Purpose
A significant number of children fail to meet recommended daily physical activity levels, increasing their risk of poor health and wellbeing in the future. The us of school settings to deliver physical activity interventions in schools is common despite evidence suggesting they are not effective in increasing physical activity. This failure could, in part, be attributed to a lack of consideration of local context. Acknowledging the importance of local factors, the Medical Research Council emphasises the need for early stakeholder engagement in complex intervention development and implementation.
Method
This study used Experience-Based Co-Design (EBCD) principles and the Behaviour Change Wheel to develop a primary school intervention for improving childhood physical activity. Purposive sampling was used to recruit 45 participants from one school, 15 pupils, parents, and school staff each. The process involved setting up, collecting pupil, parent, and staff experiences, and a co-design event to finalise and agree on possible intervention for each identified priority. To address power dynamics, initial validation occurred solely with pupils to shape the co-design priorities. Pupils also had opportunity to provide feedback and approval of final interventions. This approach increased the likelihood of designing an intervention acceptable to the student population.
Results
Following the co-design event, two interventions were crafted. The first involves a daily group walk for 15 minutes per day, incorporating gamification with steps or distance tracking and certificates of achievement awarded for engagement. The second is an after-school fitness class for staff, children, and parents, led by school PE department. The school also acted independently to create a walking track with a learning area, fostering outdoor learning during the school day.
Conclusion
EBCD empowers and engages stakeholders in a collaborative process of problem solving and intervention design. It can be effective in developing tailored, complex health interventions for schools which are responsive to local needs and stakeholder contexts. Following completion of the process, the school was able to independently implement interventions enhancing children's activity opportunities leading to increased opportunity for all pupils and staff to be more active during the school day.

Purpose: Women diagnosed with gestational diabetes mellitus (GDM) during pregnancy have a high 10-year risk of developing type 2 diabetes mellitus (T2DM), which is exacerbated by postpartum weight retention. We conducted a randomized, controlled trial (RCT) to test the efficacy of a simple, novel intervention of wearing ankle weights during routine daily activities such as childcare and housework on changes in body weight, body composition, and glycemic, lipid, and inflammatory biomarkers in postpartum women who were diagnosed with GDM during their pregnancy.
Methods: The Moms in Motion parallel two-arm RCT tested the efficacy of wearing ankle weights (1.1 kgs each, 2 hours/day, from 25-35 to 190-210 days postpartum) compared to a standard-of-care control group in women diagnosed with GDM during pregnancy. The primary outcome was body weight while secondary outcomes included body composition and glycemic, lipid, and inflammatory biomarkers. 31/39 (79.5%) of participants had weight data at study completion (12 months postpartum). Linear mixed models with time*treatment arm interaction compared changes in outcomes among those assigned to the intervention (ANK, n=18) vs. those assigned to control (CTRL, n=21), adjusted for clinic site and pre-pregnancy BMI category.
Results: Median (IQR) age was 32 (28, 35) years. There was no significant effect of the intervention on change in weight (mean ± SD: 3.8 ± 1.8 kg for ANK vs. 2.2 ± 1.6 kg for CTRL, P-for-interaction = 0.51) or percent body fat (-0.6 ± 0.9 for ANK vs. -1.5 ± 0.8 for CTRL, P-for-interaction = 0.48). Both groups significantly reduced their total cholesterol over time but there was no intervention effect on this change (-25.3 ± 7.3 mg/dL for ANK vs. -18.5 ± 6.7 mg/dL for CTRL, P-for-interaction = 0.50). ANK slightly increased their C-reactive protein while CTRL significantly reduced it (0.5 ± 1.6 mmHg for ANK vs. -4.0 ± 1.5 mmHg for CTRL, P-for-interaction = 0.048).
Conclusion: Contrary to our hypothesis, the ankle weight intervention did not result in more weight loss or improved biomarkers compared to standard care. Potential compensatory effects of the intervention on energy intake and other domains of physical activity are plausible explanations that warrant further research.

Introduction: Health behaviors such as physical activity (PA) are socially influenced such that individuals from shared social networks or living environments may exhibit similar habits. This study examined the associations of social support, social control, and family member stage of change with self-reported and objective measures of moderate-to-vigorous PA in dyads of adult Latino family members.
Methods: We examined social support for PA using family participation and family punishment subscales, the study partner’s stage of change, and perceived social control. We performed multivariable multilevel analysis using generalized estimating equations (GEE) to account for within-dyad correlations. We conducted negative binomial regression for MET-minutes (self-reported; N=429) and accelerometer data (N=356) and logistic regression for meeting PA guidelines (self-reported; N=429), adjusting for age, BMI category, gender, marital status, birth country, education, and insurance.
Results: Most dyads were comprised of spouses (41%) or parents and adult children (32%). The majority of participants (mean age=41) were women (77%), overweight/obese (86%), born outside the U.S. (88%), and had low levels of education (50% Discussion: Social influences appear to play an important role in PA engagement in Latino families and warrant further consideration for PA promotion efforts although further research is needed.

Purpose: The aim of this study was to describe the development of, and test the acceptability and feasibility of providing feedback on infant movement behaviours in the context of supportive approaches. We hypothesised that providing individual behavioural feedback to mothers may improve maternal self-efficacy to promote infant movement behaviours.

Methods: Feedback was developed following expert consultation with working groups, and consisted graphical feedback on mother and infant movement behaviours measured using accelerometry. Participants wore the devices for one week, following which individual feedback on movement behaviours was delivered using supportive guidance. Feasibility and acceptability was tested by conducting focus group discussions with a sample of 8 mothers of infants aged 4-months using a semi-structured interview guide. Each FGD was analysed using an inductive, iterative analytical approach. Main emerging themes and subthemes were identified by coding transcripts for content, line by line, and patterns in the data were thus interpreted and described.

Results: Mothers included in this study were generally single, unemployed, and less than half had completed formal schooling. The feedback was found to be both feasible, and largely acceptable in this context and compliance was 100%. Mothers reported learning about the importance of play and routines, but needed more information on promoting sleep. They were not previously aware of infant movement guidelines.

Conclusions: We have developed feedback with the potential to sensitise mothers to their infants’ movement behaviours. When embedded in a supportive intervention, this feedback has the potential to improve mother’s self-efficacy for promoting these behaviours through increasing feelings of competence.

Purpose: This study provides insight into the worldwide significance of maternal nutrition, demonstrating the potential of pre-pregnancy nutritional status to impact maternal and infant health outcomes. By examining the moderating role of pre-pregnancy Body Mass Index (BMI) on the relationship between folic acid intake—as a proxy for the quality of antenatal care—and breastfeeding duration, the research seeks to reveal patterns that could improve maternal health standards worldwide. Despite its roots in US Hispanic population data, its findings contribute to a broader understanding of maternal health practices, potentially shaping international health guidelines and interventions sensitive to cultural and regional dietary practices.

Methods: Utilizing a robust secondary data analysis from the 2016-2021 Pregnancy Risk Assessment and Monitoring System, this study encompasses a diverse cohort of 27,671 Hispanic mothers. The analytical approach included stratified logistic regression models, controlling for potential confounders to isolate the impact of pre-pregnancy folic acid intake across different BMI categories.

Results: Among 27,671 mothers, 40.9% took folic acid pre-pregnancy, 64.9% breastfed for >3 months, and 2.9% were underweight, 38.8% were normal weight, 29.9% were overweight, and 28.3% were obese. In the logistic regression model stratified by pre-pregnancy BMI, among underweight mothers, there was a significantly lower likelihood of breastfeeding when mothers did not take folic acid (aOR=0.117, 95% CI 0.035-0.395), took 1-3 times per week (aOR=0.117, 95% CI 0.029-0.465), or took daily (aOR=0.085, 95% CI 0.024-0.304), compared to folic acid intake 4-6 times per week. Among mothers with normal weight and obesity, compared to folic acid intake 4-6 times per week, there was a significantly lower likelihood of breastfeeding when mothers did not take folic acid (aOR=0.702, 95% CI 0.503-0.978 and aOR=0.641, 95% CI 0.425-0.967, respectively).

Conclusions: The insight that folic acid intake—representative of antenatal care quality—can affect breastfeeding duration has significant implications for developing universal nutritional guidelines. These guidelines could be adapted to diverse healthcare systems worldwide, promoting longer breastfeeding durations and enhanced infant health outcomes. Further research should focus on cross-cultural studies to validate these findings and implement effective public health strategies in various international contexts.