Promoting Adolescent Cardio-Metabolic Health Through a Psychological Need-Supportive Online Lifestyle Intervention

Promoting Adolescent Cardio-Metabolic Health Through a Psychological Need-Supportive Online Lifestyle Intervention | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Promoting Adolescent Cardio-Metabolic Health Through a Psychological Need-Supportive Online Lifestyle Intervention Junhyuk Park, Sanga Yun, Taewoo Kim, Victoria Lorenzo, Juana Prieto, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7707057/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Purpose This study aimed to evaluate the preliminary efficacy of a 12-week self-determination theory-centered online lifestyle intervention for Hispanic adolescents with obesity, including considerations for the intervention’s feasibility. Method Nineteen adolescents (intervention = 11; control = 8) participated in this quasi-experimental study. The intervention consisted of two 60-minute moderate-to-vigorous exercise sessions and one 30-minute nutrition lesson delivered via Zoom each week for 12 weeks to examine changes in body mass index (BMI), health-related fitness indicators, physical activity levels, and motivational regulations. Program fidelity was assessed through session heart rate, perceived exertion, and perceived need-support measures. Moreover, interviews with adolescents and parents were thematically analyzed to inform intervention feasibility. Result The study showed statistically significant intervention efficacy in BMI ( F [ 1 , 16 ] = 8.14, p = .012), abdominal muscular endurance and strength ( F [ 1 , 16 ] = 14.13, p = .002), and physical activity level ( F [ 1 , 16 ] = 9.345, p = .008). Fidelity measures confirmed exercise adherence, showing that participants maintained moderate-to-vigorous intensity and consistently reported high levels of perceived need-support. Qualitative findings further supported these results and emphasized practical strategies for recruitment and dissemination efforts. Conclusion The findings emphasize this online lifestyle intervention’s potential to promote cardio-metabolic health in adolescents and offer direction for future implementation and dissemination. mHealth lifestyle intervention self-determination theory obesity prevention 1. Introduction Obesity among children and adolescents is a public health concern in the United States [ 1 , 2 ]. Having childhood obesity is associated with the risk of later developing comorbidities as an adult, including type 2 diabetes mellitus, hypertension, fatty liver disease, as well as increased likelihood of adulthood obesity [ 3 – 5 ]. Childhood obesity disproportionately affects Hispanic children due to a combination of factors, including parental influence, higher levels of sedentary behavior, socioeconomic status, and food security [ 6 , 7 ]. A variety of interventions focusing on preventing and treating childhood obesity have been conducted [ 8 ]. Evidence suggests that to maximize program effectiveness, interventions should: a) be conducted in late adolescence, b) focus on a single, specific goal (e.g., treating obesity) rather than multiple goals, c) provide behavior modification counseling or therapy to enhance participants’ motivation and engagement, and d) provide nutrition education [ 9 – 11 ]. Lifestyle interventions, which include exercise, nutrition education, and behavioral modifications, are widely utilized for the prevention and treatment of pediatric obesity, and studies have reported their effectiveness in treating childhood obesity [ 9 , 12 ]. Research supports their efficacy in improving physical and psychological outcomes, including body mass index (BMI), fitness, and physical activity (PA) [ 9 , 12 ]. Despite the increase in research and interventions designed to treat childhood obesity, there are still barriers that hinder participation, particularly among Hispanic families. It has been shown that Hispanic individuals comprised less than 10% of participants in behavioral weight loss interventions [ 13 ]. Reasons for lower adherence include a lack of programs tailored to Hispanic cultures, transportation issues, and inadequate social and emotional support [ 14 ]. This study further highlighted that community-based, culturally relevant approaches produced the most significant results, underscoring their importance in developing interventions for minority groups. Recently, the mHealth approach has become increasingly popular in pediatric intervention groups, suggesting that mobile technology may be an effective strategy for promoting healthy behaviors in the general population [ 15 ]. mHealth technologies may address some of these inherent challenges of traditional lifestyle interventions by bringing the program to participants' homes and reducing transportation and geographical barriers [ 16 ]. In addition, they offer several advantages over face-to-face methods, such as cost-effective dissemination, real-time data collection and feedback, and flexible program personalization [ 17 ]. mHealth technology is particularly appealing to the technologically savvy younger generation and can support youth in achieving and maintaining a healthy lifestyle by engaging their interest and enhancing their self-regulatory capacities. Despite growing interest in technology-based interventions, review studies have highlighted a lack of feasibility studies for obesity prevention programs targeting Hispanic adolescents [ 18 , 19 ]. Specifically, many of the previous studies did not implement a multicomponent intensive lifestyle intervention that includes exercise, family nutrition education, and behavior modification modules. To address these gaps, we transferred an existing in-person healthy lifestyle intervention tailored for Hispanic adolescents, the Bracing up Research on Adolescents’ prevention of Obesity (BRAVO!) [ 20 , 21 ], to an online format. Previously, the in-person BRAVO! interventions have demonstrated efficacy in producing positive changes in BMI and health-related fitness outcomes [ 20 , 21 ]. Specifically, the participants in the study showed statistically significant reductions in BMI, improvements in cardiovascular endurance, upper body strength/endurance, and abdominal strength/endurance. Furthermore, based on Self-Determination Theory (SDT) [ 22 , 23 ], which explains the development of human motivation, BRAVO! provides a need-supportive environment that promotes autonomous adoption of a healthier lifestyle among overweight and obese adolescents. According to SDT, supporting participants’ basic psychological needs for autonomy (i.e., need for self-regulation of experiences and actions), competence (i.e., need for success, ability, and confidence in demonstrating, achieving, and mastering desired goals and outcomes), and relatedness (i.e., need for connection and belonging to others) enhances intrinsic motivation, goal pursuit, and long-term behavioral maintenance [ 24 ]. Supporting this, previous in-person BRAVO! interventions have shown improvements in behavioral and psychosocial outcomes, including PA behaviors, motivational regulations, and well-being [ 20 , 21 ]. Therefore, this study aimed to evaluate the preliminary efficacy of a 12-week online lifestyle intervention for Hispanic adolescents with obesity and considerations for the intervention’s feasibility. 2. Methods Research Design and Intervention This study employed a quasi-experimental design consisting of an intervention group (BRAVO!) and a usual-care control group. BRAVO! is a 12-week health intervention for adolescents (ages 11–16 years) that combines structured exercise training, nutrition education, and behavioral modification strategies. Each week, adolescents in the BRAVO! intervention participated in two 60-minute moderate-to-vigorous intensity (approximately 65% of maximum heart rate) exercise sessions and one 30-minute family-based nutrition lesson. Each exercise session included a cardiovascular endurance or muscular strength and endurance-focused workout, paired with a cooperative game to promote participants’ sense of relatedness, as well as a warm-up and cool-down period. This schedule provided 24 hours of exercise and 6 hours of nutrition education over 12 weeks (see Table 1 ). All sessions were delivered live via Zoom software, allowing participants to join from home. The nutrition education curriculum followed the 2020–2025 Dietary Guidelines for Americans [ 25 ]. Table 1 Online BRAVO! Lifestyle Intervention Overview Week Exercise Session (2 sessions/week) Nutrition Session (1 session/week) 1 Lesson 1 (Cardiovascular Endurance) & 2 (Muscular Strength and Endurance) Introduction & Goal Setting 2 Lesson 3 (Cardiovascular Endurance) & 4 (Muscular Strength and Endurance) MyPlate: 5 Food Groups Friends 3 Lesson 5 (Cardiovascular Endurance) & 6 (Muscular Strength and Endurance) MyPlate: Discovery Trail 4 Lesson 7 (Cardiovascular Endurance) & 8 (Plan Your Own Workout) MyPlate: Eat the Colors 5 Lesson 1 (Cardiovascular Endurance) & 2 (Muscular Strength and Endurance) MyPlate: Avoid Sugary Beverages 6 Lesson 3 (Cardiovascular Endurance) & 4 (Muscular Strength and Endurance) MyPlate: Be Whole, Go Whole Grain 7 Lesson 5 (Cardiovascular Endurance) & 6 (Muscular Strength and Endurance) MyPlate: Dietary Fats, Knowing the Types 8 Lesson 7 (Cardiovascular Endurance) & 8 (Plan Your Own Workout) MyPlate: Reduce Trans & Saturated Fats 9 Lesson 1 (Cardiovascular Endurance) & 2 (Muscular Strength and Endurance) MyPlate: Rock Your Snacks 10 Lesson 3 (Cardiovascular Endurance) & 4 (Muscular Strength and Endurance) MyPlate: Drink up Diary Daily 11 Lesson 5 (Cardiovascular Endurance) & 6 (Muscular Strength and Endurance) MyPlate: Creating a Healthy Environment 12 Lesson 7 (Cardiovascular Endurance) & 8 (Plan Your Own Workout) Bring it All Together This intervention was grounded in SDT and incorporated positive psychology principles to foster intrinsic motivation for healthy behavior change. This involved various need-supportive instructional strategies (see Table 2 ) shown to enhance motivation and well-being [ 26 , 27 ]. Participants in the control arm did not receive any structured intervention during the 12-week period. They continued with their usual activities and were asked to inform the research team if they began any new exercise or nutrition programs that might influence study outcomes. Table 2 Need-Supportive Strategies Implemented in the Online BRAVO! Lifestyle Intervention (Adapted from Manninen & Yli-Piipari, 2021; Yun et al., 2024) Need-Supportive Strategy Example 1 Use informational and noncontrolling language “might, could, suggest, I propose… (O), must… (X)” ; I suggest that you select a suitable activity that helps you to move toward your short/long term goals. ; We could try…. 2 Use meaningful rationales Today’s exercises are focusing especially on your calf muscles. ; This exercise is highly important because… ; This will help you plan your own exercise and train more successfully . 3 Provide choice You can select inclined push-ups instead of floor push-ups ; Control the depth of the lunges based on your feelings ; You can control the intensity and the number of repetitions yourselves. 4 Acknowledge and respect different perspectives and feelings I understand that these workouts can be difficult and tired for you sometimes, but these workouts will help us to be healthier and stronger. ; I hear you. It was a hard activity for sure. 5 Demonstrating interest in each student [Name], how was your school today? ; [Name], did you have the game you mentioned last week? 6 Encourage students to ask questions and be proactive Do you have any questions about our activities today? ; Please feel free to ask me, if something is not clear. I will happily reintroduce activities again. 7 Encourage cooperation Let’s modify the game a bit. Now, everyone in your team needs to touch the ball at least once before scoring. Let me know if you have any questions. 8 Clarify expectations The objective of the lesson is…. Do you have any questions on this? 9 Set optimal learning challenges When you have made three shots in a row, you can move on to the next spot. 10 Give constructive, clear, and relevant feedback Thanks for your hard work everyone! ; Great work, [name]. You really had great intensity today. ; [Name], make sure that you keep your knee high. Other than that, you’re doing perfect. Online Need-Supportive Strategy Challenges in the Online Environment 1. Visual accessibility and interaction 2. Verbal communication and interaction Additional Need-Supportive Strategies in the Online Environment 1. Encouraging camera use with positive reinforcement. 2. Treating unseen students with trust and patience. 3. Allowing diverse response options. 4. Offering tailored and thorough guidance and explanation. 5. Correcting the group collectively to avoid embarrassment. 6. Exercising alongside students for motivation and demonstration. 7. Engaging students with questions about their lives and interests. 8. Personalizing interactions by using names and tailored questions. 9. Fuel engagement with instructor’s positive energy and genuineness. All BRAVO! sessions were led by pairs of undergraduate student instructors majoring or minoring in exercise science, health promotion, or related fields, under the supervision of one or more graduate-level staff [ 28 ]. All instructors received 4hr of training (1hr IRB, 2hr study and need-supportive instruction, and 1hr data collection) by the research team before leading the sessions, which was informed by evidence on creating need-supportive environments [ 26 , 27 ]. [Insert Table 1 ] [Insert Table 2 ] Participants and Procedures Participants were recruited via pediatric primary care clinics and community advertisements. Pediatricians at participating clinics identified and referred potential participants to the research team. In addition, the research team distributed flyers containing information about the program in the community and posted them online. The eligibility criteria included: a) age between 11 and 16 years, b) Hispanic ethnicity, c) a pediatrician's diagnosis of overweight or obesity, d) access to a smart device or computer with stable internet, e) ability to use the Zoom platform, and f) access to an indoor or outdoor space measuring at least 6×6 feet for exercise. Parents of interested youth used the QR code to access an online eligibility screening questionnaire. Research staff contacted families to confirm eligibility and share additional study details, and provided a link to complete electronic consent/assent forms. Once consent and assent were obtained, the first laboratory visit for baseline measurements was scheduled before the program. BRAVO! program booklet was distributed to each family at this time, outlining each session and suggesting homework exercises for non-session days. Following the 12-week intervention period, a post-intervention assessment was conducted during the second laboratory visit in the week immediately after the final BRAVO! session. A total of 43 adolescents and their families were screened and were eligible to participate. Out of these, 22 adolescents agreed to take part and completed the baseline assessments. Three participants in the intervention group withdrew from the study during the 12-week intervention, yielding 19 adolescents ( M age = 13.05 ± 1.75) who completed the program and the post-test. Table 3 provides baseline characteristics of the participants. Lastly, all study procedures were approved by the Institutional Review Board of the local university. Table 3 Baseline Characteristics of the Participants Variable Intervention ( N = 11) Control ( N = 8) p M ( SD ) M ( SD ) Gender (m/f) (n, %) 5 (45.4), 6 (54.6) 5 (62.5), 3 (37.5) .530 Age (years) 13.45 (1.92) 12.50 (1.41) .251 BMI (kg/m 2 ) 32.54 (8.22) 34.53 (8.52) .615 BMIz 2.07 (.66) 2.38 (.32) .235 PACER (laps) 15.14 (9.35) 13.25 (6.90) .660 Push-up (counts) 7.18 (10.22) 2.88 (4.09) .278 Curl-up (counts) 6.36 (8.02) 8.63 (6.30) .517 Physical Activity Level 2.38 (.59) 2.08 (.71) .331 Intrinsic Motivation 3.40 (.65) 3.84 (.42) .114 Integrated Regulation 3.40 (.86) 3.13 (.60) .454 Identified Regulation 3.63 (.53) 3.38 (.65) .383 External Regulation 2.08 (.84) 2.44 (1.11) .441 Amotivation 1.83 (.92) 1.75 (.61) .846 Note 1. m/f: male/female. BMI: body mass index. Note 2. A chi-square test was used for gender, and t-tests were used for all other variables, with a significance level at p < .05, and no significant baseline difference was observed. [Insert Table 3 ] Fidelity Outcomes Exercise intensity was measured by having participants take a quick 20-second pulse count (carotid or radial artery) after warm-up and after the main session. Participants then rated the difficulty of the session on a 1–10 modified Borg Rating of Perceived Exertion Scale (RPE; 1: very easy to 10: maximal) [ 29 ]. Participants received training during the pre-test on how to perform these procedures. The target intensity for each session was moderate-to-vigorous, defined as 64% of maximum heart rate and RPE between 5 and 6. Also, to evaluate the implementation of need-supportive teaching, the instructors’ need-supportive behaviors were assessed during the program at weeks 4, 8, and 12 using the 15-item Perceived Environmental Supportiveness Scale (1: strongly disagree to 7: strongly agree) [ 30 ]. Internal consistency of this scale was .91, .96, and .96, respectively. Primary Outcomes BMI. Height and weight were measured to the nearest .1cm and .1kg using a stadiometer. BMI was calculated using the standard formula of weight/height 2 . Standardized BMI (BMIz) was calculated using an SPSS macro [ 31 ]. Health-related Fitness. Cardiovascular endurance was measured using the PACER test [ 32 ]. Participants were instructed to run as many 20-meter laps as possible, following a cadence that increased in pace over time. PACER test is a reliable and valid measure of cardiorespiratory endurance in adolescents [ 33 ]. Push-up test was used to assess participants’ upper-body muscular endurance and strength. The final score was determined by the number of correctly completed push-ups, with boys performing the test with their feet on the floor, while girls did a modified version with their knees on the ground. Push-up test is a reliable and valid measure of upper-body muscular endurance and strength in adolescents [ 32 ]. Curl-up test was used to measure participants’ abdominal muscular endurance and strength. Participants began in a supine position with knees bent, feet to the floor, and arms straight and parallel to the body. An 11.4 cm wide measuring tape was placed under them so that their fingertips rested on the near edge of the tape. Participants were instructed to perform a curl-up by sliding their fingers across the tape until reaching the far edge. The final score was the number of correctly completed curl-ups. Curl-up test is a reliable and valid measure of abdominal strength and endurance in adolescents [ 32 ]. PA Level. Participants’ daily PA level was measured using the PA Questionnaire for Adolescents (PAQ-A) scale [ 34 ]. PAQ-A is a 9-item, 7-day PA recall questionnaire that assesses participation in various types of PA, including activity during physical education classes, lunch breaks, after school, evenings, and weekends. Each item is scored on a 5-point scale, with “1” indicating the lowest and “5” indicating the highest levels of PA. The final score was calculated by averaging the points obtained, with higher scores indicating a higher level of PA. PAC-A is a valid measurement of PA among adolescents [ 34 ]. Motivational Regulation. Participants’ exercise motivation was assessed with the Behavioral Regulation in Exercise Questionnaire (BREQ-3) [ 35 ]. The scale is rated by a 5-point Likert Scale (1: not true for me to 5: very true for me), with 24 items measuring participants’ intrinsic motivation (e.g., “because it’s fun”), integrated regulation (e.g., “because it is consistent with my life goals”), identified regulation (e.g., “it is important to me”), introjected regulation (e.g., “I feel guilty when I do not”), external regulation (e.g., “because other people say I should”), and amotivation (e.g., “I do not see why I should have to participate”). BREQ-3 is a valid measurement of motivational regulation [ 35 ]. The internal consistency for the pre- and post-test values is reported in Table 3 . Introjected regulation was excluded from the analysis due to low reliability ( α < .70 in pre- and post-tests). Interviews . At the post-test, interviews were conducted with the participants and parents. These semi-structured interviews aimed to understand the participants’ overall perceptions about the recruitment and dissemination of the online BRAVO! lifestyle intervention program. The interview guide was developed by research team members with experience in qualitative research, and interviewers received training from these researchers. For confidentiality, research team members replaced participant names with pseudonyms during the transcription process. Data Analyses A concurrent mixed-methods design was adopted, collecting and analyzing quantitative and qualitative data simultaneously to achieve a comprehensive understanding [ 36 ]. Specifically, the study used the intervention mixed-methods model, which extends convergent or sequential designs by integrating an experimental component and enriching it with qualitative data [ 37 ]. Quantitative Analyses . Preliminary analyses were conducted to examine missing data, outliers, normality, descriptive statistics, and internal consistency using Cronbach’s alpha. To assess between-group differences over time, separate fixed-effect analyses of covariance (ANCOVAs) were conducted. These tests examined the interaction between group and changes from baseline to post-test. Each model included time, group, and a group-by-time interaction term, with the group-by-time interaction interpreted as the primary effect of interest. The assumptions of ANCOVA, such as normality and homogeneity of variance, were examined and verified. Effect sizes for between-group differences were calculated using partial eta squared ( ηp² ), interpreted as small (.01), medium (.06), and large (.14). All analyses were conducted using SPSS version 28.0. Qualitative Analyses . A qualitative thematic analysis was conducted to provide additional insights into program efficacy, recruitment, and dissemination. Interview data were transcribed and analyzed thematically [ 38 ] using ATLAS.ti software. Researchers thoroughly read the transcripts, developed codes, and collaboratively identified themes. These were iteratively reviewed and refined to ensure consistency and clarity, culminating in a thematic map. Representative quotes were selected to illustrate each theme. To ensure the trustworthiness of the qualitative analysis, the eight criteria for qualitative rigor were followed [ 39 ]. 3. Results Fidelity Outcomes Table 4 presents the average heart rate, average perceived exertion, and perceived need-support to evaluate program fidelity, specifically session intensity and instructional quality. Table 4 Fidelity Outcomes of the Online BRAVO! Lifestyle Intervention Variable M ( SD ) Range Age (years) 13.45 (1.92) 11–16 Maximum HR (220-age) 206.55 (1.92) 204–209 64% of Maximum HR 132.18 (1.25) 130.56-133.76 Average HR after activity 126.39 (9.84) 112.14-144.23 Average RPE (1–10) 6.01 (.94) 4.41–7.38 Perceived Need-Support (1–7) Week 4 6.06 (1.10) Week 8 6.11 (1.05) Week 12 6.21 (1.05) Note. HR: heart rate, RPE: Borg rating of perceived exertion, 64% of Maximum Heart Rate indicates moderate-to-vigorous physical activity, which is the target intensity of the program. [Insert Table 4 ] The average post-activity heart rate was 126.39 ± 9.84 BPM, and the average RPE was 6.01 ± .94. Since heart rate was self-measured about one minute after the main activity, the values might slightly underestimate the actual exercise intensity compared to the moderate-to-vigorous PA benchmark, which was an average of 132.18 for this population. Additionally, the participants exhibited high levels of need-support throughout the program, with mean scores of 6.06 ± 1.10 in Week 4, 6.11 ± 1.05 in Week 8, and 6.21 ± 1.05 in Week 12 on a 1–7 scale. Quantitative Findings A sensitivity analysis for ANCOVA ( α = .05, power = .80) indicated that, with the current sample size ( N = 19), the study was only powered to reach statistical significance for very large effects ( ηp² ≥ .32), with a corresponding critical F -value of 4.494 across the outcome variables. Therefore, the following results should be interpreted with the understanding that non-significant findings may reflect the limited power of this preliminary study rather than the absence of real effects. Table 5 summarizes the results of this study. Table 5 Changes in Outcomes from Pre- to Post-test and ANCOVA results Variable Intervention ( N = 11) Control ( N = 8) p ηp² α Pre Post Δ Pre Post Δ M ( SD ) M ( SD ) BMI (kg/m 2 ) 32.54 (8.22) 31.95 (8.13) − .59 (.74) 34.53 (8.52) 34.79 (8.36) .26 (.52) .012* .34 BMIz 2.07 (.66) 1.99 (.74) − .08 (.13) 2.38 (.32) 2.40 (.30) .02 (.03) .108 .15 PACER (laps) 15.14 (9.35) 27.86 (27.94) 12.71 (19.22) 13.25 (6.90) 13.13 (6.20) − .13 (1.96) .065 + .26 Push-up (counts) 7.18 (10.22) 12.00 (12.13) 4.82 (7.85) 2.88 (4.09) 3.13 (4.32) .25 (.71) .120 .14 Curl-up (counts) 6.36 (8.02) 21.50 (11.13) 15.10 (10.59) 8.63 (6.30) 8.75 (5.97) .13 (1.13) .002** .49 Physical Activity Level 2.38 (.59) 3.03 (.71) .60 (.69) 2.08 (.71) 2.11 (.49) .03 (.29) .008** .37 Intrinsic Motivation 3.40 (.65) 3.83 (.64) .43 (.76) 3.84 (.42) 3.75 (.35) − .09 (.13) .311 .07 .71 a /.77 a Integrated Regulation 3.40 (.86) 3.33 (.50) − .08 (.79) 3.13 (.60) 3.09 (.53) − .03 (.09) .576 .02 .75 a /.71 a Identified Regulation 3.63 (.53) 3.55 (.48) − .08 (.70) 3.38 (.65) 3.41 (.58) .03 (.09) .936 .00 .77/.90 b Introjected Regulation 2.43 (.51) 2.83 (.76) .40 (.59) 2.84 (.64) 2.84 (.64) .00 (.00) .115 .16 < .70/<.70 External Regulation 2.08 (.84) 1.98 (.85) − .10 (.66) 2.44 (1.11) 2.41 (.98) − .03 (.25) .566 .02 .85/88 Amotivation 1.83 (.92) 1.58 (.58) − .25 (.58) 1.75 (.61) 1.81 (.58) .06 (.18) .108 .16 .74/.79 Note 1. Δ : Post-Pre changes, BMI: body mass index, α : Cronbach’s alpha Note 2 . ANCOVA models adjusted for baseline (pre-test) values, ηp² = partial eta squared, S ignificance at p < .05, p < .10( + ), p < .05(*), p < .01(**), p < .001(***), a = without item 4, b = without item 2. [Insert Table 5 ] BMI . Significant group × time interaction was found for BMI ( F [ 1 , 16 ] = 8.14, p = .012, ηp² = .34). On average, the intervention group’s BMI decreased by .59 ± .74 kg/m², whereas the control group’s BMI increased by .26 ± .52 kg/m². These opposing trajectories indicate that the intervention produced a clinically meaningful reduction in participants’ BMI. However, BMIz was not statistically significant between groups ( F [ 1 , 16 ] = 2.89, p = .108, ηp² = .15). Health-related Fitness . Significant group × time interaction was also observed for curl-up ( F [ 1 , 16 ] = 14.13, p = .002, ηp² = .50). The intervention group improved by 15.10 ± 10.59 curl-ups, while the control group showed minimal change (.13 ± 1.13). However, there were no statistically significant differences in PACER ( F [ 1 , 16 ] = 4.13, p = .065, ηp² = .26; Δ INT = 12.71 ± 19.22; Δ CONT = − .13 ± 1.96) and push-up between groups ( F [ 1 , 16 ] = 2.70, p = .120, ηp² = .14; Δ INT = 4.82 ± 7.85; Δ CONT = .25 ± .71). Although the PACER and push-up results did not achieve statistical significance, the intervention group showed improvements in both. PA Level. Significant group × time interaction emerged for PA level ( F [ 1 , 16 ] = 9.345, p = .008, ηp² = .36). Intervention group’s PAQ-A score increased by .60 ± .69, whereas the control group’s score change was 03 ± .29. These opposing trajectories indicate that the intervention produced a meaningful improvement in participants’ PA behavior. Motivational Regulation. Motivational regulation outcomes were not statistically significant. Intrinsic motivation increased for the intervention group but showed no significant group × time interaction ( F [ 1 , 16 ] = 1.101, p = .311, ηp² = .07; Δ INT = .43 ± .76; Δ CONT = − .09 ± .13). Integrated regulation ( F [ 1 , 16 ] = .326, p = .576, ηp² = .02; Δ INT = − .08 ± .79; Δ CONT = − .03 ± .09), identified regulation ( F [ 1 , 16 ] = .007, p = .936, ηp² = .00; Δ INT = − .08 ± .70; Δ CONT = .03 ± .09), external regulation ( F [ 1 , 16 ] = .344, p = .566, ηp² = .02; Δ INT = − .10 ± .66; Δ CONT = − .03 ± .25), and amotivation ( F [ 1 , 16 ] = 2.925, p = .108, ηp² = .16; Δ INT = − .25 ± .58; Δ CONT = .06 ± .18) scores all decreased more in the intervention group, but did not reach significance. Introjected regulation was excluded from analysis due to low reliability. Although the results did not achieve statistical significance, the pattern of changes suggested a trend toward higher intrinsic motivation and lower controlled motivation and amotivation in the intervention group. Lastly, a sensitivity analysis for ANCOVA at α = .05 and power (1– β ) = .80 indicated that the current sample size of 19 can only detect statistical significance when there is a very large effect size ( ηp² = .32 or higher). For example, some results in this study (i.e., BMIz, PACER, push-up, and amotivation) still surpass the conventional threshold for a large effect size ( ηp² = .14) but were not statistically significant. This suggests that with a larger sample, more effects would probably reach statistical significance. Qualitative Findings Interviews with ten adolescents and two parents who agreed to participate generated three overarching themes: 1) program efficacy and acceptability, 2) recruitment suitability, and 3) dissemination considerations. Together, these provide information on how the online BRAVO! lifestyle intervention functioned in the everyday family lives of participants. Program Efficacy and Acceptability Improvements in lifestyle behavior. Participants reported exercising more often and with greater intensity both at school and at home. Emily explained, “Once I started the sessions, I became way more active in PE class,” while Paul noted that the routines “moved right into the school gym”, and he was able to experience increased PA time at school. Several teens also described healthier eating. Justin said, “I eat way less than I used to; now I grab fruit instead of chips,” and Sofia shared that replacing sugary snacks “helps me tell myself to stop being fat.” Psychological benefits and sustained motivation. Many adolescents framed their newfound habits in terms of confidence and future aspirations. Emily commented that she now had “more energy and felt less lazy.” Brittney echoed this by sharing that her son had begun planning gym workouts after the program, “He wants to do weights now; it’s the first time he’s asked to exercise on his own.” Perceptions of online delivery. Most families expressed satisfaction with the online format for eliminating travel time and scheduling hassles. As Camden put it, “What I liked most was not having to drive across town.” Brittney agreed, noting that online sessions “fit around work hours when you just don’t have the time.” Although Emily occasionally missed the “in-person group vibe,” even she conceded the online approach was “still really convenient and comfortable.” David remarked, “Having everyone on screen actually makes you less embarrassed and gives you more confidence.”, suggesting the positive aspect of online delivery. Recruitment Suitability Trusted medical referral. Pediatric providers were the primary gateway to enrollment. Gabrielle recalled, “The pediatrician basically said, ‘This program will motivate them,’ and that made me enroll my kids in it.” Likewise, Brittney said their doctor assured them the intervention was “really good and evidence-based,” indicating that their participation was motivated by recommendations from trusted medical professionals. Family is the primary motivator. Participation was motivated by the opportunity to engage alongside participants’ family members. Emily credited her sister for joining this program and her mother for the ongoing encouragement: “My family plays a big role. They all want me to be healthy.” Brittney mentioned cooking healthier meals to support her children, indicating that family support is the primary motivator for recruitment and sustained participation. Dissemination Considerations Diverse outreach strategies. Parents suggested broadening recruitment beyond clinics to capture families who seldom see a pediatrician. Gabrielle, stating that “The flyers and online posts were really helpful in keeping us informed.”, appreciated the use of online posts, flyers, and community bulletin boards. They also noted that Spanish-language materials made the program more appealing to local Hispanic families. Positive word-of-mouth and cultural resonance. Expressing gratitude for the program, Brittney said she planned to tell her friends "so their kids spend less time on screens." Notably, several adolescents highlighted the impact of a bilingual instructor: Alice said, “The Hispanic guy was my favorite, he joked with us in Spanish and kept everyone moving.” This underscores the value of culturally competent, relatable staff, especially when serving minority communities. 4. Discussion Findings from this study indicated that online BRAVO! lifestyle intervention was effective in enhancing health outcomes among adolescents, highlighting the dissemination potential of the BRAVO! intervention in addressing adolescent health disparities. Qualitative findings reinforced the program’s effectiveness, confirmed the suitability of its recruitment strategies, and identified key factors for successful dissemination. Consistent with previous SDT-based lifestyle interventions, we observed improvements across several outcomes. Participants showed statistically significant improvements in BMI, abdominal muscle endurance and strength, and daily PA levels. These findings align with prior research demonstrating that lifestyle interventions contribute to reductions in BMI 9 , improvements in health-related fitness [ 40 ], and increased daily PA levels [ 41 ]. Furthermore, the in-person BRAVO! lifestyle intervention with 40 participants [ 20 ] reported significant reductions in BMI (1.58 unit reduction) along with improvements in cardiovascular endurance (.34 PACER laps improvement), upper body strength/endurance (almost 4 added pushups), and abdominal strength/endurance (more than 10 added pushups). There were also significant changes in some motivational regulations, including increases in intrinsic motivation and decreases in external regulation. Compared with the in-person BRAVO! intervention, the effect sizes for statistically significant findings were similar across delivery modes, with BMI favoring in-person (.45 vs. .34), while curl-up (.45 vs. .49) favored online, and PA level (.38 vs. .37) showed nearly identical effects. Overall, these results indicate comparable effects for both in-person and online interventions. Although some outcomes from the online BRAVO! intervention did not reach statistical significance, sensitivity analyses suggest that these results likely reflect limited statistical power rather than the absence of true effects. For example, BMIz, PACER, push-up, and amotivation did not reach statistical significance, but demonstrated effect sizes exceeding the conventional threshold for a large effect ( ηp² ≥ .14). This pattern indicates that larger samples may yield statistically significant findings. Overall, the results indicate that the online BRAVO! intervention showed trends similar to those observed in the in-person program, confirming the preliminary efficacy of this program. One likely explanation of the program’s broad efficacy lies in its need-supportive design. By supporting participants’ basic psychological needs for autonomy, competence, and relatedness, the program fostered self-determined forms of motivation. Although motivational shifts did not reach statistical significance, high perceived need-support scores throughout the program suggest the environment addressed their basic psychological needs satisfaction. This aligns with existing research showing that need-supportive environments positively influence motivational regulation and health behaviors in youth [ 42 , 43 ]. Implementing a mHealth approach retained many benefits of in-person programs. Fidelity measures, including heart rate and RPE, confirmed appropriate exercise intensity, and perceived need-support measure indicated a need-supportive environment. Together, these findings demonstrate that online sessions can meet both exercise intensity and instructional fidelity targets. While the online format offered distinct advantages, such as greater flexibility and accessibility [ 18 ], participants also received a structured program booklet with weekly exercise and diet advice, providing access to health PA and dietary behaviors on non-session days. Furthermore, implementing the program in a home-based context likely reinforced adopting a healthier lifestyle by enabling participants to exercise in their everyday environment [ 44 , 45 ]. This combination of online accessibility, structured guidance, and opportunities for independent engagement has created a motivational environment that empowered adolescents to adopt and maintain healthier behaviors. These findings suggest not only the potential of online programs to promote meaningful behavior change but also the ease with which participants can incorporate the learned workouts into their daily lives. This aligns with previous research showing that novel movement skills can be effectively taught and learned in an online setting [ 46 , 47 ]. The literature highlights a lack of obesity interventions specifically designed for Latino youth, despite their high obesity rates [ 18 , 19 ]. Online BRAVO! intervention demonstrated that lifestyle interventions tailored to a community's cultural context and needs can effectively reduce health risk among Hispanic adolescents [ 48 , 49 ]. In line with this, participants also offered meaningful insights into recruitment and dissemination, emphasizing the importance of trusted referrals and family involvement. This study has several limitations that should be considered. First, the small, non-randomized sample ( N = 19) limits generalizability and introduces potential selection bias. Additionally, the sensitivity analysis indicated that the sample size was insufficient to power some of the outcome variables to achieve statistical significance despite the sizable effects. A larger, methodologically rigorous randomized controlled trial is warranted to establish the efficacy and generalizability of the intervention. Second, outcomes were measured once after intervention, making it unclear whether improvements are sustained over time. Future studies should include long-term follow-up (e.g., 6, 12, or 24 months) to explore the effects over time. Third, the reliance on self-reported data for PA levels and heart rate may introduce bias. Although perceived exertion ratings exceeded the moderate-to-vigorous target range, heart rate data partially confirmed exercise intensity, as HR was measured after, not during, sessions. Future interventions should incorporate real-time monitoring using smartwatches or heart rate monitors to ensure appropriate intensity and improve data accuracy. 5. Conclusion This preliminary study provides evidence that SDT-based online lifestyle interventions can lead to meaningful improvements in cardio-metabolic health and help reduce obesity disparities among Hispanic adolescents with obesity. Despite the small sample size, participants experienced significant improvements in BMI, abdominal strength and endurance, and PA levels, while other outcomes (e.g., BMIz, PACER, push-up, and amotivation) showed large but non-significant effects. Fidelity measures confirmed that the program achieved desired exercise intensity and created a highly need-supportive environment, while qualitative findings further supported its acceptability and feasibility. Overall, these results suggest that the online BRAVO! lifestyle intervention has the potential to be an effective and scalable way to improve access and equity in adolescent health promotion, especially for youth facing participation barriers, while providing exercise intensity and need-support comparable to in-person programs. However, future large-scale interventions with long-term follow-up are needed to more rigorously establish efficacy, evaluate sustainability, and strengthen recruitment and dissemination strategies. Declarations Author Contributions : JP and SY conducted the study, collected data, performed the analyses, and drafted the manuscript. TK contributed to data collection and manuscript review. VL, JP, and MV assisted with conducting the intervention, collecting data, and contributing to the manuscript. SYP supervised the project and contributed to writing and reviewing the manuscript. Funding : The authors did not receive support from any organization for the submitted work. Data Availability : The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request. Conflict of Interest : The authors have no relevant financial or non-financial interests to disclose. Ethical Approval : The study was approved and reviewed by the institution's Institutional Review Board (institution redacted for peer review). Informed Consent : Informed consent was obtained from all individual participants included in the study. Additionally, consent to publish based on de-identified data was obtained from all study participants. References Centers for Disease Control and Prevention. Childhood obesity facts. U.S. Department of Health & Human Services; 2023. Available at: https://www.cdc.gov/obesity/data/childhood.html Sanyaolu A, Okorie C, Qi X, Locke J, Rehman S. 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Prevention of overweight and obesity in children and youth: a systematic review and meta‑analysis. CMAJ Open . 2015;3(1):E23‑E33. Deng Y, Manninen M, Hwang Y, Kim T, Yli‑Piipari S. Efficacy of lifestyle interventions to treat pediatric obesity: a systematic review and multivariate meta‑analysis of randomized controlled trials. Obes Rev . 2024;25(11):e13817. Hadley AM, Hair EC, Dreisbach N. What works for the prevention and treatment of obesity among children: lessons from experimental evaluations of programs and interventions. Child Trends . 2010;2010‑07. Reinehr T. Lifestyle intervention in childhood obesity: changes and challenges. Nat Rev Endocrinol . 2013;9(10):607‑614. Dishman RK, Heath GW, Schmidt MD, Lee IM. Physical Activity Epidemiology . 2nd ed. Champaign, IL: Human Kinetics; 2021. Haughton CF, Silfee VJ, Wang ML, et al. Racial/ethnic representation in lifestyle weight‑loss intervention studies in the United States: a systematic review. Prev Med Rep . 2018;9:131‑137. Perez LG, Arredondo EM, Elder JP, Baquera S, Nagle B, Holub CK. Evidence‑based obesity treatment interventions for Latino adults in the United States: a systematic review. Am J Prev Med . 2013;44(5):550‑560. Lee M, Lee H, Kim Y, et al. Mobile app‑based health promotion programs: a systematic review of the literature. Int J Environ Res Public Health . 2018;15(12):2838. Perego P, Rashid R, Gluud C, Jakobsen JC, Andreoni G, Lissau I. Comparison of different mobile health applications for intervention in children and adolescents with overweight: protocol for a systematic review with meta‑analysis and trial sequential analysis. BMJ Open . 2020;10(12):e032570. Tate EB, Spruijt‑Metz D, O’Reilly G, et al. mHealth approaches to child obesity prevention: successes, unique challenges, and next directions. Transl Behav Med . 2013;3(4):406‑415. Alves TF, Santos N, Squarcini C, et al. Relevance and acceptability of a technology‑delivered childhood obesity intervention for Hispanic/Latino families in rural Nebraska: a qualitative approach. J Prim Care Community Health . 2025;16:21501319251338544. Soltero EG, Lopez C, Hernandez E, O’Connor TM, Thompson D. Technology‑based obesity prevention interventions among Hispanic adolescents in the United States: a scoping review. JMIR Pediatr Parent . 2022;5(4):e39261. Deng Y. Piloting a Psychological Need‑Support Centered Lifestyle Program to Treat Pediatric Overweight and Obesity Among Hispanic Adolescents [dissertation]. University of Georgia; 2022. Kim T, Park J, Yun S, et al. Comparing two child obesity interventions to improve body composition, motivation, and well‑being: a feasibility study. J Teach Res Media Kinesiol . 2024;10:1‑9. Deci EL, Ryan RM. The general causality orientations scale: self‑determination in personality. J Res Pers . 1985;19(2):109‑134. Deci EL, Ryan RM. The “what” and “why” of goal pursuits: human needs and the self‑determination of behavior. Psychol Inq . 2000;11(4):227‑268. Ryan RM, Deci EL. Self‑Determination Theory: Basic Psychological Needs in Motivation, Development, and Wellness . New York, NY: Guilford Press; 2017. US Department of Health and Human Services; US Department of Agriculture. 2020‑2025 Dietary Guidelines for Americans . 9th ed. Washington, DC; 2021. Manninen M, Yli‑Piipari S. Ten practical strategies to motivate students in physical education: psychological need‑support approach. Strategies . 2021;34(2):24‑30. Yun S, Park J, Yli‑Piipari S. Supporting psychological needs online: learning and teaching experiences of physical activity educators. J Teach Phys Educ . 2024;1(aop):1‑10. Park J, Yun S, Yli‑Piipari S. Becoming future health professionals: the role of experiential learning on exercise science students’ pre‑professional identity. Pedagogy Health Promot . 2025;Epub ahead of print. Borg G. Borg’s Perceived Exertion and Pain Scales . Champaign, IL: Human Kinetics; 1998. Markland D, Tobin VJ. Need support and behavioural regulations for exercise among exercise referral scheme clients: the mediating role of psychological need satisfaction. Psychol Sport Exerc . 2010;11(2):91‑99. World Health Organization. Growth reference data for 5–19 years. Geneva, Switzerland: WHO; 2007. Available at: https://www.who.int/tools/growth-reference-data-for-5to19-years/application-tools Plowman SA, Meredith MD. Reference Guide . Dallas, TX: The Cooper Institute; 2013. Olds T, Tomkinson G, Léger L, Cazorla G. Worldwide variation in the performance of children and adolescents: an analysis of 109 studies of the 20‑m shuttle run test in 37 countries. J Sports Sci . 2006;24(10):1025‑1038. Kowalski KC, Crocker PR, Donen RM. The Physical Activity Questionnaire for Older Children (PAQ‑C) and Adolescents (PAQ‑A) Manual . Saskatoon, SK: University of Saskatchewan; 2004. Markland D, Tobin V. A modification to the Behavioural Regulation in Exercise Questionnaire to include an assessment of amotivation. J Sport Exerc Psychol . 2004;26(2):191‑196. Tashakkori A, Teddlie C. Quality of inferences in mixed methods research: calling for an integrative framework. Adv Mixed Methods Res . 2008;53(7):101‑119. Creswell JW. Revisiting Mixed Methods and Advancing Scientific Practices . Thousand Oaks, CA: Sage; 2015. Clarke V, Braun V. Teaching thematic analysis: overcoming challenges and developing strategies for effective learning. Psychologist . 2013;26(2). Tracy SJ. Qualitative quality: eight “big‑tent” criteria for excellent qualitative research. Qual Inq . 2010;16(10):837‑851. Joschtel B, Gomersall SR, Tweedy S, Petsky H, Chang AB, Trost SG. Effects of exercise training on physical and psychosocial health in children with chronic respiratory disease: a systematic review and meta‑analysis. BMJ Open Sport Exerc Med . 2018;4(1):e000409. Teixeira PJ, Carraça EV, Markland D, Silva MN, Ryan RM. Exercise, physical activity, and self‑determination theory: a systematic review. Int J Behav Nutr Phys Act . 2012;9:78. Ntoumanis N, Ng JY, Prestwich A, et al. A meta‑analysis of self‑determination theory‑informed intervention studies in the health domain: effects on motivation, health behavior, physical and psychological health. Health Psychol Rev . 2021;15(2):214‑244. Yun S, Jaakkola T, Huhtiniemi M, Gråstén A, Park J, Yli-Piipari S. Psychological needs satisfaction in physical education predicts a positive development of motivation in early adolescence: a latent growth modeling study. Eur Phys Educ Rev . 2025;31(2):295‑313. Rourke K, Wilson CJ. How adolescents perceive that community‑based exercise improves their well‑being. Australas Psychiatry . 2017;25(5):456‑459. Robbins LB, Ling J, Clevenger K, et al. A school‑ and home‑based intervention to improve adolescents’ physical activity and healthy eating: a pilot study. J Sch Nurs . 2020;36(2):121‑134. Kim T, Park J, Yun S, Yli‑Piipari S. Training motor and specialized skills online: a systematic review. Kinesiol Rev . 2025;1(aop):1‑15. Kim T, Yun S, Park J, Yli‑Piipari S. A cluster randomized controlled trial to compare online and in‑person motor skill acquisition. J Teach Phys Educ . 2025;1(aop):1‑15. Falbe J, Cadiz AA, Tantoco NK, Thompson HR, Madsen KA. Active and healthy families: a randomized controlled trial of a culturally tailored obesity intervention for Latino children. Acad Pediatr . 2015;15(4):386‑395. La Charite J, DeCamp LR, Prichett L, et al. Two‑year outcomes for the Active and Healthy Families pediatric obesity group intervention for families in an emerging Hispanic community: a mixed‑methods study. J Racial Ethn Health Disparities . 2025;Epub ahead of print Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 16 Apr, 2026 Reviewers agreed at journal 23 Mar, 2026 Reviewers invited by journal 23 Mar, 2026 Editor assigned by journal 25 Sep, 2025 Submission checks completed at journal 25 Sep, 2025 First submitted to journal 24 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7707057","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":522194805,"identity":"051554b2-88bd-4081-a2f2-72a861735d91","order_by":0,"name":"Junhyuk 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Introduction","content":"\u003cp\u003eObesity among children and adolescents is a public health concern in the United States [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Having childhood obesity is associated with the risk of later developing comorbidities as an adult, including type 2 diabetes mellitus, hypertension, fatty liver disease, as well as increased likelihood of adulthood obesity [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Childhood obesity disproportionately affects Hispanic children due to a combination of factors, including parental influence, higher levels of sedentary behavior, socioeconomic status, and food security [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. A variety of interventions focusing on preventing and treating childhood obesity have been conducted [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Evidence suggests that to maximize program effectiveness, interventions should: a) be conducted in late adolescence, b) focus on a single, specific goal (e.g., treating obesity) rather than multiple goals, c) provide behavior modification counseling or therapy to enhance participants\u0026rsquo; motivation and engagement, and d) provide nutrition education [\u003cspan additionalcitationids=\"CR10\" citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLifestyle interventions, which include exercise, nutrition education, and behavioral modifications, are widely utilized for the prevention and treatment of pediatric obesity, and studies have reported their effectiveness in treating childhood obesity [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Research supports their efficacy in improving physical and psychological outcomes, including body mass index (BMI), fitness, and physical activity (PA) [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Despite the increase in research and interventions designed to treat childhood obesity, there are still barriers that hinder participation, particularly among Hispanic families. It has been shown that Hispanic individuals comprised less than 10% of participants in behavioral weight loss interventions [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Reasons for lower adherence include a lack of programs tailored to Hispanic cultures, transportation issues, and inadequate social and emotional support [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. This study further highlighted that community-based, culturally relevant approaches produced the most significant results, underscoring their importance in developing interventions for minority groups.\u003c/p\u003e\u003cp\u003eRecently, the mHealth approach has become increasingly popular in pediatric intervention groups, suggesting that mobile technology may be an effective strategy for promoting healthy behaviors in the general population [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. mHealth technologies may address some of these inherent challenges of traditional lifestyle interventions by bringing the program to participants' homes and reducing transportation and geographical barriers [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In addition, they offer several advantages over face-to-face methods, such as cost-effective dissemination, real-time data collection and feedback, and flexible program personalization [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. mHealth technology is particularly appealing to the technologically savvy younger generation and can support youth in achieving and maintaining a healthy lifestyle by engaging their interest and enhancing their self-regulatory capacities.\u003c/p\u003e\u003cp\u003eDespite growing interest in technology-based interventions, review studies have highlighted a lack of feasibility studies for obesity prevention programs targeting Hispanic adolescents [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Specifically, many of the previous studies did not implement a multicomponent intensive lifestyle intervention that includes exercise, family nutrition education, and behavior modification modules. To address these gaps, we transferred an existing in-person healthy lifestyle intervention tailored for Hispanic adolescents, the Bracing up Research on Adolescents\u0026rsquo; prevention of Obesity (BRAVO!) [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], to an online format.\u003c/p\u003e\u003cp\u003ePreviously, the in-person BRAVO! interventions have demonstrated efficacy in producing positive changes in BMI and health-related fitness outcomes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Specifically, the participants in the study showed statistically significant reductions in BMI, improvements in cardiovascular endurance, upper body strength/endurance, and abdominal strength/endurance. Furthermore, based on Self-Determination Theory (SDT) [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], which explains the development of human motivation, BRAVO! provides a need-supportive environment that promotes autonomous adoption of a healthier lifestyle among overweight and obese adolescents. According to SDT, supporting participants\u0026rsquo; basic psychological needs for autonomy (i.e., need for self-regulation of experiences and actions), competence (i.e., need for success, ability, and confidence in demonstrating, achieving, and mastering desired goals and outcomes), and relatedness (i.e., need for connection and belonging to others) enhances intrinsic motivation, goal pursuit, and long-term behavioral maintenance [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Supporting this, previous in-person BRAVO! interventions have shown improvements in behavioral and psychosocial outcomes, including PA behaviors, motivational regulations, and well-being [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Therefore, this study aimed to evaluate the preliminary efficacy of a 12-week online lifestyle intervention for Hispanic adolescents with obesity and considerations for the intervention\u0026rsquo;s feasibility.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003e\u003cb\u003eResearch Design and Intervention\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study employed a quasi-experimental design consisting of an intervention group (BRAVO!) and a usual-care control group. BRAVO! is a 12-week health intervention for adolescents (ages 11\u0026ndash;16 years) that combines structured exercise training, nutrition education, and behavioral modification strategies. Each week, adolescents in the BRAVO! intervention participated in two 60-minute moderate-to-vigorous intensity (approximately 65% of maximum heart rate) exercise sessions and one 30-minute family-based nutrition lesson. Each exercise session included a cardiovascular endurance or muscular strength and endurance-focused workout, paired with a cooperative game to promote participants\u0026rsquo; sense of relatedness, as well as a warm-up and cool-down period. This schedule provided 24 hours of exercise and 6 hours of nutrition education over 12 weeks (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). All sessions were delivered live via Zoom software, allowing participants to join from home. The nutrition education curriculum followed the 2020\u0026ndash;2025 Dietary Guidelines for Americans [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eOnline BRAVO! Lifestyle Intervention Overview\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWeek\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExercise Session (2 sessions/week)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNutrition Session (1 session/week)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLesson 1 (Cardiovascular Endurance) \u0026amp;\u003c/p\u003e\u003cp\u003e2 (Muscular Strength and Endurance)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIntroduction \u0026amp; Goal Setting\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLesson 3 (Cardiovascular Endurance) \u0026amp;\u003c/p\u003e\u003cp\u003e4 (Muscular Strength and Endurance)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMyPlate: 5 Food Groups Friends\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLesson 5 (Cardiovascular Endurance) \u0026amp;\u003c/p\u003e\u003cp\u003e6 (Muscular Strength and Endurance)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMyPlate: Discovery Trail\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLesson 7 (Cardiovascular Endurance) \u0026amp;\u003c/p\u003e\u003cp\u003e8 (Plan Your Own Workout)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMyPlate: Eat the Colors\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLesson 1 (Cardiovascular Endurance) \u0026amp;\u003c/p\u003e\u003cp\u003e2 (Muscular Strength and Endurance)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMyPlate: Avoid Sugary Beverages\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLesson 3 (Cardiovascular Endurance) \u0026amp;\u003c/p\u003e\u003cp\u003e4 (Muscular Strength and Endurance)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMyPlate: Be Whole, Go Whole Grain\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLesson 5 (Cardiovascular Endurance) \u0026amp;\u003c/p\u003e\u003cp\u003e6 (Muscular Strength and Endurance)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMyPlate: Dietary Fats, Knowing the Types\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLesson 7 (Cardiovascular Endurance) \u0026amp;\u003c/p\u003e\u003cp\u003e8 (Plan Your Own Workout)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMyPlate: Reduce Trans \u0026amp; Saturated Fats\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLesson 1 (Cardiovascular Endurance) \u0026amp;\u003c/p\u003e\u003cp\u003e2 (Muscular Strength and Endurance)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMyPlate: Rock Your Snacks\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLesson 3 (Cardiovascular Endurance) \u0026amp;\u003c/p\u003e\u003cp\u003e4 (Muscular Strength and Endurance)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMyPlate: Drink up Diary Daily\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLesson 5 (Cardiovascular Endurance) \u0026amp;\u003c/p\u003e\u003cp\u003e6 (Muscular Strength and Endurance)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMyPlate: Creating a Healthy Environment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLesson 7 (Cardiovascular Endurance) \u0026amp;\u003c/p\u003e\u003cp\u003e8 (Plan Your Own Workout)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBring it All Together\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThis intervention was grounded in SDT and incorporated positive psychology principles to foster intrinsic motivation for healthy behavior change. This involved various need-supportive instructional strategies (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) shown to enhance motivation and well-being [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Participants in the control arm did not receive any structured intervention during the 12-week period. They continued with their usual activities and were asked to inform the research team if they began any new exercise or nutrition programs that might influence study outcomes.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eNeed-Supportive Strategies Implemented in the Online BRAVO! Lifestyle Intervention\u003c/em\u003e\u003c/p\u003e \u003cdiv class=\"Credit\"\u003e\u003cp\u003e\u003cem\u003e(Adapted from Manninen \u0026amp; Yli-Piipari, 2021; Yun et al., 2024)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eNeed-Supportive Strategy\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExample\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUse informational and noncontrolling language\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;might, could, suggest, I propose\u0026hellip; (O), must\u0026hellip; (X)\u0026rdquo;\u003c/em\u003e; \u003cem\u003eI suggest that you select a suitable activity that helps you to move toward your short/long term goals.\u003c/em\u003e; \u003cem\u003eWe could try\u0026hellip;.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eUse meaningful rationales\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eToday\u0026rsquo;s exercises are focusing especially on your calf muscles.\u003c/em\u003e; \u003cem\u003eThis exercise is highly important because\u0026hellip;\u003c/em\u003e; \u003cem\u003eThis will help you plan your own exercise and train more successfully\u003c/em\u003e.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProvide choice\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eYou can select inclined push-ups instead of floor push-ups\u003c/em\u003e; \u003cem\u003eControl the depth of the lunges based on your feelings\u003c/em\u003e; \u003cem\u003eYou can control the intensity and the number of repetitions yourselves.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAcknowledge and respect different perspectives and feelings\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eI understand that these workouts can be difficult and tired for you sometimes, but these workouts will help us to be healthier and stronger.\u003c/em\u003e; \u003cem\u003eI hear you. It was a hard activity for sure.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDemonstrating interest in each student\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003e[Name], how was your school today?\u003c/em\u003e; \u003cem\u003e[Name], did you have the game you mentioned last week?\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEncourage students to ask questions and be proactive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eDo you have any questions about our activities today?\u003c/em\u003e; \u003cem\u003ePlease feel free to ask me, if something is not clear. I will happily reintroduce activities again.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEncourage cooperation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eLet\u0026rsquo;s modify the game a bit. Now, everyone in your team needs to touch the ball at least once before scoring. Let me know if you have any questions.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClarify expectations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eThe objective of the lesson is\u0026hellip;. Do you have any questions on this?\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSet optimal learning challenges\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eWhen you have made three shots in a row, you can move on to the next spot.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGive constructive, clear, and relevant feedback\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eThanks for your hard work everyone!\u003c/em\u003e; \u003cem\u003eGreat work, [name]. You really had great intensity today.\u003c/em\u003e; \u003cem\u003e[Name], make sure that you keep your knee high. Other than that, you\u0026rsquo;re doing perfect.\u003c/em\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eOnline Need-Supportive Strategy\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eChallenges in the Online Environment\u003c/p\u003e\u003cp\u003e1. Visual accessibility and interaction\u003c/p\u003e\u003cp\u003e2. Verbal communication and interaction\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eAdditional Need-Supportive Strategies in the Online Environment\u003c/p\u003e\u003cp\u003e1. Encouraging camera use with positive reinforcement.\u003c/p\u003e\u003cp\u003e2. Treating unseen students with trust and patience.\u003c/p\u003e\u003cp\u003e3. Allowing diverse response options.\u003c/p\u003e\u003cp\u003e4. Offering tailored and thorough guidance and explanation.\u003c/p\u003e\u003cp\u003e5. Correcting the group collectively to avoid embarrassment.\u003c/p\u003e\u003cp\u003e6. Exercising alongside students for motivation and demonstration.\u003c/p\u003e\u003cp\u003e7. Engaging students with questions about their lives and interests.\u003c/p\u003e\u003cp\u003e8. Personalizing interactions by using names and tailored questions.\u003c/p\u003e\u003cp\u003e9. Fuel engagement with instructor\u0026rsquo;s positive energy and genuineness.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAll BRAVO! sessions were led by pairs of undergraduate student instructors majoring or minoring in exercise science, health promotion, or related fields, under the supervision of one or more graduate-level staff [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. All instructors received 4hr of training (1hr IRB, 2hr study and need-supportive instruction, and 1hr data collection) by the research team before leading the sessions, which was informed by evidence on creating need-supportive environments [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e]\u003c/p\u003e\u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e]\u003c/p\u003e\u003cp\u003e\u003cb\u003eParticipants and Procedures\u003c/b\u003e\u003c/p\u003e\u003cp\u003eParticipants were recruited via pediatric primary care clinics and community advertisements. Pediatricians at participating clinics identified and referred potential participants to the research team. In addition, the research team distributed flyers containing information about the program in the community and posted them online. The eligibility criteria included: a) age between 11 and 16 years, b) Hispanic ethnicity, c) a pediatrician's diagnosis of overweight or obesity, d) access to a smart device or computer with stable internet, e) ability to use the Zoom platform, and f) access to an indoor or outdoor space measuring at least 6\u0026times;6 feet for exercise. Parents of interested youth used the QR code to access an online eligibility screening questionnaire. Research staff contacted families to confirm eligibility and share additional study details, and provided a link to complete electronic consent/assent forms. Once consent and assent were obtained, the first laboratory visit for baseline measurements was scheduled before the program. BRAVO! program booklet was distributed to each family at this time, outlining each session and suggesting homework exercises for non-session days. Following the 12-week intervention period, a post-intervention assessment was conducted during the second laboratory visit in the week immediately after the final BRAVO! session.\u003c/p\u003e\u003cp\u003eA total of 43 adolescents and their families were screened and were eligible to participate. Out of these, 22 adolescents agreed to take part and completed the baseline assessments. Three participants in the intervention group withdrew from the study during the 12-week intervention, yielding 19 adolescents (\u003cem\u003eM\u003c/em\u003e\u003csub\u003eage\u003c/sub\u003e = 13.05\u0026thinsp;\u0026plusmn;\u0026thinsp;1.75) who completed the program and the post-test. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e provides baseline characteristics of the participants. Lastly, all study procedures were approved by the Institutional Review Board of the local university.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eBaseline Characteristics of the Participants\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntervention (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eControl (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGender (m/f) (n, %)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5 (45.4), 6 (54.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5 (62.5), 3 (37.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.530\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e13.45 (1.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.50 (1.41)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.251\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.54 (8.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.53 (8.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.615\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMIz\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.07 (.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.38 (.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.235\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePACER (laps)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.14 (9.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.25 (6.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.660\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePush-up (counts)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.18 (10.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.88 (4.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.278\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurl-up (counts)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.36 (8.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.63 (6.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.517\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical Activity Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.38 (.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.08 (.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.331\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntrinsic Motivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.40 (.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.84 (.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.114\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntegrated Regulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.40 (.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.13 (.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.454\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIdentified Regulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.63 (.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.38 (.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.383\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExternal Regulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.08 (.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.44 (1.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.441\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmotivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.83 (.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.75 (.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.846\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cp\u003e\u003cem\u003eNote 1.\u003c/em\u003e m/f: male/female. BMI: body mass index.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eNote 2.\u003c/em\u003e A chi-square test was used for gender, and t-tests were used for all other variables, with a significance level at \u003cem\u003ep\u003c/em\u003e \u0026lt; .05, and no significant baseline difference was observed.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e]\u003c/p\u003e\u003cp\u003e\u003cb\u003eFidelity Outcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003e Exercise intensity was measured by having participants take a quick 20-second pulse count (carotid or radial artery) after warm-up and after the main session. Participants then rated the difficulty of the session on a 1\u0026ndash;10 modified Borg Rating of Perceived Exertion Scale (RPE; 1: very easy to 10: maximal) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Participants received training during the pre-test on how to perform these procedures. The target intensity for each session was moderate-to-vigorous, defined as 64% of maximum heart rate and RPE between 5 and 6. Also, to evaluate the implementation of need-supportive teaching, the instructors\u0026rsquo; need-supportive behaviors were assessed during the program at weeks 4, 8, and 12 using the 15-item Perceived Environmental Supportiveness Scale (1: strongly disagree to 7: strongly agree) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Internal consistency of this scale was .91, .96, and .96, respectively.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePrimary Outcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eBMI.\u003c/b\u003e Height and weight were measured to the nearest .1cm and .1kg using a stadiometer. BMI was calculated using the standard formula of weight/height\u003csup\u003e2\u003c/sup\u003e. Standardized BMI (BMIz) was calculated using an SPSS macro [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eHealth-related Fitness.\u003c/b\u003e Cardiovascular endurance was measured using the PACER test [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Participants were instructed to run as many 20-meter laps as possible, following a cadence that increased in pace over time. PACER test is a reliable and valid measure of cardiorespiratory endurance in adolescents [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. Push-up test was used to assess participants\u0026rsquo; upper-body muscular endurance and strength. The final score was determined by the number of correctly completed push-ups, with boys performing the test with their feet on the floor, while girls did a modified version with their knees on the ground. Push-up test is a reliable and valid measure of upper-body muscular endurance and strength in adolescents [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Curl-up test was used to measure participants\u0026rsquo; abdominal muscular endurance and strength. Participants began in a supine position with knees bent, feet to the floor, and arms straight and parallel to the body. An 11.4 cm wide measuring tape was placed under them so that their fingertips rested on the near edge of the tape. Participants were instructed to perform a curl-up by sliding their fingers across the tape until reaching the far edge. The final score was the number of correctly completed curl-ups. Curl-up test is a reliable and valid measure of abdominal strength and endurance in adolescents [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003ePA Level.\u003c/b\u003e Participants\u0026rsquo; daily PA level was measured using the PA Questionnaire for Adolescents (PAQ-A) scale [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. PAQ-A is a 9-item, 7-day PA recall questionnaire that assesses participation in various types of PA, including activity during physical education classes, lunch breaks, after school, evenings, and weekends. Each item is scored on a 5-point scale, with \u0026ldquo;1\u0026rdquo; indicating the lowest and \u0026ldquo;5\u0026rdquo; indicating the highest levels of PA. The final score was calculated by averaging the points obtained, with higher scores indicating a higher level of PA. PAC-A is a valid measurement of PA among adolescents [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eMotivational Regulation.\u003c/b\u003e Participants\u0026rsquo; exercise motivation was assessed with the Behavioral Regulation in Exercise Questionnaire (BREQ-3) [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The scale is rated by a 5-point Likert Scale (1: not true for me to 5: very true for me), with 24 items measuring participants\u0026rsquo; intrinsic motivation (e.g., \u0026ldquo;because it\u0026rsquo;s fun\u0026rdquo;), integrated regulation (e.g., \u0026ldquo;because it is consistent with my life goals\u0026rdquo;), identified regulation (e.g., \u0026ldquo;it is important to me\u0026rdquo;), introjected regulation (e.g., \u0026ldquo;I feel guilty when I do not\u0026rdquo;), external regulation (e.g., \u0026ldquo;because other people say I should\u0026rdquo;), and amotivation (e.g., \u0026ldquo;I do not see why I should have to participate\u0026rdquo;). BREQ-3 is a valid measurement of motivational regulation [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The internal consistency for the pre- and post-test values is reported in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. Introjected regulation was excluded from the analysis due to low reliability (\u003cem\u003eα\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.70 in pre- and post-tests).\u003c/p\u003e\u003cp\u003e\u003cb\u003eInterviews\u003c/b\u003e. At the post-test, interviews were conducted with the participants and parents. These semi-structured interviews aimed to understand the participants\u0026rsquo; overall perceptions about the recruitment and dissemination of the online BRAVO! lifestyle intervention program. The interview guide was developed by research team members with experience in qualitative research, and interviewers received training from these researchers. For confidentiality, research team members replaced participant names with pseudonyms during the transcription process.\u003c/p\u003e\u003cp\u003e\u003cb\u003eData Analyses\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA concurrent mixed-methods design was adopted, collecting and analyzing quantitative and qualitative data simultaneously to achieve a comprehensive understanding [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Specifically, the study used the intervention mixed-methods model, which extends convergent or sequential designs by integrating an experimental component and enriching it with qualitative data [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eQuantitative Analyses\u003c/b\u003e. Preliminary analyses were conducted to examine missing data, outliers, normality, descriptive statistics, and internal consistency using Cronbach\u0026rsquo;s alpha. To assess between-group differences over time, separate fixed-effect analyses of covariance (ANCOVAs) were conducted. These tests examined the interaction between group and changes from baseline to post-test. Each model included time, group, and a group-by-time interaction term, with the group-by-time interaction interpreted as the primary effect of interest. The assumptions of ANCOVA, such as normality and homogeneity of variance, were examined and verified. Effect sizes for between-group differences were calculated using partial eta squared (\u003cem\u003eηp\u0026sup2;\u003c/em\u003e), interpreted as small (.01), medium (.06), and large (.14). All analyses were conducted using SPSS version 28.0.\u003c/p\u003e\u003cp\u003e\u003cb\u003eQualitative Analyses\u003c/b\u003e. A qualitative thematic analysis was conducted to provide additional insights into program efficacy, recruitment, and dissemination. Interview data were transcribed and analyzed thematically [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] using ATLAS.ti software. Researchers thoroughly read the transcripts, developed codes, and collaboratively identified themes. These were iteratively reviewed and refined to ensure consistency and clarity, culminating in a thematic map. Representative quotes were selected to illustrate each theme. To ensure the trustworthiness of the qualitative analysis, the eight criteria for qualitative rigor were followed [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e].\u003c/p\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cb\u003eFidelity Outcomes\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e presents the average heart rate, average perceived exertion, and perceived need-support to evaluate program fidelity, specifically session intensity and instructional quality.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eFidelity Outcomes of the Online BRAVO! Lifestyle Intervention\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRange\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAge (years)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.45 (1.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11\u0026ndash;16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eMaximum HR (220-age)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e206.55 (1.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e204\u0026ndash;209\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003e64% of Maximum HR\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e132.18 (1.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e130.56-133.76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAverage HR after activity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e126.39 (9.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e112.14-144.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cp\u003eAverage RPE (1\u0026ndash;10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.01 (.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.41\u0026ndash;7.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003ePerceived Need-Support\u003c/p\u003e\u003cp\u003e(1\u0026ndash;7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e6.06 (1.10)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e6.11 (1.05)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeek 12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003e6.21 (1.05)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cem\u003eNote.\u003c/em\u003e HR: heart rate, RPE: Borg rating of perceived exertion, 64% of Maximum Heart Rate indicates moderate-to-vigorous physical activity, which is the target intensity of the program.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThe average post-activity heart rate was 126.39\u0026thinsp;\u0026plusmn;\u0026thinsp;9.84 BPM, and the average RPE was 6.01\u0026thinsp;\u0026plusmn;\u0026thinsp;.94. Since heart rate was self-measured about one minute after the main activity, the values might slightly underestimate the actual exercise intensity compared to the moderate-to-vigorous PA benchmark, which was an average of 132.18 for this population. Additionally, the participants exhibited high levels of need-support throughout the program, with mean scores of 6.06\u0026thinsp;\u0026plusmn;\u0026thinsp;1.10 in Week 4, 6.11\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05 in Week 8, and 6.21\u0026thinsp;\u0026plusmn;\u0026thinsp;1.05 in Week 12 on a 1\u0026ndash;7 scale.\u003c/p\u003e\u003cp\u003e\u003cb\u003eQuantitative Findings\u003c/b\u003e\u003c/p\u003e\u003cp\u003eA sensitivity analysis for ANCOVA (\u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.05, power\u0026thinsp;=\u0026thinsp;.80) indicated that, with the current sample size (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;19), the study was only powered to reach statistical significance for very large effects (\u003cem\u003eηp\u0026sup2;\u003c/em\u003e \u0026ge; .32), with a corresponding critical \u003cem\u003eF\u003c/em\u003e-value of 4.494 across the outcome variables. Therefore, the following results should be interpreted with the understanding that non-significant findings may reflect the limited power of this preliminary study rather than the absence of real effects. Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e summarizes the results of this study.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eChanges in Outcomes from Pre- to Post-test and ANCOVA results\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"10\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eVariable\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003eIntervention (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;11)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003eControl (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;8)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cem\u003eηp\u0026sup2;\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c10\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e\u003cem\u003eα\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePost\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eΔ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePre\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003ePost\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u003cem\u003eΔ\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e (\u003cem\u003eSD\u003c/em\u003e)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e32.54\u003c/p\u003e\u003cp\u003e(8.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.95\u003c/p\u003e\u003cp\u003e(8.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.59\u003c/p\u003e\u003cp\u003e(.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e34.53\u003c/p\u003e\u003cp\u003e(8.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e34.79\u003c/p\u003e\u003cp\u003e(8.36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.26\u003c/p\u003e\u003cp\u003e(.52)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.012*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\" morerows=\"5\" rowspan=\"6\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eBMIz\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.07\u003c/p\u003e\u003cp\u003e(.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.99\u003c/p\u003e\u003cp\u003e(.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.08\u003c/p\u003e\u003cp\u003e(.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.38\u003c/p\u003e\u003cp\u003e(.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.40\u003c/p\u003e\u003cp\u003e(.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.02\u003c/p\u003e\u003cp\u003e(.03)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.15\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePACER (laps)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15.14\u003c/p\u003e\u003cp\u003e(9.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.86\u003c/p\u003e\u003cp\u003e(27.94)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e12.71\u003c/p\u003e\u003cp\u003e(19.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e13.25\u003c/p\u003e\u003cp\u003e(6.90)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e13.13\u003c/p\u003e\u003cp\u003e(6.20)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.13\u003c/p\u003e\u003cp\u003e(1.96)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.065\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePush-up (counts)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7.18\u003c/p\u003e\u003cp\u003e(10.22)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.00\u003c/p\u003e\u003cp\u003e(12.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4.82\u003c/p\u003e\u003cp\u003e(7.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.88\u003c/p\u003e\u003cp\u003e(4.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.13\u003c/p\u003e\u003cp\u003e(4.32)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.25\u003c/p\u003e\u003cp\u003e(.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.120\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCurl-up (counts)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.36\u003c/p\u003e\u003cp\u003e(8.02)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.50\u003c/p\u003e\u003cp\u003e(11.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e15.10\u003c/p\u003e\u003cp\u003e(10.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e8.63\u003c/p\u003e\u003cp\u003e(6.30)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e8.75\u003c/p\u003e\u003cp\u003e(5.97)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.13\u003c/p\u003e\u003cp\u003e(1.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.002**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.49\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePhysical Activity Level\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.38\u003c/p\u003e\u003cp\u003e(.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.03\u003c/p\u003e\u003cp\u003e(.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.60\u003c/p\u003e\u003cp\u003e(.69)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.08\u003c/p\u003e\u003cp\u003e(.71)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.11\u003c/p\u003e\u003cp\u003e(.49)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.03\u003c/p\u003e\u003cp\u003e(.29)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.008**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntrinsic\u003c/p\u003e\u003cp\u003eMotivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.40\u003c/p\u003e\u003cp\u003e(.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.83\u003c/p\u003e\u003cp\u003e(.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.43\u003c/p\u003e\u003cp\u003e(.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.84\u003c/p\u003e\u003cp\u003e(.42)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.75\u003c/p\u003e\u003cp\u003e(.35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.09\u003c/p\u003e\u003cp\u003e(.13)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.311\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.07\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.71\u003csup\u003ea\u003c/sup\u003e/.77\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntegrated\u003c/p\u003e\u003cp\u003eRegulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.40\u003c/p\u003e\u003cp\u003e(.86)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.33\u003c/p\u003e\u003cp\u003e(.50)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.08\u003c/p\u003e\u003cp\u003e(.79)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.13\u003c/p\u003e\u003cp\u003e(.60)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.09\u003c/p\u003e\u003cp\u003e(.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.03\u003c/p\u003e\u003cp\u003e(.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.576\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.75\u003csup\u003ea\u003c/sup\u003e/.71\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIdentified\u003c/p\u003e\u003cp\u003eRegulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3.63\u003c/p\u003e\u003cp\u003e(.53)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.55\u003c/p\u003e\u003cp\u003e(.48)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.08\u003c/p\u003e\u003cp\u003e(.70)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e3.38\u003c/p\u003e\u003cp\u003e(.65)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e3.41\u003c/p\u003e\u003cp\u003e(.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.03\u003c/p\u003e\u003cp\u003e(.09)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.936\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.00\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.77/.90\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eIntrojected\u003c/p\u003e\u003cp\u003eRegulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.43\u003c/p\u003e\u003cp\u003e(.51)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.83\u003c/p\u003e\u003cp\u003e(.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e.40\u003c/p\u003e\u003cp\u003e(.59)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.84\u003c/p\u003e\u003cp\u003e(.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.84\u003c/p\u003e\u003cp\u003e(.64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.00\u003c/p\u003e\u003cp\u003e(.00)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.115\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;.70/\u0026lt;.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eExternal\u003c/p\u003e\u003cp\u003eRegulation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2.08\u003c/p\u003e\u003cp\u003e(.84)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.98\u003c/p\u003e\u003cp\u003e(.85)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.10\u003c/p\u003e\u003cp\u003e(.66)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e2.44\u003c/p\u003e\u003cp\u003e(1.11)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e2.41\u003c/p\u003e\u003cp\u003e(.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.03\u003c/p\u003e\u003cp\u003e(.25)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.566\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.02\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.85/88\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmotivation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1.83\u003c/p\u003e\u003cp\u003e(.92)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.58\u003c/p\u003e\u003cp\u003e(.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u0026minus;\u0026thinsp;.25\u003c/p\u003e\u003cp\u003e(.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e1.75\u003c/p\u003e\u003cp\u003e(.61)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003e1.81\u003c/p\u003e\u003cp\u003e(.58)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003e.06\u003c/p\u003e\u003cp\u003e(.18)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003e.108\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e.16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c10\"\u003e\u003cp\u003e.74/.79\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"10\"\u003e\u003cem\u003eNote 1. Δ\u003c/em\u003e: Post-Pre changes, BMI: body mass index, \u003cem\u003eα\u003c/em\u003e: Cronbach\u0026rsquo;s alpha \u003cem\u003eNote\u003c/em\u003e \u003cspan refid=\"FPar6\" class=\"InternalRef\"\u003e\u003cem\u003e2\u003c/em\u003e\u003c/span\u003e. ANCOVA models adjusted for baseline (pre-test) values, \u003cem\u003eηp\u0026sup2;\u003c/em\u003e= partial eta squared, \u003cem\u003eS\u003c/em\u003eignificance at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.10(\u003csup\u003e+\u003c/sup\u003e), \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.05(*), \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.01(**), \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;.001(***), \u003csup\u003ea\u003c/sup\u003e = without item 4, \u003csup\u003eb\u003c/sup\u003e = without item 2.\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e[Insert Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e\u003cp\u003e\u003cb\u003eBMI\u003c/b\u003e. Significant group \u0026times; time interaction was found for BMI (\u003cem\u003eF\u003c/em\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026thinsp;=\u0026thinsp;8.14, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.012, \u003cem\u003eηp\u0026sup2;\u003c/em\u003e = .34). On average, the intervention group\u0026rsquo;s BMI decreased by .59\u0026thinsp;\u0026plusmn;\u0026thinsp;.74 kg/m\u0026sup2;, whereas the control group\u0026rsquo;s BMI increased by .26\u0026thinsp;\u0026plusmn;\u0026thinsp;.52 kg/m\u0026sup2;. These opposing trajectories indicate that the intervention produced a clinically meaningful reduction in participants\u0026rsquo; BMI. However, BMIz was not statistically significant between groups (\u003cem\u003eF\u003c/em\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026thinsp;=\u0026thinsp;2.89, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.108, \u003cem\u003eηp\u0026sup2;\u003c/em\u003e = .15).\u003c/p\u003e\u003cp\u003e\u003cb\u003eHealth-related Fitness\u003c/b\u003e. Significant group \u0026times; time interaction was also observed for curl-up (\u003cem\u003eF\u003c/em\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026thinsp;=\u0026thinsp;14.13, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.002, \u003cem\u003eηp\u0026sup2;\u003c/em\u003e = .50). The intervention group improved by 15.10\u0026thinsp;\u0026plusmn;\u0026thinsp;10.59 curl-ups, while the control group showed minimal change (.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.13). However, there were no statistically significant differences in PACER (\u003cem\u003eF\u003c/em\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026thinsp;=\u0026thinsp;4.13, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.065, \u003cem\u003eηp\u0026sup2;\u003c/em\u003e = .26; \u003cem\u003eΔ\u003c/em\u003eINT\u0026thinsp;=\u0026thinsp;12.71\u0026thinsp;\u0026plusmn;\u0026thinsp;19.22; \u003cem\u003eΔ\u003c/em\u003eCONT\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.13\u0026thinsp;\u0026plusmn;\u0026thinsp;1.96) and push-up between groups (\u003cem\u003eF\u003c/em\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026thinsp;=\u0026thinsp;2.70, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.120, \u003cem\u003eηp\u0026sup2;\u003c/em\u003e = .14; \u003cem\u003eΔ\u003c/em\u003eINT\u0026thinsp;=\u0026thinsp;4.82\u0026thinsp;\u0026plusmn;\u0026thinsp;7.85; \u003cem\u003eΔ\u003c/em\u003eCONT\u0026thinsp;=\u0026thinsp;.25\u0026thinsp;\u0026plusmn;\u0026thinsp;.71). Although the PACER and push-up results did not achieve statistical significance, the intervention group showed improvements in both.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePA Level.\u003c/b\u003e Significant group \u0026times; time interaction emerged for PA level (\u003cem\u003eF\u003c/em\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026thinsp;=\u0026thinsp;9.345, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.008, \u003cem\u003eηp\u0026sup2;\u003c/em\u003e = .36). Intervention group\u0026rsquo;s PAQ-A score increased by .60\u0026thinsp;\u0026plusmn;\u0026thinsp;.69, whereas the control group\u0026rsquo;s score change was 03\u0026thinsp;\u0026plusmn;\u0026thinsp;.29. These opposing trajectories indicate that the intervention produced a meaningful improvement in participants\u0026rsquo; PA behavior.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMotivational Regulation.\u003c/b\u003e Motivational regulation outcomes were not statistically significant. Intrinsic motivation increased for the intervention group but showed no significant group \u0026times; time interaction (\u003cem\u003eF\u003c/em\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026thinsp;=\u0026thinsp;1.101, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.311, \u003cem\u003eηp\u0026sup2;\u003c/em\u003e = .07; \u003cem\u003eΔ\u003c/em\u003eINT\u0026thinsp;=\u0026thinsp;.43\u0026thinsp;\u0026plusmn;\u0026thinsp;.76; \u003cem\u003eΔ\u003c/em\u003eCONT\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.09\u0026thinsp;\u0026plusmn;\u0026thinsp;.13). Integrated regulation (\u003cem\u003eF\u003c/em\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026thinsp;=\u0026thinsp;.326, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.576, \u003cem\u003eηp\u0026sup2;\u003c/em\u003e = .02; \u003cem\u003eΔ\u003c/em\u003eINT\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.08\u0026thinsp;\u0026plusmn;\u0026thinsp;.79; \u003cem\u003eΔ\u003c/em\u003eCONT\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.03\u0026thinsp;\u0026plusmn;\u0026thinsp;.09), identified regulation (\u003cem\u003eF\u003c/em\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026thinsp;=\u0026thinsp;.007, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.936, \u003cem\u003eηp\u0026sup2;\u003c/em\u003e = .00; \u003cem\u003eΔ\u003c/em\u003eINT\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.08\u0026thinsp;\u0026plusmn;\u0026thinsp;.70; \u003cem\u003eΔ\u003c/em\u003eCONT\u0026thinsp;=\u0026thinsp;.03\u0026thinsp;\u0026plusmn;\u0026thinsp;.09), external regulation (\u003cem\u003eF\u003c/em\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026thinsp;=\u0026thinsp;.344, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.566, \u003cem\u003eηp\u0026sup2;\u003c/em\u003e = .02; \u003cem\u003eΔ\u003c/em\u003eINT\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.10\u0026thinsp;\u0026plusmn;\u0026thinsp;.66; \u003cem\u003eΔ\u003c/em\u003eCONT\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.03\u0026thinsp;\u0026plusmn;\u0026thinsp;.25), and amotivation (\u003cem\u003eF\u003c/em\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026thinsp;=\u0026thinsp;2.925, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.108, \u003cem\u003eηp\u0026sup2;\u003c/em\u003e = .16; \u003cem\u003eΔ\u003c/em\u003eINT\u0026thinsp;=\u0026thinsp;\u0026minus;\u0026thinsp;.25\u0026thinsp;\u0026plusmn;\u0026thinsp;.58; \u003cem\u003eΔ\u003c/em\u003eCONT\u0026thinsp;=\u0026thinsp;.06\u0026thinsp;\u0026plusmn;\u0026thinsp;.18) scores all decreased more in the intervention group, but did not reach significance. Introjected regulation was excluded from analysis due to low reliability. Although the results did not achieve statistical significance, the pattern of changes suggested a trend toward higher intrinsic motivation and lower controlled motivation and amotivation in the intervention group.\u003c/p\u003e\u003cp\u003eLastly, a sensitivity analysis for ANCOVA at \u003cem\u003eα\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.05 and power (1\u0026ndash;\u003cem\u003eβ\u003c/em\u003e)\u0026thinsp;=\u0026thinsp;.80 indicated that the current sample size of 19 can only detect statistical significance when there is a very large effect size (\u003cem\u003eηp\u0026sup2;\u003c/em\u003e = .32 or higher). For example, some results in this study (i.e., BMIz, PACER, push-up, and amotivation) still surpass the conventional threshold for a large effect size (\u003cem\u003eηp\u0026sup2;\u003c/em\u003e = .14) but were not statistically significant. This suggests that with a larger sample, more effects would probably reach statistical significance.\u003c/p\u003e\u003cp\u003e\u003cb\u003eQualitative Findings\u003c/b\u003e\u003c/p\u003e\u003cp\u003eInterviews with ten adolescents and two parents who agreed to participate generated three overarching themes: 1) program efficacy and acceptability, 2) recruitment suitability, and 3) dissemination considerations. Together, these provide information on how the online BRAVO! lifestyle intervention functioned in the everyday family lives of participants.\u003c/p\u003e\u003cp\u003e\u003cb\u003eProgram Efficacy and Acceptability\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eImprovements in lifestyle behavior.\u003c/em\u003e Participants reported exercising more often and with greater intensity both at school and at home. Emily explained, \u0026ldquo;Once I started the sessions, I became way more active in PE class,\u0026rdquo; while Paul noted that the routines \u0026ldquo;moved right into the school gym\u0026rdquo;, and he was able to experience increased PA time at school. Several teens also described healthier eating. Justin said, \u0026ldquo;I eat way less than I used to; now I grab fruit instead of chips,\u0026rdquo; and Sofia shared that replacing sugary snacks \u0026ldquo;helps me tell myself to stop being fat.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003cem\u003ePsychological benefits and sustained motivation.\u003c/em\u003e Many adolescents framed their newfound habits in terms of confidence and future aspirations. Emily commented that she now had \u0026ldquo;more energy and felt less lazy.\u0026rdquo; Brittney echoed this by sharing that her son had begun planning gym workouts after the program, \u0026ldquo;He wants to do weights now; it\u0026rsquo;s the first time he\u0026rsquo;s asked to exercise on his own.\u0026rdquo;\u003c/p\u003e\u003cp\u003e\u003cem\u003ePerceptions of online delivery.\u003c/em\u003e Most families expressed satisfaction with the online format for eliminating travel time and scheduling hassles. As Camden put it, \u0026ldquo;What I liked most was not having to drive across town.\u0026rdquo; Brittney agreed, noting that online sessions \u0026ldquo;fit around work hours when you just don\u0026rsquo;t have the time.\u0026rdquo; Although Emily occasionally missed the \u0026ldquo;in-person group vibe,\u0026rdquo; even she conceded the online approach was \u0026ldquo;still really convenient and comfortable.\u0026rdquo; David remarked, \u0026ldquo;Having everyone on screen actually makes you less embarrassed and gives you more confidence.\u0026rdquo;, suggesting the positive aspect of online delivery.\u003c/p\u003e\u003cp\u003e\u003cb\u003eRecruitment Suitability\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eTrusted medical referral.\u003c/em\u003e Pediatric providers were the primary gateway to enrollment. Gabrielle recalled, \u0026ldquo;The pediatrician basically said, \u0026lsquo;This program will motivate them,\u0026rsquo; and that made me enroll my kids in it.\u0026rdquo; Likewise, Brittney said their doctor assured them the intervention was \u0026ldquo;really good and evidence-based,\u0026rdquo; indicating that their participation was motivated by recommendations from trusted medical professionals.\u003c/p\u003e\u003cp\u003e\u003cem\u003eFamily is the primary motivator.\u003c/em\u003e Participation was motivated by the opportunity to engage alongside participants\u0026rsquo; family members. Emily credited her sister for joining this program and her mother for the ongoing encouragement: \u0026ldquo;My family plays a big role. They all want me to be healthy.\u0026rdquo; Brittney mentioned cooking healthier meals to support her children, indicating that family support is the primary motivator for recruitment and sustained participation.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDissemination Considerations\u003c/b\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eDiverse outreach strategies.\u003c/em\u003e Parents suggested broadening recruitment beyond clinics to capture families who seldom see a pediatrician. Gabrielle, stating that \u0026ldquo;The flyers and online posts were really helpful in keeping us informed.\u0026rdquo;, appreciated the use of online posts, flyers, and community bulletin boards. They also noted that Spanish-language materials made the program more appealing to local Hispanic families.\u003c/p\u003e\u003cp\u003e\u003cem\u003ePositive word-of-mouth and cultural resonance.\u003c/em\u003e Expressing gratitude for the program, Brittney said she planned to tell her friends \"so their kids spend less time on screens.\" Notably, several adolescents highlighted the impact of a bilingual instructor: Alice said, \u0026ldquo;The Hispanic guy was my favorite, he joked with us in Spanish and kept everyone moving.\u0026rdquo; This underscores the value of culturally competent, relatable staff, especially when serving minority communities.\u003c/p\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eFindings from this study indicated that online BRAVO! lifestyle intervention was effective in enhancing health outcomes among adolescents, highlighting the dissemination potential of the BRAVO! intervention in addressing adolescent health disparities. Qualitative findings reinforced the program\u0026rsquo;s effectiveness, confirmed the suitability of its recruitment strategies, and identified key factors for successful dissemination.\u003c/p\u003e\u003cp\u003eConsistent with previous SDT-based lifestyle interventions, we observed improvements across several outcomes. Participants showed statistically significant improvements in BMI, abdominal muscle endurance and strength, and daily PA levels. These findings align with prior research demonstrating that lifestyle interventions contribute to reductions in BMI \u003csup\u003e9\u003c/sup\u003e, improvements in health-related fitness [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e], and increased daily PA levels [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Furthermore, the in-person BRAVO! lifestyle intervention with 40 participants [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] reported significant reductions in BMI (1.58 unit reduction) along with improvements in cardiovascular endurance (.34 PACER laps improvement), upper body strength/endurance (almost 4 added pushups), and abdominal strength/endurance (more than 10 added pushups). There were also significant changes in some motivational regulations, including increases in intrinsic motivation and decreases in external regulation. Compared with the in-person BRAVO! intervention, the effect sizes for statistically significant findings were similar across delivery modes, with BMI favoring in-person (.45 vs. .34), while curl-up (.45 vs. .49) favored online, and PA level (.38 vs. .37) showed nearly identical effects. Overall, these results indicate comparable effects for both in-person and online interventions. Although some outcomes from the online BRAVO! intervention did not reach statistical significance, sensitivity analyses suggest that these results likely reflect limited statistical power rather than the absence of true effects. For example, BMIz, PACER, push-up, and amotivation did not reach statistical significance, but demonstrated effect sizes exceeding the conventional threshold for a large effect (\u003cem\u003eηp\u0026sup2;\u003c/em\u003e \u0026ge; .14). This pattern indicates that larger samples may yield statistically significant findings. Overall, the results indicate that the online BRAVO! intervention showed trends similar to those observed in the in-person program, confirming the preliminary efficacy of this program.\u003c/p\u003e\u003cp\u003eOne likely explanation of the program\u0026rsquo;s broad efficacy lies in its need-supportive design. By supporting participants\u0026rsquo; basic psychological needs for autonomy, competence, and relatedness, the program fostered self-determined forms of motivation. Although motivational shifts did not reach statistical significance, high perceived need-support scores throughout the program suggest the environment addressed their basic psychological needs satisfaction. This aligns with existing research showing that need-supportive environments positively influence motivational regulation and health behaviors in youth [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eImplementing a mHealth approach retained many benefits of in-person programs. Fidelity measures, including heart rate and RPE, confirmed appropriate exercise intensity, and perceived need-support measure indicated a need-supportive environment. Together, these findings demonstrate that online sessions can meet both exercise intensity and instructional fidelity targets. While the online format offered distinct advantages, such as greater flexibility and accessibility [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e], participants also received a structured program booklet with weekly exercise and diet advice, providing access to health PA and dietary behaviors on non-session days. Furthermore, implementing the program in a home-based context likely reinforced adopting a healthier lifestyle by enabling participants to exercise in their everyday environment [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e, \u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. This combination of online accessibility, structured guidance, and opportunities for independent engagement has created a motivational environment that empowered adolescents to adopt and maintain healthier behaviors. These findings suggest not only the potential of online programs to promote meaningful behavior change but also the ease with which participants can incorporate the learned workouts into their daily lives. This aligns with previous research showing that novel movement skills can be effectively taught and learned in an online setting [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe literature highlights a lack of obesity interventions specifically designed for Latino youth, despite their high obesity rates [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Online BRAVO! intervention demonstrated that lifestyle interventions tailored to a community's cultural context and needs can effectively reduce health risk among Hispanic adolescents [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e, \u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. In line with this, participants also offered meaningful insights into recruitment and dissemination, emphasizing the importance of trusted referrals and family involvement.\u003c/p\u003e\u003cp\u003eThis study has several limitations that should be considered. First, the small, non-randomized sample (\u003cem\u003eN\u003c/em\u003e\u0026thinsp;=\u0026thinsp;19) limits generalizability and introduces potential selection bias. Additionally, the sensitivity analysis indicated that the sample size was insufficient to power some of the outcome variables to achieve statistical significance despite the sizable effects. A larger, methodologically rigorous randomized controlled trial is warranted to establish the efficacy and generalizability of the intervention. Second, outcomes were measured once after intervention, making it unclear whether improvements are sustained over time. Future studies should include long-term follow-up (e.g., 6, 12, or 24 months) to explore the effects over time. Third, the reliance on self-reported data for PA levels and heart rate may introduce bias. Although perceived exertion ratings exceeded the moderate-to-vigorous target range, heart rate data partially confirmed exercise intensity, as HR was measured after, not during, sessions. Future interventions should incorporate real-time monitoring using smartwatches or heart rate monitors to ensure appropriate intensity and improve data accuracy.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003eThis preliminary study provides evidence that SDT-based online lifestyle interventions can lead to meaningful improvements in cardio-metabolic health and help reduce obesity disparities among Hispanic adolescents with obesity. Despite the small sample size, participants experienced significant improvements in BMI, abdominal strength and endurance, and PA levels, while other outcomes (e.g., BMIz, PACER, push-up, and amotivation) showed large but non-significant effects. Fidelity measures confirmed that the program achieved desired exercise intensity and created a highly need-supportive environment, while qualitative findings further supported its acceptability and feasibility. Overall, these results suggest that the online BRAVO! lifestyle intervention has the potential to be an effective and scalable way to improve access and equity in adolescent health promotion, especially for youth facing participation barriers, while providing exercise intensity and need-support comparable to in-person programs. However, future large-scale interventions with long-term follow-up are needed to more rigorously establish efficacy, evaluate sustainability, and strengthen recruitment and dissemination strategies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e: JP and SY conducted the study, collected data, performed the analyses, and drafted the manuscript. TK contributed to data collection and manuscript review. VL, JP, and MV assisted with conducting the intervention, collecting data, and contributing to the manuscript. SYP supervised the project and contributed to writing and reviewing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: The authors did not receive support from any organization for the submitted work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e: The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e: The authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e: The study was approved and reviewed by the institution\u0026apos;s Institutional Review Board (institution redacted for peer review).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent\u003c/strong\u003e: Informed consent was obtained from all individual participants included in the study. Additionally, consent to publish based on de-identified data was obtained from all study participants.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCenters for Disease Control and Prevention. Childhood obesity facts. U.S. Department of Health \u0026amp; Human Services; 2023. Available at: https://www.cdc.gov/obesity/data/childhood.html\u003c/li\u003e\n\u003cli\u003eSanyaolu A, Okorie C, Qi X, Locke J, Rehman S. Childhood and adolescent obesity in the United States: a public health concern. \u003cem\u003eGlob Pediatr Health\u003c/em\u003e. 2019;6:2333794X19891305.\u003c/li\u003e\n\u003cli\u003eKansra AR, Lakkunarajah S, Jay MS. Childhood and adolescent obesity: a review. \u003cem\u003eFront Pediatr\u003c/em\u003e. 2020;8:581461.\u003c/li\u003e\n\u003cli\u003eMarcus C, Danielsson P, Hagman E. Pediatric obesity\u0026mdash;Long-term consequences and effect of weight loss. 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A cluster randomized controlled trial to compare online and in‑person motor skill acquisition. \u003cem\u003eJ Teach Phys Educ\u003c/em\u003e. 2025;1(aop):1‑15.\u003c/li\u003e\n\u003cli\u003eFalbe J, Cadiz AA, Tantoco NK, Thompson HR, Madsen KA. Active and healthy families: a randomized controlled trial of a culturally tailored obesity intervention for Latino children. \u003cem\u003eAcad Pediatr\u003c/em\u003e. 2015;15(4):386‑395.\u003c/li\u003e\n\u003cli\u003eLa Charite J, DeCamp LR, Prichett L, et al. Two‑year outcomes for the Active and Healthy Families pediatric obesity group intervention for families in an emerging Hispanic community: a mixed‑methods study. \u003cem\u003eJ Racial Ethn Health Disparities\u003c/em\u003e. 2025;Epub ahead of print\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"sport-sciences-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssfh","sideBox":"Learn more about [Sport Sciences for Health](http://link.springer.com/journal/11332)","snPcode":"11332","submissionUrl":"https://submission.nature.com/new-submission/11332/3","title":"Sport Sciences for Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"mHealth, lifestyle intervention, self-determination theory, obesity prevention","lastPublishedDoi":"10.21203/rs.3.rs-7707057/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7707057/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003eThis study aimed to evaluate the preliminary efficacy of a 12-week self-determination theory-centered online lifestyle intervention for Hispanic adolescents with obesity, including considerations for the intervention\u0026rsquo;s feasibility.\u003c/p\u003e\u003ch2\u003eMethod\u003c/h2\u003e\u003cp\u003eNineteen adolescents (intervention\u0026thinsp;=\u0026thinsp;11; control\u0026thinsp;=\u0026thinsp;8) participated in this quasi-experimental study. The intervention consisted of two 60-minute moderate-to-vigorous exercise sessions and one 30-minute nutrition lesson delivered via Zoom each week for 12 weeks to examine changes in body mass index (BMI), health-related fitness indicators, physical activity levels, and motivational regulations. Program fidelity was assessed through session heart rate, perceived exertion, and perceived need-support measures. Moreover, interviews with adolescents and parents were thematically analyzed to inform intervention feasibility.\u003c/p\u003e\u003ch2\u003eResult\u003c/h2\u003e\u003cp\u003eThe study showed statistically significant intervention efficacy in BMI (\u003cem\u003eF\u003c/em\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026thinsp;=\u0026thinsp;8.14, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.012), abdominal muscular endurance and strength (\u003cem\u003eF\u003c/em\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026thinsp;=\u0026thinsp;14.13, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.002), and physical activity level (\u003cem\u003eF\u003c/em\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u0026thinsp;=\u0026thinsp;9.345, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;.008). Fidelity measures confirmed exercise adherence, showing that participants maintained moderate-to-vigorous intensity and consistently reported high levels of perceived need-support. Qualitative findings further supported these results and emphasized practical strategies for recruitment and dissemination efforts.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThe findings emphasize this online lifestyle intervention\u0026rsquo;s potential to promote cardio-metabolic health in adolescents and offer direction for future implementation and dissemination.\u003c/p\u003e","manuscriptTitle":"Promoting Adolescent Cardio-Metabolic Health Through a Psychological Need-Supportive Online Lifestyle Intervention","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-01 04:17:46","doi":"10.21203/rs.3.rs-7707057/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-04-16T06:37:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"287179811404659481321512432146675952846","date":"2026-03-23T19:48:15+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-23T10:59:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-26T01:33:04+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-26T01:31:40+00:00","index":"","fulltext":""},{"type":"submitted","content":"Sport Sciences for Health","date":"2025-09-24T21:35:27+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"sport-sciences-for-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ssfh","sideBox":"Learn more about [Sport Sciences for Health](http://link.springer.com/journal/11332)","snPcode":"11332","submissionUrl":"https://submission.nature.com/new-submission/11332/3","title":"Sport Sciences for Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"970452f3-c2d8-4a48-a5c6-3c9179291f16","owner":[],"postedDate":"October 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-23T11:09:08+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-01 04:17:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7707057","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7707057","identity":"rs-7707057","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}