Increasing Physical Activity in Schools: Strategies for School Health Practitioners.

Background. Colorado passed House Bill 11-1069 in 2011 requiring all public elementary schools to provide students with a minimum of 30 minutes of physical activity (PA) per school day (Physical Activity Expectation in Schools, 2011). The purpose of this article is to describe the results of a 3-year initiative to increase opportunities for PA and to provide recommendations for school health practitioners implementing similar programming. Intervention. In 2014, 13 school districts were funded to increase student PA during school hours and before and after school hours. Intervention activities spanned all components of the Comprehensive School Physical Activity Program framework. An evaluation was conducted to estimate the number of schools providing at least 30 minutes of PA a day. A mixed methods evaluation design was implemented that included tracking the number of minutes of PA provided before, during, and after school and semistructured interviews with school health coordinators. Results. In Year 1, an average of 48 minutes of PA were provided per day. By the end of year 3, the average minutes of PA doubled to 90 minutes per day. Teachers and staff identified professional development and administrator support as key components to incorporating more PA throughout the school day. Conclusions. Health promotion interventions in schools can increase access to PA opportunities for students. Sustainability of PA efforts in schools is dependent on funding to support professional development for teachers and staff and building administrative support for school-based PA.

A Profile of Active Transportation in Colorado Public Schools, 2014-2015.

Active transportation (AT) may represent an ideal opportunity to accumulate physical activity (PA). Thus, the purpose of this study was to describe the AT profile among students from two Colorado school districts. Students completed a survey on AT resulting in a final dataset (n = 3738) from which descriptive and inferential statics were calculated. Respondents were 11.32 ± 2.82 years of age (Boys = 48.27 %; Girls = 51.73 %). Most students (87.29 %) traveled to or from school via automobile, while 11.17 % walked and 1.53 % biked. Boys rode bicycles to school significantly more (p < 0.0001) than girls, and when walking, accumulated significantly more time (p = 0.02) than females. When examining by grade level significant differences were found for days/week walking (p = 0.0002) to school and biking (p < 0.001) to school. High school students accumulated significantly (p < 0.0001) more time walking to school than middle or elementary school students. Similarly, high school students spent more time biking (p < 0.0001) to school than middle school and elementary school respondents. These findings indicate that travel to school by automobile is still the dominant mode of travel for most public school students. Further, males were generally more likely to obtain extra time in AT. Moreover, older students were more likely to engage in AT, and to spend more time during their AT.

A Method for Evaluating Physical Activity Programs in Schools.

Providing opportunities for students to be physically active during the school day leads to increased academic performance, better focus, and fewer behavioral problems. As schools begin to incorporate more physical activity programming into the school day, evaluators need methods to measure how much physical activity students are being offered through this programming. Because classroom-based physical activity is often offered in 3-minute to 5-minute bouts at various times of the day, depending on the teachers' time to incorporate it, it is a challenge to evaluate this activity. This article describes a method to estimate the number of physical activity minutes provided before, during, and after school. The web-based tool can be used to gather data cost-effectively from a large number of schools. Strategies to increase teacher response rates and assess intensity of activity should be explored.

Examining mental health stigma in a first-year seminar for student veterans.

Objective: To examine perceptions of mental health stigma among first-year student service members/veterans (SSM/Vs). Participants: 107 SSM/Vs enrolled in a first-semester seminar completed a pre- and post-test measuring five constructs; 1) stigma toward mental health in the military, 2) academic readiness, 3) mental health stigma in college, 4) connection to campus, and 5) resiliency. Methods: Data were analyzed using paired samples t-tests to measure growth on the scales of interest, along with a multiple regression analysis to establish predictors of growth. Results: Stigma-Military and Connection to Campus increased while Stigma-College reduced (p<.05). For the regression analysis, statistically significant predictors of stigma include number of deployments and having served in a combat role (p<.05) Conclusions: Results suggest classroom interventions for SSM/Vs on campus may be related to reduced stigma toward mental health services. This study provides a starting point for expanding research on health and wellness curricular interventions for SSM/V.

Neuroimaging and Neuropsychological Outcomes Following Clinician-Delivered Cognitive Training for Six Patients With Mild Brain Injury: A Multiple Case Study.

Nearly half of all mild brain injury sufferers experience long-term cognitive impairment, so an important goal in rehabilitation is to address their multiple cognitive deficits to help them return to prior levels of functioning. Cognitive training, or the use of repeated mental exercises to enhance cognition, is one remediation method for brain injury. The primary purpose of this hypothesis-generating pilot study was to explore the statistical and clinical significance of cognitive changes and transfer of training to real-life functioning following 60 h of Brain Booster, a clinician-delivered cognitive training program, for six patients with mild traumatic brain injury (TBI) or non-traumatic acquired brain injury (ABI). The secondary purpose was to explore changes in functional connectivity and neural correlates of cognitive test gains following the training. We used a multiple case study design to document significant changes in cognitive test scores, overall IQ score, and symptom ratings; and we used magnetic resonance imaging (MRI) to explore trends in functional network connectivity and neural correlates of cognitive change. All cognitive test scores showed improvement with statistically significant changes on five of the seven measures (long-term memory, processing speed, reasoning, auditory processing, and overall IQ score). The mean change in IQ score was 20 points, from a mean of 108 to a mean of 128. Five themes emerged from the qualitative data analysis including improvements in cognition, mood, social identity, performance, and Instrumental Activities of Daily Living (IADLs). With MRI, we documented significant region-to-region changes in connectivity following cognitive training including those involving the cerebellum and cerebellar networks. We also found significant correlations between changes in IQ score and change in white matter integrity of bilateral corticospinal tracts (CST) and the left uncinate fasciculus. This study adds to the growing body of literature examining the effects of cognitive training for mild TBI and ABI, and to the collection of research on the benefits of cognitive training in general. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02918994.

An Evaluation of an Unstructured and Structured Approach to Increasing Recess Physical Activity.

BACKGROUND: The purpose of this study was to evaluate an unstructured and a structured program designed to increase physical activity (PA). The unstructured program increased the amount of equipment during recess, whereas the structured program introduced activities to students. METHODS: PA was observed using the System for Observing Play and Leisure Activity in Youth (SOPLAY) in two school districts in Colorado. Researchers recorded baseline and follow-up observations for sedentary activity, moderate PA, and vigorous PA, as well as for available equipment for the unstructured program. Observations from schools were aggregated for data analyses at the district level. RESULTS: For the program increasing equipment, moderate PA and vigorous PA increased, while sedentary behavior decreased. For the structured program, moderate PA and vigorous PA did not increase, whereas sedentary behaviors increased following the program. CONCLUSIONS: Other variables are likely influencing student PA during recess, such as teachers' interaction with students or the fidelity of the program. Results indicate that funding and implementing a program aimed at increasing PA will not necessarily accomplish that goal, and additional research should be performed to determine the best practice for increasing PA.

Clinician-delivered cognitive training for children with attention problems: effects on cognition and behavior from the ThinkRx randomized controlled trial.

PURPOSE: The impact of attention problems on academic and social functioning coupled with the large number of children failing to respond to stimulant medication or behavioral therapy makes adjunctive therapies such as cognitive training appealing for families and clinicians of children with attention difficulties or childhood attention deficit hyperactivity disorder. However, the results of cognitive training studies have failed to find far transfer effects with this population. This study examined the quantitative cognitive effects and parent-reported behavioral effects of a clinician-delivered cognitive training program with children who have attention problems. PATIENTS AND METHODS: Using a randomized controlled study design, we examined the impact of a clinician-delivered cognitive training program on processing speed, fluid reasoning, memory, visual processing, auditory processing, attention, overall intelligence quotient score, and behavior of students (n=13) aged 8-14 years with attention problems. Participants were randomly assigned to either a waitlist control group or a treatment group for 60 hours of cognitive training with ThinkRx, a clinician-delivered intervention that targets multiple cognitive skills with game-like, but rigorous mental tasks in 60-90-minute training sessions at least 3 days per week. RESULTS: Results included greater mean pretest to posttest change scores on all variables for the treatment group versus the control group with statistically significant differences noted in working memory, long-term memory, logic and reasoning, auditory processing, and intelligence quotient score. Qualitative outcomes included parent-reported changes in confidence, cooperation, and self-discipline. CONCLUSION: Children with attention problems who completed 60 hours of clinician-delivered ThinkRx cognitive training realized both cognitive and behavioral improvements.

Intensity of commonly-reported classroom-based physical activity opportunities in public schools.

The purpose of this study was to examine the intensity levels of PA opportunities offered in public school classrooms. Schools (N = 101) in school districts (N = 25) reported PA opportunities offered in classrooms using an online data collection tool over a two-year period (2014-2016). Using a randomized sampling technique, 20-30% of teachers in each school were selected each week to report PA in their classroom. These responses resulted in N = 18,210 usable responses. A researcher determined the intensity of PA opportunities using the 2011 Compendium of Physical Activities as a guideline; two additional researchers confirmed the coded categories. A descriptive analysis of PA opportunities was conducted to describe the proportion of opportunities whose intensity levels were light (LPA), moderate (MPA), vigorous (VPA), sedentary (SED), and those of unknown intensity. Chi-square analyses were utilized to examine differences between proportions of intensity levels offered by semester. Kruskal-Wallace tests were utilized to examine differences in proportion of physical activity opportunity intensity offered by grade level. Most PA opportunities were MPA (58.7%), followed by VPA (17.6%) and LPA (11.5%). Few responses were SED (0.5%), and 11.6% were of indeterminate intensity. A greater proportion of more physically intense activities reported during the fall versus spring semesters (p < 0.0001). Differences in the intensity levels of PA offered by grade also differed, with a trend of decreasing intensity as grade level increased (p < 0.0001). This study provides insight into the PA actually occurring in classrooms; a previously underexplored construct of school-based PA.

LearningRx Cognitive Training Effects in Children Ages 8-14: A Randomized Controlled Trial.

In a randomized controlled study, we examined the effects of a one-on-one cognitive training program on memory, visual and auditory processing, processing speed, reasoning, attention, and General Intellectual Ability (GIA) score for students ages 8-14. Participants were randomly assigned to either an experimental group to complete 60 h of cognitive training or to a wait-list control group. The purpose of the study was to examine changes in multiple cognitive skills after completing cognitive training with ThinkRx, a LearningRx program. Results showed statistically significant differences between groups on all outcome measures except for attention. Implications, limitations, and suggestions for future research are examined.