Family-based physical activity interventions
Family-based physical activity interventions attempt to change behaviors using techniques that increase family members’ support for positive changes. Interventions typically include educational sessions on health, goal-setting, problem-solving, or family behavioral management, along with reinforcement techniques (e.g., reward charts or role modeling) and physical activities. Family-based interventions may also include information about lifestyle changes such as increased healthy eating or reduced screen time1.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Increased physical activity
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Improved weight status
Improved family functioning
Increased parent engagement
What does the research say about effectiveness?
There is some evidence that family-based physical activity interventions modestly increase physical activity among children, especially children age 5 to 121, 2, 3, 4. 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 intervention3, 5, 6, 7, 8, 9, 10. 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)7. However, other studies find inconclusive effects on weight status, in some cases, due to short follow-up times11, 12, 13. 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 data1. Some studies find effects may not last, more research is needed to understand what supports the long-term sustainability of program effects14.
Family-based physical activity interventions may improve family functioning and parent engagement1. A Minnesota-based study suggests small but significant associations between family functioning and weight-related behaviors15. Parenting styles may also influence eating behaviors and physical activity levels16. 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 levels17.
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 activity1. 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 role18.
How could this strategy advance health equity? This strategy is rated inconclusive impact on disparities.
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 participants27.
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 decreased28. 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 incomes29, 30, 31, likely due in part to living in neighborhoods with less access to safe places for physical activity and lack of supports for active lifestyles32. 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 neighborhoods33, though quality of parks and the built environment can vary widely at the local level30.
What is the relevant historical background?
The built environment in under-resourced communities is a significant contributor to health inequities for people of color with low incomes34, 35, 36. 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 cities37. Discriminatory housing, lending, and exclusionary zoning policies led to concentrated poverty and entrenched residential segregation38, 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 neglected37. City ordinances outlawed integrated forms of recreation39. 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 quality40, 41.
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 activity42. 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 color43.
Available evidence clearly shows the benefits of physical activity for health, however as children get older, their physical activity declines2, 14. Family-based interventions were designed to help get parents moving more and modelling physical activity for children and adolescents and to help encourage physical activity2, 14. 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 activity14.
Equity Considerations
- 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?
Implementation Examples
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 Kinder19.
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 action20. The CDC also includes a list of programs for increasing childhood physical activity, many of which are family-centered interventions21. 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 eating22.
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 changes23, 24. 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 settings25. 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 changes26.
Implementation Resources
‡ Resources with a focus on equity.
CDC-FHWPs - Centers for Disease Control and Prevention (CDC). (n.d.). About family healthy weight interventions. Retrieved April 8, 2025.
AHA-Active Family - American Heart Association (AHA). (n.d.). How to get your family active. 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.
AFHK-FFN - Action for Health Kids (AFHK). (n.d.). AFHK Resource Library: Family fitness night. Retrieved April 8, 2025.
Footnotes
* Journal subscription may be required for access.
1 CG-Physical activity - The Guide to Community Preventive Services (The Community Guide). Physical activity.
2 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.
3 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.
4 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.
5 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.
6 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.
7 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.
8 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.
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.
10 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.
11 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.
12 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.
13 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.
14 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.
15 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.
16 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.
17 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.
18 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.
19 RTIPs-CARDIAC Kinder - Research-Tested Intervention Programs (RTIPs). CARDIAC kinder.
20 CDC-FHWPs - Centers for Disease Control and Prevention (CDC). (n.d.). About family healthy weight interventions. Retrieved April 8, 2025.
21 CDC-FHWP list - Centers for Disease Control and Prevention (CDC). (n.d.). CDC-recognized Family Healthy Weight programs. Retrieved April 8, 2025.
22 YMCA-HWYC - Young Men’s Christian Association (YMCA). (n.d.). Healthy Weight and Your Child program. Retrieved April 8, 2025.
23 BHF - Building Healthy Families (BHF). (n.d.). A family-based pediatric weight management program. Retrieved April 8, 2025.
24 UNK-BHF - University of Nebraska-Kearney Building Healthy Families Program (UNK-BHF). A family- based healthy weight program for children and their families.
25 AFHK-FFN - Action for Health Kids (AFHK). (n.d.). AFHK Resource Library: Family fitness night. Retrieved April 8, 2025.
26 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.
27 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.
28 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.
29 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.
30 ACSM AFI-Sallis 2019 - Sallis J. Disparities in the quality of physical activity environments. American College of Sports Medicine (ACSM) American fitness index. 2019.
31 CDC-API - Centers for Disease Control and Prevention (CDC). Adult physical inactivity outside of work.
32 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.
33 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.
34 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.
35 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.
36 Brookings-Semmelroth 2020 - Semmelroth L. How Wilmington, Del. is revitalizing vacant land to rebuild community trust. Washington, D.C.: Brookings Institution; 2020.
37 NRPA-Equity 2021 - National Recreation and Park Association (NRPA). Equity in parks and recreation: A historical perspective.
38 Kaplan 2007 - Kaplan J, Valls A. Housing discrimination as a basis for Black reparations. Public Affairs Quarterly. 2007;21(3):255-273.
39 NRPA-Fleming 2021 - Fleming K. Observing from a lens of equity. National Recreation and Park Association (NRPA). 2021.
40 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.
41 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.
42 VWH-Brown 2022 - Brown S. Do you live in an ‘exercise desert’? Verywell Health (VWH). 2022.
43 MH-Lawrence 2020 - Lawrence A. How race, class, and geography keep some people from great workouts. Men’s Health (MH). 2020.
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