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Abstract Higher cardiorespiratory fitness has been associated with improved cognitive control in preadolescent children, with various studies highlighting related brain health benefits. This cross-sectional study aimed to provide novel insights into the fitness-cognition relationship by investigating task-related changes in effective connectivity within two brain networks involved in cognitive control: the cingulo-opercular and fronto-parietal networks. Twenty-four higher-fit and twenty-four lower-fit preadolescent children completed a modified flanker task that modulated inhibitory control demand while their EEG and task performance were concurrently recorded. Effective connectivity for correct trials in the theta band was estimated using directed transfer function. The results indicate that children with higher fitness levels demonstrated greater connectivity in specific directions within the cingulo-opercular network (average effect size, d = 0.72). Brain-behavior correlations demonstrated a positive association between the majority of these connections and general task accuracy, which was also higher in higher fit children (average correlation coefficient, ρ = 0.34). The findings further support a positive relationship between fitness and cognitive performance in children. EEG findings offer novel insights into the potential brain mechanisms underlying the fitness-cognition relationship. The study suggests that increased task-related connectivity within the cingulo-opercular network may mediate the cognitive benefits associated with higher fitness levels in preadolescent children.

The COVID-19 pandemic altered everyday life starting in March 2020. These alterations extended to the lives of children as their normal routines were disrupted by community lockdowns, online learning, limited in-person social contact, increased screen time, and reduced physical activity. Considerable research has investigated the physical health impact of COVID-19 infection, but far fewer studies have investigated the physiological impact of stressful pandemic-related changes to daily life, especially in children. The purpose of this study was to leverage an ongoing clinical trial to investigate physiological consequences associated with chronic stress of pandemic community lockdown on children. As a part of the clinical trial, children provided saliva samples. Saliva samples were analyzed for cortisol and salivary alpha amylase (sAA) content. This secondary cross-sectional analysis included 94 preadolescent children located within the Greater Boston, Massachusetts community. Children participated in the study either before, during, or following the pandemic community lockdown to form three groups for comparison. In response to chronic stress caused by the pandemic community lockdown, participants demonstrated dysregulation of fast-acting catecholamine response of the locus-coeruleus-norepinephrine system and slower-acting glucocorticoid response, resulting in an asymmetrical relationship of hypocortisolism (M = 0.78 ± 0.19 μg/mL, p

IntroductionThe social and behavioral effects of the COVID-19 pandemic have impacted the health and physiology of most people, including those never diagnosed with COVID-19. While the impact of the pandemic has been felt across the lifespan, its effects on cardiorespiratory fitness (commonly considered a reflection of total body health) of older adults and children may be particularly profound due to social distancing and stay-at-home advisories, as well as the closure of sport facilities and non-essential businesses. The objective of this investigation was to leverage baseline data from two ongoing clinical trials to determine if cardiorespiratory fitness and body mass index were different during COVID-19 relative to before COVID-19 in older adults and children.MethodsHealthy older individuals (N = 593; 65–80 years) and 200 typically developing children (8–10 years) completed a graded maximal exercise test and had their height and weight measured.ResultsResults revealed that older adults and children tested during COVID-19 had significantly lower cardiorespiratory fitness levels than those tested before COVID-19 shutdowns (older adults: 30% lower; children: 53% lower; p's ≤ 0.001). In addition, older adults and children tested during COVID-19 had significantly higher BMI (older adults: 31.34 ± 0.57 kg/m2, p = 0.004; children: 19.27 ± 0.44 kg/m2, p = 0.05) than those tested before COVID-19 shutdowns (older adults: 29.51 ± 0.26 kg/m2, children: 18.13 ± 0.35 kg/m2). However, these differences in BMI did not remain significant when controlling for cardiorespiratory fitness.DiscussionResults from this investigation indicate that the COVID-19 pandemic, and behavior changes taken to reduce potential exposure, may have led to lower cardiorespiratory fitness levels in older adults and children, as well as higher body mass index. These findings provide relevant public health information as lower cardiorespiratory fitness levels and higher body mass indexes recorded during the pandemic could have far-reaching and protracted health consequences. Public health guidance is needed to encourage physical activity to maintain cardiorespiratory fitness and healthy body composition.Clinical trial registrationOlder adults: https://clinicaltrials.gov/ct2/show/NCT02875301, identifier: NCT02875301; Children: https://clinicaltrials.gov/ct2/show/NCT03592238, identifier: NCT03592238.

Introduction Greater engagement in sedentary behaviours has been related to poorer cognitive functions in epidemiological research. However, the effects of reducing sedentary behaviour duration on cognitive function, brain function, and structure remain poorly understood. This systematic review aims to synthesise the evidence on the effects of reducing sedentary behaviour duration by increasing time spent in physical activity on cognitive function, brain structure and function in apparently healthy children, adolescents and adults.Methods and analysis The protocol follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The literature search will be conducted (search dates: August–September 2022) across six databases: PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature (via EBSCO Host), PsycINFO (via ProQuest), SPORTDiscus and Web of Science (Science and Social Science Citation Index). The inclusion criteria are as follows: randomised and non-randomised experimental studies as defined by the Cochrane Handbook, published in English, in peer-reviewed journals, and as theses or dissertations. References of included papers will be screened for additional studies. Acute and chronic interventions targeting children (≥ 4 years), adolescents, younger adults (≥ 18–40 years), middle-aged (40–64 years) and older adults (65+ years) will be eligible. Methodological quality will be assessed with the Effective Public Health Practice Project quality assessment tool for quantitative studies. Qualitative synthesis will be stratified by intervention type (acute vs chronic), intervention content (reducing sedentary time or interrupting prolonged sitting) and outcome (cognitive, brain structure and function).Ethics and dissemination No primary data collection will be conducted as part of this systematic review. Study findings will be disseminated through peer-reviewed publications, conference presentations and social media.PROSPERO registration number CRD42020200998.

Abstract Background There is an increasing prevalence of physical inactivity during childhood, which is associated with a variety of health problems. However, the mechanisms by which acute exercise benefits cognition in childhood remains unknown. Here we describe the protocol for a randomized crossover trial called SNEACY (Sympathetic Nervous System & Exercise Affects Cognition in Youth), a study designed to better understand mechanisms linking acute exercise and cognition in 9–10-year-old healthy, cognitively normal children. Methods Children from the Greater Boston, MA region will be recruited to participate in this single center study. A randomized crossover design will be utilized, such that participants will act as their own controls, through initial randomization to condition assignment and condition counterbalancing across participants. One hundred three children will participate in three randomized acute interventions: moderate intensity treadmill exercise (20 min, 70–75% of their maximal heart rate), seated rest (20 min), and a Trier Social Stress Test for Children (14 min). These visits will occur on 3 three separate days, approximately 5–8 days apart. Before and after each intervention, children complete a variety of cognitive tasks measuring attentional inhibition while their neuroelectric activity is recorded. Variables of interest include EEG data, accuracy and reaction time, academic achievement, and salivary alpha amylase. Academic achievement is also assessed following interventions. In addition, children provide passive drool samples throughout the interventions to measure various biomarkers that may explain the acute exercise benefit on cognition. Discussion The results from this study could influence educational and public health recommendations to enhance cognition and learning in pre-adolescent children. Trial registration ClinicalTrials.gov NCT03592238 . Registered on 19 July 2018

Abstract Background Multi-country studies examining trends in sedentary behaviors among adolescents have mainly focused on high-income or Western countries, and almost no data exists for the rest of the world. Thus, this study aims to examine temporal trends in adolescents’ leisure time sedentary behavior (LTSB) employing nationally representative datasets from 26 countries from five WHO-defined geographical regions. Methods Data from the Global School-based Student Health Survey 2003–2017 were analyzed in 17,734 adolescents [mean (SD) age: 13.7 (1.0) years; 49.0% boys]. LTSB was self-reported and included all types of sedentary behaviors, excluding time spent at school or doing homework. The prevalence and 95%CI of high LTSB (i.e., ≥3 h/day) was calculated for the overall sample and by sex for each survey. Crude linear trends in high LTSB were assessed by linear regression models. Interaction analyses were conducted to examine differing trends among boys and girls. Results Temporal variations in LTSB substantially diverged across countries, with results showing increasing (6/26 countries), decreasing (4/26) and stable trends. The sharpest increases in LTSB occurred in United Arab Emirates, Kuwait, and Thailand. Some countries did not show an increase in LTSB prevalence over time but had very high levels of LTSB (i.e., > 40%) across multiple years. Most countries showed no differences in LTSB trends between boys and girls. Conclusions Data from our study may serve as an important platform for policymakers, as well as local and national stakeholders, to establish country-specific and tailored strategies for reducing LTSB.

Background: Structured vigorous physical activity (VPA) can improve cognitive control in children, but studies relating daily physical activity (PA) to cognitive control have yielded conflicting findings. While objectively measured daily PA summarizes all occurrences of PA within a registered period, a minimum duration of continuous PA is required for registration of a PA bout. Because brief bouts of high-intensity PA can account for a large proportion of children's daily activity-related energy expenditure, this study assessed whether daily and bouted VPA were selectively related to cognitive control in preadolescents relative to other PA intensities. Methods: A total of 75 children between the ages of 8 and 10 years (49% girls) wore an ActiGraph wGT3X+ on the hip for 7 days. The acceleration signal from the vertical axis was summarized over 1 s, 5 s, and 15 s epochs. Daily and bouted moderate PA, moderate-to-vigorous PA, and VPA were measured. PA bouts were expressed as the frequency and time spent in 2 different continuous PA bouts, one lasting ≥10 s and the other lasting ≥30 s at a given intensity. Inhibitory control was assessed using behavioral responses to a modified flanker task (mean reaction time (RTmean) and accuracy). Attentional resource allocation and cognitive processing speed were measured using the amplitude and latency of the P3 component of event-related brain potentials, respectively. Associations between PA, behavioral indices of inhibitory control, P3 amplitude, and latency were assessed using hierarchical regression models. Results: Daily VPA was not related to RTmean or accuracy on either congruent or incongruent trials. In contrast, more time spent in VPA bouts lasting ≥30 s predicted shorter P3 latency across epochs and flanker congruencies (all β ≤ –0.24, all p ≤ 0.04). The associations between shorter P3 latency and the time spent in moderate-to-vigorous PA bouts lasting ≥30 s were less consistent and largely limited to congruent trials (congruent: β (–0.31, –0.34)). No significant associations were observed upon correction for false discovery rate. Conclusion: The pattern of uncorrected associations aligns with the dose–response literature and suggests that brief VPA bouts may yield the greatest benefits to cognitive processing speed in preadolescents. Future studies using measures of brain structure and function are needed to understand the mechanisms linking bouted VPA to neurocognitive function during childhood. Keywords: Accelerometry, Bouts, Children, ERPs, Inhibitory control, P3, Physical activity

Introduction: Brain network modularity is a principle that quantifies the degree to which functional brain networks are divided into subnetworks. Higher modularity reflects a greater number of within-module connections and fewer connections between modules, and a highly modular brain is often interpreted as a brain that contains highly specialized brain networks with less integration between networks. Recent work in younger and older adults has demonstrated that individual differences in brain network modularity at baseline can predict improvements in performance after cognitive and physical interventions. The use of brain network modularity as a predictor of training outcomes has not yet been examined in children.Method: In the present study, we examined the relationship between baseline brain network modularity and changes (post-intervention performance minus pre-intervention performance) in cognitive and academic performance in 8- to 9-year-old children who participated in an after-school physical activity intervention for 9 months (N = 78) as well as in children in a wait-list control group (N = 72).Results: In children involved in the after-school physical activity intervention, higher modularity of brain networks at baseline predicted greater improvements in cognitive performance for tasks of executive function, cognitive efficiency, and mathematics achievement. There were no associations between baseline brain network modularity and performance changes in the wait-list control group.Discussion: Our study has implications for biomarkers of cognitive plasticity in children. Understanding predictors of cognitive performance and academic progress during child development may facilitate the effectiveness of interventions aimed to improve cognitive and brain health.

Musical training has been associated with advantages in cognitive measures of IQ and verbal ability, as well as neural measures including white matter microstructural properties in the corpus callosum (CC) and the superior longitudinal fasciculus (SLF). We hypothesized that children who have musical training will have different microstructural properties in the SLF and CC. One hundred children aged 7.9–9.9 years (mean age 8.7) were surveyed for their musical activities, completed neuropsychological testing for general cognitive abilities, and underwent diffusion tensor imaging (DTI) as part of a larger study. Children who play a musical instrument for more than 0.5 h per week (n = 34) had higher scores on verbal ability and intellectual ability (standardized scores from the Woodcock-Johnson Tests of Cognitive Abilities), as well as higher axial diffusivity (AD) in the left SLF than those who did not play a musical instrument (n = 66). Furthermore, the intensity of musical practice, quantified as the number of hours of music practice per week, was correlated with axial diffusivity (AD) in the left SLF. Results are not explained by age, sex, socio-economic status, or physical fitness of the participants. The results suggest that the relationship between musical practice and intellectual ability is related to the maturation of white matter pathways in the auditory-motor system. The findings suggest that musical training may be a means of improving cognitive and brain health during development.

Objectives: The aims of this study were (i) to examine the association between cardiorespiratory fitness and white matter volume and test whether those associations differ between normal-weight and overweight/obese children (ii) to analyze the association between other physical fitness components (i.e., motor and muscular) and white matter volume, and (iii) to examine whether the fitness-related associations in white matter volume were related to academic performance.Methods: Data came from two independent projects: ActiveBrains project (n = 100; 10.0 ± 1.1 years; 100% overweight/obese; Spain) and FITKids2 project (n = 242; 8.6 ± 0.5 years; 36% overweight/obese, United States). Cardiorespiratory fitness was assessed in both projects, and motor and muscular fitness were assessed in the ActiveBrains project. T1-weighted images were acquired with a 3.0 T S Magnetom Tim Trio system. Academic performance was assessed by standardized tests.Results: Cardiorespiratory fitness was associated with greater white matter volume in the ActiveBrain project (P < 0.001, k = 177; inferior fronto-opercular gyrus and inferior temporal gyrus) and in the FITKids project (P < 0.001, k = 117; inferior temporal gyrus, cingulate gyrus, middle occipital gyrus and fusiform gyrus) among overweight/obese children. However, no associations were found among normal-weight children in the FITKids project. In the ActiveBrains project, motor fitness was related to greater white matter volume (P < 0.001, k = 173) in six regions, specifically, insular cortex, caudate, bilateral superior temporal gyrus and bilateral supramarginal gyrus; muscular fitness was associated with greater white matter volumes (P < 0.001, k = 191) in two regions, particularly, the bilateral caudate and bilateral cerebellum IX. The white matter volume of six of these regions were related to academic performance, but after correcting for multiple comparisons, only the insular cortex remained significantly related to math calculations skills (β = 0.258; P < 0.005). In both projects, no brain regions showed a statistically significant negative association between any physical fitness component and white matter volume.Conclusion: Cardiorespiratory fitness may positively relate to white matter volume in overweight/obese children, and in turn, academic performance. In addition, motor and muscular fitness may also influence white matter volume coupled with better academic performance. From a public health perspective, implementing exercise interventions that combine aerobic, motor and muscular training to enhance physical fitness may benefit brain development and academic success.

The present study is the first to investigate whether cerebral blood flow in the hippocampus relates to aerobic fitness in children. In particular, we used arterial spin labeling (ASL) perfusion MRI to provide a quantitative measure of blood flow in the hippocampus in 73 7- to 9-year-old preadolescent children. Indeed, aerobic fitness was found to relate to greater perfusion in the hippocampus, independent of age, sex, and hippocampal volume. Such results suggest improved microcirculation and cerebral vasculature in preadolescent children with higher levels of aerobic fitness. Further, aerobic fitness may influence how the brain regulates its metabolic demands via blood flow in a region of the brain important for learning and memory. To add specificity to the relationship of fitness to the hippocampus, we demonstrate no significant association between aerobic fitness and cerebral blood flow in the brainstem. Our results reinforce the importance of aerobic fitness during a critical period of child development.

Children are becoming increasingly inactive, unfit, and overweight, yet there is relatively little causal evidence regarding the effects of physical activity on brain health during childhood. The present study examined the effects of an after-school physical activity program (FITKids2) on the microstructure of white matter tracts in 7- to 9-year-old children. We measured the microstructural properties of white matter via diffusion tensor imaging in 143 children before and after random assignment to either a 9-month after-school physical activity program (N = 76, mean age = 8.7 years) or a wait list control group (N = 67, mean age = 8.7 years). Our results demonstrate that children who participated in the physical activity program showed increased white matter microstructure in the genu of the corpus callosum, with no changes in white matter microstructure in the wait list control group which reflects typical development. Specifically, children in the physical activity program showed increases in fractional anisotropy (FA) and decreases in radial diffusivity (RD) in the genu from pre- to post-test, thereby suggesting more tightly bundled and structurally compact fibers (FA) and increased myelination (RD), with no changes in estimates of axonal fiber diameter (axial diffusivity, AD). The corpus callosum integrates cognitive, motor, and sensory information between the left and right hemispheres of the brain, and the white matter tract plays a role in cognition and behavior. Our findings reinforce the importance of physical activity for brain health during child development.

Macular pigment optical density (MPOD)—assessed using customized heterochromatic flicker photometry (cHFP)—is related to better cognition and brain lutein among adults. However, the reliability of MPOD assessed by cHFP has not been investigated in children. We assessed inter-session reliability of MPOD using modified cHFP. 7–10-year-olds (n = 66) underwent cHFP over 2 visits using 11 examiners. Reliability was also assessed in a subsample (n = 46) with only 2 examiners. Among all participants, there was no significant difference between the two sessions (p = 0.59—session 1: 0.61 ± 0.28; session 2: 0.62 ± 0.27). There was no significant difference in the MPOD of boys vs. girls (p = 0.56). There was a significant correlation between sessions (Y = 0.52x + 0.31; R2 = 0.29, p ≤ 0.005), with a reliability of 0.70 (Cronbach’s α). Among the subsample with 2 examiners, there was a significant correlation between sessions (Y = 0.54x + 0.31; R2 = 0.32, p < 0.005), with a reliability of 0.72 (Cronbach’s α). In conclusion, there is moderate reliability for modified cHFP to measure MPOD in preadolescents. These findings provide support for future studies aiming to conduct noninvasive assessments of retinal xanthophylls and study their association with cognition during childhood.

In this study, an in-duct ultrasonic airflow measurement device has been designed, developed and tested. The airflow measurement results for a small range of airflow velocities and temperatures show that the accuracy was better than 3.5% root mean square (RMS) when it was tested within a round or square duct compared to the in-line Venturi tube airflow meter used for reference. This proof of concept device has provided evidence that with further development it could be a low-cost alternative to pressure differential devices such as the orifice plate airflow meter for monitoring energy efficiency performance and reliability of ventilation systems. The design uses a number of techniques and design choices to provide solutions to lower the implementation cost of the device compared to traditional airflow meters. The design choices that were found to work well are the single sided transducer arrangement for a “V” shaped reflective path and the use of square wave transmitter pulses ending with the necessary 180° phase changed pulse train to suppress transducer ringing. The device is also designed so that it does not have to rely on high-speed analogue to digital converters (ADC) and intensive digital signal processing, so could be implemented using voltage comparators and low-cost microcontrollers.

One of the keys to understanding scholastic success is to determine the neural processes involved in school performance. The present study is the first to use a whole-brain connectivity approach to explore whether functional connectivity of resting state brain networks is associated with scholastic performance in seventy-four 7- to 9-year-old children. We demonstrate that children with higher scholastic performance across reading, math and language have more integrated and interconnected resting state networks, specifically the default mode network, salience network, and frontoparietal network. To add specificity, core regions of the dorsal attention and visual networks did not relate to scholastic performance. The results extend the cognitive role of brain networks in children as well as suggest the importance of network connectivity in scholastic success.

The importance of breakfast consumption for ideal cognitive performance has received much attention in recent years, although research on the topic has yielded mixed results. The present study utilized event-related brain potentials (ERPs) elicited during a modified flanker task to investigate the neuroelectric implications of receiving different mixed macronutrient beverages after an overnight fast. A repeated measures design was employed whereby preadolescent participants (9–10 years of age) completed cognitive testing while ERPs were collected during two non-consecutive testing sessions, one in which they received one of three treatment beverages consisting of mixed-macronutrient formulations (either Carbohydrate Blend, Sucrose, Maltodextrin) and the other in which they received a placebo drink containing Sucralose. Performance indices, ERPs, and blood glucose were recorded at three time points before the testing session and after the ingestion of each drink. While the behavioral performance indices and N2 results showed some evidence of glucose facilitation, the effects were small and selective. Participants who received the Maltodextrin treatment showed faster reaction times and more stable N2 amplitudes after ingesting the treatment beverage. The most robust effects were seen in the P3 amplitude measurement. Across the three drink groups, participants showed a marked amplitude increase over time after the placebo drink was ingested, although P3 amplitudes remained stable when a carbohydrate treatment drink was ingested. These effects were eliminated when changes in blood glucose were accounted for, suggesting that the neurolectric effects were directly related to glycemic change. These findings suggest that ingestion of carbohydrates after an overnight fast results in changes to the P3 amplitude of the ERP waveform elicited during an attentional inhibition task.

The present study examined the effects of moderate-intensity aerobic exercise on aspects of cognitive control in two groups of children categorized by higher- and lower-task performance. Event-related brain potentials (ERPs) were collected in 40 preadolescent children during a modified flanker task following 20 min of treadmill walking and seated rest on separate occasions. Participants were bifurcated into two groups based on task performance following the resting session. Findings revealed that following exercise, higher-performers maintained accuracy and exhibited no change in P3 amplitude compared to seated rest. Lower-performers demonstrated a differential effect, such that accuracy measures improved, and P3 amplitude increased following exercise. Lastly, both groups displayed smaller N2 amplitude and shorter P3 latency following exercise, suggesting an overall facilitation in response conflict and the speed of stimulus classification. The current findings replicate prior research reporting the beneficial influence of acute aerobic exercise on cognitive performance in children. However, children with lower inhibitory control capacity may benefit the most from single bouts of exercise. These data are among the first to demonstrate the differential effect of physical activity on individuals who vary in inhibitory control, and further support the role of aerobic exercise for brain health during development.

Executive functions emerge throughout childhood and shape multiple cognitive and behavioral outcomes across the lifespan. Given the importance of these functions, there is considerable interest in understanding the role of environmental enrichment to support their development. The past 20 years have seen the emergence of a body of evidence around the beneficial effects of engaging in physical activity for executive functioning in children. Despite this, there are still unanswered questions, particularly about the confounding effects of the timing and dose of exercise-based interventions. During development, sensitive periods with heightened neural plasticity and sensitivity to environmental influences can offer an optimal time to introduce enrichment interventions. As such, sensitive periods for executive function could indicate an ideal time to introduce physical activity or be a potential confounder to study results if not considered. This narrative review discusses the potential presence of sensitive periods in preadolescent development where physical activity has greater benefits for executive function. Initially, we briefly review the largely parallel fields investigating the presence of sensitive periods for executive function and the effects of physical activity on executive function outcomes. We then bring together these 2 concepts to discuss the theoretical basis for developmentally sensitive periods during which children may be particularly amenable to physical activity-based interventions and offer potential ways forward to investigate this phenomenon. We hope this review will attract researchers to collaborate in the area and extend our current understanding of the development of executive functions as well as interventions like physical activity.

Growing evidence suggests that aerobic fitness benefits the brain and cognition during childhood. The present study is the first to explore cortical brain structure of higher fit and lower fit 9- and 10-year-old children, and how aerobic fitness and cortical thickness relate to academic achievement. We demonstrate that higher fit children (>70th percentile VO2max) showed decreased gray matter thickness in superior frontal cortex, superior temporal areas, and lateral occipital cortex, coupled with better mathematics achievement, compared to lower fit children (

[This corrects the article DOI: 10.1371/journal.pone.0134115.].

IntroductionThere is a growing trend of inactivity among children, which may not only result in poorer physical health, but also poorer cognitive health. Previous research has shown that lower fitness has been related to decreased cognitive function for tasks requiring perception, memory, and cognitive control as well as lower academic achievement.PurposeTo investigate the relationship between aerobic fitness, learning, and memory on a task that involved remembering names and locations on a fictitious map. Different learning strategies and recall procedures were employed to better understand fitness effects on learning novel material.MethodsForty-eight 9-10 year old children (n = 24 high fit; HF and n = 24 low fit; LF) performed a task requiring them to learn the names of specific regions on a map, under two learning conditions in which they only studied (SO) versus a condition in which they were tested during study (TS). The retention day occurred one day after initial learning and involved two different recall conditions: free recall and cued recall.ResultsThere were no differences in performance at initial learning between higher fit and lower fit participants. However, during the retention session higher fit children outperformed lower fit children, particularly when the initial learning strategy involved relatively poor recall performance (i.e., study only versus test-study strategy).ConclusionsWe interpret these novel data to suggest that fitness can boost learning and memory of children and that these fitness-associated performance benefits are largest in conditions in which initial learning is the most challenging. Such data have important implications for both educational practice and policy.

Financial stress and lack of financial well-being are significant contributors to physician burnout. Many trainees believe little can contribute to developing financial freedom during their training years. However, residency is a pivotal moment in a young attending's life; strategic financial steps taken during this time can lead to a path of financial freedom and well-being for years to come., Methods: We introduce 12 effective financial steps physicians can take at the start of their careers. These essential steps were compiled both anecdotally and from published financial resources such as White Coat Investigator and the Millionaire Next Door. Steps include building your "why," becoming financially educated, eliminating debt, attaining insurance, optimizing contracts, awareness of self-net worth, budgeting, maximizing investment strategies, smart investing, wise spending, K.I.S.S, and creating a personal financial plan., Results: As an example, an IRA is a retirement account set up by you, and to take advantage of the tax benefits, you must have a modified adjusted gross income of less than $124,000 as a single tax filer for 2022. Most physicians are compensated at a rate higher than this; however, there is a legal loophole to take advantage of to allow earners to still contribute to a Roth IRA that is discussed., Conclusions: Financial education is the first step toward a path to financial success in a young physician's life. Implementation of these 12 financial steps early in a physician's career will enrich one's financial freedom and well-being., Competing Interests: The authors have no financial interest to declare in relation to the content of this article. Disclosure statements are at the end of this article, following the correspondence information., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)