Associations between objectively measured physical activity and academic attainment in adolescents from a UK cohort

Investigating the Potential of a Conversational Agent (Phyllis) to Support Adolescent Health and Overcome Barriers to Physical Activity: Co-Design Study

BACKGROUND

Conversational agents (CAs) are a promising solution to support people in improving physical activity (PA) behaviors. However, there is a lack of CAs targeted at adolescents that aim to provide support to overcome barriers to PA. This study reports the results of the co-design, development, and evaluation of a prototype CA called "Phyllis" to support adolescents in overcoming barriers to PA with the aim of improving PA behaviors. The study presents one of the first theory-driven CAs that use existing research, a theoretical framework, and a behavior change model.

OBJECTIVE

The aim of the study is to use a mixed methods approach to investigate the potential of a CA to support adolescents in overcoming barriers to PA and enhance their confidence and motivation to engage in PA.

METHODS

The methodology involved co-designing with 8 adolescents to create a relational and persuasive CA with a suitable persona and dialogue. The CA was evaluated to determine its acceptability, usability, and effectiveness, with 46 adolescents participating in the study via a web-based survey.

RESULTS

The co-design participants were students aged 11 to 13 years, with a sex distribution of 56% (5/9) female and 44% (4/9) male, representing diverse ethnic backgrounds. Participants reported 37 specific barriers to PA, and the most common barriers included a "lack of confidence," "fear of failure," and a "lack of motivation." The CA's persona, named "Phyllis," was co-designed with input from the students, reflecting their preferences for a friendly, understanding, and intelligent personality. Users engaged in 61 conversations with Phyllis and reported a positive user experience, and 73% of them expressed a definite intention to use the fully functional CA in the future, with a net promoter score indicating a high likelihood of recommendation. Phyllis also performed well, being able to recognize a range of different barriers to PA. The CA's persuasive capacity was evaluated in modules focusing on confidence and motivation, with a significant increase in students' agreement in feeling confident and motivated to engage in PA after interacting with Phyllis. Adolescents also expect to have a personalized experience and be able to personalize all aspects of the CA.

CONCLUSIONS

The results showed high acceptability and a positive user experience, indicating the CA's potential. Promising outcomes were observed, with increasing confidence and motivation for PA. Further research and development are needed to create further interventions to address other barriers to PA and assess long-term behavior change. Addressing concerns regarding bias and privacy is crucial for achieving acceptability in the future. The CA's potential extends to health care systems and multimodal support, providing valuable insights for designing digital health interventions including tackling global inactivity issues among adolescents.

Autonomous motivation, social support, and physical activity in school children: moderating effects of school-based rope skipping sports participation

Purpose

Recent studies have shown that physical activity (PA) levels are low among children and adolescents globally. In order to reverse this trend, PA interventions are increasingly favoured. The school setting is the ideal place to address the issues that many children face. The purpose of this study was to (a) The primary focus of this study is to delve into the mediating role played by school-based rope skipping sports participation (SRSP) in the connection between social support and moderate to high-intensity physical activity (MVPA) among school children. (b) Additionally, this research aims to examine the moderating effect of within this pathway.

Methods

We conducted a survey involving 721 adolescents residing in Changsha City. The participants' ages ranged from 8 to 12 years, with an average age of 9.84 ± 1.535 years. Out of these participants, 406 were boys, and 315 were girls. To assess variables such as social support and autonomous motivation, we employed standardized measurement scales. Subsequently, we analyzed the collected data using various statistical methods, including independent s-amples t-tests, bivariate correlation analysis, descriptive statistical analysis, structural equation modeling (SEM), and the Johnson-Neyman method.

Results

An independent samples t-test revealed a statistically significant difference in MVPA between genders (p = 0.003 < 0.05), with boys exhibiting a higher level of engagement in MVPA compared to girls, Correlation analysis revealed significant positive associations among several key variables. Specifically, social support demonstrated a noteworthy positive correlation with autonomous motivation (r = 0.331, p < 0.01) as well as school children's engagement in MVPA (r = 0.308, p < 0.01). Moreover, autonomous motivation displayed a significant positive correlation with school children's involvement in MVPA (r = 0.459, p < 0.01). The moderating analysis revealed a significant influence of the interaction between increased participation in and social support on school children's engagement in MVPA.

Conclusion

Social support and autonomy support have been proven effective in enhancing school children's engagement in MVPA. They exert their influence indirectly by fostering autonomous motivation. Notably, robust social support can significantly benefit MVPA school children with high activity requirements, particularly those regularly engaged in MVPA during the school day.

Balancing academics and athletics: School-level athletes' results are positively associated with their academic performance

BACKGROUND

Using data from a nationwide high-school sample, the present study aimed to examine whether school-level athletes' sporting results are positively or negatively associated with their academic performance.

METHODS

Athletic performance was assessed using the results of spring and summer regional qualifying interschool tennis tournaments in Japan among both male and female tournaments across all prefectures in Japan. Academic performance was assessed using the standardized rank scores for academic performance at the school level, with higher scores denoting superior academic levels; this is the most common measure of academic performance in Japanese high schools. Linear mixed models were conducted to compare the academic performance of high schools with winning and losing records, respectively, for all games together and for the spring and summer tournaments separately. The results of a total of 4,870 games were analyzed.

RESULTS

High schools with winning records showed a significantly higher academic-performance score than those with losing records, and this association was stronger among boys than girls. The observed difference in academic-performance scores between the schools with winning and losing records, respectively, was replicated in both tournament settings (i.e., spring and summer).

CONCLUSIONS

Athletic results are positively associated with academic performance at the school level. Given the cross-sectional nature of the present study, the present results do not necessarily imply that sports participation can improve academic performance; rather, the present study suggests that balancing academic and athletic commitments is feasible.

Exploring regression dilution bias using repeat measurements of 2858 variables in ≤49 000 UK Biobank participants

BACKGROUND

Measurement error in exposures and confounders can bias exposure-outcome associations but is rarely considered. We aimed to assess random measurement error of all continuous variables in UK Biobank and explore approaches to mitigate its impact on exposure-outcome associations.

METHODS

Random measurement error was assessed using intraclass correlation coefficients (ICCs) for all continuous variables with repeat measures. Regression calibration was used to correct for random error in exposures and confounders, using the associations of red blood cell distribution width (RDW), C-reactive protein (CRP) and 25-hydroxyvitamin D [25(OH)D] with mortality as illustrative examples.

RESULTS

The 2858 continuous variables with repeat measures varied in sample size from 109 to 49 121. They fell into three groups: (i) baseline visit [529 variables; median (interquartile range) ICC = 0.64 (0.57, 0.83)]; (ii) online diet by 24-h recall [22 variables; 0.35 (0.30, 0.40)] and (iii) imaging measures [2307 variables; 0.85 (0.73, 0.94)]. Highest ICCs were for anthropometric and medical history measures, and lowest for dietary and heart magnetic resonance imaging.The ICCs (95% confidence interval) for RDW, CRP and 25(OH)D were 0.52 (0.51, 0.53), 0.29 (0.27, 0.30) and 0.55 (0.54, 0.56), respectively. Higher RDW and levels of CRP were associated with higher risk of all-cause mortality, and higher concentration of 25(OH)D with lower risk. After correction for random measurement error in the main exposure, the associations all strengthened. Confounder correction did not influence estimates.

CONCLUSIONS

Random measurement error varies widely and is often non-negligible. For UK Biobank we provide relevant statistics and adaptable code to help other researchers explore and correct for this.

The longitudinal association between objectively-measured school-day physical activity and academic achievement in US elementary school students

Background

It is recommended that school-aged children accrue 30 minutes of daily moderate-to-vigorous physical activity (MVPA) in school. Current literature is inconclusive about the long-term associations between school-based physical activity and academic achievement. In this study, we use a large sample and longitudinal design to rigorously evaluate whether school-day MVPA is associated with academic achievement.

Methods

In a diverse suburban public school district, 4936 Grade 4 students were recruited in 40 elementary schools. Students wore accelerometers to measure school-day MVPA for 15 days across three semesters. Academic performance data was collected across Grade 3 fall to Grade 5 spring, including teacher-assigned grades and standardized test scores. Multilevel modeling was conducted controlling for student demographics and school characteristics.

Results

Cross-sectional analyses found small negative associations in Grade 4. Grade 4 full-year mean daily school-day MVPA had β = −-0.066, β = −-0.063, β = −-0.066, and β = −-0.058 associations (p <  0.001) with Grade 4 math, reading, spelling, and writing grades respectively, and Grade 4 full-year mean daily school-day MVPA had β = −-0.206 and β = −-0.283 (p <  0.001) associations with Grade 4 math and English Language Arts (ELA) standardized test scores respectively out of approximately 500 points. Longitudinal analyses found no significant associations between Grade 4 full-year mean daily school-day MVPA and Grade 5 Fall course grades. Results also indicated small negative associations for students attaining 30+ minutes of daily school-day MVPA compared to those attaining less than 15 minutes, but only in Grade 4 Fall cross-sectional analyses where teacher-assigned reading, spelling, and writing grades were − 1.666, − 1.638, and − 1.993 points lower respectively (p <  0.001).

Conclusion

The cross-sectional findings, while statistically significant in a negative direction, have a negligible association when translated practically. For example, even if students attained twice the recommended amount of school-day MVPA – which would constitute an approximately 300% increase from current levels – results suggest that grades would only decrease by 2 points on a 100-point scale. Furthermore, longitudinal analyses suggest school-day MVPA does not have a predictive association with course grades or standardized test scores. Findings suggest school-based MVPA implemented in accordance with recommendations does not meaningfully detract from academic progress.

Trial registration

ClinicalTrials.gov, NCT03765047. Registered 05 December 2018 - Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT03765047

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-022-01328-7.

The Impact of the Daily Mile™ on School Pupils' Fitness, Cognition, and Wellbeing: Findings From Longer Term Participation

Background

School based running programmes, such as The Daily Mile™, positively impact pupils' physical health, however, there is limited evidence on psychological health. Additionally, current evidence is mostly limited to examining the acute impact. The present study examined the longer term impact of running programmes on pupil cognition, wellbeing, and fitness.

Method

Data from 6,908 school pupils (mean age 10.2 ± 0.7 years), who were participating in a citizen science project, was examined. Class teachers provided information about participation in school based running programmes. Participants completed computer-based tasks of inhibition, verbal and visual-spatial working memory, as well as the Children's Feeling scale and Felt arousal scale to determine subjective wellbeing. A multistage 20-m shuttle run test was used to estimate fitness.

Results

From our total sample of 6,908 school pupils, 474 participants had been taking part in a running programme for <2 months (Shorter term participation); 1,004 participants had Longer Term participation (>3 months); and 5,430 did not take part in a running programme. The Longer Term participation group had higher fitness levels than both other groups and this remained significant when adjusted for age, sex and SES. Moderated regression analysis found that for the Shorter Term participation group, higher shuttle distance was associated with better visual-spatial working memory. Effect sizes were small though.

Conclusion

We identified small and selective positive impact of participation in school based running programmes on fitness and cognition. While no long term benefit was identified for cognition or wellbeing, the impact on fitness and short term benefit suggest schools should consider participation.

The Association between Physical Activity and Smartphone Addiction in Korean Adolescents: The 16th Korea Youth Risk Behavior Web-Based Survey, 2020

Many side effects of smartphone addiction have been reported, such as a lack of sleep, obesity, and poor concentration. However, the relationship between physical activity (PA) and smartphone addiction has not been fully elucidated. This study aimed to analyze the relationship between physical activity and smartphone addiction among 53,534 Korean adolescents using raw data from the 16th (2020) Korea Youth Risk Behavior Web-based Survey (KYRBS). The dependent variables were the general user group, potential risk user group, and high-risk user group for smartphone addiction. The independent variables were moderate PA (over 5 days per week), vigorous PA (over 3 days per week), and strength exercise (over 3 days per week). Sex, body mass index (BMI), school grade, academic achievement, sleep satisfaction, depression, loneliness, and stress were selected as confounding variables. A complex sample logistic regression analysis was performed. Potential smartphone addiction risk users showed statistically significant odds ratios of 1.423 (p < 0.001), 1.379 (p < 0.001), and 1.383 (p < 0.001) based on general users participating in moderate PA, vigorous PA, and strength exercise, respectively. High-risk users showed statistically significant odds ratios of 1.475 (p < 0.001), 1.484 (p < 0.001), and 1.619 (p < 0.001), respectively. In conclusion, to prevent smartphone addiction among Korean adolescents, participation in moderate PA for more than five days a week, vigorous PA for more than three days a week, or strength exercise for more than three days a week is considered effective.

Associations between Physical Activity and Academic Competence: A Cross-Sectional Study among Slovenian Primary School Students

Physical activity has beneficial effects on overall academic performance in children. However, there is a lack of evidence regarding how the individual characteristics of physical activity interact with other confounding variables of academic competence. Leisure-time physical activity with potential confounders-such as developmental, behavioral, family, and school factors, predicting overall, mathematical, and reading academic competence-was studied in a random sample of 1520 Slovenian primary school students in grades 4-6 (51.9% female; mean age = 10.4 years; SD = 0.93). A structured self-reported questionnaire was used to gather data on the children's leisure-time physical activity and social-demographic variables, while academic competence was measured by teachers using the SSRS Academic Competence Evaluation Scale. The findings showed that children engage in physical activity most days a week, with moderate-intensity and unorganized activities. It was predicted that engaging in physical activity would lead to an increase in academic performance by 4.2% in males (p = 0.002) and 3.2% in females (p = 0.024), but after fully adjusting the model for controlling confounding variables, the prediction increased to 81.1% in females and 84.1% in males (p < 0.001). The frequency and intensity of physical activity, the absence of digital games, and attending sports clubs seem to have the most beneficial effects in terms of academic competence in school children, among other relevant confounders mediating in this complex relationship.

Interventions to Increase Moderate-to-Vigorous Physical Activity in Elementary School Physical Education Lessons: Systematic Review

BACKGROUND

This systematic review aimed to synthesize recent evidence on interventions to increase moderate-to-vigorous physical activity (MVPA) content of physical education (PE) in children age 8 to 11.

METHODS

A search of 6 databases was conducted in December 2019. Controlled intervention studies were included so long as they used objective measures of MVPA. Methodological quality was assessed using the appropriate Joanna Briggs Institute (JBI) Checklist. Random effects meta-analysis was used where appropriate.

RESULTS

Of the 5459 records, only 5 studies met all inclusion criteria, reporting on 1452 participants; 3 quasi-experimental studies and 2 RCTs. All 5 eligible studies reported favorable intervention effects. Meta-analysis was possible from 4/5 studies: the mean difference between intervention and control groups at follow-up was +14.3% of lesson time in MVPA (confidence interval [CI] 2.7 to 25.8).

CONCLUSIONS

Efforts to increase the MVPA content of elementary school PE are achievable. Two studies employed PE specialist teachers and 1 study used an expert instructor as their intervention, 2 studies worked with the class teachers using self-determination theory. All studies focused on health (MVPA) outcomes and included either "fitness infusions" or physically active games to engage students' in physical activities and increase their activity level.

Objectively measured physical activity and academic performance in school-aged youth: The UP&DOWN longitudinal study

To examine the longitudinal relationships between objectively measured total volume and specific intensities of physical activity (PA) with academic performance in a large sample of youth aged 6-18 years. A longitudinal study of 1046 youth (10.04 ± 3.10 years) from Spain was followed over 2 years. PA (volume and intensity) was measured by accelerometry. Academic performance was assessed through grades reported on the transcript at the end of the academic year (Mathematics, Language, an average of these two core subjects, and grade point average [GPA]). Longitudinal relationships between PA and four indicators of academic performance were examined using covariance and regression analyses, adjusted for a variety of confounders. Youth Quartile 2 for PA volume at baseline obtained better scores than those who participated in Quartiles 1 or 4 volumes of PA in GPA 2 years later (p = 0.006). There were generally no longitudinal associations between specific PA intensities and any of the academic performance indicators (all p > 0.170). However, a change in light PA over 2 years was inversely associated with three academic indicators in youth (β_range , -.103 to - 090; all P < 040). Findings suggest that participants in Quartile 2 volume of PA had a better GPA in comparison with Quartiles 1 and 4 volumes of PA during youth, but there was no association with changes in PA volume over time. PA intensity was generally unrelated to academic performance during youth. However, there was an inverted u-shape relationship between light PA changes and GPA.

Sedentary time is related to deficits in response inhibition among adults with overweight and obesity: An accelerometry and event-related brain potentials study

Excessive sedentariness has been related to poorer cognitive control in adults. Sedentariness may compound obesity-related impairments in response inhibition, but its relationship to response inhibition remains poorly understood. This study investigated the relationship between accelerometer-measured sedentary time (ST, min/day), performance on the Oddball and NoGo tasks, N2 and P3-ERP indices of response inhibition and attentional control in 80 adults with overweight and obesity (55 females, M_age  = 35.2 ± 5.8 years, BMI = 32.8 ± 5.3 kg/m² ). ST was not related to performance on the Oddball task. However, more sedentary adults had larger P3b amplitude to targets. Higher ST was also related to increased attentional resource allocation during NoGo target and nontarget trials as indicated by higher P3b amplitudes across centroparietal sites (C1, Cz, C2, CP1, CPz, CP2; ps ≤ .03). ST was negatively indirectly related to target accuracy on NoGo trials through its association with faster response times to nontargets (95% percentile bootstrap CI for a standardized effect: -0.182, -0.014). ST was not related to N2 amplitude on either Oddball or NoGo target trials. Adjustment for moderate-to-vigorous physical activity (MVPA; all models), age (models with P3b NoGo target amplitude, N2 NoGo target amplitude and latency), and % fat mass (models with target NoGo accuracy and N2 NoGo target amplitude) did not modulate behavioral findings. MVPA did not significantly predict P3b amplitude. Our results suggest suboptimal response inhibition due to trading accuracy for speed and despite the upregulation of attentional resources among more sedentary adults with overweight and obesity.

Effects of a school-based physical activity intervention on academic performance in 14-year old adolescents: a cluster randomized controlled trial - the School in Motion study

BACKGROUND

School-based physical activity interventions evaluating the effect on academic performance usually includes children. We aimed to investigate the effect of a nine-month, school-based physical activity intervention titled School in Motion (ScIM) on academic performance in adolescents.

METHODS

Thirty secondary schools in Norway were cluster-randomized into three groups: the Physically active learning (PAL) group (n = 10), the Don't worry - Be Happy (DWBH) group (n = 10) or control (n = 10). Target dose in both intervention groups was 120 min/week of additional PA during school hours. Parental consent was obtained from 2084 adolescent students (76%). Standardized national tests in reading and numeracy was conducted at baseline and at the end of the intervention. We used linear mixed model to test intervention effects. We found significant intervention effects in numeracy and reading among students in both interventions when compared with controls.

RESULTS

The mean difference in change in numeracy was 1.7 (95% CI: 0.9 to 2.5; Cohen's d = 0.12) and 2.0 (95% CI: 1.4 to 2.7; Cohen's d = 0.23) points in favour of students in the PAL and DWBH intervention, respectively. Similar results were found for reading, where the mean difference in change was 0.9 (95% CI 0.2 to 1.6; Cohen's d = 0.06) and 1.1 (95% CI 0.3 to 1.9; Cohen's d = 0.18) points in favour of students in the PAL and DWBH intervention, respectively. When conducting intention to treat analysis with imputed data the estimates were attenuated and some no longer significant.

CONCLUSION

The ScIM study demonstrates that two different school-based PA interventions providing approximately 120 min of additional PA weekly over nine months, significantly improved numeracy and reading performance in 14-year old students compared with controls. However, the results should be interpreted with caution as the effect sizes reported were very small or small and the estimates were attenuated when conducting intention to treat analysis. Despite this, our results are still positive and suggest that PA interventions are viable models to increase academic performance among adolescents.

TRIAL REGISTRATION

Retrospectively registered (25/01/2019): NCT03817047 .

Differential effects of changes in cardiorespiratory fitness on worst- and best- school subjects

Accumulating evidence shows a beneficial association between physical fitness and school children's academic performance. However, several other studies have failed to demonstrate such an association. We reanalyzed data of a two-year longitudinal study of the association between changes in cardiorespiratory fitness and academic performance of school children by focusing on intra-individual variability in grade points as a possible source of this discrepancy. We analyzed data from 469 junior high school students to examine if improvements in cardiorespiratory fitness had a differential effect on an individual student's worst and best grade points. Results indicated that improvements in physical fitness were associated with an improvement in the worst grade points. On the contrary, we did not observe a similar longitudinal association with the best grade points. These findings suggest that improving cardiorespiratory fitness improves the worst grade points of an individual, selectively. We suggest that intra-individual variability in grade points might moderate the association between physical fitness and academic performance changes.

Estimating the global economic benefits of physically active populations over 30 years (2020-2050)

Objectives

We assess the potential benefits of increased physical activity for the global economy for 23 countries and the rest of the world from 2020 to 2050. The main factors taken into account in the economic assessment are excess mortality and lower productivity.

Methods

This study links three methodologies. First, we estimate the association between physical inactivity and workplace productivity using multivariable regression models with proprietary data on 120 143 individuals in the UK and six Asian countries (Australia, Malaysia, Hong Kong, Thailand, Singapore and Sri Lanka). Second, we analyse the association between physical activity and mortality risk through a meta-regression analysis with data from 74 prior studies with global coverage. Finally, the estimated effects are combined in a computable general equilibrium macroeconomic model to project the economic benefits of physical activity over time.

Results

Doing at least 150 min of moderate-intensity physical activity per week, as per lower limit of the range recommended by the 2020 WHO guidelines, would lead to an increase in global gross domestic product (GDP) of 0.15%–0.24% per year by 2050, worth up to US$314–446 billion per year and US$6.0–8.6 trillion cumulatively over the 30-year projection horizon (in 2019 prices). The results vary by country due to differences in baseline levels of physical activity and GDP per capita.

Conclusions

Increasing physical activity in the population would lead to reduction in working-age mortality and morbidity and an increase in productivity, particularly through lower presenteeism, leading to substantial economic gains for the global economy.

Physical activity and academic achievement among Norwegian adolescents: Findings from a longitudinal study

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A longitudinal study of youth explored physical activity and academic achievement.

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Physical activity was assessed by accelerometry and academic achievement by school grades.

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Mediation through changes in waist circumference and sleep duration were explored.

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Changes in physical activity were not associated with changes in academic achievement.

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There was no mediation via changes in waist circumference or sleep duration.

Regular physical activity (PA) has been associated with academic achievement, but the evidence is mainly based on cross-sectional research and self-reported measures of PA. The purpose of the current study was to explore the longitudinal relationship between objectively measured PA and academic achievement among a cohort of adolescents in Norway between 2016 and 2018. As a secondary aim, an indirect relationship via waist circumference (WC) and sleep duration was assessed. Data from 599 adolescents (54.4% female, mean age at baseline ± SD 13.3 ± 0.3 years) were collected annually during their three years at lower secondary school. PA was measured objectively using accelerometry. Academic achievement was assessed using grade point average (GPA) from school records. Linear regression analysis was performed to explore associations between longitudinal changes in measures of PA (Total PA and moderate-to-vigorous PA [MVPA]) and academic achievement directly or via mediators. Results showed no significant associations between Total PA or MVPA and academic achievement, either in the main analyses or through mediation of WC and sleep duration. The results contribute to a growing evidence base of studies showing no association between objectively measured PA and academic achievement among adolescents.

Influence of Organized vs Non Organized Physical Activity on School Adaptation Behavior

It is now well-established that physical activity has positive effects on both physical and mental health. However, the influence of organized physical activity (i.e., programs controlled and supervised by a trainer) on school adaptive behavior of adolescents with disabilities and/or behavioral disorders remains unclear. School behavior adaptation involves the ability to learn, conform to school norms and manage school activities without major behavior conflicts. A cross-sectional study was conducted to test the differences between organized physical activity and non-organized physical activity in an after school program. Eighty Romanian adolescents were recruited and allocated to three groups: (a) with disabilities [Ds; N = 17, M_age = 14.55 years (SD = 1.16), 12 males and 5 females], (b) with conduct disorders [CDs, N = 21, M_age = 14.52 years (SD = 1.11) 16 males and 5 females], and (c) participants who had not shown signs of conduct disorders or disabilities [as a control group; N = 42, M_age = 14.2 years (SD = 0.46) 20 males and 22 females]. Personality traits, school behavior, and sensorimotor coordination were assessed by using the Eysenck personality questionnaire—junior scale, school in-adaptability questionnaire scale, and Vienna Test System Sport (SMK—sensorimotor coordination test) respectively. Multivariate analysis of variance MANOVA (3 × 3) and discriminant analysis were used to examine differences between the psychological and sensorimotor coordination outcomes across three groups and three types of physical activity context: (a) organized physical activity, (b) non-organized physical activity, and (c) no physical activity. The findings indicate that not participating in an organized physical activity program results in a reduced level of physical mobility and consequently is associated with maladaptive social and psychological outcomes. Thus, we argued that attending in an organized physical activity program is more beneficial for participants with disabilities and/or behavior disorders, due to an increase in the probability of school integration and development of their motor skills. Clearly more research is needed in order to investigate these effects in neurophysiological levels.

Assessment of academic performance of licensed athletes

Objectives Physical activity and sports can be used to reduce stress and anxiety by increasing aerobic capacity and muscle endurance, gain positive behavioral changes and improve their self-discipline, use time well, adopt positive lifestyle such as regular eating and sleeping, which will result in an increase in school success. There are no comprehensive study that examines the academic performance of licensed student athletes and the factors influencing their success rates. The aim of this study was to evaluate the academic performance and related factors in licensed athletes. Methods One hundred eleven licensed athletes at junior high school level were enrolled. Participants filled out questionnaires specifically designed to assess for factors affecting academic performance, where personal and familial factors as well as school performance was taken into consideration. Their academic success rates were evaluated out of mean grade points before as well as after professional sports activities. Academic fields that were graded were, namely, mathematics, life sciences, language, and grammar studies as well as social sciences. Fifty one of participants lived in Ankara (Group 1) and the other 60 lived in Kahramanmaraş (Group 2). The effects of sport and other factors that may affect school success in all groups and between the groups were evaluated before and after sports. Results The age of the athletes were 14.1 ± 2.3 years, 49.5% were male. The grades of athletes before they started competing in professional sports were 80.4 ± 10.6 for mathematics, 80.5 ± 12.5 for sciences, 82.7 ± 9.5 for language studies, and 83.6 ± 9.3 for social sciences. Following a mean period of 4.3 ± 3.1 years of professional sports, the grades of athletes were, with the same order for respective discipline were, 81.6 ± 10.9, 82.4 ± 11.9, 84.3 ± 9.4, and 85.5 ± 8.5. Following sports activities, academic performance in life sciences, language, and grammar studies as well as social sciences showed a significant improvement where grades for mathematics did not show any significant change (p=0.054). The most important factor that improves school performance is the financial status of the family. In Group 1 demonstrated grade improvements following sports activities only in social sciences, whereas Group 2 athletes showed such an improvement for all the disciplines (p<0.05). Conclusions Licensed athletes' school success during the junior high school period showed a significant increase after sports in this study. The most important factors that affected the academic performance were the socioeconomic status of the family.

Engaging adolescents in changing behaviour (EACH-B): a study protocol for a cluster randomised controlled trial to improve dietary quality and physical activity

BACKGROUND

Poor diet and lack of physical activity are strongly linked to non-communicable disease risk, but modifying them is challenging. There is increasing recognition that adolescence is an important time to intervene; habits formed during this period tend to last, and physical and psychological changes during adolescence make it an important time to help individuals form healthier habits. Improving adolescents' health behaviours is important not only for their own health now and in adulthood, but also for the health of any future children. Building on LifeLab-an existing, purpose-built educational facility at the University of Southampton-we have developed a multi-component intervention for secondary school students called Engaging Adolescents in Changing Behaviour (EACH-B) that aims to motivate and support adolescents to eat better and be more physically active.

METHODS

A cluster randomised controlled trial is being conducted to evaluate the effectiveness of the EACH-B intervention. The primary outcomes of the intervention are self-reported dietary quality and objectively measured physical activity (PA) levels, both assessed at baseline and at 12-month follow-up. The EACH-B intervention consists of three linked elements: professional development for teachers including training in communication skills to support health behaviour change; the LifeLab educational module comprising in-school teaching of nine science lessons linked to the English National Curriculum and a practical day visit to the LifeLab facility; and a personalised digital intervention that involves social support and game features that promote eating better and being more active. Both the taught module and the LifeLab day are designed with a focus on the science behind the messages about positive health behaviours, such as diet and PA, for the adolescents now, in adulthood and their future offspring, with the aim of promoting personal plans for change. The EACH-B research trial aims to recruit approximately 2300 secondary school students aged 12-13 years from 50 schools (the clusters) from Hampshire and neighbouring counties. Participating schools will be randomised to either the control or intervention arm. The intervention will be run during two academic years, with continual recruitment of schools throughout the school year until the sample size is reached. The schools allocated to the control arm will receive normal schooling but will be offered the intervention after data collection for the trial is complete. An economic model will be developed to assess the cost-effectiveness of the EACH-B intervention compared with usual schooling.

DISCUSSION

Adolescents' health needs are often ignored and they can be difficult to engage in behaviour change. Building a cheap, sustainable way of engaging them in making healthier choices will benefit their long-term health and that of their future children.

TRIAL REGISTRATION

ISRCTN 74109264 . Registered on 30 August 2019. EACH-B is a cluster randomised controlled trial, funded by the National Institute for Health Research (RP-PG-0216-20004).

Accelerometer-measured physical activity and sedentary behavior in Chinese children and adolescents: a systematic review and meta-analysis

OBJECTIVE

To synthesize evidence on accelerometer-measured moderate-to-vigorous physical activity (MVPA) and sedentary behavior (SB) levels of Chinese children and adolescents.

STUDY DESIGN

This is both a systematic review and meta-analysis study.

METHODS

Online databases were searched for studies published from January 2009 up to February 2019. These studies reported accelerometer-measured daily minutes of MVPA and/or SB among Chinese children and adolescents. Random-effects meta-analysis was used to separately pool the time spent in MVPA and SB.

RESULTS

Of 4754 records, 20 studies were included in the meta-analysis. Sample sizes ranged from 96 to 2163. The meta-analysis showed that Chinese children and adolescents spent 41.11 min/day in MVPA and 529.83 min/day in SB averagely. Boys spent more time in MVPA compared with girls (P = 0.01). Children accumulated more MVPA time than adolescents (P = 0.05), and children spent less time in SB than adolescents (P = 0.05). Unlike weekdays, SB was lower on weekends (P = 0.02). There were significant differences in children and adolescents' MVPA time in regions (P < 0.001).

CONCLUSIONS

MVPA level in Chinese children and adolescents is well below international recommendations, and their SB level is very high.

Association of Physical Fitness with Intelligence and Academic Achievement in Adolescents

Physical fitness, intelligence and academic achievement are being studied from a multidisciplinary perspective. In this line, studies to advance our understanding of intelligence and academic achievement could be relevant for designing school-based programs. Our study analyzed the relationship between components of physical fitness including cardiorespiratory fitness, muscular strength and flexibility and general intelligence and academic achievement in adolescents. We recruited 403 adolescents (53.6% boys) with a mean age of 13.7 ± 1.2 years from a secondary school in Spain with a medium socioeconomic status, during the 2015/2016 school year. Cardiorespiratory fitness was assessed by the 20-m shuttle run, muscular strength with the standing long jump test and flexibility with the sit-and-reach test. General intelligence was measured by both the D48 and the Raven tests. School grades were used to determine academic achievement. Linear regression analyses showed that cardiorespiratory fitness was positively associated with intelligence in both the D48 (all β ≥ 0.184, p ≤ 0.016) and the Raven tests (all β ≥ 0.183, p ≤ 0.024). Muscular strength, flexibility and overall fitness were not associated with intelligence (all β ≤ 0.122, p ≥ 0.139). Cardiorespiratory fitness, muscular strength and flexibility were positively associated with academic achievement (all β ≥ 0.089, p ≤ 0.038), except muscular strength, which was not significantly associated with Spanish language or mathematics, (all β ≤ 0.050, p ≥ 0.200). Overall, cardiorespiratory fitness was positively associated with intelligence and academic achievement.

Associations of Heart Rate Measures during Physical Education with Academic Performance and Executive Function in Children: A Cross-Sectional Study

The current evidence for a relation between children’s heart rate measures and their academic performance and executive functioning is infancy. Despite several studies observing dose-response effects of physical activity on academic performance and executive function in children, further research using objective measures of the relative intensity of physical activity (e.g., heart rate) is warranted. The present study aimed to inspect associations between heart rate response and various academic performance indicators and executive function domains. A total of 130 schoolchildren between the ages of 9 and 13 years (M = 10.69, SD 0.96 years old; 56.9% boys) participated in a cross-sectional study. Children’s heart rate data were collected through participation in physical education classes using the polar Team^TM hardware and software. One week before heart rate measures, academic performance was obtained from the school records in maths, Spanish language, Catalan language, physical education, and Grade point average. Executive function was measured by two domains, cognitive flexibility with the Trail Making Test and inhibition with the Stroop test. Associations between children’s heart rate data and academic performance and executive function were analyzed using regression models. Academic performance was found to be positively related to four heart rate measures (β range, 0.191 to 0.275; all p < 0.040). Additionally, the hard heart rate intensity level was positively related to two academic indicators (β range, 0.183 to 0.192; all p < 0.044). Three heart rate measures were associated with two cognitive flexibility subdomains (β range, −0.248 to 0.195; all p < 0.043), and three heart rate measures were related to one inhibition subdomain (β range, 0.198 to 0.278; all p < 0.028). The results showed slight associations of heart rate responses during physical education lessons with academic performance but did not clearly indicate associations with executive function. Future experimental studies testing associations between different bouts of intensity levels are needed to disentangle the relationship with brain function during childhood.

Effects of a Physical Education Intervention on Academic Performance: A Cluster Randomised Controlled Trial

Background: We investigated the effects of three different interventions on academic performance in students enrolled in the first year of high school. Methods: This was a cluster randomised controlled trial conducted with 1200 students enrolled in the first year of high school. Schools were randomly assigned to: 1. Doubling physical education (PE) classes (3:20 h of PE/week); 2. workshop with the PE teachers; 3. workshop with the PE teachers and doubling the PE classes; and 4. control group (1:40 h of PE/week). We assured that the schools within the groups were equal regarding: The structural condition of the sports court; number of PE teachers; number of school classes; and the average number of students per classroom. Results: Overall, the intervention was not effective in improving the students’ academic performance. However, the subgroup analysis showed that the workshop intervention group increased the academic performance of students who had failed an academic year (from 16 years of age), compared to their peers in the doubling the PE classes (1.3 points on average) and the control groups (1.4 points on average). Conclusions: Enhancing the pedagogical skills of the teachers is a promising approach in improving the academic performance of students who failed an academic year.

Relationship of participation in specific sports to academic performance in adolescents: A 2-year longitudinal study

Physical activity is considered a promising behavior to improve cognitive function and academic performance in adolescents. As evidence on the relationship of specific sports activity is not conclusive, this study aimed to determine the longitudinal relationships of different sports to academic performance in adolescents and evaluate the cardiorespiratory fitness mediation effect of these sports. We focused on the demands of complex motor skills and the differences between individual sports vs team sports. Four hundred and sixty-three 7th-grade students (227 girls and 236 boys) were followed up over 2 years. Data regarding participation in sports activities, types of sports activities, academic performance, and cardiorespiratory fitness were obtained at baseline and after a 2-year follow-up. Structural equation modeling revealed that participation in all sports activity was positively associated with improvement of academic performance from baseline to follow-up, and that these associations were mediated by cardiorespiratory fitness gains. Participation in sports activities that require more complex motor skills and individual sports activity was directly associated with an improvement of academic performance from baseline to follow-up. Furthermore, quitting sports activities was negatively associated with academic performance via a reversal in cardiorespiratory fitness gains. These findings indicate that participation in specific sports may have significant benefits for academic performance in adolescents. Although these relationships are presumably mediated by cardiorespiratory fitness, sports activities that require more complex motor skills and individual sports participation may be directly related to academic performance. Considering that quitting sports activities reversed these benefits, sustained participation in sports is important for academic success.

Physical Activity, Mental and Personal Well-Being, Social Isolation, and Perceptions of Academic Attainment and Employability in University Students: The Scottish and British Active Students Surveys

BACKGROUND

Physical activity (PA) promotes health and well-being. For students, university represents a transitional period, including increased independence over lifestyle behaviors, in addition to new stressors and barriers to engaging in PA. It is, therefore, important to monitor PA trends in students to gain a greater understanding about the role it might play in physical and mental well-being, as well as other factors, such as attainment and employability.

METHODS

Cross-sectional surveys were conducted in 2016 in Scottish universities and colleges, and in 2017 in universities and colleges across the United Kingdom, and the data were pooled for the present study (N = 11,650). Cumulative ordinal logistic regression was used to model the association between PA levels and mental and personal well-being, social isolation, and perceptions of academic attainment and employability.

RESULTS

Only 51% of the respondents met the recommended levels of moderate to vigorous PA per week. There was a linear relationship between PA levels and all outcomes, with better scores in more active students.

CONCLUSIONS

UK university students are insufficiently active compared with the general population of 16- to 24-year olds. Yet, students with higher PA report better outcomes for mental and personal well-being, social isolation, and perceptions of academic attainment and employability.

Longitudinal associations of physical activity and pubertal development with academic achievement in adolescents

OBJECTIVE

We sought to investigate the longitudinal associations of moderate-to-vigorous physical activity (MVPA) and pubertal development with academic achievement in adolescents.

METHODS

A total of 635 adolescents (283 boys, 352 girls) aged 11-13 years participated in the study. MVPA was assessed by the Health Behaviour in School-aged Children study questionnaire, and pubertal development was assessed by the Pubertal Development Scale at beginning of the 6th grade (baseline) and end of the 7th grade (follow-up). Grade point average (GPA) at the end of Grades 5 and 7 was computed from data acquired from the school registers. The data were analyzed using linear regression and analyses of covariance.

RESULTS

In boys, MVPA was positively associated with GPA at baseline after adjustment for age (β = 0.144, 95% confidence interval (CI): 0.028-0.260, p = 0.028). In girls, the Pubertal Development Scale was positively associated with GPA at baseline (β = 0.104, 95%CI: -0.004 to 0.211, p = 0.058) and follow-up (β = 0.104, 95%CI: -0.002 to 0.211, p = 0.055) after adjustment for age, and these associations strengthened after further adjustment for MVPA (p < 0.05). Adolescents who were inactive at baseline or at baseline and follow-up had lower GPA during follow-up than their continuously highly active peers (mean difference = -0.301, 95%CI: -0.543 to -0.058, p = 0.009) and all other adolescents (mean difference = -0.247, 95%CI: -0.475 to -0.019, p = 0.029). These differences were greater in girls than in boys.

CONCLUSION

Lower levels of MVPA were associated with lower GPA in boys at baseline. Girls who were continuously inactive had lower GPA over the follow-up period than those who were continuously active. Finally, earlier pubertal development was associated with better academic achievement in girls.

The Relationship between Physical Activity Levels, Cardiorespiratory Fitness and Academic Achievement School-Age Children from Southern Spain

The relationship between physical activity (PA), cardiorespiratory fitness (CRF) and academic achievement in young people is unclear. The aim of this study was to analyze the relationship between PA, CRF and academic achievement in 152 children according to sex (average age of 8.6 ± 0.3 years) in southern Spain. A tri-axial accelerometer was used to measure PA; the 20-m Shuttle Run Test was performed to assess the CRF; and to know the academic achievement, the official school records were considered. The results showed a weak correlation between moderate PA and moderate-to-vigorous PA (MVPA) with CRF in boys (all, 0.2 > r < 0.4; p < 0.05), whereas the vigorous PA showed a moderate and weak correlation with CRF (all, p < 0.05), in both boys (r = 0.537) and girls (r = 0.382), respectively. In addition, a weak inverse correlation between moderate PA and MVPA with academic achievement showed in girls (all, 0.2 > r < 0.4; p < 0.05). Finally, the CRF weakly correlated with academic achievement only in boys (all, 0.2 > r < 0.4; p < 0.05). Our study showed a relationship between PA and CRF in both sexes. Nonetheless, the PA was inversely related to academic achievement in girls, whereas the CRF was related to academic achievement in boys.

Physical fitness disparities among New York City public school youth using standardized methods, 2006-2017

Standardized physical fitness monitoring provides a more accurate proxy for youth health when compared with physical activity. Little is known about the utilization of broad-scale individual-level youth physical fitness testing to explore health disparities. We examined longitudinal trends in population-level fitness for 4^th-12^th grade New York City youth during 2006/7-2016/17 (average n = 510,293 per year). Analyses were performed in 2019. The primary outcome was whether or not youth achieved sex-/age-specific performance levels (called the Healthy Fitness Zone) on the aerobic capacity, muscular strength and muscular endurance tests using the NYC FITNESSGRAM. The Cooper Institute’s most recent Healthy Fitness Zone criteria were applied to all tests and years. Prevalence estimates were weighted, accounted for school clustering, adjusted for student-level sociodemographics, and run by sociodemographic subgroups and year. The overall prevalence for meeting 3 Healthy Fitness Zones increased from 15.5% (95%CI: 13.9%-17.0%) in 2006/7 to 23.3% (95%CI: 22.2%-24.4%) in 2016/17 for students in grades 4–12. Fitness for all student groups increased over time, although Hispanic and non-Hispanic black girls consistently had the lowest prevalence of meeting 3 Healthy Fitness Zones as compared to all other race/sex subgroups. Also, 9^th-12^th graders had a lower prevalence of meeting 3 Healthy Fitness Zones as compared to 4^th-8^th graders. Given forecasted sharp increases in cardiovascular disease prevalence, routine youth fitness surveillance using standardized, criterion referenced methods can identify important fitness disparities and inform interventions.

The Daily Mile: Whole-school recommendations for implementation and sustainability. A mixed-methods study

Regular physical activity (PA) during childhood is associated with a range of positive health outcomes and higher educational attainment. However, only 2.0% to 14.7% of girls and 9.5% to 34.1% of boys are meeting the current PA guidelines of 60 minutes of moderate to vigorous PA daily. Schools are targeted as a key setting to improve children's PA levels. The Daily Mile (TDM), a teacher-led 15 minute PA intervention was established in 2012 and has been widely adopted globally. However, the dynamic school environment generates challenges for school-based interventions to follow a uniform implementation method resulting in sustainability issues and limited evaluation. The aims of this mixed-methods study were to (1) explore whether whole-school experiences of TDM were related to implementation and (2) examine the association between TDM and CRF in children from high and low socio-economic groups. Focus groups with pupils (n = 6) and interviews with teachers (n = 9) and headteachers (n = 2) were conducted to explore factors associated with successful implementation. Pupils (n = 258 imputed) aged 9-11 from six primary schools in south Wales, United Kingdom participated in CRF assessments (20m shuttle run test) at two time-points (baseline, 6 month follow-up). Thematic analyses of qualitative measures and linear regression analyses of quantitative measures were used to assess the research questions. Qualitative findings identified implementation factors associated with a positive experience of TDM; flexible and adaptable, not replacing current play provision but delivered as an additional playtime, incorporate personal goal setting, teacher participation, whole-school delivery with community support. Both groups demonstrated equal increases in shuttles between baseline and follow-up (deprived: 4.7 ± 13.4, non-deprived: 4.8 ± 16.0). There was no significant difference in this increase for deprived compared to non-deprived children adjusted for age and gender. Findings from this study provide a set of recommendations for the future implementation and sustainability of TDM.

An Overview on the Associations between Health Behaviors and Brain Health in Children and Adolescents with Special Reference to Diet Quality

Unhealthy diet has been associated with overweight, obesity, increased cardiometabolic risk, and recently, to impaired cognition and academic performance. The aim of this review is to provide an overview of the associations between health behaviors and cognition and academic achievement in children and adolescents under 18 years of age with a special reference to diet quality. Dietary patterns with a low consumption of fish, fruits, and vegetables, and high in fast food, sausages, and soft drinks have been linked to poor cognition and academic achievement. The studies on the associations between the high intake of saturated fat and red meat and low intake of fiber and high-fiber grain products with cognition are limited. The available evidence and physiological mechanisms suggest that diet may have direct, indirect, and synergistic effects on brain and cognition with physical activity, sedentary behaviors, cardiometabolic health, and sleep, but the associations have been modest. Therefore, integrating a healthy diet, physically active lifestyle, and adequate sleep may provide optimal circumstances for brain development and learning. We conclude that most of the existing literature is contained in cross-sectional studies, which therefore highlights the need for longitudinal and intervention studies on the effects of diet, physical activity, sedentary behavior, and sleep on cognition and academic performance.

Five models for child and adolescent data linkage in the UK: a review of existing and proposed methods

Over the last decade dramatic advances have been made in both the technology and data available to better understand the multifactorial influences on child and adolescent health and development. This paper seeks to clarify methods that can be used to link information from health, education, social care and research datasets. Linking these different types of data can facilitate epidemiological research that investigates mental health from the population to the patient; enabling advanced analytics to better identify, conceptualise and address child and adolescent needs. The majority of adolescent mental health research is not able to maximise the full potential of data linkage, primarily due to four key challenges: confidentiality, sampling, matching and scalability. By presenting five existing and proposed models for linking adolescent data in relation to these challenges, this paper aims to facilitate the clinical benefits that will be derived from effective integration of available data in understanding, preventing and treating mental disorders.

The Effect of Strengthened Physical Education on Academic Achievements in High School Students: A Quasi-Experiment in China

Objectives: Evidence of school-based physical activity (PA) on academic performance in children and adolescents was inconsistent, especially in high school students who face a high academic burden. In this study, we tested the efficacy of a strengthened physical education (PE) program on academic outcomes in Shanghai. Methods: A quasi-experimental design was conducted to investigate the effect of strengthened PE on academic scores by calculating the grade-cohort difference before and after the intervention. PE curriculum switched from traditional short duration (40 minutes) general fitness training to long duration (90 minutes) specialized sports (e.g., football, aerobics). A total of 460 high school students (236 pre-intervention and 224 post-intervention) were enrolled in grade 10 and followed for two and three semesters. The academic outcome was assessed by district-standardized test scores. A difference-in-difference approach was employed. Results: After two semesters, the standardized Chinese language scores and English language scores for the post intervention group were increased by 0.61 SD (95% confidence interval (CI): 0.44, 0.78, p < 0.001) and 0.28 SD (95% CI: 0.09, 0.47, p = 0.01). However, the standardized math scores for the post intervention group were decreased in girls. After three semesters, standardized Chinese language scores for the post intervention group were increased by 0.27 SD (95% CI: 0.06, 0.48, p = 0.01). Math scores and English language scores decreased by 0.18 SD (95% CI: −0.36, −0.01, p = 0.04) and 0.23 SD (95% CI: −0.38, −0.09, p = 0.00), respectively. Conclusion: A school-based physical education program had mixed effects on academic scores in high school students.

The effects of student, school and neighborhood poverty on the association between fitness and absenteeism in New York City middle school youth

Recent research demonstrates that youth fitness improvements are associated with lower absenteeism. This study assessed whether the effects of poverty on the longitudinal fitness-absenteeism relationship are consistent across poverty measures at the student, school, and neighborhood levels and across sex in New York City (NYC) public school youth individually followed over 4 years. Negative binomial longitudinal mixed models with random-intercepts were developed stratified by five dichotomized student, school and neighborhood poverty measures and sex to test the change in fitness-lagged absenteeism relationship in six cohorts of NYC middle school students (2006/7-2012/13). Models were adjusted for individual-level race/ethnicity, place of birth, change in obesity status, grade, time, and school size. The sample included 360,743 students (51% male, 39% Hispanic, 28% non-Hispanic black, 69% qualifying for free/reduced price school meals). Adjusted estimates showed an inverse dose-response fitness-absenteeism relationship in high poverty youth across all poverty measures, including the student, school and neighborhood levels. For example, in girls exposed to high poverty based on school neighborhood, absenteeism decreased by 11.3% (IRR = -0.12, 95% CI: -0.20, -0.04), 10.4% (IRR = -0.11, 95% CI: -0.21, -0.02), 6.8% (IRR = -0.07, 95% CI: -0.14, 0.00) and 4.9% (IRR = -0.05, 95% CI: -0.15, 0.04) for students who had a >20% increase, 10-20% increase, <10% change, and 10-20% decrease in fitness from the prior year, respectively, relative to the reference group (>20% decrease in fitness). Future research should explore the impact of tailored interventions for youth that aim to promote youth physical activity at each of the individual, school and neighborhood levels, and particularly among high poverty subgroups.

Effects of a programme of vigorous physical activity during secondary school physical education on academic performance, fitness, cognition, mental health and the brain of adolescents (Fit to Study): study protocol for a cluster-randomised trial

BACKGROUND

Early adolescence is a period of dynamic neurobiological change. Converging lines of research suggest that regular physical activity (PA) and improved aerobic fitness have the potential to stimulate positive brain changes, improve cognitive function and boost academic attainment in this age group, but high-quality studies are needed to substantiate these findings. The primary aim of the Fit to Study trial is to investigate whether short infusions of vigorous PA (VPA) delivered during secondary school physical education (PE) can improve attainment in maths, as described in a protocol published by NatCen Social Research. The present protocol concerns the trial's secondary outcome measures, which are variables thought to moderate or mediate the relationship between PA and attainment, including the effect of the intervention on cardiorespiratory fitness, cognitive performance, mental health and brain structure and function.

METHOD

The Fit to Study project is a cluster-randomised controlled trial that includes Year 8 pupils (aged 12-13) from secondary state schools in South/Mid-England. Schools were randomised into an intervention condition in which PE teachers delivered an additional 10 min of VPA per PE lesson for one academic year, or a 'PE as usual' control condition. Intervention and control groups were stratified according to whether schools were single-sex or co-educational. Assessments take place at baseline (end of Year 7, aged 11-12) and after 12 months (Year 8). Secondary outcomes are cardiorespiratory fitness, objective PA during PE, cognitive performance and mental health. The study also includes exploratory measures of daytime sleepiness, attitudes towards daily PA and PE enjoyment. A sub-set of pupils from a sub-set of schools will also take part in a brain imaging sub-study, which is embedded in the trial.

DISCUSSION

The Fit to Study trial could advance our understanding of the complex relationships between PA and aerobic fitness, the brain, cognitive performance, mental health and academic attainment during adolescence. Further, it will add to our understanding of whether school PE is an effective setting to increase VPA and fitness, which could inform future PA interventions and education policy.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT03286725 . Retrospectively registered on 18 September 2017. ClinicalTrials.gov, NCT03593863 . Retrospectively registered on 19 July 2018.

The impact of a park refurbishment in a low socioeconomic area on physical activity: a cost-effectiveness study

Background

Physical inactivity is the fourth highest cause of death globally and is a major contributor to increases in healthcare expenditure. Improving public open spaces such as parks in areas of low socio-economic position (SEP) may increase recreational physical activity in disadvantaged populations. We assessed the cost-effectiveness of the installation of a play-space in a large metropolitan park in a low socioeconomic area based on changes in physical activity.

Methods

Observational data of visitor counts and activities undertaken in the park before the installation of the new play-scape (T1), at two months (T2) and 14 months post-installation (T3) were obtained for the intervention and a control park (with no refurbishment) located in a high SEP metropolitan area. Observed sitting, standing, and moderate and vigorous-intensity physical activity were converted to yearly MET-h according to age. Costs of the play-scape and ongoing maintenance were obtained from the organisation managing the refurbishment. The incremental cost-effectiveness ratio (ICER) (ratio of incremental cost to incremental effect) was calculated based on the incremental increase in MET-h from T1 to T3 assuming a 20-year lifetime of the play-scape. Observation counts combining moderate and vigorous activity were used in the sensitivity analysis.

Results

When compared with T1, at T3 the new play-scape resulted in an overall incremental net gain of 114,114 MET-h (95% UI: 80,476 − 146,096) compared with the control park and an incremental cost effectiveness ratio (or cost per MET-h gained per park visitor) of AUD $0.58 (95% UI: $0.44–$0.80).

The sensitivity analysis combining moderate and vigorous activity into one category showed an increase in estimated incremental MET-h of 118,190 (95% CI: 83,528 − 149,583) and a lower incremental cost per MET-h gained of AUD $0.56 (95% UI: $0.43–$0.77).

Conclusions

Using a benchmark of cost-effectiveness for physical activity interventions of AUD $0.60–$1.30, this study suggests that the installation of a play-scape located in a low SEP area is cost-effective based on its potential to facilitate increases in MET-h. It provides much needed preliminary evidence and requires replication elsewhere.

Electronic supplementary material

The online version of this article (10.1186/s12966-019-0786-5) contains supplementary material, which is available to authorized users.

Physical Activity and Sedentary Time Are Positively Associated With Academic Performance: A 3-Year Longitudinal Study

BACKGROUND

To analyze the longitudinal association between academic performance and moderate to vigorous physical activity (MVPA), vigorous physical activity (VPA), and sedentary (SED) in a 3-year longitudinal study. A secondary aim was to determine whether MVPA and VPA were indirectly related with academic performance via waist circumference (WC).

METHODS

Physical activity (PA) and SED were measured by accelerometers. Academic performance was assessed by national tests in Danish and Math. Structural equation modeling was performed to evaluate whether MVPA, VPA, and SED were associated with academic performance and the potential PA-academic performance indirect relationship via WC.

RESULTS

MVPA and VPA were associated with academic performance, mediated via WC (β = 0.036; 95% confidence interval [CI], 0.002 to 0.070 and β = 0.096; 95% CI, 0.027 to 0.164, respectively). SED was directly associated with academic performance (β = 0.124; 95% CI, 0.030 to 0.217, MVPA model and β = 0.132; 95% CI, 0.044 to 0.221, VPA model). WC was negatively associated with academic performance.

CONCLUSIONS

Both PA and SED time were positively associated with academic performance. Based on this, PA should be encouraged in children and youth not only to promote physical health but also to promote academic performance. Future studies should distinguish between school-related SED and other SED activities and their relationship with academic performance.

Physical Activity, Health-Related Fitness, and Classroom Behavior in Children: A Discriminant Function Analysis

PURPOSE

The purpose of this study was to examine the predictive relationship among physical activity, health-related fitness, and on-task classroom behavior in children using a discriminant function analysis.

METHOD

Participants were a convenience sample of children (N = 533; M_age = 8.8 ± 1.9 years) recruited from 77 1st- through 5th-grade classrooms at 3 low-income schools in a capital city in the Southwest United States. Percent of the school day spent in sedentary behavior (%SED), moderate-to-vigorous physical activity (%MVPA), and health-related fitness scores (body mass index [BMI] and Progressive Aerobic Cardiovascular Endurance Run [PACER] laps) were assessed during school hours. Classrooms were observed for on-task behavior during the academic year with the use of 5-s momentary time sampling methodology. A discriminant function analysis was performed using a binary on-task behavior outcome, stratified by an 80% on-task behavior cut point.

RESULTS

The results yielded 1 function (r² = .26, F = 13.1) explaining approximately one quarter of the total variance. The standardized function coefficients were -.29, .29, -.48, and .48 for %SED, %MVPA, BMI, and PACER laps, respectively. The sensitivity and specificity of the derived function for classifying a child into an on-task or off-task classroom were .79 and .73, respectively. Children who belonged to classrooms that achieved 80% on-task behavior displayed shorter times in sedentary behaviors (d = 1.01), lower BMI (d = 0.13), and higher PACER scores (d = 0.22) compared with children who belonged to off-task classrooms.

CONCLUSION

School-day physical activity behaviors and health-related fitness scores can moderately discriminate children who belong to classrooms from low-income schools that are categorized as being sufficiently on task.

The Relationship between Levels of Physical Activity and Academic Achievement among Medical and Health Sciences Students at Cyberjaya University College of Medical Sciences

Background

This study aimed to explore the prevalence of physical activity among medical and health sciences students at Cyberjaya University College of Medical Sciences (CUCMS) and to determine the relationship of their physical activity level with their academic achievement and self-determination level.

Methods

An analytical cross-sectional study was conducted among 244 Medical and Health Sciences undergraduate students at CUCMS from January to April 2017 using self-administered short-form version of the International Physical Activity Questionnaire (IPAQ-SF) and the third version of the Behavioural Regulation in Exercise Questionnaire (BREQ-3). Multiple regression models were fitted using SPSS version 20 to examine the relationships between study variables.

Results

Half of the male students (51.7%) were in the health-enhancing physical activity (HEPA) group, as compared to only 24.7% of females. The odds of having a good grade point average was twice as high among HEPA active students (odds ratio [OR] = 1.89, 95% CI [1.09, 3.27], P = 0.023) than among non-HEPA active students. Further, the odds of being HEPA active was higher for males (OR = 3.16, 95% CI [1.61, 6.14], P < 0.01) than for females and higher for overweight students than for normal weight students (OR = 2.58, 95% CI [1.24, 5.57], P = 0.017). The odds of being HEPA active was 1.79 times higher for each unit increase in the integrated regulation score (OR = 1.79, 95% CI [1.14, 2.91], P = 0.020).

Conclusion

The prevalence of physical inactivity was higher among females than males. This study also confirmed a significant association between physical activity level and academic achievement. HEPA active students performed better academically than those who were non-HEPA active.

Physical fitness predicts the academic achievement over one-school year follow-up period in adolescents

The purposes of this study were to examine how fitness at the baseline could predict both academic achievement and academic achievement changes one school year in advance. A total of 194 adolescents (mean age: 14.15 ± 0.97 years old, 112 boys) who attended secondary school participated in our study. Cardiorespiratory fitness was measured with the 20 m endurance shuttle-run test. We also assessed the lower-limbs muscular strength with the standing long jump test and flexibility with the sit-and-reach test. The academic achievement was assessed by school grades. We performed linear regression analyses. Additionally, we examined the relationship between fitness and changes in the academic performance following the same statistical methodology. Cardiorespiratory fitness was positively associated with mathematics one school year in advance (p = 0.025). Cardiorespiratory fitness was also positively associated with changes in Spanish language (p = 0.005), mathematics (p = 0.023), and the grade point average (p = 0.006). Muscular strength was also positively associated with changes in Spanish language (p = 0.040) and mathematics (p = 0.010), while flexibility was associated with changes in Spanish language (p = 0.039) and the grade point average (0.027). Our results suggest that cardiorespiratory fitness was positively associated with academic achievement in adolescents.

Effect of multiple risk behaviours in adolescence on educational attainment at age 16 years: a UK birth cohort study

OBJECTIVES

To explore the association between adolescent multiple risk behaviours (MRBs) and educational attainment.

DESIGN

Prospective population-based UK birth cohort study.

SETTING

Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort of children born in 1991-1992.

PARTICIPANTS

Data on some or all MRB measures were available for 5401 ALSPAC participants who attended a clinic at age 15 years and/or completed a detailed questionnaire at age 16 years. Multiple imputation was used to account for missing data.

PRIMARY OUTCOME MEASURES

Capped General Certificate of Secondary Education (GCSE) score and odds of attaining five or more GCSE examinations at grades A*-C. Both outcome measures come from the National Pupil Database and were linked to the ALSPAC data.

RESULTS

Engagement in MRB was strongly associated with poorer educational attainment. Each additional risk equated to -6.31 (95% CI -7.03 to -5.58, p<0.001) in capped GCSE score, equivalent to a one grade reduction or reduced odds of attaining five or more A*-C grades of 23% (OR 0.77, 95% CI 0.74 to 0.81, p<0.001). The average cohort member engaged in 3.24 MRB and therefore have an associated reduction in GCSE score equivalent to three and a half grades in one examination, or reduced odds of attaining five or more A*-C grades of 75%.

CONCLUSION

Engagement in adolescent MRB is strongly associated with poorer educational attainment at 16 years. Preventing MRB could improve educational attainment and thereby directly and indirectly improve longer-term health.

Physical Activity and Health-Related Fitness of Adolescents within the Juvenile Justice System

Background

The purpose of this study was to examine the physical activity patterns and health-related fitness levels of adolescents within the Juvenile Justice System.

Methods

Participants included 68 adolescents (Mean age = 17.1 ± 1.0 years) in two secure Juvenile Justice correctional facilities in the Western USA. Moderate-to-vigorous physical activity (MVPA) was monitored for one week using the ActiGraph GT9X accelerometer. Health-related fitness was measured using the FITNESSGRAM test battery.

Results

Adolescents averaged 43.3±21.6 minutes of MVPA per weekday compared to 42.7±27.5 per weekend day. During school hours, adolescents accumulated 17.1±9.0 minutes of MVPA compared to 5.9±3.4 minutes before school and 21.0±13.6 minutes after school. Adolescents averaged 18.9±11.0 push-ups, 44.5±26.4 curl-ups, 34.7±24.8 PACER laps, and 22.1%±10.0% body fat.

Conclusions

Adolescents within the Juvenile Justice System are falling short of the recommended 60 minutes of MVPA per day and 30 minutes of MVPA during school and also need to improve their health-related fitness, especially cardiorespiratory endurance.

A Person-Centered Analysis of Motivation for Physical Activity and Perceived Neighborhood Environment in Residents of Assisted Living Facilities

This study sought to identify profiles of individual, social, and perceived neighborhood environmental correlates of physical activity (PA) and to explore differences between the identified profiles in PA. Residents of assisted living facilities ( N = 87, M age = 77.57 years) were recruited for the cross-sectional study. Participants reported their perceived support from important others for PA, basic psychological need satisfaction and motivation for PA, and perceived neighborhood environment around the assisted living facilities. Engagement in light PA and moderate-to-vigorous PA was measured by accelerometers over 1 week. We identified three profiles using latent profile analysis: ‘low self-determined and minimally supported', ‘moderately self-determined and supported', and ‘highly self-determined and supported'. Results showed participants in the highly self-determined and supported profile engaged in higher levels of light PA and moderate-to-vigorous PA than participants from other profiles. Findings showed perceptions of the neighborhood environment should be taken into account with motivation regarding PA.

Children's Compliance With Wrist-Worn Accelerometry Within a Cluster-Randomized Controlled Trial: Findings From the Healthy Lifestyles Programme

PURPOSE

The purpose of this study was to assess children's compliance with wrist-worn accelerometry during a randomized controlled trial and to examine whether compliance differed by allocated condition or gender.

METHODS

A total of 886 children within the Healthy Lifestyles Programme trial were randomly allocated to wear a GENEActiv accelerometer at baseline and 18-month follow-up. Compliance with minimum wear-time criteria (≥10 h for 3 weekdays and 1 weekend day) was obtained for both time points. Chi-square tests were used to determine associations between compliance, group allocation, and gender.

RESULTS

At baseline, 851 children had usable data, 830 (97.5%) met the minimum wear-time criteria, and 631 (74.1%) had data for 7 days at 24 hours per day. At follow-up, 789 children had usable data, 745 (94.4%) met the minimum wear-time criteria, and 528 (67%) had complete data. Compliance did not differ by gender (baseline: χ² = 1.66, P = .2; follow-up: χ² = 0.76, P = .4) or by group at follow-up (χ² = 2.35, P = .13).

CONCLUSION

The use of wrist-worn accelerometers and robust trial procedures resulted in high compliance at 2 time points regardless of group allocation, demonstrating the feasibility of using precise physical activity monitors to measure intervention effectiveness.

Modeling relationships of achievement motivation and physical fitness with academic performance in Japanese schoolchildren: Moderation by gender

The aim of this study was to determine, using structural equation modeling, the comprehensive relationships of achievement motivation (self-fulfillment achievement motivation [SFAM] and competitive achievement motivation [CAM]), daily behaviors (exercise habits, screen time, and learning duration), body mass index [BMI], and cardiorespiratory fitness [CRF]) with academic performance among schoolchildren. Three hundred twenty-five schoolchildren (172 males and 153 females; 12-13 years old) were recruited. Academic performance was assessed using the total grade points in 8 academic subjects (GP8); CRF using the 20-m shuttle run; and achievement motivation, daily behaviors, and socioeconomic status using questionnaires. Socioeconomic status was included as a control variable. In males, two cascade associations of achievement motivation to GP8 were detected: (1) SFAM → screen time/learning duration → GP8, and (2) CAM → exercise habit → CRF → GP8 (χ² = 8.72, p = .19, AGFI = .92). In females, two cascade associations were also detected: (1) SFAM → screen time/learning habit → GP8, and (2) exercise habit → BMI² → GP8 (χ² = 6.17, p = .41, AGFI = .93). Our results suggest that greater achievement motivation is associated with academic success via various physiological/behavioral factors, and that these associations differ by gender.

The association of fitness and school absenteeism across gender and poverty: a prospective multilevel analysis in New York City middle schools

PURPOSE

One-fifth to one-third of students in high poverty, urban school districts do not attend school regularly (missing ≥6 days/year). Fitness is shown to be associated with absenteeism, although this relationship may differ across poverty and gender subgroups.

METHODS

Six cohorts of New York City public school students were followed up from grades 5 to 8 during 2006/2007-2012/2013 (n = 349,381). Stratified three-level longitudinal generalized linear mixed models were used to test the association between changes in fitness and 1-year lagged child-specific days absent across gender and poverty.

RESULTS

In girls attending schools in high/very high poverty areas, greater improvements in fitness the prior year were associated with greater reductions in absenteeism (P = .034). Relative to the reference group (>20% decrease in fitness composite percentile scores from the prior year), girls with a large increase in fitness (>20%) demonstrated 10.3% fewer days absent (incidence rate ratio [IRR] 95% confidence interval [CI]: 0.834, 0.964), followed by those who had a 10%-20% increase in fitness (9.2%; IRR 95% CI: 0.835, 0.987), no change (5.4%; IRR 95% CI: 0.887, 1.007), and a 10%-20% decrease in fitness (3.8%; IRR 95% CI: 0.885, 1.045). In girls attending schools in low/mid poverty areas, fitness and absenteeism also had an inverse relationship, but no clear trend emerged. In boys, fitness and absenteeism had an inverse relationship but was not significant in either poverty group.

CONCLUSIONS

Fitness improvements may be more important to reducing absenteeism in high/very high poverty girls compared with low/mid poverty girls and both high/very high and low/mid poverty boys. Expanding school-based physical activity programs for youth particularly in high poverty neighborhoods may increase student attendance.

Distraction versus Intensity: The Importance of Exercise Classes for Cognitive Performance in School

OBJECTIVE

The aim of this study was to compare the influence of a class of aerobic exercise and an art class on brain cortical activity and possible effects on cognitive performance.

SUBJECT AND METHODS

Electroencephalography was used to record the electrocortical activity of 16 schoolchildren (8-10 years old) before and after an aerobic exercise class and an art class. Performance in a standardized test of educational attainment (VERA-3) was assessed following both classes.

RESULTS

A significant decrease in cortical activity was detected in all 4 lobes after exercise but not after art classes (p < 0.05). No changes in cognitive performance were observed after exercise and art classes.

CONCLUSION

In this study, cortical activity was reduced after an exercise class but no effect on cognitive performance was observed. Hence, the neurophysiological effect of exercise should be further evaluated regarding different kinds of cognitive performance: creativity, knowledge acquisition as well as the outlasting effects of exercise on academic achievement.