Structured physical exercise interventions and children and adolescents with attention deficit hyperactivity disorder: A systematic review and meta-analysis.

BACKGROUND: The efficacy of structured physical exercise (SPE) has been examined in empirical studies to treat attention deficit hyperactivity disorder (ADHD). This review aimed (i) to systematically review and quantify the effects of SPE on ADHD symptomology and executive function (primary outcomes) and on physical health, physical fitness and mental health issues (secondary outcomes) in children/adolescents with ADHD; (ii) to evaluate the study quality and explore moderation of the effects of SPE; and (iii) to summarize the design of SPE interventions. METHODS: An extensive literature search in the databases of PubMed, Web of Science and EBSCOhost was conducted to identify eligible intervention studies for meta-analysis. A descriptive account of the features of the studies is provided, including assessment of risk/quality (ROB-2/ROBINS-I). Standardized mean difference (SMD) with 95% confidence intervals (CIs) were calculated with random effects models to compare post-intervention effects. RESULTS: A total of 18 studies were included in the review. The majority of the studies examined the effects of SPE lasting for 3-12 weeks. Assessment of bias/quality indicated half of the included studies as high quality. The meta-analysis (pooled n = 627) revealed that SPE had a positive effect on primary and secondary outcomes, that is, inattention (SMD = -1.79), executive function (SMD = 2.19), physical fitness (SMD = 1.39) and mental health issues (SMD = -0.89). Subgroup analysis showed that long-term practice of SPE, featured/tailored SPE, non-Chinese participants, taking methylphenidate and study with low quality had larger effects. CONCLUSIONS: There is emerging evidence that SPE is a promising option to enhance symptom management and physical/mental health in children/adolescents with ADHD.

A scoping review of physical activity-based interventions for obesity management in children and adolescents during the COVID-19 pandemic.

Overweight and obesity have emerged as global health issues among children and adolescents. Restrictions related to the COVID-19 pandemic have aggravated the threat of paediatric obesity due to the prevalent reduction in physical activity (PA) in children and adolescents. However, this has also created an opportunity for healthcare professionals to explore new strategies to address this persistent problem. A systematically conducted scoping review was performed on 15 online databases to summarise and analyse the design, efficacy, and feasibility of PA-based weight management interventions for children and adolescents during the pandemic. Finally, we reviewed 23 eligible studies that were published between 2021 and 2023. The included interventions were presented to 1938 children and adolescents and 355 parents using a virtual or virtually blended face-to-face approach during the pandemic. The intervention design included a basic PA programme with three optional components (nutritional education, sociopsychological counselling, and medication consultations). Implementation generally resulted in favourable changes in body mass index (BMI) and/or body size or composition (primary outcomes), as well as health behaviours, physical health or fitness, and individual well-being (secondary outcomes). A longer duration of exposure to the intervention, female sex, and older age were associated with a higher efficacy of the included interventions. Moreover, the interventions showed high feasibility, with medium-high participant attendance, high acceptance/satisfaction in both children and adolescents and their parents and teachers, and strong participant engagement. This may be related to the high accessibility of health information, timely social support, and enhanced self-efficacy. In conclusion, both the virtual and blended delivery of well-planned weight management interventions during the pandemic show promise for the treatment and control of paediatric obesity. The lessons learned from the pandemic may help improve the design of future interventions and inform the proper integration of new technologies that have emerged in the post-pandemic world.

From parental issues of job and finance to child well-being and maltreatment: A systematic review of the pandemic-related spillover effect.

BACKGROUND: Covid-19 pandemic jeopardized family well-being at the population level internationally. Pandemic-related job/financial difficulties in parents have a spillover effect on their child's well-being and issues of child maltreatment. OBJECTIVE: The current review sought to systematically summarize and analyze this pandemic-related spillover effect. PARTICIPANTS AND SETTINGS: In the home setting, participants involved 11,100 adolescents, 9144 parents/caregivers, and another 7927 parent-children dyads. METHODS: An extensive literature search in 13 electronic databases was conducted. A total 21 eligible papers published from 2020 to 2022 were included for further thematic analysis. RESULTS: A significant positive relationship between the pandemic-related spillover effect from parental job or financial issues to child maltreatment and child's mental/behavioral issues was established. The internal mechanisms demonstrated that this relationship was intermediated or moderated by the interactions of parental mental health issues, parenting practice, and family relationships. Families with particular factors may be more vulnerable and sensitive to the spillover effect during the pandemic. The work-from-home arrangement was found as positively related to enhanced parenting warmth and parent-child relationship in some cases who had relatively high familial social-economic status. CONCLUSIONS: Findings of current review provided the evidences from empirical data. During the Covid-19 pandemic, spillover effect from parental job/financial issues significantly influenced the child well-being and family functioning. Future efforts for intervention/service design should be made to enhance familial protective factors and support those families with vulnerable factors.

Younger Adults Are More Likely to Increase Fruit and Vegetable Consumption and Decrease Sugar Intake with the Application of Dietary Monitoring.

Establishing healthy eating habits is considered to be a sustainable strategy for health maintenance, and mobile applications (apps) are expected to be highly effective among the young-aged population for healthy eating promotion. The purpose of this study was to investigate the effectiveness of a dietary monitoring app on younger adults' nutrition knowledge and their dietary habits. A controlled-experimental study was performed with one experimental group having a three-hour nutrition seminar and 12 weeks of dietary monitoring with the app, and one control group receiving a three-hour nutrition seminar. Behavioral feedback delivered by the app was evaluated in facilitating the transfer of nutritional knowledge to nutrition behavior. A total of 305 younger adults aged from 19 to 31 were recruited. Baseline and post-intervention nutrition knowledge and dietary behavior were collected. All mean scores of post-GNKQ-R increased from baseline for both the control and the experimental groups. The mean differences of sugar intake, dietary fiber intake, and vitamin C intake for the experimental group were significantly more than those for the control group (all p < 0.001). In addition, the experimental group increased fruit and vegetable consumption significantly more than the control group (all p < 0.001). For those younger adults with a relatively large body size, they were more likely to increase fruit consumption with the application of dietary monitoring.

Using Physical Food Transformation to Enhance the Sensory Approval of Children with Autism Spectrum Disorders for Consuming Fruits and Vegetables.

Introduction: Children with autistic spectrum disorders (ASD) commonly exhibit aberrant tactile, taste, and smell sensitivity to foods. Food transformation that alters the appearance, texture, and temperature of foods is promising for solving this sensitivity problem. Objectives: This study evaluated the effect of physical transformation of fruits and vegetables (FV) to snacks to enhance ASD children's sensory approval for eating them. Design: This was a quasiexperimental design study. It lasted for 4 weeks with three episodes of FV exposure to the ASD children per week. The original condition was conducted in the first and fourth week, while intervention was performed in the second and third week. Settings: Food exposure took place in schools in a quiet room. Subjects: This study recruited 56 ASD children. Intervention: Food transformation constituted changing bananas into ice-cream, zucchinis and sweet potatoes into chips, apples and kiwis into popsicles, and carrots into juice. Outcome Measures: FV acceptance and habitual consumption were measured at baseline and postintervention. Results: ASD children increased their consumption of all FV, but only banana consumption was statistically significant from 55.3 to 78.0 g (p < 0.05). For habitual consumption, parents reported increases in all FV consumption for all three measured fruits and 2 of 3 measures of vegetables (pre vs. post mean for bananas: 2.4 vs. 2.9, apples 2.6 vs. 3.2, kiwis 2.4 vs. 2.9, zucchinis 1.9 vs. 2.5, and sweet potatoes 1.8 vs. 2.4; p < 0.05). Conclusion: Physical changes of foods may improve impaired sensory processing of ASD children to promote their FV acceptance. Project Code: RG 55/2019-2020R.

Building Healthy Eating Knowledge and Behavior: An Evaluation of Nutrition Education in a Skill Training Course for Construction Apprentices.

BACKGROUND: Prior research has found poor health among construction workers is related to poor nutrition and low fruit and vegetable consumption. Promoting nutrition knowledge can improve dietary behaviors, but nutrition education among construction workers is limited. We evaluated the effectiveness of nutrition education on fruit and vegetable consumption among construction apprentices. In this pilot evaluative study, 36 construction apprentices enrolled in skill training programs received two 1.5-hour nutrition classes. Twelve questions addressing healthy eating knowledge and behavior were administered at baseline, after intervention, and at three months follow-up. After intervention, daily fruit consumption improved from baseline (mean (s.d.) =1.42 (0.55)) to post intervention (mean (s.d.) =1.72 (0.70)) (p < 0.05) and to three months follow-up (mean(s.d.) =1.94 (0.83)) (p > 0.05). After intervention, daily vegetable consumption improved from baseline (mean (s.d.) =1.67 (0.59)) to post intervention (mean (s.d.) =1.97 (0.74)) (p < 0.05) and to three months follow-up (mean (s.d.) = 2.19 (0.82)) (p > 0.05). Younger construction apprentices showed better healthy eating knowledge at post intervention and three months follow-up (p > 0.05). Working in normal hours showed better healthy eating knowledge at post intervention but not at three months follow up (p > 0.05). Both age groups and working hours did not show significant differences on healthy eating behaviour. Nutrition education implemented as a three-hour session within skill courses may possibly promote fruit and vegetable consumption among construction apprentices. Further research with control group is required to support the findings in this study.

Appearance alteration of fruits and vegetables to increase their appeal to and consumption by school-age children: A pilot study.

Picky eating with regard to fruit and vegetables is common among children. This study investigated the effectiveness of enhancing the visual appeal of fruit and vegetables to increase children's liking and consumption of fruit and vegetables. A pre-post experimental design was used, and the control and experimental groups were repeatedly exposed to the original food and transformed food, respectively, over 6 weeks. Significant differences in the consumption of pumpkin, sweet potato, spinach, carrot and aubergine were observed between the groups, demonstrating that the appearance appeal of fruit and vegetables improves the willingness of children to try disliked fruit and vegetables and increases their vegetable consumption.

Cardiovascular Health of Construction Workers in Hong Kong: A Cross-Sectional Study.

BACKGROUND: Given a shortage of construction workers, it is important to develop strategies to avoid early retirement caused by cardiovascular diseases in Hong Kong. OBJECTIVES: (1) to describe the cardiovascular health of construction workers in Hong Kong, (2) to examine the demographic differences in cardiovascular health, and (3) to examine the association between health behaviors and cardiovascular health factors. METHODS: 626 registered construction workers were included in the analysis. Blood chemistry, blood pressure, weight, and height were measured. Face-to-face questionnaire interviews for health behaviors were conducted. RESULTS: Approximately two-thirds of the construction workers achieved only three out of the seven “ideal” cardiovascular health metrics. The younger, more educated, and female subjects had better cardiovascular health scores than the older, less educated, and male counterparts. Fish and seafood consumption was associated with (1) ideal weight status and (2) ideal cholesterol level, whereas less soft drink consumption was associated with ideal cholesterol level. CONCLUSIONS: The findings highlighted the importance of promoting cardiovascular health in the construction industry. This study provided some insights for future interventions, which should include increasing fish and seafood intake, decreasing soft drink consumption, and enhancing the health literacy amongst older, less educated, and male construction workers.

Role of behavioural feedback in nutrition education for enhancing nutrition knowledge and improving nutritional behaviour among adolescents.

BACKGROUND AND OBJECTIVES: The integration of nutrition knowledge into nutritional behaviour can help children to develop a healthy lifestyle that may be carried forward into adulthood. E-learning enables students to take ownership of recording their dietary intake and modify their diets by making their own decisions regarding food choices and portion sizes through reflective feedback. This study investigated the role of behavioural feedback in nutrition education in modifying students' nutrition knowledge and behaviour. METHODS AND STUDY DESIGN: Ninety-five secondary students studying from Secondary 1 to Secondary 3 were recruited from five schools. Moreover, 50 and 45 students were randomly assigned to experimental and control groups, respectively. Nutrition education delivered through e-learning (NeL) was adopted to record students' diets. Online reports with behavioural feedback were provided for the experimental group but not for the control group. NeL sessions lasted for 12 weeks. The energy and nutrient profiles of the students were recorded as pre-post measurements. Pre-post nutrition knowledge was assessed using a self-administered questionnaire at the baseline and after intervention. RESULTS: The experimental group had significantly higher scores in the 'dietary recommendation' and 'food choices' domains of the questionnaire and demonstrated significant dietary improvement in the intake of all studied macronutrients and micronutrients. CONCLUSIONS: Nutrition education conducted with behavioural feedback can effectively improve adolescents' nutrition knowledge and nutritional behaviour.

Physiological and Perceived Responses in Different Levels of Exergames in Elite Athletes.

OBJECTIVE: Exergames have been suggested to increase the public's physical activity and to benefit cardiovascular health, particularly among the youth. However, not many studies compared the physiological and perceived responses between exergames and the authentic sports especially for elite athletes. This study aimed to investigate the physiological and perceived responses in different levels of Nintendo® Wii Fit™ U rowing exergames in one group of elite rowing athletes. MATERIALS AND METHODS: All participants were asked to perform the authentic rowing on the indoor rowing machine on the first day and to play the rowing exergames on the second day, in three levels with 1 hour rest between levels. Oxygen consumption (VO2), lactate concentration, heart rate (HR), rating of perceived exertion (RPE), and muscle soreness scale (MSS) of the elite athletes were measured in three levels of rowing exergames and were compared with those measured in indoor rowing. RESULTS: Percentages of HR ranged from 57% to 64% and from 67% to 82% of peak HR in males and females, respectively. Percentages of RPE and MSS obtained from the three levels of rowing exergames ranged from 34% to 55% and from 2% to 33% of the peak RPE and the peak MSS, respectively, in authentic rowing. CONCLUSION: Physiological and perceived responses of elite rowing athletes could not reach their highest response in authentic rowing even for the hard level of exergames. This study contributed direct data on the physiological benefits of exergames against authentic rowing.

Predicting actual weight loss: A review of the determinants according to the theory of planned behaviour.

Weight reduction that corresponds with lifestyle modification is difficult to foster. The theory of planned behaviour has been actively cited in explaining health-related behaviour. This review evaluated the application of the theory of planned behaviour to weight-loss behaviour. Among the three reviewed papers, cross-sectional survey designs and subjective outcome measurements were commonly applied. All of the studies recruited obese female adults as participants, limiting the generalisability of the studies' findings. The theory of planned behaviour can be effectively applied in weight-reduction programmes targeting female obese patients. This review confirmed critiques citing the limitations of experimental studies, the subjective measurement of behaviour and short follow-up periods.

Electronic dietary recording system improves nutrition knowledge, eating attitudes and habitual physical activity: a randomised controlled trial.

OBJECTIVE: This study's objective was to investigate whether use of an electronic dietary recording system improves nutrition knowledge, eating attitudes and habitual physical activity levels compared to use of a food diary and no self-monitoring. METHODS: Sixty adults aged 20-60 with a body mass index ≥25 were recruited and randomly assigned to one of three groups: a group using an electronic system (EG), a group using a food diary (FD) and a control group using nothing (CG) to record food intake. All participants took part in three 60-90 nutrition seminars and completed three questionnaires on general nutrition knowledge, habitual physical activity levels and eating attitudes at the beginning and end of the 12-week study. The pre- and post-test scores for each questionnaire were analysed using a paired sample t-test. RESULTS: Significant improvements in the domain of 'dietary recommendations' were found in the EG (p=0.009) and FD groups (p=0.046). Great improvements were found in 'sources of nutrients', 'choosing everyday foods' and 'diet-disease relationships' in EG and FD groups. EG group showed greater improvement in the work index and sport index. CONCLUSION: An electronic dietary recording system may improve eating and exercise behaviour in a self-monitoring process.

Effectiveness of a food education program in improving appetite and nutritional status of elderly adults living at home.

OBJECTIVE: To evaluate a 3-week program comprising cooking demonstrations with free food samples in motivating elderly adults to cook more and improve their nutritional status. DESIGN: An experimental pre-post study. SETTING: Three districts in Hong Kong. PARTICIPANTS: Sixty aged 59-95 home-living adults. INTERVENTION: Group A (one 1-day food sample given free weekly) and Group B (three 1-day food samples given free weekly). MAIN OUTCOME MEASURE: Satisfaction questionnaires were conducted every week. Mini Nutritional Assessment (MNA) scores were assessed at baseline and 6 months after the program's completion. ANALYSIS: Nutritional status was assessed before and after intervention. Repeated analysis of variance measures of compliance, appetite, easiness of program at 3-week time-points were calculated to differentiate a more frequent (Group B) and a less frequent (Group A) provision of food sample reinforced their cooking skills to a greater extent. RESULTS: The compliance rate of Group B was higher than that of Group A. More than 60% of the participants intended to continue cooking and a third of the participants expressed satisfaction with the program. The MNA scores had improved 6 months later (combined data from both groups). CONCLUSIONS: Nutrition education through cooking demonstrations and the community-based distribution of food ingredients can improve the nutrition status of the elderly population.

Teledietetics improves weight reduction by modifying eating behavior: a randomized controlled trial.

BACKGROUND: Weight reduction without behavioral modification is not sustainable. However, with a technology application such as teledietetics, the recording process could be a cognitive cue for individuals to change their eating behavior. This study tested obese participants to determine whether teledietetics shows better results in weight reduction. STUDY DESIGN AND METHODS: We conducted a double-blinded randomized controlled trial. The participants in the food diary (FD) and electronic diary (ED) groups recorded their dietary intakes in logbooks and on an electronic diary system, respectively. The participants in the control group (CG) did nothing. Subjects were adults 20-60 years of age with a body mass index (BMI) of ≥25 kg/m(2). The ED and FD groups were the intervention groups and were compared with the CG group. The participants' body weights, BMIs, fat percentages, waist-to-hip ratios (WHRs), and mean arterial pressures (MAPs) were measured before the study, at Week 6, and at Week 12. Demographic data were collected using self-administered questionnaires. A chi-squared test and descriptive statistics were used to describe the demographic and biomeasurement data. Repeated-measures analysis of variance was used to evaluate the effectiveness of the three groups over time. RESULTS: Significant decreases in body weight (F1.705,86.950=20.508, p<0.001) and BMI (F1.657, 84.486=21.256, p<0.001) and insignificant decreases in fat percentage (F2,94=0.547, p=0.581), WHR (F1.785,91.052=2.888, p=0.067), and MAP (F2,94=7.542, p=0.0001) were observed among the three measurement times. CONCLUSIONS: Electronic dietary records were better than food diaries in terms of fat percentage reduction in our trials, indicating that teledietetics increases healthy-eating awareness.