BackgroundThe study aimed to investigate the effectiveness of the European Feel4Diabetes intervention, promoting a healthy lifestyle, on physical activity and its correlates among families at risk for type 2 diabetes mellitus (based on the Finnish Diabetes Risk Score) in Belgium.MethodsThe Feel4Diabetes intervention involved three components: family, school and community component, with the family component consisting of 6 counseling sessions for families at risk. Main outcomes were objectively measured physical activity levels and its subjectively measured correlates. The final sample consisted of 454 parents (mean age 39.4years; 72.0% women) and 444 children (mean age 8.0years; 50.1% girls). Multilevel repeated measures analyses were performed to assess intervention effectiveness after 1 year.ResultsIn parents, there was no significant intervention effect. In children, there were only significant negative effects for moderate to vigorous physical activity (p=0.05; eta (2)(p)=0.008) and steps (p=0.03; eta (2)(p)=0.006%) on weekdays, with physical activity decreasing (more) in the intervention group.ConclusionsThe F4D-intervention lacks effectiveness on high-risk families' physical activity and its correlates in Belgium. This could partially be explained by low attendance rates and a large drop-out. To reach vulnerable populations, future interventions should invest in more appropriate recruitment (e.g. more face-to-face contact) and more bottom-up development of the intervention (i.e. co-creation of the intervention with the target group).Trial registrationThe Feel4Diabetes-study was prospectively registered at clinicaltrials.gov as NCT02393872 on 20 March 2015.