Received: 3 March 2021 Revised: 19 August 2021
DOI: 10.1111/ijpo.12850
SHORT COMMUNICATION
Academic performance and psychosocial functioning in
European schoolchildren: The role of cardiorespiratory
fitness and weight status
Pedro L. Valenzuela1 | Tania Pinto-Escalona2
Óscar Martínez-de-Quel2
1
Faculty of Sport Sciences, Universidad
Europea de Madrid, Madrid, Spain
2
Department of Didactics of Language, Arts
and Physical Education, University
Complutense of Madrid, Madrid, Spain
3
Department of Physical Activity and Health
Research Group (PaHerg), Research Institute
of Hospital 12 de Octubre (‘i+12’), Madrid,
Spain
Correspondence
Óscar Martínez-de-Quel, Facultad de
Educacio n—Universidad Complutense de
Madrid, C/ Rector Royo Villanova, n 1. 28.040
Madrid, Spain.
Email: odequel@ucm.es
Funding information
European Commission, Grant/Award Number:
567201-EPP-1-2015-2-IT-SPO-SCP.; Spanish
Ministry of Economy and Competitiveness and
Fondos FEDER, Grant/Award Numbers:
PI15/25400558, PI18/00139
Pedro L. Valenzuela and Tania Pinto-Escalona contributed equally as first co-authors.
Pediatric Obesity. 2021;e12850.
https://doi.org/10.1111/ijpo.12850
Accepted: 23 August 2021
| Alejandro Lucia1,3 |
Summary
Background: Whether a high cardiorespiratory fitness (CRF) can attenuate the poten-
tial detrimental effect of childhood obesity on academic performance and particularly
psychosocial functioning remains unclear.
Objectives: To analyse the academic performance/psychosocial functioning of
schoolchildren attending to their CRF and weight status.
Methods: 470 schoolchildren (46% girls, 7 ± 0 years) from 20 schools in five
European countries were categorized as (i) having overweight/obesity (n = 113) or
normal weight (n = 357) attending to body mass index and (ii) ‘fit’ (n = 282) or ‘unfit’
(n = 188) based on 20-meter shuttle-run performance (CRF ≥ or <42 ml
kg 1

min 1
[boys] and 35 ml
kg 1

min 1
[girls], respectively). Academic performance and psycho-
social functioning were assessed using the grades attained in school subjects and the
Strengths and Difficulties Questionnaire (SDQ) for parents, respectively.
Results: Independent of their weight status, fit children showed a greater academic
performance and psychosocial functioning than their peers who were unfit and over-
weight/obese. In fit children, academic performance and psychosocial functioning did
not differ between the two weight status categories (normal weight or overweight/
obesity).
Conclusions: Children with a higher CRF show a greater performance achievement
and psychosocial functioning regardless of their weight status, thereby supporting
the ‘fat but fit’ paradox and reinforcing the importance of improving CRF in this
population.
KEYWORDS
academic achievement, cognitive performance, obesity, overweight, physical fitness,
psychosocial problems
1 | INTRODUCTION
The prevalence of childhood obesity has increased in the last decades,
affecting more than 100 million boys and girls worldwide.1 Although
controversy exists,2 obesity seems to exert a negative influence on
wileyonlinelibrary.com/journal/ijpo © 2021 World Obesity Federation 1 of 4
2 of 4 VALENZUELA ET AL.

academic performance in schoolchildren.3 Childhood obesity might
also impair psychosocial functioning (i.e., potentially inducing greater
emotional and behavioural problems, such as hyperactivity or peer
relationship problems). 4,5
There is evidence that an optimal cardiorespiratory fitness (CRF)
attenuates some of the adverse consequences of obesity, at least at
the cardiovascular level—the so-called ‘fat but fit’ paradox. CRF can
6
also influence academic achievement,7 with a high CRF attenuating
the detrimental effects of obesity on academic performance in adoles-
cents.8 In addition, a high CRF has been associated with a better psy-
9
chosocial functioning. However, whether a high CRF attenuates the
potential detrimental influence of obesity on psychosocial functioning
remains unclear.
In the present study, we aimed to analyse children's academic
performance and psychosocial functioning attending to their CRF and
weight status.
2 | MATERIALS AND METHODS
This study followed a cross-sectional observational design and repre-
sents an ancillary analysis of a larger randomized controlled trial.10
Briefly, second-grade students (7–8 years) from 20 schools (2 class-
rooms per school) in France, Germany, Poland, Portugal, and Spain
were assessed before starting a school-based sport intervention (see
elsewhere for further details on inclusion/exclusion criteria).10 Writ-
ten informed consent was obtained from parents or legal guardians.
Only children with baseline data of body mass index (BMI), CRF, and
academic achievement or psychosocial functioning were included.
The study was conducted following the Declaration of Helsinki and
approved by the relevant Ethics Committee (Universidad Com-
plutense de Madrid, Spain).
Participants' weight status (normal weight or overweight/obesity)
was determined using the cut-off points established by the World
Obesity Federation.11 CRF (i.e., maximal oxygen uptake) was esti-
mated from 20-meter shuttle-run performance considering individ-
ual's age, sex, weight and height,8 with participants categorized as ‘fit’
(CRF ≥42 ml
kg 1

min 1
[boys] or ≥35 ml
kg 1

min 1
[girls]) or ‘unfit’
(CRF below the aforementioned sex-specific cutoffs).12
Academic performance was assessed using the grades attained on
Math and Native Language—which are core subjects for schoolchildren
in all the aforementioned countries—and the grade point average of all
school subjects. In order to standardize school grades across countries,
teachers were asked to transform students' grades into a 0 (lowest
score) to 10 (highest score) scale. A parent/guardian of each partici-
pant was asked to rate psychosocial functioning using an online ver-
sion of the Strengths and Difficulties Questionnaire (SDQ) for parents.
The SDQ provides separate scores (for emotional symptoms, conduct
problems, hyperactivity/inattention, peer problems, and prosocial
behaviour, respectively) and a ‘total difficulties’ score.13,14
Differences in academic performance and psychosocial function-
ing on four different categories of CRF and weight status (i.e., fit and
normal weight, fit and overweight/obese, unfit and normal weight,
and unfit and overweight/obese) were studied with a one-way analy-
sis of covariance using the following covariates: schools within coun-
tries, and children's age, sex, and socioeconomic status (Q1009
question from the Short Questionnaire Rotation A [SQR-A]).15 The
Bonferroni post hoc test was applied when a significant main effect
was found. Statistical analyses were performed with SPSS (version
23.0, Armonk, NY) setting the significance level at 0.05.
3 | RE SU LT S
From a total of 759 children baseline data of CRF and weight status was
available in 470 participants (46% girls, 7.4 ± [SD] 0.4 years), with the fol-
lowing distribution: fit and normal weight, 49%; fit and overweight/
obese, 11%; unfit and normal weight, 26%; and unfit and overweight/

TABLE 1 Academic performance and psychosocial functioning of school children attending to their cardiorespiratory fitness and weight
status

Overweight/obese Overweight/obese Normal weight and Normal weight

and unfit (n = 64) and fit (n = 50) unfit (n = 122) and fit (n = 234) p-value
Academic performance (grades on a 0 to 10 scale)
Grade point average 7.2 ± 0.2b,d 8.5 ± 0.2a,c 7.7 ± 0.1 b 8.0 ± 0.1a <0.001
b a,c b
Math 7.3 ± 0.3 8.5 ± 0.3 7.4 ± 0.2 7.9 ± 0.1 0.010
b,d a,c b a
Language 6.7 ± 0.3 8.3 ± 0.3 7.2 ± 0.2 7.7 ± 0.1 0.010
Psychosocial functioning (scores on a 0 to 40 scale, with lower scores indicating better functioning)
Total 20.0 ± 0.8b,c,d 16.7 ± 0.9a 17.9 ± 0.6 a 17.5 ± 0.4 a 0.030
Emotional symptoms 2.6 ± 0.3 1.6 ± 0.3 2.2 ± 0.2 2.0 ± 0.2 0.139
Conduct problems 2.4 ± 0.3 1.6 ± 0.3 1.8 ± 0.2 1.8 ± 0.1 0.157
Hyperactivity/inattention 4.7 ± 0.4 3.7 ± 0.4 4.0 ± 0.3 3.7 ± 0.2 0.141
Peers problems 2.0 ± 0.3 1.4 ± 0.3 1.8 ± 0.2 1.5 ± 0.1 0.167

Note: Data are estimated marginal means ± SD. Analyses were adjusted for school within countries, age, sex, and socioeconomic status. Significant
p-values are in bold. Symbols: adifferent from ‘overweight/obese and unfit’. bdifferent from ‘overweight/obese and fit’. cdifferent from ‘normal
weight and unfit’. ddifferent from ‘normal weight and fit’ (all p < 0.05).
VALENZUELA ET AL.
F I G U R E 1 Academic performance
(grade point average, panel A) and
psychosocial functioning (SDQ scores
[where lower scores reflects better
psychosocial functioning], panel B) of
schoolchildren by groups of
cardiorespiratory fitness and weight
status. Analyses were adjusted for
school within countries, age, sex, and
socioeconomic status. Symbols: a
different from ‘overweight/obese and
unfit’; b different from ‘overweight/
obese and fit’; c different from ‘normal
weight and unfit’; d different from
‘normal weight and fit’ (all p < 0.05)
obese, 14%. Data on academic performance and psychosocial functioning
were available in 458 and 346 children, respectively.
Differences between groups attending to CRF and weight status
categories are shown in Table 1 and Figure 1. Fit children with normal
weight showed a greater academic performance than their peers who
were unfit and overweight/obese—with this result confirmed in separate
analyses for language grades. Fit children who were overweight/obese
had a greater overall academic performance than their unfit peers with
or without overweight/obesity—as also confirmed in separate analyses
for Math and Language grades. Results remained essentially unchanged
when removing physical education grades from the analyses (data not
shown). In turn, fit children (whether with normal weight or not) reported
a greater psychosocial functioning than their peers who were unfit and
overweight/obese, whereas those children who were unfit and had nor-
mal weight also showed a greater psychosocial functioning than their
peers who were also unfit but had overweight/obesity.
In separate analyses for the two CRF or weight categories,
respectively, fit children showed a higher academic performance (and
higher marks in Language and Math) and a trend towards a greater
psychosocial functioning (with significantly lower peer problems and a
non-significant trend towards lower hyperactivity/inattention) than
their unfit peers (File S1—Supplementary material). In turn, no signifi-
cant differences in academic performance or psychosocial functioning
were observed between children with overweight/obesity and those
with normal weight.
4 | DISCUSSION
The present study suggests that fit children show a greater academic
performance and psychosocial functioning than their unfit peers
regardless of weight status. Thus, our findings would overall support
the so-called ‘fat but fit’ paradox.
Although it has been suggested that childhood obesity might
potentially affect academic performance3,16,17 some controversy exists,
with most studies (56%) finding uncertain evidence.2 The debate
3 of 4
might be potentially due to the mediating role of CRF, which has proven
to be positively associated with academic achievement.7 A recent report
by our group suggested that a high CRF can modulate the negative
association between overweight/obesity and academic performance.8 In
this regard, a novel finding of the present study is that a low CRF—but
not overweight/obesity per se—might have a detrimental effect on psy-
chosocial functioning. In this regard, although an impaired psychosocial
functioning has been reported among children with overweight/obesity
compared with those with normal weight,4 our results suggest that
these findings might be confounded by the fact that CRF levels are usu-
ally low in children with overweight/obesity. In line with our results, a
study with approximately 100 000 adolescents found a positive associa-
tion between physical exercise levels and psychosocial functioning as
assessed through SDQ scores.18 Another recent study reported an
inverse association between BMI and psychosocial functioning
(as assessed with SDQ scores) but only in those children with the lower
physical activity levels.19 Taken together, the present and previous18
data support the promotion of physical exercise among children as a
means to improve their CRF while reducing their psychosocial problems.
There are some limitations in our study, notably the cross-
sectional design we used and the potential subjective component of
some study outcome measures (notably, psychosocial functioning
assessed by the participants' parents/caregivers and academic perfor-
mance by teachers). On the other hand, there was a high attrition rate
for the multistage 20-metre shuttle run test—largely because this test
was not allowed to be performed by schoolchildren in Portugal—and
some questionnaires could not be completed by those parents who
had local internet connection problems. In turn, a major strength of
our study is the relatively large sample size that we analysed, with
schoolchildren from different European countries.
5 | CONC LU SIONS
Children with a high CRF present with greater academic performance
and psychosocial functioning regardless of their weight status. Efforts
4 of 4
are thus needed to promote implementation of physical exercise
interventions aimed at improving CRF among schoolchildren.
ACKNOWLEDGEMEN TS
This project was funded by the Erasmus+ program of the European
Union (567201-EPP-1-2015-2-IT-SPO-SCP. AL is supported by the
Spanish Ministry of Economy and Competitiveness and Fondos
FEDER (PI15/25400558 and PI18/00139).
CONF LICT OF IN TE RE ST
The authors declare no conflicts of interest.
AUTHOR CONTRIBUTIONS
Study design: Pedro L. Valenzuela, Tania Pinto-Escalona, Óscar Martí-
nez-de-Quel; data collection: Tania Pinto-Escalona, Óscar Martínez-
de-Quel; data analysis: Óscar Martínez-de-Quel; data interpretation:
all authors; initial draft of the manuscript: Pedro L. Valenzuela,
Alejandro Lucia; revision of the manuscript for important intellectual
content: all authors. All authors read and approved the final version of
the manuscript to be submitted.
ORCID
Pedro L. Valenzuela https://orcid.org/0000-0003-1730-3369
Tania Pinto-Escalona https://orcid.org/0000-0002-2210-3073
Alejandro Lucia https://orcid.org/0000-0002-3025-2060
Óscar Martínez-de-Quel https://orcid.org/0000-0003-0992-4149
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SUPPORTING INF ORMATION
Additional supporting information may be found in the online version
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How to cite this article: Valenzuela PL, Pinto-Escalona T,
Lucia A, Martínez-de-Quel Ó. Academic performance and
psychosocial functioning in European schoolchildren: The role
of cardiorespiratory fitness and weight status. Pediatric
Obesity. 2021;e12850. doi:10.1111/ijpo.12850