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Background: Attention-deficit/hyperactivity disorder (ADHD) is a common developmental disorder in childhood, with a 5%-6% worldwide prevalence. Children with ADHD often demonstrate impaired executive function, which is closely related to the development of the commonly observed behavioral problems such as inattention, impaired inhibition, and hyperactivity. The purpose of this study is to examine whether a game-based high-intensity interval training (HIIT) program can improve the executive function of children with ADHD, compared with a traditional structured aerobic exercise program and a non-treatment control group.
Methods/design: A total of 42 children with ADHD will be recruited to participate in this three-arm school-based randomized controlled trial. An 8-week specially designed game-based HIIT (GameHIIT) program and a traditional game-based structured aerobic exercise (GameSAE) program will be delivered to those children randomly assigned to these two intervention groups, while the children in the control group will maintain their regular physical activity over the same period. A number of outcome measures including executive function, cerebral hemodynamic response, physical activity, physical fitness, and enjoyment and adherence to the intervention will be assessed for both groups at baseline (T0), immediately after the intervention period (T1), and after the follow-up period (T2).
Discussion: HIIT has recently emerged as a feasible and efficacious strategy for increasing physical health outcomes and cognitive function, including executive function, in healthy young people. However, research has yet to investigate whether the executive function of children with ADHD can be effectively enhanced through HIIT. If, as hypothesized, GameHIIT program improves outcomes for children with ADHD, the present research will inform the development of targeted exercise programs that can be more broadly used with this particular population.
Keywords: Special education need, Physical activity, fNIRS,
There is strong evidence that regular physical activity (PA) is associated with a range of physical health benefits for school-age youth, including improvements in body composition, physical capacity, and overall health-related indicators (e.g., blood pressure, insulin resistance, lipid profile). Emerging evidence also suggests that PA and physical fitness have a positive effect on mental health, cognitive function, and academic performance. Executive functions are generally defined as "high-level cognitive processes" that manage other basic cognitive functions. They consist of functions such as planning, self-regulation, initiation and inhibition, and cognitive flexibility. These functions are believed to be important prerequisites for successful learning in preadolescent children, predict better health and wealth, and have been associated with a reduced likelihood of being convicted of a criminal offense. Several recent meta-analyses have suggested that PA may positively affect cognition and executive function in children. Despite the known benefits of an active lifestyle, more than half of Hong Kong's children and young people fail to follow the current physical activity recommendations, and trends show a decline in health-related physical fitness. Executive functions develop from early childhood and through adolescence into adulthood, with large developmental changes occurring during the elementary school years. Accordingly, effective interventions implemented early in life when the higher cortex is still developing, have the potential to elicit significant long-term improvements. Therefore, it is important to find effective strategies to promote the PA of children, so as to improve their executive function during their childhood.
Attention-deficit/hyperactivity disorder (ADHD) is a commonly diagnosed developmental disorder, with a 5.3% worldwide prevalence in children and adolescents. The most common symptoms include inattention, impulsivity, impaired inhibition, and hyperactivity. Also, young people with ADHD are often characterized by dysfunction in high-level cognitive functions such as executive function. This executive dysfunction may play an important role in the commonly observed behavioral problems in children with ADHD. There are a number of ways to treat ADHD, e.g., medication, psychotherapy, psychoeducation, neuro-feedback, behavior management, etc. Of these treatments, PA and exercise have emerged as effective strategies to manage ADHD given that neither are associated with negative side effects (see recent reviews. To summarize, although not always consistently, PA, especially moderate- to high-intensity aerobic exercise, may improve the emotion/mood, behavior, executive function, and some physical measures of children with ADHD. Acute aerobic exercise may have a positive effect on a variety of measures with a large effect size up to 1.26 in children with ADHD. Two studies have reported medium-to-large effects of acute exercise on executive function. Long-term exercise interventions have also been shown to benefit children with ADHD, with improvements in some measures showing a large effect size up to 0.96. However, these benefits have been mainly described as an improvement of behavioral and emotional problems. Several studies have reported that long-term 'mixed exercise programs' may have moderate to significant effects on several aspects of executive function (e.g., inhibition) and attention in children and adolescents with ADHD, but other studies did not report the same findings. Therefore, so far evidence-based suggestions regarding the optimal exercise for children with ADHD remain somewhat inconsistent.
Research into the relationship between PA and ADHD has generally involved mixed exercise programs at a low- to moderate-intensity; running and stationary cycling have been the most common exercise modes. Whether structured PA is effective for young people is yet to be examined. Children's habitual PA patterns are characterized by participation in games or "unpredictable" sports activities (e.g., football, basketball). Given that children's intrinsic motivation, or level of enjoyment, is also a strong predictor of PA participation, any intervention program should be designed to optimize their enjoyment of PA and thus enhance the likelihood of long-term adherence. When compared to structured exercises such as running or cycling, games-based PA arguably provides a more attractive, acceptable, sustainable, and enjoyable exercise model for young children. To date, only a few studies have examined the effect of an acute bout of team game-based activity on cognitive function in healthy children and adolescents. Research has found that different aspects of cognitive function, such as free recall memory, attention, executive function, and working memory are improved following an acute bout of game-based team exercise (e.g., basketball, tennis). For children with ADHD, mixed exercise protocols have generally been used in intervention programs, and only a few studies have used team sport-based games as part of their exercise intervention. However, given the design of these studies, it is not possible to distinguish the sole effect of game-based PA from those of the mixed exercise protocols in these studies. A recent study has reported that a 12-week table tennis exercise has positive effects on the gross motor skills and some of the executive function performances (mainly inhibition) in the ADHD training group, compared with the ADHD non-training group and a control group. It should be noted that the game-based PA in these aforementioned studies was generally 'aerobic' in nature and completed at low- to moderate intensities.
Recently high-intensity interval training (HIIT) has emerged as a feasible and efficacious strategy for improving the physical health of young people. The HIIT can be completed in a short period of time while resulting in equivalent physiological adaptations to longer sessions of traditional aerobic training. Recent research has suggested that traditional HIIT intervention programs, including running and cycling, may improve executive function in healthy children and adolescents. It has been suggested that a very brief HIIT intervention over two weeks reduced off-task behavior and enhanced selective attention in primary school children. For children with ADHD, to the best of our knowledge, only one recent study was conducted to investigate the effect of a traditional HIIT program on physical fitness, motor skills, social behavior, and quality of life. In this randomized controlled trial, 28 boys with ADHD were assigned to either a traditional HIIT group or a standard multimodal therapy (TRAD) group. After the three-week intervention, the authors reported that HIIT was more effective in improving motor skills, self-esteem, relations with friends, competence, and subjective ratings of attention, compared with TRAD. However, despite this encouraging preliminary evidence, it remains unclear whether HIIT can be adapted to treat children with ADHD to improve their executive function, a key aspect in many facets of life.
While the limited findings regarding the effects of HIIT on executive function are encouraging, and HIIT has emerged as an enjoyable and effective exercise for children, previous studies have tended to prescribe HIIT interventions with a focus on running and jumping. The effect of game-based HIIT interventions on the executive function of children has yet to be investigated. Research of this nature is needed, particularly to determine whether game-based HIIT can improve outcomes (e.g., executive function, social behavior, sports skills, etc.) for children with ADHD. Therefore, the aim of the proposed study is to investigate the effect of two different kinds of exercise programs, i.e., an 8-week game-based HIIT (GameHIIT) program and an 8-week game-based structured aerobic exercise (GameSAE) program, on the executive function of children with ADHD. The hypothesis of the proposed study is that both GameHIIT and GameSAE programs will significantly improve the executive function of children with ADHD, compared with those in the control group. A secondary hypothesis is that the GameHIIT group may confer additional benefits when compared with the GameSAE group.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| GameHIIT intervention group | Experimental | In the GameHIIT group, a specially designed game-based training program with HIIT in nature will be delivered to the participants for 8 weeks. |
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| GameSE intervention group | Active Comparator | In the GameSAE group, participants will attend a tailor-made game-based exercise training program. Similar to GameHIIT, the intervention will comprise 8 weeks of structured aerobic exercise sessions, lasting one hour on average in each session and up to twice per week. |
|
| Control group | No Intervention | No intervention. |
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Game-based High-Intensity Interval Training | Other | There will be two training sessions each week. In each training session, there will be four sets of training programs separated by 3 minutes of passive recovery in accordance with a previous study.Each set of activities will last for around 5 minutes; therefore, the total duration of each training session will be approximately 30 minutes. A small group size (4-6 children per group) will be adopted to facilitate individual supervision and adaption of the exercise program. |
| Measure | Description | Time Frame |
|---|---|---|
| Colour-Word Stroop Test (CWST) | The executive function will be assessed using a battery of tests on a laptop computer that will take approximately five minutes to complete. The battery of tests include the Colour-Word Stroop Test (CWST), Corsi Block Tapping Test (CBTT), Wisconsin Card Sorting Test (WCST), and Tower of London Test (TLT) which are classic tasks that measure inhibition response, one of important components of executive function. | The measurements are assessed at baseline (T0). |
| Corsi Block Tapping Test (CBTT) | Executive function will be assessed using a battery of tests on a laptop computer that will take approximately five minutes to complete. The battery of tests include the Colour-Word Stroop Test (CWST), Corsi Block Tapping Test (CBTT), Wisconsin Card Sorting Test (WCST), and Tower of London Test (TLT) which are classic tasks that measure inhibition response, one of important components of executive function. | The measurements are assessed at baseline (T0). |
| Wisconsin Card Sorting Test (WCST) | The executive function will be assessed using a battery of tests on a laptop computer that will take approximately five minutes to complete. The battery of tests include the Colour-Word Stroop Test (CWST), Corsi Block Tapping Test (CBTT), Wisconsin Card Sorting Test (WCST), and Tower of London Test (TLT) which are classic tasks that measure inhibition response, one of the important components of executive function. | The measurements are assessed at baseline (T0). |
| Tower of London Test (TLT) | Executive function will be assessed using a battery of tests on a laptop computer that will take approximately five minutes to complete. The battery of tests include the Colour-Word Stroop Test (CWST), Corsi Block Tapping Test (CBTT), Wisconsin Card Sorting Test (WCST), and Tower of London Test (TLT) which are classic tasks that measure inhibition response, one of important components of executive function. | The measurements are assessed at baseline (T0). |
| Measure | Description | Time Frame |
|---|---|---|
| Body height | Body height will be measured in meters. The measurement will follow the Anthropometry Procedures Manual of the National Health and Nutrition Examination Survey (NHANES). Weight and height will be combined to report BMI in kg/m^2. | The measurements are assessed at baseline (T0). |
| Body height |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Fenghua Sun, Dotcor | The Education University of Hong Kong | Study Director |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| The Education University of Hong Kong | Hong Kong | Hong Kong |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 20459784 | Background | Janssen I, Leblanc AG. Systematic review of the health benefits of physical activity and fitness in school-aged children and youth. Int J Behav Nutr Phys Act. 2010 May 11;7:40. doi: 10.1186/1479-5868-7-40. | |
| 16421041 | Background | Parfitt G, Eston RG. The relationship between children's habitual activity level and psychological well-being. Acta Paediatr. 2005 Dec;94(12):1791-7. doi: 10.1111/j.1651-2227.2005.tb01855.x. |
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| ID | Term |
|---|---|
| D009043 | Motor Activity |
| ID | Term |
|---|---|
| D001519 | Behavior |
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Participants will not be blinded to treatment allocation because of the intervention nature. To avoid contamination between treatment groups, intervention deliverers will be provided with a list of students in the intervention program. Only those on the list can participate in the intervention.
|
| GameSAE | Other | Similar to GameHIIT, the intervention will comprise 8 weeks of structured aerobic exercise sessions, lasting one hour on average in each session and up to twice per week. Six to eight stations of multidimensional exercises will be set up for each session. Adopting the train-the-trainer (TTT) model, training will be provided by front-line healthcare providers or trained helpers. Children will be instructed to finish the exercises in all stations one after another in a predetermined order. |
|
| Colour-Word Stroop Test (CWST) | Executive function will be assessed using a battery of tests on a laptop computer that will take approximately five minutes to complete. The battery of tests include the Colour-Word Stroop Test (CWST), Corsi Block Tapping Test (CBTT), Wisconsin Card Sorting Test (WCST), and Tower of London Test (TLT) which are classic tasks that measure inhibition response, one of important components of executive function. | The measurements are assessed after the 8-week intervention period (T1). |
| Corsi Block Tapping Test (CBTT) | Executive function will be assessed using a battery of tests on a laptop computer that will take approximately five minutes to complete. The battery of tests include the Colour-Word Stroop Test (CWST), Corsi Block Tapping Test (CBTT), Wisconsin Card Sorting Test (WCST), and Tower of London Test (TLT) which are classic tasks that measure inhibition response, one of important components of executive function. | The measurements are assessed after the 8-week intervention period (T1). |
| Wisconsin Card Sorting Test (WCST) | Executive function will be assessed using a battery of tests on a laptop computer that will take approximately five minutes to complete. The battery of tests include the Colour-Word Stroop Test (CWST), Corsi Block Tapping Test (CBTT), Wisconsin Card Sorting Test (WCST), and Tower of London Test (TLT) which are classic tasks that measure inhibition response, one of important components of executive function. | The measurements are assessed after the 8-week intervention period (T1). |
| Tower of London Test (TLT) | Executive function will be assessed using a battery of tests on a laptop computer that will take approximately five minutes to complete. The battery of tests include the Colour-Word Stroop Test (CWST), Corsi Block Tapping Test (CBTT), Wisconsin Card Sorting Test (WCST), and Tower of London Test (TLT) which are classic tasks that measure inhibition response, one of important components of executive function. | The measurements are assessed after the 8-week intervention period (T1). |
| Colour-Word Stroop Test (CWST) | Executive function will be assessed using a battery of tests on a laptop computer that will take approximately five minutes to complete. The battery of tests include the Colour-Word Stroop Test (CWST), Corsi Block Tapping Test (CBTT), Wisconsin Card Sorting Test (WCST), and Tower of London Test (TLT) which are classic tasks that measure inhibition response, one of important components of executive function. | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Corsi Block Tapping Test (CBTT) | Executive function will be assessed using a battery of tests on a laptop computer that will take approximately five minutes to complete. The battery of tests include the Colour-Word Stroop Test (CWST), Corsi Block Tapping Test (CBTT), Wisconsin Card Sorting Test (WCST), and Tower of London Test (TLT) which are classic tasks that measure inhibition response, one of important components of executive function. | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Wisconsin Card Sorting Test (WCST) | Executive function will be assessed using a battery of tests on a laptop computer that will take approximately five minutes to complete. The battery of tests include the Colour-Word Stroop Test (CWST), Corsi Block Tapping Test (CBTT), Wisconsin Card Sorting Test (WCST), and Tower of London Test (TLT) which are classic tasks that measure inhibition response, one of important components of executive function. | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Tower of London Test (TLT) | Executive function will be assessed using a battery of tests on a laptop computer that will take approximately five minutes to complete. The battery of tests include the Colour-Word Stroop Test (CWST), Corsi Block Tapping Test (CBTT), Wisconsin Card Sorting Test (WCST), and Tower of London Test (TLT) which are classic tasks that measure inhibition response, one of important components of executive function. | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Cerebral Hemodynamic Response | Accompanied by the executive function test, the cortical hemodynamic response in the prefrontal cortex will also be recorded using a multi-channel fNIRS (Octamon fNIRS system, Artinis, Netherland) applying two wavelengths of near-infrared light (785 and 830 nm). The device consists of eight light sources and two detectors secured onto a head cap. The device will be placed over the left and right prefrontal cortex according to the guidelines in the handbook provided by the manufacturer. | The measurements are assessed at baseline (T0). |
| Cerebral Hemodynamic Response | Accompanied by the executive function test, the cortical hemodynamic response in the prefrontal cortex will also be recorded using a multi-channel fNIRS (Octamon fNIRS system, Artinis, Netherland) applying two wavelengths of near-infrared light (785 and 830 nm). The device consists of eight light sources and two detectors secured onto a head cap. The device will be placed over the left and right prefrontal cortex according to the guidelines in the handbook provided by the manufacturer. | The measurements are assessed after the 8-week intervention period (T1). |
| Cerebral Hemodynamic Response | Accompanied by the executive function test, the cortical hemodynamic response in the prefrontal cortex will also be recorded using a multi-channel fNIRS (Octamon fNIRS system, Artinis, Netherland) applying two wavelengths of near-infrared light (785 and 830 nm). The device consists of eight light sources and two detectors secured onto a head cap. The device will be placed over the left and right prefrontal cortex according to the guidelines in the handbook provided by the manufacturer. | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
Body height will be measured in meters. The measurement will follow the Anthropometry Procedures Manual of the National Health and Nutrition Examination Survey (NHANES). Weight and height will be combined to report BMI in kg/m^2. |
| The measurements are assessed after the 8-week intervention period (T1). |
| Body height | Body height will be measured in meters. The measurement will follow the Anthropometry Procedures Manual of the National Health and Nutrition Examination Survey (NHANES). Weight and height will be combined to report BMI in kg/m^2. | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Body weight | Bodyweight will be measured in kilograms. The measurement will follow the Anthropometry Procedures Manual of the National Health and Nutrition Examination Survey (NHANES). Weight and height will be combined to report BMI in kg/m^2. | The measurements are assessed at baseline (T0). |
| Body weight | Bodyweight will be measured in kilograms. The measurement will follow the Anthropometry Procedures Manual of the National Health and Nutrition Examination Survey (NHANES). Weight and height will be combined to report BMI in kg/m^2. | The measurements are assessed after the 8-week intervention period (T1). |
| Body weight | Bodyweight will be measured in kilograms. The measurement will follow the Anthropometry Procedures Manual of the National Health and Nutrition Examination Survey (NHANES). Weight and height will be combined to report BMI in kg/m^2. | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Waist circumference | Waist circumference will be measured and presented in centimetres. The measurement will follow the Anthropometry Procedures Manual of the National Health and Nutrition Examination Survey (NHANES). | The measurements are assessed at baseline (T0). |
| Waist circumference | Waist circumference will be measured and presented in centimetres. The measurement will follow the Anthropometry Procedures Manual of the National Health and Nutrition Examination Survey (NHANES). | The measurements are assessed after the 8-week intervention period (T1). |
| Waist circumference | Waist circumference will be measured and presented in centimetres. The measurement will follow the Anthropometry Procedures Manual of the National Health and Nutrition Examination Survey (NHANES). | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Hip circumference | Hip circumference will be measured and presented in centimetres. The measurement will follow the Anthropometry Procedures Manual of the National Health and Nutrition Examination Survey (NHANES). | The measurements are assessed at baseline (T0). |
| Hip circumference | Hip circumference will be measured and presented in centimetres. The measurement will follow the Anthropometry Procedures Manual of the National Health and Nutrition Examination Survey (NHANES). | The measurements are assessed after the 8-week intervention period (T1). |
| Hip circumference | Hip circumference will be measured and presented in centimetres. The measurement will follow the Anthropometry Procedures Manual of the National Health and Nutrition Examination Survey (NHANES). | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Body mass index (BMI) | Weight and height will be combined to report BMI in kg/m^2. | The measurements are assessed at baseline (T0). |
| Body mass index (BMI) | Weight and height will be combined to report BMI in kg/m^2. | The measurements are assessed after the 8-week intervention period (T1). |
| Body mass index (BMI) | Weight and height will be combined to report BMI in kg/m^2. | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Social Behavior | Conners' Teacher Rating Scale 15-Item (CTRS-15) will be used to measure the social behaviours of participants. It has been widely used to assess problematic behaviours in children with ADHD. | The measurements are assessed at baseline (T0). |
| Social Behavior | Conners' Teacher Rating Scale 15-Item (CTRS-15) will be used to measure the social behaviours of participants. It has been widely used to assess problematic behaviours in children with ADHD. | The measurements are assessed after the 8-week intervention period (T1). |
| Social Behavior | Conners' Teacher Rating Scale 15-Item (CTRS-15) will be used to measure the social behaviours of participants. It has been widely used to assess problematic behaviours in children with ADHD. | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Overall ADHD Symptoms | The Overall ADHD symptoms will be assessed by the Attention-Deficit/Hyperactivity-symptoms and Normal-behaviors (SWAN) rating scale (0-3), the scale scores in '0' means 'Not true' and '3' in 'Very much true'. | The measurements are assessed at baseline (T0). |
| Overall ADHD Symptoms | The Overall ADHD symptoms will be assessed by the Attention-Deficit/Hyperactivity-symptoms and Normal-behaviors (SWAN) rating scale (0-3), the scale scores in '0' means 'Not true' and '3' in 'Very much true'. | The measurements are assessed after the 8-week intervention period (T1). |
| Overall ADHD Symptoms | The Overall ADHD symptoms will be assessed by the Attention-Deficit/Hyperactivity-symptoms and Normal-behaviors (SWAN) rating scale (0-3), the scale scores in '0' means 'Not true' and '3' in 'Very much true'. | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Moderate-to-Vigorous Physical Activity (MVPA) | Children's leisure-time MVPA will be determined using an accelerometer (ActiGraph, Shalimar, USA).Participants will be required to wear an accelerometer on their right hip for seven days to collect objective data of PA levels. The time on and time off of wearing the accelerometer each day will be recorded, and the data will be used to estimate the time spent in moderate-to-vigorous PA (MVPA). | The measurements are assessed at baseline (T0). |
| Moderate-to-Vigorous Physical Activity (MVPA) | Children's leisure-time MVPA will be determined using an accelerometer (ActiGraph, Shalimar, USA).Participants will be required to wear an accelerometer on their right hip for seven days to collect objective data of PA levels. The time on and time off of wearing the accelerometer each day will be recorded, and the data will be used to estimate the time spent in moderate-to-vigorous PA (MVPA). | The measurements are assessed after the 8-week intervention period (T1). |
| Moderate-to-Vigorous Physical Activity (MVPA) | Children's leisure-time MVPA will be determined using an accelerometer (ActiGraph, Shalimar, USA).Participants will be required to wear an accelerometer on their right hip for seven days to collect objective data of PA levels. The time on and time off of wearing the accelerometer each day will be recorded, and the data will be used to estimate the time spent in moderate-to-vigorous PA (MVPA). | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Self-reported Physical Activity | The modified version of the Physical Activity Questionnaire for Children (PAQ-C) is a 7-day self-report questionnaire designed to assess daily activities from moderate to the vigorous range, and the score is in a continuous range from 1 (low active) to 5 (high active). | The measurements are assessed at baseline (T0). |
| Self-reported Physical Activity | The modified version of the Physical Activity Questionnaire for Children (PAQ-C) is a 7-day self-report questionnaire designed to assess daily activities from moderate to the vigorous range, and the score is in a continuous range from 1 (low active) to 5 (high active). | The measurements are assessed after the 8-week intervention period (T1). |
| Self-reported Physical Activity | The modified version of the Physical Activity Questionnaire for Children (PAQ-C) is a 7-day self-report questionnaire designed to assess daily activities from moderate to the vigorous range, and the score is in a continuous range from 1 (low active) to 5 (high active). | The measurements are assessed after the 8-week intervention period and another 8-week follow up (T2). |
| Enjoyment | Enjoyment will be assessed by the Physical Activity Enjoyment Scale, which is a valid and reliable tool for evaluating perceived enjoyment. The PACES consisted of 18 bipolar statements on a 7-point continuum (I enjoy it-I hate it) which are summed to produce a total enjoyment score. | The measurements are assessed at baseline (T0). |
| Enjoyment | Enjoyment will be assessed by the Physical Activity Enjoyment Scale, which is a valid and reliable tool for evaluating perceived enjoyment. The PACES consisted of 18 bipolar statements on a 7-point continuum (I enjoy it-I hate it) which are summed to produce a total enjoyment score. | The measurements are assessed after the 8-week intervention period (T1). |
| Enjoyment | Enjoyment will be assessed by the Physical Activity Enjoyment Scale, which is a valid and reliable tool for evaluating perceived enjoyment. The PACES consisted of 18 bipolar statements on a 7-point continuum (I enjoy it-I hate it) which are summed to produce a total enjoyment score. | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Adherence | Adherence to the intervention program will be evaluated by attendance frequency and dropout rate. | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Physical Fitness (cardiovascular fitness) | The cardiovascular fitness will be assessed by the 20 m shuttle run test using the ALPHA fitness test battery. | The measurements are assessed at baseline (T0). |
| Physical Fitness (cardiovascular fitness) | The cardiovascular fitness will be assessed by the 20 m shuttle run test using the ALPHA fitness test battery. | The measurements are assessed after the 8-week intervention period (T1). |
| Physical Fitness (cardiovascular fitness) | The cardiovascular fitness will be assessed by the 20 m shuttle run test using the ALPHA fitness test battery. | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Physical Fitness (muscular strength) | The muscular strength will be assessed by the handgrip strength test and standing long jump test using the ALPHA fitness test battery. | The measurements are assessed at baseline (T0). |
| Physical Fitness (muscular strength) | The muscular strength will be assessed by the handgrip strength test and standing long jump test using the ALPHA fitness test battery. | The measurements are assessed after the 8-week intervention period (T1). |
| Physical Fitness (muscular strength) | The muscular strength will be assessed by the handgrip strength test and standing long jump test using the ALPHA fitness test battery. | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
| Physical Fitness (speed-agility) | The speed-agility will be assessed by the 4 × 10 m shuttle run test using the ALPHA fitness test battery. | The measurements are assessed at baseline (T0). |
| Physical Fitness (speed-agility) | The speed-agility will be assessed by the 4 × 10 m shuttle run test using the ALPHA fitness test battery. | The measurements are assessed after the 8-week intervention period (T1). |
| Physical Fitness (speed-agility) | The speed-agility will be assessed by the 4 × 10 m shuttle run test using the ALPHA fitness test battery. | The measurements are assessed after the 8-week intervention period, as well as another 8-week follow up (T2). |
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