Study protocol: the Fueling Learning through Exercise (FLEX) study – a randomized controlled trial of the impact of school-based physical activity programs on children’s physical activity, cognitive function, and academic achievement

Abstract

BackgroundPhysical activity (PA) is critical to preventing childhood obesity and contributes to children’s overall physical and cognitive health, yet fewer than half of all children achieve the recommended 60 min per day of moderate-to-vigorous physical activity (MVPA). Schools are an ideal setting to meeting PA guidelines, but competing demands and limited resources have impacted PA opportunities. The Fueling Learning through Exercise (FLEX) Study is a randomized controlled trial that will evaluate the impact of two innovative school-based PA programs on children’s MVPA, cognitive function, and academic outcomes.MethodsTwenty-four public elementary schools from low-income, ethnically diverse communities around Massachusetts were recruited and randomized to receive either 100 Mile Club® (walking/running program) or Just Move™ (classroom-based PA program) intervention, or control. Schoolchildren (grades 3–4, approximately 50 per school) were recruited to participate in evaluation. Primary outcome measures include PA via 7-day accelerometry (Actigraph GT3X+ and wGT3X-BT), cognitive assessments, and academic achievement via state standardized test scores. Additional measures include height and weight, surveys assessing psycho-social factors related to PA, and dietary intake. School-level surveys assess PA infrastructure and resources and intervention implementation. Data are collected at baseline, mid-point (5–6 months post-baseline), and post-intervention (approximately 1.5 years post-baseline). Demographic data were collected by parents/caregivers at baseline. Mixed-effect models will test the short- and long-term effects of both programs on minutes spent in MVPA, as well as secondary outcomes including cognitive and academic outcomes.DiscussionThe FLEX study will evaluate strategies for increasing children’s MVPA through two innovative, low-cost, school-based PA programs as well as their impact on children’s cognitive functioning and academic success. Demonstration of a relationship between school-based MVPA with neutral or improved, rather than diminished, academic outcomes in a naturalistic environment has the potential to positively influence investment in school PA programs and initiatives.Trial registrationClinicalTrials.gov Identifier: NCT02810834. Registered May 11, 2015. (Retrospectively registered)

A Systematic Review and Qualitative Synthesis Resulting in a Typology of Elementary Classroom Movement Integration Interventions

“…The duration of the training varied from 30 min [54] to a full school day [50,60,61,78]. Ongoing support throughout the implementation was reported only by five interventions [51,58,60,61,86] with one providing weekly consultations [51] and two offering 1-2 booster sessions halfway through [60,61]. The remaining two interventions reported providing consultation support throughout implementation without being specific about the type of support.…”

“…The majority of the researcher-driven interventions (26 out of 37) focused on the intensity (MVPA) of the MI activities [52-54, 56-59, 61-66, 68, 69, 71-75, 79-84, 86], whereas some had a fitness approach, either in the form of aerobic exercise [81,83] or strengthening exercise [83]. Two researcher-driven interventions focused on fundamental motor skill development [78,85] and six on light intensity physical activities, such as stretching, yoga, coordination and breathing exercises [57,72,76,77,84,86]. Lastly, five interventions did not report the type and/or intensity of the activities [51,55,60,67,70].…”

“…About one-fourth of the researcher-driven interventions did not measure fidelity [52,53,63,64,67,69,72,76,82,84], and of those that measured it, about half studies reported that the intervention was delivered as intended [50,51,58,61,62,65,68,70,74,80,81,83,85]. The measures used for fidelity varied between teacher logs [54-56, 58, 73, 75, 77], direct observation [51,57,65,68,74], activity monitors [62,70,80], meetings or ending surveys [60,86], or a combination of measures [50,59,61,66,78,79].…”

Active Commute in Relation to Cognition and Academic Achievement in Children and Adolescents: A Systematic Review and Future Recommendations

“…Therefore, 12 articles were included in the systematic review. The reasons for exclusion of studies were: physical activity measured in general and active commute results not specifically discussed [32][33][34][35][36][37]; age >18 [38,39]; no physical activity [40]; study currently ongoing (protocol published in clinical trials) [41]; and study protocol [31]. Figure 1 shows the study selection flowchart.…”

Exercise, cognition, and the adolescent brain

“…First, longitudinal and intervention studies that target adolescents are necessary. A number of exercise intervention studies, including FITKids (University of Illinois‐Urbana; 7 to 9 year olds) (Hillman et al, ), the ActiveBrains project (University of Granada; 8 to 11 year olds) (Cadenas‐Sanchez et al, ) and the Fuel Learning through Exercise (FLEX) study (Tufts University; 3 rd to 5 th graders) (Wright et al, ) have been established to better understand the effects (rather than just the associations) of exercise on brain and cognition in children. Despite adolescent intervention studies on academic performance, to our knowledge LCoMotion is the only randomized controlled teen study to objectively measure physical exercise and cognition (Tarp et al, ).…”