Motor problems in autism: Co-occurrence or feature?

Motor features of autism have long been acknowledged by clinicians, researchers, and community stakeholders. Current DSM-5 and ICD-11 guidelines allow clinicians to assign a co-occurring diagnosis of developmental [motor] coordination disorder (DCD) for autistic individuals with significant motor problems. DCD is characterized by poor motor proficiency with an onset of symptoms in early development. Studies have shown considerable overlap in the behavioral motor features observed in autism and DCD. However, others indicate that motor problems in autism and DCD may stem from different underlying sensorimotor mechanisms. Regardless of whether autism has a unique motor phenotype or an overlap with DCD, changes need to be made in the clinical pipeline to address motor problems in autism at the stages of recognition, assessment, diagnosis, and intervention. Consensus is needed to address unmet needs in research on the etiology of motor problems in autism and their overlap with DCD, to optimize clinical practice guidelines. The development of screening and assessment tools for motor problems that are valid and reliable for use with autistic individuals is essential, and an evidence-based clinical pipeline for motor problems in autism is urgently needed. WHAT THIS PAPER ADDS: Motor problems in autism are highly prevalent, yet underdiagnosed and poorly managed. An evidence-based clinical pipeline for motor problems in autism is urgently needed.

Dropout From Exercise Interventions in Adults With Fibromyalgia: A Systematic Review and Meta-analysis.

OBJECTIVE: To meta-analyze the prevalence and predictors of dropout rates among adults with fibromyalgia participating in exercise randomized controlled trials (RCTs). DATA SOURCES: Two authors searched Embase, CINAHL, PsycARTICLES, and Medline up to 01/21/2023. STUDY SELECTION: We included RCTs of exercise interventions in people with fibromyalgia that reported dropout rates. DATA EXTRACTION: Dropout rates from exercise and control conditions and exerciser/participant, provider, and design/implementation related predictors. DATA SYNTHESIS: A random effects meta-analysis and meta-regression were conducted. In total, 89 RCTs involving 122 exercise arms in 3.702 people with fibromyalgia were included. The trim-and-fill-adjusted prevalence of dropout across all RCTs was 19.2% (95% CI=16.9%-21.8%), which is comparable with the dropout observed in control conditions with the trim-and-fill-adjusted odds ratio being 0.31 (95% CI=0.92-1.86, P=.44). Body mass index (R2=0.16, P=.03) and higher effect of illness (R2=0.20, P=.02) predicted higher dropout. The lowest dropout was observed in exergaming, compared with other exercise types (P=.014), and in lower-intensity exercises, compared with high intensity exercise (P=.03). No differences in dropout were observed for the frequency or duration of the exercise intervention. Continuous supervision by an exercise expert (eg, physiotherapist) resulted in the lowest dropout rates (P<.001). CONCLUSIONS: Exercise dropout in RCTs is comparable with control conditions, suggesting that exercise is a feasible and accepted treatment modality; however, interventions are ideally supervised by an expert (eg, physiotherapist) to minimize the risk of dropout. Experts should consider a high BMI and the effect of the illness as risk factors for dropout.

Dropout From Exercise Interventions in Adults With Knee or Hip Osteoarthritis: A Systematic Review and Meta-analysis.

OBJECTIVE: To investigate the prevalence and moderators of dropout rates among adults with knee or hip osteoarthritis participating in exercise randomized controlled trials (RCTs). DATA SOURCES: Two authors searched Embase, CINAHL, PsycARTICLES, and PubMed up to 01/09/2023. STUDY SELECTION: We included RCTs of exercise interventions in people with knee or hip osteoarthritis that reported dropout rates. DATA EXTRACTION: Dropout rates from exercise and control conditions and exerciser/participant, provider, and design/implementation related moderators. DATA SYNTHESIS: In total, 209 RCTs involving 277 exercise arms in 13,102 participants were included (mean age at study level=64 years; median prevalence of men participants=26.8%). The trim-and-fill-adjusted prevalence of dropout across all RCTs was 17.5% (95% CI=16.7%-18.2%), which is comparable with dropout observed in control conditions (trim-and-fill-adjusted odds ratio=0.89; 95% CI=0.71-1.12, P=.37). Higher prevalence of antidepressant use at study-level predicted higher dropout (R2=0.75, P=.002, N RCTs=6, n exercisers=412). Supervision by an exercise professional was associated with lower dropout rates, with a trim-and-fill-adjusted rate of 13.2% (95% CI=11.7%-14.9%) compared with 20.8% without supervision (95% CI=18.3%-23.5%) (P<.001). CONCLUSIONS: Dropout rates for exercise in RCTs are comparable with control conditions, suggesting that exercise is a generally well-accepted intervention. However, interventions should be supervised by an exercise professional, such as a physiotherapist or exercise physiologist, to further minimize the risk of dropout. Health professionals should consider participants' use of antidepressants as a risk factor for dropout from exercise.

The Physiological and Clinical-Behavioral Effects of Heart Rate Variability Biofeedback in Adolescents with Autism: A Pilot Randomized Controlled Trial.

Adolescents with autism present lower levels of cardiac vagal modulation. It was hypothesized that Heart Rate Variability Biofeedback (HRVB) increases cardiac vagal modulation in adolescents with autism, resulting in positive effects on physiological and psychosocial parameters. It was also hypothesized that home-based HRVB training is feasible. In a single-blind, randomized sham-controlled pilot trial, adolescents with autism performed supervised HRVB (n = 24) or sham training (n = 20). Subsequently, half of the adolescents received HRVB training at home, whereas the other subset did not practice. Physiological, cortisol and behavioral data were collected during stress-provoking assessments before and after each training period. Supervised HRVB resulted in a late increase in cardiac vagal modulation in adolescents with autism. Heart rate increased and cortisol decreased significantly immediately after supervised HRVB, but none of these effects remained after follow-up. Following supervised HRVB, no significant change in psychosocial functioning was found. Home-based HRVB was feasible, adolescents reported lower symptoms of stress, but a significant decrease in compliance rate was found. HRVB is feasible and effective in adolescents with autism given the late-emerging increases in cardiac vagal modulation and decrease in stress symptoms. Replicating this study with a larger sample and further exploration of the working mechanisms of HRVB are recommended. ClinicalTrials.gov , NCT04628715.

A Systematic Review of Digital Interventions to Promote Physical Activity in People With Intellectual Disabilities and/or Autism.

This systematic review synthesized the literature on digital health interventions for the promotion of physical activity (PA) among people with intellectual disabilities and/or autism. From an initial screening of 553 records, 10 studies underwent full-text review. Data were extracted relating to study, intervention, and sample characteristics and PA-related findings. Methodological quality was evaluated using the Crowe Critical Appraisal Tool. There were mixed findings pertaining to the effectiveness of digital health interventions for promoting PA among these populations. Positive results were reported for three of five active-video-game interventions, two of three social-media-based interventions, and one of two e-learning/multicomponent interventions. Digital health interventions can potentially be effective for promoting PA among people with intellectual disabilities and/or autism. However, the large variation in the samples and intervention types and a reliance on pre- and quasi-experimental research designs suggest that inferences should be made with caution and additional research is needed.

Prevalence of diabetes in people with intellectual disabilities and age- and gender-matched controls: A meta-analysis.

BACKGROUND: This meta-analysis aims to: (i) describe the pooled prevalence of diabetes in people with intellectual disabilities, (ii) investigate the association with demographic, clinical and treatment-related factors and (iii) compare the prevalence versus age- and gender-matched general population controls. METHODS: Pubmed, Embase and CINAHL were searched until 01 May 2021. Random effects meta-analysis and an odds ratio analysis were conducted to compare rates with controls. RESULTS: The trim- and fill-adjusted pooled diabetes prevalence amongst 55,548 individuals with intellectual disabilities (N studies = 33) was 8.5% (95% CI = 7.2%-10.0%). The trim- and fill-adjusted odds for diabetes was 2.46 times higher (95% CI = 1.89-3.21) (n = 42,684) versus controls (n = 4,177,550). Older age (R2  = .83, p < .001), smoking (R2  = .30, p = .009) and co-morbid depression (R2  = .18, p = .04), anxiety (R2  = .97, p < .001), and hypertension (R2  = 0.29, p < .001) were associated with higher diabetes prevalence rates. CONCLUSIONS: Our findings demonstrate that people with intellectual disabilities are at an increased risk of diabetes, and therefore routine screening and multidisciplinary management of diabetes is needed.

Mental health outcomes of the Daily Mile in elementary school children: a single-arm pilot study.

BACKGROUND: School-based physical activity (PA) programmes such as The Daily Mile (TDM) are widely promoted to address shortfalls in meeting PA recommendations. This study is the first to examine TDM (a daily one mile outdoor run/walk performed at a self-selected pace during school hours) on mental health, self-esteem and self-perceived competence of elementary schoolchildren. METHODS: In total, 550 children (n = 289 boys, aged 5-13 years) were recruited from seven schools across Flanders. The Self-Perception Profile for Children (SPPC) and the Strengths and Difficulties Questionnaire (SDQ) were completed before, during and post-intervention. One-way repeated measures ANOVA was used to examine changes over time. Additional subgroup analyses of children with low scores on the SPPC (-1SD) were performed. RESULTS: Only perceived global self-worth (SPPC) was significantly higher (p = .041) following TDM. However, in children with low baseline SPPC scores, significant increases with large effect sizes were found for global self-worth (p = <.001), scholastic competence (p = .001), social competence (p = .003), athletic competence (p = .002), physical appearance (p = <.001) and behavioural conduct (p = .003) following TDM. Moreover, significant reductions over time were reported by parents for total difficulties (p < .001), hyperactivity (p = .004), peer problems (p = .008) and emotional symptoms (p = <.001) and an increase in prosocial behaviour (p = .038) on the SDQ following TDM. However, no changes for conduct problems were observed (p = .143). CONCLUSIONS: The study is the first to indicate that TDM potentially improves mental health, self-esteem and self-perceived competence in elementary schoolchildren, especially in those with a poor mental health status. Randomised controlled trials are now required to more definitively test these findings.

Associations between mild depression and anxiety and physical inactivity among school-going Ugandan adolescents aged 14 to 17 years.

Objective: The aim of this cross-sectional study was to investigate associations between physical activity levels and emotional and behavioural problems in school-going adolescents aged 14 to 17 years in Uganda.Methods: Two-hundred and five adolescents [median (interquartile range) age = 16.0 (1.0) years; female = 61.9%] completed the interviewer-administered Strengths and Difficulties Questionnaire (SDQ), Patient Health Questionnaire-9 (PHQ-9), the Generalised Anxiety Disorder-7 questionnaire (GAD-7), and the Physical Activity Vital Sign (PAVS) measure. Spearman's rho correlations and Mann-Whitney U-tests were applied.Results: Among 205 adolescents, 97.1% were physically inactive (PAVS < 420min/week), while 64.4% reported either mild depressive (PHQ-9 ≥ 5) or anxiety (GAD-7 ≥ 5) symptoms. Higher PAVS scores correlated significantly with lower SDQ emotional problems (ρ = -0.23, p < 0.001), lower PHQ-9 (ρ = -0.26, p < 0.001), and lower GAD-7 (ρ = -0.22, p < 0.001) scores. Those with emotional problems (SDQ ≥ 5) (n = 86) were significantly less physically active than those without (n = 119) [30.0 (62.5) versus 60.0 (105.0) min/week, p < 0.001]. Those with depressive symptoms (PHQ-9 ≥ 5) were significantly less physically active than those without [35.0 (70.0) versus 60.0 (120.0) min/week, p < 0.001].Conclusion: Physical inactivity and mental health problems are related important public health concerns in school-going adolescents in low-income countries such as Uganda. The efficacy and effectiveness of school-based mental health literacy programs, including physical activity promotion, should be explored in these low-resource settings.

Comparison of Sport Competitive Anxiety Levels of Flemish athletes with and without intellectual disability.

BACKGROUND: High anxiety levels are common in people with intellectual disabilities (ID) and anxiety can affect sport performance, but sport competitive anxiety profiles in athletes with ID are unknown. METHODS: A total of 303 athletes; 116 with ID (33% female, M age = 22.64, SD = 3.94), and 187 without ID (54% female, M age = 21.81, SD = 3.23), completed the modified questionnaire Sport Anxiety Scale-2-FLemish-ID (SAS-2-FL-ID). RESULTS: The SAS-2-FL-ID was a valid tool to use in a population of athletes with ID. They had higher trait anxiety (9.36 ± 2.62) than peers without ID (7.58 ± 2.44), F = 26.95, p<.001. With respect to sport anxiety, they only scored higher on the "concentration disruption" subscale. Their overall level of competitive anxiety across all subscales (24.14 ± 7.73) was significantly lower compared to athletes without ID (26.51 ± 7.49), F = 27.10, p<.001. CONCLUSION: On the sporting field, athletes with ID worry less and feel less somatic anxiety compared to athletes without ID.

Correlates of physical activity among 142,118 adolescents aged 12-15 years from 48 low- and middle-income countries.

Physical inactivity is a serious public health concern in adolescents from low- and middle-income countries (LMICs). Despite this, only a few multinational studies has investigated correlates of physical activity (PA) in young adolescents in this part of the world. In this study, we identified physical activity correlates using data from the Global school-based Student Health Survey. In total, 142,118 adolescents from 48 LMICs (age 13.8 ±â€¯1.0 years; 49% girls) were included in the analyses. PA was assessed by the PACE+ Adolescent Physical Activity Measure and participants were dichotomised into those who do (60 min of moderate-vigorous PA every day of the week) and do not comply with the World Health Organization recommendations. We used multivariable logistic regression in order to assess the correlates. The prevalence of low PA was 15.3% (95%CI = 14.5%-16.1%). Boys (OR = 1.64; 95%CI = 1.47-1.83) and those who participated in physical education for ≥5 days/week (OR = 1.12; 95%CI = 1.10-1.15) were more likely to meet PA guidelines, while adolescents with food insecurity (OR = 0.85; 95%CI = 0.80-0.90), low fruit and vegetable intake (OR = 0.68; 95%CI = 0.63-0.74), low parental support/monitoring (OR = 0.68; 95%CI = 0.62-0.74), no friends (OR = 0.80; 95%CI = 0.72-0.88), and who experienced bullying (OR = 0.93; 95%CI = 0.86-0.99) were less likely to have adequate levels of PA. There were a few variations in the correlates depending on country-income level. Our data indicate that in adolescents aged 12 to 15 years living in LMICs physical activity participation is a complex and multi-dimensional behavior determined by sociocultural, socio-economic, and policy-related factors. Longitudinal research is needed to confirm/refute the present findings.

Sedentary Behavior and Quality of Life in People with Psychotic Disorders from a Low Income Country: A Study from Uganda.

The current study examined the impact of sedentary behaviour (SB) on quality of life (QoL) in people with psychotic disorders. Thirty-six Ugandan women (mean age = 33.9 ± 8.0 years) and 23 men (37.4 ± 11.8 years) with a DSM 5 diagnosis of psychosis completed the World Health Organization Quality of Life-Brief version and Simple Physical Activity Questionnaire (SIMPAQ). Medication use, physical co-morbidities, weight, height, blood pressure and smoking habits were recorded. Multiple regression analyses were undertaken. Variability in SIMPAQ sedentary and walking scores explained 56% of the variability in psychological QoL, while variability in SIMPAQ walking explained 46% of the variability in physical QoL. Health care professionals should not only consider increasing physical activity but also reducing SB to improve QoL in their patients.

Functional exercise capacity is associated with global functioning in patients with alcohol use disorder.

This study explored whether the Global Assessment of Functioning (GAF) score is associated with the functional exercise capacity among inpatients with alcohol use disorders (AUD). 45 (32 men) inpatients (41.1 ±â€¯13.2 years, range = 18-70 years) performed a 6-minute walk test (6 MWT), a standing broad jump (muscle strength) and were assessed with several questionnaires. The GAF-score correlated significantly with the 6 MWT-score (Pearson's r = 0.47, p = 0.002). Variance in illness duration (11.1 ±â€¯11.0 years) explained 27.9% of the GAF-score (50.8 ±â€¯8.0) variance. Variance in GAF and muscle strength (148.3 ±â€¯44.8 cm) explained 50.9% of the 6 MWT-score (638.2 ±â€¯77.6 m) variance. Future research should explore whether improving the functional exercise capacity improves global functioning in this vulnerable population.

Sedentary behavior and depressive symptoms among 67,077 adolescents aged 12-15 years from 30 low- and middle-income countries.

BACKGROUND: Depression is common and burdensome in adolescents. Understanding modifiable environmental risk factors is essential. There is evidence that physical activity is protective of depression. However, the impact of sedentary behavior (SB) on depression is relatively under-researched especially in low- and middle-income countries (LMICs). In this cross-sectional study, we explored the association between SB and depressive symptoms in adolescents from 30 LMICs, controlling for confounders including physical activity. METHOD: Data from the Global school-based Student Health Survey were analyzed in 67,077 adolescents [mean (SD) age 13.8 (0.9) years; 50.6% girls). Self-report measures assessed depressive symptoms during the past 12 months, and SB, which was a composite variable assessing time spent sitting and watching television, playing computer games, talking with friends during a typical day excluding the hours spent sitting at school and doing homework. Multivariable logistic regression analysis was conducted and a countrywide meta-analysis undertaken. RESULTS: The prevalence of depressive symptoms and ≥ 3 h/day of SB were 28.7 and 30.6%, respectively. There was a linear increase in the prevalence of depressive symptoms with increasing sedentary time beyond ≥3 h/day (vs. < 1 h/day). Among boys, 1-2 h/day of SB was associated with lower odds for depression (vs. < 1 h/day). Countrywide meta-analysis demonstrated that spending ≥3 h/day versus < 3 h/day was associated with a 20% increased odds for depressive symptoms (OR = 1.20; 95% CI = 1.16-1.24) with low between-country heterogeneity (I2 = 27.6%). CONCLUSION: Our data indicate that being sedentary for ≥3 h/day is associated with increased odds for depressive symptoms in adolescence. Future longitudinal data are required to confirm/refute the findings to inform public interventions which aim to limit the time spent being sedentary in adolescents.

Changes in eating disorder characteristics over the years.

Since 1980, the diagnostic criteria of patients with eating disorders (ED) have changed over the years. Are these changes also expressed in the clinical features of the ED patients? A cross-sectional sample was drawn consisting of 100 consecutive female patients' files diagnosed with anorexia nervosa (AN) and bulimia nervosa (BN) and bulimia nervosa and admitted at an inpatient unit from the first of January 1990, 2000, and 2010, respectively. Several reliable and well-validated questionnaires (Eating Disorder Inventory, Body Attitude Test, Symptom Checklist, and the Beck Depression Inventory) were administered and scores were compared. The ratio AN/BN remained the same (65/35). No differences were found between the three cohorts except for depression, which increased over the years. This pattern is the same for the subsamples of anorexia nervosa and bulimia nervosa. Specific characteristics of eating disorder pathology did not change across time.

The concurrent validity and test-retest reliability of a submaximal exercise test in adolescents with autism.

PURPOSE: There is a need for valid and reliable clinical assessment tools to assess cardiorespiratory fitness (CRF) levels in adolescents with autism. Therefore, this study aimed to examine the concurrent validity and test-retest reliability of the Astrand-Rhyming Test (ART) in this population. MATERIALS AND METHODS: 45 adolescents with autism aged 12-18 years (n = 32 males, 14.47 ± 1.79 years) performed the ART twice (test-retest reliability) and completed a maximal cardiopulmonary exercise test (CPET) (concurrent validity). Reliability parameters included Pearson correlations, intraclass correlation coefficients (ICCs), standard error of measurements (SEM), minimal detectable changes (MDC), coefficients of variation, paired sample t-tests, linear regressions and Bland-Altman plots. The concurrent validity was evaluated with Pearson correlations, ICCs, paired sample t-tests, linear regressions and Bland-Altman plots. RESULTS: Strong test-retest reliability (r = 0.84-0.85, ICC = 0.84-0.85) was found for the ART, but the wide limits of agreement intervals suggest the presence of substantial variability. The large SEM (4.73-5.08 mL/kg/min) and MDC (13.20-14.07 mL/kg/min) values suggest lower absolute reliability. Moderate to strong levels of association (r = 0.74-0.75) and agreement (ICC = 0.59-0.66) were found between estimated (ART1) and measured (CPET) VO2 max levels, but significant systematic differences (5.71-8.82 mL/kg/min) were observed. CONCLUSION: The ART is an accessible and promising method to monitor submaximal CRF levels over time but is less appropriate to estimate maximal CRF levels in this population.

Adolescents with autism are at increased risk of exhibiting low cardiorespiratory fitness (CRF) levels and as a result, placing them at risk for poor physical and mental health outcomes.In clinical practice, the CRF levels of this population should be screened and monitored routinely to identify those at risk and most likely to benefit from a targeted intervention.A submaximal exercise test appears to be feasible in adolescents with autism.The Astrand-Rhyming Test shows good reliability to monitor submaximal CRF levels over time, but is less appropriate to estimate maximal CRF levels in adolescents with autism.The use of the age correction factor of the Astrand-Rhyming Test nomogram is not required to adequately estimate CRF levels in adolescents with autism.

The behavioral phenotype of children and adolescents with attenuated non-ketotic hyperglycinemia, intermediate to good subtype.

AIM: We aim to describe the behavioral phenotype of children and adolescents with the good to intermediate attenuated form of non-ketotic hyperglycinemia (NKH) and to explore associations between the behavioral phenotype and age, sex, plasma glycine levels and drug treatment. METHOD: Parents of children with attenuated NKH completed questionnaires assessing maladaptive behavior, adaptive behavior, social communication, speech/language development and motor development in addition to demographic and medical questions. RESULTS AND INTERPRETATION: Twelve children, age 6 to 21y, functioned at mild to severe intellectual disability levels. Their speech/language development was in line with their developmental quotient. Relative to their intellectual functioning, their motor development and communication were weaker in comparison to their general development. Their adaptive behavior, however, appeared a relative strength. There was no evidence for autism spectrum disorder occurring more frequently than expected, rather social skills, except for communication, were rated as a relative strength. Maladaptive behaviors with ADHD-like characteristics were present in more than two thirds of children. Maladaptive behaviors were significantly related to female sex and to taking dextromethorphan, but no significant relation between plasma glycine levels and behavior was found. Future studies will need to evaluate causality in the observed relation between dextromethorphan use and maladaptive behaviors. Clinicians should reconsider the benefit of dextromethorphan when presented with disruptive behaviors in children with attenuated NKH.

Associations of 24-hour movement behaviors with externalizing and internalizing problems among children and adolescents prescribed with eyeglasses/contact lenses.

Background: Emerging evidence points towards the psychological benefits of meeting 24-hour movement behavior (24-HMB) guidelines, but such associations have not yet been investigated among children and adolescents of prescribed eyeglasses/contact lenses. To this end, we examined associations of meeting 24-HMB guidelines with internalizing and externalizing challenges in this population. Methods: We used data from the 2021 National Survey of Children's Health, a cross-sectional survey including a representative sample of US children and adolescents. Data on movement behaviors (physical activity [PA], sedentary behavior operationalized via screen time [ST], and sleep duration [SL]) and internalizing and externalizing problems were collected through caregiver proxy reports. Caregivers completed questionnaires for 6030 (2799 girls) US children and adolescents of prescribed eyeglasses/contact lenses. Logistic regression analyses were conducted to determine the above-presented associations. Results: Only 7.1 % of those prescribed eyeglasses/contact lenses met all three 24-HMB guidelines, while they were more likely to meet SL guideline alone (32.1 %) in relation to other independent guidelines including PA (2.5 %) and ST (10.9 %). Compared to not meeting any of the three 24-HMB guidelines, meeting at least two guidelines (25.22 %) was significantly linked to lower odds of internalizing problems and externalizing problems. Conclusion: Meeting at least two components of the 24-HMB guidelines was beneficially linked to internalizing and externalizing problems. Thus, strategies or intervention programs that focus on meeting 24-HMB guidelines should be implemented among children and adolescents of those prescribed eyeglasses/contact lenses to foster coping with psychological issues.

Meeting 24-h movement behavior guidelines is linked to academic engagement, psychological functioning, and cognitive difficulties in youth with internalizing problems.

BACKGROUND: This study aimed to investigate associations of meeting 24-h movement behavior (24-HMB: physical activity [PA], screen time [ST] in the school-aged youth, and sleep) guidelines with indicators of academic engagement, psychological functioning, and cognitive function in a national representative sample of U.S. youth. METHODS: In this cross-sectional study, 1794 participants aged 6 to 17 years old were included for multivariable logistic regression to determine the above-mentioned associations, while adjusting for sociodemographic and health covariates. RESULTS: The proportion of participants who met 24-HMB guideline(s) varied greatly (PA+ ST+ sleep = 34 [weighted 1.17 %], PA + ST = 23 [weighted 1.72 %], PA + sleep = 52 [weighted 2.15 %], PA = 34 [weighted 2.88 %], ST = 142 [weighted 7.5 %], ST+ sleep = 209 [weighted 11.86 %], sleep = 725 [weighted 35.5 %], none = 575 [weighted 37.22 %]). Participants who met ST guideline alone and integrated (ST + Sleep and ST + sleep + PA) guidelines demonstrated the consistently beneficial associations with learning interest/curiosity, caring for school performance, completing required homework, resilience, cognitive difficulties, self-regulation (ps < 0.05). CONCLUSION: Meeting 24-HMB guidelines in an isolated or integrative manner was associated with improved academic engagement, psychological functioning, and reduced cognitive difficulties. These findings highlight the importance of the promotion of 24-HMB guidelines in youth with internalizing problems. Future longitudinal studies are needed to investigate whether changes or modifications of meeting specific 24-HMB guidelines (especially ST) is beneficial for youth with internalizing problems.

Recent trends and disparities in 24-hour movement behaviors among US youth with mental, behavioral and neurodevelopmental conditions.

BACKGROUND: Meeting 24-h movement behaviors (24-HMB: physical activity [PA], screen time [ST], and sleep [SL]) recommendations may be associated with positive health outcomes among youth with specific mental, behavioral, and neurodevelopmental (MBD) conditions. However, temporal trends and disparities in meeting 24-HMB guidelines in these higher-risk groups have not been investigated, hampering the development of evidence-based clinical and public health interventions. METHODS: Serial, cross-sectional analyses of nationally National Survey of Children's Health (NSCH) data (including U.S. youth aged 6-17 years with MBD conditions) were conducted. The time-trends survey data was conducted between 2016 and 2021. The prevalence of 24-HMB adherence estimates were reported for the overall sample and for various sociodemographic subgroups. The subgroups analyzed included: age group (children[aged 6 to 13 years], adolescents[aged 14 to 17 years]), sex, socioeconomic status, and ethnicity. RESULTS: Data on 52,634 individuals (mean age, 12.0 years [SD,3.5]; 28,829 [58.0 %] boys) were analyzed. From 2016 to 2021 the estimated trend in meeting PA + ST + SL guidelines declined (-0.8 % [95%CI, -1.0 % to -0.5 %], P for trend <0.001), whereas meeting none of 24-HMB guidelines increased (2.2 % [1.8 % to 2.6 %], P for trend <0.001). White participants, children, and boys reported higher estimated prevalence of meeting full integrated (PA + ST + SL) guidelines. DISCUSSION: The temporal trends observed in this study highlight the importance of consistently monitoring movement behavior among MBD youth and identifying variations by sociodemographic groups in meeting 24-HMB guidelines for health promotion within these vulnerable groups.

The Physical Activity Vital Sign and associations with cardiometabolic risks in people with bipolar disorder in a low-income country.

BACKGROUND: The mortality gap compared with the general population is with 29 years of potential life lost for people with bipolar disorder (BD) highest in Africa. The most significant contributor to premature mortality are preventable cardiovascular diseases due to an unhealthy lifestyle. This study investigated if the Physical Activity Vital Sign (PAVS), i.e. two questions which clarify if someone meets the recommended 150 min of physical activity (PA) per week, can identify patients with BD at higher risk of cardiometabolic abnormalities and mental health symptoms in a low-income country from Sub-Sahara Africa. METHODS: 99 (54♀) Ugandan in- and outpatients (mean age = 34.5 ± 9.4 years) with BD completed the PAVS and Brief Symptoms Inventory-18. Participants were screened for abdominal obesity (waist circumference > 90 cm), overweight (body mass index≥25) and hypertension (systolic pressure ≥ 140 mmHg and/or diastolic pressure ≥ 90 mmHg). RESULTS: 49.5 % (n = 49) met the PA recommendation. 43.4 % (n = 43) were overweight, 43.3 % (n = 43) had abdominal obesity and 20.2 % (n = 20) hypertension. Those who did not meet the PA recommendation were older (37.1 ± 10.4 versus 32.2 ± 7.7 years, p = 0.009), had a higher BSI-18 somatisation score (13.7 ± 4.5 versus 10.4 ± 4.2, p = 0.026), and a higher risk for overweight [relative risk (RR) = 2.99, 95 % confidence interval (CI) = 1.69-5.29], abdominal obesity (RR = 1.92, 95%CI = 1.19-3.09), and hypertension (RR = 2.23, 95%CI = 1.02-4.88). CONCLUSIONS: The PAVS might be an important risk identification tool in patients with BD in low-income countries such as Uganda. The low-cost and brevity of the PAVS may help promote the importance of PA assessment and prescription as a core part of the treatment of patients with BD in low-income settings.