Concussion Risk and Recovery in Athletes With Psychostimulant-Treated Attention-Deficit/Hyperactivity Disorder: Findings From the NCAA-DOD CARE Consortium.

The aim of the present study was to examine the effects of attention-deficit/hyperactivity disorder (ADHD) -related psychostimulant use in the context of concussion risk and symptom recovery. Data were obtained from the National Collegiate Athletic Association Department of Defense Grand Alliance Concussion Assessment, Research, and Education (NCAA-DOD CARE) Consortium from 2014 to 2017. Relative to individuals without diagnosed ADHD (i.e., control), both ADHD diagnosis and the combination of ADHD diagnosis and psychostimulant use were associated with a greater risk of incurring a concussive injury. Following a concussive injury, ADHD diagnosis was associated with longer symptom recovery time relative to the control group. However, individuals with ADHD who use psychostimulants did not take longer to resolve symptoms than controls, suggesting that psychostimulants may have a positive influence on recovery. Regardless of time point, ADHD diagnosis was associated with an elevated number of concussion-related symptoms; however, this effect appears mitigated by having used ADHD-related psychostimulants.

Attention-Deficit/Hyperactivity Disorder-Related Self-Reported Symptoms Are Associated With Elevated Concussion Symptomatology.

The aim of the present investigation was to provide insight into how postconcussion symptomatology may be altered in individuals exhibiting attention-deficit/hyperactivity disorder (ADHD)-related behaviors and examine factors that may be responsible for driving such relationships. A total of 99 individuals were assessed during the subacute phase of concussion recovery. Inattentive symptomatology, but not diagnosis of ADHD, was related to greater concussion-symptom severity and overall symptoms endorsed. Cluster and factor analyses highlighted that the relationship between ADHD symptomatology and concussion symptomatology was not a function of overlapping constructs being assessed (i.e., concussion-related symptomatology was not a proxy of ADHD-related symptomatology). These relationships were not mediated by parental observations of impairments in behaviors associated with executive functioning (i.e., executive dysfunction was not driving the greater concussion-related symptomatology associated with ADHD-related symptomatology). These findings highlight the importance of moving beyond categorical frameworks of ADHD to, instead, consider the continuum of underlying behaviors.

Placebo controlled phase II clinical trial: Safety and efficacy of combining intranasal insulin & acute exercise.

A growing number of investigations are exploring the utility of intranasal insulin as a means of mitigating cognitive decline. However, as a basic tenant of dementia prevention programs is increasing physical activity, it is essential to obtain a preliminary assessment of the safety profile of combining intranasal insulin with physical activity; to ensure that undue risks are not incurred. Utilizing a randomized double-blind placebo-controlled design, a sample of 116 non-diabetic, fasted college-aged adults were randomly assigned to receive a dose of 0-to-120 IU of NovoLog (Insulin Aspart) before being randomized to 20 min of exercise or sitting control condition. The safety of intranasal insulin was assessed by examining the incidence of potential symptoms of hypoglycemia and changes in peripheral blood glucose. The efficacy of a combination therapeutic approach was assessed using behavioral measures of inhibition and sustained attention alongside neuroelectric indices of attentional engagement. The frequency of symptoms reported following administration of intranasal insulin were not observed to interact with exercise so as to make their occurrence any more or less prominent, nor was the frequency observed to relate to the dose of intranasal insulin. However, doses of intranasal insulin of 100 IU or more were observed to result in a 7-fold increase in the likelihood of a level 1 hypoglycemic event for those individuals in the exercise condition. This study provides preliminary evidence to suggest that exercise is not associated with an increase in risk when combined with lower doses of intranasal insulin.Clinical trial registration The trial is registered at ClinicalTrials.gov, number NCT04292535.

Preschoolers exhibit greater on-task behavior following physically active lessons on the approximate number system.

OBJECTIVE: To determine how the dual-task nature of incorporating physical activity with instructional activities immediately impacts acuity of the approximate number system and on-task behavior in preschoolers. METHODS: Using a randomized within-participants repeated-measures crossover design, 51 children completed an approximate number system task before and after either 20-min of physically active instruction corresponding to 38% heart rate reserve (HRR; light-to-moderate intensity) or conventional sedentary instruction at corresponding to 21% HRR (very light intensity). RESULTS: Findings revealed that preschool-aged children exhibited similar learning and greater on-task behavior following a single bout of physically active instruction relative to conventional sedentary instruction. Overall, preschoolers accrued 931.3 ± 8.2 more steps and an additional 9 minutes at or above light-intensity activity during the physically active instruction. CONCLUSION: Accordingly, these findings suggest that the dual-task nature of physically active learning does not compromise learning, reduces the need for redirecting off-task behavior, and ultimately allows children to avoid sedentary behavior in educational contexts.

Aerobic Fitness Unrelated to Acquisition of Spatial Relational Memory in College-Aged Adults.

While compelling evidence indicates that poorer aerobic fitness relates to impairments in retrieving information from hippocampal-dependent memory, there is a paucity of research on how aerobic fitness relates to the acquisition of such relational information. Accordingly, the present investigation examined the association between aerobic fitness and the rate of encoding spatial relational memory-assessed using a maximal oxygen consumption test and a spatial configuration task-in a sample of 152 college-aged adults. The findings from this investigation revealed no association between aerobic fitness and the acquisition of spatial relational memory. These findings have implications for how aerobic fitness is characterized with regard to memory, such that aerobic fitness does not appear to relate to the rate of learning spatial-relational information; however, given previously reported evidence, aerobic fitness may be associated with a greater ability to recall relational information from memory.

Physical Fitness, Physical Activity, and the Executive Function in Children with Overweight and Obesity.

OBJECTIVE: To examine the associations of physical fitness and physical activity with executive function in children with overweight and obesity. STUDY DESIGN: A cross-sectional study involving 100 children with overweight and obesity (10.1 ± 1.1 years old; 58.0% boys). We assessed physical fitness components (ie, muscular strength, speed-agility, and cardiorespiratory fitness) using the ALPHA battery, and physical activity and sedentary time by accelerometry. Cognitive flexibility was measured by the Design Fluency Test and Trail Making Test, inhibition by the Stroop test, and planning ability by the Zoo Map Test. RESULTS: Handgrip strength was positively associated with planning ability (P = .025). Speed-agility was positively related to cognitive flexibility and inhibition (P < .05). Cardiorespiratory fitness and an overall fitness Z-score were positively associated with indicators of cognitive flexibility (P < .05). No associations were found for physical activity and sedentary time with executive function (P ≥ .05). CONCLUSIONS: Muscular strength, speed agility, and cardiorespiratory fitness are associated with executive function in children with overweight and obesity. Cognitive flexibility seems to be more robustly associated with all fitness components, whereas planning ability and inhibition might depend on the component analyzed. The positive associations found in the present study in children with overweight and obesity call for more exercise-based randomized controlled trials in this population.

Fitness, physical activity, working memory, and neuroelectric activity in children with overweight/obesity.

The aim of the present study was to examine the associations of physical fitness, sedentary time, and physical activity (PA) with working memory and neuroelectric activity in children with overweight/obesity. Seventy-nine children with overweight/obesity (10.2 ± 1.1 years old) participated in this cross-sectional study. We assessed physical fitness components (ie, muscular strength, speed agility, and cardiorespiratory fitness) using the ALPHA battery. Sedentary time and PA were assessed by GT3X+accelerometers (ActiGraph). Working memory was assessed using the delayed non-matched-to-sample task; mean reaction time (RT) and response accuracy were registered. Neuroelectric activity (ie, P3 amplitude and latency) was registered using the ActiveTwo System of BioSemi electroencephalogram. Higher upper-limb absolute strength was associated with lower response accuracy (P = 0.023), while higher lower-limb relative-to-weight strength was associated with larger P3 amplitude (P < 0.05). Higher speed agility and cardiorespiratory fitness levels were associated with shorter mean RT and larger P3 amplitude, and speed agility was also associated with shorter P3 latency (all P < 0.05). Vigorous PA was associated with larger P3 amplitude (P < 0.05). No associations were found for sedentary time or the rest of PA intensities (P ≥ 0.05). In addition to cardiorespiratory fitness, muscular strength and speed agility are also associated with working memory and neuroelectric activity in children with overweight/obesity. The association between PA and working memory is intensity-dependent, as significant findings were only observed for vigorous PA. Randomized controlled trials in this population would help to better understand whether improvements in different components of fitness and PA lead to better working memory and underlying brain function.

Expert's Choice: 2018's Most Exciting Research in the Field of Pediatric Exercise Science.

This commentary highlights 23 noteworthy publications from 2018, selected by leading scientists in pediatric exercise science. These publications have been deemed as significant or exciting in the field as they (a) reveal a new mechanism, (b) highlight a new measurement tool, (c) discuss a new concept or interpretation/application of an existing concept, or (d) describe a new therapeutic approach or clinical tool in youth. In some cases, findings in adults are highlighted, as they may have important implications in youth. The selected publications span the field of pediatric exercise science, specifically focusing on: aerobic exercise and training; neuromuscular physiology, exercise, and training; endocrinology and exercise; resistance training; physical activity and bone strength; growth, maturation, and exercise; physical activity and cognition; childhood obesity, physical activity, and exercise; pulmonary physiology or diseases, exercise, and training; immunology and exercise; cardiovascular physiology and disease; and physical activity, inactivity, and health.

Reliability and Validity of Commercially Available Low-Cost Bioelectrical Impedance Analysis.

Research comparing portable body composition methods, such as bioelectrical impedance analysis (BIA), to air displacement plethysmography (ADP) is limited. We assessed reliability and validity of predicting fat-free mass (FFM) by the RJL, Omron, and Tanita BIA machines using ADP via BodPod as a criterion. FFM (kg) was assessed twice in college students (N = 77, 31 males and 46 females; age = 19.1 ± 1.2 years) using ADP, RJL, Omron, and Tanita BIAs. Reliability was assessed using analysis of variance to obtain an intraclass correlation statistic (Rxx). Validity was assessed using Pearson correlation (r) coefficient. FFM averaged 75.6 ± 9.4 kg in men and 59.8 ± 7.6 kg in women. Reliability was high in both genders RJL (Rxx = .974-.994), Omron (Rxx = .933-.993), and Tanita (Rxx = .921-.991). Validity within males was also high: RJL (r = .935), Omron (r = .942), and Tanita (r = .934), and only slightly lower in females: RJL (r = .924), Omron (r = .897), and Tanita (r = .898). The RJL, Omron, and Tanita BIA machines appear to be both reliable and valid for predicting FFM of male and female college students. Therefore, any of these three BIA devices is appropriate to use for body composition assessment in a healthy adult population.

The Influence of Pitch-by-Pitch Feedback on Neural Activity and Pitch Perception in Baseball.

This study was designed to examine the influence of performance feedback on task performance and neural activity in expert and novice baseball players. Participants completed a video task to determine whether thrown pitches were balls or strikes while their neural activity was recorded. After each pitch, participants were given feedback on the accuracy of their choice. Results indicated that college players exhibited larger frontocentral positivity amplitudes compared with novices, regardless of feedback type. Furthermore, results showed that the feedback-related negativity was related to response accuracy following incorrect feedback for college players, with larger feedback-related negativity amplitude associated with greater response accuracy. This relationship is independent of any relations between overall task accuracy and either feedback-related negativity amplitude or response accuracy following incorrect feedback. These results indicate that the nature of neural activity during pitch feedback for college baseball players can inform and influence participants' subsequent pitch-location performance.

Obesity, Visceral Adipose Tissue, and Cognitive Function in Childhood.

OBJECTIVES: To evaluate the effects of a 9-month physical activity intervention on changes in adiposity and cognitive control based on pretrial weight status (ie, healthy weight vs obese) in children. STUDY DESIGN: Participants included obese (n = 77) and matched healthy-weight (n = 77) preadolescents (8-9 years) who participated in a 9-month physical activity randomized controlled trial. Cognitive function was assessed with an inhibitory control task (modified flanker task). RESULTS: After the 9-month physical activity intervention, participants exhibited a reduction in adiposity. In contrast, children in the waitlist-control condition, particularly children identified as obese pretrial, gained visceral adipose tissue (P= .008). Changes in visceral adipose tissue were related to changes in cognitive performance, such that the degree of reduction in visceral adipose tissue directly related to greater gains in inhibitory control, particularly among obese intervention participants (CI -0.14, -0.04; P= .001). CONCLUSIONS: Participation in a daily physical activity program not only reduces adiposity but also improves children's cognitive function as demonstrated by an inhibitory control task. Furthermore, these findings reveal that the benefits of physical activity to improvements in cognitive function are particularly evident among children who are obese. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01334359 and NCT01619826.

The association between aerobic fitness and congruency sequence effects in preadolescent children.

Aerobic fitness has previously been related to cognitive control in preadolescents; however, these investigations have generally relied on global measures of performance. Thus, we have little understanding of how aerobic fitness may relate to trial-by-trial modulations in cognitive control. This study utilized congruency sequence effects (CSEs), which characterize how behavior on the current trial is influenced by the previous trial, to investigate the relation of aerobic fitness on varying levels of cognitive control. One hundred eighty-seven children completed tests of aerobic fitness and a flanker task. Regressions were performed to determine relationships between CSE sequences and aerobic fitness while controlling for other potential confounding factors (e.g., age, sex, IQ). Lower-fit children were less able to modulate cognitive control during sequences requiring relatively less cognitive control. Additionally, lower-fit children were less able to adjust for variable levels of cognitive control during relatively more difficult sequences. Lastly, lower-fit children had longer reaction times (RTs) for all sequences in the condition requiring greater amounts of cognitive control. These findings corroborate the importance of aerobic fitness for cognitive control in school-aged children, and extend the literature by demonstrating a relationship between fitness and trial-by-trial modulations in control demands.

Aerobic Fitness and Inhibition in Young Children: Moderating Roles of ADHD Status and Age.

We examined the relation between aerobic fitness and inhibition in young children with and without attention deficit hyperactivity disorder (ADHD)-risk status. Participants (91 ADHD risk, 107 typically developing, Mage = 6.83, 53.5% male, 68.2% Caucasian) completed an assessment of aerobic fitness and a flanker task requiring variable amounts of inhibitory control. Aerobic fitness was positively associated with inhibition. When inhibitory control demands were largest, the relation varied as a function of ADHD-risk status such that the link between aerobic fitness and inhibition was significant only for children with ADHD risk. The relation between aerobic fitness, status, and inhibition was further moderated by age for interference control. Specifically, the positive relation between aerobic fitness and interference control was only significant for younger children with ADHD risk. A fitness-cognition link appears in young childhood that seems particularly salient for those in the earliest school years with ADHD risk. The findings extend work on typically developing children and suggest that exploring aerobic fitness interventions to address executive function impairments in children at risk for ADHD is warranted.

Does Walking Mitigate Affective and Cognitive Responses to Social Exclusion?

Social exclusion can produce harmful affective and cognitive responses that undermine healthy functioning. Physical activity is known to have acute affective and cognitive effects that are adaptive and therefore may mitigate these responses. The purpose of this study was to assess walking as a strategy to reduce the effects of social exclusion on affect and working memory performance. Healthy female college students (N = 96, Mage = 19.2 ± 0.8 years) were randomly assigned to one of four experimental conditions: (a) sedentary plus neutral feedback, (b) sedentary plus exclusion feedback, (c) walking plus neutral feedback, or (d) walking plus exclusion feedback. Pre- and postactivity and pre- and postfeedback measures of affect and working memory performance were recorded. Excluded participants had a significant negative shift in affect following feedback, p < .05. Those who were sedentary prior to exclusion had lower affect scores following exclusion than the walking plus exclusion and neutral feedback conditions, p < .05. There were no direct effects of walking or social exclusion on working memory. However, perceptions of being ignored predicted smaller improvements in working memory performance for participants who were sedentary prior to exclusion, p < .05. The findings suggest that walking prior to social exclusion may mitigate the affective response to social exclusion as well as social perceptions that can undermine working memory. More broadly, this work supports continued examination of physical activity as a potential strategy for helping individuals cope with negative social experiences.

Whole-blood fatty acids are associated with executive function in Tanzanian children aged 4-6 years: a cross-sectional study.

Essential fatty acids (EFA) are PUFA that are metabolised to long-chain PUFA and are important for brain development and cognitive function. The objective of this study was to determine the association between whole-blood EFA and cognitive function in Tanzanian children. A total of 325 2-6-year-old children attempted the dimensional change card sort (DCCS) tasks to assess executive function. Blood samples were collected for fatty acid (FA) analysis by GC. Associations between executive function and FA levels were assessed by regression. Among the 130 4-6-year-old children who attempted the DCCS tasks, whole-blood levels of linoleic acid were positively associated with executive function, whereas whole-blood levels of α-linolenic acid and nervonic acid were inversely associated with executive function. A full model including all twenty-five FA explained 38 % of the variation in executive function, whereas a reduced model including only the EFA (α-linolenic acid and linoleic acid), DHA and EPA explained 25 % of the variation in executive function. Children who had sufficient whole-blood levels of EFA were 3·8 times more likely to successfully complete all DCCS tasks compared with children with insufficient EFA. These results suggest that whole-blood FA levels are associated with cognitive abilities. Intervention trials that include assessment of whole-blood FA levels are required to determine the relationships between intake, blood levels and executive function in Tanzanian children.

The sexual dimorphic association of cardiorespiratory fitness to working memory in children.

The present investigation examined the sexual dimorphic patterns of cardiorespiratory fitness to working memory in preadolescent children (age range: 7.7-10.9). Data were collected in three separate studies (Study 1: n = 97, 42 females; Study 2: n = 95, 45 females; Study 3: n = 84, 37 females). All participants completed a cardiorespiratory fitness assessment in addition to a specific measure of working memory (i.e. the operation span task, the n-back task, or the Sternberg task). Results from all three samples revealed that higher cardiorespiratory fitness levels were associated with better working memory performance only for males with no such relation observed for females. In addition, the sexually dimorphic pattern was selective for the most challenging working memory conditions in each task. Together, these findings reveal new evidence that cardiorespiratory fitness is selectively related to better working memory performance for male children. This investigation provides additional insight into how interventions aimed at improving fitness may influence cognitive development differentially among preadolescent children.

The negative association of childhood obesity to cognitive control of action monitoring.

The global epidemic of childhood obesity has become a major public health concern. Yet, evidence regarding the association between childhood obesity and cognitive health has remained scarce. This study examined the relationship between obesity and cognitive control using neuroelectric and behavioral measures of action monitoring in preadolescent children. Healthy weight and obese children performed compatible and incompatible stimulus-response conditions of a modified flanker task, while task performance and the error-related negativity (ERN) were assessed. Analyses revealed that obese children exhibited a longer reaction time (RT) relative to healthy weight children for the incompatible condition, whereas no such difference was observed for the compatible condition. Further, obese children had smaller ERN amplitude relative to healthy weight children with lower post-error response accuracy. In addition, healthy weight children maintained post-error response accuracy between the compatible and incompatible conditions with decreased ERN amplitude in the incompatible condition, whereas obese children exhibited lower post-error response accuracy for the incompatible relative to the compatible condition with no change in ERN amplitude between the compatibility conditions. These results suggest that childhood obesity is associated with a decreased ability to modulate the cognitive control network, involving the prefrontal cortex and anterior cingulate cortex, which supports action monitoring.

Poorer aerobic fitness relates to reduced integrity of multiple memory systems.

Epidemiological investigations have revealed increases in the prevalence of sedentary behaviors in industrialized societies. However, the implications of those lifestyle choices and related cardiorespiratory fitness levels for memory function are not well-understood. To determine the extent to which cardiorespiratory fitness relates to the integrity of multiple memory systems, a cross-sectional sample of young adults were tested over the course of 3 days in areas related to implicit memory, working memory, long-term memory, and aerobic fitness. Findings revealed an association between aerobic fitness and memory function such that individuals with lower cardiorespiratory fitness exhibited poorer implicit memory performance and poorer long-term memory retention. These data indicate that cardiorespiratory fitness may be important for the optimal function of neural networks underlying these memory systems.

VI. The role of physical activity in reducing barriers to learning in children with developmental disorders.

Emerging research suggests that physical activity may be an effective non-pharmaceutical intervention approach for childhood developmental disorders. Findings indicate that both single bouts of activity and chronic physical activity associate with improved mental health and classroom performance in children with attention-deficit/hyperactivity disorder and children with autism spectrum disorders. This review describes the research in this area and identifies limitations and challenges to the translation of these findings to promote physical activity in clinical practice and educational policy.

V. The differential association of adiposity and fitness with cognitive control in preadolescent children.

With the increasing prevalence of sedentary behaviors during childhood, a greater understanding of the extent to which excess adiposity and aerobic fitness relate to cognitive health is of increasing importance. To date, however, the vast majority of research in this area has focused on adiposity or fitness, rather than the possible inter-relationship, as it relates to cognition. Accordingly, this study examined the differential associations between body composition, aerobic fitness, and cognitive control in a sample of 204 (96 female) preadolescent children. Participants completed a modified flanker task (i.e., inhibition) and a switch task (i.e., cognitive flexibility) to assess two aspects of cognitive control. Findings from this study indicate that fitness and adiposity appear to be separable factors as they relate to cognitive control, given that the interaction of fitness and adiposity was observed to be nonsignificant for both the flanker and switch tasks. Fitness exhibited an independent association with both inhibition and cognitive flexibility whereas adiposity exhibited an independent association only with cognitive flexibility. These results suggest that while childhood obesity and fitness appear to both be related to cognitive control, they may be differentially associated with its component processes.