Impact of COVID-19 on Physical Activity in Families Managing ADHD and the Cyclical Effect on Worsening Mental Health.

Physical activity supports symptom management in children with ADHD and reduces the mental health burden associated with caregiving for children with ADHD. Survey-based research shows that COVID-19 reduced physical activity among diverse populations. This study used a qualitative approach situated within a socioecological framework to (1) understand how COVID-19 impacted physical activity of children with ADHD and their caregivers, to (2) identify barriers to their physical activity, and to (3) identify potential areas of support. Thirty-three participants were interviewed between October 2020 and January 2021. Content analysis revealed that physical activity declined for children and caregivers; significant barriers were social isolation and rising intrapersonal difficulties such as diminishing self-efficacy and energy levels and increased mental health difficulties. Worsening mental health further alienated caregivers and children from physical activity, undermining its protective effects on ADHD symptom management and mental wellbeing. Participants identified needing community support programs that offer virtual, live physical activity classes as well as psycho-emotional support groups. There is vital need to support physical activity opportunities during high-stress situations in families managing ADHD to buffer against diminishing mental wellbeing. This will promote further physical activity engagement and allow families to reap the cognitive, psychological, and emotional benefits.

Exploring Barriers and Facilitators to Physical Activity in Adults with ADHD: A Qualitative Investigation.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by executive dysfunction. Physical activity (PA) may improve executive dysfunction; however, specific barriers and facilitators to PA participation for adults with ADHD have not been formally documented, which was the aim of the present study. Thirty adults with ADHD completed virtual semi-structured interviews, which were analyzed thematically and guided by the Theoretical Domains Framework. Expressions of both barriers and facilitators to PA were identified. Themes such as executive dysfunction (described as forgetfulness, difficulty with sustained focus, and time management), poor self-esteem, and lack of motivation were seen as barriers to PA. Key facilitators were tied to the benefits of being physically active including improvements in executive functioning, mood, and mental health during and after activity, as well as the enjoyment of being active with others. To better support adults with ADHD in initiating physical activity, it is crucial to develop unique resources that are tailored to their specific needs. These resources should be designed to minimize barriers and maximize facilitators, while also supporting the awareness and acceptance of neurodiverse experiences.

The impact of the COVID-19 pandemic on the mental health of families dealing with attention-deficit hyperactivity disorder.

BACKGROUND: The COVID-19 pandemic uprooted regular routines forcing many children to learn from home, requiring many adults to work from home, and cutting families off from support outside the home. Public health restrictions associated with the pandemic caused widespread psychological distress including depression and anxiety, increased fear, panic, and stress. These trends are particularly concerning for families raising neuroatypical children such as those with Attention-Deficit Hyperactivity Disorder (ADHD), as these children are already more likely than their typically developing peers to experience comorbid mental health issues, and to experience greater distress when required to stay indoors. Families with children who have ADHD are also at greater risk for experiencing heightened familial stress due to the challenges associated with managing ADHD behavioural symptoms, greater parental discord and divorce, and greater financial difficulties compared to other families. The current study engaged families comprised of at least one child diagnosed with ADHD to elucidate 1) the unique ways that the COVID-19 pandemic affected their mental health and 2) the specific barriers these families faced to maintaining optimal mental wellbeing. METHODS AND FINDINGS: A total of 33 participants (15 parent-child dyads) engaged in virtual interviews. Content analysis revealed that the most frequently identified mental health effects for families were increased child anxiety and disconnectedness, as well as deteriorating parental mental health. The most frequently identified barriers to maintaining optimal mental wellbeing were lack of routine, lack of social interaction and social supports, and uncertainty and fear. CONCLUSIONS: Findings underscore areas of need during times of large-scale social isolation, specifically for families with children who have ADHD. This work contributes to a growing body of research aimed at creating safeguards to support mental wellbeing for vulnerable families during times of crisis.

Pre-Service Teachers' Perceptions of and Experiences with Classroom Physical Activity.

Physical inactivity is one of the most modifiable factors linked to childhood obesity. Several Canadian provinces adopted daily physical activity (DPA) policies to promote physical activity during the school day. In Ontario, only 23% of in-service teachers meet DPA mandates. Promoting DPA implementation must occur at the pre-service level to foster self-efficacy and create long-term teaching habits. This study surveyed 155 pre-service teachers from an Ontario university to determine key perceptions and practices that should be targeted during their educational training to improve DPA fidelity. Findings revealed that over 96% of pre-service teachers viewed physical activity as beneficial for their own and their students mental and physical health, and as much as 33% received no education or training related to DPA. Pre-service teachers valued DPA more if they had opportunities to learn about and observe DPA during school placements. Pre-service teachers were more confident implementing DPA if they were more physically active, viewed themselves as more athletic, and had more positive physical education experiences. This work brings to the forefront important factors that could contribute to DPA implementation among in-service teachers and highlights target areas at the pre-service level for improved fidelity.

A mixed method investigation of teacher-identified barriers, facilitators and recommendations to implementing daily physical activity in Ontario elementary schools.

BACKGROUND: Fewer than 17% of children worldwide are meeting the international recommendations for daily physical activity. Since most children are in school for the bulk of their day, the classroom has been identified as an ideal space to incorporate physical activity opportunities. In Ontario (Canada), the Daily Physical Activity (DPA) policy aims to ensure all elementary school children receive a minimum of 20 min of moderate to vigorous physical activity each school day during instructional time. However, a 2015 evaluation found that only half of Ontario teachers were meeting this expectation; this work advocated for additional research to monitor implementation and its predictors and to further identify fidelity recommendations. Thus, the current study investigated contemporary factors influencing DPA fidelity in Ontario elementary schools and provides teacher-identified recommendations to support DPA implementation. METHODS: The first part of the study was a quantitative approach surveying 186 elementary school teachers across Ontario. Descriptive statistics including frequencies and means were used to characterize barriers, facilitators, and recommendations to DPA implementation. Spearman's correlations were used to assess the relation between the likelihood of DPA implementation and intrapersonal factors of gender, teaching experience, prior DPA training and personal physical activity participation. The second part of the study consisted of a qualitative approach using teacher interviews to explore in-depth teachers' recommendations to support DPA implementation. A thematic analysis was used to analyze the transcripts and identify recommendations for DPA. RESULTS: Survey results showed that only 23% of teachers met the mandated 20 min of DPA per day. Barriers to implementation included space and time constraints, inadequate training, student behavioural issues and low self-efficacy. Gender, teaching experience and prior DPA training were not related to the likelihood of DPA implementation. Teachers who rated themselves as more physically fit were more likely to implement DPA. Teacher interviews elucidated key areas for improving DPA implementation including greater DPA training opportunities, resources, community partnerships, accountability and strategies that support school-wide implementation. CONCLUSION: The current study demonstrated that fidelity to the DPA policy in Ontario elementary schools is on the decline. This work highlights unique factors implicated in DPA fidelity and brings to the forefront teacher recommendations to improve DPA implementation.

Physical Activity in High School Classrooms: A Promising Avenue for Future Research.

Adolescence represents a sensitive period whereby lifestyle factors such as physical activity can have profound, long-lasting effects on development and later life habits. However, adolescence constitutes a period of frequent sedentary behaviour. Among children, integrating physical activity into elementary school classrooms has been shown to reduce sedentary behaviour and improve academic achievement and overall physical and mental health. However, this promising area of research has not extended to adolescents and high school classrooms. In this paper, we describe the benefits of conducting research on the impact of physically active high school classrooms, and highlight the challenges and potential misconceptions associated with research in this field. Specifically, we review research on the role of physical activity in adolescent development, the benefits of classroom-based physical activity for children, and discuss the factors that may have led researchers to focus on classroom-based physical activity primarily for children, despite the potentially similar benefits for adolescents.

Examining the Acute Effects of Classroom-Based Physical Activity Breaks on Executive Functioning in 11- to 14-Year-Old Children: Single and Additive Moderation Effects of Physical Fitness.

Objective: Research supports the efficacy of acute, classroom-based, physical activity breaks on executive functioning in children. However, research pertaining to the effect of physical fitness on the acute physical activity-executive functioning relationship remains limited. The primary purpose of this study was to investigate the acute effects of classroom-based, teacher-delivered, physical activity breaks on executive functioning in 11-14-year-old children. We also investigated the potential moderating effects of both aerobic and musculoskeletal fitness on the acute physical activity-executive functioning relationship. Method: Participants (N = 116) completed pre- and post-test assessments of executive functioning (i.e., inhibition, switching, and updating) separated by a classroom-based physical activity break or sedentary classroom work. We manipulated the dose (i.e., length) and type of physical activity breaks. With regards to dose, participants in the experimental conditions engaged in 5-, 10-, or 20-min of physical activity whereas controls completed sedentary classroom math work at their desk. With regards to type, one experimental condition completed traditional physical activity breaks whereas the other experimental condition completed academic physical activity breaks (i.e., performed mental math and physical activity). Participants' mood, motivation, and self-efficacy were also assessed following the experimental manipulations. Results: Overall, executive function scores improved across each assessment following the physical activity breaks when compared to sedentary classroom work regardless of dose and type. Participants also reported more positive mood states, higher motivation to complete the executive function tests, and higher self-efficacy to perform the executive functions tests following the physical activity breaks. Single moderation analyses showed that low-moderate levels of aerobic fitness moderated the acute physical activity-executive functioning relationship. Additive moderation analysis showed, collectively, that both aerobic and musculoskeletal fitness moderated the acute physical activity-executive functioning relationship. Conclusion: Findings from the present study provide evidence for the acute effects of short (i.e., 5-20 min) classroom-based physical activity breaks on executive functioning and psychological states in children. Results also suggest levels of both aerobic and musculoskeletal fitness moderate these effects, however future research is needed to further elucidate this complex relationship.

The Differential Impact of Acute Exercise and Mindfulness Meditation on Executive Functioning and Psycho-Emotional Well-Being in Children and Youth With ADHD.

This study investigated how acute exercise and mindfulness meditation impacts executive functioning and psycho-emotional well-being in 16 children and youth with ADHD aged 10-14 (male = 11; White = 80%). Participants completed three interventions: 10 min of exercise, 10 min of mindfulness meditation, and 10 min of reading (control). Before and after each intervention, executive functioning (inhibitory control, working memory, task-switching) and psycho-emotional well-being (mood, self-efficacy) were assessed. Mindfulness meditation increased performance on all executive functioning tasks whereas the other interventions did not (d = 0.55-0.86). Exercise enhanced positive mood and self-efficacy whereas the other interventions did not (d = 0.22-0.35). This work provides preliminary evidence for how acute exercise and mindfulness meditation can support differential aspects of executive and psycho-emotional functioning among children and youth with ADHD.

A mental health paradox: Mental health was both a motivator and barrier to physical activity during the COVID-19 pandemic.

The COVID-19 pandemic has impacted the mental health, physical activity, and sedentary behavior of people worldwide. According to the Health Belief Model (HBM), health-related behavior is determined by perceived barriers and motivators. Using an online survey with 1669 respondents, we sought to understand why and how physical activity and sedentary behavior has changed by querying about perceived barriers and motivators to physical activity that changed because of the pandemic, and how those changes impacted mental health. The following results were statistically significant at p < .05. Consistent with prior reports, our respondents were less physically active (aerobic activity, -11%; strength-based activity, -30%) and more sedentary (+11%) during the pandemic as compared to 6-months before. The pandemic also increased psychological stress (+22%) and brought on moderate symptoms of anxiety and depression. Respondents' whose mental health deteriorated the most were also the ones who were least active (depression r = -.21, anxiety r = -.12). The majority of respondents were unmotivated to exercise because they were too anxious (+8%,), lacked social support (+6%), or had limited access to equipment (+23%) or space (+41%). The respondents who were able to stay active reported feeling less motivated by physical health outcomes such as weight loss (-7%) or strength (-14%) and instead more motivated by mental health outcomes such as anxiety relief (+14%). Coupled with previous work demonstrating a direct relationship between mental health and physical activity, these results highlight the potential protective effect of physical activity on mental health and point to the need for psychological support to overcome perceived barriers so that people can continue to be physically active during stressful times like the pandemic.

Virtual Dissection: An Interactive Anatomy Learning Tool.

The novelty of three-dimensional visualization technology (3DVT), such as virtual reality (VR), has captured the interest of many educational institutions. This study's objectives were to (1) assess how VR and physical models impact anatomy learning, (2) determine the effect of visuospatial ability on anatomy learning from VR and physical models, and (3) evaluate the impact of a VR familiarization phase on learning. This within-subjects, crossover study recruited 78 undergraduate students who studied anatomical structures at both physical and VR models and were tested on their knowledge immediately and 48 hours after learning. There were no significant differences in test scores between the two modalities on both testing days. After grouping participants on visuospatial ability, low visuospatial ability learners performed significantly worse on anatomy knowledge tests compared to their high visuospatial ability counterparts when learning from VR immediately (P = 0.001, d = 1.515) and over the long-term (P = 0.003, d = 1.279). In contrast, both low and high visuospatial ability groups performed similarly well when learning from the physical model and tested immediately after learning (P = 0.067) and over the long-term (P = 0.107). These results differ from current literature which indicates that learners with low visuospatial ability are aided by 3DVT. Familiarizing participants with VR before the learning phase had no impact on learning (P = 0.967). This study demonstrated that VR may be detrimental to low visuospatial ability students, whereas physical models may allow all students, regardless of their visuospatial abilities, to learn similarly well.

Examining Associations Between Physical Activity and Academic Performance in a Large Sample of Ontario Students: The Role of Inattention and Hyperactivity.

BACKGROUND: Participation in physical activity (PA) is a modifiable factor that contributes to academic success, yet the optimal dose (ie, frequency) and mechanisms underlying the effect require further exploration. METHODS: Using data from 19,886 elementary and 11,238 secondary school students across Ontario, Canada, this study examined associations between PA participation frequency, academic achievement, and inattention and hyperactivity. RESULTS: Among elementary students, there was a positive association between PA frequency and academic achievement. Participating in 1 to 2 days per week of PA related to higher academic achievement compared with no days, whereas 7 days per week had the largest associations. For secondary students, a minimum of 3 to 4 days per week was associated with higher academic achievement with no significant benefit of additional days. Indirect effects of inattention and hyperactivity were found for both groups, suggesting that the benefits of PA on academic achievement may be partly explained by reductions in inattention and hyperactivity, especially for secondary school students. CONCLUSION: Students may experience academic benefits from PA even if they are not meeting the guidelines of exercising daily. These benefits may occur, in part, through reductions in inattention and hyperactivity. Further work is needed to determine the temporality and mechanism of these associations.

The effects of aerobic exercise intensity on memory in older adults.

Aerobic exercise may enhance memory in older adults. However, the optimal intensity and underlying mechanism are unclear. This community-based study examined the effect of aerobic exercise intensity on memory and general cognitive abilities. Brain-derived neurotrophic factor (BDNF) was examined as a potential mechanism. Sixty-four sedentary older adults participated in 1 of 3 groups: (i) high-intensity interval training (HIIT); (ii) moderate continuous training (MCT); or (iii) stretching control (CON). Prior to and following the intervention, high-interference memory was assessed using a Mnemonic Similarity task and executive functions were assessed using Go Nogo and Flanker tasks. HIIT led to the greatest memory performance compared with MCT and CON (F[2,55] = 6.04, p = 0.004) and greater improvements in memory correlated with greater increases in fitness (rs (46) = 0.27, p = 0.03). Exercise intensity seemed to matter less for executive functioning, as positive trends were observed for both HIIT and MCT. No significant differences in BDNF were found between groups. Overall, these results suggest that aerobic exercise may enhance memory in older adults, with the potential for higher intensity exercise to yield the greatest benefit. While our findings suggest that BDNF does not regulate these adaptations, the mechanisms remain to be determined. Novelty High-intensity interval training results in the greatest memory performance in inactive older adults compared with moderate continuous training or stretching. Improvement in fitness correlates with improvement in memory performance.

The effect of image quality, repeated study, and assessment method on anatomy learning.

The use of two-dimensional (2D) images is consistently used to prepare anatomy students for handling real specimen. This study examined whether the quality of 2D images is a critical component in anatomy learning. The visual clarity and consistency of 2D anatomical images was systematically manipulated to produce low-quality and high-quality images of the human hand and human eye. On day 0, participants learned about each anatomical specimen from paper booklets using either low-quality or high-quality images, and then completed a comprehension test using either 2D images or three-dimensional (3D) cadaveric specimens. On day 1, participants relearned each booklet, and on day 2 participants completed a final comprehension test using either 2D images or 3D cadaveric specimens. The effect of image quality on learning varied according to anatomical content, with high-quality images having a greater effect on improving learning of hand anatomy than eye anatomy (high-quality vs. low-quality for hand anatomy P = 0.018; high-quality vs. low-quality for eye anatomy P = 0.247). Also, the benefit of high-quality images on hand anatomy learning was restricted to performance on short-answer (SA) questions immediately after learning (high-quality vs. low-quality on SA questions P = 0.018), but did not apply to performance on multiple-choice (MC) questions (high-quality vs. low-quality on MC questions P = 0.109) or after participants had an additional learning opportunity (24 hours later) with anatomy content (high vs. low on SA questions P = 0.643). This study underscores the limited impact of image quality on anatomy learning, and questions whether investment in enhancing image quality of learning aids significantly promotes knowledge development. Anat Sci Educ 10: 249-261. © 2016 American Association of Anatomists.

Physical Exercise Moderates the Relationship of Apolipoprotein E (APOE) Genotype and Dementia Risk: A Population-Based Study.

Genetics and lifestyle independently determine dementia risk, but the interaction is unclear. We assessed the interactive relationship of apolipoprotein E (APOE) genotype and physical exercise on dementia risk over a 5-year period in 1,646 older adults from the Canadian Study of Health and Aging who were dementia-free at baseline. Physical exercise moderated the relationship between genotype and dementia (p < 0.01). Specifically, for APOE ɛ4 non-carriers, the odds of developing dementia were higher in non-exercisers than exercisers (OR = 1.98, 95% CI = 1.44, 2.71, p < 0.001), whereas, for APOE ɛ4 carriers, the odds of developing dementia were not significantly different between non-exercisers and exercisers (OR = 0.71, 95% CI = 0.46, 1.31, p = 0.34). Given that most individuals are not at genetic risk, physical exercise may be an effective strategy for preventing dementia.

One size does not fit all: older adults benefit from redundant text in multimedia instruction.

The multimedia design of presentations typically ignores that younger and older adults have varying cognitive strengths and weaknesses. We examined whether differential instructional design may enhance learning in these populations. Younger and older participants viewed one of three computer-based presentations: Audio only (narration), Redundant (audio narration with redundant text), or Complementary (audio narration with non-redundant text and images). Younger participants learned better when audio narration was paired with relevant images compared to when audio narration was paired with redundant text. However, older participants learned best when audio narration was paired with redundant text. Younger adults, who presumably have a higher working memory capacity (WMC), appear to benefit more from complementary information that may drive deeper conceptual processing. In contrast, older adults learn better from presentations that support redundant coding across modalities, which may help mitigate the effects of age-related decline in WMC. Additionally, several misconceptions of design quality appeared across age groups: both younger and older participants positively rated less effective designs. Findings suggest that one-size does not fit all, with older adults requiring unique multimedia design tailored to their cognitive abilities for effective learning.

Learners misperceive the benefits of redundant text in multimedia learning.

Research on metacognition has consistently demonstrated that learners fail to endorse instructional designs that produce benefits to memory, and often prefer designs that actually impair comprehension. Unlike previous studies in which learners were only exposed to a single multimedia design, the current study used a within-subjects approach to examine whether exposure to both redundant text and non-redundant text multimedia presentations improved learners' metacognitive judgments about presentation styles that promote better understanding. A redundant text multimedia presentation containing narration paired with verbatim on-screen text (Redundant) was contrasted with two non-redundant text multimedia presentations: (1) narration paired with images and minimal text (Complementary) or (2) narration paired with minimal text (Sparse). Learners watched presentation pairs of either Redundant + Complementary, or Redundant + Sparse. Results demonstrate that Complementary and Sparse presentations produced highest overall performance on the final comprehension assessment, but the Redundant presentation produced highest perceived understanding and engagement ratings. These findings suggest that learners misperceive the benefits of redundant text, even after direct exposure to a non-redundant, effective presentation.