- Title
- The M.A.D.E (Mothers and Daughters Exercising) 4 Life pilot randomised control trial: a theory-based, physical activity intervention targeting mothers and their daughters
- Creator
- Barnes, Alyce Therese
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2015
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- There is a marked gender difference in physical activity levels, with girls less active than boys at every age. Given the established low physical activity levels of girls, there is a need to develop and evaluate innovative strategies to increase girls’ physical activity levels. It is widely recognised that parents play a key role in the promotion and provision of physical activity opportunities, and mothers might be particularly influential for their daughters. This thesis had three major aims relating to understanding and improving the physical activity levels of mothers and daughters. Aim One: The first aim of this thesis was to systematically review the literature surrounding the effectiveness of mother-daughter lifestyle interventions to improve physical activity, fitness and/or diet. A systematic search across eight databases was conducted. All 12 studies (11 unique interventions) met the eligibility criteria. There were five Randomised Controlled Trials, one pseudo-randomised controlled trial, one non-randomised controlled trial and five pre-post trials. Half of the studies were conducted in the past five years, and the majority were conducted within the U.S. Overall, study quality was poor, with a high risk of bias apparent in the majority of studies. Significant intervention effects in fitness (n=6) were reported in both mothers and daughters. Although dietary behaviours were only assessed in three studies, intervention findings were generally positive. Statistically significant improvements in physical activity were reported for two out of five studies, although measures of physical activity were less commonly reported overall. Characteristics associated with increases in mother-daughter fitness were face-to-face, structured physical activity and fitness programs that ran for at least two to three times per week for a minimum of 60 minutes per session. Future high-quality trials in this area are needed to determine the impact of gender-specific interventions that target mothers and daughters in community settings. Aim Two: The second aim of this thesis was to establish potential associations between maternal measures and girls’ physical activity measures. A cross-sectional design was used to assess 40 girls (mean±SD age 8.8±1.6 years; mean BMI [body mass index] z-score=0.7±1.2) and their mothers (39.1±4.8 years; mean BMI=27.6±5.5). Maternal correlates of daughters’ accelerometer-assessed physical activity (moderate-to-vigorous physical activity % MVPA; counts per minute, CPM; sedentary behaviour; % SED), screen time and BMI z-score (objectively measured) included demographic, anthropometric, maternal behaviours, activity-related parenting practices and physical activity cognitions. Correlates were examined using regression models. A number of maternal behaviours, social-cognitive and parenting correlates were found to be significantly associated with daughters’ physical activity. A significant relationship was found between daughters’ % MVPA and mothers’ beliefs about the benefits of girls physical activity and explained a weak proportion of variance (R²=0.14). Furthermore, the relationships between daughters’ CPM, mothers’ logistic support (P=0.03), mothers’ CPM (P=0.02) and outcome expectations (P=0.01) were all significant and this model explained a moderate proportion of the variance (R²=0.24). Daughters’ % SED and their mothers’ logistic support (P=0.02) was inversely related, and explained a small proportion of the variance (R²=0.11). Experimental studies targeting mothers as the primary agents of change to increase physical activity and reduce sedentary behaviour among girls may be warranted. Specific maternal targets included their beliefs about the benefits of physical activity for girls, logistic support regarding girls physical activity involvement, and outcome expectations of physical activity. Aim Three: The final aim of this thesis was to establish both the feasibility and preliminary efficacy of a physical activity program designed specifically to target mothers and their daughters (MADE4Life intervention). A randomised controlled trial (RCT) of 48 primary school-aged girls and their 40 mothers was conducted. Families were randomised to (i) the ‘Mothers And Daughters Exercising for Life’ (MADE4Life) (n=21 mothers, n=25 daughters) group, or (ii) a wait-list control (n=19 mothers, n=23 daughters) group. The eight-week program involved eight sessions, 25-minute separate mothers’ and daughters’ education sessions and 60 minutes of physical activity together. Assessments were at baseline, postintervention (10 weeks) and three-month post-intervention (20 weeks). The primary outcome measure was daughters’ MVPA (seven days of accelerometry). Secondary outcomes included mother and daughter accelerometer-assessed light/moderate/vigorous physical activity, BMI, waist circumference, body composition, blood pressure, resting heart rate, sedentary behaviours and mothers’ self-reported physical activity, parenting measures and cognitions. Intention-to-treat analysis was conducted utilising linear mixed models. Recruitment and retention goals (>80%) were exceeded. Attendance rates, program acceptability and satisfaction were high (m=4.8/5). There was no significant group-by-time effect for daughters’ % MVPA (-0.08; 95%CI -1.49, 1.33, d=-0.03) or other secondary outcomes for girls (post intervention range d=0.01– -0.46). Significant intervention effects were found for mothers’ % VPA (P=0.04, d=0.25) and role modelling (P=0.02, d=0.66). MADE4Life was highly feasible and acceptable for mothers and daughters. Future fully-powered trials targeting physical activity in mothers and daughters are warranted. The study targeted the topic of intergenerational female physical activity. Findings from this thesis make an important contribution to the paucity of studies targeting mothers and daughters. However, the primary hypothesis was not supported. Further research is needed that involves larger samples of mothers and daughters in a family-based, gender-specific program in a community setting. Numerous recommendations were made from the findings in this thesis to assist future program development aiming to improve PA levels of females, in particular mothers and daughters, with regards to intervention design, intervention content and methodological considerations. Of great importance and concern is the growing evidence base for females being less active compared to males and the negative health consequences of physical inactivity. Further exploration of the impact of gender-tailored PA interventions is needed, along with sustained research attention. MADE4Life is one step in developing this evidence base.
- Subject
- physical activity; girls; women; accelerometer; randomised control trial; mother; daughter; community; family; intervention
- Identifier
- http://hdl.handle.net/1959.13/1312702
- Identifier
- uon:22452
- Rights
- Copyright 2015 Alyce Therese Barnes
- Language
- eng
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