Effect of physical activity and fitness on executive functions and academic performance in children of elementary school. A systematic review

Introduction

The importance of physical activity (PA) for health and quality of life is well known and researched. Children experience both physical and psychological benefits when participating in PA (Ahn and Fedewa, 2011; Janssen and Leblanc, 2010; Lobelo et al., 2020). Moreover, previous studies have shown that PA influences cognitive functions (Ellemberg and St-Louis-Deschênes, 2010; Gallotta et al., 2014; Gunnell et al., 2019; Verburgh et al. 2014). A recent review showed that physical fitness (PF), single bouts of PA, and PA interventions benefit children’s cognitive functioning (Donnelly et al., 2016). Children who demonstrated to have high physical aptitudes exhibited greater cortical activation and corresponding cognitive functions than less fit children (Álvarez-Bueno et al., 2017; Latorre Román et al., 2017; Lemes et al., 2021). Chaddock, Pontifex, Hillman and Kramer (2011) demonstrated how PA improved brain health and cognitive functions during child development. Chang et al. (2012) and Gallotta et al. (2014) showed that several variables associated with PA such as PA duration, PA intensity and specific types of PA performed during a training programme were significant moderators in the association between cognitive functions and PA.

The terms PA and PF are often confused. Although these terms are closely related, they should not be treated as synonyms. PA refers to any bodily movement produced by skeletal muscle which requires consumption of energy. PF in turn is interpreted as a measure of the capacity to perform PA that include the majority of the physical functions (skeletomuscular, CRF, hematocirculatory, endocrine-metabolic, and psycho-neurological) involved in PA. PF is made up of 3 components: cardiorespiratory fitness (CRF), strength, and agility (Martínez-Vizcaíno and Sánchez-López, 2008). The close relationship between these terms is what justifies attending to both in this systematic review.

Previous studies have found several associations between PA and cognitive functions on specific factors such as academic performance (AP), executive function (EF), memory, intellectual maturity, concentration, and creativity in children (Donnelly et al., 2016; Latorre-Román et al., 2016; Lees and Hopkins, 2013; Soga, Shishido and Nagatomi, 2015). These studies analysed both acute and chronic effects of PA on cognitive actions. In addition, literature reviews (e.g. Marques et al., 2018) show how higher cardiorespiratory fitness (CRF) may be important to enhance academic performance.

Academic performance can be improved through PA at school (Carriedo and González, 2019). Wittberg et al. (2012) demonstrated how students who have healthy PF had significantly higher scores in different school subjects than students who had a low level of PF. In addition, current research has shown that AP was higher when children completed an intervention dedicated to doing more PA at school (Resaland et al., 2015; Donnelly et al., 2013).

Aerobic exercises have the potential to promote multiple facets of development through its direct impact on EF (Best, 2010). The term EF makes reference to capabilities we utilise when we formulate our goals and objectives, organise and plan, and when we carry out a series of adjusted and effective behaviours to achieve a goal (Lezak, Howieson and Loring, 2004). Multiple cognitive functions such as inhibiting dominant responses, updating working memory representations, shifting between task sets and attention are included in EF (Friedman et al., 2008). Working memory is an important element which belongs with EF. Pesce et al. (2009) investigated the effects of PA on memory performance in children through two sessions immediately following a PE class (aerobic circuit training vs. team games). They found that memory improved in both experimental groups compared to the control group. In addition, Berrios Aguayo et al. (2019) demonstrated the effectiveness of two PE classes (team game exercise and aerobic exercise) on memory. Additionally, attentional control and selective attention are other components of EF (Anderson, 2002). Mahar (2011) showed how after a break from a PE class, attention on a task was better. Syväoja et al. (2014) found that sedentary behaviour was associated with weaker flexibility of attention.

Different variables for PA have been associated with childhood neurocognition, however how cognitive aspects in children are developed through their physical development are still poorly understood. Further research is necessary to understand the relationship between PA and cognition performance during development. Mahar et al. (2006) claimed opportunities to be physically active at school are limited by pressure on scholastic performance. The incorporation of PA time into the school day is needed (Kibbe et al., 2011; Segura-Martínez et al., 2020).

Considering all previous evidence about how the practice of PA is related to greater cognitive and academic development in school-aged children, the research question focuses on: is there enough research literature that analyse this issue? Therefore, the objective of this systematic review was to analyse research that investigated the relationship and/or influence of PA and the level of PF on AP and EF in school-age children.

Method

The study was designed following the structure and recommendation of other systematic reviews (Ruiz-Ariza et al., 2017; García-Pinillos et al., 2016), the protocol used by PRISMA guidance for reports and studies (Moher, Liberati, Tetzlaff, Altman and PRISMA Group, 2009) and the Cochrane Manual of systematic reviews of interventions (Higgins and Green, 2011).

Search strategy

A comprehensive search of 4 databases (Medline, Pubmed, Eric ProQuest and Web of Science) from January 2010 through to January 2021 was undertaken. The principal categories of search terms were identified and employed in different combinations using “AND” (combining terms by retrieving the records in which all the searched terms appear) and “OR” (joining different terms by retrieving the records in which any of the terms appear) (Table 1).

Inclusion and exclusion criteria

The relevant papers selected for inclusion in the review were checked against the following criteria:

(1) There were no exclusion criteria with regard to sex or ethnic origin; (2) There was exclusion with children with physical or intellectual disabilities. (3) Age: children aged between 6-12 years old; (4) Language: English; (5) Year of publication: 2010-2021; (6) The systematic review uses cross-sectional, repeated measures or interventional studies; (7) Review articles were not included in this systematic review.

Reliability and data extraction

Based on the inclusion and exclusion criteria, two independent reviewers screened the citations of potentially relevant publications. If the citation showed any potential relevance, it was screened at the abstract level. When abstracts indicated potential inclusion, full-text articles were reviewed. A third-party consensus meeting was held with a third author (APV) if the 2 reviewers were not able to reach agreement. In conclusion, authors reviewed the studies resulting from the systematic review and agreed on their inclusion.

Quality assessment and level of evidence

The quality assessment of the study has carried out on the basis of other standardised assessment lists. Cross-sectional studies were assessed using the modified version of the Quality Index developed by Downs and Black (Downs and Black, 1998) (Table 2). The original scale was reported to have good test-retest (. = 0.88) and inter-rater (. = 0.75) reliability and high internal consistency (Kuder-Richardson Formula 20 (KR-20) = 0.89). Reliability of the subscales varied from good to poor validity. The Quality Index correlated highly with an existing, established instrument for assessing randomised studies r = 0.90. The modified version of the Downs and Black Quality Index is scored from 1 to 14, with higher scores indicating higher-quality studies. Those items that corresponded to the selected studies were selected based on the needs of the study, as well as relevant systematic reviews already published, such as the one by Ruiz-Ariza et al. (2017).

The methodological quality of interventional studies was assessed using the Physiotherapy Evidence Database (PEDro) scale (Maher et al., 2003) (Table 3). This 11-item scale rates randomised controlled trials from 0 to 10, with 6 representing the cut off score for high-quality studies. Studies scoring 9-10 on the PEDro scale were considered to be of “excellent” methodologically quality, 6-8 of “good” quality, 4-5 of “fair” quality, and below 4 of “poor” quality.

Result

The flow of search results through the systematic review process is shown in Figure 1. Firstly, 9892 papers from the different databases were extracted based on the language, type of document, age and date. Secondly, duplicate papers were excluded (4562 duplicate papers). Then, the titles of the articles were read to exclude those that were not related with our bibliographical search (123 papers were selected). Specifically, population, age, language, design, variables, and other excluding factors were meticulously inspected. Finally, 123 papers were read in full in order to select the final sample (28 papers) (Table 4).

A meticulous analysis was conducted with the final papers. Nine papers (32,14%) were cross-sectional studies (Wittberg et al. 2012; Lambourne et al., 2013; Hansen et al., 2014; Haapala et al., 2014; Syväoja et al., 2014; van der Niet et al., 2015; Pontifex et al., 2012; Raine et al., 2013; Schmidt et al. 2017); six papers (21,42%) were repeated measures studies (van den Berg et al., 2016; Gallotta et al., 2015; Ma et al., 2015; Jäger et al., 2015; Schmidt et al., 2015; Pirrie and Lodewyk, 2012). Both cross-sectional studies and repeated measures studies were methodologically assessed through the modified Down and Black scale providing an adequate assessment of the articles based on the scale scores. Finally, 13 papers (46.42%) were interventional studies (Mullender-Wijnsma et al., 2015; Käll et al., 2014; Erwin et al., 2012; Hillman et al., 2014; Fisher et al., 2011; Kamijo et al., 2011; Ou et al., 2016; de Greeff et al., 2016; Sardinha et al., 2016; Kvalø et al. 2017; Lind et al., 2018; Chaddock-Heyman et al., 2020; Layne et al., 2021) . These articles were assessed through the PEDro scales obtaining an evaluation of Good Quality or Excellent Quality.

The main findings of the studies analyzed in the systematic review agree that PA has an acute and chronic effect on the cognitive and academic performance of primary school children. The results will mainly depend on the intensity and the time of development of the PA.

Discussion

This systematic review has explored the association between PA and PF on AP and EF in elementary school children (6-12 years old). Studies from January 2010 to January 2021 were obtained from 4 databases. A total of 26 articles met the inclusion criteria: 9 studies used a cross-sectional design, 6 were repeated measures studies and 11 were intervention studies. PA and levels of PF were assessed by CRF, muscular strength, speed-agility, motor coordination, perceptual-motor skill and other physical variables.

A large number of studies have examined, through cross-sectional designs, the association between the level of PF and various cognitive functions at school. The detailed analysis of the influence of each physical fitness component revealed that CRF has the greatest influence on AP and EF. To evaluate CRF, some studies used the 20-m shuttle run test PACER (Wittberg et al., 2012; Lambourne et al., 2013; Hansen, et al., 2014) and two studies used a formula to calculate the maximal oxygen consumption (VO.max) (Pontifex et al., 2012; Raine et al., 2013). Wittberg et al. (2012), Lambourne et al. (2013) and Hansen et al. (2014) found that children with more CRF had a higher AP. On the other hand, Pontifex et al. (2012) and Raine et al. (2013) used a computerised indirect calorimetry system with averages for oxygen uptake (VO.) and respiratory exchange ratio to assess CRF, showing how children with a high level of CRF had better memory ability. A suitable PF is an possible condition for better inhibition, working memory and cognitive flexibility in children (Syväoja et al., 2014; van der Niet et al., 2015). In addition, a good CRF, an adequate body composition, and a higher motor performance are associated better AP (Haapala et al., 2014). However, Jansen et al. (2019) did not find relationship between PF (body coordination and speed) and working memory in school-aged children.

Some research has focused on determining the acute and chronic effect of PA on children's cognitive abilities. The type of effect depended on the duration of the intervention carried out. Several research has shown a acute effect when children perform PA before academic subjects on AP and EF. Different PE classes in which children have to activate their brain function, lead to they are more prone to obtain better scores on AP, memory, attention or concentration (Yanagisawa et al., 2010). MVPA performed in a PE session has an acute effect on different EF like planning, attention, simultaneous processing and successive processing and school performance in children during elementary school (Pirrie and Lodewyk, 2012). Moreover, short periods of aerobic exercise (20 seconds of high-intensity activity separated by 10 seconds of rest and repeated 8 times) have an important acute effect on attention in the next academic classes (Ma et al., 2015). Team game sessions, which demand control and complex eye-hand coordination and require goal-directed behaviour, and aerobic exercises, based on high-intensity cardiomyopathy, help students to better develop inhibition, shifting and memory update of themselves to face scholary activities in an appropriate way (Jäger et al., 2015). This was also supported by authors such as Mezcua et al. (2019) who showed that short-term training of C-HIIT has benefits in cognitive functions. However, a team game session had a better result in cognitive function than a class in aerobic exercise because it is producing a cognitive compromise when the frontal lobe is activated in the execution (Yanagisawa et al., 2010). This statement attempts to explain how PE sessions which include a cognitive compromise can have an acute effect on the cognitive capacities of children. Thus, Gallotta et al. (2015) demonstrated in an experiment that those sessions that require cognition exercises like playing mini-games with coordination, meant students were able to develop their cognitive skills more effectively. However, van den Berg et al. (2016) did not find any improvement on memory, attention or the PA in children who did aerobic, coordination or strength sessions in comparison with children who were in the control group.

On the other hand, current research has demonstrated the chronic effect of PA on AP and EF for elementary school children. Most of them have performed PA programmes in which children increased the time dedicated to PA at school (Lind et al., 2018). Käll et al. (2014) carried out a controlled interventional study in a Swedish government programme (Handslaget) based on group play and other activities which increased the proportion of students who achieved national learning compared with three reference schools. Higher proportions of students in the intervention school achieved the national goals in all three subjects compared with the reference schools after initiation of the intervention programme. Sardinha et al. (2016) also performed an intervention study to assess AP of children after a three-year intervention dedicated to avoiding childhood obesity. The result of this intervention was positive regarding the national goals. On the other hand, active lessons of MVPA in the classroom for several weeks improved the AP and EF of students due to the fact that they exercise not only the body but also the cognitive processes reflected in the AP (Mullender-Wijnsma et al., 2015; Erwin et al., 2012; Layne et al., 2021). Hillman et al. (2009) showed that an intervention over 9 months where children do short periods of moderate-intense aerobic exercise can improve cognitive control and attention. Increasing the number of hours of PE at school (two hours), over at least 10 weeks, is a suitable method to enhance the students’ marks and cognitive aspects such as working memory and attention (Fisher et al., 2011). Children who have physical afterschool sessions for two hours per week (over 9 months) performing MVPA achieve better results on their behaviour (analysing accuracy and reaction time) and on executive control such as modulated attentional, inhibition and cognitive flexibility (Hillman et al., 2014). Moreover, afterschool sessions based on aerobic exercises (Kamijo et al., 2011; Chaddock-Heyman et al., 2020) and cardiovascular and motor exercises (Ou et al., 2016) showed improvements in some EF such as memory work or inhibitory control and AP. Continuing with afterschool sessions performing MVPA is a good way to enhance children’s cognitive functions. In addition, it is relevant to determine not only whether team games and aerobic exercises have an acute effect on PA, but also whether it has a chronic effect if carried out for several weeks on EF such as inhibition, shifting and update (Schmidt et al., 2015). However, de Greeff et al. (2016) did not find improvements in mathematical and language activities for the experiment group after a two-year intervention dedicated to active MVPA classes.

Limitations of research and implications for research and practice

The limitations of the study are manifested in the selected databases. Although relevant databases were used, others such as Scopus were ignored. In addition, all types of studies that met the inclusion criteria were attended without paying attention to factors that could determine the quality of the study, such as the sample size.

Finally, based on the measurement instruments of the different variables, the suitability of the same can be confirmed in consideration of the context where the measurement was carried out and the age of the sample. All reflect an appropriate degree of reliability and are tailored to the sample. Certainly, more innovative and effective techniques such as image analysis could have been used, however, in the educational field, which has a fairly large sample, the use of such instruments is very complicated.

The literature suggests that cognitive and academic performance of children not improved by limiting the time allocated to PE and PA (Trudeau and Shephard, 2008). Therefore, increasing the amount of time devoted to PA and so improving their PF can promote acute and chronic cognitive benefits on EF such as working memory, attention, inhibition and shifting have important implications for AP (Fisher et al., 2011). In addition, activity breaks can produce positive, chronic cognitive response. This literature review serves as the basis for future research in the field of educational psychology that promotes PA programs in the school context in primary education.

Conclusion

The present review found a total of 26 articles that analysed the association between PA with AP and EF in children. Nine articles focused on AP and fifteen on EF. Thirteen of those focused on attention and working memory and two on other EF like inhibition, shifting, cognitive flexibility, update or planning. Most studies showed a positive relationship between PA on AP and EF. In the nine studies which analysed the effect of PA and PF on AP, only one did not find an association. Regarding EF, in two studies PA did not produce any effects. CRF was the physical variable that was correlated with better AP and EF. On the other hand, active classes of MVPA and PE classes when children had to perform coordination exercises revealed a better acute effect. In addition, a large chronic effect was found mainly in children who carried out PE sessions over several weeks which involved cognitive compromises by means of coordination exercises. Finally, confounders could have played a pivotal role in these associations. Sex, age, BMI, sociodemographic factors, and previous marks must be taken into account. More research is needed to explain the effect of different types of PA on AP and EF to clarify the role of confounders and better predict the relationship between physical and cognitive variables. Intervention studies in which children have to move more at school or outside school are necessary in order to enhance cognitive processes which are used during the school day. Integrating educational departments, the school and the families can guarantee the cognitive and physical health of children. Promoting PA in children as a tool for improving cognitive aspects is everyone's responsibility.

References

Author notes

* Correspondence: jsalas@ujaen.es

Additional information

HOW TO CITE THIS ARTICLE: Berrios-Aguayo, B., Latorre-Román, P.A., Salas-Sánchez, J., & Pantoja-Vallejo, A. (2022). Effect of physical activity and fitness on executive functions and academic performance in children of elementary school. A systematic review. Cultura, Ciencia y Deporte, 17(51), 85-103. http://dx.doi.org/10.12800/ccd.v17i51.1699.

Cultura, Ciencia y Deporte
ISSN: 1696-5043
Vol. 17
Num. 51
Año. 2022

Effect of physical activity and fitness on executive functions and academic performance in children of elementary school. A systematic review

BeatrizPedro ÁngelJesúsAntonio Berrios AguayoLatorre RománSalas SánchezPantoja Vallejo
Universidad de JaénUniversidad de JaénUniversidad Autónoma de Chile,EspañaEspañaChile