ActiveGirls: Physical Activity, Hormone Health, and Diabetes Risk in Early Adolescence

Inclusion Criteria:

* Caregiver: Caregiver of child (ie mother, father, or other legal guardian), English-speaking, Access to a device where they are able to receive study e-mails or texts
* Child: English-speaking, Female, ages 8-12 years old at time of enrollment, Pre-menarchal at time of baseline visit, at risk for Polycystic Ovary Syndrome (PCOS)/insulin resistance, as defined by (1) History of maternal PCOS/maternal GDM, (2) BMI \>/= 85th percentile, (3) History of premature adrenarche, or (4) Small (\<10th %ile) for gestational age

Exclusion Criteria (Child):

* Medications at time of enrollment: Metformin, GLP-1R Agonist, Insulin, GnRH agonist
* Endocrine conditions that would impact either insulin sensitivity, androgen concentrations, or growth
* Insulin dynamics: Type 1 diabetes, Type 2 diabetes, Congenital Hyperinsulinism
* Androgen Conditions: Adrenal tumor, Congenital Adrenal Hyperplasia
* Hyperthyroidism or uncontrolled hypothyroidism (TSH \>7.0 mIU/mL)
* Growth Hormone Deficiency
* Medical conditions that would impact PA participation: Type 1 diabetes; Cardiovascular, neurologic, and/or musculoskeletal conditions limiting ability to participate in physical activity.
* Other medical comorbidities that would limit generalizability of findings, including: Severe congenital heart disease, Congenital anomalies, Cystic fibrosis, Cerebral palsy, Condition requiring use of nasogastric, gastric tube, or other alternative method of feeding, Undiagnosed conditions with significant impact on child's growth and development; Significant cardiac, hepatic, oncologic, inflammatory, or psychiatric disease.