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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
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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
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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
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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
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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
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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
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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
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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.









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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.