Physical activity intervention (Movi-Kids) on improving academic achievement and adiposity in preschoolers with or without attention deficit hyperactivity disorder: study protocol for a randomized controlled trial

Development and Calibration of a PATCH Device for Monitoring Children's Heart Rate and Acceleration

INTRODUCTION

Current wearables that collect heart rate and acceleration were not designed for children and/or do not allow access to raw signals, making them fundamentally unverifiable. This study describes the creation and calibration of an open-source multichannel platform (PATCH) designed to measure heart rate and acceleration in children ages 3-8 yr.

METHODS

Children (N = 63; mean age, 6.3 yr) participated in a 45-min protocol ranging in intensities from sedentary to vigorous activity. Actiheart-5 was used as a comparison measure. We calculated mean bias, mean absolute error (MAE) mean absolute percent error (MA%E), Pearson correlations, and Lin's concordance correlation coefficient (CCC).

RESULTS

Mean bias between PATCH and Actiheart heart rate was 2.26 bpm, MAE was 6.67 bpm, and M%E was 5.99%. The correlation between PATCH and Actiheart heart rate was 0.89, and CCC was 0.88. For acceleration, mean bias was 1.16 mg and MAE was 12.24 mg. The correlation between PATCH and Actiheart was 0.96, and CCC was 0.95.

CONCLUSIONS

The PATCH demonstrated clinically acceptable accuracies to measure heart rate and acceleration compared with a research-grade device.

Decrease in the prevalence of hypertension in Spanish schoolchildren from 2010 to 2017: Cuenca Study

AIMS

To examine the secular trends in blood pressure measurements and normal or high blood pressure classification among Spanish schoolchildren from 2010 to 2017, to analyze the persistence in the blood pressure category reported in 2017 compared with 2013 in those children born in 2007-08 and to compare in this cohort the prevalence of high blood pressure using both definitions, the 2004 and 2017 guidelines.

METHODS AND RESULTS

The data for the prevalence/trend analysis were obtained from cross-sectional analyses conducted in 2010, 2013, and 2017 of 2709 schoolchildren aged 4-6 and 8-11 years from 22 schools in the province of Cuenca, Spain. The data for the longitudinal analysis were obtained from cross-sectional analyses of measurements gathered in 2013 and 2017 in the same cohort of children (n = 275). The prevalence of normal blood pressure increased by 5.4% in children aged 4-6 years from 2013 to 2017 and by 2.2% in children aged 8-11 from 2010 to 2017. This increase was mainly driven by a decrease in the children classified in any stage of hypertension by 4.2% and 2.3% in each age range, respectively. In the same birth cohort, there was an increase of 7.6% in normal blood pressure prevalence.

CONCLUSION

The high blood pressure prevalence in Spanish children has clearly decreased over the last decade, but is still important to detect this condition to design specific school-based interventions and the evaluation of children classified as hypertensive who might need medical supervision and treatment.

Effects of different physical activity interventions on children with attention-deficit/hyperactivity disorder: A network meta-analysis of randomized controlled trials

Background

Previous studies have shown that physical activity interventions positively affect core symptoms and executive functioning in children with attention-deficit/hyperactivity disorder (ADHD). However, comparisons between different physical activity interventions still need to be made. This study is the first to analyze the effects of 10 different types of physical activity on children with ADHD through a network meta-analysis.

Methods

PubMed, Embase, Web of Science, and Cochrane Library databases were searched for randomized controlled trials on the effects of physical activity interventions on children with ADHD. The search time frame was from database creation to October 2022. Two investigators independently performed literature screening, extraction, and quality assessment. Network meta-analysis was performed with Stata 15.1.

Results

A total of 31 studies were included, and the results indicated that perceptual-motor training was the most effective in terms of motor ability and working memory (SUCRA = 82.7 and 73.3%, respectively). For attention problems and cognitive flexibility, aquatic exercise was the most effective (SUCRA = 80.9 and 86.6%, respectively). For social problems, horsemanship was the most effective (SUCRA = 79.4%). For inhibition switching, cognitive-motor training was the most effective (SUCRA = 83.5%).

Conclusion

Our study revealed that aquatic exercise and perceptual-motor training had a superior overall performance. However, the effects of various physical activity interventions on different indicators in children with ADHD can vary depending on the individual and the intervention's validity. To ensure an appropriate physical activity intervention is selected, it is important to assess the severity of symptoms exhibited by children with ADHD beforehand.

Effectiveness of MOVI-KIDS programme on health-related quality of life in children: Cluster-randomized controlled trial

OBJECTIVE

To test the effectiveness of an 8-month school-based multicomponent intervention (MOVI-KIDS) in improving health-related quality of life (HRQoL) in schoolchildren.

STUDY DESIGN

A randomized cluster trial was conducted including 1168 children aged 4-6 years who attended 21 schools in two Spanish provinces (Cuenca and Ciudad Real). MOVI-KIDS study is a multicomponent physical activity intervention, which consisted of (i) 3 × 60-min sessions/week, (ii) educational materials for parents and teachers, and (iii) school playground modifications. The parent's proxy report of the KINDL-R Spanish version (6 subdimensions and a total score), and the KINDL-R self-reported by children (total score) was used to measure HRQoL. Mixed linear regression models were conducted to test differences in each HRQoL dimension between intervention and control groups, controlling for baseline values, cardiorespiratory fitness, and socioeconomic status, by gender.

RESULTS

The boys in the intervention group presented better scores on total HRQoL than the control group in both the parent (ß = 1.46; 95% CI: 0.23-2.70) and self-reported (ß = 2.13; 95% CI: 0.53-3.74) versions, as well as on the emotional well-being dimension (ß = 2.43; 95% CI: 0.48-4.36). There was no significant effect of the intervention on physical well-being, self-esteem, family, and friends. In girls, no statistically significant differences were found between those who participated in MOVI-KIDS and those who did not.

CONCLUSION

Our data support gender differences in the effect of MOVI-KIDS, such that while in boys the intervention was successful in increasing total scores of HRQoL, as well as emotional well-being scores, the intervention was not effective in improving girls' HRQoL.

Treatment of ADHD: Drugs, psychological therapies, devices, complementary and alternative methods as well as the trends in clinical trials

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders having a high influence on social interactions. The number of approved treatments and clinical trials for ADHD have increased markedly during the recent decade. This analytical review provides a quantitative overview of the existing pharmacological and non-pharmacological methods of ADHD treatments investigated in clinical trials during 1999-2021. A total of 695 interventional trials were manually assessed from clinicaltrial.gov with the search term « ADHD», and trial data has been used for analysis. A clear majority of the studies investigated non-pharmacological therapies (∼80%), including many behavioral options, such as social skills training, sleep and physical activity interventions, meditation and hypnotherapy. Devices, complementary and other alternative methods of ADHD treatment are also gaining attention. The pharmacological group accounts for ∼20% of all the studies. The most common drug classes include central nervous system stimulants (e.g., methylphenidate hydrochloride, lisdexamfetamine dimesylate, amphetamine sulfate, mixed amphetamine salts, a combination of dexmethylphenidate hydrochloride and serdexmethylphenidate chloride), selective noradrenaline reuptake inhibitors (atomoxetine, viloxazine), and alpha2 adrenergic receptor agonists (guanfacine hydrochloride, clonidine hydrochloride). Several studies investigated antidepressants (e.g., bupropion hydrochloride, vortioxetine), and atypical antipsychotics (e.g., quetiapine, aripiprazole) but these are yet not approved by the FDA for ADHD treatment. We discuss the quantitative trends in clinical trials and provide an overview of the new drug agents and non-pharmacological therapies, drug targets, and novel treatment options.

Can Physical Exercise Promote the Development of Teenagers' Non-Cognitive Ability?-Evidence from China Education Panel Survey (2014-2015)

Background: With the development of educational philosophy, physical exercise is considered to be an important factor in the development of individual cognitive abilities in adolescents. However, the effects of physical exercise on non-cognitive abilities in adolescents remain inadequate. Objective: This study examined the effect of physical exercise on non-cognitive ability and further examined the differences in this effect in different groups. Methods: Survey data on non-cognitive ability, physical exercise and covariates were collected in the China Education Panel Survey (2014−2015) from a nationally representative sample of adolescents (n = 7904) in the eighth (follow-up) grade. Results: The results show that, after controlling for the influence of other factors, physical exercise has a promoting effect on six non-cognitive abilities—social behavior (p < 0.001), communication ability (p < 0.01), perseverance (p < 0.05), school adaptation (p < 0.001), educational expectation (p < 0.01) and creative thinking (p < 0.01)—and there is no significant effect on emotional control (p > 0.05). Furthermore, the development of non-cognitive ability in physical exercise shows certain group differences. Conclusions: There are gender differences in the performance of non-cognitive ability. Girls perform better than boys in non-cognitive ability. Physical exercise is an important means to develop non-cognitive ability, which indicates that non-cognitive ability has plasticity in adolescence. Future intervention may improve the non-cognitive ability of Chinese adolescents by increasing physical exercise.

Serious Video Games: Angels or Demons in Patients With Attention-Deficit Hyperactivity Disorder? A Quasi-Systematic Review

OBJECTIVE

To carry out a quasi-systematic review of the use of serious video games for health as a cognitive rehabilitative tool in patients diagnosed with attention-deficit hyperactivity disorder.

METHOD

A quasi-systematic review of serious video games used as an evaluative and rehabilitative tool in patients with ADHD was conducted. It included behavioral patterns in the use of video games and addiction problems in this population. For its elaboration the PRISMA GUIDES were followed. The search was carried out in three PubMed databases, MEDLINE, and PsycInfo using the keywords: [game OR serious game OR computer game) AND (psychotherapy OR rehabilitation OR intervention OR mental disorders) AND (adhd)], [(adhd) AND (Video game addiction)]. All articles written in English, Spanish, or Portuguese from January 1970 to June 2021 were included: those in which reference was made to the use of video games and/or new technologies as a therapeutic and evaluative tool in children and adults diagnosed with ADHD, as well as those that referred to behavioral and clinical patterns in the use of video games.

RESULTS

We found 605 articles of which 128 were reviewed (44 observational studies, 26 quasi-experimental studies, 26 experimental studies, 8 systematic reviews, 9 narrative texts, 6 case reports, 7 pilot studies, 8 systematic reviews, and 2 meta-analyses). Serious video games can be used to ameliorate ADHD symptoms while improving adherence to treatment. Some serious video games show high accuracy properties assessing ADHD features.

CONCLUSION

Serious video games for health are increasingly being used as a cognitive rehabilitation tool in patients with attention-deficit hyperactivity disorder (ADHD).

SYSTEMATIC REVIEW REGISTRATION

[www.crd.york.ac.uk/prospero], identifier [CRD42021247784].

Health-related quality of life in developmental coordination disorder and typical developing children

PURPOSE

To analyse: 1) the differences in health-related quality of life (HRQoL) between typically developing (TD) children and children with developmental coordination disorder (DCD) according to parents' and children's perception, and 2) the differences and level of agreement between parents and children's perceptions in HRQoL in both children's samples.

METHODS

Cross-sectional analysis in 115 Spanish schoolchildren 4-to-7 years. Motor competence and HRQoL were assessed using the MACB-2 and the KINDL-R questionnaire, respectively.

RESULTS

ANCOVA model showed that children with DCD children obtained lower scores in physical well-being, friends, school and total HRQoL dimensions than TD peers after controlling for covariates (p < 0.05). Moreover, parents' perception scores in HRQoL were lower in children with DCD than in TD peers (79.7 vs 84.8; p = 0.022). Student T-tests for repeated-measures showed non-significant differences between children and parents' perceptions in mean HRQoL scores, by motor competence categories. The intraclass correlations coefficients between parents and children's perception of HRQoL was moderate in DCD category (0.62; p = 0.024) and small in TD category (0.29; p = 0.049).

CONCLUSIONS

Children under 6 years old with DCD have lower HRQoL scores than their TD peers. No differences were found between children's and parents' perceptions in total HRQoL, although the perceptions of children and parents in DCD category showed a significantly higher level of agreement than TD children. Interventions aimed at promoting motor skills in school settings during the preschool age seem necessary to improve children's quality of life.

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.

Parents' Perceptions on Barriers and Facilitators of Physical Activity among Schoolchildren: A Qualitative Study

Given that physical activity (PA) plays an important role in early childhood, understanding the factors that affect the practice of PA at an early age could help develop effective strategies for overcoming barriers and increasing activity levels in this age group. A qualitative study was conducted based on grounded theory aimed at exploring the perceptions of mothers and fathers from Cuenca and Ciudad Real (Castilla La Mancha, Spain) regarding barriers and facilitators of physical activity of their children during the adiposity rebound period. Data were collected using focus groups involving 46 parents of children in the 3rd grade of pre-school and 1st grade of elementary school. During the analysis, the socio-ecological model and grounded theory were used. The barriers encountered were the preferences of children for sedentary activities (individual factors), academic tasks as a main priority of parents, the influence of older siblings and the unfavorable school environment (microsystem), the lack of family conciliation (mesosystem), and barriers related to the built environment or lack of facilities for physical activity (exosystem). Facilitators were the preferences for active games (individual factors), parental models including the co-participation of parents in activities, the influence of friends, living in large homes, the support provided by teachers and the school (microsystem), living in rural areas, having sufficient facilities, favorable weather conditions (exosystem), and the existence of free or subsidized activities (macro system). Programs aimed at promoting PA in early childhood should include strategies that address contextual factors and not only focus on individual factors related to the child.

School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials

OBJECTIVES

To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness.

DESIGN

Pooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity.

PARTICIPANTS

Data for 6621 children and adolescents aged 4-18 years from 20 trials were included.

MAIN OUTCOME MEASURES

Peak oxygen consumption (VO2Peak mL/kg/min) and minutes of moderate and vigorous physical activity.

RESULTS

Interventions modestly improved students' cardiorespiratory fitness by 0.47 mL/kg/min (95% CI 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness.

CONCLUSIONS

Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.

Effect of Gender, Physical Activity and Stress-Related Hormones on Adolescent's Academic Achievements

BACKGROUND

Physical activity (PA) has been shown to develop better fitness and body function in children. Various studies have shown that as the age of students increases, its correlation with school achievement decreases. Different hormonal changes during adolescence make it difficult to adjust in his/her environment, causing stress. To the best of our knowledge, no study has studied the correlation between stress-related hormones and school performance among adolescents. This study was conducted to evaluate physical activity and stress-related hormones, cortisol and serotonin, among school adolescents aged 12-18 years old and find their association with academic achievements.

METHODS

A total of 300 students were invited to participate in this study. Physical activity of the participants was assessed in relation to the time spent performing various physical activities. End of the academic year grades were obtained from the school as a collective measure of academic achievement and executive function. The levels of cortisol and serotonin were measured using the competitive immunoassay techniques.

RESULTS

There was a significant correlation between age, gender, BMI, cortisol, serotonin, physical activity score; and academic achievement, and executive functioning among participants. Academic achievement and executive functioning scores correlated positively with gender, serotonin, physical activity score, but negatively with age, BMI and salivary cortisol. Stepwise regression analysis showed that physical activity and demographic parameters and stress-related hormones, cortisol and serotonin, explained around 61.9-77.9% of academic performance and executive functioning variation in school adolescents, especially females.

CONCLUSIONS

Optimal physical activity and release of stress-related hormones could be the determining factor for performance in school and other activities. These results should be taken into consideration while planning the school curriculum.

Rationale and methods of the MOVI-da10! Study -a cluster-randomized controlled trial of the impact of classroom-based physical activity programs on children's adiposity, cognition and motor competence

BACKGROUND

Although physical activity (PA) integrated in schools' classrooms have shown a positive effect on children's behaviors, its effectiveness on cognitive functions, PA levels and other health variables remains unclear. This article outlines the rationale and methods of two classroom-based PA interventions (MOVI-da10!) on improving adiposity, executive function and motor competence in preschool children.

METHODS

A three-arm cluster-randomized controlled trial (RCT) was carried out including eight schools (rural and urban areas) from Cuenca province, Spain. The schools were allocated to one of three groups: MOVI-da10-Enriched! intervention (n = 3), MOVI-da10-Standard! intervention, (n = 2), and the control group (n = 3). Around 900 children aged 4 to 6 years old were assesed at baseline (September 2017) and at the end (June 2018) of the intervention. The primary outcomes were changes in body fat by bioimpedance, executive function and motor competence. During a school year (from October 2017 to May 2018), children belonging to the MOVI-da10-Enriched! group performed enriched PA integrated into the academic curriculum including two active breaks lasting 10 min, 5 days/week. The children belonging to the MOVI-da10-Standard! group performed PA breaks (with low cognitive demand, where curricular contents were not reinforced) including two active breaks lasting 10 min, 5 days/week. In the control group, regular PA continued.

DISCUSSION

To our knowledge, MOVI-da10! is the first RCT to examine the effectiveness of two programs (enriched PA integrated into the academic curriculum and PA breaks only) versus a control group on improving adiposity, executive function and motor competence in preschool children.

TRIAL REGISTRATION

NCT03236363 (clinicaltrials.gov), 31st July 2017.

Impact of a multicomponent physical activity intervention on cognitive performance: The MOVI-KIDS study

INTRODUCTION

This study examined the impact of a multicomponent physical activity (PA) intervention (MOVI-KIDS) on improving cognition in schoolchildren. This paper also analyzed the mediator role of motor fitness between MOVI-KIDS and cognition.

METHODS

Propensity score analysis of data from a cluster randomized controlled trial (MOVI-KIDS study). This analysis including 240 5-7 years old children from nine schools in the provinces of Cuenca and Ciudad Real, Spain. MOVI-KIDS program consisted of: (a) three weekly after-school sessions of recreational non-competitive PA lasting 60 minutes during one academic year, (b) educational materials for parents and teachers, and (c) school playground modifications. Changes in cognition (logical reasoning, verbal factor, numerical factor, spatial factor, and general intelligence) were measured. A propensity score cross-cluster matching procedure and mediation analysis (Hayes's PROCESS macro) were conducted.

RESULTS

All cognitive variables pre-post mean changes were significantly higher (P ≤ 0.05) in children from intervention schools than those from control schools (effect size ranged from 0.33 to 1.48). The effect of the intervention on the spatial factor and general intelligence was partially mediated by motor fitness (indirect effect = 0.92, 95% CI: 0.36; 1.65; and indirect effect = 1.21, 95% CI: 0.06; 2.62, respectively).

CONCLUSIONS

This study shows that a one-school-year multicomponent intervention consisting of a recreational non-competitive PA program, educational materials for parents and teachers, and school playground modifications improved the cognition of first-grade children. Further, our results suggest that the effect of the intervention on cognition was mediated by changes in motor fitness.

Motor Competence Levels and Prevalence of Developmental Coordination Disorder in Spanish Children: The MOVI-KIDS Study

BACKGROUND

Motor competence (MC) affects numerous aspects of children's daily life. The aims of this study were to: evaluate MC, provide population-based percentile values for MC; and determine the prevalence of developmental coordination disorder (DCD) in Spanish schoolchildren.

METHODS

This cross-sectional study included 1562 children aged 4 to 6 years from Castilla-La Mancha, Spain. MC was assessed using the Movement Assessment Battery for Children-Second Edition. Values were analyzed according to age, sex, socioeconomic status (SES), environment (rural/urban), and type of school.

RESULTS

Boys scored higher than girls in aiming and catching, whereas girls aged 6 scored higher than boys in balance. Children living in rural areas and those attending to public schools obtained better scores in aiming and catching than those from urban areas and private schools. The prevalence of DCD was 9.9%, and 7.5% of children were at risk of having movement problems.

CONCLUSION

Motor test scores can represent a valuable reference to evaluate and compare the MC in schoolchildren. Schools should identify motor problems at early ages and design initiatives which prevent or mitigate them.

A Review: Associations Between Attention-deficit/hyperactivity Disorder, Physical Activity, Medication Use, Eating Behaviors and Obesity in Children and Adolescents

In the past few years we have become increasingly aware of strong associations between obesity and ADHD. Both conditions are major public health issues, affecting children, adolescents and adults alike.

OBJECTIVE

This review seeks to (1) examine prior research on the association between ADHD and obesity in children and adolescents; (2) discuss mechanisms and consequent behavioral attributes to gain understanding of the path association between ADHD and obesity, (3) review studies examining the role of physical activity, medication, eating behavior and gender on the relationship between ADHD and obesity in children and adolescents.

METHOD

PubMed, CINAHL and PsycINFO databases were used to search for studies whose subjects were children and adolescents, ages 0-17 years and whose publication years were from 2000 to 2016. After screening 31 studies were included in the review.

RESULTS

The literature suggests that there is a significant association between ADHD and obesity. Further, the inattentive and impulsive behaviors that characterize ADHD could contribute to dis-regulated eating behaviors and a lack of motivation to engage in physical activity. In addition, it is proposed that medication, gender and physical activity play a role in mediating and moderating the relationship between ADHD and obesity.

Prevalence of probable Attention-Deficit/Hyperactivity Disorder symptoms: result from a Spanish sample of children

Background

The aims of our study were to: (i) determine the prevalence of children aged 4 to 6 years with probable Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms in the Spanish population; and (ii) analyse the association of probable ADHD symptoms with sex, age, type of school, origin (native or foreign) and socio-economic status in these children.

Methods

This cross-sectional study included 1189 children (4 to 6 years-old) from 21 primary schools in 19 towns from the Ciudad Real and Cuenca provinces, Castilla-La Mancha region, Spain. The ADHD Rating Scales IV for parents and teachers was administered to determine the probability of ADHD. The 90th percentile cut-off was used to establish the prevalence of inattention, hyperactivity/impulsivity and combined subtype.

Results

The prevalence of children with probable ADHD symptoms was 5.4% (2.6% inattention subtype symptoms, 1.5% hyperactivity/impulsivity subtype symptoms, and 1.3% combined subtype symptoms). Children aged 4 to 5 years showed a higher prevalence of probable ADHD in the inattention subtype symptoms and in total of all subtypes than children aged 6 years, and children with low socio-economic status reported a higher prevalence of probable ADHD symptoms (each subtype and total of all of them) than those with medium and high socio-economic status.

Conclusions

Early diagnosis and an understanding of the predictors of being probable ADHD are needed to direct appropriate identification and intervention efforts. These screening efforts should be especially addressed to vulnerable groups, particularly low socio-economic status families and younger children.

Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight

BACKGROUND

The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions.

OBJECTIVES

To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group.

SEARCH METHODS

In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data.

SELECTION CRITERIA

We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes.

DATA COLLECTION AND ANALYSIS

Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes.

MAIN RESULTS

We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events.Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school.There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions.There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence).

AUTHORS' CONCLUSIONS

Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes.

Bright light therapy versus physical exercise to prevent co-morbid depression and obesity in adolescents and young adults with attention-deficit / hyperactivity disorder: study protocol for a randomized controlled trial

BACKGROUND

The risk for major depression and obesity is increased in adolescents and adults with attention-deficit / hyperactivity disorder (ADHD) and adolescent ADHD predicts adult depression and obesity. Non-pharmacological interventions to treat and prevent these co-morbidities are urgently needed. Bright light therapy (BLT) improves day-night rhythm and is an emerging therapy for major depression. Exercise intervention (EI) reduces obesity and improves depressive symptoms. To date, no randomized controlled trial (RCT) has been performed to establish feasibility and efficacy of these interventions targeting the prevention of co-morbid depression and obesity in ADHD. We hypothesize that the two manualized interventions in combination with mobile health-based monitoring and reinforcement will result in less depressive symptoms and obesity compared to treatment as usual in adolescents and young adults with ADHD.

METHODS

This trial is a prospective, pilot phase-IIa, parallel-group RCT with three arms (two add-on treatment groups [BLT, EI] and one treatment as usual [TAU] control group). The primary outcome variable is change in the Inventory of Depressive Symptomatology total score (observer-blinded assessment) between baseline and ten weeks of intervention. This variable is analyzed with a mixed model for repeated measures approach investigating the treatment effect with respect to all three groups. A total of 330 participants with ADHD, aged 14 - < 30 years, will be screened at the four study centers. To establish effect sizes, the sample size was planned at the liberal significance level of α = 0.10 (two-sided) and the power of 1-β = 80% in order to find medium effects. Secondary outcomes measures including change in obesity, ADHD symptoms, general psychopathology, health-related quality of life, neurocognitive function, chronotype, and physical fitness are explored after the end of the intervention and at the 12-week follow-up.

DISCUSSION

This is the first pilot RCT on the use of BLT and EI in combination with mobile health-based monitoring and reinforcement targeting the prevention of co-morbid depression and obesity in adolescents and young adults with ADHD. If at least medium effects can be established with regard to the prevention of depressive symptoms and obesity, a larger scale confirmatory phase-III trial may be warranted.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00011666. Registered on 9 February 2017. ClinicalTrials.gov, NCT03371810. Registered on 13 December 2017.

Physical activity, diet and other behavioural interventions for improving cognition and school achievement in children and adolescents with obesity or overweight

BACKGROUND

The global prevalence of childhood and adolescent obesity is high. Lifestyle changes towards a healthy diet, increased physical activity and reduced sedentary activities are recommended to prevent and treat obesity. Evidence suggests that changing these health behaviours can benefit cognitive function and school achievement in children and adolescents in general. There are various theoretical mechanisms that suggest that children and adolescents with excessive body fat may benefit particularly from these interventions.

OBJECTIVES

To assess whether lifestyle interventions (in the areas of diet, physical activity, sedentary behaviour and behavioural therapy) improve school achievement, cognitive function (e.g. executive functions) and/or future success in children and adolescents with obesity or overweight, compared with standard care, waiting-list control, no treatment, or an attention placebo control group.

SEARCH METHODS

In February 2017, we searched CENTRAL, MEDLINE and 15 other databases. We also searched two trials registries, reference lists, and handsearched one journal from inception. We also contacted researchers in the field to obtain unpublished data.

SELECTION CRITERIA

We included randomised and quasi-randomised controlled trials (RCTs) of behavioural interventions for weight management in children and adolescents with obesity or overweight. We excluded studies in children and adolescents with medical conditions known to affect weight status, school achievement and cognitive function. We also excluded self- and parent-reported outcomes.

DATA COLLECTION AND ANALYSIS

Four review authors independently selected studies for inclusion. Two review authors extracted data, assessed quality and risks of bias, and evaluated the quality of the evidence using the GRADE approach. We contacted study authors to obtain additional information. We used standard methodological procedures expected by Cochrane. Where the same outcome was assessed across different intervention types, we reported standardised effect sizes for findings from single-study and multiple-study analyses to allow comparison of intervention effects across intervention types. To ease interpretation of the effect size, we also reported the mean difference of effect sizes for single-study outcomes.

MAIN RESULTS

We included 18 studies (59 records) of 2384 children and adolescents with obesity or overweight. Eight studies delivered physical activity interventions, seven studies combined physical activity programmes with healthy lifestyle education, and three studies delivered dietary interventions. We included five RCTs and 13 cluster-RCTs. The studies took place in 10 different countries. Two were carried out in children attending preschool, 11 were conducted in primary/elementary school-aged children, four studies were aimed at adolescents attending secondary/high school and one study included primary/elementary and secondary/high school-aged children. The number of studies included for each outcome was low, with up to only three studies per outcome. The quality of evidence ranged from high to very low and 17 studies had a high risk of bias for at least one item. None of the studies reported data on additional educational support needs and adverse events.Compared to standard practice, analyses of physical activity-only interventions suggested high-quality evidence for improved mean cognitive executive function scores. The mean difference (MD) was 5.00 scale points higher in an after-school exercise group compared to standard practice (95% confidence interval (CI) 0.68 to 9.32; scale mean 100, standard deviation 15; 116 children, 1 study). There was no statistically significant beneficial effect in favour of the intervention for mathematics, reading, or inhibition control. The standardised mean difference (SMD) for mathematics was 0.49 (95% CI -0.04 to 1.01; 2 studies, 255 children, moderate-quality evidence) and for reading was 0.10 (95% CI -0.30 to 0.49; 2 studies, 308 children, moderate-quality evidence). The MD for inhibition control was -1.55 scale points (95% CI -5.85 to 2.75; scale range 0 to 100; SMD -0.15, 95% CI -0.58 to 0.28; 1 study, 84 children, very low-quality evidence). No data were available for average achievement across subjects taught at school.There was no evidence of a beneficial effect of physical activity interventions combined with healthy lifestyle education on average achievement across subjects taught at school, mathematics achievement, reading achievement or inhibition control. The MD for average achievement across subjects taught at school was 6.37 points lower in the intervention group compared to standard practice (95% CI -36.83 to 24.09; scale mean 500, scale SD 70; SMD -0.18, 95% CI -0.93 to 0.58; 1 study, 31 children, low-quality evidence). The effect estimate for mathematics achievement was SMD 0.02 (95% CI -0.19 to 0.22; 3 studies, 384 children, very low-quality evidence), for reading achievement SMD 0.00 (95% CI -0.24 to 0.24; 2 studies, 284 children, low-quality evidence), and for inhibition control SMD -0.67 (95% CI -1.50 to 0.16; 2 studies, 110 children, very low-quality evidence). No data were available for the effect of combined physical activity and healthy lifestyle education on cognitive executive functions.There was a moderate difference in the average achievement across subjects taught at school favouring interventions targeting the improvement of the school food environment compared to standard practice in adolescents with obesity (SMD 0.46, 95% CI 0.25 to 0.66; 2 studies, 382 adolescents, low-quality evidence), but not with overweight. Replacing packed school lunch with a nutrient-rich diet in addition to nutrition education did not improve mathematics (MD -2.18, 95% CI -5.83 to 1.47; scale range 0 to 69; SMD -0.26, 95% CI -0.72 to 0.20; 1 study, 76 children, low-quality evidence) and reading achievement (MD 1.17, 95% CI -4.40 to 6.73; scale range 0 to 108; SMD 0.13, 95% CI -0.35 to 0.61; 1 study, 67 children, low-quality evidence).

AUTHORS' CONCLUSIONS

Despite the large number of childhood and adolescent obesity treatment trials, we were only able to partially assess the impact of obesity treatment interventions on school achievement and cognitive abilities. School and community-based physical activity interventions as part of an obesity prevention or treatment programme can benefit executive functions of children with obesity or overweight specifically. Similarly, school-based dietary interventions may benefit general school achievement in children with obesity. These findings might assist health and education practitioners to make decisions related to promoting physical activity and healthy eating in schools. Future obesity treatment and prevention studies in clinical, school and community settings should consider assessing academic and cognitive as well as physical outcomes.

Children`s lifestyle behaviors in relation to anthropometric indices: a family practice study

Introduction

Obesity prevention in children represents one of the main concerns in primary care. In order to develop into a healthy adult, the child has to follow a healthy lifestyle in all aspects: nutritional, behavioral, physical and recreational. Our main goal was to identify which habits may influence the children’s somatic development.

Method

Our study, performed in a family practice, consisted in a questionnaire regarding physical activity, diet and use of electronic devices.

After obtaining the parent’s and child’s informed consent to participate in our cross-sectional study, 98 consecutive children aged 5–15 years, examined in the family practice, were enlisted. After collecting the answers, weight, height, waist circumference, wrist circumference, subscapular skinfold thickness were measured and body mass index was calculated.

Results

The analysis of the relationship between the anthropometric data showed a significant difference between girls and boys only in respect of the wrist circumference. The groups performing daily household activities had a significantly increased weight, BMI, abdominal and wrist circumference. Participation in physical education classes in school was associated significantly only with the wrist circumference. Frequent change of the option for extracurricular sport showed a significant difference in weight, waist circumference, and wrist in favor of the group that practiced many sports. Fast food diet and the type of alimentary habits of the family (home cooked, pre-cooked, or ordered food) showed differences between medians of the anthropometric indices with higher values for those eating more frequently fast food or ordered food, yet without reaching statistical significance.

Conclusion

Both girls and boys, in the presence of an unhealthy lifestyle (lack of recreational and educational physical activity, food habits, inappropriate time spent in front of a screen) had unfavorable adiposity indices.