Martial arts-based curriculum reduces stress, emotional, and behavioral problems in elementary schoolchildren during the COVID-19 pandemic: A pilot study

Abstract

This exploratory study examined the impact of Heroes Circle, a martial arts-based curriculum on stress, emotional, and behavioral problems in elementary school children. While students completed classroom surveys at baseline, post-curriculum surveys were collected from teachers, students, and parents/guardians two and five months after COVID-19-related school shutdowns. Satisfaction with the curriculum was high among those who received the intervention. Children reported increased mindfulness and decreased stress over the school year. Most children (77%) were still using the program’s techniques and reporting benefits five months later, including lower internalizing symptoms and COVID-19-related fears. These patterns were not observed at the control school.

Lay Abstract

This exploratory study examined the impact of a martial arts-based curriculum – the Heroes Circle – on stress, emotional and behavioral problems in elementary schoolchildren. Heroes Circle participants reported increased mindfulness and decreased perceived stress over the academic year. Most children were still using the program’s techniques and reporting benefits (e.g., lower anxiety/depression, lower COVID-19-related fears) up to five months after COVID-19-related school shutdowns. Martial arts may be a promising approach for improving child well-being.

Introduction

Mindfulness-based school programs are a promising approach for reducing stress and improving well-being among K-12 students (Semple, Droutman, & Reid, 2017). Such programs cultivate self-awareness and self-regulation by focusing attention on thoughts, emotions, breath, and other internal sensations (Hölzel et al., 2011). These programs have helped to reduce stress and anxiety, while also improving self-control, attention, and academic achievement (Caballero et al., 2019). Studies also underscored significant outcomes in treating common childhood emotional and behavioral disorders, such as anxiety and attention deficit hyperactivity disorder (van der Oord, Bögels, & Peijnenburg, 2012). One key explanation is that these childhood changes were mediated by functional changes in brain regions that affect attentional control, emotion regulation, body awareness, and self-reference (Bauer et al., 2019; Marusak et al., 2018).

One particular program, martial arts, is a fun program that engages children due to its pairing of mindfulness training with physical movement (Yang & Conroy, 2018). Traditional martial arts address physical and mental developments while emphasizing respect, self-discipline, focus, and character development. The themes present in martial arts may resonate well with children from disadvantaged backgrounds, who may feel they have limited control over their lives. Engaging with children from lower-income communities or who have higher initial emotional or behavioral problems is critical because research shows that these groups are at the highest risk of falling behind academically. Finally, studies showed that martial arts training also reduced pain and emotional distress among children with cancer, other chronic diseases, and their siblings (ages 5–17; Bluth et al., 2016; Marusak et al., 2020).

Given that the COVID-19 pandemic has resulted in school closures, a transition to remote teaching and learning, and various other forms of compounded stress, and uncertainty, on K-12 students and educators (Mustafa, 2020), this exploratory study investigated whether a novel martial arts-based meditative school program — the Heroes Circle (HC, Fig.1; see Appendix A) — reduced stress, emotional, and behavioral problems among elementary schoolchildren. Parallel measures were collected in a control school, wherein students did not participate in the HC program. The COVID-19 pandemic has worsened emotional and behavioral problems (Gassman-Pines et al., 2020) and exacerbated already-existing disparities in educational outcomes among lower-income and minority youth (Masonbrink & Hurley, 2020); challenges that are particularly salient among younger students who may have limited attention and self-regulation capacity. As such, school-wide interventional programs are needed to mitigate the worsened emotional and behavioral problems and widening achievement gap, particularly among younger children from disadvantaged backgrounds (Hashim et al., 2020). The following hypotheses guided this study: (1) satisfaction with the HC program would be higher than at the control school; (2) children who participate in the HC (but not in the control group) would demonstrate increased mindfulness and decreased stress and emotional and behavioral problems over the school year; and (3) report lower COVID-19-related fear.

Fig.1. Children in the Heroes Circle (HC) program practicing the Breath Brake.

The Breath Brake is a breathing exercise that allows children to take control over their stress and anxiety. This image was approved by the school principal and superintendent.

Material and Methods

Overview

This exploratory study focused on three Detroit-area (Michigan, USA) elementary schools (two public, one private) for the 2019–2020 academic year (Fig.2a, timeline). Students at Schools 1 (public) and 3 (private) participated in the HC. School 2, which was in the same district as School 1, was selected as the control school (Appendix B) and did not receive the HC. The local institutional review board approved all study procedures (See Supplemental Material for more details).

Fig.2. Survey study timeline. A: By month. B. Survey data collection time points and measures of interest.

The Heroes Circle (HC) program was administered at Schools 1 and 3 only. School 1 is a public school, and School 3 is a nearby private school (within 5 miles). School 2, a public school in the same district as School 1, served as the control school.

HC Program

The HC was adapted for the school environment from standard Kids Kicking Cancer (KKC) classes (Bluth et al., 2016; Marusak et al., 2020). KKC uses a martial arts-based approach to help children with cancer and other chronic illnesses cope with pain and anxiety. In this program, the students were taught visualization and relaxation techniques and the “Breath Brake,” a breathing exercise that allows children to control their pain and anxiety. The mantra of KKC/HC is “Power. Peace. Purpose”, which emphasizes respect, self-regulation, discipline, and a feeling of empowerment.

Surveys

Two hundred and ninety-two students and 17 teachers across all three schools completed surveys in the classroom at baseline (T0; October 2019; Table 1). During May 2020 — two months following COVID-19 — related school shutdowns, 18 teachers and 64 child-parent dyads completed T1 surveys. Another installment of survey data collection were done in August 2020 (T2) for parents and children to test for continued use of HC techniques and whether these techniques conferred benefit for anxiety or COVID-related outcomes. Teachers reported on demographics, teaching experience, and program satisfaction at T1. At T1 and T2, children reported on program satisfaction, continued use of the HC techniques, and COVID-related fears, behaviors, and impact. At T0, T1, and T2, children reported on outcome variables (i.e., stress, internalizing, externalizing, and attention problems) and the purported process variable (mindfulness). At T1, students and teachers were asked to provide qualitative feedback on the aspects they liked and disliked about the program. Fig.2 highlights the survey time points and measures.

Table 1.

Child and teacher characteristics at baseline (T0; October 2019).

Children (n=292)
	Public Schools			Private Schools
	School 1 (N=131)	School 2 (Control) (N=109)	Difference statistic: School 1 vs. School 2	School 3 (N =52)	Difference statistic: Schools 1 & 2 vs. 3
Age, M years (SD)	7.65 (.77)	7.83 (.78)	t(238)=1.8, p=.067	7.9 (.8)	t(290)=1.4, p=.16
Gender, n (%)			χ 2 (1)=4.13, p=.042		χ2(1)=.02, p=.89
Female	49 (37%)	55 (50%)		22 (42%)
Male	82 (63%)	54 (50%)		30 (58%)
Grade, n (%)			χ 2 (1)=19.7, p<.001		χ 2 (2)=50.2, p<.001
Second grade	61 (47%)	21 (19%)		20 (39%)
Third grade	70 (53%)	88 (81%)		22 (42%)
Fourth grade	0	0		10 (19%)
Race/ethnicity, n (%)			χ2(1)=3.15, p=.68		χ 2 (5)=149.6, p<.001
Black non-Hispanic	94 (72%)	75 (69%)		1 (2%)
White non-Hispanic	9 (7%)	5 (5%)		38 (73%)
Hispanic	5 (4%)	5 (5%)		1 (2%)
Asian	8 (6%)	6 (5%)		0
Other/prefer to not answer	15 (11%)	18 (16%)		12 (23%)
Teachers (n=17)
	Public Schools			Private School
	School 1 (N=6)	School 2 (Control) (N=6)	Difference statistic: School 1 vs. School 2	School 3 (N =5)	Difference statistic: Schools 1 & 2 vs. 3
Gender, n (%)			N/A		χ 2 (1)=5.4, p=.02
Female	6 (100%)	6 (100%)		3 (60%)
Male	0	0		2 (40%)
Grade, n (%)			χ2(1)=3.4, p=.56		χ2(2)=2.6, p=.27
Second grade	3 (50%)	2 (33%)		2 (40%)
Third grade	3 (50%)	4 (67%)		2 (40%)
Fourth grade				1 (20%)
Race/ethnicity, n (%)			χ2(1)=1.1, p=.3		χ2(1)=.44, p=.51
Black non-Hispanic	0	1 (17%)		0
White non-Hispanic	6 (100%)	5 (83%)		5 (100%)
Number of children, M (SD)	25.8 (1.6)	23.5 (.55)	t(10)=3.37, p=.007	17 (7.2)	t(4.18)=2.29, p=.08
Overall teaching experience, n (%)			χ2(3)=6.29, p=.099		χ2(4)=5.96, p=.2
Less than 1 year	1	0		0
1–2 years	0	1		1
3–5 years	0	0		1
6–10 years	0	3		1
Over 10 years	5	2		1

Data analyses

Descriptive phenomenology was used to assess the qualitative responses. Overall analyses examined program satisfaction and continued use of HC techniques over time (T1 vs. T2) using descriptive statistics and chi-square tests. Paired samples t-tests were conducted on mindfulness and outcome variables to examine within-group change over time from pre- to post-intervention. Correlations between change scores in mindfulness and changes in other outcomes of interest were examined following prior work (Flook et al., 2013). We also explored correlations among continued use of HC techniques, mindfulness, and outcome variables. This is an exploratory study and was likely underpowered.

Results

Satisfaction with the HC curriculum

Satisfaction with the HC curriculum was high among students (Fig.3A) and teachers (Fig.3B), and student satisfaction with the HC was higher than what was reported in the control group. Qualitative analyses showed that students reported becoming more aware of their behaviors, they liked the Breath Brakes, and the activities they completed were insightful. However, some students recalled that some of the activities were not as engaging. A large majority of teachers who observed the HC in their classroom highlighted the timeliness and relatability of the activities in conjunction with the students’ lives.

Fig.3. Child (A) and teacher (B) satisfaction with the Heroes Circle (HC) program and in the control group as reported in May 2020 (T1).

*p<.05, chi-square test.

Continued use of HC techniques

At T1, the majority of students who participated in the HC still reported using Breath Brakes and feeling the benefit from HC techniques (see Fig.4). Though there was a non-significant change at T2, most children reported still using Breath Brakes and feeling the benefit from the techniques – five months after formal instruction ended (see Fig.4).

Fig.4. Continued use of Heroes Circle (HC) program techniques in May and August 2020.

Children were surveyed about their continued use of HC techniques and whether they perceived benefit in May and August 2020 - two and five months after COVID-19-related school shutdowns and the end of formal HC instruction, respectively. The drop in use of HC techniques over time was not statistically significant.

Outcome variables

Overall, students who participated in the HC reported a significant decrease in perceived stress over the school year. There was no significant change in internalizing, externalizing, or attention problems over the school year among the students who participated in the HC nor at the control school, and no changes between T1 and T2 in either group.

Process variable

Students who participated in the HC reported a significant increase in mindfulness over the school year. Among students who participated in the HC, those with higher externalizing problems at baseline reported greater increases in mindfulness over the school year. Perceived stress, internalizing, and attention problems at baseline were not associated with a change in mindfulness over the school year. Those who participated in the HC showed greater increases in mindfulness over the academic year, and demonstrated greater decreases in perceived stress, internalizing, externalizing, and attention problems over the school year (Fig.5a). Remarkably, students who showed a greater increase in mindfulness over the school year also reported that COVID-19 had a lower impact on their lives at T1 and reported lower COVID-19 fears of contamination at T2 (Fig.5b).

Fig.5. Children in the Heroes Circle (HC) program who reported greater mindfulness increases over the school year reported lower increases in problem behaviors (top row) and lower COVID-related fears and impact (bottom row).

T0 surveys were completed before the HC program in October 2019; post-program surveys were completed in May (T1) and August 2020 (T2). COVID-10-related fears and impact measured using the Fear of Illness and Virus Evaluation (FIVE; Ehrenreich-May, 2020). Internalizing, externalizing, and problem behaviors measured using the Pediatric Symptom Checklist (PSC); trait mindfulness was measured using the Child and Adolescent Mindfulness Measure (CAMM). Change scores were computed by subtracting scores at T1 from T0.

Exploratory correlation analyses

At T2, students who reported more frequently using the Breath Brake also reported lower internalizing symptoms. At T2, students who reported feeling like a powerful martial artist reported less fear of COVID-19 contamination and less fear of social distancing.

Discussion

This exploratory study provides preliminary evidence that the HC, a novel school-based martial arts program, reduces stress and emotional and behavioral problems among elementary schoolchildren. There was an overall high level of satisfaction with the HC among children and teachers, with 100% of children and 83% of teachers recommending this program to another child or teacher. More important, 85% and 77% of children reported that they still used the HC techniques, such as the Breath Brake, two and five months after COVID-19-related school shutdowns. Children who continued to use HC techniques reported benefits such as lower internalizing symptoms and COVID-19-related fears up to five months later and had increased mindfulness and decreased perceived stress over the school year. These findings were supported by the qualitative data, which showed that the HC activities helped students become conscious of their emotions. Not surprisingly, the utilization of child-friendly and fun activities created a conducive environment that helped them retain these practices over time. Overall, although underpowered, study findings support the beneficial effects of a school-based martial arts program on social-emotional well-being among both socioeconomically disadvantaged and advantaged elementary schoolchildren.

Martial arts training associated with reduced perceived stress and increased mindfulness

The HC revealed decreased perceived stress over time whereas the control group showed no significant change. This finding supported the extant scholarship about the impact of school-based martial arts programs on socioemotional well-being, resilience, self-efficacy, and self-regulation (Lakes & Hoyt, 2004). Students who participated in the HC reported increased mindfulness over time. It is suggestable that mindfulness training may be a ‘process’ variable that is mediated by the positive effects of martial arts, and those who showed greater mindfulness improvements may be those who were more responsive to the program. Students with more externalizing problems at baseline showed the greatest increases in mindfulness, consistent with prior evidence that students with initially poorer executive functions benefit most from martial arts or mindfulness-based programs (Diamond & Lee, 2011). Intervening at the elementary school level helps mitigate widening achievement gaps. Likewise, greater mindfulness resulted in greater reductions in stress, internalizing, externalizing, and attention problems, further supporting the benefits of mindfulness for emotional and behavioral functioning. These findings’ implications are substantial, considering that student learning is optimal in a non-disruptive classroom and that teacher stress and job satisfaction are tied to classroom functioning (Montgomery & Rupp, 2005).

Martial arts for coping with COVID-19-related stress

This study occurred during COVID-19 school shutdowns and provided a unique opportunity to investigate whether HC could help students cope with a novel, unpredictable, and uncertain stressor. Prior natural disasters (e.g., hurricanes) studies suggest that children were particularly vulnerable to stressors because their capacity to adapt independently was limited though their sensitivity to uncertainties were greater (La Greca et al., 2013). Children from disadvantaged backgrounds may be even more susceptible to enduring stress in the wake of large-scale stressors, including feelings of anxiety, helplessness, and insecurity (Weems et al., 2010). Our data suggest that the continued use of HC techniques may facilitate adaptive changes in children during the COVID-19 pandemic, such as lower fear and lower perceived impact. These adaptive changes may be attributed, in part, to an increased sense of control and agency associated with martial arts training. For example, using Breath Brakes helps children control their fears and anxieties to improve their self-perception like powerful martial artists who can conquer new challenges. It was also notable that students who showed greater mindfulness increases throughout the program reported lower COVID-19-related fear and perceived impact.

Conclusions

We report preliminary evidence that a grade-wide, school-based martial arts-based meditative/mindfulness program may reduce stress, emotions, and behavioral problems and mitigate the impact of COVID-19 on elementary schoolchildren. These benefits were accompanied by increases in children’s mindfulness, which has been linked to better academic and mental health outcomes among youth (Caballero et al., 2019). Given that nearly all emotional and behavioral disorders begin during childhood (Kessler et al., 2005), martial arts-based programs may be a prophylactic approach for reducing the likelihood of developing psychopathology. Furthermore, the program appears to provide sustainability in that the initial intervention provided effects that lasted at least five months after the initial intervention. This has additional economic applications in school systems that are strained for resources. Although this study was not a randomized study design, the next step, given these interesting findings from this exploratory findings, is to design and implement a randomized, sufficiently powered protocol. School-based martial arts programs may help to level the playing field and diminish the achievement gap while improving child well-being and the broader learning environment.

Table 2.

Child characteristics at the post-program survey time point (T1; May 2020).

Children (n=64)
	Public Schools			Private School
	School 1 (N=30)	School 2 (Control) (N=16)	Difference statistic: School 1 vs. School 2	School 3 (N =18)	Difference statistic: Schools 1 & 2 vs. 3
Age, M years (SD)	8 (.61)	8.4 (.62)	t(44)=1.8, p=.08	8.4 (.78)	t(62)=1.5, p=.12
Gender, n (%)			χ2(1)=3.38, p=.067		χ2(1)=1.7, p=.2
Female	7 (23%)	8 (50%)		9 (50%)
Male	23 (77%)	8 (50%)		9 (50%)
Grade, n (%)			χ2(1)=2.1, p=.15		χ 2 (2)=9.9, p=.007
Second grade	16 (53%)	5 (31%)		10 (55%)
Third grade	14 (47%)	11 (69%)		5 (28%)
Fourth grade	0	0		3 (17%)
Race/ethnicity, n (%)			N/A		χ 2 (2)=64, p<.001
Black non-Hispanic	30 (100%)	16 (100%)		0
White non-Hispanic	0	0		16 (89%)
Other/prefer to not answer	0	0		2 (11%)
Parent’s highest education level, n (%)			χ2(4)=2.1, p=.228		χ 2 (5)=21.9, p=.001
High school or equivalent	2	2		0
Some college	9	9		4 (22%)
2-year college degree	10	4		0
4-year college degree	5	0		6 (33%)
Master’s degree	4	1		5 (28%)
Doctorate	0	0		3 (17%)