1. page 1 of 23 The Link between Nutrition, Physical Activity and Academic Achievement Sigrid Quendler Vienna University, Austria, Europe for ILSI Center for Health Promotion, Atlanta, 2002

2. page 2 of 23 Early Greek and Hebrew philosophers adopted a dualistic perspective and viewed the mind and the body as two distinct entities Piaget (1936) was one of the first who suggested that motor development is important for intellectual development in children Kephart (1960) suggested that children who have learning disabilities may be suffering from perceptual-motor problems Kirkendall (1986) suggested, that an individual functions as a whole within the environment and thus must be treated accordingly Jørgens, Perko, Hanel, Schroeder, Secher (1992) confirmed that moderate-to-high intensities of exercise shows a large increase in cerebral blood flow which benefits cognitive functioning Background

3. page 3 of 23 Breakfast and Academic Achievement (AA) Hunger and Behavioral Problems Undernourishment and Health Risks Lack of PA and Low Self-Esteem Obesity, Health Risks and Low Self-Esteem The Link between Nutrition, PA and AA

4. page 4 of 23 Breakfast and AA 10% of students at the elementary level 25% in middle school 30% of high school students start school without breakfast omitting breakfast interferes with cognition and learning Hunger and Behavioral Problems 4 million American children experience prolonged periodic food insufficiency and hunger each year Representing 8% of the children under the age of 12 Virtually all-behavioral, emotional and academic problems were more prevalent in hungry children

5. page 5 of 23 Undernourishment and Health Risks Chronically undernourished children attain lower scores on standardized achievement tests They have difficulty resisting infection and are more likely to become sick, miss school, and fall behind in class They are irritable and have difficulty concentrating They have low energy, which can limit their PA Lack of PA and Low Self-Esteem Studies show the positive effects of PA programs on physical fitness and school performance PA is consistently related to higher levels of self-esteem and lower levels of anxiety and stress

6. page 6 of 23 Obesity, Health Risks and Low Self-Esteem The prevalence of overweight among young people ages 6-17 has more than doubled in the past 20 years (in the United States) Over 4.7 million (=11%) of these youths are seriously overweight Overweight causes low self-esteem, which may lead to depression followed by gluttony Increases risks of Type 2 Diabetes, cardiovascular diseases and premature death

7. page 7 of 23 Methods of Literature Search Search Engines: Medline Pubmed Galileo (EBSCOhost, ERIC) Emory University Cross-referencing (Yahoo) Keywords: Nutrition, Dietetics Physical Activity, Education, Sport Academic Performance, Achievement, Learning Children, School Supplementation, Vitamin- Mineral Supplements

8. page 8 of 23 Resources and Approach Relevant Literature : 12 published research studies about the Link between Nutrition and AA 9 published research studies about the Link between PA and AA

9. page 9 of 23 12 Longitudinal Studies 4 Observational Studies 5 Cohort Studies Types of Key Studies ? 8 about Nutrition and AA (4 Long-/ 4 Short-Term) 4 about PA and AA (3 Long-/ 1 Short-Term) 11 about Nutrition and AA 3 about PA and AA 3 about Nutrition and AA 2 about PA and AA

10. page 10 of 23 StudiesNutritionPA Longitudinal Brief fasting, Stress and Cognition Breakfast Timing Energy Intake School Breakfast Programs (SBP) Academic Performance Academic Performance and Fitness and Sport and Education Academic Skills Observational Teachers’ Perception of SBP Teachers’ Attitude Students’ Attitude Learning Disabilities Cohort Verbal Fluency Evaluation of SBP Effect of Vitamin-Mineral Supplements on Behavior Effects on Social Skills Effects on PA during Adult Life Topics of Studies

11. page 11 of 23 Age of Subjects in the Studies StudiesAgesNo.Topics Longitudinal Students: 3-10 11-15 4848 3 about Nutrition, 1 about PA 5 about Nutrition, 3 about PA Observational Teachers Students: 6-12 Learning Disabilities: 8-10 211211 1 about Nutrition, 1 about PA 1 about PA Cohort Students: 3-10 11-12 3131 2 about Nutrition, 1 about PA 1 about PA

12. page 12 of 23 Nutrition and AA Major and General Findings: Poor nutrition hampers AA Poor nutrition hampers AA: Malnutrition affect intelligence and academic performance Students with low amount of protein in their diet have the lowest achievement scores Iron deficiency anemia leads to shortened attention span, irritability, fatigue, and difficulty with concentration Six- to eleven-year-old children from food-insufficient families had significantly lower arithmetic scores Even moderate under-nutrition can have lasting effects and compromise cognitive development and school performance Morning fasting has a negative effect on cognitive performance, even among healthy, well-nourished children

13. page 13 of 23 Proper nutrition enhances academic performance : Participation in a SBP : Relieves hunger and improves children’s ability to succeed at school Increases intake of food energy, calcium, phosphorous, and vitamin C Improves school performance and reduces absenteeism and tardiness Improves academic, behavioral, and emotional functioning Leads to increased math grades Strengthens children’s psychosocial outcomes, lowering anxiety, hyperactivity, depression and psychosocial dysfunction Raises scores on basic skills tests Parents report improved interest in school, greater concentration, and improved scholastic performance

14. page 14 of 23 The Difference between well-nourished and malnourished children during SBP: who skipped breakfast experience a negative effect on certain cognitive tests, problem solving and memory demonstrate improved scholastic performance Teachers report improved scholastic performance School environment and lifestyle factors can also enhance a child’s capacity to learn who skipped breakfast experience a negative effect on certain cognitive tests, arithmetic and verbal fluency Well-nourished children: : Mal-nourished children: The positive effects of breakfast on cognition are not universal and require further studies

15. page 15 of 23 PA and AA The General and Major Findings: Increased PA leads to higher AA: Increased PA leads to increased test scores Intense PA programs have positive effects on AA, including increased concentration, improved mathematics, reading, and writing test scores and reduced disruptive behavior. AA improves even when the physical education reduces the time for academics Aerobic conditioning may help to improve memory Exercise may strengthen particular areas of the brain, and oxygen intake during exercise may enhance greater connections between neurons

16. page 16 of 23 Improved classroom behavior in schools participating in PA: Teachers report improved students attentiveness and concentration Teachers report improved academic performance Parents report improved interest in school, greater concentration, and improved scholastic performance Classroom mood and ambience is enhanced when children participate in PA: Teachers report that students participating in PA are calmer in class and more energetic to learn Several review articles authored by experts in the field underscore the value of PA and the effect of activity and cognition School environment and lifestyle factors can also enhance a child’s capacity to learn

17. page 17 of 23 Who?Where & when? What?Other Facts CDC (Centers for Disease Control and Prevention) USA, June 1996 Guidelines for School Health Programs to Promote Lifelong Healthy Eating Provides 7 nutrition education guidelines for a comprehensive school health program ASFSA (American School Food Service Association) USA, Aug. 2002 Developed a “breakfast how-to kit”, can help school foodservices maximize their breakfast programs The theme: “A Good Breakfast = A Good Start = Good Student Performance” Nutrition and AA Summary of tables of selected nutrition programs:

18. page 18 of 23 Who?Where & when? What?Other Facts FNS (Food and Nutrition Service) USA, 1966 The SBP, a Federal entitlement program, provides cash assistance for non-profit breakfast programs Pilot project in 1966, made permanent in 1975, present in more than 72,000 schools and institutions OCRI (Ottawa Carleton Research Institute) Canada (Ottawa), 1990 School Breakfast Program, provides funding for equipment, program monitors and food 4500 students are fed in the 2002, 86 schools are enrolled in SBP, 855,500 breakfasts served NSD (Nutrition Service Division) USA (California), 1998 SBP, SLP, Special Milk Program and State Meal Program, (federally funded) Improve the diets of children to age 13, develop eating habits that for later years USDA (Food and Nutrition Service) USA, Dec. 2001 Created a new "Eat Smart. Play Hard." Campaign Message has been endorsed by ASFSA, ADA, WIC

19. page 19 of 23 Who?Where & when? What?Other Facts CDC (Centers for Chronic Disease and Prevention) USA, 2001 Kids Walk-to- School A community-based program that aims to increase opportunities for daily PA by encouraging children to walk to and from school in groups, accompanied by adults EKF (Educational Kinesiology Foundation) USA, 1990 Brain Gym ®, a program of physical activities that enhance learning ability Brain Gym® is built upon 80 years of research by specialists in physical movement and child development, EKF licensed it to help the learner experience his or her full potential PA and AA Summary of tables a few selected PA programs:

20. page 20 of 23 Who?Where&when?What?Other Facts NASBE (National Association of State Boards of Education) USA (West Virginia), 1992 Safe and Healthy School Projects, Healthy Schools Network In partnership with the National School Boards Association (NSBA), the Healthy Schools Network meets once a year to discuss youth and school health issues CSHP (Auburn School Department's Coordinated School Health Program) USA, 1998 “Healthy Androscoggin” is a School Health Program, designed to connect health with education Components: Comprehensive School Health Education, Physical Education & Activity and Health Promotion & Wellness CSEP (Health Canada and Canada Society for Exercise Physiology) Canada, 2000 “Canada’s Physical Activity Guide” for children and youth Should help young people make wise choices about PA, improve their health and help prevent diseases

21. page 21 of 23 Nutrition and PA: Teachers and parents report that students participating in SBP and PA are: A positive relationship persists between nutrition and AA or/and PA and AA!! Conclusions: Improve school performance Classroom behavior Reduce absenteeism and tardiness Strengthen children’s psychosocial outcomes Lowers anxiety, hyperactivity, depression, and psychosocial dysfunction Calmer in class More energetic and focused when studying

22. page 22 of 23 Future Research Effects of micronutrient on development of children’s intelligence Effects of nutrient/micronutrient deficiency on children’s intelligence Effects of nutrient deficiency on children’s intention to be physically active The intimate mechanisms whereby physical exercise can influence academic performance Effects of PA on AA of well-trained and untrained children PA in toddlers and the effects on later AA Differences between (micro)nutrients from supplements vs. food sources in human metabolism

23. page 23 of 23 Thank You for Your Attention!!! I want to return thanks to Debbie Kibbe who took the time to show me the everyday life in a Public Health Organization, David Dennison who proof-read this project, Asha Mulchan-Onofri and Kim Fontenot who helped me with the numerous problems I had with the computer, and everyone else on the ILSI staff who helped to make my internship as fantastic as it was in the end! Thank You all very much!!