Rationale, design and methods for a staggered-entry, waitlist controlled clinical trial of the impact of a community-based, family-centred, multidisciplinary program focussed on activity, food and attitude habits (Curtin University’s Activity, Food and Attitudes Program—CAFAP) among overweight adolescents

Abstract

BackgroundCurrent estimates place just under one quarter of adolescents in Australia as overweight or obese. Adolescence has been identified as a critical period for the development of obesity, yet despite this recognition, there is limited systematic research into or evaluation of interventions for overweight adolescents. Reviews have concluded that there is a substantive evidence gap for effective intervention, but physical activity, lifestyle change and family involvement have been identified as promising foci for treatment.MethodsThis paper reports on the development of a staggered-entry, waitlist controlled clinical trial to assess the impact of a multidisciplinary intervention aiming to change the poor health trajectory of overweight adolescents and help them avoid morbid obesity in adulthood—Curtin University’s Activity, Food and Attitudes Program (CAFAP). 96 adolescents, aged 11–16 years, and parents, will attend twice weekly during an 8 week intensive multidisciplinary program with maintenance follow-up focussed on improving activity, food and attitude habits. Follow-up assessments will be conducted immediately after completing the intensive program, and at 3, 6 and 12 months post intensive program. Main outcomes will be objectively-measured physical activity, sedentary behaviour and activity behaviours; food intake (measured by 3 day diary) and food behaviours; body composition, fitness and physical function; mental and social well-being (quality of life, mood and attitudes), and family functioning.DiscussionThis trial will provide important information to understand whether a community based multidisciplinary intervention can have short and medium term effects on activity and food habits, attitudes, and physical and mental health status of overweight adolescents.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12611001187932.

It’s A-bout Time: Detailed Patterns of Physical Activity in Obese Adolescents Participating in a Lifestyle Intervention

“…This study provides a detailed analysis of physical activity and sedentary time as part of a larger waitlist controlled clinical trial with details previously published. 5,6 Participants completed an 8-week intervention with 12 months of follow-up maintenance intervention. Six assessments were completed: baseline, 3 months following baseline and immediately prior to beginning the intervention (waitlist period for within subject comparison), immediately completing the 8-week intervention (intervention period), and at 3 months, 6 months, and 12 months following the intensive intervention (maintenance periods).…”

“…4 One such intervention was Curtin University's Activity, Food, and Attitudes Program (CAFAP), which was a community-based, family-centred lifestyle intervention focused on increasing physical activity and decreasing sedentary behavior and eating behaviors of overweight and obese adolescents. 5 Traditionally, physical activity intervention results have been reported as an overall change in physical activity (total, light, moderate-to-vigorous, and sedentary time) in response to an intervention. In a waitlist controlled clinical trial, participants in CAFAP had limited positive changes in objectively measured physical activity and sedentary behavior.…”

Multiple components of fitness improved among overweight and obese adolescents following a community-based lifestyle intervention

“…The detailed protocol for this study has been previously published (Straker et al, 2012). Briefly, the study used a staggered entry, waitlist control design as shown in Figure 1.…”

“…Curtin University's Activity, Food and Attitudes Program (CAFAP) was an 8-week community-based, family-centred lifestyle programme for overweight adolescents targeting physical activity, sedentary and nutrition behaviours (Straker et al, 2012 detail (Howie, Olds, McVeigh, Abbott, & Straker, 2015;Straker et al, 2014), with few positive changes in physical activity and body mass index (BMI). Fitness, a set of attributes including cardiorespiratory endurance, muscular strength and endurance, body composition and flexibility is a separate construct from physical activity behaviour with important, independent health implications (Caspersen, Powell, & Christenson, 1985;Myers et al, 2004).…”

Theoretical underpinnings of a need-supportive intervention to address sustained healthy lifestyle changes in overweight and obese adolescents

“…Objectives of the current paper will be accomplished by building on CAFAP's previously described overarching rationale and framework (Straker et al, 2012) to allow for a comprehensive description of theoretical rationale and delivery of behavior-change techniques specific to processes of motivation that are critical for the future development of effective interventions.…”