A Community-Based Lifestyle-Integrated Physical Activity Intervention to Enhance Physical Activity, Positive Family Communication, and Perceived Health in Deprived Families: A Cluster Randomized Controlled Trial

Abstract

Background: Zero-time exercise (ZTEx) is an approach integrating simple strength-and stamina-enhancing physical activity into daily life. The study evaluated the effectiveness of a community-based lifestyle-integrated physical activity intervention using ZTEx to enhance participants' physical activity, family communication, perceived health and happiness, and family harmony. Methods: A parallel group, cluster randomized controlled trial was conducted in a sample of 673 participants from eight Integrated Family Service Centers in Hong Kong. The experimental group (n = 316) received a physical activity intervention. The control group (n = 357) received information on healthy eating. Both groups received three face-to-face intervention sessions (totalling 6 h and 30 min) and 16 text messages. The primary outcome was the change in days spent engaged in ZTEx. Secondary outcomes included changes in sitting time, days engaged in moderate or vigorous physical activities, family communication (encouraging and engaging family members in ZTEx), dietary habits, perceived health and happiness, and family harmony. Self-administered questionnaires were used at baseline and at 3, 6, and 12 months. Mixed effects models with intention-to-treat analysis was used. Results: Compared with the control group at 3 months, the experimental group showed significantly greater increases of 1.3 days spent doing ZTEx (Cohen's d: 0.60), 0.3 days spent doing moderate physical activity (Cohen's d: 0.08), 0.3 days encouraging family members to do ZTEx (Cohen's d: 0.16), and 0.7 days doing ZTEx with family members (Cohen's d: 0.39) during the 7 days prior. At 3 months, the experimental group also showed a significantly greater improvement in perceived health, by a score of 0.2 (Cohen's d: 0.14). The effect sizes ranged from small to medium, with similar intervention effects at the 6-month and 1-year assessments. Compared with the experimental Lai et al. Positive Lifestyle-Integrated Physical Activity Intervention group, the control group showed a significantly greater reduction of 0.4 days on which sweetened beverages were consumed (95% CI: 0.01, 0.9, p < 0.05, Cohen's d: 0.28). The qualitative results supported the quantitative findings. Conclusions: Our findings show that a community-based lifestyle-integrated physical activity (PA) intervention can enhance physical activity, family communication, and perceived health in deprived families in Hong Kong.

Fear of COVID-19 and its associations with perceived personal and family benefits and harms in Hong Kong

“…Family harmony was also assessed by asking, “How harmonious do you think your family is?” on a scale of 0 (very unharmonious) to 10 (very harmonious). We have used the three family well-being questions in previous papers [ 23–26 ], and have also shown that the family happiness question is a reliable and valid measurement tool [ 24 ].…”

A Randomized Controlled Trial of a Positive Family Holistic Health Intervention for Probationers in Hong Kong: A Mixed-Method Study

“…First, because validated questionnaires were unavailable, we self-developed our outcomebased questions to assess the probationers' practices in relation to doing simple strength-and stamina-enhancing physical activity by themselves and with their family members and expressing appreciation to family members. The acceptability and applicability of these questions were shown in our previous studies with similar designs (Ho et al, 2020;Lai et al, 2020). Second, we were unable to assess the accumulated duration of physical activity objectively; we only measured the selfreported number of days engaged in physical activity.…”

“…A meta-analysis of 51 positive psychology interventions concluded that positive psychology interventions significantly enhanced psychosocial well-being ( Sin and Lyubomirsky, 2009 ). “Praise and Gratitude” is a combination of the expression of thankfulness and an emotional sense of appreciation ( Emmons and McCullough, 2003 ; Peterson and Seligman, 2004 ), which are among the easiest and most commonly applied positive psychology themes into daily life to enhance personal and family well-being ( Ho et al, 2019 ; Lai et al, 2020 ).…”

“…This approach is consistent with American physical activity guidelines that moving more and sitting less is beneficial for nearly everyone, and that some physical activity is better than none ( Piercy et al, 2018 ). ZTEx is an innovative, creative, and fun family activity, where family members of all ages can create and compete in friendly exercise games ( Lai et al, 2020 ). Examples of ZTEx while sitting and standing include pedaling both legs and standing on one leg, respectively, with more examples shown in our YouTube videos.…”

“…The project, conducted in collaboration with the School of Public Health of The University of Hong Kong (HKU-SPH), aimed to promote family well-being in Hong Kong families. We integrated ZTEx and positive psychology into various community-based programs for different populations (e.g., low-income families, parents, children, and elderly), with consistently positive impacts on family communication and personal and family well-being ( Lai et al, 2018 , 2020 ; Lai A. et al, 2019 ; Lai Y. et al, 2019 ; Ho et al, 2020 ).…”