Physical Activity in the School Setting: Cognitive Performance Is Not Affected by Three Different Types of Acute Exercise

Cluster analysis of physical activity and physical fitness and their associations with components of school skills in children aged 8-9 years

This study aimed to cluster physical activity (PA), physical fitness, visual-motor coordination, household duties, and their associations with school skills in 170 primary school children (88 girls and 82 boys) aged 8-9 years. Conducted as a cross-sectional design, the study analysed moderate-to-vigorous physical activity (MVPA) and household duties, which were assessed via questionnaires. Academic skills were evaluated using methods designed to diagnose school failure in students aged 7-9 years. Physical fitness was measured using the Eurofit test battery, and visual-motor coordination was assessed using a Piórkowski apparatus. Cluster analysis and general linear and non-linear regression analyses were used to determine associations with academic skills. Three clusters emerged: Cluster 1 (C1) was characterised by fast visual-motor coordination, high flexibility, and more time on household duties; Cluster 2 (C2) included children with the highest levels of PA and better performance in physical fitness items; Cluster 3 (C3) consisted of children with the lowest levels of PA, fitness, and low time on household duties. A regression analysis demonstrated a significant positive impact of cluster C1 on visual-auditory integration (total), with significantly better results for children in C1 compared to those in C3 (b = -2.69; p = 0.003). These results suggest that better visual-motor coordination, higher flexibility, and more time on housework are associated with better visual-auditory integration. Further research is needed to explore the physical and mental benefits of PA.

Integrating Kata Training into School Education: Effects on Sustained Attention and Cognitive Performance in 8-9-Year-Old Children

(1) Background: The ability to sustain attention in primary school children aged 8-9 years plays a critical role in maintaining focus for extended periods, enabling them to comprehend and integrate large amounts of information. Enhancing sustained attention during this formative stage significantly improves a child's capacity to acquire and consolidate new skills and knowledge, laying a strong foundation for academic and cognitive development. (2) Objectives: This study aimed to assess the effect of an 8-week kata training program on attention and its components in 8-9-year-old school-age children, a critical developmental period for attention. (3) Methods: After excluding the participants who gave a low number of correct answers in the pre-test or created a ceiling effect, 43 participants, aged 9.12 ± 0.40 years, were included in this study. This study, conducted during the academic term, included three measurement phases and a familiarization session. Attention parameters were evaluated using the Bourdon-Vos Test, and participants were categorized into Low Performers (LP) and High Performers (HP) based on pre-test scores. The intervention group (INT) underwent kata training thrice weekly for 8 weeks, while the control group (CON) followed their regular activities. Post-training, attention parameters were reassessed using the Bourdon-Vos Test. (4) Results: In the post-intervention analysis, significant improvements in the number of correct responses were observed in both the LP (p < 0.001, Cohen's d = -1.333) and HP (p = 0.001, Cohen's d = -1.644) groups within the INT group. In the CON group, significant improvement was observed only in the HP group (p = 0.031, Cohen's d = -0.948). Regarding attention processing speed, significant pre-post improvements were found exclusively in the INT group (p < 0.001). Block-wise analysis revealed significant differences only in Block 1 of the CON group (p = 0.011, Cohen's d = -0.522). However, in the INT group, significant improvements were observed in both Block 1 (p < 0.001, Cohen's d = -1.200) and Block 2 (p = 0.004, Cohen's d = -0.678). (5) Conclusions: The findings of this study highlight the effectiveness of an 8-week kata training program in enhancing sustained attention and cognitive processing speed among 8-9-year-old children, particularly in low-performing groups. This suggests that integrating structured kata-based motor and cognitive activities into school curricula can serve as a promising strategy for addressing attention deficits and promoting cognitive development during this critical developmental period. Future studies should examine the long-term effects of kata training on attention and related cognitive functions, such as working memory and executive control. Investigating neurophysiological mechanisms through neuroimaging and including diverse age groups with larger samples could further validate these findings.

Diurnal variation of psychomotor, cognitive and physical performances in schoolchildren: sex comparison

BACKGROUND

The present study investigated the effect of time of day (08h00 vs. 11h00 vs. 14h00 vs. 17h00) and sex (girls vs. boys) on physical (i.e., five jump test (5JT), push-ball test and 5 m shuttle run test (5mSRT)), cognitive (i.e., attention) and mental (i.e., mental flexibility) performances.

METHODS

Thirty schoolchildren, equally divided in girls (n = 15; age: 9.60 ± 0.51 years) and boys (n = 15; age: 9.40 ± 0.51 years) performed the digit cancellation test, the trail making test, the 5JT, the 2 kg push-ball test and the 5mSRT in a counterbalanced and cross over study design at 08h00, 11h00, 14h00 and 17h00 with 48 h of rest in between. Additionally, rating of perceived exertion (RPE) was determined after each repetition of the 5mSRT and the average of the score (i.e., sum of RPE scores divided by 6) was determined.

RESULTS

Results showed that RPE at the end of the test was significantly higher at 11h00 compared to 08h00 (p = 0.02) and 14h00 (p = 0.001) and average RPE was higher at 11h00 compared to 08h00 (p = 0.001). Likewise, attention was significantly higher at 08h00 compared to 17h00 (p = 0.001) before and after the 5mSRT test only in girls. However, 5JT performance was significantly lower at 17h00, both in girls and boys, compared to at 08h00 (p = 0.02 and p = 0.001 respectively), 11h00 (p = 0.004 and p = 0.001 respectively) and 14h00 (p = 0.001 and p = 0.001 respectively). However, push-ball (p = 0.086) and 5mSRT performances [best distance (p = 0.173), total distance (p = 0.306), mean distance (p = 0.29), fatigue index (p = 0.06)] were time of day independent. Mental flexibility was significantly higher at 08h00, 11h00 and 14h00 compared to 17h00 (p = 0.001).

CONCLUSION

Mental flexibility, attention and jump performances were time of day dependent and push-ball test and 5mSRT performances did not change according to the time of day. Also, no clear sex effect was found on the diurnal variation of mental, cognitive and physical performances.

A single session of coordinative motor training does not improve spatial ability performances in healthy children

Background

In recent years, studies have found small-to-medium positive effects of physical activity on academic achievement. Already acute bouts of exercise appear to improve certain cognitive functions. Spatial abilities are one aspect of cognition that is encountered frequently in daily life and that is closely related to success in science, technology, engineering, and mathematics (STEM)-subjects. However, little is known about the effects of an acute exercise session on spatial abilities. The aim of this study was therefore to evaluate the effect of a single session of coordinative motor training (CMT) on spatial ability performances in healthy children.

Methods

Forty-nine children were assigned to either a single session of CMT (i.e., obstacle course with motor coordinative and spatial elements) (n = 25, 12 females, mean age: 10.7 ± 0.6 years) or a resting control group (n = 24, 12 females, mean age ± SD: 11.4 ± 0.5 years). Spatial abilities were evaluated in both groups using the Paper Folding Test (PFT), Mental Rotation Test (MRT), Water Level Task (WLT), Corsi Block Test (CBT), and Numbered Cones Run (NCR).

Results

A statistical main effect for Test was observed for the majority of outcomes (i.e., all but the MRT). Test × Group interactions did not reach the level of significance.

Conclusion

The results indicate that a single session of CMT does not improve spatial ability performances of healthy children. Future research should evaluate whether repeated longer-term interventions might be more suitable to generate significant improvements in spatial abilities.

Development and validation of a questionnaire to assess the implementation of physical education programs in Chinese junior high schools

BACKGROUND

Students' physical fitness has always been the focus of attention of the Chinese government, and the school as an important way to improve students' physical fitness, there are many studies on the current status of the implementation of physical education in schools, and there are many studies that use self-made questionnaires to investigate the implementation of physical education in schools, but most of the studies do not adequately validate the self-made questionnaires, so the purpose of this study was to develop a questionnaire to assess the level of implementation of physical education programmes in Chinese junior secondary schools and to test its reliability and validity.

METHOD

The content of the questionnaire was developed based on the content of Annex 1 of the Assessment Measures for Physical Education in Primary and Secondary Schools issued by the Ministry of Education of China in 2014 and was modified based on feedback from the expert panel and pre-test participants. The questionnaire was initially tested for validity by 5 expert reviewers, and then we collected data information from 350 participants and conducted exploratory factor analysis (EFA) to explore the factor structure of the initial version. One week later, 40 of the 350 participants were randomly selected to assess test-retest reliability.

RESULTS

The I-CVI and KAPPA value analysis results of the expert review results show that the questionnaire has extremely high reliability and consistency among experts. EFA results indicate that the five dimensions of this questionnaire are highly reliable. In the test-retest reliability, the Pearson correlation coefficients of the initial test data and the retest data of each dimension are all greater than 0.7, and the significance probability values are all less than 0.05, reaching the significance level, the results show that the questionnaire has good stability.

CONCLUSIONS

This study concluded that the 5 dimensions and 38 items of this questionnaire had high reliability and validity and could be used as a preliminary tool to measure the implementation level of physical education programs in junior high schools in China. However, future research should explore the potential need for adjustment to suit different regions and cultures.

Acute exercise and children's cognitive functioning: What is the optimal dose of cognitive challenge?

Acute bouts of exercise have the potential to benefit children's cognition. Inconsistent evidence on the role of qualitative exercise task characteristics calls for further investigation of the cognitive challenge level in exercise. Thus, the study aim was to investigate which "dose" of cognitive challenge in acute exercise benefits children's cognition, also exploring the moderating role of individual characteristics. In a within-subject experimental design, 103 children (Mage = 11.1, SD = 0.9, 48% female) participated weekly in one of three 15-min exergames followed by an Attention Network task. Exergame sessions were designed to keep physical intensity constant (65% HRmax) and to have different cognitive challenge levels (low, mid, high; adapted to the ongoing individual performance). ANOVAs performed on variables that reflect the individual functioning of attention networks revealed a significant effect of cognitive challenge on executive control efficiency (reaction time performances; p = .014, ƞ2p = .08), with better performances after the high-challenge condition compared to lower ones (ps < .015), whereas alerting and orienting were unaffected by cognitive challenge (ps > .05). ANOVAs performed on variables that reflect the interactive functioning of attention networks revealed that biological sex moderated cognitive challenge effects. For males only, the cognitive challenge level influenced the interactive functioning of executive control and orienting networks (p = .004; ƞ2p = .07). Results suggest that an individualized and adaptive cognitively high-challenging bout of exercise is more beneficial to children's executive control than less challenging ones. For males, the cognitive challenge in an acute bout seems beneficial to maintain executive control efficiency also when spatial attention resources cannot be validly allocated in advance. Results are interpreted referring to the cognitive stimulation hypothesis and arousal theory.

Effects of a games-based physical education lesson on cognitive function in adolescents

Despite the importance of physical education (PE) lessons for physical activity in adolescents, the acute cognitive responses to PE lessons have not been explored; a gap in the literature that this study addresses. Following familiarisation, 76 (39 female) adolescents (12.2 ± 0.4 y) completed two trials (60 min games-based PE lesson and 60 min academic lesson) separated by 7-d in a counterbalanced, crossover design. Attention, executive function, working memory, and perception were assessed 30 min before, immediately post, and 45 min post-lesson in both trials. Participants were split into high-and low-fit groups based on a gender-specific median split of distance run on the multi-stage fitness test. Furthermore, participants were split into high and low MVPA groups based on a gender-specific median split of MVPA time (time spent &gt;64% HR max) during the PE lesson. Overall, a 60 min games-based PE lesson had no effect on perception, working memory, attention, or executive function in adolescents (all p &gt; 0.05) unless MVPA time is high. The physical activity-cognition relationship was moderated by MVPA, as working memory improved post-PE lesson in adolescents who completed more MVPA during their PE lesson (time*trial*MVPA interaction, p &lt; 0.05, partial η2 = 0.119). Furthermore, high-fit adolescents displayed superior cognitive function than their low-fit counterparts, across all domains of cognitive function (main effect of fitness, all p &lt; 0.05, partial η2 0.014–0.121). This study provides novel evidence that MVPA time moderates the cognitive response to a games-based PE lesson; and emphasises that higher levels of fitness are beneficial for cognitive function in adolescents.

Associations Between Gross Motor Coordination and Executive Functions: Considering the Sex Difference in Chinese Middle-Aged School Children

Considering that motor and cognitive processes are intertwined and inhibit or help each other throughout life and that primary school age is one of the most critical stages of children's cognitive and motor development, this study aimed to investigate the relationship between executive functions and gross motor skills in Chinese children aged 9–10 years, as well as gender differences. The flanker task, the 1-back task, the more-odd shifting task, and the test of gross motor coordination (Körperkoordinationtest für Kinder) were used to collect data on executive functions and gross motor coordination. The results were as follows. First, there was a weak association between gross motor coordination and the inhibition reaction time in the congruent test and the reaction time of working memory (r = −0.181 to −0.233), but no association was found between gross motor coordination and cognitive flexibility. Second, a weak-to-moderate correlation was presented between the move sideways test and the inhibition reaction time in the congruent test and the reaction time in the refreshing test of the working memory (r = −0.211 to −0.330). Finally, gender influenced on the relationship between gross motor coordination and the reaction time of both inhibition (βGender = −0.153, p &lt; 0.05) and working memory (βGender = −0.345, p &lt; 0.01). To conclude, our results suggest that children with better motor coordination skills require less reaction time, especially girls, and this association was more substantial than in boys. The finding supports the current assertion that there are commonalities between gross motor coordination and cognitive control by showing the relationship between gross motor coordination and complex cognitive processes (executive function) in preadolescent children.

Effects of Classroom-Based Resistance Training With and Without Cognitive Training on Adolescents' Cognitive Function, On-task Behavior, and Muscular Fitness

Aim: Participation in classroom physical activity breaks may improve children's cognition, but few studies have involved adolescents. The primary aim of this study was to examine the effects of classroom-based resistance training with and without cognitive training on adolescents' cognitive function. Methods: Participants were 97 secondary school students (45.4% females, mean age 15.78 ± 0.44). Four-year 10 classes from one school were included in this four-arm cluster randomized controlled trial. Classes were randomly assigned to the following groups: sedentary control with no cognitive training, sedentary with cognitive training, resistance training without cognitive training, and resistance training with cognitive training. Sessions varied in levels of both cognitive demand and resistance training (i.e., high vs. low) and were administered three times per week for 4 weeks (12 sessions). Inhibition, cognitive flexibility, episodic memory, on-task behavior, and muscular fitness were assessed at baseline and post-test. Linear mixed models were used to examine changes within and between groups. Results: In comparison with the control group, episodic memory improved significantly in the resistance training without cognitive training group (-9.87 units, 95% CI: -17.71 to -2.03, p = 0.014, d = 0.72). There were no group-by-time effects for inhibition or cognitive flexibility. Classroom activity breaks both with and without cognitive demand improved participants' on-task behavior in comparison with the control and sedentary group. The resistance training programs did not lead to improvements in muscular fitness. Conclusion: Participation in body weight resistance training without cognitive training led to selective improvements in episodic memory. No training effects were found for inhibition or cognitive flexibility. A longer study period may be necessary to induce improvements in muscular fitness and associated changes in inhibition and cognitive flexibility. Clinical Trial Registration: https://www.anzctr.org.au/ACTRN12621001341819.aspx, Australian New Zealand Clinical Trials Registry-ACTRN12621001341819.

A collaborative approach to adopting/adapting guidelines. The Australian 24-hour movement guidelines for children (5-12 years) and young people (13-17 years): An integration of physical activity, sedentary behaviour, and sleep

Abstract

Background

In 2018, the Australian Government updated the Australian Physical Activity and Sedentary Behaviour Guidelines for Children and Young People. A requirement of this update was the incorporation of a 24-hour approach to movement, recognising the importance of adequate sleep. The purpose of this paper was to describe how the updated Australian 24-Hour Movement Guidelines for Children and Young People (5 to 17 years): an integration of physical activity, sedentary behaviour and sleep were developed and the outcomes from this process.

Methods

The GRADE-ADOLOPMENT approach was used to develop the guidelines. A Leadership Group was formed, who identified existing credible guidelines. The Canadian 24-Hour Movement Guidelines for Children and Youth best met the criteria established by the Leadership Group. These guidelines were evaluated based on the evidence in the GRADE tables, summaries of findings tables and recommendations from the Canadian Guidelines. We conducted updates to each of the Canadian systematic reviews. A Guideline Development Group reviewed, separately and in combination, the evidence for each behaviour. A choice was then made to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. We then conducted an online survey (n=237) along with three focus groups (n=11 in total) and 13 key informant interviews. Stakeholders used these to provide feedback on the draft guidelines.

Results

Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Guideline Development Group agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, maintain the wording of the guidelines, preamble, and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-hours), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for children (5-12 years) and young people (13-17 years).

Conclusions

To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used to develop movement behaviour guidelines. The judgments of the Australian Guideline Development Group did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian Guidelines were adopted with only very minor alterations. This allowed the Australian Guidelines to be developed in a shorter time frame and at a lower cost. We recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines that was developed using the GRADE approach is available with all supporting materials. Other countries may consider this approach when developing and/or revising national movement guidelines.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01236-2.

Short breaks at school: effects of a physical activity and a mindfulness intervention on children's attention, reading comprehension, and self-esteem

BACKGROUND

Although breaks are essential to restoring cognitive and psychological conditions for learning, short breaks within school lessons are not established and the specificity of effects has not often been investigated. Therefore, the effects of a physical activity (Study 1) and a mindfulness intervention (Study 2) were investigated.

PROCEDURE

By an intervention-control group design, the effects of daily 10-min physical activity (Study 1: N = 162, 4th grade) and mindfulness breaks (Study 2: N = 79, 5th grade) were implemented within regular school lessons over a 2-week time period to research the impact on attention, reading comprehension, and self-esteem.

RESULTS

In the physical activity intervention children's attention improved (attention-processing speed: p < .004, η_p² = .05, attention-performance: p < .025, η_p² = .03), and in the mindfulness intervention reading comprehension improved (p < .012, η_p² = .08) compared to the controls. Results further indicated that self-esteem moderated the relationship between groups and attention improvement in study 1.

CONCLUSION

Classroom-based short physical and mindfulness breaks could support attention and reading comprehension, which are known to support overall academic success.

The impact of physically active learning during the school day on children's physical activity levels, time on task and learning behaviours and academic outcomes

The benefits of physical activity in school settings and its impact on health and academic outcomes are of interest from public health and educational contexts. This study investigates how physically active learning (PAL): (i) contributes to children's physical activity levels, (ii) impacts on academic outcomes and (iii) influences children's focus and concentration, defined as time on task (ToT).

METHODS

Over a 2-week period, participants were exposed to PAL and non-active learning (NAL) lessons in a counterbalanced design. Physiological responses and ToT behaviour were recorded throughout PAL and NAL lessons. Academic outcomes were assessed the week before, during and the week after each mode of delivery.

RESULTS

Children were more active during PAL (196�542 steps per week) compared to NAL (152�395 steps per week, P = 0.003). The physiological demands of PAL (73% HRmax), were significantly greater (P < 0.001) than NAL (51% HRmax). Children's ToT was significantly higher (P < 0.001) with PAL (97%) than NAL (87%). There were no differences in academic outcomes when PAL and NAL were compared.

CONCLUSIONS

Modest levels of PAL increased activity levels. No evidence was found to suggest PAL had a negative effect on children's academic outcomes, and PAL could positively impact on children's concentration.

Active School Breaks and Students' Attention: A Systematic Review with Meta-Analysis

School physical activity breaks are currently being proposed as a way to improve students’ learning. However, there is no clear evidence of the effects of active school breaks on academic-related cognitive outcomes. The present systematic review with meta-analysis scrutinized and synthesized the literature related to the effects of active breaks on students’ attention. On January 12th, 2021, PubMed, PsycINFO, Scopus, SPORTDiscus, and Web of Science were searched for published interventions with counterbalanced cross-over or parallel-groups designs with a control group, including school-based active breaks, objective attentional outcomes, and healthy students of any age. Studies’ results were qualitatively synthesized, and meta-analyses were performed if at least three study groups provided pre-post data for the same measure. Results showed some positive acute and chronic effects of active breaks on attentional outcomes (i.e., accuracy, concentration, inhibition, and sustained attention), especially on selective attention. However, most of the results were not significant. The small number of included studies and their heterogeneous design are the primary limitations of the present study. Although the results do not clearly point out the positive effects of active breaks, they do not compromise students’ attention. The key roles of intensity and the leader of the active break are discussed. INPLASY registration number: 202110054.

Examining the Effects of Acute Cognitively Engaging Physical Activity on Cognition in Children

Cognitively engaging physical activity (PA) has been suggested to have superior effects on cognition compared to PA with low cognitive demands; however, there have been few studies directly comparing these different types of activities. The aim of this study is to compare the cognitive effects of a combined physically and cognitively engaging bout of PA to a physical or cognitive activity alone in children. Children were randomized in pairs to one of three 20-min conditions: (1) a cognitive sedentary activity; (2) a non-cognitively engaging PA; and a (3) cognitively engaging PA. Executive function (EF) was assessed using a modified Eriksen flanker task immediately before and 10-15 min following the experimental condition. Children ages 6-8 years (n = 48, Mage = 7.04, SD = 1.37; 40% girls) were included in the study. A repeated measures ANOVA found no significant difference between groups with respect to scores on the flanker task. The results do not support the hypotheses that a cognitively engaging bout of PA enhances cognitive performance over non-cognitively engaging PA or sedentary activities. Possible explanations for our findings include overexertion during the acute bout of PA and depletion of positive affect prior to performing the post-intervention EF tasks.

The Physical Activity Type Most Related to Cognitive Function and Quality of Life

BACKGROUND

Physical activity has been found to maintain and improve cognitive function and consequently improve health-related quality of life (HRQoL). The relationships between different types of physical activities, cognitive function, and HRQoL have not been studied sufficiently and compared in different age and gender groups. This study is aimed at examining the relationship between different types of physical activity (high-intensity, moderate-intensity, and walking exercise), cognitive function, and HRQoL. In addition, this study is aimed at examining these relationships in different age and gender groups.

METHODS

This cross-sectional study included 150 adults with a mean age of 50 ± 8.8 years. Participants completed the International Physical Activity Questionnaire (IPAQ) to assess the level of the physical activity types and the Short-Form Health Survey (SF-36) questionnaire to assess HRQoL. Cognitive function was measured using the Montreal Cognitive Assessment (MoCA) screening instrument. Spearman correlation analysis was used to explore the relationships between the different variables of the study.

RESULTS

There were significant positive relationships between all types of physical activities, cognitive ability, and HRQoL. The relationships between moderate-intensity physical activities and cognitive function (r = 0.38) and HRQoL (r = 0.33) were higher than the relationships with walking exercise and high-intensity physical activity. The middle-aged group had a significantly higher cognitive function compared to the senior adults (p < 0.001), while there was no significant difference between the age groups in HRQoL (p = 0.18).

CONCLUSION

The cognitive function and HRQoL were more related to moderate-intensity physical activities compared to walking exercise or high-intensity physical activities. These relationships were more pronounced in the senior adult population compared to the middle-aged group.

Are There Extended Cognitive Improvements from Different Kinds of Acute Bouts of Physical Activity?

Acute bouts of physical activity of at least moderate intensity have shown to enhance cognition in young as well as older adults. This effect has been observed for different kinds of activities such as aerobic or strength and coordination training. However, only few studies have directly compared these activities regarding their effectiveness. Further, most previous studies have mainly focused on inhibition and have not examined other important core executive functions (i.e., updating, switching) which are essential for our behavior in daily life (e.g., staying focused, resisting temptations, thinking before acting), as well. Therefore, this study aimed to directly compare two kinds of activities, aerobic and coordinative, and examine how they might affect executive functions (i.e., inhibition, updating, and switching) in a test-retest protocol. It is interesting for practical implications, as coordinative exercises, for example, require little space and would be preferable in settings such as an office or a classroom. Furthermore, we designed our experiment in such a way that learning effects were controlled. Then, we tested the influence of acute bouts of physical activity on the executive functioning in both young and older adults (young 16–22 years, old 65–80 years). Overall, we found no differences between aerobic and coordinative activities and, in fact, benefits from physical activities occurred only in the updating tasks in young adults. Additionally, we also showed some learning effects that might influence the results. Thus, it is important to control cognitive tests for learning effects in test-retest studies as well as to analyze effects from physical activity on a construct level of executive functions.

Feasibility of test administration and preliminary findings for cognitive control in the Burn 2 learn pilot randomised controlled trial

The feasibility requirements of administering field-based cognitive assessments are rarely reported. We examined the feasibility of administering a group-based cognitive test battery in a school setting with older adolescents. Several types of reliability were also assessed in the control group. Preliminary efficacy and the relationship between changes in fitness and changes in cognitive control were also explored following a 14-week HIIT intervention (3 sessions/week). Participants completed a cognitive test battery measuring inhibition (flanker), and working memory (n-back) at baseline and post-test. Health-related fitness assessments were also conducted. Test administration took approximately 30.8 ± 1.5 minutes to complete with up to six participants simultaneously. The test battery demonstrated acceptable reliability (ICC = 0.5-0.81), with significant changes observed for flanker incongruent accuracy, and 2-back non-target accuracy from baseline to post-test. Regarding efficacy, small-to-moderate effects were observed for accuracy outcomes, while several small associations were found between changes in fitness and changes in cognition. Findings from the current study suggest a cognitive test battery can be administered with older adolescents in a school setting. However, there remains a lack of adequate reporting of administration requirements for field-based cognitive assessments. Efficacy findings should be confirmed with a larger and more representative sample of older adolescents.

Wearable devices for remote vital signs monitoring in the outpatient setting: an overview of the field

Early detection of physiological deterioration has been shown to improve patient outcomes. Due to recent improvements in technology, comprehensive outpatient vital signs monitoring is now possible. This is the first review to collate information on all wearable devices on the market for outpatient physiological monitoring.

A scoping review was undertaken. The monitors reviewed were limited to those that can function in the outpatient setting with minimal restrictions on the patient’s normal lifestyle, while measuring any or all of the vital signs: heart rate, ECG, oxygen saturation, respiration rate, blood pressure and temperature.

A total of 270 papers were included in the review. Thirty wearable monitors were examined: 6 patches, 3 clothing-based monitors, 4 chest straps, 2 upper arm bands and 15 wristbands. The monitoring of vital signs in the outpatient setting is a developing field with differing levels of evidence for each monitor. The most common clinical application was heart rate monitoring. Blood pressure and oxygen saturation measurements were the least common applications. There is a need for clinical validation studies in the outpatient setting to prove the potential of many of the monitors identified.

Research in this area is in its infancy. Future research should look at aggregating the results of validity and reliability and patient outcome studies for each monitor and between different devices. This would provide a more holistic overview of the potential for the clinical use of each device.

A Systematic Review and Qualitative Synthesis Resulting in a Typology of Elementary Classroom Movement Integration Interventions

Background/Objective

Movement integration (MI) involves infusing physical activity into normal classroom time. A wide range of MI interventions have succeeded in increasing children’s participation in physical activity. However, no previous research has attempted to unpack the various MI intervention approaches. Therefore, this study aimed to systematically review, qualitatively analyze, and develop a typology of MI interventions conducted in primary/elementary school settings.

Subjects/Methods

Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to identify published MI interventions. Irrelevant records were removed first by title, then by abstract, and finally by full texts of articles, resulting in 72 studies being retained for qualitative analysis. A deductive approach, using previous MI research as an a priori analytic framework, alongside inductive techniques were used to analyze the data.

Results

Four types of MI interventions were identified and labeled based on their design: student-driven, teacher-driven, researcher-teacher collaboration, and researcher-driven. Each type was further refined based on the MI strategies (movement breaks, active lessons, other: opening activity, transitions, reward, awareness), the level of intrapersonal and institutional support (training, resources), and the delivery (dose, intensity, type, fidelity). Nearly half of the interventions were researcher-driven, which may undermine the sustainability of MI as a routine practice by teachers in schools. An imbalance is evident on the MI strategies, with transitions, opening and awareness activities, and rewards being limitedly studied. Delivery should be further examined with a strong focus on reporting fidelity.

Conclusions

There are distinct approaches that are most often employed to promote the use of MI and these approaches may often lack a minimum standard for reporting MI intervention details. This typology may be useful to effectively translate the evidence into practice in real-life settings to better understand and study MI interventions.

Inter-Individual Differences in Cognitive Response to a Single Bout of Physical Exercise-A Randomized Controlled Cross-Over Study

Recent reviews have shown that acute exercise can improve cognitive functions, especially executive functions. However, a closer look at the included studies revealed a wide inter-individual variability in the effects of exercise on cognition. Therefore, thirty-nine healthy adults (age: 19–30 years) were analyzed in a randomized, controlled cross-over study with two exercise groups (n = 13 each) and a sedentary control group (n = 13). The exercise conditions included moderate (30 min at 40–59% VO_2max) and high intensity interval (five × 2 min at 90% VO_2max with 3 min active recovery at 40% VO_2max) treadmill exercise. The main outcome assessed was cognitive performance (attention, inhibitory control, cognitive flexibility) and underlying inter-individual variability in young adults. On the group level no significant group or group × time interaction effects were observed. Using a median split, we found significant differences between low and high cognitive performers regarding cognitive function following moderate and high intensity interval treadmill exercise. Furthermore, using a pre-determined threshold we could identify responders and non-responders to acute exercise. Therefore, future research should consider individual performance requirements.

Effects of Exercise on Cognitive Performance in Children and Adolescents with ADHD: Potential Mechanisms and Evidence-based Recommendations

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with a complex symptomatology, and core symptoms as well as functional impairment often persist into adulthood. Recent investigations estimate the worldwide prevalence of ADHD in children and adolescents to be ~7%, which is a substantial increase compared to a decade ago. Conventional treatment most often includes pharmacotherapy with central nervous stimulants, but the number of non-responders and adverse effects call for treatment alternatives. Exercise has been suggested as a safe and low-cost adjunctive therapy for ADHD and is reported to be accompanied by positive effects on several aspects of cognitive functions in the general child population. Here we review existing evidence that exercise affects cognitive functions in children with and without ADHD and present likely neurophysiological mechanisms of action. We find well-described associations between physical activity and ADHD, as well as causal evidence in the form of small to moderate beneficial effects following acute aerobic exercise on executive functions in children with ADHD. Despite large heterogeneity, meta-analyses find small positive effects of exercise in population-based control (PBC) children, and our extracted effect sizes from long-term interventions suggest consistent positive effects in children and adolescents with ADHD. Paucity of studies probing the effect of different exercise parameters impedes finite conclusions in this regard. Large-scale clinical trials with appropriately timed exercise are needed. In summary, the existing preliminary evidence suggests that exercise can improve cognitive performance intimately linked to ADHD presentations in children with and without an ADHD diagnosis. Based on the findings from both PBC and ADHD children, we cautiously provide recommendations for parameters of exercise.

Test-Retest Reliability and Minimal Detectable Change of the D2 Test of Attention in Patients with Schizophrenia

Objective

The d2 Test of Attention (D2) is a commonly used measure of selective attention for patients with schizophrenia. However, its test-retest reliability and minimal detectable change (MDC) are unknown in patients with schizophrenia, limiting its utility in both clinical and research settings. The aim of the present study was to examine the test-retest reliability and MDC of the D2 in patients with schizophrenia.

Method

A rater administered the D2 on 108 patients with schizophrenia twice at a 1-month interval. Test-retest reliability was determined through the calculation of the intra-class correlation coefficient (ICC). We also carried out Bland-Altman analysis, which included a scatter plot of the differences between test and retest against their mean. Systematic biases were evaluated by use of a paired t-test.

Results

The ICCs for the D2 ranged from 0.78 to 0.94. The MDCs (MDC%) of the seven subscores were 102.3 (29.7), 19.4 (85.0), 7.2 (94.6), 21.0 (69.0), 104.0 (33.1), 105.0 (35.8), and 7.8 (47.8), which represented limited-to-acceptable random measurement error. Trends in the Bland-Altman plots of the omissions (E1), commissions (E2), and errors (E) were noted, presenting that the data had heteroscedasticity.

Conclusions

According to the results, the D2 had good test-retest reliability, especially in the scores of TN, TN-E, and CP. For the further research, finding a way to improve the administration procedure to reduce random measurement error would be important for the E1, E2, E, and FR subscores.

Improving Cognitive Performance of 9-12 Years Old Children: Just Dance? A Randomized Controlled Trial

Exercise is assumed to have positive effects on children's cognitive performance. However, given the inconclusive evidence for the long-term effects of exercise, it is difficult to advice schools on what specific exercise programs can improve children's cognitive performance. In particular, little is known about the effects of small exercise programs that may be feasible in daily school practice. Therefore, we assessed the effects of a 9-weeks program consisting of daily exercise breaks on children's cognitive performance, aerobic fitness and physical activity levels. We conducted a cluster-randomized controlled trial in 21 classes of eight Dutch primary schools. A total of 512 children aged 9-12 years participated. The exercise intervention had a duration of 9 weeks and consisted of a daily 10-min classroom-based exercise break of moderate to vigorous intensity. Before and after the intervention, we used four cognitive tasks (i.e., the Attention Network Test, Stroop test, d2 test of attention and Fluency task) to measure children's cognitive performance in domains of selective attention, inhibition and memory retrieval. In addition, we measured aerobic fitness with a Shuttle Run test and physical activity during school hours by accelerometers. We analyzed data using mixed models, adjusting for baseline scores, class and school. After 9 weeks, there were no intervention effects on children's cognitive performance or aerobic fitness. Children in the intervention group spent 2.9 min more of their school hours in moderate to vigorous physical activity as compared to the children in the control group. In conclusion, daily 10-min exercise breaks in the classroom did not improve, nor deteriorate cognitive performance in children. The exercise breaks had no effect on children's fitness, and resulted in 2.9 min more time spent in moderate to vigorous physical activity during school hours. Daily exercise breaks can be implemented in the classroom to promote children's physical activity during school time, without adverse effect on their cognitive performance.

48-Hour Effects of Monitored Cooperative High-Intensity Interval Training on Adolescent Cognitive Functioning

Physical activity has been positively related to better cognitive performance though the effects of varied exercise type and intensity and the duration of cognitive benefits are unclear. This study analyzed the effect of 16 minutes of monitored cooperative high-intensity interval training (monitored C-HIIT) at the start of the school day, on various cognitive variables over the next 24-48 hours. We randomly assigned 158 participants either to a control group ( n = 81) that engaged only in static stretching or to an experimental group ( n = 77) that performed monitored C-HIIT. We assessed cognitive functioning before the exercise, immediately afterward, and for five follow-up time points over the next two days (i.e., at 2, 3, 4, 24, and 48 hours). We analyzed age, sex, body mass index, and moderate-to-vigorous physical activity as potential confounder variables. Adolescents in the monitored C-HIIT group increased selective attention by 17.39% during the next hour ( p = .015) and increased concentration by 20.31% and 15.26% during the first ( p = .022) and second ( p = .059) subsequent hours, respectively. This positive short-term benefit of monitored C-HIIT during immediate subsequent hours is an important finding with implications for the school curricula and schedule.

Exercise of Varying Durations: No Acute Effects on Cognitive Performance in Adolescents

Participation in structured physical activity is assumed to have a positive effect on cognitive and academic performance. A single bout of moderate to vigorous exercise has been found to have a small acute positive effect on the cognitive performance of children and adolescents. However, the dose-response effects of exercise duration are largely unknown. Therefore, the current study examined the acute effects of moderate-to-vigorous exercise with a duration of either 10, 20, or 30 min on selective attention and working memory performance of young adolescents. One hundred and nineteen adolescents (11-14 years old) participated in a randomized, controlled crossover study. Adolescents were assigned to one of the three exercise durations, each paired with a sedentary control session of the same duration. Cognitive performance was measured before and immediately after the exercise and control condition. The Attention Network Test and n-back task were used to measure selective attention and working memory, respectively. There were no significant exercise effects on selective attention (i.e., alerting, orienting, or executive control) or working memory performance measured immediately after the exercise bouts. Furthermore, there were no differential effects of exercise duration. In sum, acute exercise bouts with a duration of 10, 20, or 30 min did not improve, but neither deteriorate cognitive performance of young adolescents compared to a sedentary control condition.

The Effects of Moderate Physical Exercise on Adult Cognition: A Systematic Review

Background: Physical exercise is a systematic sequence of movements executed with a predefined purpose. This muscular activity impacts not only on circulatory adaptations, but also neuronal integration with the potential to influence cognition. The aim of this review was to determine whether the literature supports the idea that physical exercise promotes cognitive benefits in healthy adults.

Methods: A systematic search for relevant articles was performed according to the Preferred Reporting Items for Systematic Review and Meta-Analysis criteria using available databases (PubMed, LILACS, Scopus, Web of Science, The Cochrane Library, OpenGrey, Google Scholar and CENTRAL). The search terms included “humans” or “adults” or “cognition” or “awareness” or “cognitive dissonance” or “cognitive reserve” or “comprehension” or “consciousness” and “motor activity” or “exercise” or “physical fitness,” and not “aged” or “nervous system diseases,” with the purpose of finding associations between moderate physical exercise and cognition. A methodological quality and risk of bias unit assessed the eligibility of articles.

Results: A total of 7179 articles were identified. Following review and quality assessment, three articles were identified to fulfill the inclusion criteria. An association between moderate physical exercise and cognition was observed. Improvements in cognitive parameters such as reduced simple reaction time, improved response precision and working memory were identified among the included articles.

Conclusion: This systematic review found that moderate physical exercise improves cognition.

Concentration Endurance Test (d2): Normative data for Spanish-speaking pediatric population

OBJECTIVE

To generate normative data for the Concentration Endurance Test (d2) in Spanish-speaking pediatric populations.

METHOD

The sample consisted of 4,373 healthy children from nine countries in Latin America (Chile, Cuba, Ecuador, Guatemala, Honduras, Mexico, Paraguay, Peru, and Puerto Rico) and Spain. Each participant was administered the d2 test as part of a larger neuropsychological battery. The Total number of items processed (TN), Total number of correct responses (CR), Total performance (TP), and Concentration performance (CP) scores were normed using multiple linear regressions and standard deviations of residual values. Age, age2, sex, and mean level of parental education (MLPE) were included as predictors in the analyses.

RESULTS

The final multiple linear regression models showed main effects for age on all scores, such that scores increased linearly as a function of age. TN scores were affected by age2 for Guatemala and Puerto Rico; CR scores were affected by age2 for Mexico; TP scores were affected by age2 for Chile, Mexico, Puerto Rico, and Spain; and CP scores for Mexico and Spain. Models indicated that children whose parents had a MLPE >12 years obtained higher scores compared to children whose parents had a MLPE≤12 years for Mexico and Spain in all scores, and Puerto Rico for TN, CR, and TP, and Guatemala and Paraguay for CP scores. Sex affect the scores for Ecuador and Honduras (CP scores).

CONCLUSIONS

This is the largest Spanish-speaking pediatric normative study in the world, and it will allow neuropsychologists from these countries to have a more accurate approach to interpret the d2 test in pediatric populations.

Systematic review of acute physically active learning and classroom movement breaks on children's physical activity, cognition, academic performance and classroom behaviour: understanding critical design features

Objective

To examine the impact of acute classroom movement break (CMB) and physically active learning (PAL) interventions on physical activity (PA), cognition, academic performance and classroom behaviour.

Design

Systematic review.

Data sources

PubMed, EBSCO, Academic Search Complete, Education Resources Information Center, PsycINFO, SPORTDiscus, SCOPUS and Web of Science.

Eligibility criteria for selecting studies

Studies investigating school-based acute bouts of CMB or PAL on (PA), cognition, academic performance and classroom behaviour. The Downs and Black checklist assessed risk of bias.

Results

Ten PAL and eight CMB studies were identified from 2929 potentially relevant articles. Risk of bias scores ranged from 33% to 64.3%. Variation in study designs drove specific, but differing, outcomes. Three studies assessed PA using objective measures. Interventions replaced sedentary time with either light PA or moderate-to-vigorous PA dependent on design characteristics (mode, duration and intensity). Only one study factored individual PA outcomes into analyses. Classroom behaviour improved after longer moderate-to-vigorous (>10 min), or shorter more intense (5 min), CMB/PAL bouts (9 out of 11 interventions). There was no support for enhanced cognition or academic performance due to limited repeated studies.

Conclusion

Low-to-medium quality designs predominate in investigations of the acute impacts of CMB and PAL on PA, cognition, academic performance and classroom behaviour. Variable quality in experimental designs, outcome measures and intervention characteristics impact outcomes making conclusions problematic. CMB and PAL increased PA and enhanced time on task. To improve confidence in study outcomes, future investigations should combine examples of good practice observed in current studies.

PROSPERO registration number

CRD42017070981.

Effect of classroom-based physical activity interventions on academic and physical activity outcomes: a systematic review and meta-analysis

Background

Physical activity is associated with many physical and mental health benefits, however many children do not meet the national physical activity guidelines. While schools provide an ideal setting to promote children’s physical activity, adding physical activity to the school day can be difficult given time constraints often imposed by competing key learning areas. Classroom-based physical activity may provide an opportunity to increase school-based physical activity while concurrently improving academic-related outcomes. The primary aim of this systematic review and meta-analysis was to evaluate the impact of classroom-based physical activity interventions on academic-related outcomes. A secondary aim was to evaluate the impact of these lessons on physical activity levels over the study duration.

Methods

A systematic search of electronic databases (PubMed, ERIC, SPORTDiscus, PsycINFO) was performed in January 2016 and updated in January 2017. Studies that investigated the association between classroom-based physical activity interventions and academic-related outcomes in primary (elementary) school-aged children were included. Meta-analyses were conducted in Review Manager, with effect sizes calculated separately for each outcome assessed.

Results

Thirty-nine articles met the inclusion criteria for the review, and 16 provided sufficient data and appropriate design for inclusion in the meta-analyses. Studies investigated a range of academic-related outcomes including classroom behaviour (e.g. on-task behaviour), cognitive functions (e.g. executive function), and academic achievement (e.g. standardised test scores). Results of the meta-analyses showed classroom-based physical activity had a positive effect on improving on-task and reducing off-task classroom behaviour (standardised mean difference = 0.60 (95% CI: 0.20,1.00)), and led to improvements in academic achievement when a progress monitoring tool was used (standardised mean difference = 1.03 (95% CI: 0.22,1.84)). However, no effect was found for cognitive functions (standardised mean difference = 0.33 (95% CI: -0.11,0.77)) or physical activity (standardised mean difference = 0.40 (95% CI: -1.15,0.95)).

Conclusions

Results suggest classroom-based physical activity may have a positive impact on academic-related outcomes. However, it is not possible to draw definitive conclusions due to the level of heterogeneity in intervention components and academic-related outcomes assessed. Future studies should consider the intervention period when selecting academic-related outcome measures, and use an objective measure of physical activity to determine intervention fidelity and effects on overall physical activity levels.