Eero A. Haapala

Cardiorespiratory fitness and motor skills in relation to cognition and academic performance in children - a review.

Different elements of physical fitness in children have shown a declining trend during the past few decades. Cardiorespiratory fitness and motor skills have been associated with cognition, but the magnitude of this association remains unknown. The purpose of this review is to provide an overview of the relationship of cardiorespiratory fitness and motor skills with cognitive functions and academic performance in children up to 13 years of age. Cross-sectional studies suggest that children with higher cardiorespiratory fitness have more efficient cognitive processing at the neuroelectric level, as well as larger hippocampal and basal ganglia volumes, compared to children with lower cardiorespiratory fitness. Higher cardiorespiratory fitness has been associated with better inhibitory control in tasks requiring rigorous attention allocation. Better motor skills have been related to more efficient cognitive functions including inhibitory control and working memory. Higher cardiorespiratory fitness and better motor skills have also been associated with better academic performance. Furthermore, none of the studies on cardiorespiratory fitness have revealed independent associations with cognitive functions by controlling for motor skills. Studies concerning the relationship between motor skills and cognitive functions also did not consider cardiorespiratory fitness in the analyses. The results of this review suggest that high levels of cardiorespiratory fitness and motor skills may be beneficial for cognitive development and academic performance but the evidence relies mainly on cross-sectional studies.

Associations of Motor and Cardiovascular Performance with Academic Skills in Children

PURPOSE We investigated the associations of cardiovascular and motor performance in grade 1 with academic skills in grades 1-3. METHODS The participants were 6- to 8-yr-old children with complete data in grades 1-2 for 174 children and in grade 3 for 167 children. Maximal workload during exercise test was used as a measure of cardiovascular performance. The shuttle run test (SRT) time, the errors in balance test, and the number of cubes moved in box and block test (BBT) were measures of motor performance. Academic skills were assessed using reading fluency, reading comprehension, and arithmetic skill tests. RESULTS Among boys, longer SRT time was associated with poorer reading fluency in grades 1-3 (β = -0.29 to -0.39, P < 0.01), reading comprehension in grades 1-2 (β = -0.25 to -0.29, P < 0.05), and arithmetic skills in grades 1-3 (β = -0.33 to -0.40, P < 0.003). Poorer balance was related to poorer reading comprehension (β = -0.20, P = 0.042). The smaller number of cubes moved in BBT was related to poorer reading fluency in grades 1-2 (β = 0.23-0.28, P < 0.03), reading comprehension in grade 3 (β = 0.23, P = 0.037), and arithmetic skills in grades 1-2 (β = 0.21-0.23, P < 0.043). Among girls, longer SRT time was related to poorer reading fluency in grade 3 (β = -0.27, P = 0.027) and arithmetic skills in grade 2 (β = -0.25, P = 0.040). The smaller number of cubes moved in BBT was associated with worse reading fluency in grade 2 (β = 0.26, P = 0.030). Cardiovascular performance was not related to academic skills. CONCLUSIONS Poorer motor performance was associated with worse academic skills in children, especially among boys. These findings emphasize early identification of children with poor motor performance and actions to improve these childrens motor performance and academic skills during the first school years.

Associations of physical activity and sedentary behavior with academic skills--a follow-up study among primary school children.

Background There are no prospective studies that would have compared the relationships of different types of physical activity (PA) and sedentary behavior (SB) with academic skills among children. We therefore investigated the associations of different types of PA and SB with reading and arithmetic skills in a follow-up study among children. Methods The participants were 186 children (107 boys, 79 girls, 6–8 yr) who were followed-up in Grades 1–3. PA and SB were assessed using a questionnaire in Grade 1. Reading fluency, reading comprehension and arithmetic skills were assessed using standardized tests at the end of Grades 1–3. Results Among all children more recess PA and more time spent in SB related to academic skills were associated with a better reading fluency across Grades 1–3. In boys, higher levels of total PA, physically active school transportation and more time spent in SB related to academic skills were associated with a better reading fluency across the Grades 1–3. Among girls, higher levels of total PA were related to worse arithmetic skills across Grades 1–3. Moreover, total PA was directly associated with reading fluency and arithmetic skills in Grades 1–3 among girls whose parents had a university degree, whereas these relationships were inverse in girls of less educated parents. Conclusions Total PA, physically active school transportation and SB related to academic skills may be beneficial for the development of reading skills in boys, whereas factors that are independent of PA or SB may be more important for academic skills in girls. Trial Registration ClinicalTrials.gov: NCT01803776

The Effects of a 2-year Individualized and Family-based Lifestyle Intervention on Physical Activity, Sedentary Behavior and Diet in Children

OBJECTIVE To investigate the effects of a long-term, individualized and family-based lifestyle intervention on physical activity, sedentary behavior and diet quality in children. METHODS We carried out a 2-year intervention study in a population sample of 506 children aged 6-8years in Finland in 2007-2012. We allocated the participants at baseline in the intervention and control group. We assessed physical activity and sedentary behavior by questionnaires and diet by food records. RESULTS Total physical activity (+9min/d in intervention group vs. -5min/d in control group, p=0.001 for time*group interaction), unsupervised physical activity (+7min/d vs. -9min/d, p<0.001) and organized sports (+8min/d vs. +3min/d, p=0.001) increased in the intervention group but not in the control group. Using computer and playing video games increased less in the intervention group than in the control group (+9min/d vs. +19min/d, p=0.003). Consumption of vegetables (+12g/d vs. -12g/d, p=0.001), high-fat vegetable-oil based margarine (+10g/d vs. +3g/d, p<0.001) and low-fat milk (+69g/d vs. +11g/d, p=0.042) and intake of dietary fiber (+1.3g/d vs. +0.2g/d, p=0.023), vitamin C (+4.5mg/d vs. -7.2mg/d, p=0.042) and vitamin E (+1.4mg/d vs. +0.5mg/d, p=0.002) increased in the intervention group but not in the control group. Consumption of butter-based spreads increased in the control group but not in the intervention group (+2g/d vs. -1g/d, p=0.002). CONCLUSIONS Individualized and family-based lifestyle intervention increased physical activity, attenuated increase in sedentary behavior and enhanced diet quality in children. TRIAL REGISTRATION ClinicalTrials.gov: NCT01803776.

Physical activity and sedentary time in relation to academic achievement in children.

Objectives To investigate the independent and combined associations of objectively measured moderate-to-vigorous physical activity (MVPA) and sedentary time (ST) with reading and arithmetic skills. Design Cross-sectional/prospective. Methods Participants were 89 boys and 69 girls aged 6–8 years. MVPA and ST were measured using a combined heart rate and movement sensor and body fat percentage by dual-energy X-ray absorptiometry in Grade 1. Reading fluency, reading comprehension, and arithmetic skills were assessed using standardized tests in Grades 1–3. The data were analyzed using linear regression analyses and analyses of covariance with repeated measures. Results In boys, MVPA was directly and ST inversely associated with reading fluency in Grades 1–3 and arithmetic skills in Grade 1 (P < 0.05). Higher levels of MVPA were also related to better reading comprehension in Grade 1 (P < 0.05). Most of the associations of MVPA and ST with reading and arithmetic skills attenuated after mutual adjustment for MVPA or ST. Furthermore, boys with a combination of lower levels of MVPA and higher levels of ST had consistently poorer reading fluency (P = 0.002) and reading comprehension (P = 0.027) across Grades 1–3 than other boys. In girls, ST was directly associated with arithmetic skills in Grade 2 (P < 0.05). However, this relationship of ST with arithmetic skills was no longer significant after adjustment for body fat percentage. Conclusions Lower levels of MVPA and higher levels of ST and particularly their combination were related to poorer reading skills in boys. In girls, higher levels of ST were related to better arithmetic skills.

Associations of cardiorespiratory fitness, physical activity, and adiposity with arterial stiffness in children

Associations of cardiorespiratory fitness (CRF), physical activity (PA), sedentary behavior, and body fat percentage (BF%) with arterial stiffness and dilation capacity were investigated in 160 prepubertal children (83 girls) 6–8 years of age. We assessed CRF (watts/lean mass) by maximal cycle ergometer exercise test, total PA, structured exercise, unstructured PA, commuting to and from school, recess PA and total and screen‐based sedentary behavior by questionnaire, BF% using dual‐energy X‐ray absorptiometry, and arterial stiffness and dilation capacity using pulse contour analysis. Data were adjusted for sex and age. Poorer CRF (standardized regression coefficient β = −0.297, P < 0.001), lower unstructured PA (β = −0.162, P = 0.042), and higher BF% (β = 0.176, P = 0.044) were related to higher arterial stiffness. When CRF, unstructured PA, and BF% were in the same model, only CRF was associated with arterial stiffness (β = −0.246, P = 0.006). Poorer CRF was also related to lower arterial dilation capacity (β = 0.316, P < 0.001). Children with low CRF (< median) and high BF% (≥ median; P = 0.002), low CRF and low unstructured PA (< median; P = 0.006) or children with low unstructured PA and high BF% (P = 0.005) had higher arterial stiffness than children in the opposite halves of these variables. Poor CRF was independently associated with increased arterial stiffness and impaired arterial dilation capacity among children.

Associations of Physical Performance and Adiposity with Cognition in Children.

OBJECTIVES To investigate the independent and combined associations of cardiorespiratory performance (CP), neuromuscular performance (NP; including motor performance [MP]) and body fat percentage (BF%) with cognition in children. METHODS The participants were 202 boys and 201 girls age 6-8 yr. Cardiorespiratory performance was assessed using maximal cycle ergometer test and was expressed as maximal workload per lean body mass. Neuromuscular performance score included muscle strength, speed, agility, balance, manual dexterity, and flexibility; and MP included speed and agility, balance, and manual dexterity. Body fat percentage was assessed by dual-energy x-ray absorptiometry. Cognition was assessed using Raven Coloured Progressive Matrices (CPM). Linear regression and general linear models were used to analyze the independent and combined associations of CP, NP, MP, and BF% with Raven CPM score. RESULTS Neuromuscular performance and MP were directly associated with the Raven CPM score (β = 0.138-0.190; P < 0.01). Children in the lowest or the highest thirds of BF% and in the lowest third of MP had a lower Raven CPM score than other children (P < 0.05). Children in the lowest or highest third of BF% along with the poorest MP had a lower Raven CPM score than those in the middle third of BF% and higher MP (P < 0.05). These associations and differences were much stronger in boys than in girls. Cardiorespiratory performance was not related to the Raven CPM score. CONCLUSIONS Poorer NP and MP were associated with a worse cognition in children and particularly in boys. Cognition was poorer especially among children with the lowest or highest BF% accompanied with a poorer MP.

The associations of cardiorespiratory fitness, adiposity and sports participation with arterial stiffness in youth with chronic diseases or physical disabilities:

Background The evidence on the associations of cardiorespiratory fitness, body adiposity and sports participation with arterial stiffness in children and adolescents with chronic diseases or physical disabilities is limited. Methods Altogether 140 children and adolescents with chronic diseases or physical disabilities participated in this cross-sectional study. Cardiorespiratory fitness was assessed using maximal exercise test with respiratory gas analyses either using shuttle run, shuttle ride, or cycle ergometer test. Cardiorespiratory fitness was defined as peak oxygen uptake by body weight or fat-free mass. Body adiposity was assessed using waist circumference, body mass index standard deviation score and body fat percentage. Sports participation was assessed by a questionnaire. Aortic pulse wave velocity and augmentation index were assessed by a non-invasive oscillometric tonometry device. Results Peak oxygen uptake/body weight (standardised regression coefficient β −0.222, 95% confidence interval (CI) −0.386 to −0.059, P = 0.002) and peak oxygen uptake/fat-free mass (β −0.173, 95% CI −0.329 to −0.017, P = 0.030) were inversely and waist circumference directly (β 0.245, 95% CI 0.093 to 0.414, P = 0.002) associated with aortic pulse wave velocity. However, the associations of the measures of cardiorespiratory fitness with aortic pulse wave velocity were attenuated after further adjustment for waist circumference. A higher waist circumference (β −0.215, 95% CI −0.381 to −0.049, P = 0.012) and a higher body mass index standard deviation score (β 0.218, 95% CI −0.382 to −0.054, P = 0.010) were related to lower augmentation index. Conclusions Poor cardiorespiratory fitness and higher waist circumference were associated with increased arterial stiffness in children and adolescents with chronic diseases and physical disabilities. The association between cardiorespiratory fitness and arterial stiffness was partly explained by waist circumference.

Mediating effects of motor performance, cardiorespiratory fitness, physical activity, and sedentary behaviour on the associations of adiposity and other cardiometabolic risk factors with academic achievement in children

ABSTRACT We investigated the associations of cardiometabolic risk factors with academic achievement and whether motor performance, cardiorespiratory fitness, physical activity, or sedentary behaviour mediated these associations. Altogether 175 children 6–8 years-of-age participated in the study. We assessed body fat percentage (BF%), waist circumference, insulin, glucose, triglycerides, HDL cholesterol, and systolic and diastolic blood pressure, leptin, alanine aminotransferase, and gamma-glutamyltransferase (GGT). Reading fluency, reading comprehension, and arithmetic skills were assessed using standardized tests. Speed/agility, balance, and manual dexterity test results were used to calculate motor performance score and physical activity was assessed by combined heart rate and movement sensor and cardiorespiratory fitness by maximal cycle ergometer test. In boys, BF% was inversely associated with reading fluency (β = −0.262, P = 0.007) and reading comprehension (β = −0.216, P = 0.025). Motor performance mediated these associations. Leptin was inversely related to reading fluency (β = −0.272, P = 0.006) and reading comprehension (β = −0.287, P = 0.003). The inverse association of leptin with reading fluency was mediated by motor performance. In girls, GGT was inversely associated with reading fluency independent of confounders (β = −0.325, P = 0.007). The inverse association of BF% with academic achievement among boys was largely explained by motor performance. Leptin in boys and GGT in girls were inversely associated with academic achievement independent of confounding factors.

Cardiopulmonary Exercise Testing in Pediatrics

&NA; Aerobic fitness is an important determinant of overall health. Higher aerobic fitness has been associated with many health benefits. Because myocardial ischemia is rare in children, indications for exercise testing differ in children compared with adults. Pediatric exercise testing is imperative to unravel the physiological mechanisms of reduced aerobic fitness and to evaluate intervention effects in children and adolescents with a chronic disease or disability. Cardiopulmonary exercise testing includes the measurement of respiratory gas exchange and is the gold standard for determining aerobic fitness, as well as for examining the integrated physiological responses to exercise in pediatric medicine. As the physiological responses to exercise change during growth and development, appropriate pediatric reference values are essential for an adequate interpretation of the cardiopulmonary exercise test.