Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials.

OBJECTIVE: To identify the optimal dose and modality of exercise for treating major depressive disorder, compared with psychotherapy, antidepressants, and control conditions. DESIGN: Systematic review and network meta-analysis. METHODS: Screening, data extraction, coding, and risk of bias assessment were performed independently and in duplicate. Bayesian arm based, multilevel network meta-analyses were performed for the primary analyses. Quality of the evidence for each arm was graded using the confidence in network meta-analysis (CINeMA) online tool. DATA SOURCES: Cochrane Library, Medline, Embase, SPORTDiscus, and PsycINFO databases. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Any randomised trial with exercise arms for participants meeting clinical cut-offs for major depression. RESULTS: 218 unique studies with a total of 495 arms and 14 170 participants were included. Compared with active controls (eg, usual care, placebo tablet), moderate reductions in depression were found for walking or jogging (n=1210, κ=51, Hedges' g -0.62, 95% credible interval -0.80 to -0.45), yoga (n=1047, κ=33, g -0.55, -0.73 to -0.36), strength training (n=643, κ=22, g -0.49, -0.69 to -0.29), mixed aerobic exercises (n=1286, κ=51, g -0.43, -0.61 to -0.24), and tai chi or qigong (n=343, κ=12, g -0.42, -0.65 to -0.21). The effects of exercise were proportional to the intensity prescribed. Strength training and yoga appeared to be the most acceptable modalities. Results appeared robust to publication bias, but only one study met the Cochrane criteria for low risk of bias. As a result, confidence in accordance with CINeMA was low for walking or jogging and very low for other treatments. CONCLUSIONS: Exercise is an effective treatment for depression, with walking or jogging, yoga, and strength training more effective than other exercises, particularly when intense. Yoga and strength training were well tolerated compared with other treatments. Exercise appeared equally effective for people with and without comorbidities and with different baseline levels of depression. To mitigate expectancy effects, future studies could aim to blind participants and staff. These forms of exercise could be considered alongside psychotherapy and antidepressants as core treatments for depression. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018118040.

An umbrella review of the benefits and risks associated with youths' interactions with electronic screens.

The influence of electronic screens on the health of children and adolescents and their education is not well understood. In this prospectively registered umbrella review (PROSPERO identifier CRD42017076051 ), we harmonized effects from 102 meta-analyses (2,451 primary studies; 1,937,501 participants) of screen time and outcomes. In total, 43 effects from 32 meta-analyses met our criteria for statistical certainty. Meta-analyses of associations between screen use and outcomes showed small-to-moderate effects (range: r = -0.14 to 0.33). In education, results were mixed; for example, screen use was negatively associated with literacy (r = -0.14, 95% confidence interval (CI) = -0.20 to -0.09, P ≤ 0.001, k = 38, N = 18,318), but this effect was positive when parents watched with their children (r = 0.15, 95% CI = 0.02 to 0.28, P = 0.028, k = 12, N = 6,083). In health, we found evidence for several small negative associations; for example, social media was associated with depression (r = 0.12, 95% CI = 0.05 to 0.19, P ≤ 0.001, k = 12, N = 93,740). Limitations of our review include the limited number of studies for each outcome, medium-to-high risk of bias in 95 out of 102 included meta-analyses and high heterogeneity (17 out of 22 in education and 20 out of 21 in health with I2 > 50%). We recommend that caregivers and policymakers carefully weigh the evidence for potential harms and benefits of specific types of screen use.

A dynamic sequence of visual processing initiated by gaze shifts.

Animals move their head and eyes as they explore the visual scene. Neural correlates of these movements have been found in rodent primary visual cortex (V1), but their sources and computational roles are unclear. We addressed this by combining head and eye movement measurements with neural recordings in freely moving mice. V1 neurons responded primarily to gaze shifts, where head movements are accompanied by saccadic eye movements, rather than to head movements where compensatory eye movements stabilize gaze. A variety of activity patterns followed gaze shifts and together these formed a temporal sequence that was absent in darkness. Gaze-shift responses resembled those evoked by sequentially flashed stimuli, suggesting a large component corresponds to onset of new visual input. Notably, neurons responded in a sequence that matches their spatial frequency bias, consistent with coarse-to-fine processing. Recordings in freely gazing marmosets revealed a similar sequence following saccades, also aligned to spatial frequency preference. Our results demonstrate that active vision in both mice and marmosets consists of a dynamic temporal sequence of neural activity associated with visual sampling.

School principals' mental health and well-being under threat: A longitudinal analysis of workplace demands, resources, burnout, and well-being.

Schools are critical organisational settings, and school principals face extreme stress levels. However, there are few large-scale, longitudinal studies of demands and resources that drive principals' health and well-being. Using the Job Demands-Resources (JD-R) framework, we evaluated longitudinal reciprocal effects over 3 years relating to job demands, job resources (resilience), job-related outcomes (burnout and job satisfaction), and personal outcomes (happiness and physical health) for a nationally representative sample of 3683 Australian school principals. Prior demands and resources led to small changes in subsequent outcomes, beneficial effects of resources, and adverse effects of demands, particularly for job-related outcomes. Furthermore, we also found reverse-reciprocal effects, prior outcomes (burnout and job satisfaction) influencing subsequent job characteristics. However, in response to substantively and theoretically important research questions, we found no support for Yerkes-Dodson Law (nonlinear effects of demands) or Nietzsche effects and inoculation effects (that which does not kill you, makes you stronger; manageable levels of demands build resilience). Relating our study to new and evolving issues in JD-R research, we offer limitations of our research-and JD-R theory and research more generally-and directions for further research in this essentially unstudied application of JD-R to school principals' mental health and well-being.

Combinations of Physical Activity, Sedentary Behavior, and Sleep Duration and Their Associations With Physical, Psychological, and Educational Outcomes in Children and Adolescents: A Systematic Review.

We conducted a systematic review to evaluate combinations of physical activity, sedentary behavior, and sleep duration (defined as "movement behaviors") and their associations with physical, psychological, and educational outcomes in children and adolescents. MEDLINE, CINAHL, PsychInfo, SPORTDiscus, PubMed, EMBASE, and ERIC were searched in June 2020. Included studies needed to 1) quantitatively analyze the association of 2 or more movement behaviors with an outcome, 2) analyze a population between 5 and 17 years of age, and 3) include at least an English abstract. We included 141 studies. Most studies included the combination of physical activity and sedentary behavior in their analyses. Sleep was studied less frequently. In combination, a high level of physical activity and a low level of sedentary behavior were associated with the best physical health, psychological health, and education-related outcomes. Sleep was often included in the combination that was associated with the most favorable outcomes. Sedentary behavior had a stronger influence in adolescents than in children and tended to be associated more negatively with outcomes when it was defined as screen time than when defined as overall time spent being sedentary. More initiatives and guidelines combining all 3 movement behaviors will provide benefit with regard to adiposity, cardiometabolic risk factors, cardiorespiratory fitness, muscular physical fitness, well-being, health-related quality of life, mental health, academic performance, and cognitive/executive function.

Overcoming Limitations in Peer-Victimization Research That Impede Successful Intervention: Challenges and New Directions.

Peer victimization at school is a worldwide problem with profound implications for victims, bullies, and whole-school communities. Yet the 50-year quest to solve the problem has produced mostly disappointing results. A critical examination of current research reveals both pivotal limitations and potential solutions. Solutions include introducing psychometrically sound measures to assess the parallel components of bullying and victimization, analyzing cross-national data sets, and embracing a social-ecological perspective emphasizing the motivation of bullies, importance of bystanders, pro-defending and antibullying attitudes, classroom climate, and a multilevel perspective. These solutions have been integrated into a series of recent interventions. Teachers can be professionally trained to create a highly supportive climate that allows student-bystanders to overcome their otherwise normative tendency to reinforce bullies. Once established, this intervention-enabled classroom climate impedes bully-victim episodes. The take-home message is to work with teachers on how to develop an interpersonally supportive classroom climate at the beginning of the school year to catalyze student-bystanders' volitional internalization of pro-defending and antibullying attitudes and social norms. Recommendations for future research include studying bullying and victimization simultaneously, testing multilevel models, targeting classroom climate and bystander roles as critical intervention outcomes, and integrating school-wide and individual student interventions only after improving social norms and the school climate.

A meta-analysis of the dark side of the American dream: Evidence for the universal wellness costs of prioritizing extrinsic over intrinsic goals.

Self-determination theory holds that the intrinsic and extrinsic content of people's aspirations differentially affect their wellness. An evidence base spanning nearly 30 years indicates that focusing on intrinsic goals (such as for growth, relationships, community giving, and health) promotes well-being, whereas a focus on extrinsic goals (such as for wealth, fame, and beauty) deters well-being. Yet, the evidence base contains exceptions, and some authors have argued that focusing on extrinsic goals may not be universally detrimental. We conducted a systematic review and used multilevel meta-analytic structural equation modeling to evaluate the links between intrinsic and extrinsic aspirations with indices of well-being and ill-being. Across 92 reports (105 studies), 1,808 effects, and a total sample of N = 70,110, we found that intrinsic aspirations were linked positively with well-being, r = 0.24 [95% CI 0.22, 0.27], and negatively with ill-being, r = -0.11 [-0.14, -0.08]. When the variety of extrinsic aspiration scoring methods were combined, the link with well-being was not statistically significant, r = 0.02 [-0.02, 0.06]. However, when extrinsic aspirations were evaluated in terms of their predominance in the overall pattern of aspiring the effect was universally detrimental, linking negatively to well-being, r = -0.22 [-0.32, -0.11], and positively to ill-being, r = 0.23 [0.17, 0.30]. Meta-analytic conclusions about the associations between goal types and wellness are important because they inform how individuals could shape aspirations to support their own happiness and how groups and institutions can frame goals such that their pursuit is for the common good. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The roles of social-emotional skills in students' academic and life success: A multi-informant and multicohort perspective.

Social-emotional skills have been shown to be beneficial for many important life outcomes for students. However, previous studies on the topic have suffered from many issues (e.g., consideration of only a small subset of skills, single-informant, and single-cohort design). To address these limitations, this study used a multi-informant (self, teacher, and parent) and multicohort (ages 10-15 from Finland, N = 5,533) perspective to study the association between 15 social-emotional skills and 20 educational (e.g., school grades), social (e.g., relationships with teachers), psychological health (e.g., life satisfaction), and physical health outcomes (e.g., sleep trouble). Results showed that (a) there was a modest level of interrater agreement on social-emotional skills, with the highest agreement between students and parents (mean r = .41); (b) inclusion of multi-informant ratings substantially enhanced the ability of social-emotional skills in predicting outcome variables, with parent- and self-rated skills playing important, unique roles; (c) by modeling skills at the facet level rather than at the domain level, we identified the key skills for different outcomes and found significant variation in facets' predictive utility even within the same domain; and (d) although the older cohort showed lower levels of most social-emotional skills (9/15), there were only minor changes in the interrater agreement and predictive utility on outcomes. Overall, self-control, trust, optimism, and energy were found among the four most important skills for academic and life success. We further identified the unique contribution of each skill for specific outcomes, pointing the way to effective and precise interventions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

School socioeconomic status context and social adjustment in children.

Social adjustment is critical to educational and occupational attainment. Yet little research has considered how the school's socioeconomic context is associated with social adjustment. In a longitudinal sample of Australian 4- to 8-year-olds (N = 9369; 51% boys) we tested the association between school average socioeconomic status and social skills (parent and teacher reported). Models controlled for age 4 social adjustment and additional covariates. Results showed that children from more advantaged schools are more likely to have better prosocial behavior and fewer peer and conduct problems. An interaction between family and school average socioeconomic status (SES) suggested that this association was mainly present for children from lower SES backgrounds. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The Dimensionality of Reading Self-Concept: Examining Its Stability Using Local Structural Equation Models.

For results from large-scale surveys to inform policy and practice appropriately, all participants must interpret and respond to items similarly. While organizers of surveys assessing student outcomes often ensure this for achievement measures, doing so for psychological questionnaires is also critical. We demonstrate this by examining the dimensionality of reading self-concept-a crucial psychological construct for several outcomes-across reading achievement levels. We use Programme for International Student Assessment 2018 data (N = 529,966) and local structural equation models (LSEMs) to do so. Results reveal that reading self-concept dimensions (assessed through reading competence and difficulty) vary across reading achievement levels. Students with low reading achievement show differentiated responses to the two item sets (high competence-high difficulty). In contrast, students with high reading achievement have reconciled responses (high competence-low difficulty). Our results highlight the value of LSEMs in examining factor structure generalizability of constructs in large-scale surveys and call for greater cognitive testing during item development.

Mastery-approach goals: A large-scale cross-cultural analysis of antecedents and consequences.

Mastery-approach (MAP) goals, focusing on developing competence and acquiring task mastery, are posited to be the most optimal, beneficial type of achievement goal for academic and life outcomes. Although there is meta-analytic evidence supporting this finding, such evidence does not allow us to conclude that the extant MAP goal findings generalize across cultures. Meta-analyses have often suffered from overrepresentation of Western, educated, industrialized, rich, and democratic (WEIRD) samples; reliance on bivariate correlations; and lack the ability to directly control individual-level background variables. To address these limitations, this study used nationally representative data from 77 countries/regions (N = 595,444 adolescents) to examine the relations of MAP goals to four antecedents (workmastery, competitiveness, fear of failure, fixed mindset) and 16 consequences (task-specific motivational, achievement-related, and well-being outcomes), and tested the cross-cultural generalizability of these relations. Results showed that MAP goals were: (a) grounded primarily in positive but not negative achievement motives/beliefs; (b) most strongly predictive of well-being outcomes, followed by adaptive motivation; (c) positively but consistently weakly associated with achievement-related outcomes, particularly for academic performance (ß = .069); (d) negatively and weakly associated with maladaptive outcomes; and (e) uniquely predictive of various consequences, controlling for the antecedents and covariates. Further, the MAP goal predictions were generalizable across countries/regions for 13 of 16 consequences. While directions of effect sizes were slightly mixed for academic performance, perceived reading, and PISA test difficulty, the effect sizes were consistently small for most countries/regions. This generalizability points to quite strong cross-cultural support for the observed patterns. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Joint coding of visual input and eye/head position in V1 of freely moving mice.

Visual input during natural behavior is highly dependent on movements of the eyes and head, but how information about eye and head position is integrated with visual processing during free movement is unknown, as visual physiology is generally performed under head fixation. To address this, we performed single-unit electrophysiology in V1 of freely moving mice while simultaneously measuring the mouse's eye position, head orientation, and the visual scene from the mouse's perspective. From these measures, we mapped spatiotemporal receptive fields during free movement based on the gaze-corrected visual input. Furthermore, we found a significant fraction of neurons tuned for eye and head position, and these signals were integrated with visual responses through a multiplicative mechanism in the majority of modulated neurons. These results provide new insight into coding in the mouse V1 and, more generally, provide a paradigm for investigating visual physiology under natural conditions, including active sensing and ethological behavior.

Distance estimation from monocular cues in an ethological visuomotor task.

In natural contexts, sensory processing and motor output are closely coupled, which is reflected in the fact that many brain areas contain both sensory and movement signals. However, standard reductionist paradigms decouple sensory decisions from their natural motor consequences, and head-fixation prevents the natural sensory consequences of self-motion. In particular, movement through the environment provides a number of depth cues beyond stereo vision that are poorly understood. To study the integration of visual processing and motor output in a naturalistic task, we investigated distance estimation in freely moving mice. We found that mice use vision to accurately jump across a variable gap, thus directly coupling a visual computation to its corresponding ethological motor output. Monocular eyelid suture did not affect gap jumping success, thus mice can use cues that do not depend on binocular disparity and stereo vision. Under monocular conditions, mice altered their head positioning and performed more vertical head movements, consistent with a shift from using stereopsis to other monocular cues, such as motion or position parallax. Finally, optogenetic suppression of primary visual cortex impaired task performance under both binocular and monocular conditions when optical fiber placement was localized to binocular or monocular zone V1, respectively. Together, these results show that mice can use monocular cues, relying on visual cortex, to accurately judge distance. Furthermore, this behavioral paradigm provides a foundation for studying how neural circuits convert sensory information into ethological motor output.

Implementing AACN's Healthy Work Environment Framework in an Intensive Care Unit.

BACKGROUND: Bedside nurse turnover in the United States is 15.9%, representing a national challenge that has been attributed to poor work environments. Healthy work environments are associated with improved nurse satisfaction and retention as well as positive patient outcomes; unhealthy work environments have the opposite effects. OBJECTIVES: To implement the American Association of Critical-Care Nurses (AACN) healthy work environment (HWE) framework in an intensive care unit and to evaluate staff satisfaction, turnover, and tenure 2 years later. METHODS: A pre-post study design was used to evaluate implementation of the HWE framework in an intensive care unit in a large academic medical facility. Interventions for each of the 6 HWE standards were performed. The AACN HWE assessment survey was used to measure skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership in 2017 and in 2019. RESULTS: Nurse cohorts (n = 165 in 2017; n = 176 in 2019) had a mean age of 31 (median, 27; range, 23-63) years, were predominantly female (76%), and had a mean of 5 (median, 3) years of intensive care unit nursing experience. Statistically significant improvements were found in all standards except the skilled communication and overall measures. Registered nurse turnover remained stable and tenure increased by 79 days in this 2-year period. CONCLUSIONS: Findings from this study suggest that interventions addressing the HWE standards are associated with improved staff satisfaction, turnover, and average tenure, further demonstrating the value of the HWE framework in improving retention.

A Systematic Review of Machine Learning for Assessment and Feedback of Treatment Fidelity / Revisión sistemática del aprendizaje automático para la evaluación y feedback de la fidelidad al tratamiento

Many psychological treatments have been shown to be cost-effective and efficacious, as long as they are implemented faithfully. Assessing fidelity and providing feedback is expensive and time-consuming. Machine learning has been used to assess treatment fidelity, but the reliability and generalisability is unclear. We collated and critiqued all implementations of machine learning to assess the verbal behaviour of all helping professionals, with particular emphasis on treatment fidelity for therapists. We conducted searches using nine electronic databases for automated approaches of coding verbal behaviour in therapy and similar contexts. We completed screening, extraction, and quality assessment in duplicate. Fifty-two studies met our inclusion criteria (65.3% in psychotherapy). Automated coding methods performed better than chance, and some methods showed near human-level performance; performance tended to be better with larger data sets, a smaller number of codes, conceptually simple codes, and when predicting session-level ratings than utterance-level ones. Few studies adhered to best-practice machine learning guidelines. Machine learning demonstrated promising results, particularly where there are large, annotated datasets and a modest number of concrete features to code. These methods are novel, cost-effective, scalable ways of assessing fidelity and providing therapists with individualised, prompt, and objective feedback. (AU)

Se ha puesto de manifiesto que muchos tratamientos psicológicos tienen un coste efectivo y son eficaces siempre que se apliquen con fidelidad. La evaluación de esta y el feedback son caros y exigen mucho tiempo. El aprendizaje automático se ha utilizado para evaluar la fidelidad al tratamiento, aunque su fiabilidad y capacidad de generalización no estén claras. Recopilamos y analizamos todas las aplicaciones de aprendizaje automático con el fin de evaluar el comportamiento verbal de todos los profesionales de ayuda, con el acento particular en la fidelidad al tratamiento de los terapeutas. Llevamos a cabo búsquedas en nueve bases de datos electrónicas para enfoques automáticos de codificación de comportamiento verbal en terapia y contextos semejantes. Llevamos a cabo el cribado, la extracción y la evaluación de la calidad por duplicado. Cincuenta y dos estudios cumplían nuestros criterios de inclusión (el 65.3% en psicoterapia). Los métodos de codificación automática resultaban mejor que el azar y algunos de ellos mostraban un desempeño casi al nivel humano, que tendía a ser mejor con conjuntos más grandes de datos, un número de códigos menor, códigos conceptualmente simples y cuando predecían índices al nivel de sesión que los de tipo declaración. Escasos estudios cumplían las directrices de buena praxis en aprendizaje automático. Este presentó unos resultados alentadores, sobre todo donde había conjuntos de datos grandes y anotados y un escaso número de características concretas que codificar, modos expansibles de evaluar la fidelidad y facilitar a los terapeutas un feedback individualizado, rápido y objetivo. (AU)

Reliability of GENEActiv accelerometers to estimate sleep, physical activity, and sedentary time in children.

BACKGROUND: Reliable estimates of habitual sleep, physical activity, and sedentary time are essential to investigate the associations between these behaviours and health outcomes. While the number of days needed and hours/day for estimates of physical activity and sedentary time are generally known, the criteria for sleep estimates are more uncertain. The objective of this study was to identify the number of nights needed to obtain reliable estimates of habitual sleep behaviour using the GENEActiv wrist worn accelerometer. The number of days to obtain reliable estimate of physical activity was also examined. METHODS: Data was used from a two-year longitudinal study. Children wore an accelerometer for up to 8 days 24 h/day across three timepoints. The sample included 2,745 children (51 % girls) between the ages of 7-12-years-old (mean = 9.8 years, SD = 1.1 year) with valid accelerometer data from any timepoint. Reliability estimates were calculated for sleep duration, sleep efficiency, sleep onset, wake time, time in bed, light physical activity, moderate physical activity, moderate-to-vigorous physical activity, vigorous physical activity, and sedentary time. RESULTS: Intraclass correlations and the Spearman Brown prophecy formula were used to determine the nights and days needed for reliable estimates. We found that between 3 and 5 nights were needed to achieve acceptable reliability (ICC = 0.7) in sleep outcomes, while physical activity and sedentary time outcomes required between 3 and 4 days. CONCLUSIONS: To obtain reliable estimates, researchers should consider these minimum criteria when designing their studies and prepare strategies to ensure sufficient wear time compliance.

Effect of a Scalable School-Based Intervention on Cardiorespiratory Fitness in Children: A Cluster Randomized Clinical Trial.

Importance: Cardiorespiratory fitness is an important marker of childhood health and low fitness levels are a risk factor for disease later in life. Levels of children's fitness have declined in recent decades. Whether school-based physical activity interventions can increase fitness at the population level remains unclear. Objective: To evaluate the effect of an internet-based intervention on children's cardiorespiratory fitness across a large number of schools. Design, Setting, and Participants: In this cluster randomized clinical trial, 22 government-funded elementary schools (from 137 providing consent) including 1188 students stratified from grades 3 and 4 in New South Wales, Australia, were randomized. The other schools received the intervention but were not included in the analysis. Eleven schools received the internet-based intervention and 11 received the control intervention. Recruitment and baseline testing began in 2016 and ended in 2017. Research assistants, blinded to treatment allocation, completed follow-up outcome assessments at 12 and 24 months. Data were analyzed from July to August 2020. Interventions: The internet-based intervention included standardized online learning for teachers and minimal in-person support from a project mentor (9-10 months). Main Outcomes and Measures: Multistage 20-m shuttle run test for cardiorespiratory fitness. Results: Of 1219 participants (49% girls; mean [SD] age, 8.85 [0.71] years) from 22 schools, 1188 students provided baseline primary outcome data. At 12 months, the number of 20-m shuttle runs increased by 3.32 laps (95% CI, 2.44-4.20 laps) in the intervention schools and 2.11 laps (95% CI, 1.38-2.85 laps) in the control schools (adjusted difference = 1.20 laps; 95% CI, 0.17-2.24 laps). By 24 months, the adjusted difference was 2.22 laps (95% CI, 0.89-3.55 laps). The cost per student was AUD33 (USD26). Conclusions and Relevance: In this study, a school-based intervention improved children's cardiorespiratory fitness when delivered in a large number of schools. The low cost and sustained effect over 24 months of the intervention suggests that it may have potential to be scaled at the population level. Trial Registration: http://anzctr.org.au Identifier: ACTRN12616000731493.

Maternal Judgments of Child Numeracy and Reading Ability Predict Gains in Academic Achievement and Interest.

In a representative longitudinal sample of 2,602 Australian children (52% boys; 2% Indigenous; 13% language other than English background; 22% of Mothers born overseas; and 65% Urban) and their mothers (first surveyed in 2003), this article examined if maternal judgments of numeracy and reading ability varied by child demographics and influenced achievement and interest gains. We linked survey data to administrative data of national standardized tests in Year 3, 5, and 7 and found that maternal judgments followed gender stereotype patterns, favoring girls in reading and boys in numeracy. Maternal judgments were more positive for children from non-English speaking backgrounds. Maternal judgments predicted gains in children's achievement (consistently) and academic interest (generally) including during the transition to high school.

School-based interventions modestly increase physical activity and cardiorespiratory fitness but are least effective for youth who need them most: an individual participant pooled analysis of 20 controlled trials.

OBJECTIVES: To determine if subpopulations of students benefit equally from school-based physical activity interventions in terms of cardiorespiratory fitness and physical activity. To examine if physical activity intensity mediates improvements in cardiorespiratory fitness. DESIGN: Pooled analysis of individual participant data from controlled trials that assessed the impact of school-based physical activity interventions on cardiorespiratory fitness and device-measured physical activity. PARTICIPANTS: Data for 6621 children and adolescents aged 4-18 years from 20 trials were included. MAIN OUTCOME MEASURES: Peak oxygen consumption (VO2Peak mL/kg/min) and minutes of moderate and vigorous physical activity. RESULTS: Interventions modestly improved students' cardiorespiratory fitness by 0.47 mL/kg/min (95% CI 0.33 to 0.61), but the effects were not distributed equally across subpopulations. Girls and older students benefited less than boys and younger students, respectively. Students with lower levels of initial fitness, and those with higher levels of baseline physical activity benefitted more than those who were initially fitter and less active, respectively. Interventions had a modest positive effect on physical activity with approximately one additional minute per day of both moderate and vigorous physical activity. Changes in vigorous, but not moderate intensity, physical activity explained a small amount (~5%) of the intervention effect on cardiorespiratory fitness. CONCLUSIONS: Future interventions should include targeted strategies to address the needs of girls and older students. Interventions may also be improved by promoting more vigorous intensity physical activity. Interventions could mitigate declining youth cardiorespiratory fitness, increase physical activity and promote cardiovascular health if they can be delivered equitably and their effects sustained at the population level.

Day-to-day and longer-term longitudinal associations between physical activity, sedentary behavior, and sleep in children.

STUDY OBJECTIVES: To determine the day-to-day and longer-term longitudinal associations between daytime physical activity and night-time sleep. METHODS: We used data from a 2-year longitudinal study which included three time points (i.e. baseline, year 1, and year 2). Participants were recruited from primary schools and included 1059 children (50% girls) with a mean age of 8.81-years-old (SD = 0.72) at baseline. Sleep variables included sleep duration, sleep efficiency, time in bed, sleep onset, and wake time. Physical activity variables included light, moderate, moderate-to-vigorous, and vigorous physical activity as well as sedentary time. We objectively assessed physical activity and sleep behaviors using the GENEActiv wrist-worn accelerometer over an 8-day period at each timepoint for a potential 21 190 observed days. RESULTS: We used fixed-effects multilevel models and parallel latent growth curve modeling to examine day-to-day and longer-term associations, respectively. Day-to-day, physical activity, and sleep variables were significantly, positively, and bidirectionally associated, except for sleep efficiency, which showed little association with physical activity. Longer-term, we found little association between physical activity and sleep variables. CONCLUSIONS: Overall, our findings indicate that there is a day-to-day association between the amount of time spent being physically active and improved sleep. The lack of a longer-term association indicates that a focus on children's daily behavior may be most appropriate to help children improve sleep and increase physical activity.