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The use of mobile touch screen devices (MTSDs) has increased rapidly over the last decade, and there are concerns that their use may have negative musculoskeletal consequences; yet evidence on the association of MTSD use with musculoskeletal symptoms and exposures is currently dispersed. The aim of this study was to systematically review available literature on musculoskeletal symptoms and exposures associated with MTSD use. The synthesised information may facilitate wise use of MTSDs and may identify areas in need of further research. EMBASE, Medline, Scopus, PsycINFO and Proquest electronic databases were searched for articles published up to June 2016, using keywords describing MTSD, musculoskeletal symptoms (e.g. pain, discomfort) and musculoskeletal exposures (e.g. posture, muscle activity). Two reviewers independently screened the articles, extracted relevant data and assessed methodological quality of included studies. Due to heterogeneity in the studies, a meta-analysis was not possible and a structured narrative synthesis of the findings was undertaken. A total of 9,908 articles were screened for eligibility with 45 articles finally included for review. Included articles were of cross-sectional, case-control or experimental laboratory study designs. No longitudinal studies were identified. Findings were presented and discussed in terms of the amount, features, tasks and positions of MTSD use and its association with musculoskeletal symptoms and musculoskeletal exposures. There is limited evidence that MTSD use, and various aspects of its use (i.e. amount of usage, features, tasks and positions) are associated with musculoskeletal symptoms and exposures. This is due to mainly low quality experimental and case-control laboratory studies, with few cross-sectional and no longitudinal studies. Further research is warranted in order to develop guidelines for wise use of MTSDs.

Background The use of mobile touch screen devices, e.g. smartphones and tablet computers, has become increasingly prevalent among adolescents. However, little is known about how adolescents use these devices and potential influences on their use. Hence, this qualitative study explored adolescents’ perceptions on their patterns of use and factors influencing use, and perceptions and concerns from parents. Methods Semi-structured interviews were conducted with adolescents ( n  = 36; 11 to 18 years) and their parents/caregivers ( n  = 28) in Singapore recruited to represent males and females across a range of ages from different socioeconomic groups. Prompts covered weekday and weekend use patterns, types of activities, perspectives on amount of use, parental control measures and concerns. Interviews were recorded and transcribed. Transcripts were coded and thematic analysis was carried out. Results Smartphone was the most common mobile device owned and used by many of the adolescents, while only some used a tablet. Many adolescents and their parents felt that adolescents’ MTSD use was high, frequent and ubiquitous, with frequent checking of device and multitasking during use. Reported influences of use included functional, personal and external influences. Some of the influences were irresistibility of mobile devices, lack of self-control, entertainment or relaxation value, and high use by peers, family and for schoolwork that contributed to high use, or school/parental control measures and lack of internet availability that limited use. Most adolescents were generally unconcerned about their use and perceived their usage as appropriate, while most parents expressed several concerns about their adolescents’ use and perceived their usage as excessive. Conclusions This study has provided rich insights into the patterns and influences of contemporary mobile device use by adolescents. Mobile device use has become an integral part of adolescents’ daily routines, and was affected by several functional, personal and external influences which either facilitated or limited their use. There also seemed to be a strong inclination for adolescents to frequently check and use their mobile devices. There is an urgent need to understand the implications of these common adolescent behaviours to inform advice for wise mobile device use by adolescents.

Recess provides a key physical activity opportunity for students in school, yet a wide range of recess requirements exist. To design optimal recess policies, the effect of recess on students' educational outcomes must be better understood. Therefore, the purpose of this mixed-method systematic review is to identify and systematically evaluate research on the effects of recess on student educational outcomes, including behavior, cognitive performance and academic achievement. A systematic search of the literature in ERIC (EBSCO), ProQuest Central, PsycINFO, Teacher Reference Center, MEDLINE Complete (EBSCO), and CINAHL Complete was performed through September 2022. Data was extracted from quantitative studies, and reported themes with exemplar quotes were extracted from qualitative studies. The Mixed Method Appraisal Tool (MMAT) was used to assess study quality. The search identified 932 articles, of which 13 were included in the review, including 8 quantitative and 5 qualitative studies. Eleven studies were conducted in the United States, and reported sample size of studies ranged from 12 to 11,624. Studies found mixed effects on student behavior, discipline referrals and academic achievement. Qualitative studies reported multiple benefits of recess including increased focus, improved problem solving and academic achievement. Overall, evidence suggests positive benefits for behavior and either positive or null benefits of recess on academic achievement. However, evidence is limited by non-controlled study designs and diversity in outcome assessments. Additional quantitative evidence is needed to convince policymakers of the specific evidence supporting recess, but also to advise on the optimal recess policies and practices to improve student learning.

Background Current guidelines suggest too little sleep, too little physical activity, and too much sedentary time are associated with poor health outcomes. These behaviours may also influence academic performance in school children. The primary purpose of this study was to examine the relationships between sleep, physical activity, or sedentary behaviours and academic performance in a school with a well-developed and integrated technology use and well-being program. Methods This was a cross-sectional survey of students ( n  = 934, Grades 5–12) in an Australian school with a bring-your-own device (tablet or laptop computer) policy. Students reported sleep, physical activity, and sedentary (screen and non-screen) behaviours. Academic performance was obtained from school records. Linear regressions were used to test the association between behaviours and academic performance outcomes. Results Seventy-four percent of students met sleep guidelines (9 to 11 h for children 5–13 years and 8 to 10 h for 14–17 year olds), 21% met physical activity guidelines (60 min of moderate-to-vigorous physical activity every day), and 15% met screen time guidelines (no more than 2 h recreational screen time per day); only 2% met all three. There were no associations between meeting sleep guidelines and academic performance; however later weekend bedtimes were associated with poorer academic performance (− 3.4 points on the Average Academic Index, 95%CI: − 5.0, − 1.7, p  < .001). There were no associations between meeting physical activity guidelines and academic performance. Meeting screen guidelines was associated with higher Average Academic Index (5.8, 95%CI: 3.6, 8.0, p  < .001), Maths 7.9, 95%CI: 4.1, 11.6, p  < .001) and English scores (3.8, 95%CI: 1.8, 5.8, p  < .001) and higher time in sedentary behaviours was associated with poorer academic performance, including total sedentary behaviours in hrs/day (5.8 points on Average Academic Index, 95%CI: 3.6, 8.0, p  < .001. Meeting at least two of the three behaviour guidelines was associated with better academic performance. Conclusions Sleep and sedentary behaviours were linked to academic performance. School communities should emphasize comprehensive wellness strategies to address multiple behaviours to maximize student health and academic success.

Purpose: The purpose of this study was to determine the acute dose-response relationship of classroom exercise breaks with executive function and math performance in 9- to 12-year-old children by comparing 5-min, 10-min, or 20-min classroom exercise breaks to 10 min of sedentary classroom activity. Method: This study used a within-subjects experimental design conducted in the spring of 2012. Ninety-six 4th- and 5th-grade students in 5 classrooms in South Carolina were randomized to receive each of 4 treatments: 5-min, 10-min, or 20-min exercise breaks or 10 min of a sedentary lesson led by research staff. Students completed the Trail-Making Test, an Operational Digit Recall test, and a math fluency test immediately before and after each condition. Planned linear contrasts were used to compare posttest scores between conditions using a repeated-measures mixed model, adjusted for gender, classroom, and the time-varying pretest scores. Potential effect modifiers were added as interaction terms. Results: Math scores were higher after the 10-min and 20-min exercise breaks compared with the sedentary condition (d = 0.24, p = .04, and d = 0.27, p = .02, respectively), and an interaction was observed with gender, IQ, aerobic fitness, and lower engagement in some of the conditions. There were no improvements in executive function tasks. Conclusions: A 10-min and 20-min classroom exercise break moderately improved math performance in students compared with a seated classroom lesson.

Background Evidence suggests that access to green schoolyards may facilitate vigorous play and lead to increased physical activity, which could lead to improved academic outcomes and reduce excess childhood weight gain. Greener schoolyards can also provide additional outdoor amenities that help the community at large. The Little Rock Green Schoolyard Initiative, a program aiming to promote outdoor learning and play in two of the city’s community schools, provides a natural experiment to evaluate the role of such interventions. This article presents the protocols and study plans that will be used to evaluate this community-led initiative on several outcomes including physical activity, sleep quality, use of schoolgrounds, and perceptions of the school environment. Administrative datasets will be used to assess exposure to green schoolyard improvements on academic achievement, attendance, and disciplinary referrals during elementary school. Methods Data will be gathered in two community schools where the green schoolyard improvements are taking place and in two demographically-matched comparison schools located elsewhere within the Little Rock School District. Data will be collected before, during, and after the green schoolyard improvements go into effect. Physical activity and sleep quality will be measured using actigraphy. Physical activity will also be assessed through direct playground observations during recess and outside of school hours. During the final year of the study, administrative data will be assembled and evaluated using difference-in-differences estimation and synthetic controls, two causal inference methods from the program evaluation literature. Discussion The study is designed to provide new insights into the design, implementation, and evaluation of playgrounds among schoolchildren, especially those who are at risk of developing severe obesity during their elementary school years. The research herein will develop empirical data, elucidate potential mechanisms, and practical experience for future study, policymaking, and health services.

Background Recess is a part of school-based physical activity promotion offered worldwide with equitable recess access a social justice issue. From a policy perspective, in the U.S. few states currently require elementary school recess and little is known about its implementation. The purpose of this study was to determine the current implementation of one state system as a case study to investigate minimum recess requirement and to compare the implementation between school geographic and racial factors. Methods A cross-sectional, observational study of the implementation of one state’s minimum daily recess requirement of 40-minutes recess was conducted during the 2023–2024 academic year. A school audit of provided recess time was conducted of all public elementary schools in Arkansas through an online search of bell schedules, a survey sent to principals and physical education teachers, and phone call surveys to school offices. Key demographic and geographic features of the schools included enrollment data (e.g., race, grade, and % Free-and-Reduced Lunch composition), rurality, and region. Results Recess information was obtained from 384 (73%) of 526 eligible schools with an average student enrollment of 398 students (SD 154), 19.8% (SD 27.9) Black student enrollment, and 63.8% (SD 20.0%) students receiving free-and-reduced lunch. 306 (85.5%) schools met recess requirements. There were no differences in meeting recess requirements by rurality. Of schools with higher Black student enrollment (≥ 25% Black enrollment), 75.3% met recess requirements compared to 89.5% in schools with lower Black enrollment (< 25% Black enrollment, OR 0.36, 95%CI: 0.16, 0.78, p  =.010). There were differences in survey-reported available playground spaces and equipment between by meeting recess requirements and Black student enrollment ( p  <.05). Conclusions Schools in a state with a 40-minute daily recess requirement reported high compliance with the state policy. However, students in schools with higher Black student enrollment were less likely to meet the 40-minute recess requirement, and thus strategies are needed to ensure all students have access to recess opportunities. Ensuring equal access to recess through wide-reaching place-based and policy-based strategies may be a step in reducing health and education disparities, especially among populations where disparities are greatest.

Background Emerging adults (aged 18–29) report high levels of musculoskeletal pain; however, it is unknown if body location and intensity patterns are related to different biopsychosocial characteristics. This study identified patterns of self-reported musculoskeletal pain among emerging adults and assessed if there were differences in their lifestyle and psychological characteristics. Methods Data from survey responses from a large public university and a large medical university in the United States were used (n = 1,318). Self-reported pain location and intensity at five body regions were assessed, and latent class analysis identified classes separately for men and women. Mental health, physical activity, and sleep outcomes were compared between the classes. Results Four classes were identified for men and women. Three of the classes were consistent between genders – “no pain,” (women = 28% of their sample; men = 40% of their sample) “mild multisite pain,” (women = 50%; men = 39%) and “moderate-severe multisite pain” (women = 9%; men = 7%). The fourth class for women was “moderate spine pain,” (13%) and for men was “mild extremity pain” (13%). For both men and women, the “moderate-severe multisite” pain classes reported the highest levels of depression, anxiety, and stress, poorer sleep, and higher work physical activity than the “no pain” class. The “mild multisite” and “moderate spine” (women only) pain classes fell between the “no pain” and “moderate-severe” pain classes. The characteristics of the “mild upper extremity pain” class for men was similar to the “no pain” class. Conclusions The identified classes provide unique information on pain location and intensity in emerging adults. The high prevalence of “mild multisite pain” (n = 593; 45% of the total sample) demonstrates an intervention opportunity during this age range to prevent further increases in musculoskeletal pain later in life. Future work should assess the longitudinal outcomes of these pain classes, the impact of interventions for this age group, and the balance between leisure and occupational physical activity when addressing musculoskeletal health.

Adolescent and young adult (AYA) survivors of pediatric oncology related cerebral insult are vulnerable to numerous treatment-induced deficits that significantly enhance cardiovascular disease risk. Regular exercise improves endothelial function, fitness, body composition and musculoskeletal function which may reduce predisposition for cardiovascular disease. Here we assessed the feasibility and effectiveness of a 24-week exercise intervention on cardiovascular, physical and metabolic outcomes in this population. Thirteen survivors (6 male, 7 female; median age 19 y (range 16-23 y) were recruited to participate in a 48-week study consisting of a 24-week control period (regular care) followed by a 24-week exercise intervention. Outcome measures were collected at entry (week 0) and following regular care (24-week) and exercise (48-week). Assessed variables included endothelial function (flow mediated dilation, FMD), blood pressure, heart rate (HR), aerobic capacity, anthropometry, body composition, muscular strength (3 repetition maximum testing), muscular endurance (repetitions/min) and physical activity levels (accelerometry). Compared to baseline, delta diameter (p = 0.008) and FMD (p = 0.029) of the brachial artery increased following exercise. Bicep-curl strength also increased following exercise compared to baseline (p = 0.019), while submaximal (6 min mark) measures of ventilation (p = 0.012), rating of perceived exertion (p = 0.012), HR (p = 0.001), absolute (p = 0.000) and relative (p = 0.000) aerobic capacity decreased. Breaks in sedentary time increased (p = 0.043) following exercise compared to regular care. Although the sample was small and heterogeneous, this study demonstrates that exercise is achievable and has positive effects on vascular function, submaximal fitness, local strength and physical activity in a population of AYA survivors of pediatric oncology related cerebral insult.

Background The socioecological model proposes a wide array of factors that influence behaviours. There is a need to understand salient correlates of these activity behaviours in a specific population. However, few studies identified socio-demographic, behavioural, physical, and psychological correlates of objectively-assessed physical activity and sedentary time in young adults. Methods This was a cross-sectional analysis of participants in the Raine Study (a pregnancy cohort started in 1989) . Australian young adults (mean 22.1 years ± SD 0.6) wore Actigraph GT3X+ accelerometers on the hip 24 h/day for seven days to assess moderate-to-vigorous physical activity (MVPA) and sedentary time ( n  = 256 women, n  = 219 men). Potential correlates were assessed via clinical assessment and questionnaire and included socio-demographic variables (ethnicity, relationship status, work/study status, education, mothers education), health behaviours (food intake, alcohol consumption, smoking status, sleep quality), and physical and psychological health aspects (anthropometrics, diagnosed disorders, mental health, cognitive performance). Backwards elimination ( p  < 0.2 for retention) with mixed model regressions were used and the gender-stratified analyses were adjusted for demographic variables, waking wear time and number of valid days. Results Increased time spent in MVPA was associated with: being single (IRR 1.44 vs in a relationship living together, 95%CI: 1.17, 1.77, p  = .001) in women; and better sleep quality in men (lower scores better IRR 0.97, 95%CI: 0.93, 1.00). Less time spent sedentary was associated with: lower mother’s education (− 32.1 min/day, 95%CI -52.9, 11.3, p  = 0.002 for having mother with no university degree vs at least a baccalaureate degree) and smoking (− 44.3 min/day, 95%CI: - 72.8, − 15.9, p  = .0002) for women; lower education status (− 32.1 min/day, 95%CI: -59.5, − 4.8, p  = 0.021 for having no university degree vs at least a baccalaureate degree) and lower depression scores in men (− 2.0, 95%CI: - 3.5, − 0.4, p  = 0.014); more alcoholic drinks per week for women (− 1.9 min/day, 95%CI: -3.1, − 0.6, p  = 0.003) and men (− 1.0, 95%CI: -1.8, − 0.3, p  = 0.007). Conclusions Less desirable correlates were associated with positive levels of activity in young Australian adult women and men. Interventions to increase MVPA and decrease sedentary activity in young adults need to specifically consider the life stage of young adults.