2016 Research

Academic and psychosocial outcomes of a physical activity program with fourth graders: Variations among schools in six urban school districts

• ABSTRACT: The purpose was to examine academic achievement, school attachment, and peer acceptance before and after a comprehensive school-based physical activity program (CSPAP) with 378 children in 12 fourth-grade classrooms across six schools in primarily low-socioeconomic status (SES) districts of a large Midwestern metropolitan area. Both personal and normative rate of academic achievement improvement metrics were used. Overall, all students showed personal math and reading growth. However, effects varied by types of achievement indicator and comparison group, revealing noteworthy school-level demographic and implementation characteristics that are inextricably intertwined with program effectiveness and student growth. Implications, especially for minimizing generalizations, are significant.
• CITATION: Somers, C. L., Centeio, E. E., Kulik, N., Garn, A., Martin, J., Shen, B., … McCaughtry, N. A. (2016). Academic and psychosocial outcomes of a physical activity program with fourth graders: Variations among schools in six urban school districts. Urban Education. http://journals.sagepub.com/doi/pdf/10.1177/0042085916668951

Reach and implementation of physical activity breaks and active lessons in elementary school classrooms

• ABSTRACT: The integration of physical activity into elementary school classrooms, through brief activity breaks (ABs) and lessons that incorporate movement into instruction as active lessons (ALs), are key parts of school physical activity programming and can improve children’s health and academic outcomes. With nationally representative survey data from 640 public elementary schools in the United States, we examined the use of these practices and the extent of implementation within classrooms. ALs were used in 71.7% of schools, and ABs were used in 75.6% of schools. In multivariate models, ALs were significantly less likely to be used in majority-Latino schools (adjusted odds ratio = 0.48, 95% confidence interval [0.25, 0.93], p < .05) than in predominantly White schools. ABs were significantly less likely to be used in lower socioeconomic schools (adjusted odds ratio = 0.57, 95% confidence interval [0.34, 0.95], p < .05) than in higher socioeconomic schools. At schools where ABs were ever used, they were used by 45.6% of teachers, but fewer teachers used them at larger schools (β = −.08, p < .01) and at lower socioeconomic schools (β = −.09, p < .05). The reach of ALs and ABs is modest and classroom-level implementation is quite low. Additional dissemination and support is warranted to improve the reach and implementation of these strategies in elementary schools. Such efforts could improve the school-day experience in ways that benefit millions of young children.
• CITATION: Turner, L., & Chaloupka, F. J. (2016). Reach and implementation of physical activity breaks and active lessons in elementary school classrooms. Health Education Behavior, 44(3), 370-375. doi:10.1177/1090198116667714

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SECTION 2: Other Relevant Research

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• OBJECTIVE: The purpose of this review was to examine the treatment effect of physical exercise on depressive symptoms for adolescents aged 13 to 17 years.
• METHOD: A systematic search of 7 electronic databases identified relevant randomized controlled trials. Following removal of duplicates, 543 texts were screened for eligibility. Screening, data extraction, and trial methodological quality assessment (using the Delphi list) were undertaken by 2 independent researchers. Standardized mean differences were used for pooling postintervention depressive symptom scores.
• RESULTS: Eleven trials met the inclusion criteria, 8 of which provided the necessary data for calculation of standardized effect size. Exercise showed a statistically significant moderate overall effect on depressive symptom reduction (standardized mean difference [SMD] = −0.48, 95% CI = −0.87, −0.10, p = .01, I2 = 67%). Among trials with higher methodological scoring, a nonsignificant moderate effect was recorded (SMD = −0.41, 95% CI = −0.86, 0.05, p = .08). In trials with exclusively clinical samples, exercise showed a statistically significant moderate effect on depressive symptoms with lower levels of heterogeneity (SMD = −0.43, 95% CI = −0.84, −0.02, p = .04, I2 = 44%).
• CONCLUSION: Physical exercise appears to improve depressive symptoms in adolescents, especially in clinical samples in which the moderate antidepressant effect, higher methodological quality, and lowered statistical heterogeneity suggest that exercise may be a useful treatment strategy for depression. Larger trials with clinical samples that adequately minimize the risk of bias are required for firmer conclusions on the effectiveness of exercise as an antidepressant treatment.
• CITATION: Carter, T., Morres, I. D., Meade, O., & Callaghan, P. (2016). The effect of exercise on depressive symptoms in adolescents: A systematic review and meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, 55(7), 580–590. http://doi.org/10.1016/j.jaac.2016.04.016

Physical activity, fitness, cognitive function, and academic achievement in children: A systematic review

• BACKGROUND: The relationship among physical activity (PA), fitness, cognitive function, and academic achievement in children is receiving considerable attention. The utility of PA to improve cognition and academic achievement is promising but uncertain; thus, this position stand will provide clarity from the available science.
• OBJECTIVE: The purpose of this study was to answer the following questions: 1) among children age 5-13 yr, do PA and physical fitness influence cognition, learning, brain structure, and brain function? 2) Among children age 5-13 yr, do PA, physical education (PE), and sports programs influence standardized achievement test performance and concentration/attention?
• STUDY ELIGIBILITY CRITERIA: This study used primary source articles published in English in peer-reviewed journals. Articles that presented data on, PA, fitness, or PE/sport participation and cognition, learning, brain function/structure, academic achievement, or concentration/attention were included. DATA SOURCES: Two separate searches were performed to identify studies that focused on 1) cognition, learning, brain structure, and brain function and 2) standardized achievement test performance and concentration/attention. PubMed, ERIC, PsychInfo, SportDiscus, Scopus, Web of Science, Academic Search Premier, and Embase were searched (January 1990-September 2014) for studies that met inclusion criteria. Sixty-four studies met inclusion criteria for the first search (cognition/learning/brain), and 73 studies met inclusion criteria for the second search (academic achievement/concentration). STUDY APPRAISAL AND SYNTHESIS METHODS: Articles were grouped by study design as cross-sectional, longitudinal, acute, or intervention trials. Considerable heterogeneity existed for several important study parameters; therefore, results were synthesized and presented by study design.
• RESULTS: A majority of the research supports the view that physical fitness, single bouts of PA, and PA interventions benefit children’s cognitive functioning. Limited evidence was available concerning the effects of PA on learning, with only one cross-sectional study meeting the inclusion criteria. Evidence indicates that PA has a relationship to areas of the brain that support complex cognitive processes during laboratory tasks. Although favorable results have been obtained from cross-sectional and longitudinal studies related to academic achievement, the results obtained from controlled experiments evaluating the benefits of PA on academic performance are mixed, and additional, well-designed studies are needed. LIMITATIONS: Limitations in evidence meeting inclusion criteria for this review include lack of randomized controlled trials, limited studies that are adequately powered, lack of information on participant characteristics, failure to blind for outcome measures, proximity of PA to measurement outcomes, and lack of accountability for known confounders. Therefore, many studies were ranked as high risk for bias because of multiple design limitations.
• CONCLUSIONS: The present systematic review found evidence to suggest that there are positive associations among PA, fitness, cognition, and academic achievement. However, the findings are inconsistent, and the effects of numerous elements of PA on cognition remain to be explored, such as type, amount, frequency, and timing. Many questions remain regarding how to best incorporate PA within schools, such as activity breaks versus active lessons in relation to improved academic achievement. Regardless, the literature suggests no indication that increases in PA negatively affect cognition or academic achievement and PA is important for growth and development and general health. On the basis of the evidence available, the authors concluded that PA has a positive influence on cognition as well as brain structure and function; however, more research is necessary to determine mechanisms and long-term effect as well as strategies to translate laboratory findings to the school environment. Therefore, the evidence category rating is B. The literature suggests that PA and PE have a neutral effect on academic achievement. Thus, because of the limitations in the literature and the current information available, the evidence category rating for academic achievement is C.
• CITATION: Donnelly, J.E., Hillman, C.H., Castelli, D., Etnier, J.L., Lee, S., Tomporowski, P., Lambourne, K., Szabo-Reed, A.N. (2016). Physical activity, fitness, cognitive function, and academic achievement in children: A systematic review. Medicine & Science in Sports & Exercise, 48(6), 1197-222. doi: 10.1249/MSS.0000000000000901

Not enough time in the day: A qualitative assessment of in-school physical activity policy as viewed by administrators, teachers, and students

• BACKGROUND: In recent decades, the alignment of health and education has been at the forefront of school reform. Whereas the establishment of national in-school physical activity (ISPA) recommendations and state-level mandates demonstrates success, there has been less achievement in areas that address health disparities. The purpose of this investigation was to explore barriers and facilitators to implementing state-mandated ISPA policies in the Mississippi Delta.
• METHODS: Focus groups or interviews were conducted with district administrators, school principals, teachers, and students. A total of 2 semistructured moderator guides were developed to focus on (1) student ISPA practices and preferences and (2) facilitators and barriers to implementing ISPA policies and practices.
• RESULTS: A total of 6 themes were developed. In that, 2 themes addressed participant-described barriers (primary challenges and interferences and excuses). Three themes highlighted participant-described facilitators (compromises, things that work, and being active at school). Finally, 1 theme encompassed the participant-described need to address educating the whole child.
• CONCLUSIONS: There is a critical need for meaningful and relevant solutions to circumvent challenges to implementing ISPA policies and practices in the Mississippi Delta. The Whole School, Whole Community, Whole Child model offers a broad means of visualizing rural, low-income, racially concentrated schools to circumvent challenges and foster ISPA policies and practices.
• CITATION: Gamble, A., Chatfield, S. L., Cormack, Jr., M. L., & Hallam, J. S. (2016). Not enough time in the day: A qualitative assessment of in-school physical activity policy as viewed by administrators, teachers, and students. Journal of School Health, 87(1), 21-28. doi:10.1111/josh.12464

Normal weight children have higher cognitive performance – Independent of physical activity, sleep, and diet

• BACKGROUND: Aside from the health consequences, observational studies indicate that being overweight may also negatively affect cognitive function. However, existing evidence has to a large extent not controlled for the possible confounding effect of having different lifestyles. Therefore, the objective was to examine the independent associations between weight status and lifestyle indicators with cognitive performance in 8–11 year old Danish children.
• SUBJECTS/METHODS: The analyses included 828 children (measured in 2011–2012) each having one to three measurement occasions separated by approximately 100 days. Dietary intake, physical activity, sedentary time, and sleep duration were measured using dietary records and accelerometers. The Children’s Sleep Habits Questionnaire was used to access sleep problems and the Andersen test was carried out to estimate cardio-respiratory fitness (CRF). Weight status (underweight, normal weight, and overweight/obese) was defined according to body mass index and cognitive performance was assessed using the d2-test of attention, a reading test, and a math test. A linear mixed model including a number of fixed and random effects was used to test associations between lifestyle indicators as well as BMI category and cognitive performance.
• RESULTS: After adjustment for demographics, socioeconomics, and multiple lifestyle indicators, normal weight children had higher cognitive test scores than overweight/obese and underweight children of up to 89% and 48% of expected learning within one school year (P < 0.05). Daily breakfast consumption, fewer sleep problems, higher CRF, less total physical activity, more sedentary time, and less light physical activity were associated with higher cognitive performance independently of each other in at least one of the three cognitive tests (P < 0.05).
• CONCLUSIONS: Normal weight children had higher cognitive performance compared to overweight/obese as well as underweight children, independent of multiple lifestyle indicators.
• CITATION: Hjorth, M. F., Sorensen, L. B., Adnersen, R., Dyssegaard, C. B., Ritz, C., Tetens, I., … Sjodin, A. (2016). Normal weight children have higher cognitive performance – Independent of physical activity, sleep, and diet. Physiology & Behavior, 165, 398-404. http://dx.doi.org/10.1016/j.physbeh.2016.08.021

Using physical activity to manage ADHD symptoms: The state of the evidence

• ABSTRACT: This article summarizes the evidence for management of attention-deficit/hyperactivity disorder (ADHD) using chronic aerobic physical activity (PA). Known studies comparing chronic aerobic PA to at least one control group are listed; uncontrolled studies and studies of non-aerobic PA are not considered. Key challenges to conducting chronic PA studies with children and youth with ADHD are summarized. After condensing information from widely varying studies, measures, and research designs, conclusions are stated in broad brush stroke terms. Preliminary evidence supports PA as beneficial for ADHD symptoms, executive function, and motor abilities. Social, emotional, and behavioral outcomes also may benefit. The preliminary state of the evidence supports PA as an adjunctive treatment for ADHD at this time, but the body and sophistication of the research to date is insufficient at present to support PA as a stand-alone treatment. Critical directions for future research are discussed.
• CITATION: Hoza, B., Martin, C. P., Pirog, A., & Shoulberg, E. K. (2016). Using physical activity to manage ADHD symptoms: The state of the evidence. Current Psychiatry Reports, 18(12), 113. doi:10.1007/s11920-016-0749-3

The effect of three types of physical education instruction on whole-day sedentary time and moderate to vigorous physical activity in third grade students

• BACKGROUND: The purpose of this study was to determine the effect of three types of physical education (PE) instruction on whole-day sedentary time and moderate to vigorous physical activity (MVPA) in third grade students.
• METHODS: Forty-five participants (22 M, 23 F; 8.4±0.8 yrs) from three 3rd grade classrooms were combined into 1 PE class as part of the schools normal schedule. Students were then randomly assigned to one of three types of PE instruction: motor skill (MS), physical activity (PA), or motor skill and PA (MS+PA). The PE instruction took place for 10 weeks, 3 times a week, for 30-40 minutes each day. Objective PA was measured using an Actigraph GT3X+ accelerometer. Participants wore the accelerometer during weeks 1 and 10 on the right hip for seven days at each time point. Epoch length was set to 15 seconds. Evenson cut-points were used to determine sedentary time and MVPA. Sedentary time and MVPA were then divided by total wear time to determine percent time spent in each category. Wear time criteria was 600 minutes per day for 4 days. Paired samples t-tests were used to determine differences in percent sedentary time and MVPA at weeks 1 and 10 from the three PE instruction groups.
• RESULTS: Five participants were excluded at week 1 for not meeting wear time criteria. For week 10, 10 participants were noncompliant and did not wear the accelerometer and 9 participants were excluded due to insufficient wear time. A significant difference in percent sedentary time was found for the MS (52.75±6.1%; 54.4±7.5 mean±S.D.), PA (53.14±6.9; 54.27±6.1) and PA+MS (60.21±6.8; 56.4±9.4) instruction groups. A significant difference was further found in MVPA for the MS (13.7±2.6; 14.2±2.8), PA (14.3±3.1; 13.8±2.8), and PA+MS (12.02±5.1; 13.4±5.6) groups.
• DISCUSSION: The MS and MS+PA groups showed a decrease in sedentary time and an increase in MVPA following 10 weeks of PE instruction. Unexpectedly, the PA group showed a decrease in MVPA, which could be due to examining the entire day instead of only time spent in PE. A limitation to this study was low accelerometer compliance at week 10.
• CITATION: Moore, R. W., Palmer, K. K., & Robinson, L. E. (2016). The effect of three types of physical education instruction on whole-day sedentary time and moderate to vigorous physical activity in third grade students. Pediatric Exercise Science, 28, 47–47.

Physical activity and sedentary time among children with disabilities at school

• PURPOSES: Physical activity (PA) is important for the development of children with disabilities, but rarely does this population meet recommended standards. Schools are salient locations for PA, but little is known about how specific school settings affect the PA of children with diverse disabilities. We assessed PA and sedentary time (ST) of children with disabilities in three school settings (physical education (PE), recess, lunchtime).
• METHODS: Participants included 259 children from 13 Hong Kong special schools for five primary disabilities: visual impairments [VI], hearing impairments [HI], physical disabilities [PD], intellectual disabilities [ID], and impaired social development [SD]. Children wore accelerometers at school for 3 days, and the time (min and %) they engaged in moderate-to-vigorous physical activity (MVPA) and ST were extracted for each school setting by gender. Analyses included multiple linear mixed models to determine differences in MVPA and ST by gender across disability types, adjusting for BMI, grade level, and duration in each setting.
• RESULTS: Overall, children spent 70% of their day at school being sedentary and accrued little MVPA (mean 17 min+/-4.2 daily). Children with ID (severe) had especially low levels of MVPA. All three settings contributed significantly to both MVPA and ST, with recess contributing more to MVPA than PE or lunchtime.
• CONCLUSIONS: This is the first study to examine MVPA and ST among different disability types at school using accelerometry. Given the low levels of PA, this population should receive priority in the development of cost-effective interventions to improve their PA opportunities.
• CITATION: Sit, C. H. P., McKenzie, T. L., Cerin, E., Chow, B. C., Huang, W. Y., & Yu, J. (2016). Physical activity and sedentary time among children with disabilities at school. Medicine & Science in Sports & Exercise, 49(2), 292-297. doi:10.1249/MSS.0000000000001097

Evaluation of a pilot school-based physical activity challenge for primary school students

• ISSUE ADDRESSED: Physical inactivity and sedentary behaviour among children are growing public health concerns. The Culture-Health-Communities Activity Challenge is a school-based pedometer program in which classes compete to achieve the highest class average daily steps in an 8-week period. The Challenge aims to encourage physical activity in primary school students, with a focus on engaging Aboriginal students. The program was piloted in fifteen classes in New South Wales in 2014.
• METHODS: The evaluation aimed to explore students’€™ and teachers’€™ experiences of the Challenge, and assess the impact of the Activity Challenge on students’€™ physical activity levels. Data sources were a pre- and post-intervention survey of students’€™ physical activity levels and sedentary time (n=209), qualitative interviews with teachers (n=11), and discussions with 10 classes.
• RESULTS: Fifteen Year 5 and 6 classes comprising 318 students participated. Fifty percent of participants were girls, the average age was 11 years, and the majority (57%) were Aboriginal students. Participation in the Challenge was associated with a slight but statistically significant increase in students’€™ physical activity levels (p<0.05), and a significant decrease in weekend screen time (p<0.05). However, when stratified by Aboriginality these changes were not statistically significant for Aboriginal students. Qualitative feedback from teachers and students indicated high levels of engagement and satisfaction with the Challenge. Teachers and students reported positive impacts including increased motivation to be physically active, and improved student attendance, engagement in class activities and teamwork.
• CONCLUSION: Participation in the Challenge was associated with increased physical activity and decreased screen time for some students. Students and teachers also reported positive social and educational outcomes. So what? The findings highlight the importance of primary schools as a setting for health promotion, and demonstrate that school-based physical activity programs can be engaging and appropriate for classes with high proportions of Aboriginal students.
• CITATION: Passmore, E., Donato-Hunt, C., Maher, L., Havrlant, R., Hennessey, K., Milat, A., & Farrell, L. (2016). Evaluation of a pilot school-based physical activity challenge for primary students. Health Promotion Journal of Australia, 28(2), 103-109. Retrieved from http://www.publish.csiro.au/HE/justaccepted/HE16021    

Physical activity is associated with attention capacity in adolescents

• OBJECTIVE: To assess the relationships among physical activity, measured objectively, and attention capacity in European adolescents.
• STUDY DESIGN: The study included 273 adolescents, aged 12.5-17.5 years, who participated in the Healthy Lifestyle in Europe by Nutrition in Adolescence Study. Participants wore a uniaxial accelerometer for 7 days to measure physical activity. The d2 Test of Attention was administered to assess attention capacity. Multivariate analyses were used to study the association of attention capacity with each measure of physical activity. Receiver operating characteristic analysis was performed to determine thresholds that best discriminate between low and good attention capacity.
• RESULTS: After controlling for potential confounding variables (age, sex, body mass index, parental educational level, fat mass, aerobic fitness, and center), adolescents’ attention capacity test performances were significantly and positively associated with longer time spent in moderate or moderate-to-vigorous physical activity (MVPA) in free-living conditions (P < .05). Receiver operating characteristic curve analyses revealed that the physical activity thresholds that best discriminated between low/good attention capacities were ≥41 min·day(-1) for moderate, ≥12 min·day(-1) for vigorous, and ≥58 min·day(-1) for MVPA.
• CONCLUSION: These findings suggest that promoting MVPA may be have a beneficial effect on attention capacity, an important component of cognition, in adolescents.
• CITATION: Vanhelst, J., Béghin, L., Duhamel, A., Manios, Y., Molnar, D., De Henauw, S., … Healthy Lifestyle in Europe by Nutrition in Adolescence HELENA Study Group. (2016). Physical activity is associated with attention capacity in adolescents. The Journal of Pediatrics, 168, 126-131.e2. https://doi.org/10.1016/j.jpeds.2015.09.029