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Table 3 Cognitive outcomes: findings from systematic reviews and meta-analyses (ordered by quality rating)

From: A critical evaluation of systematic reviews assessing the effect of chronic physical activity on academic achievement, cognition and the brain in children and adolescents: a systematic review

AuthorsPopulationSystematic review resultsMeta-analysis resultsc
High-quality reviews
 Martin et al. [31]Overweight or obese children (3–18 years)High quality evidence for an effect of PA on composite executive functions and non-verbal memory, but not cognitive flexibility, inhibition (low quality), attention or visuo-spatial abilities
Composite executive functions (s = 3): 2/3 no evidence for an effect, 1/3 showing a positive effect
Inhibition control (s = 1): no evidence for an effect
Attention (s = 3): no evidence for an effect
Working memory (s = 1): no evidence for an effect
Visuo-spatial abilities (s = 3): no evidence for an effect
Cognitive flexibility (s = 2): no evidence for an effect
Non-verbal memory (s = 2): some evidence for a small effect
General intelligence (s = 1): some evidence for an effect
Composite executive functions:PA: 0.42 (0.05, 0.78), (s = 1); Exergaming: 0.58 (−0.02, 1.18), (s = 1)
Inhibition control: not performed
Attention: 0.46 (−0.16, 1.08), I2 =41% (s = 2)
Working memory: not performed
Visuo-spatial abilities: not performed
Cognitive flexibility: −0.06 (−0.37, 0.25),  I2 =0% (s = 2)
Non-verbal memory: not performed
General intelligence: not performed
Low-quality reviews
 Singh et al. [25]Children and adolescents (3–16 years)6 high-quality studies: 10/21 (48%) analyses found a significant beneficial intervention effect, leading to inconclusive evidenceNA
Critically low-quality reviews
 Álvarez-Bueno et al. [38]aHealthy children and adolescents (4–18 years)Non-executive functions: 7/7 found improvements; of 4 studies that included multiple intervention groups, two suggested that increases in duration and intensity were associated with greater improvements
Executive functions: 29/29 found improvements; of 11 studies that included multiple intervention groups, three did not find differences between the groups
Meta-cognition: 15/15 found improvements; of 6 studies that included multiple intervention groups, none found differences in improvements
Non-executive functions:d =0.23 (0.09, 0.37), I2 =21.9% (s = 6, k = 17)
Executive functions:d =0.20 (0.10, 0.30), I2 =70.0% (s = 22, k = 42)
Working memory:d =0.14 (0.00, 0.27), I2 =48% (s = 9, k = 13)
Selective attention / inhibition:d =0.26 (0.10, 0.41), I2 =76.0% (s = 17, k = 24)
Selective attention:d =0.13 (−0.07, 0.33), I2 =66.8%
Inhibition:d =0.38 (0.13, 0.63), I2 =68.7%
Cognitive flexibility:d =0.11 (−0.10, 0.32), I2 =68.7% (s = 4, k = 5)
Meta-cognition:d =0.23 (0.13, 0.32), I2 =4.7% (s = 10, k = 21)
Higher level executive functions:d =0.19 (0.06, 0.31), I2 =12.9% (s = 7, k = 13)
 de Greeff et al. [24]Primary school children (6–12 years)Combined academic achievement and cognition: 9/14 reported positive findings on at least 1 outcome measure, 5 reported no significant findingsOverall cognitive functions:g =0.37 (0.20, 0.55), I2 =64.92% (s = 14, k = 18)
Executive functions:g =0.24 (0.09, 0.39), I2 = 34% (s = 12, k = 15)
Working memory:g =0.36 (0.10, 0.62), I2 =56.79% (s = 6, k = 8)
Cognitive flexibility:g =0.18 (0.01, 0.35), I2 =4.79% (s = 4, k = 4)
Inhibition:g =0.19 (−0.04, 0.42), I2 =49.7% (s = 6, k = 7)
Planning:g =0.12 (−0.08, 0.32), I2< 0.01% (s = 4, k = 4)
 Gunnell et al. [27]bHealthy children (1–17.99 years)Inhibitory control:PA vs none (n = 1248, s = 5): 3/5 —, 1/5 — ↑, 1/5 — ↓; PA vs PA (n = 557, s = 6): 3/6 ↑, 1/6 —, 2/6 — ↑; Multiple comparisons (n = 181, s = 1): 1/1 —
Working memory:PA vs none (n = 1804, s = 3): 1/3 —, 1/3 ↑, 1/3 —↑; PA vs PA (n = 487, s = 3): 2/3 —, 1/3 ↑; Multiple comparisons (n = 181, s = 1): 1/1 —
Cognitive flexibility:PA vs PA (n = 501, s = 2): 1/2 —↑, 1/2 ↑; Multiple comparisons (n = 246, s = 2): 1/2 —, 1/2 — ↑
Unitary constructs:PA vs none (n = 549, s = 2): 1/2 — ↑, 1/2 —; PA vs PA (n = 472, s = 3): 1/3 ↑, 1/3 — ↑, 1/3 —
Attention:PA vs none (n = 1809, s = 8): 5/8 —, 1/8 ↑, 1/8 — ↑; PA vs PA (n = 156, s = 5): 1/5 — ↑, 2/5 ↑, 2/5 —; Multiple comparisons (n = 757, s = 1): 1/1 — ↑
Information processing:PA vs none (n = 1659, s = 5): 1/5 ↑, 4/5 —; Multiple comparisons (n = 265, s = 2): 2/2 — ↑; PA vs PA (n = 448, s = 3): 3/3 —
Memory:PA vs none (n = 44, s = 1): 1/1 —
Motor speed and learning:PA vs PA (n = 508, s = 2): 1/2 ↑, 1/2 —
Composite cognition:PA vs none (n = 1794, s = 3): 1/3 —, 2/3 — ↑
Not performed given heterogeneity of study designs, PA exposures and outcomes
 Verburgh et al. [37]Children and adolescents (6-17 years), but one study in young adultsInconsistent results among 5 studies that reported on the effect of chronic PA on executive functions (one in young adults)Executive functions across age groups: d =0.14 (−0.04, 0.32), Q =5.1 (s = 5)
Planning:d = 0.16 (-0.07, 0.39), Q = 0.89 (s=3)
 Jackson et al. [40]Healthy children (7–12 years)8/8 studies showed a positive effect of PA on inhibitory control, but none were statistically significant in isolation; other domains of executive function were measured too infrequently to perform a meta-analysisInhibitory control:d =0.2 (0.03, 0.37), I2 =0%
 Li et al. [30]Healthy adolescents (13–18 years)1/2 studies showed a beneficial effect on cognitive function; of five cognitive function parameters, only one showed significanceNA
 Lees and Hopkins [29]Children and adolescents (< 19 years)1/1 studies showed positive effects of PA on cognitive performance; another study was included in the data table, but not part of the results section or evidence synthesisNA
 Bustamante, Williams, and Davis [39]Overweight or obese children and/or adolescentsQuasi-experimental (s = 4): each of the four studies showed some benefit on neural, cognitive or academic outcomes; but the PA was confounded with other elements of the intervention and no control groups were present, thus providing little evidence for PA effects
RCT (s = 10, but only 5 independent studies): high quality RCT’s (s = 2) have shown benefits for different executive functions
NA
 Suarez-Manzano et al. [36]Children and adolescents with ADHD (6–18 years)7/7 studies showed a positive effect of PA on cognition, no study revealed a negative association; the systematic practice of PA between 5-20 weeks, 30-90mins at moderate-vigorous intensity (40-75%) produces a chronic effect that improves cognition in young people with ADHDNA
 Mura et al. [33]Children (3–18 years)7/9 studies showed an improvement in global cognitive performance, 1/9 showed no difference and 1/9 worse intelligence; two of these studies found dose-response relationships, with high dose PA performing better than low-dose PA or control; specific cognitive skills improved in almost all studies (6 studies)NA
 Vazou et al. [35]Typically developing children and adolescents (4–16 years)Aerobic only (s = 7): Significant cognitive outcomes: planning (s = 1), creativity (s = 2), working memory and spatial memory span (s = 4), attentional accuracy and spatial inattention (s = 1), cued recall memory (s = 1) and mathematics fluency (s = 1)
Motor skills (s = 4): Improvements in working memory (s = 1), spatial processing/math/reading/concentration (s = 1 study), lower error on attentional task (s = 1), mixed effects (s = 1)
Cognitively engaging PA (s = 2): Improved planning (s = 1), and spatial memory, but not verbal memory (s = 1)
Aerobic and motor skill (s = 1): No difference in inhibition accuracy or reaction time (s = 1)
Motor skills and cognitively engaging PA (s = 7): Improved inhibition (s = 1), attention related to arithmetic (s = 1), parent-rated inhibitory behavioral control and reaction time (s = 1), inhibition (s = 1), attention (s = 1), inattention and hyperactivity (s = 1) and attentional accuracy (s = 1)
Aerobic and cognitively engaging PA (s = 8): Improvements in math fluency (s = 2), math and spelling (s = 1), fluid intelligence (s = 1), cognitive shifting (s = 1), memory recall (s = 1), verbal working memory and inhibition (s = 1), time-on-task in classroom (s = 1)
Aerobic, motor and cognitively engaging PA (s = 1): Improved receptive attention (s = 1)
Overall cognitive function:g =0.46 (0.28, 0.64), I2 =85% (s = 21, k = 28)
PA interventions versus comparison treatments:
PA vs no treatment: 0.86 (0.18, 1.55), I2 = 93% (s = 5)
PA vs academic instruction: 0.57 (0.32, 0.83), I2 =81% (s = 10)
PA vs traditional PE: 0.09 (−0.07, 0.24), I2 = 44% (s = 9)
PA combinations vs aerobic PA: 0.80 (−0.08, 1.67), I2 =88% (s = 4)
Qualitatively different PA interventions vs comparison: see subgroup analysis in Additional file 9
  1. Abbreviations: d = Cohen’s d, g = Hedges’ g, k number of comparisons, n number of participants, NA not assessed, PA physical activity, RCT randomised controlled-trial, s number of study/studies
  2. aThis review also analysed cognitive life skills, which is different from any of the other typically examined cognitive functions and therefore excluded from this table
  3. bPA vs none: PA was compared to a sedentary control condition, Multiple comparisons: studies with multiple treatment and/or control groups, PA vs PA: comparison of multiple types of PA interventions. Coding represents combinations of: —= null results, ↓ = unfavourable results, ↑ = favourable results
  4. cResults are reported as: standardized mean difference, 95% confidence intervals, heterogeneity statistics if available, the number of studies (s) and number of comparisons (k)