Persistent visual and vestibular impairments for Postural control following concussion

Neurology ◽  
2020 ◽  
Vol 95 (20 Supplement 1) ◽  
pp. S14.3-S15
Author(s):  
Jaclyn B. Caccese ◽  
Fernando Vanderlinde Santos ◽  
Felipe Yamaguchi ◽  
John J. Jeka
Keyword(s):  
Confidence Interval ◽  
Visual Stimulus ◽  
Group Differences ◽  
Control Group ◽  
Upright Stance ◽  
Post Injury ◽  
Sensory Reweighting ◽  
Vestibular Stimulus ◽  
Concussion History ◽  
Proprioceptive Stimulus

ObjectiveThe purpose of this study was to examine sensory reweighting for upright stance in three groups (i.e., sub-acute concussion, concussion history, control).BackgroundBalance impairments are common following concussion; however, the physiologic mechanisms underlying these impairments are not well understood.Design/methodsThere were 13 participants (8 women, 21 ± 3 years) between 2 weeks and 6 months post-injury who reported being asymptomatic at the time of testing (i.e., sub-acute concussion group), 13 participants (8 women, 21 ± 1 year) with a history of concussion (i.e., concussion history group, >1 year following concussion), and 26 participants (8 women, 22 ± 3 years) with no concussion history (i.e., control group). We assessed sensory reweighting by simultaneously perturbing participants' visual, vestibular, and proprioceptive systems. The visual stimulus was a sinusoidal translation of the visual scene at 0.2Hz, the vestibular stimulus was ±1 mA binaural monopolar galvanic vestibular stimulation (GVS) at 0.36Hz, and the proprioceptive stimulus was Achilles' tendon vibration at 0.28Hz. The visual stimulus was presented at two different amplitudes (low vision = 0.2m, high vision = 0.8m). We computed center of mass gain to each modality.ResultsThe sub-acute concussion group (95% confidence interval = 0.078-0.115, p = 0.001) and the concussion history group (95% confidence interval = 0.056-0.094, p = 0.038) had higher gains to the visual stimulus than the control group (95% confidence interval = 0.040-0.066). The sub-acute concussion group (95% confidence interval = 0.795–1.159, p = 0.002) and the concussion history group (95% confidence interval = 0.633–1.012, p = 0.018) had higher gains to the vestibular stimulus than the control group (95% confidence interval = 0.494-0.752). There were no group differences in gains to the proprioceptive stimulus and there were no group differences in sensory reweighting.ConclusionsFollowing concussion, participants responded more strongly to visual and vestibular stimuli during upright stance, suggesting they may have abnormal dependence on visual and vestibular feedback. These findings may indicate an area for targeted rehabilitation interventions.

scholarly journals Repetitive head impact exposure and sensory reweighting for upright stance

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S6.2-S6
Author(s):  
Felipe Yamaguchi ◽  
Jaclyn Caccese ◽  
Fernando Santos ◽  
John Jeka
Keyword(s):  
Visual Stimulus ◽  
Repeated Measures ◽  
Vestibular Function ◽  
Group Differences ◽  
Upright Stance ◽  
Sensory Reweighting ◽  
Head Impacts ◽  
Posterior Direction ◽  
Anterior Posterior ◽  
Soccer Heading

ObjectiveTo compare sensory reweighting between soccer players who report higher exposure to soccer heading and those who report lower exposure to soccer heading.BackgroundExposure to repetitive head impacts (RHI), such as through routine soccer heading, may have potentially detrimental effects.Design/MethodsThirty participants completed a self-reported questionnaire to estimate the number of RHI sustained weekly, and were divided into low-, medium-, and high-RHI groups based on their responses. Sensory reweighting was compared between low-RHI (N = 10, 4 males, 22.9 ± 3.0 years, 170.5 ± 7.7 cm, 70.0 ± 12.14 kg, 2 ± 2 RHI) and high-RHI groups (N = 10, 5 males, 20.0 ± 1.1 years, 170.4 ± 7.4 cm, 69.6 ± 13.4 kg, 60 ± 37 RHI). Participants experienced a visual stimulus at 0.2 Hz, a ±1 mA binaural monopolar galvanic vestibular stimulus (GVS) at 0.36 Hz, and a vibratory stimulus to their bilateral Achilles tendons at 0.28 Hz during standing. The visual stimulus was presented at different amplitudes (0.2, 0.8 m translation in the anterior-posterior direction) to measure the change in leg gain to vision, gain to vibration, and gain to GVS. A repeated-measures ANOVA was used to compare sensory reweighting between groups.ResultsThere were group differences in sensory reweighting for leg gain to GVS (i.e. condition X group effect; F3,54 = 5.068, p = 0.004, η2 = 0.220), whereby the high-RHI group did not reweight gain to GVS across conditions, and gain to vision (F3,54 = 3.397, p = 0.024, η2 = 0.159), whereby the high-RHI group had higher gains than the low-RHI group in the 0.2 m visual stimulus condition. There were no group differences in sensory reweighting for gain to vibration (F1,18 = 0.045, p = 0.834, η2 = 0.003).ConclusionsRoutine soccer heading is associated with relatively high head accelerations. These results suggest that exposure to frequent RHI may induce adaptation that diminishes reliance on vestibular function. Consequently, visual feedback is upweighted to maintain balance during upright stance.

scholarly journals Influence of Family History of Neurodegenerative Diseases on Outcome Following Pediatric Concussion

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S7.2-S8
Author(s):  
Colt Coffman ◽  
Jacob Kay ◽  
Adam Harrison ◽  
Jeffery Holloway ◽  
Robert Davis Moore
Keyword(s):  
Family History ◽  
Neurodegenerative Disease ◽  
Clinical Symptoms ◽  
Cognitive Outcomes ◽  
Group Differences ◽  
Post Injury ◽  
Pediatric Concussion ◽  
History Of ◽  
Concussion History ◽  
Data Group

ObjectiveTo longitudinally evaluate the relation between family history of neurodegenerative disease and clinical symptoms, as well as vestibular-ocular and cognitive outcomes following concussion in children.BackgroundResearch indicates that pediatric concussion may lead to chronic alterations in neuropsychological health that can adversely affect neurodevelopment. Therefore, it is critical to identify risk factors that may moderate recovery to improve concussion outcomes in children. Evidence suggests that one such moderator may be a family history of neurodegenerative disease (FHND).Design/MethodsData were collected from a local pediatric concussion clinic. Patients were examined at 2- and 5-weeks post-injury. Clinical symptoms were measured using the Rivermead Post-Concussion Symptoms Questionnaire (RPQ). Vestibular-ocular function was assessed using the Vestibular/Ocular Motor Screening (VOMS) tool. Cognition was measured using a modified CogState Brain Injury Test Battery. Log-transformations were applied to normalize data. Group differences between those with (n = 13) and without (n = 26) a family history of neurodegenerative disease (Alzheimer’s, Non-Alzheimer’s Dementias, Parkinson’s, and/or Multiple Sclerosis) were analyzed. Children without FHND were double-matched based on sex, age, and concussion history.ResultsAcross timepoints, children with FHND reported more severe clinical symptoms on the RPQ (p’s < 0.05). Additionally, those with FHND showed higher VOMS saccades scores across timepoints compared to those without FHND (p’s < 0.05). Further, children with FHND reported greater dizziness following VOMS saccades and convergence tests at 5-weeks post-injury (p’s < 0.01). No group differences at any timepoint were observed for any measure of cognition.ConclusionsOur findings indicate that a family history of neurodegenerative disease is associated with more severe clinical symptoms and greater vestibular-ocular dysfunction following pediatric concussion.

scholarly journals Age of first exposure to soccer heading and sensory reweighting for upright stance

Neurology ◽  
2019 ◽  
Vol 93 (14 Supplement 1) ◽  
pp. S6.1-S6
Author(s):  
Jaclyn Caccese ◽  
Fernando Santos ◽  
Felipe Yamaguchi ◽  
John Jeka
Keyword(s):  
Early Adolescence ◽  
Repeated Measures ◽  
Soccer Players ◽  
Upright Stance ◽  
Sensory Reweighting ◽  
Behavioral Deficits ◽  
Balance Deficits ◽  
Concussion History ◽  
Soccer Heading

ObjectiveTo compare sensory reweighting for upright stance between soccer players who began soccer heading before age 10 years (AFE ≤ 10) and those who began soccer heading after age 10 years (AFE > 10).BackgroundIn 2015, US Soccer announced an initiative to eliminate soccer heading for youth players ages 10 years and younger and to limit soccer heading for children ages 11 to 13 years. Limited empirical evidence associates soccer heading during early adolescence and long-term behavioral deficits.Design/MethodsThirty college-aged soccer players self-reported AFE to soccer heading. Sensory reweighting was compared between AFE ≤ 10 [n = 19, 11 males (58%), 22 ± 3 years, 171 ± 9 cm, 70 ± 11 kg, 5 with concussion history (26%)] and AFE > 10 [N = 11, 5 males (45%), 22 ± 2 years, 172 ± 7 cm, 69 ± 13 kg, 3 with concussion history (27%)]. To evaluate sensory reweighting, we simultaneously perturbed upright stance with visual (i.e., moving visual scene at 0.2 Hz), vestibular (i.e., ±1 mA bilateral monopolar galvanic vestibular stimulus (GVS) at 0.36 Hz), and proprioceptive stimulation (i.e., 80 Hz vibratory stimulus to their bilateral Achilles tendons at 0.28 Hz). The visual stimulus was presented at different amplitudes (i.e., 0.2 m, 0.8 m in the anterior-posterior (AP) direction) to measure the leg-segment AP displacement change in gain to vision, an intramodal effect; and change in gain to GVS and vibration, both intermodal effects. A repeated-measures ANOVA was used to compare sensory reweighting between groups.ResultsThere were no differences in gain to vision (F1,28 = 0.033, p = 0.857, η2 = 0.001), gain to GVS (F1,28 = 0.001, p = 0.971, η2 = 0.000), or gain to vibration (F1,28 = 0.001, p = 0.974, η2 = 0.000), and no differences in sensory reweighting (i.e. conditionXgroup effect; vision, F3,84 = 0.160, p = 0.923, η2 = 0.006; GVS, F3,84 = 0.043, p = 0.988, η2 = 0.002; vibration, F1,28 = 0.068, p = 0.797, η2 = 0.002).ConclusionsThere were no differences in sensory processing for upright stance between AFE ≤ 10 and AFE > 10, suggesting that soccer heading during early adolescence is not associated with balance deficits in college-aged soccer players, notwithstanding potential deficits in other markers of neurological function.

scholarly journals Physical Fitness in Patients With Ankylosing Spondylitis: Comparison With Population Controls

2012 ◽  
Vol 92 (2) ◽  
pp. 298-309 ◽  
Author(s):  
Silje Halvorsen ◽  
Nina K. Vøllestad ◽  
Camilla Fongen ◽  
Sella A. Provan ◽  
Anne G. Semb ◽  
...  
Keyword(s):  
Ankylosing Spondylitis ◽  
Physical Therapy ◽  
Confidence Interval ◽  
Physical Fitness ◽  
Disease Activity ◽  
Cardiorespiratory Fitness ◽  
Patient Group ◽  
Group Differences ◽  
Control Group ◽  
Muscular Capacity

Background Although flexibility traditionally has been the main focus for physical therapy in patients with ankylosing spondylitis (AS), there is now evidence for an increased risk of cardiovascular diseases (CVDs) in this group. Objective The purposes of this study were: (1) to compare physical fitness (cardiorespiratory fitness, muscular capacity, flexibility, and balance) in patients with AS and controls and (2) to explore associations between physical fitness and disease activity in the patient group. Design This was a cross-sectional study. Methods The physical fitness variables were cardiorespiratory fitness (treadmill test for estimation of peak oxygen uptake [V̇o2peak]), muscular capacity (push-ups test), balance (30-second single-leg stand and walking in a figure-of-eight pattern), and flexibility (Bath Ankylosing Spondylitis Metrology Index [BASMI]). The Ankylosing Spondylitis Disease Activity Score (ASDAS) was used to assess disease activity. Group differences and associations were tested with the chi-square test for categorical variables, the Mann-Whitney U test for ordinal variables, and analysis of covariance for continuous variables. Results One hundred forty-nine of 250 of the invited patients with AS and 133 of 329 of the invited controls were included in the study. The mean ASDAS score of the patient group was 2.3 (range=0.5–4.7), and the median disease duration was 23 years (range=7–55). The patient group had significantly lower V̇o2 peak values, with a mean difference of −2.7 mL·kg−1·min−1 (95% confidence interval=−4.3, −1.1), and higher BASMI scores, with a mean difference of 1.6 (95% confidence interval=1.5, 1.8), compared with the control group. No group differences were found in balance or muscular capacity. In the patient group, significant inverse associations were found between ASDAS scores and V̇o2peak and muscular capacity. Limitations The response rate was lower in the control group (40.4%) than in the patient group (59.6%). Conclusion The lower cardiorespiratory fitness and reduced flexibility in the AS group indicate that physical therapy programs should include cardiorespiratory fitness exercises as a basic component to reduce the risk of cardiovascular disease.

Preventing Post-injury Hypothermia During Prolonged Prehospital Evacuation

2002 ◽  
Vol 17 (1) ◽  
pp. 23-26 ◽  
Author(s):  
Hans Husum ◽  
Tone Olsen ◽  
Mudhafar Murad ◽  
Yang Van Heng ◽  
Torben Wisborg ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Hospital Admission ◽  
Penetrating Trauma ◽  
Mean Value ◽  
Control Group ◽  
Prospective Clinical Study ◽  
Trauma Patients ◽  
Post Injury ◽  
Northern Iraq ◽  
Care Protocol

AbstractIntroduction:Post-injury hypothermia is a risk predictor in trauma patients whose physiology is deranged. The aim of the present study was to examine the effect of simple, in-field, hypothermia prevention to victims of penetrating trauma during long prehospital evacuations.Methods:A total of 170 consecutively injured landmine victims were included in a prospective, clinical study in Northern Iraq and Cambodia. Thirty patients were provided with systematic prehospital hypothermia prevention, and for 140 patients, no preventive measures were provided.Results:The mean value for the time from injury to hospital admission was 6.6 hours (range: 0.2–72). The incidence of hypothermia (oral temperature <36°C) before prevention/rewarming was 21% (95% confidence interval: 15% to 28%). The Prevention Group had a statistically significant lower rate of hypothermia on hospital admission compared to the control group (95% confidence interval for difference: 6% to 24%).Conclusion:Simple, preventive, in-field measures help to prevent hypothermia during protracted evacuation, and should be part of the trauma care protocol in rural rescue systems.

scholarly journals Age of First Exposure to Soccer Heading and Sensory Reweighting for Upright Stance

2020 ◽  
Vol 41 (09) ◽  
pp. 616-627
Author(s):  
Jaclyn B. Caccese ◽  
Fernando V. Santos ◽  
Felipe Yamaguchi ◽  
John J. Jeka
Keyword(s):  
Visual Stimulus ◽  
Early Adolescence ◽  
Soccer Players ◽  
Upright Stance ◽  
Sensory Reweighting ◽  
Behavioral Deficits ◽  
Proprioceptive Stimulation ◽  
Balance Deficits ◽  
Soccer Heading

AbstractUS Soccer eliminated soccer heading for youth players ages 10 years and younger and limited soccer heading for children ages 11–13 years. Limited empirical evidence associates soccer heading during early adolescence with medium-to-long-term behavioral deficits. The purpose of this study was to compare sensory reweighting for upright stance between college-aged soccer players who began soccer heading ages 10 years and younger (AFE ≤ 10) and those who began soccer heading after age 10 (AFE > 10). Thirty soccer players self-reported age of first exposure (AFE) to soccer heading. Sensory reweighting was compared between AFE ≤ 10 and AFE > 10. To evaluate sensory reweighting, we simultaneously perturbed upright stance with visual, vestibular, and proprioceptive stimulation. The visual stimulus was presented at two different amplitudes to measure the change in gain to vision, an intra-modal effect; and change in gain to galvanic vestibular stimulus (GVS) and vibration, both inter-modal effects. There were no differences in gain to vision (p=0.857, η2=0.001), GVS (p=0.971, η2=0.000), or vibration (p=0.974, η2=0.000) between groups. There were no differences in sensory reweighting for upright stance between AFE ≤ 10 and AFE > 10, suggesting that soccer heading during early adolescence is not associated with balance deficits in college-aged soccer players, notwithstanding potential deficits in other markers of neurological function

EXPRESS: Altering the rehabilitation environment to improve stroke survivor activity (AREISSA): a Phase II trial.

2021 ◽  
pp. 174749302110069
Author(s):  
Heidi Janssen ◽  
Louise Ada ◽  
Sandy Middleton ◽  
Michael Pollack ◽  
Michael Nilsson ◽  
...  
Keyword(s):  
Adverse Events ◽  
Clinical Outcomes ◽  
Environmental Enrichment ◽  
Brain Plasticity ◽  
Social Activity ◽  
Stroke Survivor ◽  
Group Differences ◽  
Control Group ◽  
Serious Adverse Events ◽  
Clinical Trial Registration

Background: Environmental enrichment involves organisation of the environment and provision of equipment to facilitate engagement in physical, cognitive and social activity. In animals with stroke, it promotes brain plasticity and recovery. Aims: To assess the feasibility and safety of a patient-driven model of environmental enrichment incorporating access to communal and individual environmental enrichment. Methods: A non-randomised cluster trial with blinded measurement involving people with stroke (n=193) in 4 rehabilitation units was carried out. Feasibility was operationalised as activity 10 days after admission to rehabilitation and availability of environmental enrichment. Safety was measured as falls and serious adverse events. Benefit was measured as clinical outcomes at 3 months, by an assessor blinded to group. Results: The experimental group (n=91) spent 7% (95% CI -14 to 0) less time inactive, 9% (95% CI 0 to 19) more time physically, and 6% (95% CI 2 to 10) more time socially active than the control group (n=102). Communal environmental enrichment was available 100% of the time, but individual environmental enrichment was rarely within reach (24%) or sight (39%). There were no between-group differences in serious adverse events or falls at discharge or 3 months nor in clinical outcomes at 3 months. Conclusions: This patient-driven model of environmental enrichment was feasible and safe. However, the very modest increase in activity by people with stroke, and the lack of benefit in clinical outcomes 3 months after stroke do not provide justification for an efficacy trial. Clinical Trial Registration: ANZCTR 12613000796785 Words: 245

scholarly journals Retinal vascular fractal dimensions and their association with macrovascular cardiac disease.

2021 ◽  
Author(s):  
Sebastian Dinesen ◽  
Pia Søndergaard Jensen ◽  
Maria Bloksgaard ◽  
Søren Leer Blindbæk ◽  
Jo G.R. De Mey ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Cardiac Disease ◽  
Artery Bypass ◽  
Fractal Dimensions ◽  
Macrovascular Disease ◽  
Control Group ◽  
Vascular Structure ◽  
Non Invasive ◽  
Automatic Software ◽  
Multivariable Regression

Introduction As the only part of the human vasculature, retina is available for direct, non-invasive inspection. Retinal vascular fractal dimension (DF) is a method to measure the structure of the retinal vascular tree, with higher non-integer values between 1 and 2 representing a more complex and dense retinal vasculature. Retinal vascular structure has been associated with a variety of systemic diseases and this study examined the association of DF and macrovascular cardiac disease in a case-control design. Methods Retinal fundus photos were captured with Topcon TRC-50X in 38 persons that had coronary artery bypass grafting (CABG, cases) and 37 cardiovascular healthy controls. The semi-automatic software VAMPIRE was used to measure retinal DF. Results Patients with CABG had lower DF of the retinal main venular vessels compared to the control group (1.15 vs. 1.18, p=0.01). In a multivariable regression model adjusted for gender and age, eyes in the fourth quartile with higher DF were less likely to have CABG compared to patients in the first (OR, 7.20; 95% confidence interval, 1.63 to 31.86; p=0.009) and second quartile (OR, 8.25; 95% confidence interval, 1.70 to 40.01; p=0.009). Conclusions This study demonstrates that lower complexity of main venular vessels associates with higher risk of having CABG. The research supports the hypothesis that the retinal vascular structure can be used to assess non-ocular macrovascular disease.

scholarly journals Effects of a Rehabilitation Programme Using a Nasal Inspiratory Restriction Device in COPD

2021 ◽  
Vol 18 (8) ◽  
pp. 4207
Author(s):  
Jose L. Gonzalez-Montesinos ◽  
Jorge R. Fernandez-Santos ◽  
Carmen Vaz-Pardal ◽  
Jesus G. Ponce-Gonzalez ◽  
Alberto Marin-Galindo ◽  
...  
Keyword(s):  
Pulmonary Rehabilitation ◽  
Rehabilitation Programme ◽  
Group Differences ◽  
Control Group ◽  
Chronic Obstructive ◽  
Maximum Value ◽  
Copd Patients ◽  
Significant Difference ◽  
Pulmonary Rehabilitation Programme ◽  
Positive Increment

Chronic obstructive pulmonary disease (COPD) patients are characterised for presenting dyspnea, which reduces their physical capacity and tolerance to physical exercise. The aim of this study was to analyse the effects of adding a Feel-Breathe (FB) device for inspiratory muscle training (IMT) to an 8-week pulmonary rehabilitation programme. Twenty patients were randomised into three groups: breathing with FB (FBG), oronasal breathing without FB (ONBG) and control group (CG). FBG and ONBG carried out the same training programme with resistance, strength and respiratory exercises for 8 weeks. CG did not perform any pulmonary rehabilitation programme. Regarding intra group differences in the value obtained in the post-training test at the time when the maximum value in the pre-training test was obtained (PostPRE), FBG obtained lower values in oxygen consumption (VO2, mean = −435.6 mL/min, Bayes Factor (BF10) > 100), minute ventilation (VE, −8.5 L/min, BF10 = 25), respiratory rate (RR, −3.3 breaths/min, BF10 = 2), heart rate (HR, −13.7 beats/min, BF10 > 100) and carbon dioxide production (VCO2, −183.0 L/min, BF10 = 50), and a greater value in expiratory time (Tex, 0.22 s, BF10 = 12.5). At the maximum value recorded in the post-training test (PostFINAL), FBG showed higher values in the total time of the test (Tt, 4.3 min, BF10 = 50) and respiratory exchange rate (RER, 0.05, BF10 = 1.3). Regarding inter group differences at PrePOST, FBG obtained a greater negative increment than ONBG in the ventilatory equivalent of CO2 (EqCO2, −3.8 L/min, BF10 = 1.1) and compared to CG in VE (−8.3 L/min, BF10 = 3.6), VCO2 (−215.9 L/min, BF10 = 3.0), EqCO2 (−3.7 L/min, BF10 = 1.1) and HR (−12.9 beats/min, BF10 = 3.4). FBG also showed a greater PrePOST positive increment in Tex (0.21 s, BF10 = 1.4) with respect to CG. At PreFINAL, FBG presented a greater positive increment compared to CG in Tt (4.4 min, BF10 = 3.2) and negative in VE/VCO2 intercept (−4.7, BF10 = 1.1). The use of FB added to a pulmonary rehabilitation programme in COPD patients could improve tolerance in the incremental exercise test and energy efficiency. However, there is only a statically significant difference between FBG and ONBG in EqCO2. Therefore, more studies are necessary to reach a definitive conclusion about including FB in a pulmonary rehabilitation programme.

scholarly journals Can Health-Promoting Schools Contribute to Better Health Behaviors? Physical Activity, Sedentary Behavior, and Dietary Habits among Israeli Adolescents

2021 ◽  
Vol 18 (3) ◽  
pp. 1183
Author(s):  
Hila Beck ◽  
Riki Tesler ◽  
Sharon Barak ◽  
Daniel Sender Moran ◽  
Adilson Marques ◽  
...  
Keyword(s):  
Physical Activity ◽  
Health Behavior ◽  
Confidence Interval ◽  
Health Behaviors ◽  
Sedentary Behavior ◽  
Dietary Habits ◽  
Group Differences ◽  
Time Behavior ◽  
Health Promoting ◽  
The Mean

Schools with health-promoting school (HPS) frameworks are actively committed to enhancing healthy lifestyles. This study explored the contribution of school participation in HPS on students’ health behaviors, namely, physical activity (PA), sedentary behavior, and dieting. Data from the 2018/2019 Health Behavior in School-aged Children study on Israeli adolescents aged 11–17 years were used. Schools were selected from a sample of HPSs and non-HPSs. Between-group differences and predictions of health behavior were analyzed. No between-group differences were observed in mean number of days/week with at least 60 min of PA (HPS: 3.84 ± 2.19 days/week, 95% confidence interval of the mean = 3.02–3.34; non-HPS: 3.93 ± 2.17 days/week, 95% confidence interval of the mean = 3.13–3.38). Most children engaged in screen time behavior for >2 h/day (HPS: 60.83%; non-HPS: 63.91%). The odds of being on a diet were higher among more active children (odds ratio [OR] = 1.20), higher socio-economic status (OR = 1.23), and female (OR = 2.29). HPS did not predict any health behavior. These findings suggest that HPSs did not contribute to health behaviors more than non-HPSs. Therefore, health-promoting activities in HPSs need to be improved in order to justify their recognition as members of the HPS network and to fulfill their mission.

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