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[26 01 2013] Amika Singh Et Al. 2012_physical Activity and Performance at School, A Systematic Review of Literature Including a Methodological Quality Assessment

[26 01 2013] Amika Singh Et Al. 2012_physical Activity and Performance at School, A Systematic Review of Literature Including a Methodological Quality Assessment

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REVIEW ARTICLE
Physical Activity and Performance at School
 A Systematic Review of the Literature Includinga Methodological Quality Assessment
 Amika Singh, PhD; Le´onie Uijtdewilligen, MSc; Jos W. R. Twisk, PhD;Willem van Mechelen, PhD, MD; Mai J. M. Chinapaw, PhD
Objective
:
Todescribetheprospectiverelationshipbe-tween physical activity and academic performance.
DataSources
:
Prospectivestudieswereidentifiedfromsearches in PubMed, PsycINFO, Cochrane Central, andSportdiscus from 1990 through 2010.
Study Selection
:
We screened the titles and abstractsforeligibility,ratedthemethodologicalqualityofthestud-ies, and extracted data.
MainExposure
:
Studies had to report at least 1 physi-calactivityorphysicalfitnessmeasurementduringchild-hood or adolescence.
Main Outcome Measures
:
Studies had to report atleast1academicperformanceorcognitionmeasuredur-ing childhood or adolescence.
Results
:
 Weidentified10observationaland4interven-tionstudies.Thequalityscoreofthestudiesrangedfrom22% to 75%. Two studies were scored as high quality.Methodological quality scores were particularly low forthe reliability and validity of the measurement instru-ments. Based on the results of the best-evidence synthe-sis,wefoundevidenceofasignificantlongitudinalposi-tiverelationshipbetweenphysicalactivityandacademicperformance.
Conclusions
:
Participationinphysicalactivityispositivelyrelatedtoacademicperformanceinchildren.Becausewefoundonly2high-qualitystudies,futurehigh-qualitystud-iesareneededtoconfirmourfindings.Thesestudiesshouldthoroughly examine the dose-response relationship be-tweenphysicalactivityandacademicperformanceaswellas explanatory mechanisms for this relationship.
 Arch Pediatr Adolesc Med. 2012;166(1):49-55
P
HYSICAL ACTIVITY AND SPORTS
are generally promoted fortheir positive effect on chil-dren’s physical health; regu-lar participation in physicalactivityinchildhoodisassociatedwithade-creased cardiovascular risk in youth andadulthood.
1
There is also a growing bodyofliteraturesuggestingthatphysicalactiv-ity has beneficial effects on several mentalhealth outcomes, including health-relatedquality of life and better mood states.
1
Inadditiontothepositivephysicalandmentalhealthimpactofphysicalactivity,there is a strong belief that regular par-ticipation in physical activity is linked toenhancement of brain function and cog-nition,
2
therebypositivelyinfluencingaca-demicperformance.Thereareseveralhy-pothesized mechanisms for why exerciseis beneficial for cognition, including (1)increased blood and oxygen flow to thebrain
3
;(2)increasedlevelsofnorepineph-rine and endorphins,
4,5
resulting in a re-duction of stress and an improvement of mood
6
; and (3) increased growth factorsthathelptocreatenewnervecellsandsup-port synaptic plasticity.
7,8
Besides thesesuggestedphysiologicaleffects,regularpar-ticipationinsportactivitiesmayimprovechildren’s behavior in the classroom, in-creasing the odds of better concentrationontheacademiccontentoftheselessons.Although schools are able to offeruniqueopportunitiesforstructuredphysi-cal activity for children, there is a ten-dency to cut back physical education les-sons.Theincreasingpressurestoimproveacademic scores often lead to additionalinstructional time for subjects such asmathematics and language at the cost of time for being physically active.Given the suggested relationship andthe ongoing discussions on the replace-mentofphysicaleducationlessonsbyaca-demicsubjects,weaimedtoreviewtheevi-dence on the longitudinal relationshipbetween these 2 variables.Two previous reviews
9,10
have studiedthe influence of physical activity on aca-demic performance. Trudeau andShephard
9
present an overview of the lit-eratureontherelationshipbetweenphysi-cal activity in the school setting and sev-
Author Affiliations:
Department of Public andOccupational Health, EMGOInstitute for Health and CareResearch (Drs Singh, vanMechelen, and Chinapaw andMs Uijtdewilligen), andDepartment of ClinicalEpidemiology and Biostatistics(Dr Twisk), Vrije Universiteit(VU) University MedicalCenter, and Department of Methodology and AppliedBiostatistics, Institute of HealthSciences, VU University(Dr Twisk), Amsterdam,the Netherlands.
ARCH PEDIATR ADOLESC MED/VOL 166 (NO. 1), JAN 2012 WWW.ARCHPEDIATRICS.COM
49
©2012 American Medical Association. All rights reserved.
 
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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
10
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.
METHODS
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,
and
sport
); (2) academicachievement (eg,
academic achievement, cognition, academic performance,
and
school learning
); and (3) age (eg,
child,infant, adolescent,
and
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.
INCLUSION CRITERIA
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.
SELECTION PROCESS
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.
DATA EXTRACTION
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
11,12
and for prognosis studies in systematic reviews.
13
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.
14
This rating system con-sists of 3 levels and takes into account the number,methodologicalquality,andconsistencyofoutcomesofthestud-ies, as follows:
v
Strong evidence, provided by generally consistent find-ings in multiple (
Ն
2) high-quality studies;
v
Moderateevidence,providedbygenerallyconsistentfind-ingsin1high-qualitystudyand1ormorelow-qualitystudies,or in multiple low-quality studies;
v
Insufficientevidence,whenonly1studywasavailableorfindings were inconsistent in multiple (
Ն
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 (
P
Ͻ
.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
50
©2012 American Medical Association. All rights reserved.
 
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RESULTS
LITERATURE SEARCH
The systematic literature search yielded 844 publica-tions. After excluding duplicates (n=26) and those thatwere not published as full-text articles (n=87) or werepublished before 1990 (n=259), we screened the titlesand abstracts of 472 publications, of which 14 articleswere identified as relevant. The
Table
provides a sum-maryofthestudiesincludedinthepresentreviewontheirmaincharacteristics,thatis,studypopulation,studyde-sign,measuresofphysicalactivityandacademicachieve-ment/cognition,andmainresults.Anextensivedescrip-tion of the studies can be found in eTable 2.
GENERAL
Twelveofthe14studies
17-28
wereperformedintheUnitedStates,1inCanada,
15
and1inSouthAfrica.
16
Fourarticlesdescribed the results of school-based interventions. Thesamplesizerangedfrom53participants
16
toapproximately12000participants,
17
aged6through18years.Follow-upduration varied from 8 weeks
16
to more than 5 years.
18,19
Table. Description of the Studies Reporting on the Relationship Between Physical Activity and AcademicPerformance in Children and Adolescents
Source (QualityScore)StudyDesign/Country/ Follow-upDurationCharacteristicsStudy Sample atBaselineMeasure ofPhysical ActivityMeasure ofAcademicAchievement Main Results
Nelson andGordon-Larsen,
17
2006 (70%)Observational/ US/1-2 y7th-12th grades(age, 12-18 y)Both sexes
a
(N = 11957)Standard 7-dayrecallquestionnaire;self-reportedparticipation inPE, school-basedsports, academicclubs, sportswith parents, anduse of recreationcentersSelf-reported scorein math orEnglishStudents with high participation inschool-based physical activitiesand students with
Ն
5 bouts perweek MVPA were more likely toearn higher gradesEitle and Eitle,
26
2002 (60%)Observational/ US/2 y10th grade (age,15-16 y)Only boys(N = 5018)Self-reportedbasketball,football, or “othersports”participationMath and readingtest; self-reportedgradesStudents who played football orbasketball had poorer math andreading scores; white malestudents who participated inother sports earned highergrades than white malestudents who played footballand basketball and black malestudents who played football,basketball, or other sportsCarlson et al,
18
2008 (55%)Observational/ US/5.5 yMean (SE) age,74.9 (0.1) mo58.9% Boys(N = 5316)PE participationreported byclassroomteachersMath and readingtests; IRT scalescoresFemale students with the highestexposure to PE demonstratedsmall academic benefits forreading and mathEitle,
27
2005 (55%) Observational/ US/2 y8th grade (age,13-14 y)48.5% Boys(N = 10087)Self-reportedparticipation inbaseball/softball,basketball,football, or “otherteam sports” andindividual sportsStandardized testscoresParticipating in other team sportsor individual sports wasassociated with enhancedachievement; playingbaseball/softball, football, orbasketball had a negative effecton scores for male students;baseball/softball participationhad a negative effect on mathscores for black femalestudents; participating in otherteam sports had a positiveeffect on math and readingscores for white femalestudents; participating inbasketball had a negative effecton math and science scores forblack male studentsCoe et al,
22
2006 (45%)Observational/ US/1 schoolyear (11 mo)Mean (SD) age,11.5 (0.4) yBoth sexes
a
(N = 214)Self-reported 3-dayphysical activityrecallGrades; Terra Nova(nationalstandardizedtest) scoresStudents who met or exceededguidelines for vigorous physicalactivity earned higher grades
(continued) 
ARCH PEDIATR ADOLESC MED/VOL 166 (NO. 1), JAN 2012 WWW.ARCHPEDIATRICS.COM
51
©2012 American Medical Association. All rights reserved.
 
Downloaded From: http://archpedi.jamanetwork.com/ on 06/02/2012

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