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To cite this Article Keeley, Thomas J. H. and Fox, Kenneth R.(2009)'The impact of physical activity and fitness on academic
achievement and cognitive performance in children',International Review of Sport and Exercise Psychology,2:2,198 — 214
To link to this Article: DOI: 10.1080/17509840903233822
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International Review of Sport and Exercise Psychology
Vol. 2, No. 2, September 2009, 198214
The potential for physical activity and fitness to improve cognitive function,
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Introduction
The physical health benefits of participating in regular physical activity and
maintaining physical fitness are widely established (Department of Health, 2004,
United States Department of Health and Human Services, 2008). It has been clearly
demonstrated that physical activity decreases risk of developing cardiovascular
disease (CVD), stroke, some cancers, obesity, type 2 diabetes mellitus and is also
effective in the treatment of several of these diseases.
There has also been growing interest in the benefits of physical activity for mental
health and a strong evidence base shows that regular activity and improved fitness
increases psychological well-being (Biddle, Fox & Boutcher, 2001, Biddle & Mutrie,
2008). Exercise can help people feel better about themselves and their lives, reduce
anxiety and improve mood. Evidence is also building to show that physical activity is
associated with substantially reduced risks of mental illnesses and conditions such as
depression, cognitive impairment and dementia (Fox & Mutrie, in press; Hamer &
Chida, 2008). The benefits of physical activity in the treatment of depression
(National Institute of Clinical Excellence, 2004) and improvement in select aspects of
cognitive function in older adults are becoming increasingly well established
(Angevaren, Aufdemkampe, Verhaar, Aleman, & Vanhees, 2008). Furthermore,
acute bouts of well managed physical exercise may facilitate certain aspects of
information processing in adults (Tomporowski, 2003).
Some of these positive effects on mental health have also been shown in children
and adolescents, although the evidence base is limited. Few studies have investigated
the preventive or treatment effects of exercise on mental illness within this
population, partly because incidence is low. However, reviews have indicated that
exercise and/or sport involvement can have beneficial effects on psychological well-
being. For example, exercise has been shown to improve physical self-perceptions
and to a lesser extent self-esteem in children (Fox, 2001) although effects are
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inconsistent.
In addition to the effects on psychological health, there has been substantial
interest in the potential impact of improved fitness and exercise on cognitive function
and learning in children. The notion that higher levels of activity or fitness may
enhance thinking, concentration and subsequently academic performance is
attractive to educators. Not only could it benefit children, it could improve the
school’s added value for academic achievement. For physical educators and sports
coordinators, it could justify greater provision of physical activity in the school
curriculum. Indeed, since the early 1990s schools have been adopting commercial
programmes such as Brain Gym (www.braingym.org.uk), a system that utilises motor
coordination exercises to enhance learning, despite evidence of its effectiveness.
Other schemes such as ‘Wake Up Shake Up’ (www.foundation-stage.info) and
‘Energizers’ (www.ncpe4me.com/energizers) are also emerging in schools within the
UK and the US respectively.
Four literature reviews have been published on the links between physical activity
and cognitive function or academic performance since 2003. In a review of 44 studies
Sibley and Etnier (2003) examined the evidence for the influence of physical activity
on cognition in children. 28 cross-sectional associational and 16 intervention studies,
with children between the ages of four and 18 years were included. Eight different
categories of cognitive assessment were identified and associations or effects of single
bouts and regular participation in various forms of aerobic training, resistance
training and physical education curriculum were summarised. A mean effect size of
0.32 in favour of activity was reported. This review was very inclusive with several
studies being unpublished, outcome measures were diverse and some samples were
children with learning difficulties where relationships might be quite different.
The association between physical activity and school performance was reviewed
by Taras (2005) in a paper reporting 14 studies, including an unstated number with
abstract only, published between 1984 and 2004, involving participants between five
and 18 years of age. In a narrative summation of the findings, showing weak or no
correlation between activity level and academic performance, Taras concludes that
the field requires further research to better understand the impact of activity levels
upon student performance. Trudeau and Shephard (2008) presented a recent
review of studies linking school time physical activity and academic performance.
Nine cross-sectional studies and seven quasi-experimental studies assessing
200 T.J.H. Keeley and K.R. Fox
Terms of reference
The following definitions are provided to maintain clarity and consistency through
the remainder of the review.
International Review of Sport and Exercise Psychology 201
Exposure/independent variables
Childhood physical activity is a complex mix of behaviours that take place in diverse
social settings. Consideration could be given to categories such as break-time play,
active travel, sport and physical education (both within and additional to the school
curriculum), informal play and sports and dance clubs outside school. This review
considers contexts as well as modes of activity which might include walking,
running, cycling, swimming, vigorous sports, and dance. Furthermore, consideration
is given to how each of these was quantified in terms of duration, frequency and level
of intensity.
In contrast to physical activity, physical fitness is a complex set of functional
capacities and capabilities. In children, these are partly determined by genetic factors
and stage of biological maturation as well as the amount of physical activity
undertaken. Often a battery of tests are used to assess components such as
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Outcome variables
Academic achievement is the child’s performance when assessed by standardised tests
within a school, or educational setting. Often this is quantified as achievement in
specific subjects such as mathematics or reading skill, grade point average (in the
US) or through standard national assessment tests (SATs). This variable is
dependent on the ability of the child, their home background and environment, as
well as the quality and quantity of academic instruction that child receives.
Cognitive performance refers to the child’s performance when assessed using a
recognised and validated test of cognitive function. Tests assess components of
cognition such as reaction time, attention, working memory and stimulus response
(collectively referred to as executive control). Cognitive and academic performance
are thought to interrelate as aspects of cognition such as attention and working
memory are vital for academic success.
Method
Search strategies
A three-step search method was used to identify studies meeting inclusion criteria
that investigated the relationship between physical activity or physical fitness and
cognitive performance or academic achievement. The terms, and their combinations
were searched in the databases of MEDLINE, PSYCHINFO, Cochrane data base,
Google Scholar and ERIC: physical activity; habitual activity; physical education;
physical fitness; physical education; cognition; cognitive function; cognitive perfor-
mance; cognitive health; academia; academic performance; academic achievement
and academic grades. The references lists of all identified studies were also searched
for titles containing any of the above terms, and all relevant studies followed up.
Three selected prominent authors in the field were then contacted by email and
202 T.J.H. Keeley and K.R. Fox
provided with the list of studies meeting inclusion criteria and asked to identify
further relevant papers.
Data extraction
A standard data extraction template was used to extract the following data from all
studies meeting criteria; primary and secondary research questions, location, sample
size and characteristics, study design, exposure and outcome measures, adjustment
variables, results with significance levels, and conclusions. These were then used as a
basis of the summary tables.
Results
Search results
17 studies satisfied inclusion criteria. Of these, 11 were cross-sectional correlational
studies. Five studies were of quasi-experimental design. One randomised controlled
trials was identified. Five studies of correlational design (Table 1a) and five studies of
quasi-experimental design (Table 1b) assessed physical activity and academic
achievement. Four studies of correlational design assessed physical fitness and
academic achievement (Table 2). Two studies of correlational design (Table 3a) and
one study of experimental design (Table 3b) assessed physical fitness and cognitive
function. No study examining the links between physical activity and cognitive
function were found.
Carlson et al. USA 5316 students Teacher reported Mathematics Third tertile girls (70300 mins of PE per week)
(2008) followed from frequency and and reading tests. achieved slightly higher academic scores in
Kindergarten duration of PE kindergarten, first grade and fifth grade reading
to 5th grade. lessons. Tertiles and first grade mathematics compared to first
formed. tertile girls (035 mins of PE per week).
204
T.J.H. Keeley and K.R. Fox
Table 1b. Physical activity and academic achievement: intervention studies
Ahamed et al. British 288 primary AS! BC: 16 months of Canadian Achievement Usual practice schools had significantly
(2007) Columbia, school students, an additional 47 min/wk Test (CAT-3) (p 0.001) higher scores at baseline than
Canada aged 911 of school time PA intervention schools, but not at follow-up.
Coe et al. Michigan, USA 214 sixth grade One semester of one Academic achievement Academic achievement not affected by the
(2006) students 55 min lesson of grades and standardised one semester of increased PE.
PE per day test score
Sallis et al. Southern 654 fifth and Project SPARK: 2 years Metropolitan Intervention group showed significantly
(1999) California, sixth grade of an additional 2742 Achievement Test (p range0.02 to 0.001) smaller declines in
USA students min/wk of PE and an (MAT6/7) academic performance compared to control
additional 2729 min/ group.
wk of ‘self-management’
classes
Shephard et al. Trois Rivieres, 546 first to 5 hours of PE per week Standardised exam and Improvement in performance in English, but
(1984) Quebec sixth grade for five years; control teacher rating. not maths in standardised exam. Improved
students 40mins per week for teacher ratings.
same time period.
Dwyer et al. South Australia 500 fifth grade 2 years of 75 min/day of ACER arithmetic test No significant difference in either measure
(1983) students PE focusing either on and GAP reading test of academic performance.
skill or fitness. Controls
maintained three classes
of 30 min/week
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Physical fitness
Author, (date) Location Subjects assessment Academic assessment Primary finding
Eveland-Sayers et al. Tennessee, 134 third, forth 1 mile run, sit-up, Mathematics and A significant negative correlation between
(2009) USA and fifth grade sit-and-reach reading/language 1-mile run times and mathematics (r 0.28,
students and BMI. sections of p B0.01) and muscular fitness and mathe-
Terra Nova test matics (r0.20, pB0.05). When analysed by
206
Table 3a. Physical fitness and cognitive performance: correlational studies
Buck et al. Illinois, 74 children The Fitnessgram The Stroop Aerobic fitness was positively and significantly (p 0.001) associated with
(2007) USA aged 712 colour-word the word, colour and incongruent colour-word conditions of the Stroop
years task task. Results suggest aerobic fitness was associated with better cognitive
functioning and executive control.
Hillman et al. Illinois, 24 children The Fitnessgram A visual High fit children had a significantly faster reaction time (p B0.01), greater
(2005) USA mean age 9.6 oddball P3 amplitude (p B0.001) and shorter P3 latency (pB0.001). Results
years paradigm suggest greater allocation of of attention and working memory in high fit
children.
Author,
(date) Location Subjects Intervention Cognitive assessment Primary finding
Davis et al. Augusta, 94 children, Low-dose (20 mins) vs CAS (based) on the Planning, Controls showed significantly lower
(2007) Georgia, aged 711 High-dose (40 mins) of Attention, Simultaneous and post-test CAS Planning score than
USA years, mean gymnasium based exercise Successive (PASS) theory. high-dose exercise group p .01. No
age 9.2 years. eliciting a Heart Rates of significant difference between control
150BPM. 5 days per week and low-dose exercise groups or low
for 15 weeks. and high-dose exercise groups.
International Review of Sport and Exercise Psychology 207
performance. Ages ranged from 7 to 15 years with sample sizes ranging from of 134
to 884,715. Two studies used the US Fitnessgram which includes the following tests:
PACER (cardiovascular endurance), push-ups and sit-ups (muscular endurance), sit
and reach (flexibility) and body mass index. In the Eveland-Sayers et al. (2009) study
all but the PACER test of the US Fitnessgram battery was used, replacing this with a
one-mile run. The fourth study (Dwyer, Coonan, Leitch, Hetzel, & Baghurst, 2001)
used a battery of tests including standing long jump (muscular power), sit ups and
push ups (muscular endurance), sit and reach (hip flexion), skinfold thicknesses
(fatness), lung function, 50 meter sprint (muscular power) and 1.6 kilometer run
(cardiorespiratory endurance). Three studies used standardised tests to assess
academic achievement while one study used a rating of academic ability on a five-
point scale by an adult school representative (usually the school principal). Two
studies (Castelli, Hillman, Buck, & Erwin, 2007; Dwyer et al., 2001) reported
controlling for socioeconomic status and parental education.
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The only intervention study was conducted recently by Davis et al. (2007). They
used a pre and post intervention aerobic fitness treadmill test and the CAS test,
based on the Planning, Attention, Simultaneous and Successive (PASS) theory of
cognitive functioning. The intervention consisted of low and high-dose gymnasium
based exercise programmes, focused around group games. Children in the low-dose
group exercised for 20 minutes, five days per week for 15 weeks and the children in
the high-dose group exercised for 40 minutes. Both groups aimed to achieve an
average heart rate of 150 bpm for each session. The high-dose exercise group differed
significantly from the no additional exercise control group on the Planning aspect of
the CAS test. This well-designed study provides initial evidence for an effect of
exercise upon at least one aspect of executive function. It is of note that low and
high-dose intervention groups did not differ significantly on the treadmill post-test,
suggesting that difference in fitness gains made by the two groups were small.
Factors other than fitness change may have been responsible for the difference in
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cognitive function.
Discussion
During the past 10 years, interest has grown considerably in the social, mental and
educational benefits of physical activity for young people. There appears to be great
potential in this area, and indeed a belief in the value of sport and activity for social
and mental benefits has already underpinned considerable investment in their
promotion by local and national government. Particular attention has been paid to
the potential for physical activity to improve learning and academic achievement.
However, the small number of published reviews that have focused on the effects of
physical activity on academic and cognitive performance in young people have not
produced consistent results. This review attempted to take a systematic and rigorous
approach to the identification, selection, and interpretation of this body of literature.
The following general conclusions can be drawn about the state of the evidence
base (until the end of February 2009):
1. There are few published studies. Only 17 were identified. The reasons for this
paucity of research, especially given policy interest and indications of plausible
mechanisms from related areas of research (discussed later) are not clear.
2. The majority of studies are cross-sectional and correlational in design. These
at best have produced weak positive associations. There are several factors
including level of motivation and aspirations, cognitive skills, clustering of
abilities within individuals, parental encouragement and logistic support, that
could provide alternative explanations for associations between engagement in
activity and sport and mental performance. Controlled intervention studies
are therefore necessary to isolate cause and effect.
3. Only six intervention studies were identified. Experimental studies have
focused on the effect of additional school-time physical activity on academic
performance. An exception is the recent work of Davis et al. (2007) that
addressed aspects of executive function. No studies primarily addressing
effects of physical activity in other contexts such as the active travel, break-
time play, informal play from the home, or participation in non-school based
clubs and teams were located.
210 T.J.H. Keeley and K.R. Fox
Based on the existing evidence, we feel we are able to make the following statements.
1. Based on five cross sectional studies, a weak relationship may exist between
total daily physical activity and academic achievement. There are several
plausible alternative explanations for this relationship and no intervention
studies to support it.
2. There is no consistently convincing evidence to show that increasing
curricular-based physical activity improves academic achievement. However,
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cortex of rats (Kleim, Cooper, & VandenBerg, 2002). It has been postulated that this
may benefit cognitive function by allowing greater perfusion of blood through this
region.
It has been suggested that mechanisms such as these underpin the growing
evidence base that indicates reduction in the region of 30% in subsequent risk of
premature cognitive decline and dementia in older adults who have been and remain
active (Fox & Mutrie, in press, Hamer & Chida, 2009). The notion that exercise helps
maintain the hard wiring and blood supply in the brain seems plausible as metabolic
turnover with exercise increases dramatically from rest. It seems equally plausible
that exercise might stimulate neural growth and efficiency during the period of
biological maturation in children. However, there is little current evidence to support
this. Perhaps the most convincing evidence is provided by Winter et al. (2007) who
showed through a randomised cross-over design that vigorous activity can improve
brain-derived neurotropic factor, dopamine and epinephrine and these improve post-
exercise capacity for aspects of short term and medium term cognitive performance.
However, this study was conducted with young male adults.
Future research
Certainly, these diverse sources of evidence suggest that high quality research should
be undertaken to investigate the impact of both acute and regular physical activity
on the cognitive function of children and young people, particularly during
important phases of growth. There is also a case for investigating the impact of
exercise on the cognitive function of those who have cerebral impairment.
Our view of the work to date is that intervention designs are needed. Because of
the early stage of this research, many small scale studies focusing on potential
mechanisms and feasibility studies are required before more expensive trials are
attempted. There is insufficient knowledge at the descriptive level to identify
definitive mechanisms and interventions at this point. It would seem helpful to
pay more attention to the path of potential effect. For example, before impact on
academic achievement is addressed, it would seem appropriate to have some notion
of the potential mechanisms by which physical activity or fitness would take effect.
This may be through higher levels of specific cognitive performance such as
concentration, memory, decision making, alertness and thinking speed. It may be
212 T.J.H. Keeley and K.R. Fox
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