FIT-ATOMIC Exercise Feasibility Trial

Number of participants enrolled per year

ASPIRE fidelity coaching checklist. This measure assesses the fidelity with which study coaches deliver the intervention during calls with participants. Participants are scored on a scale from 0 to 2, based on the extent to which the intervention components are covered:

0: Did not cover - The intervention component was not addressed during the call.

• Partially covered - The intervention component was addressed to some extent, but not fully.
• Fully covered - The intervention component was fully addressed, meeting the intended criteria for delivery.

A higher score reflects a more complete and accurate delivery of the intervention as planned.

Percentage of total patients that dropped out of study.

Number of adverse events per total participants

Percentage of total patients that completed the study measures.

Change in blood irisin levels (ng/mL) between baseline and end of 20-week intervention.

Change in blood BDNF levels (ng/mL) between baseline and end of 20-week intervention.

This outcome measure assesses changes in brain volume following the intervention. MRI scans of the brain will be performed at baseline and at 20 weeks. The outcome metrics include the absolute change in brain volume (mm^3), percentage change in brain volume, and variance in brain volume changes across participants.

This outcome measure evaluates cognitive performance based on a combination of accuracy and reaction time. The scoring process combines accuracy and reaction time, using a 2-vector system where each vector is scored from 0 to 5. The final score ranges from 0 to 10. If a participant's accuracy is 80% or lower, the final score is based solely on accuracy. If accuracy exceeds 80%, both accuracy and reaction time are combined to calculate the final score. A score below 4 indicates that accuracy was insufficient (lower than or equal to 80%) to allow for a reaction time score. Higher scores are associated with better cognitive flexibility. Normative data are used to compare the participant's performance to age- and education-based averages, providing a contextual understanding of individual scores.

The scoring method for the Flanker test is identical to that of the DCCS and uses a 2-vector scoring system based on accuracy and reaction time, each scored on a scale from 0 to 5. The final computed score ranges from 0 to 10, representing the participant's overall performance. If a participant's accuracy is 80% or lower, the final computed score is based solely on accuracy. If accuracy exceeds 80%, the reaction time score and accuracy score are combined to calculate the final score. A computed score below 4 indicates that the participant did not achieve sufficient accuracy (lower than or equal to 80%) to include a reaction time component. Higher scores reflect better attention and the ability to ignore distractions, indicating stronger cognitive control. Normative data are used to compare the participant's performance to age- and education-based averages, providing a contextual understanding of individual scores.

The OSD assesses information processing speed, attention, and cognitive efficiency by requiring participants to match numbers with corresponding symbols using a reference key within a 120-seconds time limit. The test is scored based on the total number of correct responses (raw score), with higher scores indicating better performance.

Changes in raw scores between Time 1 and Time 2 reflect improvements or declines in cognitive processing speed over time. Normative data are used to compare the participant's performance to age- and education-based averages, providing context for individual scores.

This outcome measure evaluates visual attention, cognitive processing, and arousal through key eye-tracking metrics collected during free-viewing tasks. Data are recorded and analyzed to understand participants' visual and cognitive engagement with presented stimuli. The mean saccade rate (MSR) will be calculated as the frequency of macro-saccades (saccades with an amplitude of greater than or equal to 2 degress) across all videos combined.

This outcome measure evaluates visual attention, cognitive processing, and arousal through key eye-tracking metrics collected during free-viewing tasks. Data are recorded and analyzed to understand participants' visual and cognitive engagement with presented stimuli.The mean fixation duration (MFD) will be calculated as the average time spent fixating between any two successive saccades across all video clips.

This measure evaluates the health-related quality of life (HRQoL) in children and adolescents using the Varni Pediatric Quality of Life Inventory (PedsQL) Core Module. The PedsQL consists of 23 items across four dimensions: Physical, Emotional, Social, and School Functioning. Each item is scored on a 5-point Likert scale, with responses reverse-scored and transformed to a 0-100 scale, where higher scores indicate better HRQoL.

The Varni Pediatric Multidimensional Fatigue Scale (PedsQL-MFS) is a tool designed to measure fatigue in children and adolescents, assessing its impact on daily functioning. The scale includes 18 items across three domains: General Fatigue, Sleep/Rest Fatigue, Cognitive Fatigue. Participants rate their level of fatigue over the past month on a 5-point Likert scale, where higher scores indicate less fatigue. Items are reverse-scored and transformed to a 0-100 scale, with higher scores representing less fatigue. Subscale scores are calculated for each dimension, and a total fatigue score is derived by averaging the scores from all three domains.

The Centre for Epidemiological Studies Depression Scale Children's Rating Scale (CES-DC) is a widely used tool for assessing depressive symptoms in children and adolescents. The scale consists of 20 items that measure symptoms of depression experienced during the past week. These symptoms are related to mood, behavior, and physical well-being, and include feelings of sadness, irritability, social withdrawal, and changes in sleep or appetite. Each item is rated on a 4-point Likert scale ranging from 0 (Not At All) to 3 (A Lot). The total score is obtained by summing the ratings across all 20 items, with higher scores indicating more severe depressive symptoms.

The Screen for Anxiety-Related Disorders (SCARED) is a self-report tool designed to screen for anxiety symptoms in children and adolescents. The scale consists of 41 items that assess symptoms related to various anxiety disorders, including generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, and specific phobias. Each item is rated on a 3-point Likert scale: 0 (Not true or hardly ever true), 1 (Somewhat true or sometimes true), and 2 (Very true or often true). The total score is derived by summing the ratings across all items, with higher scores indicating more severe anxiety symptoms.

The GLTEQ is a self-report tool used to assess the frequency and intensity of physical activity during leisure time. The GLTEQ consists of three questions that measure the frequency of strenuous, moderate, and light physical activities performed for at least 15 minutes during a typical week.

Participants are asked to report the number of times they engage in each level of activity over the past week, using the following intensity categories: Strenuous activity, Moderate activity, and Light activity. Each question is rated on a 4-point scale: 0 (None), 1 (once a week), 2 (twice a week), and 3 (3 or more times a week). The GLTEQ provides a score by multiplying the frequency of each activity level by a corresponding factor (9 for strenuous, 5 for moderate, and 3 for light), and then summing the results. The final score represents the overall level of physical activity, with higher scores indicating greater levels of leisure-time physical activity.