Physical and Psychosocial Outcomes of 16-Week Classroom-Based Morning Exercise Program

A marked decline in physical activity levels among children has been observed in recent years; this reduction adversely affects not only physical health but also mental, cognitive, and social development. Factors such as urbanization, the loss of play areas, and the widespread use of digital screens restrict children's opportunities for movement and contribute to a range of issues, including obesity, postural disorders, musculoskeletal problems, concentration difficulties, and stress.

The World Health Organization and the CDC recommend at least 60 minutes of moderate-to-vigorous physical activity daily for children aged 5 to 17. Research indicates that this level of activity supports fundamental physical attributes-such as muscle strength, flexibility, balance, and posture-while also improving cardiovascular health, reducing the risk of obesity, and strengthening bone health. Furthermore, physical activity has been shown to enhance children's mental well-being, alleviate symptoms of anxiety and depression, boost self-confidence, and foster a positive body image. Short bouts of morning exercise have been found to improve children's overall mood and help them start the day feeling energized, while also enhancing their motivation to learn and their concentration skills. Furthermore, it has been emphasized that physical activities performed in the morning strengthen the brain's white matter structure and make children happier. Given that children spend the majority of their day at school-and largely at their desks-integrating school-based exercises into their daily routine is of critical importance. Short, structured exercise programs implemented in schools enhance children's adjustment to lessons, attention skills, and cognitive flexibility, while also improving overall learning outcomes.

Current literature confirms that such school-based exercises have positive effects on both physical fitness and psychological development.

The fact that school-based exercises do not require large spaces or specialized equipment enhances the inclusivity and sustainability of the programs. Exercises performed at students' desks enable participation by all students, thereby supporting physical and psychosocial development.

Physical activity boosts not only health indicators but also self-esteem, social adjustment, and life satisfaction in children. Establishing a routine of morning exercises at school also fosters the development of life skills such as empathy, cooperation, and emotional resilience. Making physical activity a routine at an early age lays the foundation for lifelong healthy behaviors.

Studies conducted in our country involving primary and secondary school students have generally been screening studies; there is no research that specifically pioneers the investigation of morning exercises and their effectiveness.

This project was planned to incorporate short exercises-which can be performed at their own desks within the classroom-into the daily routine, with the aim of supporting school-age children's skills in body awareness, flexibility, postural control, focus, and stress management.

• Classroom-Based Morning Exercise Program (Other): Exercises generally consist of movements that can be done sitting at a desk or standing next to a desk, and do not require equipment. It includes exercises for warming up, stretching, strengthening, balance and relaxation, lasting 10-15 minutes and suitable for daily use. It starts with a deep breathing exercise, continues with basic strength and flexibility exercises that mobilize the body, and ends with a deep breathing exercise again. Exercises that can be performed both sitting and standing are presented together. During the transitions between movements, small exercises such as "waving the hands" are also included as a break.

Primary outcomes

• FACES Pain Scale [from enrollment to the end of the program at 16 weeks]: Pain assessment in children will be conducted using the Faces (FACES) Pain Scale. This is a visual scale developed to assess pain intensity, particularly in individuals-such as children-who cannot clearly express themselves verbally (Hicks, von Baeyer et al. 2001). The scale features a total of six facial images, progressing from a happy expression to expressions indicating increasing levels of pain. Children rate their pain by selecting the face that best represents how they feel. Widely used for children aged three and older, this scale is a trusted choice in clinical and field studies due to its ease of understanding and rapid administration. Researchers will show the children the various facial images on the scale and ask them to select the face that best reflects their state, thereby determining the pain score.

Secondary outcomes

• Sit and Reach Test [From enrollment to the end of the program at 16 weeks]: The Sit-and-Reach Test is a common and practical physical fitness test used to evaluate the flexibility of the lower back and hamstring muscles, particularly in children (Şahiner and Balcı 2010). Due to its ease of administration, minimal equipment requirements, and practicality, it is ideal for the mass assessment of flexibility in school-aged children. During the test, children sit barefoot on a flat surface, extend their legs forward, and place the soles of their feet firmly against the test box or platform. They are asked to reach forward as far as possible with their hands stacked on top of each other, without bending their knees; the maximum distance reached is measured and recorded in centimeters. The test will be conducted using the sit-and-reach test apparatus located in the laboratory of the Department of Physiotherapy and Rehabilitation at Istanbul Medeniyet University's Faculty of Health Sciences.
• Children Body Image Scale [from enrollment to the end of the program at 16 weeks]: The scale is a psychometric assessment tool used to measure body image, body satisfaction, and body-related feelings or attitudes in children (Collins 1991). It typically utilizes images of gender-appropriate body silhouettes, and children are asked to select the silhouette that most closely resembles their own body and the one representing the body they would like to have. Body dissatisfaction is then assessed by scoring the discrepancy between the perceived current body and the ideal body. During the administration of the scale, children are shown a series of silhouettes arranged according to age and gender. The researcher asks questions such as "Which body looks most like yours?" and "Which body would you like to have?" to prompt the child to select one silhouette from each row, and the difference between the two is scored.
• WHO-5 Well-Being Index [from enrollment to the end of the program at 16 weeks]: The assessment of the children's general well-being will be conducted using the WHO-5 Well-Being Index. The WHO-5 Well-Being Index is a short, 5-item self-report scale developed by the World Health Organization to assess individuals' psychological well-being over the past two weeks (Sischka, Martin et al. 2025). Each item is scored from 0 (at no time) to 5 (all the time), yielding a total score ranging from 0 to 25. A higher score indicates better psychological well-being. Using this index, children will be asked how well they have felt over the past two weeks and to rate their feelings.
• School Burnout Scale [from enrollment to the end of the program at 16 weeks]: Participants' school burnout will be assessed using the School Burnout Scale. In its original form, the scale is a 5-point Likert-type, self-report instrument consisting of 10 items and three sub-dimensions. It was developed by Salmela-Aro et al. in 2009 to determine the school burnout levels of primary and secondary school students and was adapted to Turkish culture by Seçer et al. (2013). Regarding the distribution of items across factors, items 1, 4, 7, and 9 fall under the emotional exhaustion dimension; items 2, 5, and 6 fall under the cynicism sub-dimension; and items 3 and 8 fall under the low sense of personal accomplishment sub-dimension. Participants will be asked to indicate the extent to which they agree or disagree with statements concerning their motivation regarding lessons and school, and their responses will be recorded.

Sex: All, ages: 6 Years to 12 Years, accepts healthy volunteers

Inclusion Criteria:

* Volunteers who are between the ages of 6 and 12,
* Attend schools affiliated with the Kartal District Directorate of National Education,
* and-after the purpose of the research and the procedures have been explained to the students and their families-agree to participate on a voluntary basis and sign the informed consent form.

Exclusion Criteria:

* Children who have any condition preventing them from completing self-report scales during the assessment (inability to understand the forms, physical impairment, lack of literacy skills) Who have sustained an upper or lower extremity injury within the last 6 months, Who have undergone upper or lower extremity surgery within the last 6 months, Who have any soft tissue disease, Who are diagnosed with a serious gastrointestinal, cardiovascular, pulmonary, or hematological system disease following a specialist physician examination Who have known spinal problems such as scoliosis, kyphosis, or kyphoscoliosis Who have been diagnosed with a psychotic disorder, bipolar disorder, or autism spectrum disorder Who have a history of epilepsy or severe head trauma Or who use psychotropic medication will not be included in the project