Book Description
Introduction. The growing population of children and adolescents with low physical activity levels and poor psychosocial health necessitates accessible interventions that promote well-being. Electronic health (eHealth) physical activity interventions are a promising choice due to their scalability and accessibility. This dissertation examined the feasibility and effects of ACTIWEB-PA, a remotely delivered, web-based movement integration program for children while also assessing the correlates of physical activity and sedentary behavior in youth, providing valuable insights for future intervention design. Methods. Active Children through In-home Web-based Physical Activity (ACTIWEB-PA) pilot randomized controlled trial: Eighty-two insufficiently active children aged 8-11 years were randomized to either an exercise intervention group or a wait-list control group. The intervention was a 12-week-long, self-directed, remotely delivered web-based movement integration program offered through the UNICEF Kid Power website. Feasibility was assessed with recruitment, retention, and intervention adherence rates. Intervention satisfaction was assessed using surveys and qualitatively, with end-of-study interviews. Intervention effects on physical activity and psychosocial health outcomes were assessed using mixed models. Survey of Health of Wisconsin (SHOW) data study: Data from 308, 6-17-year-olds with valid accelerometer wear time from wave II of SHOW were used to examine potential correlates of accelerometer measured physical activity and sedentary behavior. Mixed models were used to identify sociodemographic, anthropometric, neighborhood, screen-time, and parental factors associated with the outcomes. Results. ACTIWEB-PA study: The mean age of participants was 9.2℗ł1.1 years and 51.2% were female. A recruitment rate of 73.6% was obtained. Follow-up surveys were completed by 93.9% participants (retention rate-1) and valid follow-up accelerometer wear was completed by 80.5% participants (retention rate-2). In addition, 69.4% had high program adherence in the exercise intervention group. Intervention was found to be appropriate, pragmatic, and enjoyable based on qualitative analysis. Suggestions to improve novelty, variety, and incorporating peer participation were made by families. Adjusting for baseline imbalances in outcomes, there were no significant intervention effects on the primary outcomes of physical activity. Among the secondary outcomes, only behavioral adjustment sub-scale of the Piers Harris Self-Concept scale saw significant positive improvements (p = 0.03). Our results were indicative of a gender-based variation in physical activity outcomes. SHOW data study: Mixed model analyses showed non-significant but meaningful associations of minutes/day of moderate to vigorous physical activity (MVPA) with screen time (p = 0.06) and Walk Score (p = 0.09). In addition, BMI (p = 0.04) of the participant was significantly associated while gender (p = 0.16) was non-significantly associated with minutes/day of sedentary bouts. Conclusion: The ACTIWEB-PA study was found to be feasible, and the movement integration program had high adherence rates and was deemed acceptable. The intervention did not impact children's physical activity and psychosocial health outcomes significantly. Nevertheless, given the increasing interest in and utilization of remotely delivered eHealth interventions to promote physical activity among children, this study offers valuable insights for optimizing future trials in this field. Important correlates of objectively measured MVPA and sedentary bouts in children and adolescents were also identified, including the modifiable screen time. These findings together advance the field of children's physical activity epidemiology and provide insights to inform the design of future interventions aimed at promoting physical activity and reducing sedentary behavior in children and adolescents.