Optimising exercise and physical activity support for young people living with obesity in NHS Complications from Excess Weight Services- MOTIVATE-CEW2

Davies, A ORCID: 0000-0002-9006-5881 (2026) Optimising exercise and physical activity support for young people living with obesity in NHS Complications from Excess Weight Services- MOTIVATE-CEW2. Doctoral thesis, Liverpool John Moores University.

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Abstract

The prevalence of obesity among children and young people in the UK is increasing and is associated with significant physiological and psychosocial complications across the life course (Schwimmer, Burwinkle and Varni, 2003; Reilly and Kelly, 2011; Di Cesare et al., 2019). In response, NHS England has established specialist paediatric Complications from Excess Weight (CEW) services that deliver multidisciplinary care for obesity-related comorbidities. Lifestyle treatment, including exercise and physical activity (PA), is recommended as first-line therapy (Al‐Khudairy et al., 2017); however, the optimal approach to delivering these components within CEW services remains unclear (Apperley et al., 2022). To address this, we developed and evaluated the MOTIVATE-CEW exercise and PA intervention in a preliminary feasibility randomised controlled trial within the Alder Hey Children’s Hospital CEW service (Davies et al., 2026). The intervention and trial procedures were feasible and showed promising improvements in exercise behaviour, although maintenance of exercise was limited. Therefore, this thesis aimed to refine the MOTIVATE-CEW intervention and its trial methodology and to conduct a second feasibility randomised controlled trial to evaluate the optimised programme.

Study one used a qualitative survey with intervention participants as well as focus groups and semi-structured interviews with both intervention participants and their caregivers to evaluate the acceptability of MOTIVATE-CEW. The study was designed to identify barriers, facilitators and targets for refinement within the original intervention before future refinement could commence. Ten of the twelve intervention participants completed the survey: three participated in a focus group and one in an individual interview. In addition, three caregivers attended a focus group, and one completed an interview. Key facilitators of engagement included personalised, graded action plans and feedback from the exercise physiologist, while the most frequently suggested improvement was a longer intervention duration. This study reported qualitative findings of the mixed method evaluation of the original MOTIVATE-CEW intervention. These findings, along with those of the MOTIVATE-CEW feasibility randomised control trial, informed the subsequent optimisation of the intervention and study methodology in Study two.

Study two used an Intervention Mapping framework alongside a co-development process to refine the MOTIVATE-CEW intervention and develop MOTIVATE-CEW2. This systematic process resulted in a comprehensive, evidence-informed, theory-driven exercise and physical activity (PA) intervention for CEW services that was grounded in the needs of patients, their families and CEW staff. The intervention design comprised five interrelated components: education, person centred counselling, mobile health technologies and self-monitoring, regular remote feedback and support, and ongoing motivation and encouragement strategies. Together, these components were intended to support the maintenance of exercise and PA by improving the quality of motivation, reducing barriers to accessing support and encouraging autonomy in exercise and PA behaviours. The co-development process was also used to refine the study design for the MOTIVATE-CEW2 feasibility randomised control trial. This work informs the feasibility randomised control trial undertaken in study three.

Study three consisted of a single centre, parallel group feasibility randomised controlled trial of the MOTIVATE-CEW2 intervention and study design. 22 CEW service patients were recruited and randomised to receive the MOTIVATE-CEW2 intervention for 6 months alongside usual care or to continue with usual care alone. The intervention showed a promising effect on exercise behaviour. 82% initiated purposeful exercise and 64% remained engaged at 6 months showing good maintenance throughout the intervention period. Participants completed 1.2±1.7 sessions/week and 51±69 minutes/week of exercise. The study had strong recruitment (33% of eligible patients) and good reach with participant characteristics broadly representative of the wider Alder Hey Children’s Hospital CEW service population for age, sex, indices of multiple deprivation quintile and ethnicity. However, further optimisation may be required to improve completeness of the proposed primary outcome (77% completion of PedsQL 4.0 data at 6 months) and to consider the generalisability of both the study procedures and the intervention across CEW services in the UK. Overall, the findings support progression to a fully powered, multi-site effectiveness trial.

The iterative process across these three sequential studies enabled the development and feasibility evaluation of a comprehensive, evidence informed exercise and PA intervention designed specifically for CEW services in the UK. Future research should determine the extent of further refinement required to strengthen the scalability, external validity and implementation readiness of MOTIVATE-CEW2 before progression to a multi-site effectiveness trial.

Item Type:	Thesis (Doctoral)
Uncontrolled Keywords:	Paediatric obesity; physical activity; exercise; feasibility; Intervention Mapping; co-development
Subjects:	R Medicine > RC Internal medicine > RC1200 Sports Medicine G Geography. Anthropology. Recreation > GV Recreation Leisure > GV561 Sports > GV711 Coaching
Divisions:	Sport and Exercise Sciences
Date of acceptance:	4 June 2026
Date of first compliant Open Access:	1 July 2026
Date Deposited:	01 Jul 2026 09:10
Last Modified:	01 Jul 2026 09:11
DOI or ID number:	10.24377/LJMU.t.00028850
Supervisors:	Cocks, M, Jones, H, Kinnafick, F, Senniappan, S and Hesketh, K
URI:	https://researchonline.ljmu.ac.uk/id/eprint/28850

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