• Many kids who are not physically going to school are losing out on exercise
• As it is, about 60% of US kids have an insufficient level of cardiorespiratory fitness
• With a bit of imagination, teachers and parents can adapt lessons to include physical activity

When schools close to protect families from the coronavirus, the main worry for many parents might be the lost learning. But for students who end up staying indoors and staring at phones and monitors most of the day, there could be health costs, too.

“You have to give the parents some grace and say we’re all sort of in survival mode right now,” said Hildi Nicksic, a clinical assistant professor in the department of health and kinesiology at Texas A&M University in College Station. Still, the increase in screen time and inactivity makes for “a really scary reality”.

If you’re a kid who has lost access to school, you’ve also lost recess and all the other opportunities for moving around during a school day. You’ve lost physical education classes and sports teams. “And really, you might not even be going outside because maybe you live in an area where your parent doesn’t feel comfortable with you exiting the house,” Nicksic said.

Families can find ways to cope, said Dr Geetha Raghuveer, a paediatric cardiologist at Children’s Mercy in Kansas City, Missouri. But it starts with knowing how vital it is for a child to stay physically active.

Benefits beyond basic health

According to a 2020 report in Circulation written by an American Heart Association panel Raghuveer led, about 60% of US youth have a less-than-healthy level of cardiorespiratory fitness.

The effects of low fitness are multifaceted, she said. “It’s physical, it’s cardiac, it’s mental, it’s academic, it’s long term, it’s short term.”

Federal guidelines recommend children and teens ages six to 17 get at least an hour of moderate to vigorous activity a day, including more intense activities at least three times a week.

Nicksic, who spent more than 10 years as a teacher in public schools before earning her doctorate, said the benefits of activity go beyond basic health.

Regular physical activity has been shown to boost academic results. “A lot of the improvement is seen specifically in math, but there is a general understanding that that benefit will happen across subjects,” she said.

And it might make things easier on teachers and parents by helping kids focus, studies have shown.

Adapt lessons to include action

“If you take a 60-minute lesson, and you pare that down to 55 minutes and have five minutes of physical activity, the remaining 55 minutes is likely going to be a more productive learning time,” Nicksic said.

Breaks aren’t the only way to get kids to move. Teachers – or parents – can adapt lessons to include action. Younger students learning to use a ruler can actively measure things around the room instead of sitting in front of a piece of paper. A teacher working with students over video could ask them to fetch a topic-relevant item from somewhere in their home. “That gets the student away from just looking at the screen, even if it’s just to stand up, move around and come back and sit down.”

The Wide Open School project offers additional ideas, in English and Spanish, at wideopenschool.org. Nicksic compiled her own list at classroomsinmotion.com. The American Heart Association has suggestions through efforts such as Kick Cabin Fever to the Curb and the NFL Play 60 Challenge.

Ultimately, Nicksic and Raghuveer said, fitness works best as a family activity.

“It helps a lot if the family can engage in physical fitness activities as a family as opposed to just telling the kid to go out and do something,” Raghuveer said.

Some families are privileged

That approach has worked for Jenny Groshong, a fourth-grade teacher in Eugene, Oregon.

Her daughters – Libby, 13, and Peyton, 12 – have had plenty of screen time this year, she said. But when it got to be too much, she didn’t always just tell them to put the screen down.

“I’m a runner, so I would make one of them come with me. Some days, the other one would just jump up and say, ‘I’m coming too,’ and they ride their bikes while I go run.”

Their family also hikes. An old tandem bike even gets hauled out sometimes. “Every once in a while, they’ll get on that, which is hysterical,” she said, laughing. “You want to teach your kids how to get along? Put them on a tandem.”

She’s aware that her family is privileged to get to do all they do. “When families are in crisis, or they’re struggling financially, or they’re having a hard time getting food on the table, they don’t have the luxury of hopping in their Suburban and driving an hour to go on a hike,” she said.

Okay to start small

Groshong, who teaches at a school with many students from low-income families, found small ways to work movement into her curriculum. This spring, as the region’s abundant plant life was in full bloom, she sent students (who had school-issued equipment) to capture images of flowers in “all the colours of the rainbow” and arrange them in a colour-wheel collage. Not every kid had to walk very far, she said. “But at least they got outside.”

Raghuveer and Nicksic would approve. Both emphasized it’s OK to start small.

“Baby steps are fine,” Nicksic said. “You don’t need to go from no physical activity to making sure your kid goes for an hour-long walk or something. Anything helps.”

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•  Cerebral venous thrombosis (CVT) is a rare kind of stroke that is, however, on the rise
• CVT affects veins, rather than arteries in the brain
• The incidence of CVT is higher in young women and African Americans

Most strokes strike when an artery in the brain suddenly becomes blocked, but new research shows a rarer cause of strokes is becoming more common.

It’s called cerebral venous thrombosis (CVT), and it happens when a vein in the brain is clogged. While CVT is estimated to cause less than 1% of all strokes, scientists discovered it is now more prevalent and affecting a different demographic than previously thought.

Study author Dr Fadar Otite and his colleagues pored over years of hospital records from New York and Florida to find out how many cases of CVT occurred in these states between 2006 and 2016. Otite is an assistant professor of neurology at SUNY Upstate Medical University in Syracuse, New York.

Most common in young women

Based on the data they analysed, the researchers estimated that the number of CVT cases in the United States rose from around 14 cases per million in 2006 to 20 cases per million in 2014.

“We still find that the incidence of CVT is less than 1% of all strokes, even across our study period, but the incidence increased by 70% over time,” Otite said. “In 2006, the proportion of all strokes that were CVT was 0.47%. At the end of our study, which was in 2016, that proportion increased to 0.80%.”

CVT causes blood clots to form in the veins of the brain. These veins drain blood that has already been used by brain cells, sending it back to the heart to be replenished with oxygen. If a clot forms in one of these veins, it may leak into the surrounding brain tissue and could cause a stroke, the researchers explained.

While CVT is still most common in young women – about two-thirds of all CVT hospitalisations included in the study were in females – the researchers found that the number of cases among this demographic did not increase over the 10-year study period. Instead, they saw increases in CVT among men and older women.

“Part of the message is that we agree that CVT is still more common in women, but because of the diverse clinical presentation of CVT, when other symptoms that may be attributable to CVT are present in other demographics, we should take them with more seriousness,” Otite said.

Higher in African Americans

Another major finding was that CVT incidence in African American people was significantly higher than in other races. But why that is the case remains unknown. “We have no clear explanation, because this is truly the first study to ever relate the incidence of CVT between races,” he added.

Several factors may put one at a higher risk of developing CVT, including pregnancy and taking hormonal birth control pills, which may be why it is more common in younger women, the researchers noted.

And many of the risk factors for CVT – like blood clotting disorders or medications that cause clotting, severe dehydration, infections of the ear, face or neck, head trauma, obesity and cancer – are somewhat different from the triggers typically associated with stroke.

It is important for clinicians to be aware of this rise in CVT incidence because the condition can easily be confused with something else, Otite said. Patients with CVT may have unspecific complaints such as headaches, blurry vision or seizures.

Around 3% of patients in a prior study who had CVT and went to the hospital were diagnosed with something else and sent home, according to Otite. “So, it’s important to recognise this from the start, because by the next time the clinical condition may be worse,” he said.

A specific treatment

CVT can be treated with medication to thin the blood and help prevent further clotting, which may not be prescribed if the condition isn’t properly diagnosed, he added.

Dr Jose Biller, chair of the neurology department at Loyola University Medical Center in Hines, Illinois, said the takeaway from this study is that more attention should be paid to CVT.

“I think that there should be an increased awareness of cerebral venous thrombosis because, by and large, when people think about stroke, they don’t think about it,” Biller said. “There should be an increasing level of awareness because this is a condition that has a specific treatment.”

The study was published online on 26 August in the journal Neurology.

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