Family-based physical activity interventions

There is some evidence that family-based physical activity interventions modestly increase physical activity among children, especially children age 5 to 12 (CG-Physical activity, Brown 2016c, Pamungkas 2019, Cochrane-Waters 2011). Additional evidence is needed to confirm effects and determine which intervention components are most effective.

Some studies suggest that family and parent support can positively influence children’s weight status as part of a multi-component intervention (Campbell 2007, Katz 2008, Tomayko 2021, Pamungkas 2019, Nixon 2012, Kitzman-Ulrich 2010, Niemeier 2012). These positive effects have been found for a variety of treatments (e.g. family therapy or behavior change interventions) and settings (e.g. home, schools) (Tomayko 2021). However, other studies find inconclusive effects on weight status, in some cases, due to short follow-up times (OConnor 2009, van Sluijs 2011, Knowlden 2012). Overall, studies that directly measure physical activity changes following family-based interventions (e.g., via accelerometers, pedometers, or direct observation) show slightly greater increases in physical activity than studies that use self-reported data (CG-Physical activity). Some studies find effects may not last, more research is needed to understand what supports the long-term sustainability of program effects (Rhodes 2024).

Family-based physical activity interventions may improve family functioning and parent engagement (CG-Physical activity). A Minnesota-based study suggests small but significant associations between family functioning and weight-related behaviors (Berge 2013). Parenting styles may also influence eating behaviors and physical activity levels (Sleddens 2011). A Kentucky-based study suggests interventions targeted towards mothers and daughters as young as preschool age could lead to small positive changes in physical activity levels (Dlugonski 2022).

The most successful interventions include culturally sensitive education, parent motivation components, and efforts to accommodate time constraints such as work and school responsibilities. Interventions that combine goal-setting and reinforcement techniques can increase motivation and physical activity (CG-Physical activity). Programs that encourage other family members to change behaviors or lose weight may more effectively help overweight children lose weight than programs that assign family members a strictly supporting role (Barr-Anderson 2013).

It is unclear what impact family-based physical activity interventions have on disparities in physical activity between populations with different racial/ethnic backgrounds, ages, and income levels.

Latino/a populations in the U.S. have the highest lifetime risk of developing type 2 diabetes. A family-based physical activity intervention targeting Hispanic communities successfully increased social support for physical activity and improved families’ ability to support diabetes management for participants (McEwen 2019).

Data from 2013 to 2023 suggests that female and LGBTQ+ youth were less likely to meet recommended levels of physical activity than their peers, and the percentage of Hispanic and Black adolescents meeting physical activity guidelines decreased (CDC-YRBSS 2025). Available evidence shows Hispanic, Black, Native American, and Alaska Native adults, especially with lower incomes, are less likely to engage in leisure time physical activity than white and Asian adults, especially with higher incomes (Hawes 2019, ACSM AFI-Sallis 2019, CDC-API), likely due in part to living in neighborhoods with less access to safe places for physical activity and lack of supports for active lifestyles (Patel 2022b). Overall, communities whose residents are primarily people of color with lower incomes have less access to parks and recreational facilities for physical activity than white and high income neighborhoods (ALR-Disparities 2011), though quality of parks and the built environment can vary widely at the local level (ACSM AFI-Sallis 2019).

The built environment in under-resourced communities is a significant contributor to health inequities for people of color with low incomes (Prochnow 2022, McAndrews 2022, Brookings-Semmelroth 2020). During the Industrial Revolution, parks were largely developed to allow wealthy residents access to space that was free from unsanitary conditions and the congestion of crowded cities (NRPA-Equity 2021). Discriminatory housing, lending, and exclusionary zoning policies led to concentrated poverty and entrenched residential segregation (Kaplan 2007), including segregation of parks and recreation facilities. Between 1930 and the 1970s, while the government invested in parks in wealthier, white neighborhoods, parks and facilities in neighborhoods of color were neglected (NRPA-Equity 2021). City ordinances outlawed integrated forms of recreation (NRPA-Fleming 2021). Disinvestment in and unequal distribution of recreational facilities, parks, and green space means that communities with low incomes and communities of color have fewer places to engage in outdoor activities, have less access to cooling shade, and experience poorer air quality (CAP-Rowland-Shea 2020, TPL-Chapman 2021).

Today, these formerly redlined, low income neighborhoods are more likely to be considered physical activity deserts, without access to gyms, safe green spaces, and built environments conducive to physical activity (VWH-Brown 2022). Urban areas, which are often primarily populated by individuals of color, usually have the least amount of green space available per person, limiting communities’ access to free physical activity. Four of the five cities in the U.S. with the least amount of green space are majority people of color (MH-Lawrence 2020).

Available evidence clearly shows the benefits of physical activity for health, however as children get older, their physical activity declines (Brown 2016c, Rhodes 2024). Family-based interventions were designed to help get parents moving more and modelling physical activity for children and adolescents and to help encourage physical activity (Brown 2016c, Rhodes 2024). Family-based interventions can be effective despite the structural barriers or challenges present in many communities; however, intervention effectiveness may be improved when combined with initiatives to address structural barriers to physical activity (Rhodes 2024).

• What family-based physical activity programs are available in your community? What are programs doing to increase accessibility and affordability for participants?
• How are family-based physical activity programs designed to support families in neighborhoods with low incomes? Or racially/ethnically diverse communities? Are programs culturally adapted to encourage participation among different communities of color?
• Who is making decisions about family-based physical activity program offerings and budgets in your community? What community engagement strategies could help identify and address barriers to participation?

Family-based physical activity interventions are implemented throughout the country. Programs can be implemented as independent single component programs or combined to compliment other interventions. Examples include CARDIAC Kinder (RTIPs-CARDIAC Kinder).

The Centers for Disease Control and Prevention (CDC) provides information about healthy weight programs for families that support physical activity, healthy eating, and positive behavior changes, and include potential implementation steps and guides for state-level and local-level action (CDC-FHWPs). The CDC also includes a list of programs for increasing childhood physical activity, many of which are family-centered interventions (CDC-FHWP list). For example, YMCA locations across the country use the CDC-recognized Healthy Weight and Your Child program, a family-based intervention to support behavior change especially for physical activity and healthy eating (YMCA-HWYC).

Building Healthy Families is another family-based intervention that has been designed to support families in small, rural communities with physical activity and healthy eating behavior changes (BHF, UNK-BHF). Family Fitness Night is supported by Action for Health Kids as a way for communities to offer fun and inexpensive opportunities for physical activity together either at home or in community settings (AFHK-FFN). Washington University in St. Louis, Missouri offers Family-based Behavioral Treatment, an intervention to address childhood obesity through family physical activity, healthy eating, and positive behavior changes (WUSTL-FBT).

AFHK-FFN - Action for Health Kids (AFHK). (n.d.). AFHK Resource Library: Family fitness night. Retrieved April 8, 2025.

AHA-Active Family - American Heart Association (AHA). (n.d.). How to get your family active. Retrieved April 8, 2025.

CDC-FHWPs - Centers for Disease Control and Prevention (CDC). (n.d.). About family healthy weight interventions. Retrieved April 8, 2025.

CHC-Family Exercise Tips - Children's Hospital Colorado (CHC). (n.d.). Family exercise tips for feeling great together. Retrieved April 8, 2025.

Let's Move-Family PA - Let's Move! (n.d.). Take action: Make physical activity a part of your family's routine. Retrieved April 8, 2025.

* Journal subscription may be required for access.

ACSM AFI-Sallis 2019 - Sallis J. Disparities in the quality of physical activity environments. American College of Sports Medicine (ACSM) American fitness index. 2019.

AFHK-FFN - Action for Health Kids (AFHK). (n.d.). AFHK Resource Library: Family fitness night. Retrieved April 8, 2025.

ALR-Disparities 2011 - Active Living Research (ALR). Do all children have places to be active? Disparities in access to physical activity environments in racial and ethnic minority and lower-income communities. Princeton: Robert Wood Johnson Foundation (RWJF); 2011.

Barr-Anderson 2013 - Barr-Anderson DJ, Adams-Wynn AW, DiSantis KI, Kumanyika S. Family-focused physical activity, diet and obesity interventions in African-American girls: A systematic review. Obesity Reviews. 2013;14(1):29–51.

Berge 2013* - Berge JM, Wall M, Larson N, Loth KA, Neumark-Sztainer D. Family functioning: Associations with weight status, eating behaviors, and physical activity in adolescents. Journal of Adolescent Health. 2013;52(3):351–7.

BHF - Building Healthy Families (BHF). (n.d.). A family-based pediatric weight management program. Retrieved April 8, 2025.

Brookings-Semmelroth 2020 - Semmelroth L. How Wilmington, Del. is revitalizing vacant land to rebuild community trust. Washington, D.C.: Brookings Institution; 2020.

Brown 2016c - Brown, H. E., Atkin, A. J., Panter, J., Wong, G., Chinapaw, M. J. M., & Van Sluijs, E. M. F. (2016). Family‐based interventions to increase physical activity in children: A systematic review, meta‐analysis and realist synthesis. Obesity Reviews, 17(4), 345–360.

Campbell 2007 - Campbell KJ, Hesketh KD. Strategies which aim to positively impact on weight, physical activity, diet and sedentary behaviours in children from zero to five years: A systematic review of the literature. Obesity. 2007;8(4):327-38.

CAP-Rowland-Shea 2020 - Rowland-Shea J, Doshi S, Edberg S, Fanger R. The nature gap: Confronting racial and economic disparities in the destruction and protection of nature in America. Washington, D.C.: Center for American Progress (CAP); 2020.

CDC-API - Centers for Disease Control and Prevention (CDC). Adult physical inactivity outside of work.

CDC-FHWP list - Centers for Disease Control and Prevention (CDC). (n.d.). CDC-recognized Family Healthy Weight programs. Retrieved April 8, 2025.

CDC-FHWPs - Centers for Disease Control and Prevention (CDC). (n.d.). About family healthy weight interventions. Retrieved April 8, 2025.

CDC-YRBSS 2025 - Centers for Disease Control and Prevention. (2024). Youth risk behavior survey data summary & trends report for dietary, physical activity, and sleep behaviors: 2013–2023. U.S. Department of Health and Human Services.

CG-Physical activity - The Guide to Community Preventive Services (The Community Guide). Physical activity.

Cochrane-Waters 2011* - Waters E, de Silva-Sanigorski A, Burford BJ, et al. Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews. 2011;(12):CD001871.

Dlugonski 2022* - Dlugonski, D., Schwab, L., & DuBose, K. D. (2022). Feasibility of the Mothers and Daughters Moving Together Physical Activity Intervention. Pediatric Exercise Science, 34(2), 84–92.

Hawes 2019 - Hawes AM, Smith GS, McGinty E, et al. Disentangling race, poverty, and place in disparities in physical activity. International Journal of Environmental Research and Public Health. 2019;16(7):1193-1205.

Kaplan 2007* - Kaplan J, Valls A. Housing discrimination as a basis for Black reparations. Public Affairs Quarterly. 2007;21(3):255-273.

Katz 2008* - Katz D, O’Connell M, Njike V, Yeh M-C, Nawaz H. Strategies for the prevention and control of obesity in the school setting: Systematic review and meta-analysis. International Journal of Obesity. 2008;32(12):1780-9.

Kitzman-Ulrich 2010 - Kitzman-Ulrich H, Wilson DK, St. George SM, et al. The integration of a family systems approach for understanding youth obesity, physical activity, and dietary programs. Clinical Child and Family Psychology Review. 2010;13(3):231–53.

Knowlden 2012* - Knowlden AP, Sharma M. Systematic review of family and home-based interventions targeting paediatric overweight and obesity. Obesity Reviews. 2012;13(6):499-508.

McAndrews 2022* - McAndrews C, Schneider RJ, Yang Y, et al. Toward a gender-inclusive Complete Streets movement. Journal of Planning Literature. 2022;38(1):3-18.

McEwen 2019* - McEwen, M. M., Pasvogel, A., & Murdaugh, C. (2019). Effects of a family-based diabetes intervention on family social capital outcomes for Mexican American adults. The Diabetes Educator, 45(3), 272–286.

MH-Lawrence 2020 - Lawrence A. How race, class, and geography keep some people from great workouts. Men’s Health (MH). 2020.

Niemeier 2012* - Niemeier BS, Hektner JM, Enger KB. Parent participation in weight-related health interventions for children and adolescents: A systematic review and meta-analysis. Preventive Medicine. 2012;55(1):3–13.

Nixon 2012 - Nixon CA, Moore HJ, Douthwaite W, et al. Identifying effective behavioural models and behaviour change strategies underpinning preschool- and school-based obesity prevention interventions aimed at 4-6-year-olds: A systematic review. Obesity Reviews. 2012;13(Suppl 1):106-17.

NRPA-Equity 2021 - National Recreation and Park Association (NRPA). Equity in parks and recreation: A historical perspective.

NRPA-Fleming 2021 - Fleming K. Observing from a lens of equity. National Recreation and Park Association (NRPA). 2021.

OConnor 2009* - O’Connor TM, Jago R, Baranowski T. Engaging parents to increase youth physical activity: A systematic review. American Journal of Preventive Medicine. 2009;37(2):141-9.

Pamungkas 2019 - Pamungkas, R. A., & Chamroonsawasdi, K. (2019). Home-based interventions to treat and prevent childhood obesity: A systematic review and meta-analysis. Behavioral Sciences, 9(4), 38.

Patel 2022b - Patel, N. A., Kianoush, S., Jia, X., Nambi, V., Koh, S., Patel, J., Saeed, A., Ahmed, A., Al-Mallah, M., Agarwala, A., Virani, S., & Al Rifai, M. (2022). Racial/ethnic disparities and determinants of sufficient physical activity levels. Kansas Journal of Medicine, 15(2), 267–272.

Prochnow 2022* - Prochnow T, Valdez D, Curran LS, et al. Multifaceted scoping review of Black/African American transportation and land use expert recommendations on activity-friendly routes to everyday destinations. Health Promotion Practice. 2022.

Rhodes 2024 - Rhodes, R. E., Hollman, H., & Sui, W. (2024). Family‐based physical activity interventions and family functioning: A systematic review. Family Process, 63(1), 392–413.

RTIPs-CARDIAC Kinder - Research-Tested Intervention Programs (RTIPs). CARDIAC kinder.

Sleddens 2011* - Sleddens EFC, Gerards SMP, Thijs C, de Vries NK, Kremers SPJ. General parenting, childhood overweight and obesity-inducing behaviors: A review. International Journal of Pediatric Obesity. 2011;6(2Part2):e12–27.

Tomayko 2021 - Tomayko, E. J., Tovar, A., Fitzgerald, N., Howe, C. L., Hingle, M. D., Murphy, M. P., Muzaffar, H., Going, S. B., & Hubbs-Tait, L. (2021). Parent involvement in diet or physical activity interventions to treat or prevent childhood obesity: An umbrella review. Nutrients, 13(9), 3227.

TPL-Chapman 2021 - Chapman R, Foderaro L, Hwang L, et al. Parks and an equitable recovery. San Francisco, CA: The Trust for Public Land (TPL); 2021.

UNK-BHF - University of Nebraska-Kearney Building Healthy Families Program (UNK-BHF). A family- based healthy weight program for children and their families.

van Sluijs 2011* - van Sluijs EMF, Kriemler S, McMinn AM. The effect of community and family interventions on young people’s physical activity levels: A review of reviews and updated systematic review. British Journal of Sports Medicine. 2011;45(11):914-22.

VWH-Brown 2022 - Brown S. Do you live in an ‘exercise desert’? Verywell Health (VWH). 2022.

WUSTL-FBT - Washington University in St. Louis Family-based Behavioral Treatment (WUSTL-FBT). (n.d.). A family-centered, evidence-based intervention designed to address childhood obesity. Retrieved April 8, 2025.

YMCA MKE-HWYC - Young Men’s Christian Association (YMCA) of Milwaukee. (n.d.). Healthy Weight and Your Child program. Retrieved April 8, 2025.

YMCA-HWYC - Young Men’s Christian Association (YMCA). (n.d.). Healthy Weight and Your Child program. Retrieved April 8, 2025.