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Strategies to Support Physical Activity for Parents and Caregivers of Young Children

King, Kristi M. Ph.D., CHES; Hartson, Kimberly Ph.D., R.N.; Della, Lindsay Ph.D.

doi: 10.1249/FIT.0000000000000530
Columns: Clinical Applications
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Kristi M. King, Ph.D., CHES,is an associate professor in the Exercise Physiology program at the Department of Health and Sport Sciences at the University of Louisville in Kentucky and has a joint appointment in Pediatric Endocrinology with the Wendy Novak Diabetes Center. Dr. King is the principal investigator on multiyear research studies that focus on the improvement of health, specifically through PA and nutrition interventions and policies. Dr. King earned her Ph.D. from Southern Illinois University Carbondale, completed postdoctorate training in Physical Activity and Public Health Research with the University of South Carolina’s Arnold School of Public Health and Centers for Disease Control and Prevention, and is a Commonwealth Institute of Kentucky Scholar and a Certified Health Education Specialist.

Kimberly Hartson, Ph.D., R.N.,is an assistant professor at the University of Louisville, School of Nursing. She is interested in improving the health behaviors of youth and young adults to increase well-being and prevent chronic illness. Her research focuses on PA and decreasing the gap between intention and PA behavior. Dr. Hartson earned her Ph.D. at the University of Colorado, College of Nursing, with a focus in Biobehavioral Sciences.

Lindsay Della, Ph.D.,is an associate professor in the Department of Communication at the University of Louisville. She has served as principal investigator on nationally funded grants from the National Institutes of Health, which have addressed strategies for the prevention of cancer and heart disease through increased fruit and vegetable consumption. Dr. Della is a health communicator with an emphasis on the design of lifestyle-based health improvement campaigns. She earned her Ph.D. in Health Promotion and Behavior from the University of Georgia’s College of Public Health. Prior to joining the faculty at the University of Louisville, she completed fellowships with the Centers for Disease Control and Prevention (CDC) and the Oak Ridge Institute for Science and Education (ORISE) as postdoctoral training.

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Although the scientific evidence is clear that physical activity (PA) improves health and well-being, almost all adults are not engaging in adequate amounts of PA (1). Only 23.6% (20.6% of women and 26.8% of men) of adults 18 years and older met the PA guidelines for both aerobic and muscle-strengthening activity for 2018 (at least 150 minutes a week of moderate-intensity aerobic PA, 75 minutes a week of vigorous-intensity aerobic PA, or an equivalent combination of moderate- and vigorous-intensity aerobic activity as well as muscle-strengthening activities 2 or more days a week) (2). The key guidelines for adults, women during pregnancy and postpartum, and older adults are provided in Table 1 (1). Life transitions can create additional barriers to engaging in PA. Parenthood is one such life transition that puts parents and caregivers of young children at a high risk for physical inactivity (3,4). They often struggle to get enough PA throughout their day.

TABLE 1

TABLE 1

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PURPOSE

The purpose of this Clinical Applications column is to describe how health and fitness professionals can help parents and caregivers of young children identify barriers to PA in their lives and introduce strategies to support PA for their clients. Strategies such as engaging in coactivity (e.g., playing together), using technology to help facilitate being physically active, and reorganizing daily routines are described.

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BARRIERS

The first few years of parenthood are associated with not only physical stressors (e.g., hormonal changes, recovery from birth, and lifting/holding babies, toddlers, and car seats) that accompany having children but also mental health challenges such as guilt, anxiety, and feelings of isolation (5). The constant care that newborns and young children require means that many parents and caregivers of young children face role overload as they try to meet the demands of their household, family, friends, and careers. Although being physically active in a Zumba class or lifting weights at the gym “used” to be in a parent’s typical exercise routine, having young children can thwart all good intentions. Many gyms do not have childcare facilities, and hiring a babysitter can be expensive ($15 an hour and a gym session including travel time could require 2 hours of time). Many parents are left to find new ways to keep active while caring for young children at home.

Fatigue, lack of energy, mental or physical health issues, lack of time, and work obligations are common barriers parents and caregivers indicate that prevent them from being active with their child(ren) (6,7). Coupled with sleep deprivation, an increase in household chores (e.g., dishes, laundry, and cleaning), and changing roles and responsibilities in the household, caregivers can experience an overwhelming sense (and reality) of limited time for self-care (e.g., PA). For parents and caregivers of young children, convenient and quick doses of exercise may be the best option for obtaining PA-related health benefits.

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STRATEGY NO. 1: COACTIVITY

One important strategy for helping new parents incorporate PA into their new life stage is coactivity. Coactivity is when parents facilitate activities in which they can be active with their children (8). Parents modeling an active lifestyle encourages healthy family interpersonal dynamics and also gets parents active (9). Because parental behavior can influence child behavior, and because child behavior leads to similar behavior in adulthood, it is in the best interest of our society to promote and support PA strategies for parents of young children (10,11). Children spend considerable time within the care of their parents, and indeed parents appear to be the “gatekeepers” of PA during family time (4). Health and fitness professionals can foster this positive PA cycle by encouraging and supporting parents to be physically active with their children.

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In a recent study of more than 400 parents with children between 6 and 14 years old, most parents indicated that they preferred to keep coactivity outside, in the backyard or at a local park, and with all family members included (6). Most parents want the activity time to consist of a variety of activities that are unstructured, self-paced, and of moderate intensity (e.g., family walks, bike rides, and playing at parks) (6). Although organized coactivity programs are successful, many are community-based and may be difficult for parents of young children to attend (12). When organized coactivity opportunities are limited, health and fitness professionals can suggest that parents and caregivers plan outdoor family activities such as walks, freeze tag games, and bike rides, as well as indoor activities such as exercise-themed Simon Says or Follow-the-Leader and living room family dance parties.

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STRATEGY NO. 2: USING TECHNOLOGY TO HELP ENGAGE IN PA THROUGHOUT THE DAY

There is no shortage of excellent exercise programs available through technology such as DVDs (e.g., P90x3, https://www.beachbody.com/product/fitness_programs/p90x.do), YouTube (Fitness Marshal, https://thefitnessmarshall.org/), and other streaming options, (e.g., Yoga for Beginners, https://www.gaia.com/video/stress-relief-yoga-beginners) that are fun, energetic, 30-minute-or-less workouts. These short workouts require little to minimal equipment. Some parents may choose to encourage the children to participate with them or to have the children participate in an activity such as coloring or playing with toys while in the same room. For example, if a parent or caregiver picks their child up from daycare at 5:30 p.m. and dinner preparation does not occur until 6:30 p.m., then 30 minutes of a YouTube workout video (e.g., Fitness Marshall) from 5:45 p.m. to 6:15 p.m. may be the ideal time for both the parent and the young child to “exercise” together. The parent would be exercising, and the child could be “playing” in the same room. Health and fitness professionals, however, should recognize that this scenario may work for the parent one night but not the next, or it may not work well for parents of children unable to play by themselves for 30 minutes.

Using mobile technology (also known as mHealth; e.g., phones, tablets, and wearable tracking devices) can be an effective strategy to connect parents and caregivers of young children with health and fitness professionals. Commonly used behavior change strategies used in mHealth interventions that may be helpful for encouraging PA among parents and caregivers of young children include goal setting, self-monitoring, social support, feedback, health and fitness instructions, prompts, and cues (13).

As a quick caveat, however, health and fitness professionals should exercise caution when suggesting the use of technology resources for coactivity facilitation. The American Academy of Pediatrics recommends limits on television, video, and mobile/interactive technology usage by young children and emphasizes the importance of any digital media time being a shared parent–child experience (14).

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STRATEGY NO. 3: REORGANIZING SCHEDULES

When men and women with young children who self-reported staying active during their children’s early years were asked how they accomplished the task, many reported being successful by prioritizing PA while their children were sleeping, at daycare, or involved in other structured activities (e.g., sports practice) (5). Some parents may choose to exercise early in the morning before their children wake up, during a child’s nap, or at night after the children go to bed. Men have reported being able to add PA at work during their lunch hour more easily than working women, while women are more likely to wake up early to attend to self-care (5). Some men and women also reported taking 15-minute breaks during the day to “get out and walk.” These active couples also reported that staying active requires a lot of partner negotiation. Many talked about the need for trading off child watching responsibilities while the other was active. Health and fitness professionals may be able to help parents identify how they can incorporate PA into their daily schedules. This may mean that a parent will need to advocate for dedicated self-care time during the day or negotiate trading-off time with partners or other neighborhood parents. Several parents reported feeling guilty for taking time to exercise (5). Helping parents see how PA can help them to be their best for their families may help them to see PA from a different perspective.

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SPECIAL CONSIDERATIONS FOR THE HEALTH AND FITNESS PROFESSIONAL

As health and fitness professionals, there are several special considerations to be aware of, particularly for postpartum mothers. Recent findings from a systematic review and meta-analysis investigating the benefits of PA for women during pregnancy and the postpartum period indicated the importance of increasing PA in women of childbearing age before, during, and after pregnancy (15). Strong scientific evidence demonstrated that moderate-intensity PA reduced the risk of excessive gestational weight gain, gestational diabetes (16), and symptoms of postpartum depression (16,17). Health-care providers can advise on the length of time needed for the mother to physically heal prior to returning to being physically active. This may be dependent on the mode of delivery, general health, and any complications during pregnancy, delivery, or the postpartum period (17). Once medically cleared, gradually increasing PA during the postpartum period is recommended for weight management and overall health (17). However, it is important to acknowledge that the postpartum phase can be an exhausting and emotional time for mothers as they navigate physical healing, caring for an infant, hormonal changes, sleep disturbances, and sometimes challenges around family dynamics, time constraints, lactation, health conditions, and other obligations (16). Also, lactating women may need vitamin and mineral supplementation due to breastfeeding demands, additional fluids to avoid dehydration, and schedule adjustments to allow time to nurse to avoid breast engorgement (17). Further, significant changes in joint function, flexibility, and mobility occur as hormones fluctuate; therefore, extreme caution must be used to protect against sprains and strains. These challenges may affect motivation, energy level, and time available for incorporating PA into the daily routine of postpartum and/or lactating mothers.

It also is important to understand that many of the challenges involved in the transition to parenthood affect fathers, caregivers, and other nonbirthing parents as well. There also may be additional circumstantial needs for single parents, parents with multiple children, and parents of children with special needs. Understanding the parent’s environment and circumstances will allow for more creativity and flexibility in helping them to achieve their PA goals. Meeting a parent at home with the child(ren) may be beneficial to conduct a thorough “needs assessment” of the environment in which the parent may be trying to be active. Clearly identifying specific exercise routines, and when, where, and how to engage in them, would be helpful for the parent. As the children age, parental obligations and schedules change, and the routines may need to be revisited and adjusted to meet the new demands.

Lastly, it is important that coactivity plans do not mandate that children exercise. Although children should engage daily in PA, parents and caregivers need to be cautious to engage in age-appropriate, fun activities. A “backup plan” for alternative methods of engaging in PA should be on hand for days when children flatly refuse coactivity. Health and fitness professionals can reference the SHAPE America Web site for excellent ideas about appropriate coactivity recommendations for parents and caregivers of children in different age cohorts (https://www.shapeamerica.org/advocacy/positionstatements/pa/?hkey=205f5d8e-98b2-4cc4-9018-c203549b4714) (18).

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CONCLUSION

Clearly, parents and caregivers of young children are at high risk for physical inactivity because of the numerous barriers they face upon becoming a parent or taking care of a child. As health and fitness professionals working with parents and caregivers of young children, it is helpful to understand their needs and circumstances so that we may be more creative in helping them to achieve their PA goals. Parents and caregivers may find that they now need to be more creative to fit PA into their schedules, and that it may look differently than it has in the past. For example, they may need to focus on coactivity and ways to be physically active at home, or they may need to rearrange their morning and evening schedules so that PA can be accomplished while the children are sleeping. See the “real” examples of opportunities for PA for parents and caregivers of young children in Table 2.

TABLE 2

TABLE 2

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Acknowledgments

The authors thank the parents and caregivers who contributed to the “real” examples of PAs for parents and caregivers of young children in Table 2.

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References

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© 2019 American College of Sports Medicine.