Discussion
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SECONDARY
This study evaluated the effects of a theory-based, co-created intervention aiming to improve co-physical activity (i.e. the father and the child being active together), which was used as a strategy to increase PA in both children and fathers. The ‘Run Daddy Run’ intervention led to an increase in self-reported father-child co-PA, and in objectively measured MPA and total volume PA of the father, and LPA of the child. However, inverse intervention effects were found for MPA and VPA of the child.Specifically for co-PA, significant intervention effects were found for co-PA conducted For objectively measured PA, significant intervention effects were found in the present study for objectively measured MPA of the father (+ 17 min./day in the intervention vs. control group) and total volume PA of the father (+ 6 mFor objectively measured PA in children, an increase in LPA was found in the present study (+ 35 min./day in the intervention vs. control group), but inverse intervention effects were found for MPA and VPA of the child (-15 min./day and − 4 min./day, respectively). A possible explanation for the fact that in the present study only an effect was found for MPA of father and for LPA of children (and a reversed effect for MPA and VPA), could be due to the fact that the (co-)PA promoted in the intervention did not specifically target high-intensity PA for children and adults. In this way, it is possible that children had to lower the intensity level of their PA by being physically active with their father. Although both fathers and children were offered activities of different intensities and difficulty levels during the intervention (i.e. exercises with increasing difficulty and intensity), the fathers but especially the children should be motivated to achieve an optimal intensity level (i.e. MVPA) while performing (co-)PA, and especially outside the intervention context. In this way, their activities performed could achieve a moderate to intense intensity. Nonetheless, multiple studies have shown that any form of exercise (PA), including LPA and MPA, already has positive effects on health, both in adults and in children [Regarding the secondary outcomes, significant decreases in fathers’ and children’s objectively measured SB were found, which is again comparable to the results of the Australian HDHK/DADEE programs [Last, the intervention did not significantly change the weight status of fathers and children. These findings are in line with the Australian DADEE study, which also did not find an effect on BMI (of both fathers and children) at follow-up [Last, also no significant changes were observed for the father-child relationship and the family health climate regarding PA (all p > 0.05). This could possibly be due to the fact that because of COVID-19 restrictions, not all sessions were implemented as planned. More specifically, only two out of six sessions could be implemented face-to-face as planned, the remaining sessions were delivered online for the fathers and children (i.e. four active face-to-face sessions of about 30 min), replacing the remaining face-to-face sessions as much as possible. In between two sessions, videos with exercise challenges were sent to fathers to keep them motivated. After each session, game materials were sent by postal mail together with a manual and tips on how to use them creatively for exercising together. To replace the education part of the sessions, fact sheets were developed and sent by postal mail, covering some of the remaining themes and/or summarizing the most important themes already provided. However, it is possible that the fathers did not read these fact sheets which consequently can explain why no significant changes were observed for the father-child relationship and the family health climate.Taken together, positive intervention effects of the Run Daddy Run intervention were still found with a total face-to-face contact time of 360 min (instead of the originally planned 720 min). Besides the positive effects, the online alternatives were also positively perceived by the participants. More specifically, in the process evaluation questionnaire, participants of the Run Daddy Run intervention indicated that the researchers provided useful and stimulating alternatives for the intervention during COVID-19. Based on these findings, we might assume that a limited amount of face-to-face contact, in combination with an online component throughout the entire intervention period, may be sufficient to induce and motivate fathers and children towards behavior change. This is an interesting finding, as eHealth interventions have indeed emerged as promising and effective for improving physical activity, mainly because of their ability to provide efficient, interactive and tailored information and content to the user [Strengths of the present study include the theory-based approach which was combined with co-creation, taking into account the needs and the preferences of fathers who are difficult to engage in these kind of programs; the high program attendance and low drop-out and strong retention rates, supporting the acceptability of this study; the use of objective PA data where cut-offs from the same authors (i.e. Hildebrand et al. [Future studies could adapt the (co-PA) activities so that they target and optimally stimulate MVPA in both children and adults. Efforts should also be made to stimulate (co-)PA on days on which father and children have less time and are busier, for example on weekdays. Furthermore, it could be examined whether this intervention is also suitable for a diverse range of families. For example, it could be explored whether this intervention is also suitable for an overweight/obese population, and/or lower educated or ethnic minority groups. If not, new co-creation sessions can be organized so that appropriate and required adaptations can be made. Last, future research is needed to confirm the scalability and practical feasibility of the program in a community trial. However, this programme has currently been adopted by Families Sports Flanders in which the intervention will be implemented on a larger scale in East-Flanders (Belgium), where its effects can be evaluated in a community setting too.