{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T04:28:26Z","timestamp":1787372906227,"version":"build-2736575974"},"reference-count":89,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T00:00:00Z","timestamp":1787184000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: Recent pediatric sleep research has increasingly adopted an integrated lifestyle perspective, examining sleep together with diet, physical activity, sedentary behavior, and family environments. However, bowel habits remain comparatively underrepresented despite their potential importance for child health. This conceptual narrative review revisits the Four Kai framework, which brings together sleep, eating, bowel habits, and physical activity as four fundamental daily physiological behaviors and explores their potential relationships with adaptive pleasure, self-regulation, and daytime functioning. Methods: This conceptual narrative review incorporated a descriptive PubMed literature-mapping exercise conducted on 16 July 2026. The search covered publications from January through June of each year from 2022 to 2026 and focused on studies in which sleep was a principal research topic together with terms related to diet, bowel function, physical activity, and lifestyle. Publications clearly outside pediatric or adolescent populations were excluded. Titles and abstracts were reviewed, with full texts consulted when necessary, and eligible studies were classified thematically according to their principal research objective. This exercise was intended to provide descriptive context for the conceptual review and was not conducted as a systematic or scoping review. Results: The descriptive mapping and narrative synthesis indicate that pediatric sleep research frequently examines sleep in relation to diet, physical activity, sedentary behavior, family environments, and other lifestyle factors, whereas everyday bowel habits remain comparatively underrepresented. The reviewed literature supports multiple individual and pairwise associations among sleep, eating, physical activity, bowel function, and daytime functioning but does not establish that these four behaviors operate as a single integrated physiological system. Direct empirical evidence for a pathway linking the Four Kai through adaptive pleasure and positive self-regulation to daytime functioning is currently lacking. Conclusions: The Four Kai framework is best regarded as a hypothesis-generating conceptual framework rather than an established biological or causal model. Its potential value lies in bringing sleep, eating, bowel habits, and physical activity into a common perspective and generating testable questions about their possible functional integration. Future longitudinal and intervention studies should evaluate these behaviors together with adaptive pleasure, self-regulation, and daytime functioning to determine which proposed relationships can be empirically supported.<\/jats:p>","DOI":"10.3390\/children13081115","type":"journal-article","created":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T16:05:19Z","timestamp":1787241919000},"page":"1115","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Integrating Sleep, Eating, Bowel Habits, and Physical Activity in Children and Adolescents: A Conceptual Review of the Four Kai Framework"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9793-7788","authenticated-orcid":false,"given":"Jun","family":"Kohyama","sequence":"first","affiliation":[{"name":"Tokyo Bay Urayasu Ichikawa Medical Center, 3-4-32 Toudaizima, Urayasu 279-0001, Chiba, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,20]]},"reference":[{"key":"ref_1","unstructured":"Kohyama, J. (2011). Promoting the Four Kai, Shinyosha. (In Japanese)."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"9","DOI":"10.5665\/sleep.3298","article-title":"Sleep Health: Can We Define It? Does It Matter?","volume":"37","author":"Buysse","year":"2014","journal-title":"Sleep"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Halfon, N., Forrest, C.B., Lerner, R.M., and Faustman, E.M. (2018). Handbook of Life Course Health Development, Springer.","DOI":"10.1007\/978-3-319-47143-3"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"S266","DOI":"10.1139\/apnm-2015-0627","article-title":"Systematic review of the relationships between sleep duration and health indicators in school-aged children and youth","volume":"41","author":"Chaput","year":"2016","journal-title":"Appl. Physiol. Nutr. Metab."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"326","DOI":"10.23736\/S0026-4946.17.04914-3","article-title":"Insufficient sleep in adolescents: Causes and consequences","volume":"69","author":"Owens","year":"2017","journal-title":"Minerva Pediatr."},{"key":"ref_6","unstructured":"Mindell, J.A., and Owens, J.A. (2022). A Clinical Guide to Pediatric Sleep: Diagnosis and Management, Wolters Kluwer. [4th ed.]."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Miike, T. (2024). Insufficient Sleep Syndrome in Childhood. Children, 12.","DOI":"10.3390\/children12010019"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"de Mello, G.T., Minatto, G., Costa, R.M., Leech, R.M., Cao, Y., Lee, R.E., and Silva, K.S. (2024). Clusters of 24-hour movement behavior and diet and their relationship with health indicators among youth: A systematic review. BMC Public Health, 24.","DOI":"10.1186\/s12889-024-18364-6"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Zeng, N., Jiang, S., Ringer, A., Pacheco, C., Zheng, C., and Ye, S. (2024). Associations Between Combinations of 24-Hour Movement Behaviors and Dietary Outcomes in Children and Adolescents: A Systematic Review. Nutrients, 16.","DOI":"10.3390\/nu16213678"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Silva, A.F.D., Martins, P.C., Santiago, L.N., and Silva, D.A.S. (2025). Mapping Evidence on Integrated 24-Hour Movement Behaviors in Children and Adolescents: A Scoping Review of Reviews. Children, 12.","DOI":"10.3390\/children12030260"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/S0387-7604(86)80003-1","article-title":"Sleep study on patients with severe brain damage\u2014Polysomnographical examination","volume":"8","author":"Kohyama","year":"1986","journal-title":"Brain Dev."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Zhao, H., Wu, N., Haapala, E.A., and Gao, Y. (2024). Association between meeting 24-h movement guidelines and health in children and adolescents aged 5-17\u2009years: A systematic review and meta-analysis. Front. Public Health, 12.","DOI":"10.3389\/fpubh.2024.1351972"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Ricardo-Sejin, J.R., Arango-Paternina, C.M., Fl\u00f3rez-Pregonero, A., and Pati\u00f1o-Villada, F.A. (2025). Research characteristics about the 24-h movement behaviors in children and adolescents: A scoping review. BMC Public Health, 25.","DOI":"10.1186\/s12889-025-22646-y"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"108","DOI":"10.1186\/s12966-025-01809-5","article-title":"Global research on 24-hour movement behaviours guidelines in children and adolescents: A systematic review","volume":"22","author":"Hossian","year":"2025","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e70120","DOI":"10.1111\/sms.70120","article-title":"Association Between 24-h Movement Behaviors and Mental Health in Children and Adolescents: A Systematic Review and Compositional Data Meta-Analysis","volume":"35","author":"Bourke","year":"2025","journal-title":"Scand. J. Med. Sci. Sports"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1186\/s40798-025-00961-3","article-title":"The Efficacy of Interventions Targeting 24-h Movement Behaviours in Children and Adolescents: A Systematic Review and Meta-analysis","volume":"11","author":"Feng","year":"2025","journal-title":"Sports Med.\u2014Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.sleh.2026.01.008","article-title":"Multidimensional association of sleep health with dietary habits and physical activity in adolescents","volume":"12","author":"Nyhuis","year":"2026","journal-title":"Sleep Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e23","DOI":"10.1017\/gmh.2026.10138","article-title":"The synergistic effects of diet and physical activity on sleep quality among Chinese adolescents: A comprehensive cross-sectional study","volume":"13","author":"Huang","year":"2026","journal-title":"Glob. Ment. Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1186\/s12982-026-01386-3","article-title":"Role of diet and physical activity on sleep and sleep parenting for Latine 2-to-5-year-olds","volume":"23","author":"Bailey","year":"2026","journal-title":"Discov. Public Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e85525","DOI":"10.2196\/85525","article-title":"Digital Interventions Targeting Parents to Improve Early Childhood Movement, Nutrition, and Sleep Behaviors: Systematic Review","volume":"28","author":"Sandborg","year":"2026","journal-title":"J. Med. Internet Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1080\/15402002.2026.2624609","article-title":"Family Stressors and Sleep Problems During Adolescence: Evidence from the ALSPAC Cohort","volume":"24","author":"Flouri","year":"2026","journal-title":"Behav. Sleep Med."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.jadohealth.2026.02.022","article-title":"Association of Stress and Neighborhood Social Context With Actigraphy-Measured and Self-Reported Adolescent Sleep Outcomes","volume":"79","author":"DiFiore","year":"2026","journal-title":"J. Adolesc. Health Off. Publ. Soc. Adolesc. Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e70286","DOI":"10.1111\/jsr.70286","article-title":"Impact of Environmental Exposure on Infant Sleep: The Exposome Approach","volume":"35","author":"Halbouty","year":"2026","journal-title":"J. Sleep Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1877","DOI":"10.1152\/physrev.00018.2018","article-title":"The Microbiota-Gut-Brain Axis","volume":"99","author":"Cryan","year":"2019","journal-title":"Physiol. Rev."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1038\/s41579-020-00460-0","article-title":"The gut microbiota-brain axis in behaviour and brain disorders","volume":"19","author":"Morais","year":"2021","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_26","unstructured":"Health Promotion Sleep Guideline Revision Committee (2024). Health Guide for Sleep Promotion 2023, Ministry of Health, Labour and Welfare. Available online: https:\/\/www.mhlw.go.jp\/stf\/seisakunitsuite\/bunya\/kenkou_iryou\/kenkou\/suimin\/index.html."},{"key":"ref_27","first-page":"e46175","article-title":"Poor Sleep Quality as a Risk Factor for Constipation Among Community-Dwelling Older Adults in Japan","volume":"15","author":"Nakagawa","year":"2023","journal-title":"Cureus"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Liu, J., Wang, W., Tian, J., Lv, C., Fu, Y., Fass, R., Song, G., and Yu, Y. (2022). Sleep Deficiency Is Associated With Exacerbation of Symptoms and Impairment of Anorectal and Autonomic Functions in Patients With Functional Constipation. Front. Neurosci., 16.","DOI":"10.3389\/fnins.2022.912442"},{"key":"ref_29","first-page":"12","article-title":"Association between sleep disorders and constipation Risk: A systematic review and Meta-Analysis","volume":"126","author":"Tian","year":"2024","journal-title":"J. Clin. Neurosci. Off. J. Neurosurg. Soc. Australas."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Ohkuma, T., Iwase, M., and Kitazono, T. (2024). Sleep duration and its association with constipation in patients with diabetes: The fukuoka diabetes registry. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0302430"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1186\/s41043-024-00601-8","article-title":"Association of habitual sleep duration with abnormal bowel symptoms: A cross-sectional study of the 2005-2010 national health and nutrition examination survey","volume":"43","author":"Zhang","year":"2024","journal-title":"J. Health Popul. Nutr."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1080\/07420528.2022.2139713","article-title":"U-shaped association between sleep duration with chronic constipation and diarrhea: A population-based study","volume":"39","author":"Wang","year":"2022","journal-title":"Chronobiol. Int."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"39767","DOI":"10.1038\/s41598-025-23440-x","article-title":"U shaped association between sleep duration and long term cognitive decline trajectories in a national cohort","volume":"15","author":"Feng","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"e14159","DOI":"10.1111\/acel.14159","article-title":"U-shaped association between sleep duration and biological aging: Evidence from the UK Biobank study","volume":"23","author":"Wang","year":"2024","journal-title":"Aging Cell"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Taheri, S., Lin, L., Austin, D., Young, T., and Mignot, E. (2004). Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. PLoS Med., 1.","DOI":"10.1371\/journal.pmed.0010062"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.sleep.2010.04.016","article-title":"Mortality related to actigraphic long and short sleep","volume":"12","author":"Kripke","year":"2011","journal-title":"Sleep Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"5471","DOI":"10.1097\/JS9.0000000000001695","article-title":"Sleep patterns, genetic susceptibility, and digestive diseases: A large-scale longitudinal cohort study","volume":"110","author":"Ma","year":"2024","journal-title":"Int. J. Surg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1136\/jnnp-2021-328062","article-title":"Possible predictors of phenoconversion in isolated REM sleep behaviour disorder: A systematic review and meta-analysis","volume":"93","author":"Wang","year":"2022","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_39","first-page":"47","article-title":"Non-motor symptoms are associated with REM sleep behavior disorder in Parkinson\u2019s disease: A systematic review and meta-analysis","volume":"42","author":"Xie","year":"2021","journal-title":"Neurol. Sci. Off. J. Ital. Neurol. Soc. Ital. Soc. Clin. Neurophysiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1111\/j.1440-1754.2010.01990.x","article-title":"Low defaecation frequency in Taiwanese adolescents: Association with dietary intake, physical activity and sedentary behaviour","volume":"47","author":"Chien","year":"2011","journal-title":"J. Paediatr. Child Health"},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Huang, R., Ho, S.Y., Lo, W.S., and Lam, T.H. (2014). Physical activity and constipation in Hong Kong adolescents. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0090193"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"768","DOI":"10.1097\/MPG.0b013e3182a313fc","article-title":"Preschool physical activity and functional constipation: The Generation R study","volume":"57","author":"Driessen","year":"2013","journal-title":"J. Pediatr. Gastroenterol. Nutr."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Komeno, Y., Kuchiki, T., Onodera, Y., and Machida, S. (2023). Defecation Habits in Preschoolers Are Associated with Physical Activity: A Cross-Sectional and Isotemporal Substitution Analysis. Children, 10.","DOI":"10.3390\/children10060951"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e003069","DOI":"10.1136\/bmjpo-2024-003069","article-title":"Impact of physical inactivity and sedentary behaviour on functional constipation in children and adolescents: A systematic review","volume":"8","author":"Adil","year":"2024","journal-title":"BMJ Paediatr. Open"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1093\/jpepsy\/jsad047","article-title":"Sleep Problems in Pediatric Disorders of Gut-Brain Interaction: A Systematic Review","volume":"48","author":"Robbertz","year":"2023","journal-title":"J. Pediatr. Psychol."},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Piriyakitphaiboon, V., Chia, M.Y.H., Chua, T.B.K., Amornchaicharoensuk, Y., and Sirimongkolchaiyakul, O. (2026). Relationship between screen use, physical activity, sleep duration and bladder and bowel dysfunction in Thai children. BMC Pediatr., 26.","DOI":"10.1186\/s12887-026-06666-0"},{"key":"ref_47","first-page":"604","article-title":"Lifestyle and bowel movements in school children: Results from the Toyama Birth Cohort Study","volume":"59","author":"Yamada","year":"2017","journal-title":"Pediatr. Int. Off. J. Jpn. Pediatr. Soc."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"220","DOI":"10.2188\/jea.JE20180016","article-title":"Psychological Stress, Family Environment, and Constipation in Japanese Children: The Toyama Birth Cohort Study","volume":"29","author":"Yamada","year":"2019","journal-title":"J. Epidemiol."},{"key":"ref_49","unstructured":"Japan Toilet Labo (2025). Bowel Movement Records of Elementary and Junior High School Students 2025: Seven-Day Records from 11,771 Students, Japan Toilet Labo. Available online: https:\/\/www.toilet.or.jp\/wp\/wp-content\/uploads\/2025\/12\/toiletweek2025_record_survey_7days.pdf."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"920","DOI":"10.3109\/00365529709011203","article-title":"Stool form scale as a useful guide to intestinal transit time","volume":"32","author":"Lewis","year":"1997","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"567","DOI":"10.5223\/pghn.2020.23.6.567","article-title":"Lifestyle Habits Associated with Poor Defecation Habit among Pupils in Japan","volume":"23","author":"Kohyama","year":"2020","journal-title":"Pediatr. Gastroenterol. Hepatol. Nutr."},{"key":"ref_52","first-page":"1209","article-title":"Principles of Sleep Hygiene Education and Practical Guidance for Improving Sleep [in Japanese]","volume":"56","author":"Kohyama","year":"2024","journal-title":"Shoni Naika."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1007\/s41105-025-00593-w","article-title":"Association between insufficient sleep and constipation among elementary school children in Japan","volume":"23","author":"Furuya","year":"2025","journal-title":"Sleep Biol. Rhythm."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1016\/j.clnesp.2021.07.012","article-title":"The association between dietary patterns and quality and duration of sleep in children and adolescents: A systematic review","volume":"45","author":"Alibabaei","year":"2021","journal-title":"Clin. Nutr. ESPEN"},{"key":"ref_55","doi-asserted-by":"crossref","unstructured":"Kawabata, M., Lee, K., Choo, H.C., and Burns, S.F. (2021). Breakfast and Exercise Improve Academic and Cognitive Performance in Adolescents. Nutrients, 13.","DOI":"10.3390\/nu13041278"},{"key":"ref_56","doi-asserted-by":"crossref","unstructured":"Ricotti, R., Caputo, M., Monzani, A., Pigni, S., Antoniotti, V., Bellone, S., and Prodam, F. (2021). Breakfast Skipping, Weight, Cardiometabolic Risk, and Nutrition Quality in Children and Adolescents: A Systematic Review of Randomized Controlled and Intervention Longitudinal Trials. Nutrients, 13.","DOI":"10.3390\/nu13103331"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1093\/nutrit\/nuaa125","article-title":"Bidirectional associations between sleep quality or quantity, and dietary intakes or eating behaviors in children 6\u201312 years old: A systematic review with evidence mapping","volume":"79","author":"Ward","year":"2021","journal-title":"Nutr. Rev."},{"key":"ref_58","doi-asserted-by":"crossref","unstructured":"Sejbuk, M., Miro\u0144czuk-Chodakowska, I., and Witkowska, A.M. (2022). Sleep Quality: A Narrative Review on Nutrition, Stimulants, and Physical Activity as Important Factors. Nutrients, 14.","DOI":"10.3390\/nu14091912"},{"key":"ref_59","doi-asserted-by":"crossref","unstructured":"Yoshitake, R., Park, I., Ogata, H., and Omi, N. (2023). Meal Timing and Sleeping Energy Metabolism. Nutrients, 15.","DOI":"10.3390\/nu15030763"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"101953","DOI":"10.1016\/j.smrv.2024.101953","article-title":"Chrono-nutrition and sleep: Lessons from the temporal feature of eating patterns in human studies\u2014A systematic scoping review","volume":"76","author":"Saidi","year":"2024","journal-title":"Sleep Med. Rev."},{"key":"ref_61","first-page":"150","article-title":"Sleep timing and health indicators in children and adolescents: A systematic review. Horaire de sommeil et indicateurs de sant\u00e9 chez les enfants et les adolescents: Revue syst\u00e9matique","volume":"42","author":"Dutil","year":"2022","journal-title":"Health Promot. Chronic Dis. Prev. Can. Res. Policy Pract."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.sleep.2019.02.003","article-title":"Sleep, energy balance, and meal timing in school-aged children","volume":"60","author":"Spaeth","year":"2019","journal-title":"Sleep Med."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"624","DOI":"10.5152\/TurkArchPediatr.2021.21212","article-title":"Features of Pupils in Each Dinner Habit: Non-late Regular, Regular but Late, and Irregular","volume":"56","author":"Kohyama","year":"2021","journal-title":"Turk. Arch. Pediatr."},{"key":"ref_64","doi-asserted-by":"crossref","unstructured":"Matsumoto, Y., Sasaki, H., Masutomi, H., Ishihara, K., Shibata, S., Hirao, K., and Furutani, A. (2023). Effects of Additional Granola in Children\u2019s Breakfast on Nutritional Balance, Sleep and Defecation: An Open-Label Randomized Cross-Over Trial. Children, 10.","DOI":"10.3390\/children10050779"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/j.neubiorev.2021.09.003","article-title":"Relationships between physical activity, sleep and cognitive function: A narrative review","volume":"130","author":"Sewell","year":"2021","journal-title":"Neurosci. Biobehav. Rev."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s10865-015-9617-6","article-title":"The effects of physical activity on sleep: A meta-analytic review","volume":"38","author":"Kredlow","year":"2015","journal-title":"J. Behav. Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"101278","DOI":"10.1016\/j.smrv.2020.101278","article-title":"Physical activity and sleep are inconsistently related in healthy children: A systematic review and meta-analysis","volume":"51","author":"Antczak","year":"2020","journal-title":"Sleep Med. Rev."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"e13378","DOI":"10.1111\/jsr.13378","article-title":"Relationships of physical activity and sedentary behaviour with the previous and subsequent nights\u2019 sleep in children and youth: A systematic review and meta-analysis","volume":"30","author":"Huang","year":"2021","journal-title":"J. Sleep Res."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"7732","DOI":"10.1038\/s41598-019-44059-9","article-title":"Bidirectional, Daily Temporal Associations between Sleep and Physical Activity in Adolescents","volume":"9","author":"Master","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Wang, H., Xin, X., and Pan, Y. (2025). The best approaches and doses of exercise for improving sleep quality: A network meta-analysis and dose-response relationship study. BMC Public Health, 25.","DOI":"10.1186\/s12889-025-22570-1"},{"key":"ref_71","first-page":"45","article-title":"An Association Between Physical Activity and Sleepiness","volume":"4","author":"Kohyama","year":"2021","journal-title":"Asia Pac. J. Paediatr. Child Health"},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"You, Y., Chen, Y., Fang, W., Li, X., Wang, R., Liu, J., and Ma, X. (2023). The association between sedentary behavior, exercise, and sleep disturbance: A mediation analysis of inflammatory biomarkers. Front. Immunol., 13.","DOI":"10.3389\/fimmu.2022.1080782"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.cobeha.2021.02.013","article-title":"Positive Affect: Nature and brain bases of liking and wanting","volume":"39","author":"Nguyen","year":"2021","journal-title":"Curr. Opin. Behav. Sci."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"932","DOI":"10.1016\/j.tics.2023.07.007","article-title":"Separating desire from prediction of outcome value","volume":"27","author":"Berridge","year":"2023","journal-title":"Trends Cogn. Sci."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1332","DOI":"10.1038\/s41562-023-01639-0","article-title":"A mesocorticolimbic signature of pleasure in the human brain","volume":"7","author":"Kragel","year":"2023","journal-title":"Nat. Hum. Behav."},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1038\/s41386-021-01154-8","article-title":"Mapping causal generators of appetitive motivation-hedonic functions in frontal cortex","volume":"47","author":"Baldo","year":"2022","journal-title":"Neuropsychopharmacol. Off. Publ. Am. Coll. Neuropsychopharmacol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1038\/nrn2555","article-title":"How do you feel\u2014Now? The anterior insula and human awareness","volume":"10","author":"Craig","year":"2009","journal-title":"Nat. Rev. Neurosci."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1146\/annurev.neuro.24.1.167","article-title":"An integrative theory of prefrontal cortex function","volume":"24","author":"Miller","year":"2001","journal-title":"Annu. Rev. Neurosci."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"483","DOI":"10.1016\/j.tics.2011.08.003","article-title":"Large-scale brain networks and psychopathology: A unifying triple network model","volume":"15","author":"Menon","year":"2011","journal-title":"Trends Cogn. Sci."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1038\/npp.2009.129","article-title":"The reward circuit: Linking primate anatomy and human imaging","volume":"35","author":"Haber","year":"2010","journal-title":"Neuropsychopharmacol. Off. Publ. Am. Coll. Neuropsychopharmacol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.sleep.2021.04.015","article-title":"Associations between sleep and academic performance in US adolescents: A systematic review and meta-analysis","volume":"83","author":"Musshafen","year":"2021","journal-title":"Sleep Med."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"100424","DOI":"10.1016\/j.ijchp.2023.100424","article-title":"A meta-analysis of longitudinal studies on the interplay between sleep, mental health, and positive well-being in adolescents","volume":"24","author":"Bacaro","year":"2024","journal-title":"Int. J. Clin. Health Psychol. IJCHP"},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1017\/S0954422409990175","article-title":"A systematic review of the effect of breakfast on the cognitive performance of children and adolescents","volume":"22","author":"Hoyland","year":"2009","journal-title":"Nutr. Res. Rev."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"590S","DOI":"10.3945\/an.115.010256","article-title":"The Effects of Breakfast and Breakfast Composition on Cognition in Children and Adolescents: A Systematic Review","volume":"7","author":"Adolphus","year":"2016","journal-title":"Adv. Nutr."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Liu, L., Xin, X., and Zhang, Y. (2025). The effects of physical exercise on cognitive function in adolescents: A systematic review and meta-analysis. Front. Psychol., 16.","DOI":"10.3389\/fpsyg.2025.1556721"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1186\/s12966-024-01702-7","article-title":"Comparative effectiveness of physical activity interventions on cognitive functions in children and adolescents with Neurodevelopmental Disorders: A systematic review and network meta-analysis of randomized controlled trials","volume":"22","author":"Tao","year":"2025","journal-title":"Int. J. Behav. Nutr. Phys. Act."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"565","DOI":"10.1080\/02640414.2025.2468587","article-title":"Effects of different types of chronic physical activities and sports on executive functions among children and adolescents: A systematic review and meta-analysis","volume":"43","author":"Lawson","year":"2025","journal-title":"J. Sports Sci."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1016\/j.jpeds.2019.06.059","article-title":"Quality of Life in Children with Functional Constipation: A Systematic Review and Meta-Analysis","volume":"214","author":"Vriesman","year":"2019","journal-title":"J. Pediatr."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"814","DOI":"10.5152\/tjg.2020.19509","article-title":"The treatment of functional constipation significantly increased quality of life in children aged 4\u201317 years","volume":"31","author":"Erdur","year":"2020","journal-title":"Turk. J. Gastroenterol. Off. J. Turk. Soc. Gastroenterol."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/1115\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T04:21:08Z","timestamp":1787372468000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/1115"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,20]]},"references-count":89,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["children13081115"],"URL":"https:\/\/doi.org\/10.3390\/children13081115","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,20]]}}}