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Incorporating aerobic exercises, such as cybercycling, into physical education programs for children with behavioral health disorders (BHD) may lead to significant behavioral improvements, according to a team of Harvard researchers.
Results from a randomized control trial of 103 students at a therapeutic day school found that those who engaged in cybercycling, a type of stationary bike exercise enhanced by virtual reality, experienced 32% to 51% lower odds of poor self-regulation and learning-inhibiting disciplinary time out of class (TOC), compared with those in standard phys-ed programs, reported April Bowling, ScD, of Merrimack College in North Andover, Mass., and colleagues at Harvard University (where Bowling was earning her doctorate).
The effects were more apparent on days that the students participated in the aerobic exercise, but "carryover effects" were also observed, they wrote online in Pediatrics.
Said Bowling, "This study provides compelling evidence that children and adolescents with multiple, heterogeneous BHD in a school setting can successfully engage in and experience behavioral benefits from an aerobic, cybercycling PE curriculum."
"The big takeaway from this study is that kids with these types of challenges may not need a lot of aerobic exercise to see big improvements in classroom behavior, but it is really important to find modes of exercise that appeal to them and work within the existing structures of schools," she told MedPage Today.
The study consisted of approximately 100 students (ages 7-16 years) from the Manville School who had autism (40%), attention-deficit/hyperactivity disorder (60%), anxiety (40%), and/or mood disorders (30%).
Using a 14-week crossover design, the researchers randomly assigned students by classroom to receive the 7-week intervention during fall 2014 or spring 2015, with a 10-week washout period between treatment arms. During the intervention period, students used the stationary bikes twice per week during 30-40 minute PE classes, while the control group continued to participate in standard PE programs such as basketball shooting drills.
Behavioral self-regulation was measured by the Conners' Abbreviated Teacher Rating Scale (CATRS-10) -- a validated screening tool for behavioral problems related to inattention, impulsivity/ hyperactivity, and emotional lability -- and classroom functioning was operationalized based on time out of class.
The researchers used mixed effects logistic regression to analyze the relationships between intervention exposures and clinical thresholds of behavioral outcomes, accounting for individual and classroom random effects.
By the end of the trial, Bowling and colleagues counted 913 cybercycling PE days -- with an average cycling duration of 16.1 (SD 5.3) minutes per class -- suggesting that the students achieved sustained aerobic exercise during intervention classes.
During the cybercycling phase, students experienced significantly reduced odds of exceeding screening thresholds for total CATRS-10 score (OR 0.68, 95% CI 0.57-0.81), emotional lability subscore (OR 0.64, 95% CI 0.52-0.77), and impulsivity/ hyperactivity subscore (OR 0.49, 95% CI 0.36-0.67), relative to the control program.
On days that students participated in an intervention PE class, they saw reduced odds of exceeding screening thresholds for total CATRS-10 score, emotional lability subscore and and impulsivity/hyperactivity subscore, (OR 0.29, 95% CI 0.14-0.61), (OR 0.24, 95% CI 0.11-0.53), (OR 0.28, 95% CI 0.13-0.59), respectively, relative to the control condition.
Acute effects of cybercycling PE class also resulted in significantly reduced odds of both learning-disruptive and preclusive time out of class events (OR 0.43, 95% CI 0.26-0.72; OR 0.10, 95% CI 0.02-0.61) and minutes (OR 0.50, 95% CI 0.29-0.89; OR 0.34, 95% CI 0.14-0.84).
The researchers concluded that "a cybercycling PE curriculum ... can successfully affect student behavior within existing school programming with short durations and low frequency."
They noted several benefits of cybercycling PE, compared with standard PE programming, including fewer transitions, a less noisy and chaotic experience, and a lack of peer judgment since performance data was private. However, they did acknowledge that standard PE classes are more cost-efficient and can help with socialization.
In an interview with MedPage Today, Bowling stressed the importance of "thinking outside the box" to get kids to see exercise as a source of enjoyment, not something to dislike or dread.
"Schools can use creative tools like these cybercycles or fun reward systems to make kids feel successful at aerobic exercise. They can take part in short 10-15 minute bouts throughout the school day – during recess, PE classes, behavioral breaks from class, or even before or after school programs," she said.
Bowling also commented on parental participation, noting that walking the dog, going for hikes, or playing active video games are all opportunities to use positive reinforcement to help children achieve certain exercise goals.
This work was supported by Harvard University philanthropic funding, a TriROK Foundation grant, and an Ascend Capital grant.
Bowling and colleagues reported no relevant financial interests.
- Reviewed by Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner