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1.
BMC Public Health ; 24(1): 869, 2024 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-38515090

RESUMO

BACKGROUND: Given the growing evidence on the health benefits associated with physical literacy (PL), it is necessary to develop sound measures to assess the levels of PL in children. The Physical Literacy in Children Questionnaire (PL-C Quest) is the first self-report pictorial-based scale to assess children's perceived PL. It has good validity and reliability in Australian children aged 7 to 12 years, but little is known in younger children and in other cultural contexts. The aim of this study was to examine the validity and reliability in an expanded age range. METHODS: A total of 1,870 Chinese children (girls, n = 871; 46.6%), aged 4 to 12 years (M = 8.07 ± 2.42) participated in validity testing. Structural equation modeling with the Weighted Least Squares with Mean and Variance approach was used to assess construct validity. The hypothesized theoretical model used the 30 items and four hypothesized factors: physical, psychological, social and cognitive capabilities. Multigroup confirmatory factor analysis was used to assess sex and age group (4-6 years, 7-9 years and 10-12 years) measurement invariance. Internal consistency analyses were conducted using polychoric alpha. A random subsample (n = 262) was selected to determine test-retest reliability using Intra-Class Correlations (ICC). RESULTS: All items except one (moving with equipment-skateboarding) loaded on sub-domains with λ > 0.45. The hypothesized model had a good fit (CFI = 0.954, TLI = 0.950, RMSEA = 0.042), with measurement equivalence across sex and age groups separately. Internal consistency values were good to excellent (overall: α = 0.94; physical: α = 0.86; psychological: α = 0.83; social: α = 0.81; cognitive: α = 0.86). Test-retest reliability was adequate to excellent (overall: ICC = 0.90, physical: ICC = 0.86, psychological: ICC = 0.75, social: ICC = 0.71, cognitive: ICC = 0.72). CONCLUSION: The Chinese version of the PL-C Quest is valid and reliable for testing the self-reported PL of Chinese children aged 4 to 12. This study provides the first evidence of validity for this tool in children aged 4-6 years and also evidence that the PL-C Quest would be a meaningful instrument to assess PL in Chinese children.


Assuntos
Alfabetização , Criança , Feminino , Humanos , Austrália , Psicometria , Reprodutibilidade dos Testes , Autorrelato , Inquéritos e Questionários , Masculino , Pré-Escolar
2.
Sports Med Open ; 10(1): 25, 2024 Mar 13.
Artigo em Inglês | MEDLINE | ID: mdl-38472550

RESUMO

BACKGROUND: Globally, just one in five adolescents meet physical activity guidelines and three-quarters of the school day is spent sitting. It is unclear which types of school-based interventions strategies increase physical activity and reduce sedentary time among adolescents, or how these interventions are implemented influences their effectiveness. OBJECTIVE: The three aims of our systematic review were to (a) identify intervention strategies used within secondary school settings to improve students' movement behaviours throughout school-based initiatives, delivered at or by the school; (b) determine the overall effect of the interventions (meta-analysis) on physical activity (all intensities), sedentary time, cognitive/academic, physical health and/or psychological outcomes; and (c) describe factors related to intervention implementation. METHODS: Searches were conducted in MEDLINE complete, EMBASE, CINAHL, SPORTDiscus, APA PsycINFO, and ERIC in January 2023 for studies that (a) included high school-aged adolescents; (b) involved a school-based intervention to increase physical activity and/or decrease sedentary time; and (c) were published in English. Reported effects were pooled in meta-analyses where sufficient data were obtained. RESULTS: Eighty-five articles, representing 61 interventions, met the inclusion criteria, with 23 unique intervention strategies used. Interventions that involved whole-school approaches (i.e., physical activity sessions, environmental modifications, teacher training, peer support and/or educational resources) were favourably associated with most of the outcomes. The meta-analyses showed: (a) non-significant effects for sedentary time (Standardized mean difference [SMD] = -0.02; 95%CI, -0.14, 0.11), physical activity at all intensities (light: SMD= -0.01; 95%CI, -0.08, 0.05; moderate: SMD = 0.06; 95%CI, -0.09, 0.22; vigorous: SMD = 0.08; 95%CI, -0.02, 0.18; moderate-to-vigorous: SMD = 0.05; 95%CI, -0.01, 0.12) and waist circumference (SMD = 0.09; 95%CI, -0.03, 0.21), and (b) a small statistically significant decrease in body mass index (SMD= -0.09, 95%CI -0.16, -0.0). Factors related to intervention implementation were reported in 51% of the articles. CONCLUSION: While some intervention approaches demonstrated promise, small or null effects were found in meta-analyses. Future school-based interventions should utilize a whole-school approach designed to increase adolescents' activity across the day. Consistent reporting of implementation will increase understanding of how interventions are adopted, implemented and sustained. REGISTRATION: PROSPERO (CRD42020169988).

3.
Res Q Exerc Sport ; 94(3): 839-852, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-35522990

RESUMO

Research combining physical activity with the training of cognitive skills such as executive functions is emerging as a novel and fruitful intervention approach for children. Purpose: This study aimed to examine the impact of an intervention program including cognitively engaging physical activity on preschool children's cognitive outcomes and physical activity. Methods: Children (N = 144, 65 female; Mage = 4.41 years, SD = 0.61), randomly assigned to one of three groups: cognitively engaging physical activity (CPA; i.e., storytelling, cognitive activities, and motor tasks, n = 55), cognition (i.e., storytelling and cognitive activities without motor tasks, n = 48), or control (i.e., traditional storytelling, n = 41). Sessions lasted approximately 17 minutes, conducted twice a week, for 6 weeks. Children's executive function, self-regulation, and related outcomes (i.e., numeracy) were assessed at baseline and again-along with perceived enjoyment-at the end of the program. Accelerometers measured children's physical activity during each session. Teachers completed a logbook for each session, and two fidelity checks per preschool took place by the researcher. Main analyses used linear mixed models adjusted for covariates (age, sex) and clustering at the preschool level. Results: Results showed no significant group by time interaction for executive function, self-regulation, numeracy, enjoyment. During the sessions, children in the CPA group were more physically active than children in the cognition and control groups. Conclusion: While we did not find the expected amplified cognitive benefits, making storytelling more active has the potential to meet two needs (increase cognitive stimulation and physical activity levels) in one deed.


Assuntos
Cognição , Exercício Físico , Pré-Escolar , Feminino , Humanos , Cognição/fisiologia , Função Executiva/fisiologia , Exercício Físico/fisiologia , Instituições Acadêmicas , Masculino
4.
Children (Basel) ; 9(6)2022 Jun 02.
Artigo em Inglês | MEDLINE | ID: mdl-35740760

RESUMO

Background: Physical activity health benefits are widely known. However, the association between physical activity, physical fitness, executive function, and academic performance need further investigation. Additionally, one of the literature gaps reveals scarce and mixed findings on what mediators of physical activity may affect academic achievement. Purpose: This investigation aims to provide knowledge about the mediation role of physical fitness and executive function in the association of physical activity with academic achievement in a cohort of Spanish schoolchildren using a structural equation modelling approach. Methods: The data for this cross-sectional study were collected from a convenience sample of children from Spain (Balearic Islands) aged between 9 and 13 years. Physical activity levels were self-reported with the Physical Activity Questionnaire for Children; physical fitness was assessed using the International Fitness Scale; executive function was assessed with the Trail Making Test, and children's achievements were collected from the school records. Structural equation modelling was used to explore the relationship between physical activity, physical fitness, executive function, and academic achievement. Findings: Statistically significant positive direct associations were observed between physical activity and physical fitness (ß = 0.46, 95% CI [0.29, 0.64]), physical fitness and executive function (ß = 0.28, 95% CI [0.04, 0.52]), and executive function and academic achievement (ß = 0.46, 95% CI [0.28, 0.65]), while adjusting for the confounding effects of sex and body mass index. Furthermore, indirect associations were observed between physical activity and executive function mediated by physical fitness (ß = 0.13, bias-corrected 95% CI [0.02, 0.31]) and between physical fitness and academic achievement through executive function (ß = 0.13, bias-corrected 95% CI [0.03, 0.32]). Conclusions: This investigation adds to the literature with evidence supporting the idea that regular PA leads to improvements in physical fitness and may support cognitive skills and academic performance in children.

5.
Front Psychol ; 13: 806065, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35360626

RESUMO

Approaches to foster motor creativity differ according to whether creative movements are assumed to be enacted creative ideas, or solutions to emerging motor problems that arise from task and environmental constraints. The twofold aim of the current study was to investigate whether (1) an enriched physical education (PE) intervention delivered with a joint constraints-led and cognitive stimulation approach fosters motor creativity, and the responsiveness to the intervention is moderated by baseline motor and cognitive skills and sex; (2) the intervention may benefit motor creativity through gains in motor coordination, executive function, and creative thinking. Ninety-five children, aged 6-9 years, participated in a 6-month group randomized trial with specialist-led enriched PE vs. generalist-led conventional PE. Before and after the intervention, Bertsch's Test of Motor Creativity, Movement Assessment Battery for Children, Random Number Generation task and Torrance Test of Creative Thinking were administered. Linear mixed models were run accounting for the random effects of data clusters. Multiple mediation analysis was performed to assess whether motor coordination, executive function and creative thinking mediated any improvement of motor creativity. Results showed that (1) specialist-led enriched PE, compared to generalist-led conventional practice, elicited a more pronounced improvement in all motor creativity dimensions (fluency, flexibility, and originality) independently of baseline levels of motor and cognitive skills and sex; and (2) improved motor creativity was partially mediated by improved motor coordination and, as regards motor flexibility, also by improved inhibitory ability. In conclusion, enriching PE with tailored manipulations of constraints and variability may enhance the ability to create multiple and original task-pertinent movements both directly and through indirect paths. The results are discussed extending to motor creativity a theoretical framework that distinguishes different creativity modes. The intervention may have fostered the generation of creative movements directly through the exposure to variation in constraints, activating the sensorimotor 'flow' mode of creativity that bypasses higher-order cognition, but also indirectly through a systematic and conscious convergence on solutions, activating the 'deliberate' mode of creativity that relies on inhibition to reject common or task-inappropriate movement categories.

6.
Children (Basel) ; 9(12)2022 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-36553340

RESUMO

This online study investigated the acute effects of a cognitively demanding physical activity (CDPA) vs a simple physical activity (SPA) bout on children's inhibitory and affective responses. Using a counterbalanced within-subjects' crossover design, thirty-nine participants aged 9−12 years old (29 boys; Mage = 11 ± 1 years) performed a CDPA and a SPA bout online (via ZOOM) for 15 min. Inhibition (Stroop test) was measured at the baseline, 1 and 30 min following the physical activity (PA) bouts, and self-report measures of affect, mental and physical exertion were taken prior, during and post-PA. Additionally, 31 children took part in semi-structured focus groups to explore the factors affecting their enjoyment. The quantitative results suggest no significant differences on inhibitory responses, affect and physical exertion (all p > 0.05). However, the CDPA induced more mental exertion than the SPA did (p < 0.05). In the focus groups, four themes were identified: physical exertion (e.g., tiredness), social (e.g., teams/groups), environment (e.g., outdoors and competition) and emotional (e.g., fun/enjoyment). Some children (n = 18) reported that the CDPA condition confused them, and to make these activities more interesting and enjoyable, they suggested performing the activities outdoors (n = 15) and including other children as part of a group/team (n = 19). The findings suggest no additional benefit of a cognitively enriched physical activity compared to an SPA bout on the inhibitory responses, affect and enjoyment. Using the instructions provided and given the low cost, the easy administration and the minimal amount of equipment and time involved, either of the approaches may be used in a diversity of contexts (i.e., online, schools or outdoors), and it is worth exploring the effects of these conditions on other aspects of executive function.

7.
PLoS One ; 16(7): e0253733, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34260606

RESUMO

INTRODUCTION: Classroom-based active breaks are a feasible and effective way to reduce and break up sitting time, and to potentially benefit physical health in school children. However, the effect of active breaks on children's cognitive functions and brain activity remains unclear. OBJECTIVE: We investigated the impact of an active break intervention on typically developing children's cognitive functions and brain activity, sitting/standing/stepping, on-task behaviour, and enjoyment. METHODS: Up to 141 children, aged between 6 and 8 years (46% girls), were included, although about half of them completed two of the assessments (n = 77, working memory; n = 67, dorsolateral prefrontal cortex haemodynamic response). Classrooms from two consenting schools were randomly allocated to a six-week simple or cognitively engaging active break intervention. Classrooms from another school acted as a control group. The main analyses used linear mixed models, clustered at the class level and adjusted for sex and age, to investigate the effects of the interventions on response inhibition, lapses of attention, working memory, event-related brain haemodynamic response (dorsolateral prefrontal cortex). The mediating effects of sitting/standing/stepping on cognition/brain activity were also explored. To test intervention fidelity, we investigated differences by group on the change values in children's sitting, standing, and moving patterns during class/school time using linear mixed models. Generalized linear mixed models clustered at the individual level were used to examine on-task behaviour data. For the intervention groups only, we also assessed children's perceived enjoyment, physical exertion and mental exertion related to the active breaks and compared the results using independent t-tests. RESULTS: There was a significantly greater positive change in the proportion of deoxygenated haemoglobin in the left dorsolateral prefrontal cortex of children assigned to cognitively engaging active breaks compared to the control group (B = 1.53 × 10-07, 95% CI [0.17 × 10-07, 2.90 × 10-07]), which under the same cognitive performance is suggestive of improved neural efficiency. Mixed models showed no significant effects on response inhibition, lapses of attention, working memory. The mediation analysis revealed that the active breaks positively affected response inhibition via a change in sitting and standing time. The sitting, standing, and moving patterns and on-task behaviour were positively affected by the active breaks at end of trial, but not at mid-trial. Children in both intervention groups showed similarly high levels of enjoyment of active breaks. CONCLUSION: Cognitively engaging active breaks may improve brain efficiency in the dorsolateral prefrontal cortex, the neural substrate of executive functions, as well as response inhibition, via effects partially mediated by the change in sitting/stepping time. Active breaks can effectively reduce sitting and increase standing/stepping and improve on-task behaviour, but the regular implementation of these activities might require time for teachers to become familiar with. Further research is needed to confirm what type of active break best facilitates cognition.


Assuntos
Encéfalo/fisiologia , Cognição/fisiologia , Exercício Físico/fisiologia , Instituições Acadêmicas , Comportamento Sedentário , Atenção/fisiologia , Criança , Feminino , Humanos , Masculino , Memória de Curto Prazo/fisiologia
8.
Artigo em Inglês | MEDLINE | ID: mdl-34574794

RESUMO

Physical education (PE) is acknowledged as a relevant context for holistic child and youth development promotion. However, interventional research mostly builds on individual theories focused on specific outcome domains. This study presents a multisport enriched PE intervention that capitalizes on the intersection of different theory-based approaches to motor, cognitive and socio-emotional skills development promotion. With a cross-over design, 181 fifth graders, coming from a past class-randomized trial of enriched or traditional PE in their 1st-3rd grade, were stratified (based on their previous PE experience) and class-randomized to multisport enriched PE or control group. They completed pre-post assessments in motor and sport skills, cool (inhibition, working memory) and hot (decision making) executive functions, prosocial (empathy, cooperation) and antisocial (quick-temperedness, disruptiveness) behaviors. Children in the enriched PE group showed advantages in motor and prosocial skills after the intervention, which were linked by a mediation path, and an interactive effect of past and actual PE experience on decision making but no differential effects on other variables. The results suggest that a PE intervention designed with an integrative theory base, although not allowing disentangling the contribution of individual components to its efficacy, may help pursue benefits in motor and non-motor domains relevant to whole-child development.


Assuntos
Função Executiva , Educação Física e Treinamento , Adolescente , Desenvolvimento Infantil , Estudos Cross-Over , Emoções , Humanos , Destreza Motora
9.
Children (Basel) ; 7(11)2020 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-33147706

RESUMO

The physical activity levels of children in Australia are critically low and correlate with reduced academic achievement and poor health outcomes. Schools provide an ideal setting for physical activity interventions to help children move more. Instead of targeting in-service teachers, this study embedded an evidence-based active pedagogy program called Transform-Ed! into pre-service teacher education. Pre/post surveys and post-program interviews and focus group discussions were conducted with key stakeholders (n = 5), lecturers (n = 6), and pre-service teachers (n = 274) involved with the 12-week program. The design, implementation, and evaluation of the study were systematically guided by all five dimensions of Glasgow and colleagues' RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework. Linear mixed models, descriptive analysis and a framework approach were used to analyse the data. Significant improvements were observed in pre-service teachers' willingness, confidence, and competence to implement physically active pedagogic strategies following the intervention. Pre-service teacher perceived effectiveness of such strategies on student outcomes also significantly increased and perceived barriers decreased. High adherence was consistently reported and the program was maintained after completion of the implementation trial by all lecturers. Four key themes spanning multiple dimensions and participant levels informed recommendations for program scalability: an "inter-systemic approach", a "co-design" approach, "embedded in professional practice", and "evidence of impact" on teacher practice. Anchored in real-world settings and tethered by implementation science, Transform-Ed! could have the potential to advance the teaching capability of teachers, and transform the learning experience and physical and academic outcomes of primary school students.

10.
J Sci Med Sport ; 23(3): 270-275, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31575502

RESUMO

OBJECTIVES: Self-perceptions such as perceived motor competence and psychosocial wellbeing have been identified as important to children's physical activity. The study's purpose was to explore whether perceived motor competence and psychosocial wellbeing were determinants of physical activity, one year after a baseline assessment. DESIGN: Longitudinal study. METHODS: A total of 134 children (65.7% boys, 34.3% girls) aged 6-7 years at baseline (2016), and 7-8 years at follow-up (2017) were included in this study. Pearson's correlations assessed associations at baseline and follow-up between moderate- to vigorous-intensity physical activity (MVPA) (accelerometers) and (i) total perceived motor competence and subdomains (the pictorial scale of Perceived Movement Skill Competence) and (ii) psychosocial wellbeing and sub-domains - KidKINDL KINDer Lebensqualitätsfragebogen: Children Quality of Life Questionnaire (KINDLR). Variables identified as significant in Pearson's correlations were included in mixed model analyses, adjusting for accelerometer wear time, sex and age. RESULTS: Baseline perceived object control skills was associated with MVPA at follow-up (r=0.38, p<0.001), but perceived locomotor skills were not. Self-esteem was the only subdomain of psychosocial wellbeing that demonstrated significant association with MVPA at baseline (r=0.21, p<0.05). Perceived object control (B=1.36, p=0.019, 95% CI [0.23, 2.50]) and self-esteem (B=0.32, p=0.001, 95% CI [0.13, 0.50]) positively predicted MVPA; albeit with small effects. CONCLUSIONS: Focusing on improving children's perceived object control and self-reported self-esteem may contribute to children's physical activity participation.


Assuntos
Exercício Físico , Destreza Motora , Autoimagem , Acelerometria , Austrália , Criança , Feminino , Monitores de Aptidão Física , Humanos , Estudos Longitudinais , Masculino , Autorrelato , Inquéritos e Questionários
11.
Pilot Feasibility Stud ; 5: 125, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31893128

RESUMO

PURPOSE: Low levels of physical activity and high levels of sedentary behaviour are pervasive, especially in schools. Pre-service teacher education is pivotal to school and educational reform but is an under-studied setting for physical activity and sedentary behaviour intervention research. The objective of this pilot study was to test the feasibility and potential impact of embedding evidence-based active pedagogy based on an adapted version of Transform-Us!, Transform-Ed! in one core unit of an undergraduate teacher education degree. METHODS: Baseline and follow-up measures (i.e. surveys) were conducted with Bachelor of Education (Primary) pre-service teachers who received the Transform-Ed! intervention and academic educators who delivered the intervention. Focus groups of senior academics and telephone interviews with primary school principals examined perceptions of intervention feasibility and explored potential real-world relevance and impact of pre-service teachers training in active pedagogy. RESULTS: After 12 weeks, pre-service teachers (n = 218) were significantly more willing (pre-post change Δ = 0.54, 95% CI [0.16, 0.91]), confident (Δ = 1.40, 95% CI [0.89, 1.91]) and competent (Δ = 2.39, 95% CI [1.85, 2.92]) to deliver Transform-Ed!, had more positive feelings about the impact of physical activity on student outcomes (Δ = 2.05, 95% CI [1.58, 2.52]), and perceived fewer barriers to integrating Transform-Ed! into current and future teaching (Δ = - 7.26, 95% CI [- 8.88, - 5.64]). Four major themes emerged from the focus groups (n = 9) and interviews (n = 5) around participant perceptions of Transform-Ed!: (i) acceptability and appropriateness, (ii) need (tertiary level), (iii) need (primary level) and (iv) overcoming challenges. CONCLUSION: The Transform-Ed! pilot study demonstrated promising results across multiple participant levels, as it was perceived to be feasible, acceptable and appropriate by pre-service teachers, academics and school principals. The findings have direct implications for the progression of Transform-Ed! from pilot to a future definitive trial.

12.
Artigo em Inglês | MEDLINE | ID: mdl-31027380

RESUMO

Previous research showed that children's physical activity is positively related to executive functions, whilst screen time shows negative associations. However, it is unclear how school-based sitting time and transitions from sitting to standing relate to cognition. We investigated the relationship between class time sitting/stepping/sit-to-stand transitions and cognitive functions in Grade 1-2 children. Overall, 149 children (7.7 ± 0.6 years old, 54% boys) participated. Measures included class time sitting/stepping/sit-to-stand transitions and: (i) response inhibition (i.e., response time and accuracy); (ii) lapses of attention; (iii) working memory; and (iv) brain activity (cortical haemodynamic response). Linear mixed-models, adjusting for age, sex, and clustering at the classroom level, found that more sitting time was associated with higher lapses of attention (ß = 0.12, p < 0.05). Children who stepped more had quicker inhibition response time (ß = -0.95, p < 0.01); however, they were less accurate in their responses (ß = -0.30, p < 0.05) and this was also observed with sit-to-stand transitions (ß = -0.26, p < 0.05). No associations were found with brain activity. In conclusion, reducing and breaking up sitting may help keep children focused, but the evidence regarding response inhibition is unclear.


Assuntos
Encéfalo/fisiologia , Cognição , Exercício Físico , Comportamento Sedentário , Postura Sentada , Criança , Feminino , Humanos , Masculino , Instituições Acadêmicas , Fatores de Tempo
13.
J Sport Health Sci ; 8(2): 137-148, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30997260

RESUMO

BACKGROUND: Children spend ≤70% of the school day sitting in class. Classroom-based active breaks can benefit children's physical health, but if the breaks are cognitively demanding (i.e., combine physical exertion and mental engagement), they may also improve focus and cognitive functions. Teachers and students play a crucial role in the successful implementation of active breaks, and their perspectives are critical to the feasibility of these strategies. The aim of this study was to assess the feasibility of implementing a cognitively challenging motor task as an active break in mainstream and special primary schools. METHODS: A total of 5 teachers in 2 mainstream schools and 7 teachers in 1 special school (attended by children with neurodevelopmental disorders) attended a 20-min training on how to implement a 4-min cognitively challenging active break, before conducting a feasibility trial (twice a day for 1 week). To understand individual perceptions, one-on-one semistructured interviews were conducted before and after the trial with teachers, and focus group interviews were conducted with typically developing children after the trial. Questions were based on a predefined framework for feasibility studies. All interviews were audio recorded, transcribed and analyzed in NVivo 11 using a framework approach. A total of 12 teachers (11 females; 7 between 20 and 34years old) and 34 children (16 girls; 9.3 ± 1.7years, mean ± SD) participated in the interviews. RESULTS: In mainstream schools, teachers viewed the cognitively challenging motor task as appropriate and potentially beneficial for children's health and focus. Children reported enjoying the active breaks. Teachers in special schools viewed the task as complex and potentially frustrating for children. In both school types, children's disruptive behavior and lack of time were seen as the main potential barriers to implementation. The use of music, videos, visual cards, and support staff were noted as potential facilitators. CONCLUSION: The cognitively challenging motor task was a feasible way to interrupt children's sitting time and promote physical activity in mainstream schools, but required changes in special schools. Further research could investigate the effectiveness of these types of task interruptions on children's physical and cognitive health.

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