A randomised controlled trial of an interactive family-based lifestyle programme

INTERVENTION: Randomised controlled trial across 5 European sites (locally approved and co‐ordinated) to test the effectiveness of a series of 8 lifestyle workshop sessions to see whether this will lead to increased levels of objectively measured, moderate‐to‐vigorous physical activity at 6 months compared to the control group. Control Group Children randomised to this group will be sent a leaflet with general information about increasing physical activity, reducing sedentary behaviour and improving nutrition. Their parents will also receive a general advice leaflet on improving lifestyle. Intervention Group Once the children have been randomised to the intervention group they will be invited to attend the PRE‐STARt interactive workshop series. The workshops will be delivered in interactive group‐based workshops for the children and their parent/guardian(s), and will be delivered by facilitators trained in the theory and philosophies underpinning the programme and in delivery of the curriculum and supporting resources. These sessions can be delivered between 10‐12 families at a time (family is defined as one young person and their adult carer). These eight sessions last 90 minutes each and we envisage these sessions taking place in a local school, community setting or at The Leicester Diabetes Centre. CONDITION: Type 2 diabetes ; Nutritional, Metabolic, Endocrine ; Type 2 diabetes mellitus PRIMARY OUTCOME: Objectively measured physical activity and sedentary behaviour levels at 6 months (parent(s)/guardian(s) and child): Participating children and adults will be asked to wear the wrist worn GENEActiv accelerometer (ActivInsights, Kimbolton, Cambridgeshire, UK) continuously for up to 8 days. SECONDARY OUTCOME: Measured at 3 and 6 months after baseline assessment:; 1. Objectively measured total volume of physical activity: Participating children and adults will be asked to wear the wrist worn GENEActiv accelerometer (ActivInsights, Kimbolton, Cambridgeshire, UK) continuously for up to 8 days.; 2. Proportion meeting MVPA guidelines (measured objectively) ; 3. Time spent sedentary (measured objectively and self‐reported) ; 4. Self‐reported physical activity: The physical activity questionnaire for adolescents (PAQ‐A) will be used to assess the Types and context of physical activity in order to investigate changes in the Types of sports/exercise/activities the participating child may participate in (information which is not available from the accelerometer or the majority of other validated self‐report questionnaires).; 5. Measures of adiposity (body mass index percentile, percent body fat): Body mass will be measured to the nearest 0.1kg and height will be measured to the nearest 0.1 cm using a clinically approved bioelectrical impedance scale and a portable stadiometer, respectively. BMI will be calculated as weight/height2 and will be converted to a BMI percentile based on WHO growth charts. Body fat percentage will be measured to the nearest 1% also using the bioelectrical impedance scale. All circumferences will be measured with an inelastic anthropometry tape. Waist circumference will be measured to the nearest 0.1 cm as the midpoint between the lower costal margin and iliac crest.; 6. Psychological factors that may mediate physical activity participation: Participating children will also complete a questions assessing self‐efficacy for increasing physical activity, decreasing sedentary behaviour and making positive dietary changes that have been used previously. The Investigators will also collect data on motivation for physical activity change, attitudes towards physical activity and nutrition, barriers to nutritional change and perceived social support for physical activity that the child receives from the general family and specifically from the child’s mother and father.; 7. Healthy food provision and parenting practices for healthy food ; 8. Diet composition: The Investigators will query the nutrition habits of participants to investigate any changes in the behaviours targeted in the workshops. A food frequency questionnaire (FFQ) taken from the ISCOLE study that was adapted from the HBSC Study will be used to query the consumption of 23 food categories in a “usual” week. The Investigators will also collect data on breakfast consumption for weekdays and weekend. The Investigators also created ad hoc questions on other intervention targets of snacking behaviours, fruit and vegetable intake and fizzy drink consumption. This ad hoc method has been used in other international multi‐site studies.; 9. Knowledge of physical activity and nutrition (parent(s)/guardian(s) and child): Questions on attitudes towards physical activity and nutrition will be completed by participating children. Questionnaires have been chosen that have demonstrated factorial validity and have been used in young people previously. Questions on knowledge of physical activity and nutrition practices will be ascertained by developing ad hoc questions based on the content of the workshops adapted from questions from the ENERGY project.; 10. Cardio‐metabolic variables (blood pressure, glucose, HbA1c, cholesterol) (child measure): Arterial blood pressure will be measured using an automated sphygmomanometer with an appropriate sized cuff while the patient is seated, and having rested quietly for 5 minutes. Three measurements will be obtained for blood pressure and an average of the last two will be used in any analysis. HbA1c, triglycerides, glucose, HDL‐C and total cholesterol will be measured using a point‐of‐care testing (POCT) and LDL‐C will be calculated. Capillary blood samples will be taken from each child using the finger prick method. The CardioChek® system will be used as the POCT method. The CardioChek® system is a portable hand held device that requires between 15 to 40 µL capillary sample from a finger‐stick for each test. The CardioChek® system is certified by the Cholesterol Reference Method Laboratory Network (CRMLN) and National Cholesterol Education Program (NCEP), is FDA‐cleared, CE‐marked, internationally registered, and is CLIA‐waived by the Centers for Medicare & Medicaid Services, USA. ; ; We will also include qualitative data collected from:; 1. Evaluation forms following each intervention workshop session which will be completed by the parent/guardian, child and facilitator ; 2. Feedback from focus groups to be held following completion of the total intervention i.e. 8 sessions INCLUSION CRITERIA: Participants will be invited to participate if they are 12‐14 years old inclusive (12 years 0 days to 14 years 354 days old) and are identified as having the following risk factors for development of Type 2 Diabetes (which will be identified from the eligibility questionnaire): BMI > 95th percentile for age and gender OR BMI > 85th percentile PLUS one other from the following list: 1. Family history of Diabetes (first degree relative) 2. Non‐white ethnicity 3. Watching TV/play computer games for more than 2 hours a day (self‐report) 4. Sugar intake more than 1.5 cans (or 532 ml) of fizzy pop/fruit juice per day (self‐report)