The Health Of Us Adolescent Athletes During Covid-19 Related School Closures And Sport Cancellations

2020 ◽  
Author(s):  
Timothy A. McGuine ◽  
Kevin M Biese ◽  
Labina Petrovska ◽  
Scott J Hetzel ◽  
Claudia Reardon ◽  
...  

Abstract Context: In the spring of 2020, US schools closed to in-person teaching and sports were cancelled to control the transmission of COVID-19. It is critical to understand the mental and physical health of adolescent athletes during this time. Objective: Describe the health of athletes during COVID-19 related school closures and sport cancellations. Design: Cross sectional. Setting: A national sample recruited via social media. Patients or Other Participants: 13,002 US adolescent athletes (age=16.3+1.2 yrs., female=53.1%) completed an anonymous online survey. Main Outcome Measure(s): Demographic information included: sex, grade, sports played and zip code. Assessments included the: General Anxiety Disorder-7 Item (GAD-7) for anxiety, Patient Health Questionnaire-9 Item (PHQ-9) for depression, the Pediatric Functional Activity Brief Scale (PFABS) for physical activity, and the Pediatric Quality of Life Inventory 4.0 (PedsQL) for quality of life. Mental health, physical activity and quality of life variables were compared between sex, grade, sports played and poverty level using means and 95%CI from the survey weighted ANOVA. Results: Females reported a higher prevalence of moderate to severe anxiety symptoms (females=43.7% vs. males=28.2%). The PFABS score (mean [95%CI] was highest (best) for grade 9 (14.5 [14.0,15.0]) and lowest for grade 11 (10.9 [10.5,11.3]. The prevalence of depression symptoms was highest in team sport (74.1%) and lowest for individual sport participants (64.9%). The total PedsQL score was lowest (worst) for athletes from counties with the highest poverty levels (high=74.5[73.7,75.3], middle=78.9[78.0,79.8], low=78.3 [77.4,79.1]). Conclusions: The health of US adolescents during the COVID-19 related school closures and sport cancellations varied to differing degrees depending on sex, grade level, type of sport participation and level of poverty. Health policy experts should consider these findings when creating and implementing policies to improve the health of adolescents in the US in the future.

Author(s):  
Timothy A. McGuine ◽  
Kevin Biese ◽  
Scott J. Hetzel ◽  
Labina Petrovska ◽  
Stephanie Kliethermes ◽  
...  

ABSTRACT Context: In the spring of 2020, schools closed to in-person teaching and sports were cancelled to control the transmission of CoVID-19. The changes that took place to the physical and mental health among young athletes during this time remain unknown, however. Objective: Identify changes in the health (mental health, physical activity and quality of life) of athletes that occurred during the CoVID-19 pandemic. Design: Cross-sectional study. Setting: Sample recruited via social media. Patients or Other Participants: 3243 Wisconsin adolescent athletes (age=16.2±1.2 yrs., female=58% female) completed an online survey in May 2020 (DuringCoVID-19). Health measures for this cohort were compared with previously reported data for Wisconsin adolescent athletes (n=5231, age=15.7±1.2, 47% female) collected in 2016–2018 (PreCoVID-19). Main Outcome Measure(s): Demographic information included: sex, grade and sports played. Health assessments included the Patient Health Questionnaire-9 Item (PHQ-9) to identify depression symptoms, the Pediatric Functional Activity Brief Scale (PFABS) for physical activity, and the Pediatric Quality of Life Inventory 4.0 (PedsQL) for health related quality of life (HRQoL). Univariable comparisons of these variables between groups were made via t-tests or chi-square tests. Means and 95% confidence intervals (CI) for each group were estimated by survey weighted ANOVA models. RESULTS: Compared to PreCoVID-19, a larger proportion of the During-CoVID-19 participants reported rates of moderate to severe levels of depression (9.7% vs 32.9%, p<0.001). During-CoVID-19 participants reported 50% lower (worse) PFABS scores (mean:12.2 [95%CI: 11.9, 12.5] vs 24.7 [24.5, 24.9] p<0.001) and lower (worse) PedsQL total scores compared to the PreCoVID-19 participants (78.4 [78.0, 78.8] vs. 90.9 [90.5, 91.3] p<0.001). CONCLUSIONS: During the CoVID-19 pandemic, adolescent athletes reported increased symptoms of depression, decreased physical activity and decreased quality of life compared to adolescent athletes in previous years.


Author(s):  
Timothy A. McGuine ◽  
Kevin M. Biese ◽  
Labina Petrovska ◽  
Scott J. Hetzel ◽  
Claudia Reardon ◽  
...  

Context In the spring of 2020, US schools closed to in-person teaching and sports were cancelled to control the transmission of coronavirus disease 2019 (COVID-19). It is critical to understand the mental and physical health of adolescent athletes during this time. Objective To describe the health of athletes during COVID-19–related school closures and sport cancellations. Design Cross-sectional study. Setting A national sample recruited via social media. Patients or Other Participants A total of 13 002 US adolescent athletes (age = 16.3 ± 1.2 years, females = 52.9%, males = 47.0%) completed an anonymous online survey. Main Outcome Measure(s) Demographic information collected was sex, grade, sport(s) played, and zip code. Assessments used were the General Anxiety Disorder 7-Item for anxiety, Patient Health Questionnaire 9-Item for depression, the Pediatric Functional Activity Brief Scale for physical activity, and the Pediatric Quality of Life Inventory 4.0 for quality of life. Mental health, physical activity, and health-related quality-of-life variables were compared among sex, grade, sport(s) played, and poverty level using means and 95% confidence intervals (CIs) from the survey-weighted analysis of variance. Results Females reported a higher prevalence of moderate to severe anxiety symptoms (females = 43.7% versus males = 28.2%). The Pediatric Functional Activity Brief Scale score was highest (best) for grade 9 (mean = 14.5, 95% CI = 14.0, 15.0) and lowest for grade 11 (mean = 10.9, 95% CI = 10.5, 11.3. The prevalence of depression symptoms was highest in team sport (74.1%) and lowest in individual sport (64.9%) participants. The total Pediatric Quality of Life Inventory score was lowest (worst) for athletes from counties with the highest poverty levels (high: mean = 74.5, 95% CI = 73.7, 75.3; middle: mean = 78.9, 95% CI = 78.0, 79.8; and low: mean = 78.3, 95% CI = 77.4, 79.1). Conclusions The health of US adolescents during the COVID-19–related school closures and sport cancellations varied to differing degrees depending on sex, grade level, type of sport participation, and level of poverty. Health policy experts should consider these findings in the future when creating and implementing policies to improve the health of adolescents in the United States.


2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0017
Author(s):  
Timothy McGuine ◽  
Kevin Biese ◽  
Scott Hetzel ◽  
Stephanie Kliethermes ◽  
Claudia Reardon ◽  
...  

Background: In March 2020, schools were closed to in-person teaching and interscholastic sports cancelled in an attempt to slow the spread of the COVID-19. Child health experts have stated that school closures may have profound psychosocial consequences for students and need further study. Hypothesis/Purpose: To identify how COVID-19 related school closures and sport cancellations impacted the health of adolescent athletes. Methods: Adolescent athletes in Wisconsin were recruited via social media to complete an online survey in May 2020 while schools were closed to in-person teaching and interscholastic and club sports were cancelled. Assessments included the: General Anxiety Disorder-7 Item (GAD-7) for anxiety, Patient Health Questionnaire-9 Item (PHQ-9) for depression, the Pediatric Functional Activity Brief Scale (PFABS) for physical activity, and the Pediatric Quality of Life Inventory 4.0 (PedsQL) for quality of life. PHQ-9, PFABS and PedsQL scores were compared with historical data (HD) of Wisconsin adolescent athletes (N = 5,231) collected during normal school and sport operations in the years 2016–2018. Results: A total of 3,243 (58% female, Age = 16.1+1.2 yrs., grades 9 – 12) participated in the study. May 2020 participants reported higher (worse) PHQ-9 scores than the HD participants (mean: 8.0 (95%CI: 7.8, 8.2) vs 3.3 (3.1, 3.5), p < 0.001) as well as a higher prevalence of moderate to severe levels of depression (32.9% vs 9.7%, p < 0.001). May 2020 Participants also reported lower (worse) PFABS scores (mean: 12.2 (95%CI: 11.9, 12.5) vs 24.7 (24.5, 24.9) p < 0.001) and lower (worse) PedsQL total scores compared to athletes in the HD group (78.4 (78.0, 78.8) vs. 90.9 (90.5, 91.3) p < 0.001). Females in May 2020 reported increased moderate and severe anxiety percentages than the males in May 2020 (27.7% vs 22.3%, p < 0.001). Conclusions: COVID-19 related school closures and sport cancellations in Wisconsin were associated with increased anxiety and depression as well as decreased physical activity and quality of life in adolescent athletes. The potential negative health impacts of prolonged school closures and sport cancellations should be taken into account when evaluating steps to limit the spread of COVID-19.


2021 ◽  
Author(s):  
Timothy A. McGuine ◽  
Kevin Biese ◽  
Scott J. Hetzel ◽  
Labina Petrovska ◽  
Stephanie Kliethermes ◽  
...  

ABSTRACTContextIn the spring of 2020, schools closed to in-person teaching and sports were cancelled to control the transmission of CoVID-19. The changes that took place to the physical and mental health among young athletes during this time remain unknown, however.ObjectiveIdentify changes in the health (mental health, physical activity and quality of life) of athletes that occurred during the CoVID-19 pandemic.DesignCross sectional study.SettingSample recruited via social media.Patients or Other Participants3243 Wisconsin adolescent athletes (age=16.2±1.2 yrs., female=58% female) completed an online survey in May 2020 (DuringCoVID-19). Health measures for this cohort were compared with previously reported data for Wisconsin adolescent athletes (n=5231, age=15.7±1.2, 47% female) collected in 2016–2018 (PreCoVID-19).Main Outcome Measure(s)Demographic information included: sex, grade and sports played. Health assessments included the Patient Health Questionnaire-9 Item (PHQ-9) to identify depression symptoms, the Pediatric Functional Activity Brief Scale (PFABS) for physical activity, and the Pediatric Quality of Life Inventory 4.0 (PedsQL) for health related quality of life (HRQoL). Univariable comparisons of these variables between groups were made via t-tests or chi-square tests. Means and 95% confidence intervals (CI) for each group were estimated by survey weighted ANOVA models.RESULTSCompared to PreCoVID-19, a larger proportion of the During-CoVID-19 participants reported rates of moderate to severe levels of depression (9.7% vs 32.9%, p<0.001). During-CoVID-19 participants reported 50% lower (worse) PFABS scores (mean:12.2 [95%CI: 11.9, 12.5] vs 24.7 [24.5, 24.9] p<0.001) and lower (worse) PedsQL total scores compared to the PreCoVID-19 participants (78.4 [78.0, 78.8] vs. 90.9 [90.5, 91.3] p<0.001).CONCLUSIONSDuring the CoVID-19 pandemic, adolescent athletes reported increased symptoms of depression, decreased physical activity and decreased quality of life compared to adolescent athletes in previous years.Key pointsAdolescent athletes during CoVID-19 were three times more likely to report moderate to severe symptoms of depression compared to data collected prior to CoVID-19.Adolescent athletes during CoVID-19 reported significantly lower physical activity and quality of life scores compared to high school athletes prior to the CoVID-19 pandemicPost CoVID-19 policies should be implemented to improve the health of adolescent athletes in the US.


2020 ◽  
Vol 13 (1) ◽  
Author(s):  
M. M. Al Mahrouqi ◽  
D. A. MacDonald ◽  
B. Vicenzino ◽  
M. D. Smith

Abstract Background Chronic ankle conditions affect approximately 20% of Australian adults. Although there is a plethora of research on chronic hip and knee conditions, there is limited understanding of the impact of ankle problems. Thus, the significance of chronic ankle conditions is not clear. The aim of this study was to compare self-reported function, disability, instability, physical activity and quality of life (QoL) between adults with and without ankle symptoms. A secondary aim was to explore factors associated with QoL. Method Individuals with symptoms of ankle pain and stiffness (symptomatic individuals) and controls with no ankle pain or stiffness (asymptomatic individuals) completed a cross-sectional online survey. The survey included the Ankle Osteoarthritis Scale (AOS), Foot and Ankle Ability Measure (FAAM), Cumberland Ankle Instability Tool (CAIT), International Physical Activity Questionnaire (IPAQ), Assessment of QoL (AQoL-6D), and questions about ankle injury history. Results A total of 394 individuals (270 symptomatic and 124 asymptomatic) with mean age of 48.8 (standard deviation (SD): 12.1) years and body mass index of 28.7 (7.7) kgm− 2 completed the survey. Standardized mean differences (SMD) were large to very large (1.45 to 3.20) for greater disability (AOS) and instability (CAIT), and poorer function (FAAM) in symptomatic compared to asymptomatic individuals. Individuals with ankle symptoms had higher body mass index and lower QoL (medium effect: SMD > 1). There were no differences in self-report physical activity between groups. Lower activities of daily living (ADL) function (FAAM-ADL) best explained QoL in a multiple regression model (R2 = 0.66, p = 0.001). Conclusion Individuals with ankle symptoms reported ankle instability, greater disability, compromised function and worse QoL compared to asymptomatic individuals. There was a strong relationship between ankle function and QoL. Ankle-specific ability during ADL best explained the reduced QoL in individuals with ankle symptoms. Clinicians and researchers should consider ankle function as an antecedent to poorer QoL in patients who have ankle symptoms.


2020 ◽  
Vol 8 (2) ◽  
pp. 232596711990096 ◽  
Author(s):  
Luke Donovan ◽  
Scott Hetzel ◽  
Craig R. Laufenberg ◽  
Timothy A. McGuine

Background: The prevalence and impact of chronic ankle instability (CAI) in adolescent athletes are unknown. To better develop and justify prevention strategies of lateral ankle sprains and CAI, it is important to understand the origin and associated long-term impact of CAI within populations other than adults. Purpose/Hypothesis: The purpose of this study was to determine the prevalence and impact of CAI on ankle function, health-related quality of life (HRQoL), and physical activity in adolescent athletes. The hypothesis was that the presence of CAI will be commonly reported among adolescent athletes and that participants with CAI will have lower self-reported ankle function, HRQoL, and physical activity when compared with participants without CAI. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A cohort of 1002 healthy (able to fully participate) adolescent athletes (50.4% female; mean age, 15.6 ± 1.6 years) across 8 club sport facilities and high schools completed paper-and-pencil surveys to establish the presence of CAI (Identification of Functional Ankle Instability [IdFAI]) and estimate perceived ankle function (Foot and Ankle Ability Measure [FAAM]–Activities of Daily Living and FAAM-Sport), HRQoL (Pediatric Quality of Life Inventory 4.0 [PedsQL]), and physical activity (Hospital for Special Surgery Pediatric Functional Activity Brief Scale [HSS Pedi-FABS]). Results: The overall prevalence of CAI was 20.0%. Participants with unilateral CAI reported significantly lower ( P < .001) ankle function (FAAM-Sport: 87.0 ± 14.8) and HRQoL (total PedsQL: 89.8 ± 9.8) than participants who did not have CAI (FAAM-Sport: 97.7 ± 6.0; total PedsQL: 93.5 ± 9.1). Physical activity was not different between participants with and without CAI. Conclusion: The prevalence of CAI was high among adolescent athletes. The presence of CAI negatively affected ankle function and HRQoL in adolescent athletes. Given the high prevalence and negative impact of CAI in an adolescent population, strategies to prevent ankle injuries and maintain physical activity are needed to alleviate future long-term consequences associated with developing CAI. These strategies should be implemented as soon as sport participation begins, as it appears that the origin of CAI may occur before adulthood.


Author(s):  
Timothy A. McGuine ◽  
Kevin Biese ◽  
Scott J. Hetzel ◽  
Alison Schwarz ◽  
Stephanie Kliethermes ◽  
...  

ABSTRACT Context: During the fall of 2020, some high schools across the US allowed their students to participate in interscholastic sports while others cancelled or postponed their sport programs due to concerns regarding COVID-19 transmission. It is unknown what effect this has had on the physical and mental health of adolescents. Objective: Identify the impact of playing a sport during the COVID-19 pandemic on the health of student athletes. Design: Cross-sectional study. Setting: Sample recruited via email. Patients or Other Participants: 559 STATE-XXX high school athletes (age=15.7±1.2 yrs., female=44%) from 44 high schools completed an online survey in October 2020. A total of 171 (31%) athletes played (PLY) a fall sport, while 388 (69%) did not play (DNP). Main Outcome Measure(s): Demographics included: sex, grade and sports played. Assessments included the General Anxiety Disorder-7 Item (GAD-7) for anxiety, Patient Health Questionnaire-9 Item (PHQ-9) for depression, the Pediatric Functional Activity Brief Scale (PFABS) for physical activity, and the Pediatric Quality of Life Inventory 4.0 (PedsQL) for quality of life. Univariable comparisons between the two groups were made via t-tests or chi-square tests. Means for each continuous outcome measure were compared between the groups by ANOVA models that controlled for Age, Sex, Teaching method (Virtual, Hybrid, or In-person), and the % of students eligible for free lunch. RESULTS: PLY group participants were less likely to report moderate to severe symptoms of anxiety (PLY=6.6%, DNP=44.1%, p&lt;0.001) and depression (PLY=18.2%, DNP=40.4%, p&lt;0.001). PLY athletes reported higher (better) PFABS scores (mean: [95%CI]), (PLY=23.2[22.0,24.5], DNP=16.4[15.0,17.8], p &lt;0.001) and higher (better) PedsQL total scores (PLY=88.4[85.9,90.9], DNP=79.6[76.8,82.4], p &lt;0.001). CONCLUSIONS: Adolescents who played a sport during the COVID-19 pandemic reported fewer symptoms of anxiety and depression, as well as higher physical activity and quality of life scores compared to adolescent athletes who did not play a sport.


2020 ◽  
Author(s):  
Munira Al Mahrouqi ◽  
David MacDonald ◽  
Bill Vicenzino ◽  
Michelle Smith

Abstract Background: Chronic ankle conditions affect approximately 20% of Australian adults. Although there is a plethora of research on chronic hip and knee conditions, there is limited understanding of the impact of ankle problems. Thus, the significance of chronic ankle conditions is not clear. The aim of this study was to compare self-reported function, disability, instability, physical activity and quality of life (QoL) between adults with and without ankle symptoms. A secondary aim was to explore factors associated with QoL.Method: Individuals with symptoms of ankle pain and stiffness (symptomatic individuals) and asymptomatic controls with no ankle pain or stiffness (asymptomatic individuals) completed a cross-sectional online survey. The survey included the Ankle Osteoarthritis Scale (AOS), Foot and Ankle Ability Measure (FAAM), Cumberland Ankle Instability Tool (CAIT), International Physical Activity Questionnaire (IPAQ), Assessment of QoL (AQoL-6D), and questions about ankle injury history. Results: A total of 394 individuals (270 symptomatic and 124 asymptomatic) with mean age of 48.8 (standard deviation (SD): 12.1) years and body mass index of 28.7 (7.7) kgm-2 completed the survey. Standardized mean differences (SMD) were large to very large (1.45 to 3.20) for greater disability (AOS) and instability (CAIT), and poorer function (FAAM) in symptomatic compared to asymptomatic individuals. Individuals with ankle symptoms had higher body mass index and lower QoL (medium effect: SMD >1). There were no differences in self-report physical activity between groups. Lower activities of daily living (ADL) function (FAAM-ADL) best explained QoL in a multiple regression model (R2=0.66, p, 0.001). Conclusion: Individuals with ankle symptoms reported ankle instability, greater disability, compromised function and worse QoL compared to asymptomatic individuals. There was a strong relationship between ankle function and QoL. Ankle-specific ability during ADL best explained the reduced QoL in individuals with ankle symptoms. Clinicians and researchers should consider ankle function as an antecedent to poorer QoL in patients who have ankle symptoms.


2020 ◽  
Author(s):  
Munira Al Mahrouqi ◽  
David MacDonald ◽  
Bill Vicenzino ◽  
Michelle Smith

Abstract Background Chronic ankle conditions affect approximately 20% of Australian adults. Although there is a plethora of research on chronic hip and knee conditions, there is limited understanding of the impact of ankle problems. Thus, the significance of chronic ankle conditions is not clear. The aim of this study was to compared self-reported function, disability, instability, physical activity and quality of life (QoL) between adults with and without ankle symptoms. A secondary aim was to explore factors associated with QoL. Method Individuals with symptoms of ankle pain and stiffness (symptomatic individuals) and asymptomatic controls with no ankle pain or stiffness (asymptomatic indivdiuals) completed a cross-sectional online survey. The survey included the Ankle Osteoarthritis Scale (AOS), Foot and Ankle Ability Measure (FAAM), Cumberland Ankle Instability Tool (CAIT), International Physical Activity Questionnaire (IPAQ), Assessment of QoL (AQoL-6D), and questions about ankle injury history. Results A total of 394 individuals (270 symptomatic and 124 asymptomatic) with mean age of 48.8 (standard deviation (SD): 12.1) years and body mass index of 28.7 (7.7) kgm -2 completed the survey. Standardized mean differences (SMD) were large to very large (1.45 to 3.20) for greater disability (AOS) and instability (CAIT), and poorer function (FAAM) in symptomatic compared to asymptomatic individuals. Individuals with ankle symptoms had higher body mass index and lower QoL (medium effect: SMD >1). There were no differences in self-report physical activity between groups. Lower activities of daily living (ADL) function (FAAM-ADL) best explained QoL in a multiple regression model (R 2 =0.66, p, 0.001). Conclusion Individuals with ankle symptoms reported ankle instability, greater disability, compromised function and worse QoL compared to asymptomatic individuals. There was a strong relationship between ankle function and QoL. Ankle-specific ability during ADL best explained the reduced QoL in individuals with ankle symptoms. Clinicians and researchers should consider ankle function as an antecedent to poorer QoL in patients who have ankle symtpoms.


2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0015
Author(s):  
Mathew J. Wingerson ◽  
Christine M. Baugh ◽  
Aaron Provance ◽  
Aubrey Armento ◽  
Gregory Walker ◽  
...  

Background: The benefits of sport participation and physical activity within adolescent populations has been well established, including improved physical and psychological health, social functioning, and sleep quality.1-3 However, mandated stay-at-home orders during the COVID-19 pandemic resulted in an abrupt cessation of school and sport participation for many adolescent athletes. This sudden suspension of sports, physical activity and peer/social interaction may have negative implications on adolescent anxiety and fatigue, as well as peer relationships and sleep quality. Purpose: (1) Compare quality of life and sleep quality measures in adolescent athletes during the COVID-19 pandemic to measures obtained 1-2 years earlier. (2) Assess physical activity and social interaction behavior during the two weeks prior to school closure compared to a two-week period during school closure. Methods: Participants first completed Patient Reported Outcome Measurement System (PROMIS) anxiety, fatigue, and peer relationship short forms, and the Pittsburg Sleep Quality Inventory (PSQI) during pre-participation sport physical evaluations (May 2018 or 2019), and again during May or June (2020). Physical activity and social interaction were assessed at the second timepoint by asking participants to retrospectively report behaviors during the two weeks prior to school closure, and during the two weeks preceding questionnaire completion. We compared outcomes using paired samples t-tests (continuous outcome variables) and McNemar’s test (categorical outcome variables). All statistical tests were two-sided and evaluated at a significance level of α = 0.05. Results: A significant portion (92%) of participants (n=39; 16.2±0.9 years of age; 64% female; 499±177 days between assessments) reported sport cessation due to COVID-19 (Table 1). Compared to pre-COVID assessments, participants reported significantly higher anxiety and fatigue scores, and significantly worse sleep quality after school and sport cessation (Figure 1). Physical activity frequency and duration were significantly reduced in the two weeks prior to questionnaire completion compared to the two weeks before sport and school closure (Table 2). No significant difference was found for quality of peer relationships (Figure 1), although characteristics of peer/social interactions differed significantly between timepoints. Conclusion: Following recent stay-at-home orders, high school athletes reported more anxiety and fatigue, worse sleep quality, and less physical activity compared to assessments obtained in the Spring of 2018 or 2019. The abrupt cessation of school and sport participation due to COVID-19, in combination with other life factors, likely contributed to reductions in physical activity, worse sleep quality, changes in social interaction, elevated levels of anxiety, and increased fatigue among high school athletes. References: Snyder AR, Martinez JC, Bay RC, Parsons JT, Sauers EL, Valovich McLeod TC. Health-related quality of life differs between adolescent athletes and adolescent nonathletes. J Sport Rehabil. 2010;19(3):237-248. doi:10.1123/jsr.19.3.237 Eime RM, Young JA, Harvey JT, Charity MJ, Payne WR. A systematic review of the psychological and social benefits of participation in sport for children and adolescents: informing development of a conceptual model of health through sport. Int J Behav Nutr Phys Act. 2013;10:98. Published 2013 Aug 15. doi:10.1186/1479-5868-10-98 Kredlow MA, Capozzoli MC, Hearon BA, Calkins AW, Otto MW. The effects of physical activity on sleep: a meta-analytic review. J Behav Med. 2015;38(3):427-449. doi:10.1007/s10865-015-9617-6 Tables/Figures: [Table: see text][Figure: see text][Table: see text]


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