An exercise-based randomized controlled trial on brain, cognition, physical health and mental health in overweight/obese children (ActiveBrains project): Rationale, design and methods
Introduction
Over the last years, schools in the USA and in some European countries have received pressure from different entities to reduce the time devoted to physical education in the school curriculum, with the argument that more time spent in traditional and standard academic tasks would result in improvements in academic achievement. Several systematic reviews consistently suggest that this is a wrong assumption. Studies focused on increasing physical education time within the school hours and/or after school time showed no negative effect on academic achievement [1], [2]. In fact, several studies support that regular physical activity might improve brain functioning and cognitive performance, which, in turn, would positively affect academic performance [3], [4], [5]. Recently, another systematic review concluded that overall physical activity is positively related to academic achievement, especially in girls [6]. In line with this, several authors concluded that preadolescent children with better fitness have a better cognition, particularly in the domains of cognition related to executive control [3], [4], [5], but also to learning and memory [7]. They also observed differences in brain functioning, as measured by functional neuroimaging and electrophysiological techniques, and in brain structures, as measured by magnetic resonance imaging (MRI) voxel based morphometry, concluding that fitter children have healthier brains [8], [9], [10].
The prevalence of paediatric obesity has reached epidemic proportions in most of developed and developing countries and it is a major public health problem. In Spain, paediatric obesity is of special concern. According to the data from the World Obesity Federation (www.worldobesity.org), Spain leads the ranking of overweight/obesity in children aged 7–11 years in Europe, together with Malta and Sicily. Moreover, paediatric obesity is linked to a greater risk of several other medical problems. Insulin resistance and other metabolic alterations in childhood have been consistently linked to paediatric obesity, and further studies are still needed to better understand which type of exercise is more efficient in reducing both adiposity and metabolic risk. Osteoporosis and the associated fractures occur later in life and it is a major public health problem. The economic burden of osteoporosis in Europe is higher than any kind of cancer (except lung cancer) or chronic cardiorespiratory diseases [11], [12]. Although the onset of osteoporosis is an adult disease, early prevention remains the most effective public health action. In this context, it has been consistently demonstrated that acquiring a high bone mass pick during childhood and adolescence, which can be largely influenced by exercise, is a key determinant of adult skeletal health [13].
Mental health is a major component of overall health, as defined by the World Health Organization (WHO). A key factor for a healthy mental status is a good management of chronic stress. The current evidence from prospective observational studies, both natural experiments examining real-life stressors and laboratory experiments, shows that stress modifies disease-relevant biological processes in humans. Moreover, experimental studies with animals strongly support a causal link between stress and disease, particularly, depression and cardiovascular disease [14]. Several studies conducted in adults showed that exercise can significantly reduce stress levels. However, the nature of stress in adults and in children is different, and little is known about how exercise might affect stress levels in this age group [15], [16]. Observational evidence suggests that high cardiorespiratory fitness in adulthood predicts lower risk of depression, both in cross-sectional [17] and longitudinal studies [18]. Likewise, adolescents with lower cardiorespiratory fitness level are more likely to be diagnosed of psychosis [19] or schizophrenia [20], [21].
The association between obesity and poor physical and mental health, and the boosting effects of physical exercise on stress and cognition have been established, but there is a dearth of clinical evidence on the impact of exercise interventions on physical and mental health, and there is a need for well-designed randomized controlled trials focused on this topic. The ActiveBrains project will contribute to the understanding of the causal effect of exercise on brain and cognition (primary aim), and also on a relevant set of physical and mental health outcomes (secondary aims).
Section snippets
Design
The ActiveBrains project is an individual randomized controlled trial (1:1) that aims to examine the effects of a 20-weeks physical exercise programme on brain structure and function, cognitive performance, academic achievement and physical and mental health in overweight/obese children. Participants with overweight/obesity, meeting the eligibility criteria, are included in our study. The ActiveBrains project has been approved by the Review Committee for Research Involving Human Subjects at the
Primary outcomes
The full set of primary and secondary outcomes are assessed twice, immediately before and after the 20-weeks exercise programme. A third assessment will be conducted in a subsample (50% of the total sample) 8 months after the intervention finishes.
Discussion
Brain research is considered by many as one of the key challenges of the 21st century (http://www.whitehouse.gov/administration/eop/ostp/grand-challenges). The brain is the most complex organ in the human body, and the cross talk between bodily-based physical activity and brain function is virtually unknown. Existing research has been mostly conducted in animals, and human research is scarce and has recently focused on older adults (e.g. in relation with Alzheimer). There are several studies
Conclusion
Most of current knowledge on brain, cognition and exercise is based on cross-sectional studies and animal models and there is a need for stepping further in the level of evidence and specificity to human brain, by designing and conducting well randomized controlled trials to assess the effect of exercise on brain structure, function, as well as on cognition and physical and mental health. The ActiveBrains project will explore the extent to what exercise is able to improve brain and cognition,
Conflict of interest
The authors declare that they have no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Acknowledgements
The ActiveBrains project was funded by the Spanish Ministry of Economy and Competitiveness (Reference DEP2013-47540). FBO and JRR are supported by grant from the Spanish Ministry of Science and Innovation (RYC-2011-09011and RYC-2010-05957, respectively). CC-S and FE-L are supported by grants from the Spanish Ministry of Economy and Competitiveness (BES-2014-068829 and BES-2014-067612, respectively). JM-G is supported by the Spanish Ministry of Education, Culture and Sport (FPU14/06837). This is
References (106)
- et al.
The association between school-based physical activity, including physical education, and academic performance: a systematic review of the literature
Prev. Med. (Baltim.)
(2011) - et al.
A review of chronic and acute physical activity participation on neuroelectric measures of brain health and cognition during childhood
Prev. Med. (Baltim.)
(2011) - et al.
A functional MRI investigation of the association between childhood aerobic fitness and neurocognitive control
Biol. Psychol.
(2012) - et al.
Maximizing bone mineral mass gain during growth for the prevention of fractures in the adolescents and the elderly
Bone
(2010) - et al.
The effects of physical activity and exercise training on psychological stress and well-being in an adolescent population
J. Psychosom. Res.
(1992) - et al.
Prospective study of cardiorespiratory fitness and depressive symptoms in women and men
J. Psychiatr. Res.
(2009) - et al.
Physical activity and fitness in adolescents at risk for psychosis within the Northern Finland 1986 birth cohort
Schizophr. Res.
(2010) - et al.
Symmetry in vertical ground reaction force is accompanied by symmetry in temporal but not distance variables of gait in persons with stroke
Gait Posture
(2003) - et al.
A narrative review of physical activity, nutrition, and obesity to cognition and scholastic performance across the human lifespan
Adv. Nutr.
(2011) The assessment and analysis of handedness: the Edinburgh inventory
Neuropsychologia
(1971)
A neuroimaging investigation of the association between aerobic fitness, hippocampal volume, and memory performance in preadolescent children
Brain Res.
FIT kids: time in target heart zone and cognitive performance
Prev. Med. (Baltim.)
Updating P300: an integrative theory of P3a and P3b
Clin. Neurophysiol.
A meta-analytic review of the effects of exercise on brain-derived neurotrophic factor
J. Psychiatr. Res.
Age-predicted maximal heart rate revisited
J. Am. Coll. Cardiol.
Levels of physical activity that predict optimal bone mass in adolescents: the HELENA study
Am. J. Prev. Med.
A meta-analysis of heart rate variability and neuroimaging studies: implications for heart rate variability as a marker of stress and health
Neurosci. Biobehav. Rev.
Brief report: assessing dispositional optimism in adolescence–factor structure and concurrent validity of the life orientation test—revised
J. Adolesc.
Spanish version of the pediatric sleep questionnaire (PSQ). A useful instrument in investigation of sleep disturbances in childhood. Reliability analysis
An. Pediatr. (Barc.)
A systematic review of the validity of dietary assessment methods in children when compared with the method of doubly labeled water
J. Am. Diet. Assoc.
Greek adolescents and the Mediterranean diet: factors affecting quality and adherence
Nutrition
NTU-90: a high angular resolution brain atlas constructed by q-space diffeomorphic reconstruction
Neuroimage
Permutation inference for the general linear model
Neuroimage
Connectometry: a statistical approach harnessing the analytical potential of the local connectome
Neuroimage
The relation of childhood physical activity and aerobic fitness to brain function and cognition: a review
Pediatr. Exerc. Sci.
Be smart, exercise your heart: exercise effects on brain and cognition
Nat. Rev. Neurosci.
A review of the relation of aerobic fitness and physical activity to brain structure and function in children
J. Int. Neuropsychol. Soc.
Physical activity and cognition in adolescents: a systematic review
J. Sci. Med. Sport
The influence of childhood aerobic fitness on learning and memory
PLoS One
Cardiorespiratory fitness and the flexible modulation of cognitive control in preadolescent children
J. Cogn. Neurosci.
Childhood aerobic fitness predicts cognitive performance one year later
J. Sports Sci.
An estimate of the worldwide prevalence and disability associated with osteoporotic fractures
Osteoporos. Int.
European guidance for the diagnosis and management of osteoporosis in postmenopausal women
Osteoporos. Int.
Psychological stress and disease
JAMA
Effects of differing intensities and formats of 12 months of exercise training on psychological outcomes in older adults
Health Psychol.
Inverse association between physical inactivity and mental health in men and women
Med. Sci. Sports Exerc.
Are there modifiable risk factors which will reduce the excess mortality in schizophrenia?
J. Psychopharmacol.
Chronic disease to top agenda. Cardiorespiratory fitness is an important risk factor
BMJ
Aerobic fitness enhances relational memory in preadolescent children: the FITKids randomized control trial
Hippocampus
The effects of an afterschool physical activity program on working memory in preadolescent children
Dev. Sci.
The association of childhood obesity to neuroelectric indices of inhibition
Psychophysiology
The negative association of childhood obesity to cognitive control of action monitoring
Cereb. Cortex
The relation of adiposity to cognitive control and scholastic achievement in preadolescent children
Obesity (Silver Spring)
Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity
Pediatr. Obes.
ADHD Rating Scale IV: Checklists, Norms, and Clinical Interpretation
Exercise improves executive function and achievement and alters brain activation in overweight children: a randomized, controlled trial
Health Psychol.
Exercise dose and diabetes risk in overweight and obese children: a randomized controlled trial
JAMA
Physical fitness and academic achievement in third- and fifth-grade students
J. Sport Exerc. Psychol.
Young psychophysiologist award address, 1980. P300 latency: a new metric of information processing
Psychophysiology
Stroop Color and Word Test. A Manual for Clinical and Experimental Uses
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