INTRODUCTION & AIMS Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in adults. Stimulant medications are first-line treatments, they have many side effects and do not address common comorbidities such as cardiometabolic disease, depression, and anxiety. Exercise, by contrast, not only improves ADHD symptoms in youth but effectively treats such comorbidities, making it a potentially valuable treatment option. However, exercise efficacy in adults with ADHD has not been systematically reviewed. Therefore, we aimed to summarise the results of acute exercise and training interventions on health-related outcomes for adults with ADHD, including ADHD symptoms, cognitive function, and psychological well-being. METHODS Using PRISMA guidelines, fifteen databases were searched (including grey literature) on 27/08/2020, yielding 22,088 unique publications. Database alerts were created to capture additional studies (n= 2). Screening, data extraction, Risk of Bias and GRADE assessment was conducted by CEHB. RESULTS Seven acute (6 cycling, 1 self-selected, 1 yoga) and 6 training studies (Yoga, Pilates, Kickboxing, Tai Chi, General Coordination, Group Circuit Class, Cycling) were included. Among acute studies, those reporting small-to-moderate improvements in cognitive function were characterised by longer duration exercise (>30 minutes), withholding ADHD medication before exercise, and using cohorts with clinician-confirmed ADHD diagnosis. Among the training studies, only one reported an improvement in cognition following Pilates when compared to an inactive control. It was longer (6 months vs. <8 weeks), prescribed progressive intensity and volume, and had high adherence compared to the non-significant trials. The certainty of evidence was low or very low for all outcomes. CONCLUSIONS Overall, acute exercise may have a small positive effect on cognition in adults with ADHD; however, certainty of the evidence is low. Further research is needed to investigate the impact of different modalities, durations, and intensities of acute exercise and chronic exercise on adult ADHD.

IntroductionPoor mental health is a known risk factor for poor sleep among university students; however, less is known about the role of dysfunctional sleep beliefs and its relation to mental health and sleep. Additionally, students who identify as people of color (POC) may experience unique stressors related to discrimination and inequalities which can contribute to mental health issues and in turn, influence their sleep. The present study evaluated the impact of dysfunctional sleep beliefs and poor mental health on a student's susceptibility to worse sleep and examined differences among POC.MethodsPost-secondary students completed a survey including the Insomnia Severity Index and the Dysfunctional Beliefs and Attitudes about Sleep Scale. Participants also completed questionnaires measuring symptoms of depression, anxiety, and perceived stress.ResultsOne thousand five hundred and sixty-two students were included in the analyses, 58% of which were POC. POC students had more dysfunctional sleep beliefs (p < 0.01) and worse insomnia severity (p < 0.01) compared to white students. Overall, greater dysfunctional sleep beliefs were significantly associated with worse symptoms of depression (b = 1.521), anxiety (b = 1.170), stress (b = 1.370), and poor sleep (b =1.963; ps < 0.001). Dysfunctional sleep beliefs also moderated the relation between poor mental health and sleep, specifically depression (p = 0.035) and anxiety (p = 0.007), by exacerbating sleep outcomes.DiscussionThe results suggest that dysfunctional sleep beliefs may play a role in perpetuating poor mental health and sleep. Interventions to improve students' sleep and wellbeing focused on reframing dysfunctional sleep beliefs should be examined.

Background: Promoting adolescent sports participation and physical activity may be effective low-barrier prevention strategies for co-occurring adolescent substance use (SU) and mental health symptoms (MH). The objectives of this study were to: 1) explore associations between profiles of SU/MH and sports participation; and 2) determine whether physical activity and belongingness account for these associations. Methods: Data came from a representative sample of 11,994 grade 9-12 Ontarian students (ages similar to 14-18) previously grouped into five SU/MH profiles based on patterns of use and symptoms. A series of multinomial logistic regressions, adjusted for socio-demographics and school clustering, were used to predict the risks of students belonging to SU/MH profiles based on: 1) school sports participation (>=weekly), 2) sports and physical activity (>=60 minutes; 0-7 days), and 3) sports, physical activity, and school belongingness. Results: Greater school sports participation, physical activity, and belongingness were each associated with reduced risks of belonging to most profiles with elevations in SU and/or MH symptoms relative to the low SU/ MH profile (Relative Risk Ratios: sports=0.62-0.87, physical activity=0.78-0.98, belonging=0.75-0.83). Frequency of physical activity accounted for similar to 32-60% of the associations between sports and SU/MH profiles, while school belongingness accounted for the remaining associations. Physical activity and belongingness remained independently associated with SU/MH profiles. Conclusions: Findings suggest possible indirect associations between school sports participation and SU/MH profiles through physical activity and school belongingness, which may be promising prevention targets that have independent associations over and above sports. School sports participation may be one of a number of ways to achieve these goals.

OBJECTIVE:Associations between measures of executive functioning (EF) and cardiorespiratory fitness (CRF) were examined for adults with and without ADHD.METHOD:Measures of executive functioning including the Stroop task, Wisconsin Card Sorting task, and Operation Span Task were completed virtually (n = 36 ADHD; n = 36 Control). Participants completed the Six-Minute Walk Test to estimate CRF.RESULTS:Mean performance measures of executive function did not differ by group. However, higher estimated CRF was associated with better Stroop task performance, and the association was strongest for individuals with ADHD.CONCLUSION:In adults with ADHD, higher estimated CRF was associated with better inhibitory control, but not with other measures of executive functioning.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by executive dysfunction. Physical activity (PA) may improve executive dysfunction; however, specific barriers and facilitators to PA participation for adults with ADHD have not been formally documented, which was the aim of the present study. Thirty adults with ADHD completed virtual semi-structured interviews, which were analyzed thematically and guided by the Theoretical Domains Framework. Expressions of both barriers and facilitators to PA were identified. Themes such as executive dysfunction (described as forgetfulness, difficulty with sustained focus, and time management), poor self-esteem, and lack of motivation were seen as barriers to PA. Key facilitators were tied to the benefits of being physically active including improvements in executive functioning, mood, and mental health during and after activity, as well as the enjoyment of being active with others. To better support adults with ADHD in initiating physical activity, it is crucial to develop unique resources that are tailored to their specific needs. These resources should be designed to minimize barriers and maximize facilitators, while also supporting the awareness and acceptance of neurodiverse experiences.

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OBJECTIVE:The mental health of adults with ADHD was compared to neurotypical controls, and associations between cardiorespiratory fitness (CRF) and mental health were examined. METHOD:Seventy-two participants (n = 36 with ADHD) completed demographic questions assessing ADHD and mental health symptoms. CRF was estimated using the 6-Minute Walk Test and a self-perception question. RESULTS:Those with ADHD had significantly poorer mental health outcomes than controls (p < .001), with 50% of adults with ADHD reporting severe to extremely severe symptoms of depression, anxiety, and stress. Critically, lower CRF was associated with worse depression, anxiety, and stress (all p ≤ .03) across both groups. Within the ADHD group, those with higher estimated CRF had significantly lower stress. Among participants with less severe ADHD symptoms, those with higher perceived CRF had significantly lower depressive symptoms. CONCLUSION:In our cross-sectional study, participants with ADHD had poorer mental health than neurotypical controls, and higher fitness was associated with better mental health.

The Senior Fitness Test (SFT) is a validated tool for examining older adults’ mobility, strength, and flexibility. During the COVID-19 pandemic, when in-person training facilities were closed, there was a need for effective virtual options for assessments, including the SFT. Purpose: The purpose of this study was to compare the validated SFT conducted in person versus an online virtual setting. Methods: A virtual modified version of the SFT was compared to the modified in-person validated SFT. Community-dwelling older adults were randomized, using a random number generator, to start in either the in-person or virtual modified SFT mode of delivery. After completion of the first mode of delivery (i.e., either in-person or virtual), participants completed the second mode of delivery. Results: Forty participants (50% women; 72 ± 4 years) showed no differences between the in-person and virtual delivery measurements in the 2-minute step (mean [ M] ± standard deviation in person = 87.9 ± 18.5; M virtual = 87.2 ± 20.7; p = 0.65), 30-second arm curl ( M in person = 16.9 ± 4; M virtual = 16.5±4; p = 0.43), 30-second chair stand ( M in person = 15.6 ± 5; M virtual = 15.2 ± 4; p = 0.36), and chair sit and reach ( M in person = 1.2 ± 15; M virtual = 4.2 ± 11; p = 0.06). Conclusions: Performing the modified SFT in a virtual setting may be a useful delivery mode for seniors and healthcare professionals if in-person testing is not viable.

Adolescence represents a sensitive period whereby lifestyle factors such as physical activity can have profound, long-lasting effects on development and later life habits. However, adolescence constitutes a period of frequent sedentary behaviour. Among children, integrating physical activity into elementary school classrooms has been shown to reduce sedentary behaviour and improve academic achievement and overall physical and mental health. However, this promising area of research has not extended to adolescents and high school classrooms. In this paper, we describe the benefits of conducting research on the impact of physically active high school classrooms, and highlight the challenges and potential misconceptions associated with research in this field. Specifically, we review research on the role of physical activity in adolescent development, the benefits of classroom-based physical activity for children, and discuss the factors that may have led researchers to focus on classroom-based physical activity primarily for children, despite the potentially similar benefits for adolescents.

Background Fewer than 17% of children worldwide are meeting the international recommendations for daily physical activity. Since most children are in school for the bulk of their day, the classroom has been identified as an ideal space to incorporate physical activity opportunities. In Ontario (Canada), the Daily Physical Activity (DPA) policy aims to ensure all elementary school children receive a minimum of 20 min of moderate to vigorous physical activity each school day during instructional time. However, a 2015 evaluation found that only half of Ontario teachers were meeting this expectation; this work advocated for additional research to monitor implementation and its predictors and to further identify fidelity recommendations. Thus, the current study investigated contemporary factors influencing DPA fidelity in Ontario elementary schools and provides teacher-identified recommendations to support DPA implementation. Methods The first part of the study was a quantitative approach surveying 186 elementary school teachers across Ontario. Descriptive statistics including frequencies and means were used to characterize barriers, facilitators, and recommendations to DPA implementation. Spearman’s correlations were used to assess the relation between the likelihood of DPA implementation and intrapersonal factors of gender, teaching experience, prior DPA training and personal physical activity participation. The second part of the study consisted of a qualitative approach using teacher interviews to explore in-depth teachers’ recommendations to support DPA implementation. A thematic analysis was used to analyze the transcripts and identify recommendations for DPA. Results Survey results showed that only 23% of teachers met the mandated 20 min of DPA per day. Barriers to implementation included space and time constraints, inadequate training, student behavioural issues and low self-efficacy. Gender, teaching experience and prior DPA training were not related to the likelihood of DPA implementation. Teachers who rated themselves as more physically fit were more likely to implement DPA. Teacher interviews elucidated key areas for improving DPA implementation including greater DPA training opportunities, resources, community partnerships, accountability and strategies that support school-wide implementation. Conclusion The current study demonstrated that fidelity to the DPA policy in Ontario elementary schools is on the decline. This work highlights unique factors implicated in DPA fidelity and brings to the forefront teacher recommendations to improve DPA implementation.

Apply it! By reading this article, the following key points will be reinforced: • Work with individuals exhibiting depressive symptoms in a group environment to avoid dropout. • Use sufficient rest and recovery between intense sessions for anxious clients to avoid exacerbating symptoms. • For beginner exercisers with mental health issues, start programming at lower intensity and slowly increase the intensity over time. • For executive functions, the effects of high-intensity interval training are strongest for inhibitory control, which will help clients stick with the program over the long term.

The COVID-19 pandemic has impacted the mental health, physical activity, and sedentary behavior of people worldwide. According to the Health Belief Model (HBM), health-related behavior is determined by perceived barriers and motivators. Using an online survey with 1669 respondents, we sought to understand why and how physical activity and sedentary behavior has changed by querying about perceived barriers and motivators to physical activity that changed because of the pandemic, and how those changes impacted mental health. The following results were statistically significant at p < .05. Consistent with prior reports, our respondents were less physically active (aerobic activity, -11%; strength-based activity, -30%) and more sedentary (+11%) during the pandemic as compared to 6-months before. The pandemic also increased psychological stress (+22%) and brought on moderate symptoms of anxiety and depression. Respondents' whose mental health deteriorated the most were also the ones who were least active (depression r = -.21, anxiety r = -.12). The majority of respondents were unmotivated to exercise because they were too anxious (+8%,), lacked social support (+6%), or had limited access to equipment (+23%) or space (+41%). The respondents who were able to stay active reported feeling less motivated by physical health outcomes such as weight loss (-7%) or strength (-14%) and instead more motivated by mental health outcomes such as anxiety relief (+14%). Coupled with previous work demonstrating a direct relationship between mental health and physical activity, these results highlight the potential protective effect of physical activity on mental health and point to the need for psychological support to overcome perceived barriers so that people can continue to be physically active during stressful times like the pandemic.

This study investigated how acute exercise and mindfulness meditation impacts executive functioning and psycho-emotional well-being in 16 children and youth with ADHD aged 10-14 (male = 11; White = 80%). Participants completed three interventions: 10 min of exercise, 10 min of mindfulness meditation, and 10 min of reading (control). Before and after each intervention, executive functioning (inhibitory control, working memory, task-switching) and psycho-emotional well-being (mood, self-efficacy) were assessed. Mindfulness meditation increased performance on all executive functioning tasks whereas the other interventions did not (d = 0.55-0.86). Exercise enhanced positive mood and self-efficacy whereas the other interventions did not (d = 0.22-0.35). This work provides preliminary evidence for how acute exercise and mindfulness meditation can support differential aspects of executive and psycho-emotional functioning among children and youth with ADHD.

Midterm student feedback is a common process in post-secondary institutions that can lead to enhanced teaching practices and thereby potentially to higher ratings of instructional skills in summative course evaluations. At McMaster University, midterm student feedback is called a ‘Course Refinement’ and includes consultation with educational developers. As part of a multiphase study investigating teachers’ perceptions of the Course Refinement process and its impact, this analysis presents effective attributes of the process as an adaptation of Chickering and Gamson’s well-known ‘seven principles for good practice in undergraduate education’, as our findings align with their work. To our knowledge, this marks the first educational development adaptation of the ‘seven principles’.

Objective: Emerging research within school settings suggests acute forms of physical activity and exercise lead to improvements in executive functioning among children. However, research pertaining to these effects within the afterschool setting remains limited. The primary purpose of this study was to investigate the acute effects of a community-based afterschool running and reading program on executive functioning in 8 to 12-year-old children. Method: Fifty participants were initially recruited to participate in this study. However, due to the COVID-19 pandemic, data collection was terminated prematurely which resulted in a sample size of 15 participants. Participants (N = 10) from School 1 completed two batteries of executive function assessments (i.e., inhibition, switching, and updating) separated by 15-min of running or 15-min of sedentary reading. Whereas, only 5 participants from School 2 completed assessments of executive functioning prior to and following the running portion of the program (due to the early termination of data collection). Results: Overall, executive function scores improved across each assessment following the running condition when compared to the reading condition (School 1). Inhibition scores significantly improved, and these effects were very large (School 1). Across both schools, improvements in executive functioning following the running portion of the program ranged from small-large in effect size. Conclusion: Findings from the present study provide initial evidence for the acute effects of a community-based afterschool running and reading program on executive functioning in children. Future research with larger samples in afterschool settings is recommended to replicate this preliminary work.

Background: Participation in physical activity (PA) is a modifiable factor that contributes to academic success, yet the optimal dose (ie, frequency) and mechanisms underlying the effect require further exploration. Methods: Using data from 19,886 elementary and 11,238 secondary school students across Ontario, Canada, this study examined associations between PA participation frequency, academic achievement, and inattention and hyperactivity. Results: Among elementary students, there was a positive association between PA frequency and academic achievement. Participating in 1 to 2 days per week of PA related to higher academic achievement compared with no days, whereas 7 days per week had the largest associations. For secondary students, a minimum of 3 to 4 days per week was associated with higher academic achievement with no significant benefit of additional days. Indirect effects of inattention and hyperactivity were found for both groups, suggesting that the benefits of PA on academic achievement may be partly explained by reductions in inattention and hyperactivity, especially for secondary school students. Conclusion: Students may experience academic benefits from PA even if they are not meeting the guidelines of exercising daily. These benefits may occur, in part, through reductions in inattention and hyperactivity. Further work is needed to determine the temporality and mechanism of these associations.

AbstractThe COVID-19 pandemic has impacted the mental health, physical activity, and sedentary behavior of citizens worldwide. Using an online survey with 1669 respondents, we sought to understand why and how by querying about perceived barriers and motivators to physical activity that changed because of the pandemic, and how those changes impacted mental health. Consistent with prior reports, our respondents were less physically active (aerobic activity, −11%,p<0.05; strength-based activity, −30%,p<0.01) and more sedentary (+11%,p<0.01) during the pandemic as compared to 6-months before. The pandemic also increased psychological stress (+22%,p<0.01) and brought on moderate symptoms of anxiety and depression. Respondents’ whose mental health deteriorated the most were also the ones who were least active (depressionr= −.21,p<0.01; anxietyr= −.12,p<0.01). The majority of respondents were unmotivated to exercise because they were too anxious (+8%,p<0.01), lacked social support (+6%,p=<0.01), or had limited access to equipment (+23%,p<0.01) or space (+41%,p<0.01). The respondents who were able to stay active reported feeling less motivated by physical health outcomes such as weight loss (−7%,p<0.01) or strength (−14%,p<0.01) and instead more motivated by mental health outcomes such as anxiety relief (+14%,p<0.01). Coupled with previous work demonstrating a direct relationship between mental health and physical activity, these results highlight the potential protective effect of physical activity on mental health and point to the need for psychological support to overcome perceived barriers so that people can continue to be physically active during stressful times like the pandemic.