Effects of school-based physical activity interventions on mental health in adolescents: The School in Motion cluster randomized controlled trial

Purpose To investigate the effects of two school-based physical activity interventions on mental health in Norwegian adolescents. Methods Students from 29 lower secondary schools in Norway (n = 2084; 14–15 years; 49% female) were cluster-randomized into either a control group or one of two intervention groups (M1 and M2). Two interventions based on different theoretical frameworks aimed to increase physical activity in school by approximately 120 min per week, throughout a 29-week intervention period. M1 consisted of 30 min physically active learning, 30 min physical activity and one 60 min physical education lesson. M2 consisted of one physical education lesson and one physical activity lesson, both focusing on facilitating students’ interest, responsibility and social relationships. The self-report version of the Strengths and Difficulties Questionnaire was used to assess mental health. Physical activity was measured by accelerometry. Linear mixed effects models were used to examine the effects of the interventions. Results No effects were found for the overall study population. Interaction effects warranted subgroup analyses: M1 showed favorable results in the subgroup with the highest levels of psychological difficulties at baseline (b = −2.9; −5.73 to −0.07; p = .045) and in the immigrant subgroup (b = −1.6; −3.53 to 0.27; p = .093). M2 showed favorable results in the immigrant subgroup (b = −2.1; −4.36 to 0.21; p = .075). Conclusions The two interventions did not improve mental health in the full study population. However, results indicated beneficial effects among immigrants and those with poor mental health at baseline. More research is needed due to missing values and the results should therefore be interpreted with caution.publishedVersio

Aerobic fitness mediates the intervention effects of a school-based physical activity intervention on academic performance. The school in Motion study – A cluster randomized controlled trial

publishedVersio

The effect of a school-based intervention on physical activity, cardiorespiratory fitness and muscle strength : the School in Motion cluster randomized trial

Background: Physical activity (PA) declines throughout adolescence, therefore PA promotion during this period is important. We analyzed the effect of two school-based PA interventions on daily PA levels, cardiorespiratory fitness (CRF) and muscle strength among adolescents. Methods: For the nine-month School in Motion intervention study (ScIM), we cluster-randomized 30 Norwegian secondary schools (N = 2084, mean age [SD] = 14 [0.3] years) to one of three study arms. The physically active learning (PAL) intervention included 30 min physically active learning, 30 min PA and a 60 min physical education (PE) lesson per week. The Don’t worry-Be happy (DWBH) intervention included a 60 min PA lesson and a 60 min PE lesson per week, both tailored to promote friendships and wellbeing. Both intervention arms were designed to engage the adolescents in 120 min of PA per week in addition to recess and mandatory PE lessons. The control group continued as per usual, including the standard amount of mandatory PE. PA (main outcome) was assessed by accelerometers, CRF and muscle strength (secondary outcomes) were assessed by an intermittent running test and selected tests from the Eurofit test battery. Results: Daily PA and time spent in moderate- to vigorous-intensity PA (MVPA) decreased in all groups throughout the intervention. The mean difference in PA level and MVPA for participants in the PAL-intervention arm was 34.7 cpm (95% CI: 4.1, 65.3) and 4.7 min/day (95% CI: 0.6, 8.8) higher, respectively, compared to the control arm. There were no significant intervention effects on daily PA level, MVPA or time spent sedentary for adolescents in the DWBH-intervention arm. Adolescents in the PAL-intervention arm increased distance covered in the running test compared to controls (19.8 m, 95% CI: 10.4, 29.1), whilst a negative intervention effect was observed among adolescents in the DWBH-intervention arm (− 11.6 m, 95% CI: − 22.0, − 1.1). Conclusion: The PAL-intervention resulted in a significantly smaller decrease in daily PA level, time spent in MVPA, and increased CRF compared to controls. Our results indicate that a teacher-led intervention, including three unique intervention components, is effective in curbing the decline in PA observed across our cohort and improving CRF.publishedVersio

Aerobic fitness mediates the intervention effects of a school-based physical activity intervention on academic performance. The school in Motion study - A cluster randomized controlled trial.

Little information exists on the mechanism of how physical activity interventions effects academic performance. We examined whether the effects of a school-based physical activity intervention on academic performance were mediated by aerobic fitness. The School in Motion study was a nine-month cluster randomized controlled trial between September 2017 and June 2018. Students from 30 Norwegian lower secondary schools (N = 2,084, mean age [SD] = 14 [0.3] years) were randomly assigned into three groups: the Physically Active Learning (PAL) intervention (n = 10), the Don't Worry-Be Happy (DWBH) intervention (n = 10), or control (n = 10). Aerobic fitness was assessed by the Andersen test and academic performance by national tests in reading and numeracy. Mediation was assessed according to the causal steps approach using linear mixed models. In the PAL intervention, aerobic fitness partially mediated the intervention effect on numeracy by 28% from a total effect of 1.73 points (95% CI: 1.13 to 2.33) to a natural direct effect of 1.24 points (95% CI: 0.58 to 1.91), and fully mediated the intervention effect on reading, with the total effect of 0.89 points (95% CI: 0.15 to 1.62) reduced to the natural direct effect of 0.40 points (95% CI: -0.48 to 1.28). Aerobic fitness did not mediate the effects on academic performance in the DWBH intervention. As aerobic fitness mediated the intervention effect on academic performance in one intervention, physical activity of an intensity that increases aerobic fitness is one strategy to improve academic performance among adolescents.Medical Research Council (grant number MC_UU_00006/5)

Physical activity, physical fitness and academic performance among adolescents: Intervention effects from the School in Motion study: A cluster randomized controlled trial

Introduction: Emerging evidence suggests a favourable relationship between physical activity, aerobic fitness and academic performance. Recent data show that physical activity levels decrease through adolescence, whilst only 50% of Norwegian 15-year-olds are sufficiently active meeting physical activity guidelines of ≥ 60 minutes in moderate-to-vigorous intensity physical activity (MVPA) per day. Accordingly, there is a need to develop interventions that can effectively change behaviour, leading to increased physical activity, physical fitness and academic performance among adolescents. Aims: This thesis is based on a school-based, physical activity cluster randomized controlled trial (RCT) titled School in Motion (ScIM). This thesis investigates the intervention effects of ScIM on adolescents’ physical activity level, physical fitness and academic performance. Further, we explored whether aerobic fitness mediated the intervention effects of physical activity on academic performance. Finally, we wanted to explore the associations between teacher-reported contextualised factors and intervention dose delivered. Methods: ScIM was a nine-month cluster RCT. In total 30 Norwegian secondary schools were randomized to one of three study arms; the physically active learning (PAL) (n = 10); the Don’t worry-Be happy (DWBH) intervention (n = 10); or control (n = 10). The PAL intervention included 30 min physically active learning, 30 min physical activity and a 60 min physical education (PE) lesson per week. The DWBH intervention included a 60 min physical activity lesson and a 60 min PE lesson per week. Both components in the DWBH intervention was tailored to promote friendships and wellbeing. The control group continued as usual, including the standard amount of mandatory PE. The PAL and DWBH interventions were designed to engage the adolescents in 120 min of physical activity per week in addition to recess and mandatory physical education (PE) lessons. Parental consent was obtained from 2,084 adolescent students (76%). Physical activity (main outcome) was assessed by accelerometers; physical fitness and muscle strength were assessed by an intermittent running test and selected tests from the Eurofit test battery; whilst standardized national tests in reading and numeracy was used to assess academic performance. Teacher related contextualized factors were self-reported once by teachers after randomisation, but prior intervention start. All other measurements were conducted at baseline and at the end of the intervention. Results: Physical activity levels decreased in all three groups throughout the intervention. We found significant mean difference in change in physical activity (counts per minute 34.7, 95% Confidence interval (CI): 4.1 to 65.3; moderate-to-vigorous intensity physical activity 4.7 min, 95% CI: 0.6 to 8.8) and aerobic fitness (19.8 m, 95% CI: 10.4 to 29.1) among adolescents in the PAL intervention compared with controls. No evidence was found for this in the DWBH intervention. Academic performance increased among adolescents in both interventions when compared with controls. The mean difference in change in numeracy was 1.7 (95% CI: 0.9 to 2.5) and 2.0 (95% CI: 1.4 to 2.7) points in favour of students in the PAL and DWBH intervention, respectively. For reading the mean difference in change was 0.9 (95% CI 0.2 to 1.6) and 1.1 (95% CI 0.3 to 1.9) points in favour of students in the PAL and DWBH intervention, respectively. Further, aerobic fitness did mediate the effects on academic performance in the PAL intervention, but not in the DWBH intervention. Finally, we found no associations between teacher related contextualized factors and dose delivered. Conclusion: The results from this thesis has shown that implementing two hours of extra physical activity among adolescents have several positive effects. The PAL intervention is effective in curbing the decline in physical activity observed throughout adolescents, whilst also increasing the adolescent’s aerobic fitness. Furthermore, both the PAL and DWBH interventions have proven to be feasible methods to increase academic performance among adolescents. As aerobic fitness mediated the intervention effect on academic performance in the PAL intervention, physical activity of an intensity that increases aerobic fitness is one strategy to improve academic performance among adolescents

Betydningen av perifer tretthet på prestasjonen i en utholdenhetsaktivitet

Bakgrunn for studien Hensikten med studien var å undersøke betydningen av perifer tretthet i en utholdenhets aktivitet. Metode 6 friske forsøkspersoner(FP) (alder 22±1,09 år), (vekt 79±10,5 kg), (høyde 177,5±3,79 cm) gjennomførte 5 tester totalt hvorav en tilvenning til utstyr, en tilvenningstest og 3 prestasjonstester. Prestasjon og tilvenningstest ble gjennomført med kneekstensjon av høyre ben i et KinCom dynamometer. Gjennomføringen bestod av 64 serier av 15 repetisjoner. Resultat Utholdenhetsprestasjonen målt som kraftutvikling (N) var signifikant bedre (P<0,05) ved prestasjonstestene enn ved tilvenningstesten, men det var ikke signifikant forskjell i RPE (P=0,21) mellom prestasjon og tilvenningstesten. Perifer tretthet uttrykt som kraftrespons (N) ved singelstimuli (SS) (P<0,32) og doble stimuli 100 Hz (PS100) (P<0,08) umiddelbart (10 sek) etter prestasjonstestene var ikke signifikant forskjellig mellom tilvenningstest og prestasjonstestene. Kraftrespons ved SS og PS100 sank fra serie 1-64, noe som viser økt perifer tretthet under både tilvenningstest og prestasjonstestene. Konklusjon Resultatene fra denne studien indikerer at hjernen som sentral styringsmekanisme kan ha større betydning enn perifer og sentral tretthet, på frivillig kraftutvikling (N) under denne type aktivitet. Det kan antydes at perifer tretthet ikke er en avgjørende faktor for prestasjonsevnen i utholdenhetsaktiviteter. Årsaken til denne påstanden er at resultatene viser økt perifer tretthet mot slutten av prestasjonstestene til tross for økt kraftutvikling (N) mot slutten av aktiviteten. I tillegg viser resultatene økt gjennomsnittskraft (N) fra tilvenningstest til prestasjonstesten. Derfor kan faktorer som reduserer opplevd anstrengelse relateres til bedre prestasjon i utholdenhetsaktivteter. Resultatet fra studien indikerer at utholdenhetsprestasjon er mer relatert til mekanismer i sentralnervesystemet som forventning, feed-forward, feed-back og motivasjon enn muskulære forhold

The association between physical fitness and mental health in Norwegian adolescents

Background Studies indicate that health-related components of physical fitness are associated with mental health outcomes. However, research is scarce concerning this relationship in young adolescents in general and non-existent in Norwegian populations specifically. The aim of the study was to examine whether body composition, muscular strength and cardiorespiratory fitness were associated with self-reported mental health in Norwegian adolescents. Methods Adolescents from four regions of Norway (n = 1486; mean age = 13.9; girls = 50.6%) participated. Self-reported mental health (psychological difficulties) was measured by completing the Strengths and Difficulties Questionnaire. Cardiorespiratory fitness was assessed with an intermittent running test; muscular strength was assessed by measuring handgrip strength, standing broad jump and sit-ups; and body composition was assessed by calculating body mass index from weight and height. Linear mixed effects models were conducted to assess the associations between the health-related components of physical fitness and psychological difficulties. School clusters were included as random effects and all models were controlled for sex, socioeconomic status and birthplace (domestic or foreign). Results Body composition was not associated with psychological difficulties. Muscular strength was independently associated with psychological difficulties, but when all independent variables were entered in the fully adjusted model, only cardiorespiratory fitness was associated with psychological difficulties. Conclusions There was a small but significant inverse association between cardiorespiratory fitness and levels of psychological difficulties in Norwegian adolescents. The results suggest that muscular strength is not associated with psychological difficulties in adolescents, when controlling for cardiorespiratory fitness. Future research should focus on the prospective association between physical fitness components and mental health outcomes in adolescents.publishedVersio

Innovative use of ECC (NEC3) for procurement and management of infrastructure projects with limited funding: Bervie Braes case study

Purpose To investigate the effects of two school-based physical activity interventions on mental health in Norwegian adolescents. Methods Students from 29 lower secondary schools in Norway (n = 2084; 14–15 years; 49% female) were cluster-randomized into either a control group or one of two intervention groups (M1 and M2). Two interventions based on different theoretical frameworks aimed to increase physical activity in school by approximately 120 min per week, throughout a 29-week intervention period. M1 consisted of 30 min physically active learning, 30 min physical activity and one 60 min physical education lesson. M2 consisted of one physical education lesson and one physical activity lesson, both focusing on facilitating students’ interest, responsibility and social relationships. The self-report version of the Strengths and Difficulties Questionnaire was used to assess mental health. Physical activity was measured by accelerometry. Linear mixed effects models were used to examine the effects of the interventions. Results No effects were found for the overall study population. Interaction effects warranted subgroup analyses: M1 showed favorable results in the subgroup with the highest levels of psychological difficulties at baseline (b = −2.9; −5.73 to −0.07; p = .045) and in the immigrant subgroup (b = −1.6; −3.53 to 0.27; p = .093). M2 showed favorable results in the immigrant subgroup (b = −2.1; −4.36 to 0.21; p = .075). Conclusions The two interventions did not improve mental health in the full study population. However, results indicated beneficial effects among immigrants and those with poor mental health at baseline. More research is needed due to missing values and the results should therefore be interpreted with caution

The effect of a school-based intervention on physical activity, cardiorespiratory fitness and muscle strength: the School in Motion cluster randomized trial

Background Physical activity (PA) declines throughout adolescence, therefore PA promotion during this period is important. We analyzed the effect of two school-based PA interventions on daily PA levels, cardiorespiratory fitness (CRF) and muscle strength among adolescents. Methods For the nine-month School in Motion intervention study (ScIM), we cluster-randomized 30 Norwegian secondary schools (N = 2084, mean age [SD] = 14 [0.3] years) to one of three study arms. The physically active learning (PAL) intervention included 30 min physically active learning, 30 min PA and a 60 min physical education (PE) lesson per week. The Don’t worry-Be happy (DWBH) intervention included a 60 min PA lesson and a 60 min PE lesson per week, both tailored to promote friendships and wellbeing. Both intervention arms were designed to engage the adolescents in 120 min of PA per week in addition to recess and mandatory PE lessons. The control group continued as per usual, including the standard amount of mandatory PE. PA (main outcome) was assessed by accelerometers, CRF and muscle strength (secondary outcomes) were assessed by an intermittent running test and selected tests from the Eurofit test battery. Results Daily PA and time spent in moderate- to vigorous-intensity PA (MVPA) decreased in all groups throughout the intervention. The mean difference in PA level and MVPA for participants in the PAL-intervention arm was 34.7 cpm (95% CI: 4.1, 65.3) and 4.7 min/day (95% CI: 0.6, 8.8) higher, respectively, compared to the control arm. There were no significant intervention effects on daily PA level, MVPA or time spent sedentary for adolescents in the DWBH-intervention arm. Adolescents in the PAL-intervention arm increased distance covered in the running test compared to controls (19.8 m, 95% CI: 10.4, 29.1), whilst a negative intervention effect was observed among adolescents in the DWBH-intervention arm (− 11.6 m, 95% CI: − 22.0, − 1.1). Conclusion The PAL-intervention resulted in a significantly smaller decrease in daily PA level, time spent in MVPA, and increased CRF compared to controls. Our results indicate that a teacher-led intervention, including three unique intervention components, is effective in curbing the decline in PA observed across our cohort and improving CRF

Aerobic fitness mediates the intervention effects of a school-based physical activity intervention on academic performance. The school in Motion study – A cluster randomized controlled trial

Little information exists on the mechanism of how physical activity interventions effects academic performance. We examined whether the effects of a school-based physical activity intervention on academic performance were mediated by aerobic fitness. The School in Motion study was a nine-month cluster randomized controlled trial between September 2017 and June 2018. Students from 30 Norwegian lower secondary schools (N = 2,084, mean age [SD] = 14 [0.3] years) were randomly assigned into three groups: the Physically Active Learning (PAL) intervention (n = 10), the Don’t Worry—Be Happy (DWBH) intervention (n = 10), or control (n = 10). Aerobic fitness was assessed by the Andersen test and academic performance by national tests in reading and numeracy. Mediation was assessed according to the causal steps approach using linear mixed models. In the PAL intervention, aerobic fitness partially mediated the intervention effect on numeracy by 28% from a total effect of 1.73 points (95% CI: 1.13 to 2.33) to a natural direct effect of 1.24 points (95% CI: 0.58 to 1.91), and fully mediated the intervention effect on reading, with the total effect of 0.89 points (95% CI: 0.15 to 1.62) reduced to the natural direct effect of 0.40 points (95% CI: −0.48 to 1.28). Aerobic fitness did not mediate the effects on academic performance in the DWBH intervention. As aerobic fitness mediated the intervention effect on academic performance in one intervention, physical activity of an intensity that increases aerobic fitness is one strategy to improve academic performance among adolescents