Physical Activity Stress and Sleep in Adolescents (APADOSLEEP)

Biochimie Clinique LR99ES11, Department of Biochemistry, La Rabta Hospital, Tunisia., Université de Toulon

Adolescence is characterized by major transitions in sleep and circadian rhythm. This rapid pivotal period increases the risks of sleep debt and poor sleep quality, leading to pronounced diurnal fatigue and drowsiness. On the other hand, academic stress has been also associated with increased sleep disturbances. Both academic stress and poor sleep in adolescents has been linked to increased sleepiness rate, reduced alertness, lower academic performances and the impairment of the control of energy balance through hyperphagia. Despite the importance of sleep in holistic development, physical (i.e. recovery, metabolism, muscle growth, weight control), cognitive (i.e. learning, memory, decision-making, Vigilance). Few studies have been designed to improve this behavior among college adolescents, especially in times of academic stress. Physical activity has been suggested as a non-pharmacological alternative treatment for sleep disorders . Generally, it is well established that the duration and quality of sleep were improved by regular physical activity among adolescents and far better, it was suggested that the exercise-mediated effect on sleep could be even observed in the short term. Moreover, it was suggested that aerobic exercise has positive effects on psychological stress and well-being of adolescents . Therefore, APADOSLEEP trial, was designed to examine the effect of physical activity program on sleep during and outside periods of academic stress.

Counterbalanced, cross-over, pre-post trial where each subject acts as his own control. Four sessions will be performed for each adolescent. Each session will be conducted over 5 days (from Monday to Friday): Adolescents will take part randomly in four sessions. Physical activity program will be identical between sessions and groups. 60 minn of moderate to vigorous leisure activities and exercises will be proposed each day. Heart rate monitor will be used to control intensity of exercise during the physical activity program. Control session (CTL) outside academic stress period (represented by exams) and without the physical activity program. A session outside academic stress period, with the physical activity program (PAP). A session during an academic stress period without the physical activity program (AS). A session during an academic stress period with the physical activity program (ASPAP). At each session: Continuous sleep assessments (duration and quality) by accelerometry Continuous physical activity and sedentary behaviour assessments by accelerometry one evaluation of melatonin peak from salivary specimens one evaluation of cortisol peak from salivary specimens An evaluation of the ad libitum food intake of the 5th day will be carried out by the weighing method. one assessment of cognitive performance An evaluation of subjective appetite sensations (hunger, fullness, desire to eat) of the 5th day An evaluation of subjective diurnal sleepiness (Karolinska) of the 5th day

Label : control Type : comparator Description: Outside academic stress period (represented by exams), without the physical activity program (no Intervention).

Label : physical activity program without stress Type : experimental Description: outside academic stress period (exams), with the physical activity program:60 min of mederate to vigorous leisure activities and exercises will be proposed from Monday to Thursday.

Label : academic stress Type : experimental Description: during academic stress period (exams), without the physical activity program (no Intervention)

Label : academic stress and physical activity program Type : experimental Description: during academic stress period (exams), with the physical activity program: 60 min of mederate to vigorous leisure activities and exercises will be proposed from Monday to Thursday.

Each experimental session will be carried out over 5 days of a week. Adolescents will take part randomly in four sessions. Physical activity program will be identical between sessions and groups. 60 min of moderate to vigorous leisure activities and exercises will be proposed each day. Heart rate monitor will be used to control intensity of exercise during the physical activity program.

evaluations of melatonin peak from salivary specimens (5 measures), time (180, 120, 60 min before bedtime, bedtime and 60 min after bedtime)

evaluations of cortisol peak from salivary specimens (5 measures), (upon awakening, awakening + 30mn, awakening + 60mn, awakening + 120mn et awakening + 180mn)

Energy intake and proportion of the energy derived from each class of macronutrients (carbohydrate, fat, and protein) measured on meals offered "ad-libitum"

hunger, fullness, desire to eat and prospective food consumption : upon awakening, before and right after the breakfast, lunch, snack and dinner as well as bed time. Appetite sensations will be collected throughout the day using visual analogue scales (150 mm scales). Adolescents will report their hunger, fullness, desire to eat and prospective food consumption at thirteen regulated times: upon awakening, before and right after the breakfast, lunch, snack and dinner as well as bed time. The questions were i) "How hungry do you feel?", ii) "How full do you feel?", iii) "Would you like to eat something?", iv) "How much do you think you can eat?" (adolescents were asked to respond on a scale from "not at all" to "a lot"). This method has been previously validated

this scale mesures the subjective level os sleepness at particular times during the day. this is a nine point scale (1= extreemly alert, 3= alert, 5= neither nor sleepy, 7 = sleepy but no difficulty for main awake, 9= extreemly sleepy/ fighting sleep).

Inclusion Criteria: college adolescent Tanner stages 3-5 Exclusion Criteria: Disorders and / or pathology of sleep Medical or surgical history not compatible with the study, any other chronic illness or injury that may interfere with the subject's abilities Take medication that may interfere with the results of the study (corticosteroids ...) or sleeping pills Surgical intervention in the previous 3 months Regular consumption of tobacco, cannabis or alcohol Special diet

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