Running head: CHILDRENS PHYSICAL ACTIVITY AND STRESS
Research Proposal: The Impact of Physical Activity on Childrens Stress Levels
Shelina Hassanali April 11 th , 2013 EDPS 612.02 Psychological Measurement and Statistics
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Introduction The link between exercise and physical well-being has been well established in the literature over the years. Recently, the focus has broadened to the study of exercise/physical activity on mental health. While research in this area is growing, there seems to be more focus on the impact of physical activity on adult mental health as opposed to that of children (Nieman, 2002). The question which will be examined with this proposed research study is related to the effects of physical activity on childrens stress levels and their overall mood. The study would answer the question of whether or not a school-based, targeted physical activity program would have a measureable effect on elementary-aged students perceived and actual stress levels, as well as their perceived and observable mood. Three main hypotheses of this study are that: a) Students who participate in the targeted physical activity program will have decreased perceived and actual stress levels b) Students who participate in this program will also show decreased cortisol levels c) Students who participate in more intense physical activity will demonstrate higher levels of improvement than those who participated in less and/or no activity. Research in this area is relevant to me as I work at an elementary school with a mental health promotion project, therefore knowledge of various stress-reduction and mood improvement techniques for elementary-aged children is central to the work that I do. This type of research is also important given the fact that education and health systems are moving more towards prevention rather than intervention models, thus early work with these children will be important in reducing future mental and physical health concerns. Chronic stress is a well-known culprit for future health concerns, and mood has an important role in determining ones outlook on life 3 CHILDRENS PHYSICAL ACTIVITY AND STRESS in general. The results of this proposed study will be an important contribution to the existing research in this area and could potentially be used to inform practice and programming in schools. Literature Review This topic is relatively well-researched in adult populations, but there seems to be a gap in the literature for children. As stated by Nieman (2002), the role of exercise in stress management, although intuitively seen as potentially positive, is less well defined for the paediatric population (pg. 309). There is, however, a small amount of research in this area. A very recent study carried out by Martikainen et al (2013) involved 258 eight-year-old children and examined the effect of physical activity on salivary cortisol levels after stressful experiences. The authors found that the children who had higher levels of physical activity showed significantly less increases in salivary cortisol after stress, while the opposite was true for children with lower levels of physical activity (Martikainen et al, 2013). This indicates that physical activity can potentially reduce the hormones released during and after a stressful experience, which has important implications for overall health. Another study out of Sweden examined the effects of a twice per week meditative exercise program on 119 seventh grade students and found that the students in the exercise group reported reduced stress and improved self-image as compared to the control group (Terjestam, Jouper & Johansson, 2010). The intensity of physical activity as it relates to childrens mental health has also been studied. Parfitt, Pavey & Rowlands (2009) conducted a study which examined whether differences in mental health outcomes exist for school-aged children who participate in physical activity with varying intensities, and found that eight and nine year old children who spent up to 4 CHILDRENS PHYSICAL ACTIVITY AND STRESS four hours engaged in light physical activity along with at least thirty minutes of high intensity physical activity had the most positive psychological profiles. These findings suggest that while engaging in physical activity is certainly one piece of the equation, the intensity of such activity could also play an important role. While this is an important topic, it does seem to be minimally researched and therefore a valuable area of further study. It is hoped that the proposed study outlined below will contribute to the existing literature in the area of the link between physical activity and stress in children. Procedure Participants in this study will be randomly selected from one elementary school. Information and consent forms for parents will be provided, and informed consent obtained. The sample size will be approximately 150 students between the ages of 9-11 years. As we will be using randomized control trials, the students will be randomly assigned to one of three groups with equal distribution of boys and girls in each, as well as equal distribution of each age in the groups. After the students are randomly distributed, pre-intervention data will be collected in order to achieve baseline information which can be used for comparison at a later time. This data will be collected via parent, teacher, and student self-reported rating scales to report current stress levels and mood. Children will use the Stress in Children (SiC) questionnaire to self-report pre-intervention levels of perceived stress (Osika, Friberg & Wahrborg, 2007). According to the authors of the test, This study has established that the SiC is a reliable and rapidly administered self-completion questionnaire with good psychometric properties and a high internal consistency, which is easy to use among children 911 years of age. This instrument is designed to assess the 5 CHILDRENS PHYSICAL ACTIVITY AND STRESS degree of perceived distress and the presence of symptoms or lower levels of well-being and important aspects of coping and social support (pg. 112). While parent and teacher rating scales for stress related observations in children do not seem to be readily available, this information will be gleaned by administering the BASC-2 parent and teacher forms and focusing on the ratings of social stress. Pre-intervention salivary cortisol levels in response to stressful situations will also be collected. We will use the process outlined by Strahler et al (2010) in their study on salivary a- amylase stress reactivity in children and adults. Prior to the intervention, we will administer the Trier Social Stress Test Child (TSST-C), which consists of giving students three minutes of preparation time, followed by the presentation of a five-minute oral story and five-minute mental arithmetic problems in front of an audience. Consistent with the procedure used by Strahler et al (2010), we will use cotton swabs to collect saliva immediately prior to the TSST-C, immediately after, ten minutes after, and twenty minutes after. Salivary cortisol levels will then be recorded. This portion of the proposed study will be conducted in hopes of replicating the recent study on the effect of exercise on salivary cortisol levels conducted by Martikainen et al (2013), which showed that higher levels of physical activity resulted in lower salivary cortisol levels after a stressful event. After initial pre-intervention data has been collected, the intervention will begin. Students in Group 1 (control group) will continue to engage in regular physical activity as they were prior to the start of this study, and no changes will be made to their in-school physical activity level. Students in Group 2 will begin a six-week program which will be facilitated by a trained instructor. Each week, these students will participate in three, 20 minute cardiovascular sessions using Zumba, which is a dance-based cardiovascular workout. In total, these students will 6 CHILDRENS PHYSICAL ACTIVITY AND STRESS participate in 18 sessions over the six weeks. Students in Group 3 will follow the same schedule, however, in addition to the same cardiovascular workout as Group 2, these students will also participate in a 20 minute strength-training program. In other words, Group 2 will have a 20 minute cardio workout three times a week, and Group 3 will have a 40 minute cardio and strength training program three times a week. Finally, post-intervention data will be collected using the same measures administered pre-intervention (parent, teacher, and student self-ratings scales as well as the re-administration of the TSST-C and collection of salivary cortisol levels). Data Analysis Analysis of the data will involve comparisons of pre and post-intervention data for all participants. Parent, teacher, and student rating scales from pre and post intervention will be compared and analyzed to determine any changes in reported information. Also, recorded cortisol levels will be analyzed to determine which, if any, patterns exist as a result of increased physical activity. Various statistical analyses will also be conducted, such as determining the mean cortisol levels in each group as well as for the sample as a whole pre and post intervention, and using correlation to consider the relationship between cortisol and physical activity. Variance between the groups will be determined using ANOVAs, and we will determine within group variance, between group variance, and total variance. The hope would be that the between group variance will be high, as that will indicate the effect which the intervention had on stress levels. Following the ANOVAs, we will conduct post-hoc comparisons using the Tukey HSD test to determine which of the three groups differed from each other and to what degree. Possible Results & Implications 7 CHILDRENS PHYSICAL ACTIVITY AND STRESS There are many possible results which we may see as a result of this study. The hypothesis is that participation in a targeted physical activity program over a six-week period will result in decreased levels of student stress as reported by parents, teachers, and the students themselves. Also, it is hypothesized that this involvement will reduce salivary cortisol levels in these students after experiencing stressful events. Finally, those students who participate in the physical activity at a higher intensity may experience more of this effect than those who participate in the lower intensity group. It could also be the case that physical activity has only an impact on ratings of student stress and not on salivary cortisol levels. That is, the experience or perception of stress may change, but the physiological response may stay the same. It is also possible that there will be no differences in student stress as a result of increased intensity. There are many potential implications of this study. First, the initial data collected from parents, teachers, and students, as well as pre-intervention salivary cortisol levels after experiencing a stressful situation, will give us important information regarding how stressed our students are. Second, if the hypothesis is correct and a targeted physical activity program in schools decreases student stress, this has implications for creating and implementing such programming in elementary schools. If the effect is large enough and generalizable, it may have implications for the amount of time schools allot for daily physical activity. Also, if the effect of the intervention is larger for the group which participated in the higher intensity program, this would have implications for the type of programming/curriculum which is offered in order to achieve maximum positive results. Of course, if the data indicate that physical activity had minimal impact on student stress levels, this would cause us to examine other possible interventions which would be more useful. Summary 8 CHILDRENS PHYSICAL ACTIVITY AND STRESS This study aims to examine whether a targeted physical activity program would have any impact on stress levels of school-aged children. Given the recent focus on childhood mental and physical health, it is an important and relevant topic. While it is hoped that this study is sound in terms of the methods/procedures and data collection/analysis used, it does have some potential limitations. First, it may be difficult to control childrens physical activity levels outside of the targeted programming, which could affect post-intervention data. For example, while we hope that students activity outside of the program will remain unchanged, it is possible that they may increase or decrease their activity levels during the course of the six-week intervention (i.e. starting swimming lessons afterschool or joining a soccer team). This increase or decrease in activity outside of the intervention programming may skew the results. One way to decrease this effect would be to ask parents to keep their childs activity levels the same as they normally would be for the duration of the study; that is, not to start or stop any physical activities during the study. Another limitation of this study is that while we are using the SiC questionnaire to determine child self-ratings, there are not many readily available parent/teacher ratings of child stress. Therefore, in this study we are using a general measure of behaviour which includes, but does not focus solely on, stress. It would be ideal to utilize a parent/teacher rating scale which focuses solely on child stress behaviours/experiences. Limitations notwithstanding, this study also has many strengths, including a large sample size, the use of randomized control trials, comprehensive pre and post assessment data collection including salivary cortisol levels in response to stressful experiences, and comprehensive data analysis using well-researched techniques. Whether or not the results are consistent with the hypotheses, the implications will still be useful in terms of determining levels of student stress 9 CHILDRENS PHYSICAL ACTIVITY AND STRESS and possible interventions to reduce and or alleviate both the behavioural and physiological experiences of stress for school aged children. As research in the area of how physical activity may affect stress levels in children is scarce, it would be beneficial for future studies to attempt to replicate and/or extend this study. Various aspects of the study can be modified such as the measurement tools used, the exact type of physical activity programming, and the duration of the intervention. Future studies should also focus on different age groups, particularly middle school and high school students whose stress levels may be particularly high. It may also be interesting to consider how the time of day during which the intervention occurs is related to changes in stress levels. As this is an under-researched area of study, there are many options for future directions.
10 CHILDRENS PHYSICAL ACTIVITY AND STRESS References Martikainen, S., Pesonen, A.K., Lahti, J., Heinonen, K., Feldt, K., Pyhala, R., Tammelin, T., Kajantie, E., Eriksson, J.G., Strandberg, T.E., & Raikkonen, K. (2013). Higher levels of physical activity are associated with lower hypothalamic-pituitary-adrenocortical axis reactivity to psychosocial stress in children. Journal of Clinical Endocrinology and Metabolism, 98(4), pp. 1- 9. Nieman, P. (2002). Psychosocial aspects of physical activity. Journal of Paediatric Child Health, 7(5), pp. 309-312. Osika, W., Friberg, P., & Wahrborg, P. (2007). A new short self-rating questionnaire to assess stress in children. International Journal of Behavioral Medicine, 14(2), pp. 108-117. Parfitt, G., Pavey, T., & Rowlands, A.V. (2009). Childrens physical activity and psychological health: the role of intensity. Acta Pediatrica, 98, pp. 1037-1043. DOI 10.1111/j.1651-2227.2009.01255.x Strahler, J., Mueller, A., Rosenloecher, F., Kirschbaum, C., & Rohleder, N. (2010). Salivary a-amylase stress reactivity across different age groups. Psychophysiology, 47, 587595. DOI: 10.1111/j.1469-8986.2009.00957.x Terjestam, Y., Jouper, J., & Johansson, C. (2010). Effects of scheduled Qigong exercise on pupils well-being, self-image, distress, and stress. The Journal of Alternative and Complementary Medicine, 16(9), pp. 939-944.