In a randomized controlled trial we compared the clinical outcome of acute stroke patients, 110 of whom were allocated to treatment in a stroke unit and 110 to treatment in general medical wards. No significant difference existed between these groups with regard to sex, age, marital status, medical history, or functional impairment on admission. Outcome was measured at 6 and 52 weeks after the stroke by the proportion of patients at home, the proportion of patients in an institution, the mortality, and the functional state. After 6 weeks 56.4% of the patients randomized to the stroke unit and 32.7% of the patients randomized to the general medical wards were at home (p=0.0004), and after 52 weeks 62.7% and 44.6%, respectively, were at home (p=0.002). After 6 weeks 363% of the patients from the stroke unit and 50.0% from the general medical wards were in an institution (/>=0.02); after 52 weeks 12.7% and 22.7%, respectively, were institutionalized (p=0.016). After 6 weeks mortality was 7.3% for the stroke unit group and 173% for the general medical wards group (p=0.027). After 52 weeks mortality was 24.6% for the stroke unit group and 32.7% for the general medical wards group (difference not significant). Functional state was significantly better for patients treated in the stroke unit after both 6 and 52 weeks. We conclude that care of patients with acute stroke in a stroke unit improves clinical outcome compared with treatment in general medical wards. (Stroke

Background: Studies indicate that health-related components of physical fitness are associated with mental health outcomes. However, research is scarce concerning this relationship in young adolescents in general and nonexistent in Norwegian populations specifically. The aim of the study was to examine whether body composition, muscular strength and cardiorespiratory fitness were associated with self-reported mental health in Norwegian adolescents. Methods: Adolescents from four regions of Norway (n = 1486; mean age = 13.9; girls = 50.6%) participated. Selfreported mental health (psychological difficulties) was measured by completing the Strengths and Difficulties Questionnaire. Cardiorespiratory fitness was assessed with an intermittent running test; muscular strength was assessed by measuring handgrip strength, standing broad jump and sit-ups; and body composition was assessed by calculating body mass index from weight and height. Linear mixed effects models were conducted to assess the associations between the health-related components of physical fitness and psychological difficulties. School clusters were included as random effects and all models were controlled for sex, socioeconomic status and birthplace (domestic or foreign). Results: Body composition was not associated with psychological difficulties. Muscular strength was independently associated with psychological difficulties, but when all independent variables were entered in the fully adjusted model, only cardiorespiratory fitness was associated with psychological difficulties. Conclusions: There was a small but significant inverse association between cardiorespiratory fitness and levels of psychological difficulties in Norwegian adolescents. The results suggest that muscular strength is not associated with psychological difficulties in adolescents, when controlling for cardiorespiratory fitness. Future research should focus on the prospective association between physical fitness components and mental health outcomes in adolescents. Trial registration: The study is registered in ClinicalTrials.gov ID nr: NCT03817047. Retrospectively registered January 25, 2019.

Background Physical activity (PA) declines throughout adolescence, therefore PA promotion during this period is important. We analyzed the effect of two school-based PA interventions on daily PA levels, cardiorespiratory fitness (CRF) and muscle strength among adolescents. Methods For the nine-month School in Motion intervention study (ScIM), we cluster-randomized 30 Norwegian secondary schools (N = 2084, mean age [SD] = 14 [0.3] years) to one of three study arms. The physically active learning (PAL) intervention included 30 min physically active learning, 30 min PA and a 60 min physical education (PE) lesson per week. The Don’t worry-Be happy (DWBH) intervention included a 60 min PA lesson and a 60 min PE lesson per week, both tailored to promote friendships and wellbeing. Both intervention arms were designed to engage the adolescents in 120 min of PA per week in addition to recess and mandatory PE lessons. The control group continued as per usual, including the standard amount of mandatory PE. PA (main outcome) was assessed by accelerometers, CRF and muscle strength (secondary outcomes) were assessed by an intermittent running test and selected tests from the Eurofit test battery. Results Daily PA and time spent in moderate- to vigorous-intensity PA (MVPA) decreased in all groups throughout the intervention. The mean difference in PA level and MVPA for participants in the PAL-intervention arm was 34.7 cpm (95% CI: 4.1, 65.3) and 4.7 min/day (95% CI: 0.6, 8.8) higher, respectively, compared to the control arm. There were no significant intervention effects on daily PA level, MVPA or time spent sedentary for adolescents in the DWBH-intervention arm. Adolescents in the PAL-intervention arm increased distance covered in the running test compared to controls (19.8 m, 95% CI: 10.4, 29.1), whilst a negative intervention effect was observed among adolescents in the DWBH-intervention arm (− 11.6 m, 95% CI: − 22.0, − 1.1). Conclusion The PAL-intervention resulted in a significantly smaller decrease in daily PA level, time spent in MVPA, and increased CRF compared to controls. Our results indicate that a teacher-led intervention, including three unique intervention components, is effective in curbing the decline in PA observed across our cohort and improving CRF. Trial registration ClinicalTrials.gov ID nr: NCT03817047. Registered 01/25/2019 ‘retrospectively registered’.

Background School-based physical activity interventions evaluating the effect on academic performance usually includes children. We aimed to investigate the effect of a nine-month, school-based physical activity intervention titled School in Motion (ScIM) on academic performance in adolescents. Methods Thirty secondary schools in Norway were cluster-randomized into three groups: the Physically active learning (PAL) group (n = 10), the Don’t worry – Be Happy (DWBH) group (n = 10) or control (n = 10). Target dose in both intervention groups was 120 min/week of additional PA during school hours. Parental consent was obtained from 2084 adolescent students (76%). Standardized national tests in reading and numeracy was conducted at baseline and at the end of the intervention. We used linear mixed model to test intervention effects. We found significant intervention effects in numeracy and reading among students in both interventions when compared with controls. Results The mean difference in change in numeracy was 1.7 (95% CI: 0.9 to 2.5; Cohen’s d = 0.12) and 2.0 (95% CI: 1.4 to 2.7; Cohen’s d = 0.23) points in favour of students in the PAL and DWBH intervention, respectively. Similar results were found for reading, where the mean difference in change was 0.9 (95% CI 0.2 to 1.6; Cohen’s d = 0.06) and 1.1 (95% CI 0.3 to 1.9; Cohen’s d = 0.18) points in favour of students in the PAL and DWBH intervention, respectively. When conducting intention to treat analysis with imputed data the estimates were attenuated and some no longer significant. Conclusion The ScIM study demonstrates that two different school-based PA interventions providing approximately 120 min of additional PA weekly over nine months, significantly improved numeracy and reading performance in 14-year old students compared with controls. However, the results should be interpreted with caution as the effect sizes reported were very small or small and the estimates were attenuated when conducting intention to treat analysis. Despite this, our results are still positive and suggest that PA interventions are viable models to increase academic performance among adolescents. Trial registration Retrospectively registered (25/01/2019): NCT03817047.

Background: Participation in regular physical activity (PA) is important for both physical and mental health, and positive associations have also been reported between PA and academic performance. However, PA levels decline markedly during adolescence. School in motion (ScIM) is a school-based PA intervention carried out over one school year, in a sample of 14-year-old girls and boys. The primary aim was to investigate whether two extra hours of PA weekly lead to increases in the adolescents’ accelerometer assessed PA levels. Secondary aims were to investigate the intervention effects on time spent in PA of different intensities, muscle strength, cardiorespiratory fitness, mental health, academic performance and learning environment. ffigMethods & design: This is a multicenter, school-based, three-arm cluster randomized controlled trial (RCT) recruiting ninth graders from lower secondary schools in Norway. A total of 2084 14-year-olds from 29 schools were included, yielding a participation rate of 76 %. Schools (clusters) were randomly assigned to one of three study arms: (1) the physical active learning (PAL) intervention arm, (2) the don't worry-be happy (DWBH) intervention arm, or (3) current practice (control arm). All schools participating in ScIM had two or three mandatory PE-lessons per week. Schools in the two intervention arms added two hours of PA and PE to the class schedule each week. PA was assessed by accelerometers at baseline, midpoint and at the end of the intervention. All other variables were tested at baseline and at the end of the intervention. The measures included cardiorespiratory fitness, muscle strength, mental health (general mental health, quality of life and self-perception) academic performance (standardized national tests in reading and numeracy) and learning environment. Qualitative interviews were performed with students, teachers and school management to obtain an in-depth understanding of pedagogical processes taking place during the intervention.Discussion: This study will inform what effect two added hours of PA during the school week can have on adolescents’ PA levels, their health, academic performance and learning environment. Further, the study will add valuable information if the two PA interventions will generate different effects on important factors for learning and health.Trial registration: Clinicaltrials.gov ID nr: NCT03817047. Registered 01/25/2019 ‘retrospectively registered’