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Abstract Background Despite the uncontested benefits of physical activity, its promotion lags behind in the public health agenda of low- and middle-income countries (LMICs). School-based interventions are promising strategies to foster health during childhood, but evidence of their effectiveness is limited and inconclusive for LMICs. Thus, further investigation is needed on contextual factors associated with intervention implementation in low-resource settings. We studied the acceptability and feasibility of the KaziKidz health promotion intervention and its implementation and make recommendations to improve future adoption and sustainability. Methods KaziKidz was implemented in four primary schools from low-income communities in South Africa in 2019. Semi-structured interviews with four school principals, three focus group interviews with 16 educators, and another three with 16 caregivers were conducted between October and November 2021. Participants were purposively recruited. Interview transcripts were analyzed via thematic analysis using a deductive and reflexive approach. Results Three main themes influencing intervention implementation and adoption were identified: (1) prioritizing teachers’ needs (2), integrating the program into the school structure, and (3) creating opportunities in the community. Supporting recommendations included: (theme 1) adopting intervention approaches that are inclusive of educators’ health and providing them with capacity development and external support; (theme 2) fostering a feeling of ownership and belonging among school stakeholders to adapt interventions to specific resources and needs; and (theme 3) raising community awareness to encourage individuals to claim power over and actively engage with the program. Conclusions Comprehensive interventions comprising health support, adequate training, and ongoing assistance for educators combined with school-wide and community outreach actions seeking to strengthen program ownership, accountability, and engagement can enhance uptake of school-based interventions and long-term maintenance. Trial registration ISRCTN15648510, registered on 17/04/2020.

Abstract Muscular strength represents a specific component of health-related fitness. Hand grip strength is used as a simple and dynamic marker of maximum voluntary force of the hand and to estimate overall strength. Today, little is known about the relationship between grip strength and health in forcibly displaced populations. In the present study, we examined whether grip strength is associated with various health outcomes in a sample of forcibly displaced people living in a Greek refugee camp. The present analyses are part of a larger pragmatic randomized controlled trial. In this paper, cross-sectional baseline data of 143 participants (71 men, 72 women) will be presented. In addition to grip strength, the following physical and mental health outcomes were assessed: body weight and body composition, blood pressure, total cholesterol, low- and high-density lipoprotein cholesterol, triglycerides, blood glucose levels (HbA1c), post-traumatic stress disorder (PTSD) symptoms, depressive and anxiety symptoms, pain, and quality of life. Linear regression analyses were carried out to examine how grip strength is associated with the health outcomes, separately for absolute and normalized grip strength scores. Grip strength was positively and strongly associated with percentage muscle mass (normalized grip strength: Stand. B = 0.58, p

Background: The metabolic syndrome epidemic, including in forcibly displaced individuals, requires cost-effective prevention and treatment strategies. Yet, the health needs of forcibly displaced individuals often remain underserved. Our study evaluated the effect of a co-designed exercise and sport intervention on cardiorespiratory fitness and metabolic syndrome components among individuals in a refugee camp in Greece and examined the indirect effect through cardiorespiratory fitness on metabolic syndrome components. Methods: We conducted a randomized controlled trial involving an intervention and a wait-list control group with n = 142 (52.8 % women) forcibly displaced Southwest Asians and Sub-Saharan Africans. The intervention group participated for 10 weeks in exercise and sport activities. Outcomes were cardiorespiratory fitness and single metabolic syndrome components. Effects were analyzed with structural equation modeling. Results: In total, 62.7 % of participants presented with low cardiorespiratory fitness levels (

Childhood undernutrition is a major issue in low- and middle-income countries, affecting the health, well-being, and educational outcomes of schoolchildren. This study aimed to assess the prevalence and associated factors of stunting, wasting, and underweight among schoolchildren in peri-urban areas in the south-eastern part of Tanzania. A cross-sectional study was conducted involving 930 children aged 6–12 years from four primary schools from July to August 2019. The WHO Anthro Survey Analyzer was employed to estimate the prevalence of stunting, wasting, and underweight, while logistic regression analyses examined sociodemographic background, malaria infection, anaemia, anthropometric measures, and dietary diversity score as potential factors. The prevalence of stunting, wasting, underweight, overweight, and obesity was 11.8%, 4.3%, 3.9%, 11.1%, and 2.0%, respectively. Overall, 1.5% of the children had malaria, as determined by rapid diagnostic tests, and 0.4% had severe anaemia. Univariate analysis indicated higher odds of undernutrition among children aged 9–12 compared to their younger peers. Stunting was more common among children with low and medium dietary diversity. Anaemia was found in 11.2% of schoolchildren, and severe anaemia was associated with wasting. Multivariate analysis revealed that age and low dietary diversity were significantly associated with undernutrition. These findings emphasise the need for school-based health and nutrition programmes targeting children beyond the age of 5 to improve their nutritional status and mitigate potential adverse effects on health, cognition, and academic achievement. Regular assessment of the nutritional status of schoolchildren is warranted.

Abstract: Background: Children with Attention Deficit Hyperactivity Disorder (ADHD) often face problems in the engagement and adherence of health-promoting behaviors, such as physical activity and sports. Stimulant treatment is effective for managing core symptoms, but it remains unclear if this type of treatment also normalizes the engagement in health-promoting behavior. In this case-control study, we aim to compare physical activity and sports participation between children with ADHD and healthy peers. Motor skills and aerobic fitness are investigated as potential mediators of differences between groups. Methods: Children with ADHD were matched to healthy peers based on sex, age, and socioeconomic status. Participants (N=120; age: 10.8±1.4) reported their physical activity and sports participation using a 7-day recall protocol. Their engagement in activities at moderate and vigorous intensity as well as participation in individual and team sports was derived from the protocol. Participants further completed the Movement Assessment Battery for Children-2 (MABC-2) and a submaximal test on a cycling ergometer (PWC170). Results: Children with ADHD showed lower vigorous physical activity and participation in individual sports than healthy peers. They also achieved lower scores on the MABC-2 and the PWC170. Based on path-analyses, low PWC170 partially mediated the ADHD-related fewer engagement in vigorous physical activity and individual sports. Conclusion: Children with ADHD undergoing stimulant treatment show less participation in vigorous physical activity and individual sports than healthy peers. Poor aerobic fitness partly contributes to the relation between ADHD and low physical activity.

Background/aimSchool-aged children in low- and middle-income countries carry the highest burden of intestinal helminth infections, such as soil-transmitted helminths (STH). STH infections have been associated with negative consequences for child physical and cognitive development and wellbeing. With the epidemiological transition and rise in cardiovascular disease (CVD), studies have shown that helminth infections may influence glucose metabolism by preventing obesity. Thus, the aim of this study was to determine the association of STH infections in schoolchildren from Gqeberha, focusing on physical activity, physical fitness, and clustered CVD risk score.MethodsThis cross-sectional study involved 680 schoolchildren (356 girls and 324 boys; mean age 8.19 years, SD±1.4) from disadvantaged communities in Gqeberha (formerly, Port Elizabeth), South Africa. Stool samples were collected and examined for STH infections using the Kato-Katz method. Physical activity (accelerometer) and physical fitness (grip strength, 20 m shuttle run) were measured using standard procedures. Furthermore, anthropometry, blood pressure, as well as glycated haemoglobin and lipid profile from capillary blood samples were assessed. We employed one-way ANOVAs to identify the associations of STH infections in terms of species and infection intensity with physical activity, physical fitness, and clustered CVD risk score.ResultsWe found a low STH infection prevalence (7.2%) in our study, with participants infected with at least one intestinal helminth species. In comparison to their non-infected peers, children infected with STH had lower mean grip strength scores, but higher mean VO2max estimation and higher levels of MVPA (p < .001). When considering type and intensity of infection, a positive association of A. lumbricoides infection and MVPA was found. In contrast, light T. trichiura-infected children had significantly lower grip strength scores compared to non and heavily-infected children. VO2max and MVPA were positively associated with light T. trichiura infection. No significant association between the clustered CVD risk score and infection with any STH species was evident.ConclusionsSTH-infected children had lower grip strength scores than their non-infected peers, yet, achieved higher VO2max and MVPA scores. Our study highlights that the type and intensity of STH infection is relevant in understanding the disease burden of STH infections on children's health. The findings of our study must be interpreted cautiously due to the low infection rate, and more research is needed in samples with higher prevalence rates or case-control designs.

The burden of non-communicable diseases is increasing, with risk factors emerging early in life. Physical activity reduces cardiovascular risk, but limited evidence exists for children from lower-income countries and mostly relies on self-reported methods that might be inaccurate and biased. We aimed to compare self-reported and accelerometer-measured physical activity in relation to cardiovascular risk markers in children from underserved communities in South Africa. We analysed cross-sectional data from 594 children aged 8 to 13. Physical activity was measured via accelerometry and the Physical Activity Questionnaire for Older Children (PAQ-C). Correlation analyses and linear regression models examined the relationship between accelerometer-measured and self-reported physical activity and their association with cardiovascular risk markers (body mass index, blood pressure, blood lipid profile and glycated haemoglobin). Results show a positive but weak correlation between PAQ-C scores and accelerometer-measured moderate-to-vigorous physical activity (MVPA). MVPA was inversely associated with body mass index, whilst sedentary behaviour correlated positively with lipid levels. PAQ-C scores were inversely associated with systolic blood pressure. The comparison of self-reported and accelerometer-measured physical activity in children from Gqeberha, South Africa, revealed inconsistencies in their correlation and association with cardiovascular risk markers. Accelerometry provided a more accurate cardiovascular risk estimation than PAQ-C, although associations were weak. Further, longitudinal studies should investigate the predictive power of both methodologies. These findings inform researchers and public health practitioners in the choice of method for physical activity appraisal beyond practical considerations, especially when combined with cardiovascular risk and in lower-income settings. Significance: We explore two widely used methods to assess physical activity levels in children. By comparing both methods, we expose inconsistencies in their correlation and association with cardiovascular risk markers. These data can guide researchers and public health practitioners in the use of one method beyond practical considerations. Whilst this work focuses on children from marginalised areas of South Africa, the issues explored are of relevance to other lower-income settings. Open data set: https://doi.org/10.5281/zenodo.7217145

Abstract Background A balanced nutrition is important for children’s physical and cognitive development; yet, remains a challenge in many parts of low- and middle-income countries (LMICs). Early detection of nutritional deficiency and metabolic syndrome in school-aged children is necessary to prevent non-communicable diseases (NCDs) in later life. This study aimed at obtaining baseline data on health, nutritional status, and metabolic markers of NCDs among primary schoolchildren in Côte d’Ivoire. Methods A cross-sectional survey was conducted among 620 children from 8 public primary schools located in the south-central part of Côte d’Ivoire. Underweight and overweight were defined as a body mass index (BMI; kg/m2)

BackgroundForcibly displaced people face various challenges and are therefore at higher risk of being affected by mental and physiological distress. The present study aimed to determine levels of psychological well-being, PTSD symptom severity, metabolic syndrome, and associated factors among forcibly displaced people in Greece in response to WHO’s call for evidence-based public health policies and programs for forcibly displaced people.MethodsWe conducted a cross-sectional study among n = 150 (50% women) forcibly displaced people originating from Sub-Sahara Africa and Southwest Asia living in a Greek refugee camp. Self-report questionnaires were used to assess psychological well-being, symptoms of PTSD, depression, generalized anxiety disorder and insomnia, perceived stress, headache, and perceived fitness. Cardiovascular risk markers were assessed to determine metabolic syndrome, and cardiorespiratory fitness was measured with the Åstrand-Rhyming Test of Maximal Oxygen Uptake.ResultsThe prevalence of mental distress and physiological disorders was overall elevated. Only 53.0% of participants rated their psychological well-being as high. Altogether, 35.3% scored above the clinical cut-off for PTSD, 33.3% for depression, 27.9% for generalized anxiety disorder, and 33.8% for insomnia. One in four (28.8%) participants met criteria for metabolic syndrome. While the prevalence of moderate or severe insomnia symptoms and metabolic syndrome differed little from the global population, the risk of being affected by mental distress was markedly increased. In multivariable analysis, higher perceived fitness was associated with higher psychological well-being (OR = 1.35, p = 0.003) and a decreased likelihood for metabolic syndrome (OR = 0.80, p = 0.031). Participants with elevated psychiatric symptoms were less likely to report high psychological well-being (OR = 0.22, p = 0.003) and had increased odds for higher PTSD severity (OR = 3.27, p = 0.034). Increased stress perception was associated with higher PTSD symptoms (OR = 1.13, p = 0.002).ConclusionThere is an elevated risk for mental distress compared to the global population and an overall high mental and physiological burden among people living in a Greek refugee camp. The findings underpin the call for urgent action. Policies should aim to reduce post-migration stressors and address mental health and non-communicable diseases by various programs. Sport and exercise interventions may be a favorable add-on, given that perceived fitness is associated with both mental and physiological health benefits.

IntroductionRisk factors for noncommunicable diseases such as insufficient physical activity (PA), overweight or hypertension are becoming increasingly predominant among children globally. While school-based interventions are promising preventive strategies, evidence of their long-term effectiveness, especially among vulnerable populations, is scarce. We aim to assess the short-term effects of the physical and health KaziKidz intervention on cardiometabolic risk factors and the long-term, pre-and post-COVID-19 pandemic changes thereof in high-risk children from marginalized communities.MethodsThe intervention was tested in a cluster-randomized controlled trial between January and October 2019 in eight primary schools near Gqeberha, South Africa. Children with overweight, elevated blood pressure, pre-diabetes, and/or borderline dyslipidemia were identified and re-assessed 2 years post-intervention. Study outcomes included accelerometry-measured PA (MVPA), body mass index (BMI), mean arterial pressure (MAP), glucose (HbA1c), and lipid levels (TC to HDL ratio). We conducted mixed regression analyses to assess intervention effects by cardiometabolic risk profile, and Wilcoxon signed-rank tests to evaluate longitudinal changes in the high-risk subpopulation.ResultsWe found a significant intervention effect on MVPA during school hours for physically inactive children, and among active as well as inactive girls. In contrast, the intervention lowered HbA1c and TC to HDL ratio only in children with glucose or lipid values within the norm, respectively. At follow-up, the intervention effects were not maintained in at-risk children, who showed a decline in MVPA, and an increase in BMI-for-age, MAP, HbA1c and TC to HDL ratio.ConclusionWe conclude that schools are key settings in which to promote PA and improve health; however, structural changes are necessary to ensure that effective interventions reach marginalized school populations and achieve sustainable impact.

Basic motor competencies (BMC) belong to the main learning goals of physical education (PE) in primary school and are needed to actively take part in the culture of sport and human movement. BMC levels between European countries differ widely and individual determinants like age, sex, and extracurricular physical activity participation consistently predict BMC levels (Wälti et al., 2022), but also structural aspects of PE are important factors of learning outcomes. In this study, we wanted to investigate if the weekly amount of PE accounts for differences in BMC levels across countries. We assessed BMC (object movement, self-movement), anthropometric data (sex, age, body-mass-index) and participation in extracurricular physical activity (ball sports, individual sports) in 3,069 6- to 10-year-old primary school children using the MOBAK-1-4 and structural aspects (amount of PE) in 179 teachers from eight European countries. Latent multilevel regression analyses were corrected for children’s sex, age, body-mass-index, extracurricular physical activity participation and region of assessment. Despite differences in the weekly amount of PE in the assessed samples, there were no significant associations between the amount of PE and object movement or self-movement in either the 6- to 8-year-old or the 8- to 10-year-old children. The covariates age, sex, body-mass-index and participation in ball sports were significant predictors of object movement in all children. Body-mass-index and participation in any kind of extracurricular physical activity were significantly associated with self-movement in children aged 6-8 years. In children aged 8-10 years, all anthropometric variables as well as participation in any kind of extracurricular physical activity were significant predictors of self-movement. Other country-specific or PE-related factors might be more crucial for the differences in BMC levels than the amount of PE (García-Hermoso et al., 2020). A focus on the quality and content of PE lessons as well as on the qualification and goals of PE teachers is suggested. Nevertheless, for children who do not participate in extracurricular physical activity, PE can be crucial for BMC development. References García-Hermoso, A., Alonso-Martínez, A. M., Ramírez-Vélez, R., Pérez-Sousa, M. Á., Ramírez-Campillo, R., & Izquierdo, M. (2020). Association of physical education with improvement of health-related physical fitness outcomes and fundamental motor skills among youths: A systematic review and meta-analysis. JAMA Pediatrics, 174(6), Article e200223. https://doi.org/10.1001/jamapediatrics.2020.0223 Wälti, M., Sallen, J., Adamakis, M., Ennigkeit, F., Gerlach, E., Heim, C., Jidovtseff, B., Kossyva, I., Labudová, J., Masaryková, D., Mombarg, R., De Sousa Morgado, L., Niederkofler, B., Niehues, M., Onofre, M., Pühse, U., Quitério, A., Scheuer, C., Seelig, H., Vlček, P., . . . & Herrmann, C. (2022). Basic motor competencies of 6- to 8-year-old primary school children in ten European countries: A cross-sectional study on associations with age, sex, BMI and physical activity. Frontiers in Psychology, 13, Article 804753. https://doi.org/10.3389/fpsyg.2022.804753

Objective Risk factors for chronic diseases such as insufficient physical activity (PA), overweight or hypertension are getting more predominant among children. While school-based interventions are promising preventive strategies, evidence of their long-term effectiveness, especially among vulnerable populations is scarce. KaziKidz is a physical education intervention that promotes healthy and active lifestyles among children from low-income communities. We aim at assessing the short- and long-term effects of KaziKidz on cardiovascular risk factors in high-risk children from disadvantaged communities. Methods The intervention was tested in a cluster-randomized controlled trial between January and October 2019 in eight primary schools in South Africa. Children with adverse cardiovascular profiles were defined as presenting at least one risk factor for (1) overweight, (2) elevated blood pressure, (3) glycaemia, and/or (4) cholesterolemia. After their identification, high-risk children were re-assessed 2-years post-intervention. Study outcomes include accelerometry-measured PA (MVPA), body-mass-index (BMI), mean arterial pressure (MAP), glucose (HbA1c), and lipid levels (TC/HDL). We conducted mixed regression analyses to assess intervention effects by cardiovascular risk profile, and Wilcoxon signed-rank tests to evaluate longitudinal changes in the high-risk subpopulation. Results A significant intervention effect on MVPA during school hours was found for physically inactive children (B: 1.71, 95% CI: 0.14 – 3.35, p-value: 0.008), and among active (B: 1.80, 95% CI: -0.22 – 3.82, p-value: 0.035) and inactive (B: 2.03, 95% CI: 0.58 – 3.42, p-value: < 0.001) girls. In contrast, the intervention lowered HbA1c (B: -0.26, 95% CI: -0.52 – -0.01, p-value: 0.037) and TC/HDL (B: -0.11, 95% CI: 0.18 – -0.05, p-value: 0.002) only in children with normal glucose or lipid values, respectively. The intervention effects were not maintained in at-risk children at follow-up. A decline was observed in MVPA from 53.29 to 41.90 min/day (z = -1.95, p = 0.05, r = 0.26), and an increase in BMI-for-age (z = -0.34, p = 0.737, r = 0.03), MAP (z = -5.18, p < 0.001, r = 0.42), HbA1c (z = -1.63, p = 0.104, r = 0.25) and TC/HDL (z = -1.61, p = 0.11, r = 0.21). Conclusion We conclude that schools are key settings to promote PA and improve health; however, because the intervention effects were not maintained in children at risk of NCDs, structural changes that ensure effective interventions reach disadvantaged populations are necessary to achieve sustainable impact.

Background While children with Autism Spectrum Disorder show heterogeneous cognitive profiles, they share common deficits in social-cognitive abilities and executive function. Moderate endurance exercise is known to elicit changes in the psychophysiological state, which can translate into immediate, but transient benefits for both cognitive domains. However, the cognitive response of children with Autism Spectrum Disorder to acute exercise remains unclear. We addressed this research deficit by investigating the effects of a single endurance exercise session on face recognition abilities and affective response inhibition. Methods We recruited 30 children with Autism Spectrum Disorder aged 7 to 12 years from local clinicals in Basel, Switzerland and via social media. Using a randomized cross-over design, participants completed a moderately-intense, 20-min exercise session on a cycling ergometer and control condition, which involved sitting on the ergometer. We collected heart rate and ratings of perceived exertion during these sessions. Before and after the experimental conditions, participants completed two computerized cognitive tasks. During the Mooney Face Recognition task, they had to categorize stimuli into faces and objects. In the affective Go/NoGo task, participants were instructed to inhibit their response to either sad or happy faces and press a button to all other faces. Results The experimental manipulation was successful as a main effect of condition indicated a higher heart rate and rating of perceived exertion in the exercise compared to the control condition. With regard to cognitive performance, the repeated measures ANOVA revealed an interaction of time and condition for the Mooney Face Recognition task, indicating an increase in reaction time in the exercise compared to the control condition. In contrast, no interaction of time and condition was found for accuracy on this task as well as accuracy and reaction time on the affective Go/NoGo task. Conclusion In children with Autism Spectrum Disorder, a single exercise does not seem to benefit social-cognitive abilities and executive function temporarily. A short cycling bout rather impairs the ability to recognize faces, suggesting that the maintenance of supervised exercise demands a set of joint resources. As these results are in conflict with the well-documented benefit of acute exercise in healthy populations, the atypical cognitive response in children with Autism Spectrum Disorder indicates a moderating role of this neurodevelopmental condition.

Background The school curriculum places high demands on students’ cognitive performance, including the executive domain of inhibitory control. Physical activity breaks have been suggested to restore students’ cognitive resources. However, it is unclear which properties (i.e. physical effort and cognitive load) of the physical activity break are suited best to improve subsequent cognitive performance. Therefore, the aim of our study was to investigate the effect of exercise with different physical effort and cognitive load on subsequent inhibitory control. Methods Thirty-five healthy right handed children aged 9 to 13 years were recruited from an academic high school in Basel, Switzerland. On four different days at least one week apart and in randomized order, participants underwent short exercise sessions on an interactive exergaming wall (SMARTfit Single, SMARTfit, USA). The sessions lasted 10 min and combined high (or low) physical effort with high (or low) cognitive load. Participants rated their perceived exhaustion and cognitive load using an RPE scale and the NASA task load index. Before and after the exercise sessions, a standard Stroop task and an affective Stroop task were performed to account for changes in inhibitory control with and without an additional component of emotion processing. Results The manipulation check showed that the high physical effort condition was related to higher rated perceived exhaustion and the high cognitive load condition to higher scores on the NASA task load index. Statistical analysis using 2 x 2 ANOVA revealed that independent from cognitive load, physical effort influenced reaction time on the affective, but not the standard Stroop task. This indicated a greater improvement following exercise at low compared to high physical effort in both the congruent and incongruent trials. This effect was not due to a speed-accuracy trade-off, given that no main effect of physical effort was found for accuracy. There were no main effects of cognitive load and no interaction of physical effort and cognitive load. Conclusion Our results indicated that in school children, lower exercise intensity is more suitable for improving subsequent inhibitory control than exercise with higher physical effort. However, this effect only seems to be present in situations where cognitive challenge is combined with emotionally charged stimuli. This has implications for recommendations on how to optimally organize students’ physical activity during school breaks.

Background: Accumulating evidence suggests that sports participation promotes the development of inhibitory control, but the influences of the sports category and inhibition type still remain unclear. The categorization of sports based on the open-skill (externally paced) and closed-skill (self-paced) continuum allows for the integration of the environment as a factor contributing to sports-related benefits for inhibitory control. Methods: Cross-sectional data from different studies were combined (n = 184) to examine the association between open- and closed-skill sports and cognitive control processes related to interference control and response inhibition. Participants (aged 9−14 years) filled in 7-day physical activity recall protocols and completed a Stroop Color−Word or a Go/NoGo task. The N200, N450, and P300 components of event-related potentials elicited by these tasks were recorded using electroencephalography. Results: Partial correlations supported the belief that time spent in open-skill sports was related to higher performance on inhibition trials. Additionally, path analyses revealed an association between this sports type and a greater negativity in the N200 and N450 amplitudes in both the full sample and group-level analyses. In contrast, no relation was found between sports type and P300 amplitude. Conclusion: The findings suggest that only the engagement in open-skill sports is associated with more effective conflict monitoring and higher performance on tasks demanding inhibitory control.

Abstract Background The prevalence of overweight and obesity is increasing among African children potentially predisposing them to greater obesity and non-communicable diseases (NCDs) in adulthood. This risk may be higher among growth-impaired children who may have greater fat mass. Therefore, we examined the effects of school-based physical activity (PA) promotion and multi-micronutrient supplementation (MMNS) on body composition among South African children enrolled in a longitudinal school-based randomized controlled trial. Methods Children were cluster-randomized by class to one of four groups: (a) a physical activity group (PA), (b) a multi-micronutrient supplementation group (MMNS), (c) a physical activity + multi-micronutrient supplementation group (PA + MMNS), and (d) control group, and were being followed for 3 years. Linear random effects regression models with random intercepts for school classes tested the associations of each intervention arm with overall fat mass (FM), fat-free mass (FFM), truncal fat mass (TrFM), and truncal fat-free mass (TrFFM) at 9 months (T2) for boys and girls. These differences were then explored among children who differed in height velocity (HV). Results A total of 1304 children (614 girls, 667 boys) in twelve clusters were assessed at baseline and after 9 months follow-up (T2). At baseline, approximately 15% of children were classified as overweight or obese while approximately 38% of children were classified as mildly stunted or moderately/severely stunted. Among girls, promotion of PA was associated with reduced FM and TrFM at T2 while MMNS was associated with increased FFM. Children with reduced HV in the PA arm had reduced FM while children in the MMNS arm with lower HV had increased FM compared to children in the control arm. Similarly, children with lower HV in the MM and PA groups had reduced TrFM compared to children in the control arm. Conclusions Our study suggests that the promotion of school-based physical activity programs and micronutrient supplementation can reduce childhood adiposity and so reduce the risk of obesity and chronic diseases later in adulthood. Trial registration ISRCTN, ISRCTN29534081 . Registered on August 9, 2018. The trial was designed, analyzed, and interpreted based on the CONSORT protocol (Additional file 1: CONSORT checklist for randomized trial)

Abstract Background Due to ongoing political and social conflicts, the number of international refugees has been increasing. Refugees are exposed to severe mental and physical strain, as well as traumatic experiences during their flight. Therefore, the risk of psychiatric disorders is markedly increased among international refugees. International organizations have criticized the lack of early interventions as a key problem, because untreated mental disorders are often difficult to cure at a later stage. Today, exercise and sport have been successfully employed to treat a wide range of psychiatric disorders. With patients with post-traumatic stress disorders (PTSD), very limited empirical evidence exists, and studies carried out with international refugees are nearly non-existent. Methods We intend to implement a pragmatic randomized controlled trial (RCT) with an exercise and sport intervention group (n = 68, 50% women) and a wait-list control group (n = 68, 50% women) in the Koutsochero refugee camp, located close to the city of Larissa (Greece). During the RCT, exercise and sport will be offered five times per week (60 min/session) for 10 weeks. Participants will be asked to participate in at least two sessions per week. The programme is developed according to the participants’ needs and preferences and they will be able to choose between a range of activities. PTSD symptoms will serve as primary outcome, and several secondary outcomes will be assessed. Qualitative data collection methods will be used to gain a more in-depth appraisal of the participants’ perception of the intervention programme. In the second year of study, the programme will be opened to all camp residents. A strategy will be developed how the programme can be continued after the end of the funding period, and how the programme can be scaled up beyond the borders of the Koutsochero camp. Discussion By moving towards the primary prevention of chronic physical conditions and psychiatric disorders, a relevant contribution can be done to enhance the quality and quantity of life of refugee camp residents in Greece. Our findings may also strengthen the evidence for exercise as medicine as a holistic care option in refugee camps, by helping camp residents to adopt and maintain a physically active lifestyle. Trial registration The study was registered prospectively on the 8 February 2021 with ISRCTN https://www.isrctn.com/ISRCTN16291983

Abstract Background Cardiovascular fitness has been associated with both executive function and academic achievement in multiple cohort studies including children and adolescents. However, research is scarce among children from low- and middle-income countries. Hence, this paper focuses on South African primary schoolchildren living in marginalized areas and examines if academic achievement and inhibitory control can be explained by children’s age, socioeconomic status, soil-transmitted helminth infections, food insecurity, stunting, grip strength, and cardiorespiratory fitness. Methods The sample of this cross-sectional study consisted of 1277 children (48% girls, mean age: 8.3 years). Data were assessed via questionnaires, stool samples, anthropometric measurements, 20 m shuttle run test, grip strength test, Flanker task, and school grades. Data were analysed with mixed linear regression models with random intercepts for school classes, separately for boys and girls. Results Higher socioeconomic status was most closely associated with academic achievement among boys (p

Introduction:Hypertension in children has increased globally over the past 20 years; yet, little is known about this issue among disadvantaged communities from low- and middle-income countries. Age-, sex-, and height-adjusted normative tables are the “gold” standard for the diagnosis and estimation of pediatric hypertension worldwide, but it is unclear whether the use of international standards is appropriate for all contexts. The purpose of this study was to evaluate and compare different international references to identify hypertension among South African school-aged children from disadvantaged communities.MethodsBlood pressure, weight, and height were measured in a cohort of 897 children aged 8–16 years from eight peri-urban schools in the Eastern Cape of South Africa. Cross-sectional prevalence of hypertension was calculated according to American, German, and global normative tables, as well as pseudo-normative data from the own study population. Isolated systolic hypertension and body mass index (BMI) were considered markers for cardiovascular disease. Multinomial logistic regression was used to compare the likelihood of blood pressure categorization with increasing BMI levels.ResultsHypertension prevalence ranged from 11.4% with the pseudo-normative study tables to 28.8% based on the German reference. Global guidelines showed the highest agreement both among international standards (92.5% with American guidelines) and with the study reference (72.5%). While the global and the American references presented higher systolic over diastolic hypertension rates (23.6 vs. 10.6% and 24.2 vs. 14.7%, respectively), the American guidelines predicted the highest increased risk for hypertension stage 2 [odds ratio, 1.72 (95% confidence interval: 1.43–2.07)] with raising levels of BMI.ConclusionOur results support the heterogeneity of blood pressure estimates found in the South African literature, and highlight the underrepresentation of African children in international guidelines. We call for caution in the use of international standards in different contexts and advocate for the development of normative tables that are representative of the South African pediatric population necessary to ensure an accurate identification of hypertension both from the clinical and epidemiological perspective.

Basic motor competencies (BMC) are a prerequisite for children to be physically active, participate in sports and thus develop a healthy, active lifestyle. The present study provides a broad screening of BMC and associations with age, sex, body mass index (BMI) and extracurricular physical activity (PA) in 10 different European countries. The different country and regional contexts within Europe will offer a novel view on already established BMC associations. The cross-sectional study was conducted in 11 regions in 10 European countries in 2018. The motor competence areas, object movement (OM) and self-movement (SM), were assessed using the MOBAK-1-2 test instrument in 3758 first and second graders (age: M = 6.86 ± 0.60 years; 50% girls) during Physical Education classes. Children were questioned about their extracurricular PA and age. Their body weight and height were measured in order to calculate BMI. Statistical analyses included variances and correlations. The results showed significant differences in BMC levels between countries (OM: F = 18.74, p < 0.001, η2 = 0.048; SM: F = 73.10, p < 0.001, η2 = 0.163) whereas associations between BMC and correlates were similar. Boys performed significantly better in OM while girls performed better in SM. Age was consistently positively related to OM and SM with older children reaching higher levels of BMC than younger ones. While participation rates for extracurricular PA differed widely, participation in ball sports was correlated with OM and SM. Participation in individual sports showed a significant association with SM. In summary, BMC levels of children seem to depend on where they live and are strongly related to their participation in extracurricular PA. Therefore, education and health policies, in order to enhance motor competence development and PA participation, are recommended. Further research on country-specific Physical Education frameworks and their influence on BMC will provide more insights into structural factors and cultural characteristics of BMC development. On a school level, support tools and educational materials for teachers about BMC may enable children to achieve a basic level of motor competencies through Physical Education, contributing to lifelong participation in PA.

Background: Children with Attention Deficit Hyperactivity Disorder (ADHD) face deficits in working memory capacity that often persist into adulthood. In healthy peers, exercise targeting motor skill acquisition benefits visuospatial working memory, but its potential to reduce ADHD-related deficits remains unclear. We investigated the effect of a judo training program targeting motor skills on behavioral and neurocognitive indices of working memory capacity in children with ADHD. Methods: Children with ADHD aged 8 to 12 years (N = 57) were randomly allocated to a judo training group and a wait-list control group. The training program encompassed 120 min of judo per week over three months. Before and after the intervention period, participants completed a bilateral Change Detection task with low and high memory load conditions and the Movement Assessment Battery for Children-2 (MABC-2). The contralateral delay activity (CDA) elicited by the cognitive task was recorded using electroencephalography. Results: Compared to the control group, the judo training group showed a higher K-score on the Change Detection task and an increased negativity of the CDA on the high load condition following the intervention, when pretest scores (and confounders) were accounted for. In contrast, no group differences were found for MABC-2 score. Conclusion: In children with ADHD, judo training may complement the pharmacological treatment by increasing the effectiveness of working memory maintenance processes. On a behavioral level, this improvement is accompanied with an increased capacity to store visuospatial information.

BackgroundExercise addiction is increasingly being recognized as a psychologically and physically burdensome set of symptoms. However, little is known about the psychiatric profiles of individuals who are at risk. It is well-established that individuals affected by substance use disorders frequently suffer from depression, attention deficit hyperactivity disorder (ADHD), and experiences of childhood trauma. The aim of this study is to determine whether this pattern of psychiatric disturbance is also present in individuals at risk for exercise addiction.MethodsIndividuals exercising for 10+ h/week were divided into those at risk and not at risk for exercise addiction based on their scores on the Exercise Dependence Scale (EDS). Demographic data and scores on the Beck Depression Inventory (BDI), a measure for ADHD in adults and the Childhood Trauma Questionnaire (CTQ) were also gathered.ResultsOne hundred and twenty-three individuals agreed to participate in the study, and completed the questionnaires. Twenty-nine (23.6%) of these individuals were classed as at risk for exercise addiction. There was a statistically significant difference between the at-risk and not at-risk groups on the combined dependent variable after controlling for hours of exercise per week, F(3, 95)= 10.198, p = 0.00, Wilk's Λ = 0.756, partial η2 = 0.244. Compared to those not at risk, individuals at risk for exercise addiction had significantly higher scores for symptoms of depression [t(121) = 4.944, p = 0.000], ADHD [t(121) = 2.915, p = 0.004], and childhood trauma [t(121) = 2.297, p = 0.024].ConclusionOur results suggest that exercise addiction may be accompanied by a disturbed psychiatric profile consistent with other addictive disorders. Clinical interviewing in individuals at risk for exercise addiction is a valuable and worthwhile next step in characterizing this phenomenon.

Background: Soccer injuries constitute an important public health problem and cause a high economic burden. Nevertheless, comprehensive data regarding injury costs in nonprofessional soccer are missing. The aim of this study was to determine which groups of nonprofessional soccer athletes, injury types, and injury situations caused high injury costs. Methods: A cross-sectional, retrospective telephone survey was carried out with a random sample of persons who had sustained a soccer injury between July 2013 and June 2014 and who had reported this accident to the Swiss National Accident Insurance Fund (Suva). One year after the corresponding accident, every injury was linked to its costs and to the answers obtained in the interview about injury setting, injury characteristics, and injury causes. Finally, the costs of 702 injuries were analyzed. Results: The average cost of an injury in nonprofessional soccer amounted to €4030 (bias-corrected and accelerated 95% confidence interval (BCa 95%CI): 3427–4719). Persons aged 30 years and older experienced 35% of soccer injuries but accounted for 49% of all costs. A total of 58% of all costs were the result of injuries that occurred during amateur games. In particular, game injuries sustained by players in separate leagues for players aged 30+/40+ years led to high average costs of €8190 (BCa 95%CI: 5036–11,645). Knee injuries accounted for 25% of all injuries and were responsible for 53% of all costs. Although contact and foul play did not lead to above-average costs, twisting or turning situations were highly cost relevant, leading to an average sum of €7710 (BCa 95%CI: 5376–10,466) per injury. Conclusion: Nonprofessional soccer players aged 30 years and older and particularly players in 30+/40+ leagues had above-average injury costs. Furthermore, the prevention of knee injuries, noncontact and nonfoul play injuries, and injuries caused by twisting and turning should be of highest priority in decreasing health care costs.

Abstract Background While exercise and physical activity are important parts of a healthy life, there is evidence that some individuals exercise to a degree which may jeopardize their health. These individuals may in some cases be exercising to lose weight or compensate binge eating episodes as part of an eating disorder. Others may experience an addiction-like relationship with exercise. Fitness center employees are ideally placed to observe these forms of unhealthy behavior, and are responsible for ensuring that clients do not put themselves at undue risk; however, to date, no study has addressed both eating disorders and excessive exercise. Therefore, the aim of our study is to determine whether these employees report incidences of these issues, and if they believe they can differentiate between them. Methods One-hundred-and-forty fitness centers in the German-speaking regions of Switzerland were contacted. Of these, 99 employees (60 men, 39 women, Mage = 33.33 years, SD = 12.02) responded to an online questionnaire. The questionnaire briefly described the two issues of interest (eating disorders and excessive exercise), and then invited respondents to complete a number of questions detailing whether they had experience with these issues, and how they dealt with them. Results Approximately 75% of the employees had suspected a client of having an eating disorder or exercising excessively, and 65% of these respondents confronted the client at least once. Interestingly, respondents reported clearly that they felt able to differentiate between the two types of disorder. Older respondents were significantly more likely to have suspicions and act on them. However, less than half of the respondents were aware of guidelines addressing this issue, and the majority desired more information about how to identify and address both disorders. Conclusions Swiss fitness center employees frequently encounter individuals who they suspect of exercising excessively, or suffering from an eating disorder. While they often confront these individuals, they would like more detailed information about how to manage this process. Given that both disorders can potentially lead to severe health consequences, a detailed description of symptoms, management techniques and resources should be a feature in all Swiss fitness center guidelines.

Abstract Background In low- and middle-income countries, infectious diseases remain a key public health issue. Additionally, non-communicable diseases are a rapidly growing public health problem that impose a considerable burden on population health. One way to address this dual disease burden, is to incorporate (lifestyle) health promotion measures within the education sector. In the planned study, we will (i) assess and compare physical activity, physical fitness, micronutrient status, body composition, infections with soil-transmitted helminths, Schistosoma mansoni, malaria, inflammatory and cardiovascular health risk markers, cognitive function, health-related quality of life, and sleep in schoolchildren in Côte d’Ivoire, South Africa and Tanzania. We will (ii) determine the bi- and multivariate associations between these variables and (iii) examine the effects of a school-based health intervention that consists of physical activity, multi-micronutrient supplementation, or both. Methods Assuming that no interaction occurs between the two interventions (physical activity and multi-micronutrient supplementation), the study is designed as a cluster-randomised, placebo-controlled trial with a 2 × 2 factorial design. Data will be obtained at three time points: at baseline and at 9 months and 21 months after the baseline assessment. In each country, 1320 primary schoolchildren from grades 1–4 will be recruited. In each school, classes will be randomly assigned to one of four interventions: (i) physical activity; (ii) multi-micronutrient supplementation; (iii) physical activity plus multi-micronutrient supplementation; and (iv) no intervention, which will serve as the control. A placebo product will be given to all children who do not receive multi-micronutrient supplementation. After obtaining written informed consent from the parents/guardians, the children will be subjected to anthropometric, clinical, parasitological and physiological assessments. Additionally, fitness tests will be performed, and children will be invited to wear an accelerometer device for 7 days to objectively assess their physical activity. Children infected with S. mansoni and soil-transmitted helminths will receive deworming drugs according to national policies. Health and nutrition education will be provided to the whole study population independently of the study arm allocation. Discussion The study builds on the experience and lessons of a previous study conducted in South Africa. It involves three African countries with different social-ecological contexts to investigate whether results are generalisable across the continent. Trial registration The study was registered on August 9, 2018, with ISRCTN. https://doi.org/10.1186/ISRCTN29534081.

Background: Physical inactivity and low cardiorespiratory fitness (CRF) are independent cardiovascular risk factors among children, but have rarely been investigated concurrently in sub-Saharan Africa. The purpose of this study was to compare physical activity (PA) and CRF of primary schoolchildren living in Côte d'Ivoire (CI), South Africa (ZA), and Tanzania (TZ), to test sex- and age-related differences, and to examine whether PA and CRF are associated with each other.Methods: Baseline data from an ongoing cluster-randomized controlled trial were used, including 499 children from CI (Taabo, 49% girls, M = 8.0 ± 1.6 years), 1,074 children from ZA (Gqeberha, 49% girls, M = 8.3 ± 1.4 years), and 593 children from TZ (Ifakara, 51% girls, M = 9.4 ± 1.7 years). PA was assessed by accelerometry and CRF by a 20 m shuttle-run test. The data were analyzed using multi-/univariate analyses of variance and mixed linear models.Results: Most children met recommendations put forward by the World Health Organization for moderate-to-vigorous PA (MVPA) and achieved high CRF scores. In CI, 89.6% of the children met MVPA recommendations (boys: 91.7%, girls: 87.4%), whereas this rate was 76.9% in ZA (boys: 91.0%, girls: 62.4%), and 93.8% in TZ (boys: 95.5%, girls: 92.0%). Children from TZ had the highest CRF and MVPA levels, followed by children from CI and ZA. Boys had higher MVPA levels than girls, whereas girls engaged in more sedentary behavior. Sex differences were strongest in ZA. Sedentary behavior and MVPA were higher among older schoolchildren compared to their younger peers. Higher MVPA, but not sedentary behavior, was associated with better CRF.Conclusions: In all three settings, higher levels of MVPA were associated with higher CRF scores. Nevertheless, children living in the most urbanized setting (such as observed in ZA) were physically less active and had lower CRF than peers living in more rural areas (such as observed in CI and TZ). Particularly for girls, urbanization might increase the risk for insufficient MVPA, which may have negative effects on their CRF, thus negatively influencing health and well-being at later age.

The neurophysiological mechanisms underlying executive function deficits in very preterm born children still remain unclear. Moreover, evidence on factors that can be modified by behavior and exert an influence on these deficits is lacking. The present case-control study examined the association between very preterm birth and neurophysiological indices of response inhibition (i.e. the N200-P300 complex) as well as the potential mediation of this association by aspects of physical fitness. 54 children born very preterm completed a submaximal cycling ergometer test and a motor skill test battery. Event-related potentials elicited by a Go/NoGo task were recorded using electroencephalography. Cases were then matched to full-term children (age: 11 ± 0.7 y). A higher error rate on NoGo trials was found in children born very preterm compared to those born full-term. Path-analyses further revealed that very preterm birth was associated with decreased NoGo P300 amplitude. Motor skills, but not aerobic fitness, fully mediated this association. In early adolescence, very preterm birth is associated with less effective recruitment of attentional resources for stimulus evaluation processes. The improvement of motor skills rather than cardiorespiratory fitness appears promising for reducing this specific impairment in cognitive control.

Abstract Background Major depressive disorder (MDD) is a widespread and burdensome psychiatric issue. Physical activity counselling may increase lifestyle physical activity and cardiorespiratory fitness in this specific and particularly vulnerable population, which often suffers from both mental and physical health problems. Therefore, this study will examine the impact of a lifestyle physical activity counselling intervention on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers among in-patients diagnosed with MDD compared to controls. Secondary purposes are to examine the acceptability and perceived usefulness of the intervention among these patients, to find out whether the effectiveness of the intervention is moderated by genetic factors, and to compare baseline values with an age- and gender-matched group of healthy controls. Methods The study is designed as a multi-centric two-arm randomized clinical trial including an intervention group and a placebo control group, allocation concealment, single-blinding, and intention-to-treat analysis. Participants (N = 334) will be continuously recruited from four clinics specialized in the treatment of MDD. The intervention builds on a standardized, theory-based, low-cost lifestyle physical activity counselling programme, which was specifically designed for an in-patient rehabilitation setting. The placebo control condition consists of general instructions about health-enhancing physical activity. Data assessments will take place 2–3 weeks after admission to in-patient treatment (baseline), and 6 weeks (post) and 12 months (follow-up) after discharge from in-patient treatment. The primary outcome is objectively assessed physical activity at follow-up. Discussion Because regular physical activity has proven to be an important predictor of long-term response and remission in patients with major depression, we believe that our planned study may lay important groundwork by showing how individually tailored lifestyle physical activity counselling can be integrated into given clinical structures. Improving physical activity may have important implications for tackling metabolic and cardiovascular disease and increasing mood and cognitive functioning in this at-risk population, hence limiting the future burden of multiple chronic conditions. Increased physical activity may also reduce the likelihood of future depressive episodes. By moving towards the primary prevention of chronic physical conditions, much can be done to enhance the quality and quantity of life of people with MDD. Trial registration ISRCTN, ISRCTN10469580. Registered on 3 September 2018.

Background: Preliminary evidence among adults suggests that the ways in which individuals think about their physical activity (PA) behavior is more closely associated with their well-being than self-reported PA. This study therefore aimed to examine whether and how self-reported PA and personal beliefs about sufficient PA are associated with sleep and psychological functioning in a sample of Swiss adolescents, using both cross-sectional and prospective data. Methods: An overall sample of 864 vocational students (368 girls, 17.98 ± 1.36 years, mean ± SD) was followed prospectively over a 10-month period. At each measurement occasion, participants filled in a series of self-report questionnaires to assess their PA levels, their personal beliefs about whether or not they engage in sufficient PA, sleep (insomnia symptoms, sleep quality, sleep-onset latency, and number of awakenings), and psychological functioning (depressive symptoms, quality of life, perceived stress, and mental toughness). Results: Adolescents who believe that they are sufficiently physically active to maintain good health reported more restoring sleep. No differences in sleep were found between adolescents who meet PA recommendations vs. those who do not. Additionally, adolescents who believe that they were sufficiently physically active also reported better psychological functioning. This close relationship between adolescents’ beliefs about their PA involvement and their sleep and psychological functioning was corroborated in the prospective analyses. Conclusion: Cognitive factors should be studied more intensively when elucidating the relationship among PA, sleep, and psychological functioning in young people, particularly when aiming to develop new exercise interventions targeting psychological outcomes. Keywords: Adolescents, Beliefs, Mental health, Physical activity, Psychological well-being, Public health recommendations, Sleep

Executive functions (EFs) are essential for optimal academic development. Appropriate nutrition and physical activity (PA) have been shown to facilitate optimal cognitive development. Therefore, this study examined whether a 12-week school-based PA and multi-micronutrient supplementation (MMNS) intervention would improve cognitive and academic performance. A cluster-randomized controlled trial (RCT) was conducted. Children from four schools located in a peri-urban area of South Africa were randomly assigned to (i) PA + MMNS, (ii) PA + placebo, (iii) MMNS or (iv) placebo. Information processing and inhibitory control were measured with a computerized Flanker task. End-of-year results provided insight into academic achievement. Anthropometric measures were used to determine nutritional status. Data were analyzed with linear mixed-models, adjusting for baseline scores, school classes and age; 932 children (458 girls (49.1%), Mage (mean age) = 8.42 ± 1.94 years) completed baseline and post-intervention assessments. Cognitive performance improved among all four groups, with no significant group × time effects. For academic achievement, there was no significant interaction effect between the combined intervention group and placebo. We encourage future studies in this neglected area in order to determine the most optimal design of school-based nutrition and PA programs to enhance overall cognitive performance.

Abstract Background Numerous studies suggest that exercise may be an effective adjunct treatment for substance use disorders. It has been suggested that exercise-induced improvements in inhibitory control may reduce craving for the substance of abuse. However, this potential mechanism has seldom been researched. Objectives The aim of the ExAlCo Study is to examine how acute bouts of exercise, at varying intensities, impact on craving for cocaine or alcohol. Cerebral haemodynamic responses during cognitive tests of inhibitory control, and exposure to substance-related cue imagery, will also be assessed using functional near-infrared spectroscopy. Design The study is a crossover randomised controlled trial. Participants will be recruited from inpatient and outpatient psychiatric treatment centres, on the approval of their treating physician. A healthy control group will be recruited using online advertising. All participants will undergo each of three conditions in randomised order: 20 min of cycle ergometry at 50–60% of maximum heart rate; 20 min of exercise at 70–80% of maximum heart rate; and 20 min of quiet reading. Immediately before and after each condition, participants will be asked to complete a computerised Stroop test, watch a film containing substance-related images and self-report craving levels. During the Stroop test and film viewing, participants’ neural activity will be measured via functional near-infrared spectroscopy. Outcomes The primary outcome measures are self-reported craving, inhibitory control and cerebral haemodynamic response to the Stroop test and a substance-related film. It is hoped that the findings from this study will shed more light on the role of exercise in the treatment of substance use disorders, particularly its scope in preventing relapse through reduced craving severity. Trial registration ClinicalTrials.gov, NCT03502486. Registered retrospectively on 5 April 2018.

Introduction: Exercise addiction is one of several behavioral addictions which has not yet been designated as an addictive disorder in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). This is in part due to a lack of clarity concerning co-occurring mental disorders of individuals at risk for exercise addiction. The aim of this review is to summarise the spectrum of psychopathology in populations at risk of exercise addiction. Methods: The MEDLINE, Web of Science and PsycINFO databases were searched. All studies from the date of database creation until February 2020 were considered eligible. Terms used were “exercise addiction” and other mental disorders mentioned in conjunction with substance-related and addictive disorders. Studies were included if they assessed risk for exercise addiction and at least one other mental disorder. Results: Twenty studies were included. The disorders assessed were eating disorders (n = 14), depression (n = 6), anxiety (n = 4), other substance-related and addictive disorders (n = 5), and borderline personality disorder (n = 1). In thirteen of the studies, evidence was found for higher rates of at least one mental disorder (most commonly eating disorders, anxiety and other addictive disorders) in individuals at risk for exercise addiction, compared to those not at risk. Conclusions: Individuals at risk for exercise addiction show a broad range of mental disorders as assessed by self-report, which is in line with sufferers of other addictive disorders. Systematic psychological and clinical assessments in those at risk of exercise addiction are worthwhile, and will serve to characterize the mental health problems of individuals suffering from exercise addiction.

BackgroundHigh psychosocial stress can impair executive function in adolescents, whereas acute exercise has been reported to benefit this cognitive domain. The aim of this study was to investigate whether an acute bout of aerobic exercise improves the inhibitory aspect of executive function and the associated dorsolateral prefrontal cortex (DLPFC) oxygenation when under stress.MethodsSixty male high school students aged 16–20 years performed a Stroop task (baseline condition) and were randomly assigned to an exercise group (30 min on ergometer at 70% of maximum heart rate) and a control group (30 min of reading). Subsequently, all participants underwent a modified Trier Social Stress Test, which included a Stroop task under enhanced stress. The Stroop tasks in both conditions were combined with functional near-infrared spectroscopy to record changes in DLPFC oxygenation in response to the tasks. Stress reactivity was measured with saliva samples (cortisol, alpha-amylase), heart rate monitoring, and anxiety scores.ResultsAll stress parameters indicated increases in response to the stressor (p < 0.001), with higher alpha-amylase [t(58) = −3.45, p = 0.001, d = 1.93] and anxiety [t(58) = −2.04, p = 0.046, d = 0.53] reactions in the control compared to the exercise group. Controlling for these two parameters, repeated measures analyses of covariance targeting changes in Stroop interference scores showed no main effect of stress [F(1,58) = 3.80, p = 0.056, ηp2 = 0.063] and no stress × group interaction [F(1,58) = 0.43, p = 0.517, ηp2 = 0.008]. Similarly, there was no main effect of stress [F(1,58) = 2.38, p = 0.128, ηp2 = 0.040] and no stress × group interaction [F(1,58) = 2.80, p = 0.100, ηp2 = 0.047] for DLPFC oxygenation.ConclusionOur study confirms potentially health-enhancing effects of acute exercise on some of the physiological and psychological stress reactivity indicators. However, our data do not support the notion of an effect on interference control and DLPFC activation under stress.

Background and Aims: While a number of studies have reported on individuals who exercise excessively, and feel unable to stop despite negative consequences, there is still insufficient evidence to categorize exercise as an addictive disorder. The aim of this meta-review is to summarize the published articles and to compile a list of symptoms reported in the qualitative literature in conjunction with excessive exercise. This list is compared with the DSM-5 criteria for gambling disorder, and initial diagnostic criteria for exercise addiction are suggested.Methods: The databases MEDLINE, Web of Science and PsycInfo were searched for qualitative studies or case reports, in which excessive exercise was the main focus. All symptoms reported in conjunction with excessive exercise were extracted from each study and documented. Symptoms were also compared to the diagnostic criteria for gambling disorder.Results: Seventeen studies were included in the review, yielding 56 distinct symptoms. The Critical Appraisal Skills Program tool showed that the majority of the studies were of acceptable quality. Exercise-related symptoms corresponded with seven of the nine DSM-5 criteria for gambling disorder. The ten suggested criteria for exercise addiction are: increasing volume, negative affect, inability to reduce, preoccupation, exercise as coping, continuation despite illness/injury, minimization, jeopardized relationships, continuation despite recognizing consequences, guilt when exercise is missed.Discussion: Our results suggest that excessive exercise may constitute a behavioral addiction, based on the criteria of the DSM-5.Conclusions: Subsequent studies should aim to systematically classify symptoms of excessive exercise; in addition, it should be noted that basic questionnaires may be need to be supplemented with detailed clinical examinations.

Introduction: Regular physical activity is associated with multiple health benefits for children. Evidence from cross-sectional studies suggests that physical activity is positively associated with health-related quality of life (HRQoL). The promotion of physical activity, and hence HRQoL, through a school-based intervention is therefore an important endeavor, particularly in disadvantaged areas of low- and middle-income countries, including South Africa.Methods: We designed a multicomponent physical activity intervention that was implemented over a 20-week period in 2015 in eight disadvantaged primary schools of Port Elizabeth, South Africa. Overall, 758 children aged 8–13 years participated. HRQoL was measured with the 27-item KIDSCREEN questionnaire. Self-reported physical activity was assessed with a single item of the Health-Behavior of School-Aged Children test, and cardiorespiratory fitness with the 20-m shuttle run test. Post-intervention scores were predicted with mixed linear regression models, taking into consideration the clustered nature of the data.Results: Higher baseline levels as well as increasing levels of self-reported physical activity predicted all dimensions of children's HRQoL. Baseline levels and increases in cardiorespiratory fitness predicted children's self-perceived physical well-being (one of the HRQoL subscales). Participation in the multicomponent physical activity intervention did not affect children's HRQoL.Conclusion: Higher and increasing self-reported physical activity predict all assessed HRQoL dimensions, which underlines that the promotion of regular physical activity among children living in disadvantaged settings is an important public health measure. Policy makers should encourage schools to create physical activity friendly environments, while schools should implement regular physical education as proposed by the school curriculum.

High levels of cardiorespiratory fitness have the potential to buffer against physical and mental health impairments, which can result from exposure to occupational stress. Police officers are especially at risk of high psychosocial stress; therefore, effective intervention strategies are warranted. Given this background, the purpose of the present study was to examine whether police officers with different levels of cardiorespiratory fitness differ with regard to their (a) physiological stress reactivity during acute real-life stress situations, and (b) physiological recovery related to acute and chronic work stress. In total, 201 police officers took part in this study (M = 38.6 years, SD = 10.1, 35.8% females). Officers were contacted eight times on a smartphone during their workday, and asked to report their current level of positive and negative affect, as well as feelings of stress and anger. Physiological stress responses and recovery (heart rate variability) were assessed using Movisens EcgMove3 devices. The Åstrand bicycle ergometer test was used to assess participants' cardiorespiratory fitness. Chronic work stress was assessed using the effort-reward imbalance model and the job strain model. Multilevel modeling was used to test buffering effects of cardiorespiratory fitness on physiological stress reactivity. Linear regression was applied to test stress-buffering effects of cardiorespiratory fitness on physiological recovery. Results showed lowered physiological stress reactivity to acute work stress in officers with higher levels of cardiorespiratory fitness. However, these results were not consistent, with no effects occurring for feelings of anger, positive affect, and negative affect. Chronic work stress (effort-reward imbalance) was related to lower physiological recovery. Cardiorespiratory fitness was positively related to physiological recovery. Data did not support interactions between work stress and cardiorespiratory fitness on physiological recovery. To some extent, cardiorespiratory fitness seems to have the potential to buffer stress reactivity in police officers in acute stress situations. Therefore, we encourage promoting fitness programs which aim to enhance cardiorespiratory fitness in stressful occupations such as law enforcement. Improvements in cardiorespiratory fitness might further enhance physiological recovery from chronic work stress, which is thought to improve cardiovascular health.

Background/Aim Physical inactivity (PIA) is a growing global health problem and evidence suggests that PIA is a key driver for cardiovascular and chronic diseases. Recent data from South Africa revealed that only about half of the children achieved recommended daily physical activity (PA) levels. Assessing the intensity of PA in children from low socioeconomic communities in low-income and middle-income countries is important to estimate the extent of cardiovascular risk and overall impact on health.Methods We conducted a cross-sectional survey in eight quintile 3 primary schools in disadvantaged communities in the Port Elizabeth region, South Africa. Children aged 10–15 years were subjected to PA, blood pressure, cholesterol, blood glucose and skinfold thickness assessments. Cardiovascular risk markers were converted into standardised z-scores and summed, to obtain a clustered cardiovascular risk score.Results Overall, 650 children had complete data records. 40.8% of the children did not meet recommended PA levels (ie, logged

Metabolic syndrome (MetS) is a worldwide health concern related to cardiovascular disease. Stress at work increases the risk for MetS, whereas physical activity and cardiorespiratory fitness (CF) have been shown to be potential buffers against stress. The aim of this study was to test the stress-buffering effects of physical activity and CF on the relationship between work stress and MetS. In a prospective study, we followed 97 police officers (mean age = 39.7 years; mean body mass index = 25.74 kg/m2) over one year and assessed MetS, as defined by the National Cholesterol Education Program Adult Treatment Panel III. Stress at work was measured with the Job Content Questionnaire, as well as the Effort-Reward Imbalance Questionnaire. Physical activity was assessed objectively via 7-day accelerometry. CF was assessed with the Åstrand bicycle ergometer test. Hierarchical linear regression models were carried out to predict MetS at follow-up (mean overall MetS score = 1.22), after controlling for baseline levels and sociodemographic background (mean overall MetS score = 1.19). Higher CF levels were significantly associated with lower MetS risk at follow-up (β = -.38). By contrast, no main effects were found for physical activity and work stress. However, high effort and demand were significantly correlated with increased blood pressure (effort: r = .23 for systolic blood pressure; r = .21 for diastolic blood pressure) and waist circumference (effort: r = .26; demand: r = .23). Moreover, no significant interaction effects occurred between work stress and CF/physical activity. The results emphasize the importance of high levels of CF in the prevention of MetS in police officers. Accordingly, provision of regular training opportunities and repeated CF testing should be considered as a strategy in overall corporate health promotion.

The current body of evidence suggests that an aerobic exercise session has a beneficial effect on inhibitory control, whereas the impact of coordinative exercise on this executive function has not yet been examined in children with ADHD. Therefore, the present study aims to investigate the acute effects of aerobic and coordinative exercise on behavioral performance and the allocation of attentional resources in an inhibitory control task.Using a cross-over design, children with ADHD-combined type and healthy comparisons completed a Flanker task before and after 20 min moderately-intense cycling exercise, coordinative exercise and an inactive control condition. During the task, stimulus-locked event-related potentials were recorded with electroencephalography.Both groups showed an increase of P300 amplitude and decrease of reaction time after exercise compared to the control condition. Investigating the effect of exercise modality, aerobic exercise led to greater increases of P300 amplitude and reductions in reaction time than coordinative exercise in children with ADHD.The findings suggest that a single exercise bout improves inhibitory control and the allocation of attentional resources. There were some indications that an aerobic exercise session seems to be more efficient than coordinative exercise in reducing the inhibitory control deficits that persist in children with ADHD. Keywords: P300, Executive function, Cognitive performance, Flanker task, Development, Healthy children

(1) Background: Early childhood malnutrition may result in increased fat mass (FM) among school-aged children in low- and middle-income countries (LMICs). We explored whether South African children with shorter stature have greater overall and abdominal FM compared to normal stature children. (2) Methods: Baseline assessments of body composition and weight were determined among school-aged children enrolled in a randomized controlled trial in Port Elizabeth, South Africa, using bioelectrical impedance analysis. Multiple linear regression models tested associations of children’s height and degree of stunting with FM, fat free mass (FFM), truncal fat mass (TrFM), and truncal fat free mass (TrFFM) overall and by sex. (3) Results: A total of 1287 children (619 girls, 668 boys) were assessed at baseline. Reduced child height was associated with higher FM and lower FFM and TrFFM, but these associations were reversed with increases in height. Girls classified as mildly or moderately/severely stunted had higher FM and TrFM but lower FFM and TrFFM, while no association was found for boys. (4) Conclusions: Our study suggests that efforts to reduce the non-communicable disease burden in LMICs should target growth-impaired children who may have greater overall FM and greater abdominal FM.

Background: Multiple sclerosis (MS) patients suffer from various difficulties including sleep complaints, symptoms of depression and fatigue, paresthesia, and cognitive impairments. There is growing evidence that regular physical activity has a positive effect on both sleep and psychological functioning, though there is limited evidence of this kind for MS patients. The aim of the present study was therefore to investigate the impact on this patient group of a regular exercise program with respect to subjective and objective sleep, depression, paresthesia, fatigue, and cognitive performance.Methods: A total of 46 patients [mean age: 50.74 years; Expanded Disability Status Scale (EDSS): mean: 5.3, 78.4% females] completed this 3-week intervention study. At baseline and 3 weeks later, they answered questionnaires covering sociodemographic information, subjective sleep, depression, fatigue, paresthesia, and subjective physical activity. Objective sleep [sleep electroencephalogram (EEG) recordings] and cognitive performance were also assessed at both time points. Patients participated in a regular exercise activity every weekday for about 60 min.Results: Compared to the baseline, by the end of the study, objective sleep had significantly improved (sleep efficiency, sleep onset latency, and wake time after sleep onset), and symptoms of sleep complaints, depression, fatigue, and paresthesia were significantly reduced. Subjective physical activity (moderate and vigorous) and cognitive performance also increased over the course of the intervention.Conclusions: In patients with MS, participation in regular exercise impacted positively on their objective and subjective sleep, depression, paresthesia, fatigue, and cognitive performance.

Background: Aerobic exercise (AE) may be a non-pharmacological strategy to improve depression treatment and lessen the burden of somatic comorbidity of depression. Only few studies have examined the effect of AE as an add-on treatment for moderate to severe depression in an inpatient setting, and most studies have focused on depression severity and cardiovascular parameters. The purpose of the present article is to present the study protocol, to provide information about the assessed study population, and to perform a manipulation check in order to examine whether the intervention program was properly implemented.Methods: We conducted a randomized controlled trial in two centers comparing 6 weeks of AE to a placebo control intervention (stretching) as an add-on to standardized inpatient treatment of moderate to severe depression. Besides depression severity, several other psychological and biological variables were measured such as salivary cortisol, brain-derived neurotropic factor, cognitive tests, and polysomnography. To evaluate long-term effects of the intervention, we also scheduled a follow-up 6 months after completion of the study intervention.Results: Forty-five patients were randomized to either AE (n = 23) or the placebo intervention (n = 22); 36 patients completed the 6-week intervention. In the AE group, 65% completed all 18 training sessions. Patients who were less physically active prior to admission were less likely to complete the study. With regard to energy expenditure, mean kcal/kg/week was 16.4 kcal/kg/week (range: 13.8–17.7), coming close to the targeted dose of 17.5 kcal/kg/week.Conclusions: Overall, patients showed good adherence to the intervention protocol despite at least moderate depression severity. However, the dropout rate suggests that depressed inpatients may need special support to adhere to a structured exercise intervention program. This study will add evidence on the effects of AE as an add-on to inpatient treatment of moderate to severe depression. Besides antidepressant effects, potentially beneficial effects of AE on a broad array of further variables associated with depression will be evaluated.Clinical Trial Registration:www.ClinicalTrials.gov, identifier NCT02679053.

BACKGROUND Injury prevention in amateur soccer has been promoted in recent years, but only a few studies have addressed long-term changes in injury incidence in amateur soccer. However, better knowledge of changes with respect to injury incidences and causes could make an important contribution to improving prevention strategies. AIM The aim of this study was to investigate the long-term development of injury incidence in Swiss amateur soccer with respect to level of play, injury causes and injury characteristics. METHODS A representative sample of about 1000 Swiss amateur soccer coaches was interviewed by telephone in 2004, 2008 and 2015. They were asked to recall their last game and to report details on all injuries. For every injury, the coaches were asked to remember injury characteristics and causes. The same procedure was repeated for all games that took place during the previous 4 weeks. Additionally, all training injuries in the previous 4 weeks were recorded in detail. RESULTS The incidence of game injuries decreased between the years 2004 and 2008 from 15.1 (95% confidence interval [CI] 14.2–16.0) to 13.3 (95% CI 12.4–14.2) injuries per 1000 hours, and increased between the years 2008 and 2015 to 16.5 (95% CI 15.5–17.4) injuries per 1000 hours. Between 2004 and 2015, the rate of contact injuries during games increased by 19.1%. The incidence of foul play injuries in games increased by 25.5% between 2008 and 2015. The rise in total training injury incidence between the years 2004 (2.4, 95% CI 2.2–2.7) and 2015 (2.9, 95% CI 2.6–3.1) was caused by a 22.2% higher rate of noncontact injuries. During the same period, game and training injury incidences increased across all amateur soccer leagues without exception, but these changes did not reach statistical significance. In 2015, the incidence of injuries leading to medical attention was higher than in 2004 (game 20.0%, training 37.5%). CONCLUSION There is evidence that injury incidence in Swiss amateur soccer has increased in past years.

Background: Restoring sleep is associated with favorable cognitive, emotional, and behavioral adaptations. As regards the association between sleep duration and facial emotion recognition (FER), results are conflicting, and as regards the association between symptoms of insomnia and FER, no study has been performed so far. Accordingly, the aim of the present study was to investigate whether subjective sleep was associated with FER, along with perceived stress and mental toughness.Method: A total of 201 police officers (mean age = 38.5 years, 64.2% males) took part in the present cross-sectional study. They completed questionnaires covering socio-demographic data, subjective symptoms of insomnia, perceived stress, and mental toughness. Further, they underwent a computerized FER test, consisting of facial emotion labeling and facial emotion matching.Results: Performance of FER (accuracy, speed) was unrelated to subjective symptoms of insomnia. Lower FER was associated with higher age, but not to perceived stress or mental toughness. No gender differences were observed. Higher symptoms of insomnia were associated with higher stress scores and lower scores of mental toughness.Conclusions: The pattern of results suggests that FER was not associated with symptoms of insomnia, understood as a proxy of sleep quality, among adults. This observation replicates those studies showing a zero-association between sleep and FER.

Background: In the past 3 decades, there has been an increase in the number of studies assessing exercise as a form of treatment for substance use disorders (SUDs). While a variety of substance types and outcomes have been assessed, exercise intensities have never been systematically examined. Consequently, it remains unclear whether particular forms of exercise are better suited to the treatment of these populations. Anaerobic exercise has been shown to have positive effects in populations with psychiatric disorders, but its effectiveness in the treatment of SUDs has to date not been reviewed.Methods: The aim of this systematic review is to identify and evaluate studies which have employed either an acute or chronic anaerobic exercise component as a therapy modality for SUDs. The primary outcomes are abstinence, craving, withdrawal, consumption, quality of life, and the following psychological symptoms and disorders: depression, anxiety, stress, and mood. A secondary objective is to assess whether the type of training described in the study protocol can be reliably categorized as anaerobic training.Results: Twenty-six studies are included in this review. Twelve studies addressed nicotine dependence, one addressed alcohol dependence, and 13 addressed dependence on various illicit drugs. Thirteen studies reported the intensity at which participants actually exercised, but only one employed a test to determine whether training was carried out above the anaerobic threshold (AT). The risk of bias in the included studies was generally high. Results of the studies were mixed, with the most positive effects being found for abstinence in nicotine dependence.Conclusion: The evidence for the effects of anaerobic exercise in SUDs is weak, although a tendency toward positive effects on abstinence in nicotine dependent individuals was observable. The majority of studies do not report data on exercise intensity, making a categorization of anaerobic exercise impossible in all but one case. This means that the effects of this form of exercise cannot be determined, and therefore not evaluated or compared with other forms. In order to improve the quality of evidence for exercise in SUD treatment, clearly defined and objectively assessed evaluations of anaerobic and anaerobic exercise are necessary.

Background: Learning is the relatively permanent change of behavior as a result of experience and tightly related to memory and cognition. Learning is particularly important for children. Further, restoring sleep is associated both with improved learning performance and lower cortisol levels as a proxy of the so-called hypothalamus-pituitary-adrenocortical axis activity (HPA-AA). With the present study, we investigated, if and to what extent explicit learning performance was associated with cortisol levels at baseline and under challenge conditions and with objective sleep dimensions among 9-years old children.Methods: A total of 39 children (mean age = 9.5 years; 39% females) took part in the study. Verbal and figural working and long-term memory were tested before and after the Trier Social Stress Test for Children (TSST-C). Further, children underwent sleep-EEG assessment, and cortisol awakening response (CAR) was assessed.Results: Higher cortisol levels were associated with lower explicit learning encoding (verbal, but not figural learning). Higher verbal and figural working and long-term memory performance predicted lower cortisol secretion under the TSST-C, along with higher verbal and figural working and long-term memory performance after the TSST-C. Cognitive test performances were not mediated by cortisol secretion under the TSST-C. Cognitive performance, cortisol secretion under challenge (TSST-C) and basal conditions (morning) and sleep patterns were unrelated.Conclusions: The pattern of results suggests that among a sample of 9-years old children cortisol secretion and stages of memory processes (encoding, storage, retrieval) are associated in a complex and bi-directional way. Further, it appears that cognitive-emotional processes underlying cognitive performance and its evaluation might impact on subsequent cortisol secretion as a proxy of neuroendocrinological response to cognitive-emotional processes. Last, cognitive performance and cortisol secretion under challenge conditions were not related to objective sleep patterns and baseline cortisol secretion.

(1) Background: While the antidepressant effects of aerobic exercise (AE) are well documented, fewer studies have examined impact of AE as an add-on treatment. Moreover, various effects on neurobiological variables have been suggested. This study examines effects of AE on Cortisol Awakening Reaction (CAR), serum Brain Derived Neurotrophic Factor (sBDNF), Tumor Necrosis Factor alpha (TNF-alpha) and sleep. (2) Methods: Inpatients with moderate-to-severe depression (N = 43) were randomly assigned to the AE or stretching condition (active control) taking place 3x/week for 6 weeks. CAR, sBDNF and TNF-alpha were assessed at baseline, after 2 weeks and post-intervention. The 17-item Hamilton Depression Rating Scale (HDRS17), subjective sleep quality measured by the Pittsburgh Sleep Quality Index (PSQI) and polysomnography (PSG) were obtained at baseline and post-intervention. (3) Results: Stress axis activity decreased in both groups from baseline to post-intervention. sBDNF showed a significant increase over time, whereas the number of awakenings significantly decreased. No significant time by group interactions were detected for any of the study variables. Correlational analyses showed that higher improvements in maximum oxygen capacity (VO2max) from baseline to post-intervention were associated with reduced scores on the HDRS17, PSQI and REM-latency post-intervention. (4) Conclusions: While some neurobiological variables improved during inpatient treatment (CAR, sBDNF), no evidence was found for differential effects between AE and an active control condition (stretching). However, patients in which cardiorespiratory fitness increased showed higher improvements in depression severity and depression-related sleep-parameters.