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Background

Physical activity (PA) promotes health in adults as well as children. At the same time, a large proportion of children do not meet the recommendations for PA, and more school-based efforts to increase PA are needed. This study investigates the effectiveness and feasibility of lesson-integrated PA in a Swedish primary school.

Methods

We evaluate a new method called ‘Physical Activity and Lesson in Combination’ (abbreviated FALK in Swedish) using a mixed methods approach; a quasi-experimental study followed by qualitative interviews. Two schools participated in the study, one constituting the intervention group (I-school, n = 83) and the other the control group (C-school, n = 81). In addition to regular physical education, the I-school had three 30-minute FALK lessons each week. A total of 164 students aged 7–9 years wore pedometers for a whole week, four times over two semesters, and the number of steps per day (SPD) and the proportion of students with < 10,000 SPD were compared. Statistical differences between the schools were tested with ANOVA, Chi2, t-tests, and ANCOVA. Interviews with students (n = 17), parents (n = 9) and teachers (n = 9) were conducted and analysed using qualitative content analysis.

Results

The results show that FALK led to the I-school getting more SPD and fewer students with < 10,000 SPD. Also, FALK was experienced as a positive, clear, and flexible method, simultaneously encouraging PA and learning. Challenges experienced concerned the teachers’ work situation, time, finding suitable learning activities, outdoor school environment changes, and extreme weather conditions.

Conclusions

This study indicates that FALK has the desired effects on PA and is a feasible method of integrating PA into theoretical teaching. We conclude that FALK is worth testing at more schools, given that implementation and sustainment of FALK considers both general enablers and barriers, as well as context-specific factors at the individual school.

Background: Physical activity (PA) promotes health in adults as well as children. A large proportion of schoolchildren don´t meet the recommendations for PA. Few scientific studies have investigated both effectiveness and feasibility regarding school-based efforts to increase PA. We have evaluated a method we call Physical Activity and Lesson in Combination (In Swedish: Fysisk Aktivitet och Lektion i Kombination, FALK).

Purpose: To investigate the effectiveness and feasibility of FALK.

Methods: Two schools participated, one constituted control group (C), the other intervention group (I). In addition to the same PA as C-group, the I-group had three FALK sessions of 30 minutes each week.

We used pedometers to assess changes in physical activity and interviews to evaluate feasibility.  

A total of 164 pupils aged 7-9 wore pedometers for a whole week on four occasions over two semesters. The number of steps per day (SPD) and the proportion of pupils with <10,000 SPDs were compared.

Interviews were carried out with students, parents, and educators (n = 35) and were analyzed by qualitative content analysis.

Findings: Pedometer data shows that students who perform FALK sessions are more physically active, and the proportion of students with insufficient PA is smaller, compared to students who don´t have FALK.

The interviews show both enabling factors and barriers, but overall FALK is experienced as positive, clear, and flexible.

Conclusions: FALK increases PA and is assessed as a useful and feasible practice to integrate PA into theoretical teaching.

Fysisk aktivitet (FA) främjar hälsan hos såväl vuxna som barn. En stor andel av skolbarnen uppfyller inte rekommendationerna för FA. Få vetenskapliga studier har undersökt både effektivitet och genomförbarhet när det gäller skolbaserade insatser för att öka FA. Vi har utvärderat en metod vi kallar Fysisk Aktivitet och Lektion i Kombination (FALK). Två skolor deltog, en utgjorde kontrollgrupp (K), den andra interventionsgrupp (I). Totalt 164 elever i åldern 7–9 år bar stegräknare en vecka i sträck vid fyra tillfällen under två terminer. Utöver samma FA som K-gruppen så hade I-gruppen under dessa två terminer tre FALK-pass à 30 minuter varje vecka. Antalet steg per dag (SPD) och andelen elever med <10 000 SPD jämfördes. FALK resulterade i att I-gruppen fick fler SPD och mindre andel med <10 000 SPD. Slutsatsen är att ämnesintegrerad FA har önskad effekt och fungerar i praktiken. FALK kräver inga extra resurser, men det behövs en öppenhet för alternativa undervisningsmetoder.

Studiens syfte var att undersöka hur elever, vårdnadshavare och pedagoger upplever implementering av ämnesintegrerad fysisk aktivitet (FA) vid en kommunal grundskola. En kvalitativ forskningsansats användes där datainsamling genomfördes genom intervjuer med lågstadieelever, vårdnadshavare och pedagoger (n = 35). Insamlade data analyserades med hjälp av kvalitativ innehållsanalys. Resultaten visar att det nya arbetssättet kallat Fysisk Aktivitet ochLektion i Kombination (FALK) har upplevts positivt, tydligt och flexibelt. Att arbetssättet uppmuntrar till ökad rörelse och lärande parallellt beskrivs som en möjliggörande faktor. Svårigheter avseende pedagogernas arbetsplanering, tidsåtgång och praktiska utmaningar att kombinera FA med lämpliga läraktiviteter beskrivs som hinder. Förändringar av den yttre skolmiljön och utmanande väderbetingelser är ytterligare hinder. Slutsatsen är att FALK bedöms vara ett användbart och praktiskt genomförbart arbetssätt för att integrera FA i den teoretiska undervisningen.

Cognitive impairment is one of the most pronounced symptoms reported by patients with stress-related mental health problems. Impairments related to executive function and to some extent speed and attention are therefore common in patients with stress-related burnout/exhaustion. In this paper we present a follow-up of cognitive performance in patients with stress-related exhaustion several years after they initially sought medical care. Thirty patients and 27 healthy controls, mean age 49 years (SD 6.5) and 55 years (SD 6.7) respectively, were included, all of whom had undergone baseline measurements of neuropsychological functioning. The mean follow-up time was three years. Half of the patients still reported mental health problems at follow-up and over time no major changes in cognitive performance were noted. The patients still performed significantly poorer than controls with regard to cognitive functions, mainly related to speed, attention and memory function. Long-lasting impairment of cognitive functions related to speed, attention and memory function noted in patients with stress-related exhaustion should be acknowledged and taken into consideration during treatment and when discussing a return to work. Follow-up periods longer than three years are needed to explore the persistence of the cognitive impairment.

Purpose This cross-sectional observational study examined the degree to which cardiorespiratory fitness (CRF) and self-perceived stress are associated with cardiometabolic risk factors and the overall risk score for cardiovascular diseases. The second aim was to determine whether participants' CRF levels moderate the relationships between stress and cardiometabolic risk.Methods A gender-matched stratified sample (N = 197, 51% men, M-age = 39.2 yr) was used to ensure that participants with varying stress levels were equally represented. CRF was assessed with the angstrom strand bicycle test, and perceived stress was assessed with a single-item question. Systolic blood pressure (SBP) and diastolic blood pressure (DBP), body mass index (BMI), total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), glycated hemoglobin, and total cardiometabolic risk score (sum of the z-standardized residuals of the previously mentioned indicators) were assessed as outcomes.Results Higher LDL-C, TG, and total metabolic risk were found in participants with high stress scores (P < 0.05). In addition, lower SBP, DBP, BMI, LDL-C, TG, and total metabolic risk were observed in participants with high CRF (P < 0.05). Two-way ANCOVA provided significant interaction effects for five of the nine outcome variables (P < 0.05, 3.6%-4.8% of explained variance). Participants with high stress who also had high CRF levels had lower SBP, DBP, LDL-C, TG, and total cardiometabolic risk than participants with high stress but low or moderate CRF levels. No significant main or interaction effects occurred for BMI, total cholesterol, high-density lipoprotein cholesterol, and glycated hemoglobin.Conclusion Better CRF is associated with more favorable levels of several cardiometabolic risk factors, specifically in participants experiencing high stress. Higher CRF may provide some protection against the health hazards of high chronic stress by attenuating the stress-related increase in cardiovascular risk factors.

Background: Common consequences of long-term psychosocial stress are fatigue and burnout. It has been suggested that burnout could be associated with hypocortisolism, thus, inability to produce sufficient amounts of cortisol. This study aimed to investigate whether patients with clinical burnout exhibit aberrant ACTH and cortisol responses under acute psychosocial stress compared with healthy individuals.

Methods: Nineteen patients (9 men and 10 women) and 37 healthy subjects (20 men and 17 women), underwent the Trier Social Stress Test. Blood samples and saliva samples were collected before, after, and during the stress test for measurements of plasma ACTH, serum cortisol, and salivary cortisol. Several statistical analyses were conducted to compare the responses between patients and controls. In addition, in order to investigate the possibility that burnout patients with more severe symptoms would respond differently, sub-groups of patients reporting higher and lower burnout scores were compared.

Results: In both patients and healthy controls, we observed elevated levels of ACTH and cortisol after exposure to the stressor. There were no differences in responses of ACTH, serum cortisol, or salivary cortisol between patients and controls. Patients reporting higher burnout scores had lower salivary cortisol responses than controls, indicating that patients with more severe burnout symptoms may be suffering from hypocortisolism. In addition, patients with more severe burnout symptoms tended to have smaller ACTH responses than the other patients. However, there was no corresponding difference in serum cortisol.

Conclusion: This study indicates that hypocortisolism is not present in a clinical burnout patient group as a whole but may be present in the patients with more severe burnout symptoms.

This study investigated the association between diurnal salivary cortisol profile and perceived stress at work and at home. Healthy participants (N=180, 52% women) collected saliva cortisol samples immediately after waking up, 15 min later, 30 min later, and at 9:00, 12:00, 15:00, 18:00 and 21:00. The area under the cortisol awakening curve with respect to ground (AUCgCAR) and increase (AUCiCAR), and diurnal slope between 9:00 and 21:00 were analyzed. Perceived stress at work and at home was measured with the Stress-Energy Questionnaire. Participants reporting stress at home had significantly lower AUCgCAR and a flatter diurnal slope. When performing separate analyses for men and women, this association was only significant among women. Perceived stress at work was not associated with any cortisol measure. This study highlights the importance of stress outside the workplace. The sex differences may indicate an increased vulnerability to non-work stress in women.

Patients who seek medical care for stress-related mental health problems frequently report cognitive impairments as the most pronounced symptom. The purpose of the present study was to compare cognitive function in patients with stress-related exhaustion with that in healthy controls, using a comprehensive battery of cognitive tests. We also explored whether neuropsychological findings were related to severity of illness measured using the Shirom-Melamed burnout questionnaire and hospital anxiety and depression scale. Thirty-three patients (15 males) and 37 healthy controls (11 males), mean age 46 years [standard deviation (SD) 3.9] and 47 years (SD 4.3), respectively, were included in the final analysis. Five cognitive domains were assessed: (1) speed, attention and working memory, (2) learning and episodic memory, (3) executive functions, (4) visuospatial functions and (5) language. The most pronounced difference between patients and controls was seen on executive function, when tested with a multidimensional test, including aspects of speed, control and working memory. The patients also performed poorer on Digit span, measuring attention span and working memory as well as on learning and episodic memory, when measured as delayed recall and the difference between immediate and delayed recall. Delayed recall was the only test that was significantly related to severity of burnout symptoms among the patients. This could reflect poor cognitive sustainability in the patients with the highest burnout scores, as this particular test was the last one performed during the test session. This study clearly shows that cognitive impairment should be considered when evaluating and treating patients who seek medical care for stress-related exhaustion.