEARCH METHODS AND PROCEDURES Forty-three mother/child pairs were recruited to participate . Mothers were 26.5 + /- 5 years old with a mean BMI of 29.9 + /- 3 kg/m(2 ) . Children ( 23 males ) were 22 + /- 8 months old with mean weight-for-height z ( WHZ ) scores of 0.73 + /- 1.4 . Mothers were r and omly assigned to a 16-week OPPS intervention or PS alone . The intervention was delivered one-on-one in homes by an indigenous peer educator . Baseline and week 16 assessment s included weight and height ( WHZ score and weight-for-height percentile for children ) , dietary intake ( 3-day food records ) , physical activity ( measured by accelerometers ) , parental feeding style ( Child Feeding Question naire ) , and maternal outcome expectations , self-efficacy , and intention to change diet and exercise behaviors . RESULTS Changes in WHZ scores showed a trend toward significance , with WHZ scores decreasing in the PS condition and increasing among the OPPS group ( -0.27 + /- 1.1 vs. 0.31 + /- 1.1 , p = 0.06 ) . Children in the OPPS condition also significantly decreased energy intake ( -316 + /- 835 kcal/d vs. 197 + /- 608 kcal/d , p < 0.05 ) . Scores on the restriction subscale of the Child Feeding Question naire decreased significantly in the OPPS condition ( -0.22+/- 0.42 vs. 0.08+/- 0.63 , p < 0.05 ) , indicating that mothers in the OPPS group were engaging in less restrictive child feeding practice s over time . DISCUSSION A home-visiting program focused on changing lifestyle behaviors and improving parenting skills showed promise for obesity prevention in high-risk Native-American children BACKGROUND The primary care setting offers the opportunity to reach children and parents to encourage healthy lifestyle behaviours , and improve weight status among children . OBJECTIVE Test the feasibility of Helping H AND ( Healthy Activity and Nutrition Directions ) , an obesity intervention for 5- to 8-year-old children in primary care clinics . METHODS A r and omized controlled pilot study of Helping H AND , a 6-month intervention , targeted children with body mass index 85 - 99%tile and their parents . Intervention group attended monthly sessions and self-selected child behaviours and parenting practice s to change . Control group received regular paediatric care and was wait-listed for Helping H AND . Session completion , participant satisfaction , child anthropometrics , dietary intake , physical activity , TV viewing and behaviour-specific parenting practice s were measured pre and post intervention . RESULTS Forty parent-child dyads enrolled : 82.5 % were Hispanic , 80 % had a girl and 65 % reported income ≤ $ 30 , 000/year . There was 20 % attrition from Helping H AND ( attended < 4/6 sessions ) . Families self-selected 4.35 ( SD 1.75 ) behaviours to target during the 6-month programme and each of the seven behaviours was selected by 45 - 80 % of the families . There were no between group differences in the child 's body mass index z-score , dietary intake or physical activity post intervention . Intervention group viewed 14.9 ( SE 2.3 ) h/week of TV post intervention versus control group 23.3 ( SE 2.4 ) h/week ( P < 0.05 ) . CONCLUSION Helping H AND is feasible , due to low attrition , good programme attendance , and clinical ly relevant improvements in some child and parenting behaviours OBJECTIVE The objective of this study is to evaluate the effectiveness of a simple  dyadic ( person with dementia and their main carer ) exercise regimen as a therapy for the behavioural and psychological symptoms of dementia . METHOD A two arm , pragmatic , r and omised , controlled , single-blind , parallel-group trial of a dyadic exercise regimen ( individually tailored walking regimen design ed to become progressively intensive and last between 20 - 30 min , at least five times per week).Community-dwelling individuals with ICD-10 confirmed dementia with the following : clinical ly significant behavioural and psychological symptoms , a carer willing and able to co-participate in the exercise regimen , and no physical conditions or symptoms that would preclude exercise participation were invited by mental health or primary care services into the study . RESULTS One hundred and thirty-one dyads were recruited to this study . There was no significant difference in Behavioural and Psychological Symptoms as measured by the Neuropsychiatric Inventory at week 12 between the group receiving the dyadic exercise regimen and those that did not ( adjusted difference in means ( intervention minus control ) = -1.53 , p = 0.6 , 95 % CI [ -7.37 , 4.32 ] ) . There was a significant between-group difference in caregiver 's burden as measured by the Zarit Caregiver Burden Inventory at week 12 ( OR = 0.18 , p = 0.01 , CI [ 0.05 , 0.69 ] ) favouring the exercise group . CONCLUSIONS This study found that regular simple exercise does not appear to improve the behavioural and psychological symptoms of dementia , but did seem to attenuate caregiver burden . Further study to improve exercise uptake are needed OBJECTIVE Although studies have shown that physical activity ( PA ) can reduce some treatment-related side effects of breast cancer , there is a need to offer PA programs outside of research setting s to reach more cancer survivors . We partnered with the American Cancer Society 's Reach to Recovery ( RTR ) program to train their volunteers ( breast cancer survivors ) to deliver a 12-week PA intervention to other breast cancer survivors . METHOD We conducted a r and omized controlled trial to compare the PA intervention delivered by  RTR volunteers ( PA plus RTR ) with contact control ( RTR control ) .  Eighteen RTR volunteers/coaches ( Mage = 54.9 years ; Mtime since diagnosis = 7.0 years ) delivered the contact control condition or the PA intervention .  Seventy-six breast cancer survivors in New Engl and ( Mage = 55.6 years ; Mtime since diagnosis = 1.1 years ) were r and omized to 1 of the 2 groups . At baseline , 12 weeks ( postintervention ) , and at 24 weeks , participants wore an  accelerometer  for 7 days , were interviewed about their PA , and reported their motivational readiness for PA . RESULTS Adjusted , mixed-effects longitudinal regression models showed significant group differences favoring the PA plus RTR group in minutes of moderate to vigorous PA at 12 weeks ( Mdifference = 103 min/week , p < .001 ) and at 24 weeks ( Mdifference = 34.7 min/week , p = .03 ) . Results were corroborated with significant group differences in accelerometer data favoring the PA plus RTR group at both time points . CONCLUSION Peer volunteers were able to significantly increase PA among cancer survivors relative to contact control . Partnerships with existing volunteer programs can help to widen the reach of behavioral interventions among cancer survivors . ( PsycINFO Data base Background :  Physical inactivity  is associated with obesity and type 2 diabetes . A key obstacle to physical activity is lack of motivation . Although some interactive exercise games ( i.e. , exergames — video games that require physical exertion in order to play ) motivate players to exercise more , few games take advantage of group dynamics to motivate players ' duration of exercise . In a test of the Kohler motivation gain effect , this study varied the ability level of a virtually presented partner in an interactive exergame that focused on abdominal strength to identify effects on a subject 's ( S ' ) persistence with the task . Method : Male ( n = 63 ) and female ( n = 72 ) undergraduate students were r and omly assigned to one of four conditions ( individual control or low- , moderate- , or high- partner discrepancy ) in a conditions x gender factorial design and tested on a series of isometric abdominal exercises using PlayStation 2 EyeToy : Kinetic software . They performed the first series of five exercises alone ( trial block 1 ) , and after a rest period , those in the partner conditions performed remaining trials ( trial block 2 ) with a same-sex virtually presented partner whom they could observe during their performance , while those in the individual control condition performed the remaining trials alone . In the partner conditions , the partner 's performance was manipulated to be always better than the S 's , the exact difference depending on the discrepancy condition . The partnered tasks were conjunctive ; that is , success in the game depended on the performance of the weaker team member . Persistence , the outcome measure for this study , consisted of the total number of seconds the S held the exercise position . Results : Using planned orthogonal contrasts on difference scores between blocks 1 and 2 , results showed that persistence was significantly ( p < .001 ) greater in all experimental conditions with a virtually presented partner ( M = 33.59 s ) than in the individual control condition ( M = −49.04 s ) . Subjects demonstrated more persistence in the moderate-discrepancy condition ( M = 51.36 s ) than in the low-discrepancy condition ( M = 22.52 s ) or the high-discrepancy condition ( M = 26.89 s ) . A significant quadratic trend confirmed the expected inverted-U function relating partner discrepancy and persistence ( p = .025 ) . Although Ss persisted longer and had higher heart rate in partnered conditions , they did not perceive their exertion to be any higher than those in the individual condition . Conclusions : Virtually presented partners who are moderately more capable than participants are the most effective at improving persistence in exergame tasks OBJECTIVE Older adults have low rates of physical activity participation , but respond positively to telephone-mediated support programs . Programs are often limited by reliance on professional staff . This study tested telephone-based physical activity advice delivered by professional staff versus trained volunteer peer mentors . DESIGN A 12-month , r and omized , controlled clinical trial was executed from 2003 - 2008 . Twelve volunteer peer mentors and 181 initially inactive adults ages 50 years and older were recruited from the San Francisco Bay Area . Participants were r and omized to : ( 1 ) telephone-based physical activity advice delivered by professional staff , ( 2 ) telephone-based physical activity advice delivered by trained volunteer peers , or ( 3 ) an attention-control arm of staff-delivered telephone support for nutrition . MAIN OUTCOME MEASURES Moderate-intensity or more vigorous physical activity ( MVPA ) was assessed at baseline , 6 , and 12 months with the Community Healthy Activities Model Program for Seniors ( CHAMPS ) Question naire , with accelerometry validation ( Actigraph ) in a r and omly selected sub sample . Treatment fidelity was examined through analysis of quantity and quality of intervention delivery . RESULTS At 6 and 12 months , both physical activity arms significantly increased MVPA relative to the control arm . Both physical activity arms were comparable in quantity of intervention delivery , but peers demonstrated more versatility and comprehensiveness in quality of intervention content . CONCLUSIONS This study demonstrates that trained peer volunteers can effectively promote physical activity increases through telephone-based advice . The results support a program delivery model with good dissemination potential for a variety of community setting & NA ; This study tested the separate and combined effects of spouse‐assisted pain coping skills training ( SA‐CST ) and exercise training ( ET ) in a sample of patients having persistent osteoarthritic knee pain . Seventy‐two married osteoarthritis ( OA ) patients with persistent knee pain and their spouses were r and omly assigned to : SA‐CST alone , SA‐CST plus ET , ET alone , or st and ard care ( SC ) . Patients in SA‐CST alone , together with their spouses , attended 12 weekly , 2‐h group sessions for training in pain coping and couples skills . Patients in SA‐CST+ET received spouse‐assisted coping skills training and attended 12‐weeks supervised ET . Patients in the ET alone condition received just an exercise program . Data analyses revealed : ( 1 ) physical fitness and strength :  the SA‐CST+ET and ET alone groups had significant improvements in physical fitness compared to SA‐CST alone and patients in SA‐CST+ET and ET alone had significant improvements in leg flexion and extension compared to SA‐CST alone and SC , ( 2 ) pain coping : patients in SA‐CST+ET and SA‐CST alone groups had significant improvements in coping attempts compared to ET alone or SC and spouses in SA‐CST+ET rated their partners as showing significant improvements in coping attempts compared to ET alone or SC , and ( 3 ) self‐efficacy : patients in SA‐CST+ET reported significant improvements in self‐efficacy and their spouses rated them as showing significant improvements in self‐efficacy compared to ET alone or SC . Patients receiving SA‐CST+ET who showed increased self‐efficacy were more likely to have improvements in psychological disability . An intervention that combines spouse‐assisted coping skills training and exercise training  can improve physical fitness , strength , pain coping , and self‐efficacy in patients suffering from pain due to osteoarthritis OBJECTIVE The research tested the efficacy of planning and partner-based interventions to promote physical activity over six months . METHOD Local government ( council ) employees ( N = 257 ) were r and omly allocated to one of four conditions ( collaborative implementation intentions ; partner-only ; implementation intentions ; control group ) before completing measures at baseline and follow-ups at 1 , 3 and 6 months . Outcome measures comprised vali date d self-report measures of physical activity : the international physical activity question naire ( IPAQ ; Craig et al. , 2003 ) and self-report walking and exercise tables ( SWET ; Prestwich et al. , 2012 ) ; psychosocial mediators ( enjoyment , intention , self-efficacy , social influence ) ; weight and waist size ( baseline and 6 months only ) . RESULTS As well as losing the most weight , there was evidence that participants in the collaborative implementation-intention group were more physically active than each of the other three groups at 1- , 3- and 6-month follow-ups . Those in the implementation-intention and partner-only conditions did not outperform the control group on most measures . CONCLUSION Collaborative implementation intentions represent a potentially useful intervention to change important health behaviors that help reduce weight This study evaluated  spouse health behavior outcomes  from a r and omized controlled trial of a  spouse-assisted lifestyle intervention to reduce patient low-density lipoprotein cholesterol and improve patient health behaviors . Participants were 251 spouses of patients from the Durham Veterans Affairs Medical Center r and omized to intervention or usual care . The intervention comprised 9 monthly telephone calls to patients and spouses . Outcomes were assessed at baseline , 6 and 11 months . At 11 months , there were no differences in spouse outcomes between intervention and usual care groups for moderate intensity physical activity ( i.e. , frequency , duration ) or dietary intake ( i.e. , total calories , total fat , percentage of calories from total fat , saturated fat , percentage of calories from saturated fat , cholesterol , fiber ) . To improve spouse outcomes , couple interventions may need to include spouse behavior change goals and reciprocal support between patients and spouses and consider the need for improvement in spouse outcomes Objective : This r and omized controlled trial tested the efficacy of an internetbased lifestyle behavior modification program for weight management in African-American girls . Design : African-American girls were r and omly assigned to an interactive behavioral internet program or an internet health education program , the control condition . The behavioral intervention included internet counseling and was highly interactive . The control intervention was a passive ( non-interactive ) educational program .  Parents were also participants in the study . Participants in both treatment groups met in face-to-face sessions on four occasions over the first 12 weeks of a 6-month intervention . Subjects : The study enrolled 57 African-American adolescent girls ( ages 11 to 15 years ) who were overweight or obese and had at least one biological parent who was obese [ body mass index ( BMI ) > 30 kg/m2 ] . Of the 57 participants , 50 ( 88 % ) completed the 6-month trial . Measurements : Outcome data , including BMI , body weight , body composition , dietary intake , and weight loss behaviors were collected at baseline and 6-months later . A computer server tracked utilization of the websites . Participation in the program was measured by number of “ hits ” on the website . Results : Compared to the control condition , adolescents in the behavioral treatment lost more body fat ( group difference = 1.6 % body fat ) and parents lost significantly more body weight ( group difference = 2.1 kg ) . Utilization of the behavioral website by adolescents and parents was associated with positive outcome . Dietary fat intake was lowered for adolescents and parents in the behavioral treatment group . Conclusion : An internet-based behavioral intervention was superior to internet-based health education and yielded decreased body fat for adolescent girls and decreased body weight for parents Purpose The purpose of this study was to assess the feasibility , acceptability , and impact of a ballroom dance intervention on improving quality of life ( QOL ) and relationship outcomes in cancer survivors and their partners . Methods We conducted a pilot r and omized controlled trial with two arms ( Restoring Health in You ( and Your Partner ) through Movement , RHYTHM ) : ( 1 ) immediate dance intervention and ( 2 ) delayed intervention ( wait-list control ) . The intervention consisted of 10 private weekly dance lessons and 2 practice parties over 12 weeks . Main outcomes were physical activity ( Godin Leisure-Time Exercise Question naire ) , functional capacity ( 6 Minute Walk Test ) , QOL ( SF-36 ) , Couples ’ trust ( Dyadic Trust Scale ) , and other dyadic outcomes . Exit interviews were completed by all participating couples . Results Thirty-one women survivors ( 68 % breast cancer ) and their partners participated . Survivors were 57.9 years old on average and 22.6 % African American . Partners had similar characteristics . RHYTHM had significant positive effects on physical activity ( p = 0.05 ) , on the mental component of QOL ( p = 0.04 ) , on vitality ( p = 0.03 ) , and on the dyadic trust scale ( p = 0.04 ) . Couples expressed satisfaction with the intervention including appreciating the opportunity to spend time and exercise together . Survivors saw this light-intensity physical activity as easing them into becoming more physically active . Conclusions Light intensity ballroom dancing has the potential to improve cancer survivors ’ QOL . Larger trials are needed to build strong support for this ubiquitous and acceptable activity . Implication s for cancer survivorsBallroom dance may be an important tool for cancer survivors to return to a physically active life and improve QOL and other aspects of their intimate life Purpose . To test effects of  parent/child training design ed to increase calcium intake , bone-loading physical activity ( PA )  , and bone density . Design . Two-group r and omized controlled trial . Setting . Family-based intervention delivered at research center . Subjects . 117 healthy children aged 10–13 years ( 58.1 % female , 42.7 % Hispanic , 40.2 % White ) . Ninety-seven percent of participants had at least one parent graduate from high school and 37.2 % had at least one parent graduate from a 4-year university . Intervention . Children and parents were r and omly assigned to diet and exercise ( experimental ) or injury prevention ( control ) interventions . Children were taught in eight weekly classes how to engage in bone-loading PA and eat calcium-rich foods or avoid injuries . Parents were taught behavior management techniques to modify children 's behaviors . Measures . Measures at baseline and at 3 , 9 , and 12 months included 24-hour diet and PA recalls , and bone mineral density ( BMD ) by dual-energy x-ray absorptiometry . Analysis . Analysis of variance and generalized estimating equations ( GEE ) assessed group by time differences . Comparisons were conducted separately for boys and girls . Results . For boys , cross-sectional differences between experimental and control groups were achieved for 3- and 9-month calcium intake ( 1352 vs. 1052 mg/day , 1298 vs. 970 mg/day , p < .05 ) . For girls , marginal cross-sectional differences were achieved for high-impact PA at 12 months ( p < .10 ) . For calcium intake , a significant group by time interaction was observed from pretest to posttest for the full sample ( p = .008 ) and for girls ( p = .006 ) but not for boys . No significant group by time differences in calcium were observed across the follow-up period . No group by time differences were observed for  high-impact PA  . Among boys , longitudinal group by time differences reached significance for total hip BMD ( p = .045 ) and femoral neck BMD ( p = .033 ) , even after adjusting for skeletal growth . Similar differential increases were observed among boys for bone mineral content ( BMC ) at the hip ( p = .068 ) and total body ( p = .054 ) regions . No significant group by time interaction effects were observed for girls at any bone site for BMD . For BMC , control girls showed a significant increase ( p = .03 ) in spine BMC compared to intervention girls . Conclusion . This study demonstrated that parent/preteen training can increase calcium intake and attenuate the decline in high-impact PA . Results suggest that more powerful interventions are needed to increase activity levels and maximize bone mineral accrual during preadolescent years Obese children were r and omly assigned to a family-based behavioral treatment that included either stimulus control or reinforcement to reduce sedentary behaviors . Significant and equivalent decreases in sedentary behavior and high energy density foods , increases in physical activity and fruits and vegetables , and decreases in st and ardized body mass index ( z- BMI ) were observed . Children who substituted active for sedentary behaviors had significantly greater z- BMI changes at 6 ( -1.21 vs. -0.76 ) and 12 ( -1.05 vs. -0.51 ) months , respectively . Substitution of physically active for sedentary behaviors and changes in activity level predicted 6- and 12-month z- BMI changes . Results suggest stimulus control and reinforcing reduced sedentary behaviors are equivalent ways to decrease sedentary behaviors , and behavioral economic relationships in eating and activity may mediate the effects of treatment Shaping network members into sources of support for healthy eating and exercise behaviors may be an effective strategy to enhance obesity treatment outcomes . This pilot study examined the feasibility and preliminary efficacy of a behavioral weight loss intervention adapted for Latinas with a social network component . Twenty-seven Latinas ( 43.0±10.2 years and body mass index 36.9±5.7 ) participated in a 24-week r and omized controlled intervention study . Participants attended group-based treatment either individually ( Individual Lifestyle Group [ ILG ] ) or with a weight loss partner selected from their existing network ( Partner Lifestyle Group [ PLG ] ) . Repeated measures analysis of variance was conducted to compare ILG and PLG participants on changes in weight or psychosocial variables . Participants in both intervention groups attended 70 % of treatment sessions ; 96 % and 100 % completed assessment at post-treatment ( 12 weeks ) and follow-up ( 24 weeks ) , respectively . Significant weight loss ( P<0.01 ) was achieved at post-treatment ( ILG -4.7±4.2 kg and PLG -4.3±4.4 kg ) and follow-up ( ILG -5.0±6.4 kg and PLG -4.7±5.0 kg ) , with nearly 50 % of participants losing at least 5 % of initial body weight . Both groups also experienced increased self-efficacy for weight loss ( P<0.01 ) , self-efficacy for exercise ( P=0.02 ) , and family social support for exercise habits ( P=0.01 ) . There were no significant differences between groups . Results from this study suggest a behavioral weight loss intervention for Latinas is feasible , but there is less support for the efficacy of weight loss partners CONTEXT Exercise training for patients with Alzheimer disease combined with teaching caregivers how to manage behavioral problems may help decrease the frailty and behavioral impairment that are often prevalent in patients with Alzheimer disease . OBJECTIVE To determine whether a home-based exercise program combined with caregiver training in behavioral management techniques would reduce functional dependence and delay institutionalization among patients with Alzheimer disease . DESIGN , SETTING , AND PATIENTS R and omized controlled trial of 153 community-dwelling patients meeting National Institute of Neurological and Communicative Diseases and Stroke/Alzheimer Disease and Related Disorders Association criteria for Alzheimer disease , conducted between June 1994 and April 1999 . INTERVENTIONS Patient-caregiver dyads were r and omly assigned to the combined exercise and caregiver training program , Reducing Disability in Alzheimer Disease ( RDAD ) , or to routine medical care ( RMC ) . The RDAD program was conducted in the patients ' home over 3 months . MAIN OUTCOME MEASURES Physical health and function ( 36-item Short-Form Health Survey 's [ SF-36 ] physical functioning and physical role functioning subscales and Sickness Impact Profile 's Mobility subscale ) , and affective status ( Hamilton Depression Rating Scale and Cornell Depression Scale for Depression in Dementia ) . RESULTS At 3 months , in comparison with the routine care patients , more patients in the RDAD group exercised at least 60 min/wk ( odds ratio [ OR ] , 2.82 ; 95 % confidence interval [ CI ] , 1.25 - 6.39 ; P = .01 ) and had fewer days of restricted activity ( OR , 3.10 ; 95 % CI , 1.08 - 8.95 ; P<.001 ) . Patients in the RDAD group also had improved scores for physical role functioning compared with worse scores for patients in the RMC group ( mean difference , 19.29 ; 95 % CI , 8.75 - 29.83 ; P<.001 ) . Patients in the RDAD group had improved Cornell Depression Scale for Depression in Dementia scores while the patients in the RMC group had worse scores ( mean difference , -1.03 ; 95 % CI , -0.17 to -1.91 ; P = .02 ) . At 2 years , the RDAD patients continued to have better physical role functioning scores than the RMC patients ( mean difference , 10.89 ; 95 % CI , 3.62 - 18.16 ; P = .003 ) and showed a trend ( 19 % vs 50 % ) for less institutionalization due to behavioral disturbance . For patients with higher depression scores at baseline , those in the RDAD group improved significantly more at 3 months on the Hamilton Depression Rating Scale ( mean difference , 2.21 ; 95 % CI , 0.22 - 4.20 ; P = .04 ) and maintained that improvement at 24 months ( mean difference , 2.14 ; 95 % CI , 0.14 - 4.17 ; P = .04 ) . CONCLUSION Exercise training combined with teaching caregivers behavioral management techniques  improved physical health and depression in patients with Alzheimer disease OBJECTIVE To describe the impact of a parent-led , family-focused child weight management program on the food intake and activity patterns of pre-pubertal children . METHODS An assessor-blinded , r and omized controlled trial involving 111 ( 64 % female ) overweight , pre-pubertal children 6 - 9 years of age r and omly assigned to parenting-skills training plus intensive diet and activity education ( P + DA ) , parenting-skills training alone ( P ) , or a 12-month wait-listed control ( WLC ) . Study outcomes were assessed at baseline , 6 months , and 12 months . This paper presents data on food intake assessed via a vali date d 54-item parent-completed dietary question naire and activity behaviours assessed via a parent-report 20-item activity question naire . RESULTS Intake of energy-dense nutrient-poor foods was lower in both intervention groups at 6 months ( mean difference , P + DA - 1.5 serves [ CI - 2.0 ; -1.0 ] ; P - 1.0 serves [ -2.0 ; -0.5 ] ) and 12 months ( mean difference P + DA - 1.0 serves [ CI - 2.0 ; -0.5 ] ; P - 1.0 serves [ - 1.5 ; 0.0 ] ) compared to baseline . Intake of vegetables , fruit , breads and cereals , meat and alternatives and dairy foods remained unchanged . Regardless of study group there were significant reductions over time in the reported time spent engaged in small screen activities and an increase in the time reported spent in active play . CONCLUSION A child weight management intervention that promotes food intake in line with national dietary guidelines achieves a reduction in children 's intake of energy-dense , nutrient-poor foods . This was achieved without compromising intake of nutrient-rich food and changes were maintained even once the intervention ceased Background . The family and home environment is an influential antecedent of childhood obesity . The purpose of this study was to pilot test The Enabling Mothers to Prevent Pediatric Obesity through Web-Based Education and Reciprocal Determinism ( EMPOWER ) intervention ; a newly developed , theory-based , online program for prevention of childhood obesity . Method . The two-arm , parallel group , r and omized , participant-blinded trial targeted mothers with children between 4 and 6 years of age . Measures were collected at baseline , 4 weeks , and 8 weeks to evaluate programmatic effects on constructs of social cognitive theory ( SCT ) and obesity-related behaviors . Process evaluation transpired concurrently with each intervention session . Results . Fifty-seven participants were r and omly assigned to receive either experimental EMPOWER ( n = 29 ) or active control Healthy Lifestyles ( n = 28 ) intervention . Significant main effects were identified for child physical activity , sugar-free beverage consumption , and screen time , indicating that both groups improved in these behaviors . A significant group-by-time interaction was detected for child fruit and vegetable ( FV ) consumption as well as the SCT construct of environment in the EMPOWER cohort . An increase of 1.613 cups of FVs ( 95 % confidence interval = [ 0.698 , 2.529 ] ) was found in the experimental group , relative to the active control group . Change score analysis found changes in the home environment accounted for 31.4 % of the change in child FV intake for the experimental group . Conclusions . Child physical activity , sugar-free beverage consumption , and screen time improved in both groups over the course of the trial . Only the theory-based intervention was efficacious in increasing child FV consumption . The EMPOWER program was robust for inducing change in the home environment leading to an increase in child FV intake ( Cohen ’s f = 0.160 ) OBJECTIVE This r and omized controlled trial evaluated the effectiveness of a telephone-delivered , spouse-assisted lifestyle intervention to reduce patient LDL-C.  METHOD From 2007 to 2010 , 255 out patients with LDL-C>76 mg/dL and their spouses from the Durham Veterans Affairs Medical Center were r and omized to intervention or usual care .  The intervention comprised nine monthly goal - setting telephone calls to patients and support planning calls to spouses . Outcomes were assessed at 11 months . RESULTS Patients were 95 % male and 65 % White .  LDL-C did not differ between groups ( mean difference = 2.3 mg/dL , 95 % CI = -3.6 , 8.3 , p = 0.44 ) , nor did the odds of meeting goal LDL-C ( OR = 0.95 , 95 % CI = 0.6 , 1.7 ; p = 0.87 ) . Intakes of calories ( p = 0.03 ) , total fat ( p = 0.02 ) , and saturated fat ( p = 0.02 ) were lower for the intervention group . Cholesterol and fiber intake did not differ between groups ( p = 0.11 and 0.26 , respectively ) . The estimated rate of moderate intensity physical activity per week was 20 % higher in the intervention group ( IRR = 1.2 , 95 % CI = 1.0 , 1.5 , p = 0.06 ) . Most participants did not experience a change in cholesterol medication usage during the study period in the intervention ( 71.7 % ) and usual care ( 78.9 % ) groups . CONCLUSION This intervention might be an adjunct to usual primary care to improve adherence to lifestyle behaviors In this study , we investigated the role of dyadic planning for health-behavior change .  Dyadic planning refers to planning health-behavior change together with a partner . We assumed that dyadic planning would affect the implementation of regular pelvic-floor exercise ( PFE ) , with other indicators of social exchange and self-regulation strategies serving as mediators . In a r and omized-controlled trial at a German University Medical Center , 112 prostatectomy- patients with partners were r and omly assigned to a dyadic PFE-planning condition or one of three active control conditions . Question naire data were assessed at multiple time points within six months post-surgery , measuring self-reported dyadic PFE-planning and pelvic-floor exercise  as primary outcomes and social exchange ( support , control ) and a self-regulation strategy ( action control ) as mediating mechanisms . There were no specific intervention effects with regard to dyadic PFE-planning or pelvic-floor exercise  , as two active control groups also showed increases in either of these variables . However , results suggested that patients instructed to plan dyadically still benefited from self-reported dyadic PFE-planning regarding pelvic-floor exercise . Cross-sectionally , received negative control from partners was negatively related with PFE only in control groups and individual action control mediated between self-reported dyadic PFE-planning and PFE for participants instructed to plan PFE dyadically . Longitudinally , action control mediated between self-reported dyadic PFE-planning and pelvic-floor exercise for all groups . Findings provide support for further investigation of dyadic planning in health-behavior change with short-term mediating effects of behavior-specific social exchange and long-term mediating effects of better self-regulation PURPOSE Studies have found disparities in psychological distress between lesbian and gay cancer survivors and their heterosexual counterparts .  Exercise and partner support are shown to reduce distress . However , exercise interventions have n't been delivered to lesbian and gay survivors with support by caregivers included . METHODS In this pilot r and omized controlled trial ( RCT ) , ten lesbian and gay and twelve heterosexual survivors and their caregivers were r and omized as dyads to : Arm 1 , a survivor-only , 6-week , home-based , aerobic and resistance training program ( EXCAP © ® ) ; or Arm 2 , a dyadic version of the same exercise program involving both the survivor and caregiver .  Psychological distress , partner support , and exercise adherence , were measured at baseline and post-intervention ( 6 weeks later ) . We used t-tests to examine group differences between lesbian/gay and heterosexual survivors and between those r and omized to survivor-only or dyadic exercise . RESULTS Twenty of the twenty-two recruited survivors were retained post-intervention . At baseline , lesbian and gay survivors reported significantly higher depressive symptoms ( P = .03 ) and fewer average steps walked ( P = .01 ) than heterosexual survivors . Post-intervention , these disparities were reduced and we detected no significant differences between lesbian/gay and heterosexual survivors . Participation in dyadic exercise result ed in a significantly greater reduction in depressive symptoms than participation in survivor-only exercise for all survivors ( P = .03 ) . No statistically significant differences emerged when looking across arm ( survivor-only vs. dyadic ) by subgroup ( lesbian/gay vs. heterosexual ) . CONCLUSION Exercise may be efficacious in ameliorating disparities in psychological distress among lesbian and gay cancer survivors , and dyadic exercise may be efficacious for survivors of diverse sexual orientations . Larger trials are needed to replicate these findings RATIONALE Engaging in regular physical activity requires substantial self-regulatory effort such as action control ( e.g. , continuously monitoring and evaluating an ongoing behavior with regard to one 's st and ards ) . OBJECTIVE The present study examined the effectiveness of an ecological momentary action control intervention for promoting daily physical activity . Also , we tested whether a dyadic compared to an individual intervention displayed an additional benefit . METHODS 121 overweight and obese individuals and their partners were r and omly allocated to an intervention ( n = 60 ; information + action control text messages ) or a control group ( n = 61 ; information only ) . The intervention was delivered in a dyadic vs. individual version of action control . Allocation ratio was 1:1:2 for the dyadic , individual , and control groups , respectively . Daily physical activity was assessed with triaxial accelerometers  during a 14-day intervention phase and a 14-day follow-up phase . RESULTS Participants in the intervention group showed a higher probability ( 36.5 % ) to achieve the recommended daily activity levels ( ≥30 min of moderate-to-vigorous physical activity per day performed in bouts of at least 10 min ) during the intervention and follow-up phase compared to those in the control group ( 23.0 % ) . The intervention and control group did not differ in terms of daily moderate-to-vigorous physical activity ( 40.7 vs. 38.6 min per day , p = 0.623 ) . CONCLUSION Interventions facilitating action control via text messages seem to be an effective tool for increasing adherence to physical activity guidelines in everyday life . The comparable effects for the dyadic and individual intervention suggest that automated text messages may be just as effective as personalized messages from the romantic partner . Further investigation is needed to examine the usefulness of a dyadic conceptualizing of action control . ( controlled-trials.com IS RCT N15705531 ) BACKGROUND Among patients with coronary artery disease ( CAD ) , improvement of lifestyle-related risk factors ( LRFs ) reduces cardiovascular morbidity and mortality . However , modification of LRFs is highly challenging . OBJECTIVES This study sought to evaluate the impact of combining community-based lifestyle programs with regular hospital-based secondary prevention . METHODS The authors performed a r and omized controlled trial of nurse-coordinated referral of patients and their partners to 3 widely available community-based lifestyle programs , in 15 hospitals in the Netherl and s. Patients admitted for acute coronary syndrome and /or revascularization , with ≥1 LRF ( body mass index > 27 kg/m2 , self-reported physical inactivity , and /or smoking ) were included . All patients received guideline -based usual care . The intervention was based on 3 lifestyle programs for weight reduction , increasing physical activity , and smoking cessation . The primary outcome was the proportion of success at 12 months , defined as improvement in ≥1 qualifying LRF using weight ( ≥5 % reduction ) , 6-min-walking distance ( ≥10 % improvement ) , and urinary cotinine ( 200 ng/ml detection limit ) without deterioration in the other 2 . RESULTS The authors r and omized 824 patients . Complete data on the primary outcome were available in 711 patients .  The proportion of successful patients in the intervention group was 37 % ( 133 of 360 ) compared with 26 % ( 91 of 351 ) in the control group ( p = 0.002 ; risk ratio : 1.43 ; 95 % confidence interval : 1.14 to 1.78 ) . In the intervention group , partner participation was associated with a significantly greater success rate ( 46 % vs. 34 % ; p = 0.03 ) . CONCLUSIONS Among patients with coronary artery disease , nurse-coordinated referral to a comprehensive set of community-based , widely available lifestyle interventions , with optional partner participation , leads to significant improvements in LRFs . ( RESPONSE-2 : R and omised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists 2 ; NTR3937 ) Background Community-based interventions are needed to reduce the burden of childhood obesity . Purpose To evaluate the impact of a multi-level promotora-based ( Community Health Advisor ) intervention to promote healthy eating and physical activity and prevent excess weight gain among Latino children . Methods Thirteen elementary schools were r and omized to one of four intervention conditions : individual/family level ( Family-only ) , school/community level ( Community-only ) , combined ( Family + Community ) , or a measurement-only condition .  Participants were 808 Latino parents and their children enrolled in kindergarten through 2nd grade . Measures included parent and child body mass index ( BMI ) and a self-administered parent survey that assessed several parent and child behaviors . Results There were no significant intervention effects on children ’s BMI z-score . The family intervention changed several obesity-related child behaviors ( e.g. , fruit/vegetable consumption ) and these were mediated by changes in parenting variables ( e.g. , parent monitoring ) . Conclusion A promotora-based behavioral intervention was efficacious at changing parental factors and child obesity-related health behaviors
ABSTRACT Several interventions have targeted dyads to promote  physical activity ( PA )  or reduce sedentary behaviour ( SB ) , but the evidence has not been synthesis ed .