eraloutcomemeasures,includingacademicperformance.Basedonquasi-experimentaldata,theyreportthatphysi-cal education programs demand a substantial reductionin time allocated for academic tuition. Because thechildren’s academic performance did not change,they conclude that learning efficiency had improved.Furthermore, Trudeau and Shephard report thatcross-sectional studies generally indicate a positiveassociation between physical activity and academicachievement.The review by Taras
argues that there may be someacutebeneficialeffectsofphysicalactivity,butthelong-term improvement of academic achievement is not wellestablished.Tarasconcludesthattheacutecognitiveben-efits of physical activity may adequately compensate fortime spent away from academic areas.Tosummarize,theliteratureprovidesinconclusiveevi-dence on the positive longitudinal relationship betweenphysical activity and academic performance. However,there is a strong general belief that this relationship ispresent, and research in this area is ongoing.No systematic review with the specific focus on thelongitudinal relationship between general physicalactivity and academic performance has been per-formed. Therefore, we present in this article theresults of a systematic review of the literature, examin-ing this longitudinal relationship. We include onlyprospective data and take into account the method-ological quality of the studies.
SELECTION OF THE LITERATURE
We performed a computerized search in 4 electronic biblio-graphic databases (PubMed, PsycINFO, Cochrane Central,and Sportdiscus) from 1990 through 2010, using searchterms suitable to each specific database. The search strategyconsisted of 3 elements: (1) physical activity (eg,
physicalactivity, exercise, physical fitness,
); (2) academicachievement (eg,
academic achievement, cognition, academic performance,
); and (3) age (eg,
0-18 years old
). These terms were usedas MeSH (Medical Subject Headings) and free text words inall databases. The full search strategy can be obtained onrequest.
Studies were included if they were prospective studies (ob-servational cohorts and intervention studies) examining thelongitudinal relationship between physical activity and aca-demic performance in young people. Eligible studiesdescribed (1) at least 1 physical activity or physical fitnessmeasurement during childhood or adolescence and (2) atleast 1 academic achievement or cognition measure duringchildhood or adolescence. We included only full-text articlespublished after 1990 in English-language peer-reviewed journals.
First, a single reviewer (L.U.) checked all titles and abstractsofarticlesidentifiedthroughthesearchprocesstoidentifypo-tentially relevant articles. In case of uncertainty, a second re-viewer (A.S.) screened the article. In total, 14 studies fulfilledall inclusion criteria.
Thefirstreviewer(L.U.)extracteddatafromtheidentifiedstud-ies, including (1) the study population, (2) the study design,(3) a measure of physical activity and academic achievement/ cognition, and (4) main results.
METHODOLOGICAL QUALITY ASSESSMENT
Both reviewers (A.S. and L.U.) independently scored theincluded studies. Disagreements were discussed andresolved.The methodological quality of the included studies wasscored on the basis of a criteria list that was adapted fromthe criteria lists developed for observational longitudinalstudies
and for prognosis studies in systematic reviews.
Thecriterialist(eTable1;http://www.archpediatrics.com)in-cluded11itemsandassessedthemethodologicalqualityinthefollowing4dimensions:(1)participationrate(n=1),(2)studyattrition (n=3), (3) data collection (n=4), and (4) data analy-sis (n=3). The criteria answer format included positive, nega-tive, and don’t know. We gave a positive score if the publica-tionprovidedaninformativedescriptionofthecriterionatissueandmetthequalitycriterion.Anegativescorewasgivenincaseof an informative description but an inadequate performance.Incaseofnoorinsufficientinformation,wescoredthequalityitem at issue with a question mark. If the study referred to an-otherpublicationcontainingrelevantinformationaboutthesamestudy, we retrieved the additional publication to score the cri-terion of concern. In case we were not able to decide on therating of a criterion based on the information in the publica-tion, we contacted the authors for additional information orclarification. If the information could not be retrieved, a ques-tion mark was given.For each study, we calculated the percentage of items thata study scored positively on methodological quality. A studywasconsideredtobeofhighmethodologicalqualityifthequal-ity score was at least 70%. A score less than 70% was definedas low quality.
LEVEL OF SCIENTIFIC EVIDENCE
To synthesize the methodological quality of the studies and tobe able to draw conclusions regarding the relationship be-tween physical activity and academic achievement, we ap-plied the best-evidence synthesis.
This rating system con-sists of 3 levels and takes into account the number,methodologicalquality,andconsistencyofoutcomesofthestud-ies, as follows:
Strong evidence, provided by generally consistent find-ings in multiple (
2) high-quality studies;
Moderateevidence,providedbygenerallyconsistentfind-ingsin1high-qualitystudyand1ormorelow-qualitystudies,or in multiple low-quality studies;
Insufficientevidence,whenonly1studywasavailableorfindings were inconsistent in multiple (
2) studies. We considered results to be consistent when at least 75%of the studies showed results in the same direction, whichwas defined according to significance (
.05). If 2 or morestudies were of high methodological quality, we disregardedthe studies of low methodological quality in the evidencesynthesis.
ARCH PEDIATR ADOLESC MED/VOL 166 (NO. 1), JAN 2012 WWW.ARCHPEDIATRICS.COM
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