Luca Petrigna1
Ewan Thomas1*
Jessica Brusa1
Federica Rizzo1Antonino Scardina1Claudia Galassi1,2Daniela Lo Verde3Giovanni Caramazza1,2
Marianna Bellafiore1- 1Sport and Exercise Sciences Research Unit, Department of Psychology, Educational Science and Human Movement, University of Palermo, Palermo, Italy
- 2Regional School Office of Sicily (USR Sicilia), Palermo, Italy
- 3Istituto Comprensivo Statale Giovanni Falcone, Palermo, Italy
Physically active children have greater motor competence and a faster maturation compared with their sedentary peers. Recent research also suggests that physical activity during childhood may also promote cognitive development and therefore improve academic performance. The aim of this study was to understand if physically active academic lessons may improve academic achievement in primary schoolchildren. A systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted. The search was performed on the following database: PubMed, Web of Science, Scopus, Education Resources Information Center (ERIC), and PsycINFO (APA). Studies evaluating schoolchildren aged between 3 and 11 years taking part in educational contexts that include physical activity and natural environments evaluating physical fitness and/or educational outcomes were included. A total of 54 studies (for a total sample of 29,460 schoolchildren) were considered eligible and included in the qualitative synthesis. The Effective Public Health Practice Project risk-of-bias assessment revealed a moderate quality of the included studies with only two considered weeks. Despite differences in the retrieved protocols, physically active academic lessons improve the total time engaged in physical activity, motor skills, and/or academic performance. The results of this review suggest that learning through movement is an effective, low-cost, and enjoyable strategy for elementary schoolchildren.
Introduction
Children spend an ever-increasing time in sedentary behaviors such as the ~2 h (children aged 3 years) or 3 h (children aged between 3 and 5 years) per day in television view (1). Sedentary behaviors are also in school settings during which ~80% of the time children are seated (2), and only 5% of the time is spent in moderate to vigorous activities in European schoolchildren (3). Consequently, considering the classroom as a place where students spend the majority of their waking time, the school setting can be considered as an ideal setting to improve physical activity and academic achievement and also because it has positive results inside and outside the school (4, 5).
The key point to limit sedentary behaviors is to propose health promotion programs to promote physical activity since early childhood (6). Physical activity interventions for children should improve physical fitness, promote health-related behaviors, and facilitate mental development (7, 8). Physical activity, especially during development, has positive effects on the measures of adiposity, motor skill, bone and skeletal health, psychosocial health, cardiometabolic health indicators, and cognitive development (9–11). Gross and motor skill practice has also positive effects on cognitive development (12) and functions (such as perceptual skills, intelligence quotient, academic achievement and readiness, verbal and mathematics tests, developmental level) (13, 14), non-executive cognitive functions, core executive functions, and higher-level executive functions (15). It seems that aerobic training has the largest effects (16). Its performance during early childhood could become a lifelong habit, improving cognitive and physical health (17), making the physical movement even more important in this phase of life. Consequently, states need to monitor and evaluate strategies to increase physical activity during school time, adopting a policy specific to prevent potential loopholes (18). On the other side, elementary schools could be a platform for early intervention to improve daily physical activity, but further investigations are required to secure the successful assimilation of movement integration into routine practices (19). Especially in children, physical activity practice during school days can be incorporated, and it increases moderate to vigorous physical activity levels (20) and improve aerobic fitness (4) and also has positive learning outcomes and consequently academic achievement (21). It can integrate physical activity in the academic curriculum and consequently propose a classroom-based physical activity program, increase children's cognition (15) and energy expenditure (22), develop social skills, improve mental health, and reduce risk-taking behaviors, but it also has short-term cognitive benefits (23). A physical education program could be a decisive education strategy to enhance motor and cognitive learning in preschool children and to achieve successful academic outcomes (24). Physically active lessons can be proposed with different contents such as math, language, arts, and social sciences, and this has also positive effects on physical activity level and learning and attention (25). The inclusion of physical activity in the curriculum to improve learning outcomes is feasible, and it is suggested in elementary schoolchildren (21).
Schools and teachers are culturally changing, adopting active learning and other kinds of learning methods, but further improvement is required (26). Unfortunately, individuals and schools limit the application of these kinds of programs (27). In 2012, Erwin et al. (21) suggested that more research is required to study integrated physical activity interventions, both on the learning outcome and physical activity levels. Consequently, the objective of this systematic review was to analyze the protocols adopted and the effects of outdoor learning on schoolchildren.
Materials and Methods
The systematic review was conducted following the principles outlined by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines (28).
Eligibility Criteria
The selection criteria of this review were of the PICO-S (Population, Intervention, Comparison, Outcomes, and Study) design.
The population was composed of young children aged between 3 and 11 years of primary/elementary schools. Studies that investigated only a special population such as people with disabilities were excluded because of the possible disability-specific outcomes.
The intervention of interest had to be the use of movement and natural environment with educational elements integrated to improve physical fitness and/or educational outcomes. Curriculum physical education, physical activity breaks without educational elements, recess, and after-school interventions were excluded.
The comparison and the outcomes of interest comprised physical fitness parameters and education outcomes.
About the study design, only English-written original and peer-reviewed studies were considered because of the limitations of the authors with the languages. Intervention, cross-sectional, longitudinal, correlational (randomized and non-randomized controlled, and quasi-randomized studies) studies were also included. Reviews, meta-analyses, abstracts and scientific conference abstracts, citations, opinion articles, books and book reviews, letters, editorials, statements, and commentaries were excluded.
Data Collection
The systematic search was performed through the electronic databases PubMed, Web of Science, Scopus, Education Resources Information Center (ERIC), and PsycINFO (APA).
The following keyword groups were adopted and matched with the Boolean operators AND/OR:
Group 1: child, preschool, infant, toddler, pupil, kindergarten;
Group 2: primary school, elementary school, student, education;
Group 3: psychomotor education, physical education, kinesiology education, active play, motor play, active learning, nature play, whole school, movement integration, comprehensive school, physical activity break.
This is a string example:
(Child* OR preschool* OR infant* OR toddler* OR pupil* OR kindergarten) AND (“primary school” OR “elementary school” OR student* OR education) AND (psychomotor education OR physical education OR kinesiology education OR active play OR motor play OR nature play OR whole school OR movement integration OR comprehensive school OR physical activity break OR active learning).
Study Record
The selected articles were included in EndNote software (EndNote version X8; Thompson Reuters, NY, USA). In the first step, duplicates were detected. After this step, two investigators, who worked independently, performed a selection process based on the inclusion and exclusion criteria on the title, abstract, and full-length articles. If the two investigators were in disagreement in categorizing an article, the coordinator of the study was involved and, independently, provided the tie-breaking decision. All investigators were not blinded to the authors or associated institutions of the articles during the selection process.
Information related to the sample (age, gender, and sample size) and intervention (type, duration, frequency) characteristics, and on physical fitness and educational outcomes was collected. The data were discussed narratively and represented through tables.
Risk-of-Bias Assessment
To detect the risk of bias and the quality of the study, the Effective Public Health Practice Project tool (29) was adopted. This tool is composed of three scores (weak, moderate, or strong) that were assigned to the following: (1) selection bias assessment, (2) study design evaluation, (3) confounder factors, (4) blinding, (5) data collection methods, (6) withdrawals, and (7) dropouts, to provide an overall rating. A “strong” scoring was provided to a study if at least four strong ratings and no weak rating were provided to each sub-domain. A “moderate” scoring was provided to a study if it had less than four strong ratings and one weak rating provided to the subdomains. A “weak” scoring was provided to a study if two or more weak ratings were provided to the subdomains. In order to numerically quantify the subdomains, a score of 3 was attributed to a strong evaluation, a score of 2 was attributed to a moderate evaluation, and a score of 1 was attributed to a weak evaluation.
Results
A total of 17,862 studies were found in the electronic databases searched, and 6,820 of the articles were immediately removed because they were duplicates. The final number of included studies after the eligibility criteria screening has been of 54 (three studies were included in a second moment after the reference checking of the included studies). A summary of the search process is provided in Figure 1.
Figure 1. PRISMA flow chart illustrating the systematic process.
Risk of Bias
The quality of the studies was overall moderate, with only two studies deemed weak. The mean score for selection bias was 3/3, for the study design 2.5/3, for the confounder 2.4/3, for the blinding of 1.3/3, for the data collection of 2.2/3, and for the dropout of 2.9/3, reaching an overall mean total score of 1.8 out of 3.
Study Characteristics
A summary of the study's characteristics is proposed in Table 1. The number of participants included in the studies was 29,460; one study did not specify the number of students, but the number of classrooms included was 4. A total of 11,392 were composed of girls (39%), 11,021 were boys (38%), whereas in 6,486, the gender was not specified (23%). The mean age (standard deviation) of the included participants was 8.2 (0.7) years, and it ranged from 3.9 to 11.2 years.
Table 1. Main descriptive characteristics of the included studies.
The studies were performed in different countries. The majority of the studies were performed in the United States (n = 22). In Australia, a total of nine studies were conducted. Five studies were conducted in the United Kingdom and Norway. More than one study was conducted in Denmark (n = 4), in the Netherlands (n = 3), in Greece (n = 2), and in Ireland (n = 2). Only one study was conducted in Italy, New Zealand, and Vietnam.
The majority of the studies were randomized controlled trials (n = 25). They were followed by quasi-experimental design (n = 13), observational studies (n = 5), intervention studies (n = 4), and pilot studies (n = 3). Other study designs such as mixed factorial, mixed experimental, within subject, and pedagogical experiments were adopted only one time.
Seven interventions provided negative feedback on the effect of integrated lessons on physical activity and/or academic outcomes, and there are no aspects between the studies that could suggest excluding some aspects of the intervention such as the duration of the program or session, or the kind of intervention, or the subject considered.
Intervention Characteristics
Different studies were based on national or international intervention programs. The Comprehensive School Physical Activity Programs was the intervention program adopted majority of times (n = 4). Adopted in three different studies is the Active Smarter Kids intervention. Less adopted assessment methods are provided in Table 2.
Table 2. Synthetic description of the interventions included.
Most of the interventions wanted to improve mathematics (n = 30) and language (n = 14) learning. Language arts was proposed as integrated lessons in five studies, social studies in only three studies, and two times for geography and history. Other subjects such as reading, handicrafts, science, general health, statistics, biology, and religion were studied only one time. In different studies, no information related to the curriculum subjects studied has been provided (n = 22).
The mean length of the intervention was 153.5 days, with a range from 5 to 1,095 days. The mean duration of the integrated physical activity was of 28.5 min, with interventions that were of 10 and others arrived to 60 min. Different studies proposed three interventions a week (n = 10), but other studies proposed only 2 days a week of curriculum-integrated physical activity (n = 7). Five studies proposed more than 3 days a week of intervention (n = 5). Unfortunately, the majority of the studies (n = 32) have not provided this information.
The majority of the 29 studies (Table 2) that included data related to the physical activity level collected with accelerometers or pedometers had positive results, with a percentage range of improvement from 1.8 to 96.2. Only one study reported no improvement with the integrated movement program. Unfortunately, the data are not heterogeneous; indeed, studies compared different groups or the same group before and after the intervention. Studies reported the time in which the children were engaged in moderate to the vigorous physical activity or the number of steps. Studies collected data during the school hours or during the week or the day.
Academic achievements or cognitive functions were assessed majority of times through the academic outcomes and the time on task (n = 3). In three studies, the authors evaluated them through the “on-task” behavior. Less adopted assessment methods are provided in Table 2.
Related to physical activity assessment, 29 studies evaluated it through an accelerometer or a pedometer. Some studies evaluated health-related physical fitness characteristics through physical tests such as the Test of Gross Motor Development 2 (n = 4), Andersen test (n = 2), 20-m shuttle run test (n = 3), and Progressive Aerobic Cardiovascular Endurance Run (n = 2). Less adopted evaluation methods are provided in Table 2. Skill-related physical fitness was evaluated through test to evaluate executive functions and motor skills (n = 1). Studies adopted also batteries to evaluate physical fitness such as the FITNESSGRAM (n = 2). The most interesting subjective physical activity evaluation methods were the System for Observing Student Movement in Academic Routines and Transitions (n = 3), Physical Activity Questionnaire for Older Children (n = 1), interviews, and observations.
Intervention Proposal
Some studies reported the intervention in detail or examples of intervention, and the following are proposals of the included studies. Some studies proposed outdoor structured nature-based play (33, 71) or adopted the outdoor environment to learn math, language, history, or religion (70). Games-centered interventions (34, 35) or games related the pedometer with mathematics (36) or free play or semistructured physical activity have been proposed (39). Always through play was the intervention of Pham and colleagues, which adopted balls with numbers, letters, and mathematical symbols on the surface (60). Complex, independent, and symbolic play (72) and playing with math-related materials to examine children's verbal and non-verbal mathematics exploration without adult guidance (82) were also proposed. Other proposals that comprised cooperative activities integrate health education into several school subjects (41). An intervention proposed as language activity “Scrabble relay,” where children worked in groups, or “Bingo” to improve mathematics (43). In another study, one teacher read a story while students perform the movements in the story (45). Mavilidi and colleagues proposed different interventions for different subjects. To learn language, children enacted the actions indicated by the words to be learned by physically exercising (i.e., for the word “fly,” children ran and moved their hands as if they were flying) (51). To learn geography, children “traveled” from one continent to the other, imitating the movements of the animal representing the continent (52). To learn math, foam blocks of numbers were placed on the floor, shaping a straight line, and the children ran, jumped, and stepped each time on one number while counting or walked or ran backward, sideward, or forward (53). A similar intervention to learn geography was the one proposed by Oliver et al. (59). Norris et al. (57) proposed in their intervention presentation sessions known as Virtual Field Trips, designed to be delivered using existing classroom interactive whiteboards. Similarly, children autonomously navigated through two skill stations with at least three levels of difficulty at each station (67). Other language and mathematics interventions consisted in the performance of a spell by jumping in place for every mentioned letter or to jump to solve multiplications. Similar academic tasks with different words or sums were exercised during one lesson (55, 56). Other interventions consisted in building two-digit numbers by making and simultaneously verbalizing out loud different-sized steps (68). Students stand on their self-space and jump the answer to a problem the teacher provided and the second by moving around the classroom, picking a card with a problem working as a group or with a partner (73). Locomotor skills of running, skipping, hopping, and galloping (75) integrating structured movement and motor skill practice with preschool learning concepts and integrating auditory, visual, and kinesthetic learning methods (80) were also proposed. Use and modification of movement elements, development of creative thinking during movement activities through exploration, use of movement for experienced learning of concepts of different teaching thematic areas such as mathematics, and development of critical thinking during movement activities were also adopted (81).
Discussion
The findings of the review highlighted that different interventions were proposed to teach different curriculum subjects through movement with a lack of standardization in the protocols adopted by the authors (Table 2).
Similar to the findings of Erwin and colleagues, physical activity integrated in the academic curriculum is proposed with other interventions (such as breaks), and the details on the effect on children's learning and physical fitness are not always provided (21). It is important to propose a structured intervention; only in this way that it is possible to contextualize and generalize the finding and make the procedure safer (83), and the teachers have a crucial role in following the procedures proposed (22). Differences were also detected in the length, duration, and week frequency, making impossible a comparison among the studies. These findings are similar to the study by Daly-Smith and colleagues, where differences in the design, interventions, duration and intensity, and outcomes were detected (84). The intervention duration in this study started from 5 days arriving to more 1,000 days, differently from other studies in which the intervention ranged from 13 to 300 days (21). Even if the literature suggests that the length of the intervention did not influence the effect of the intervention (21), a short-duration program is not useful to have a long-term improvement on academic performance (85). Furthermore, it is important to propose the integrated programs in daily or weekly schedule because it increases also the physical activity during the school day, and it is feasible (86). Ideally, the physical activity interventions should be three times per week to obtain the best results on children's cognitive and achievement outcomes (16).
Differences were detected also in the interventions. The movement integration program wants to teach students through the movement. It is well-known that physical activity interventions have a positive effect on cognitive performance and academic performance in children (87, 88). Integrated physical activity in the classroom can increase children's academic intrinsic motivation, perceived competence, and effort without influencing academic lessons (89).
For those studies that proposed play as an intervention, positive outcomes have been detected. Learning through play forces children to make choices and assuming responsibility having fun at the same time, working on the internal cognitive transactions and intrinsic motivation, determine life habits (90). Play should have to be enjoyable, freely chosen, non-literal safe, and actively engaged; only in this way that learning is through intrinsic motivation (90).
Other interventions, instead, were based outdoors. This way of learning can be incorporated within conventional teaching methods (91); it increases physical activity and reduces sedentary behaviors (92). Open learning environments want to educate the students with own initiative, planning, experimentation, elaboration, and self-evaluation, which is an interesting way (26).
The interventions showed improvements in the academic outcomes, motor skills, or amount of physical activity (through step count), but an important point is that they are cost-effective, teachers are not required to prepare them, and they are enjoyable both for teachers and children (5), making them ideal for primary schools. The advantage of a classroom-based physical activity program integrated in the school curriculum is that it takes time from other subjects, but improves physical activity and on-task behavior without sacrificing or influencing academic performance (93, 94). Furthermore, physical education in elementary school children has no negative effects on standardized academic achievement test scores (95). Indeed, physical activity improves mathematics-related skills, reading, and composite scores such as the classroom behaviors, suggesting physical exercise lessons in the curriculum and physical activity integration in classroom lessons (96). Even brief bouts (1 h long) of outdoor active play can improve on-task behavior (97). The level of physical activity enjoyed outdoors on the playground is higher, and the increase in on-task classroom behavior is greater; simple play outdoors seems to be not sufficient (97). Physical activity incorporated into the school day improves attention to task (98). Physical, active academic lessons have several benefits for schools and students; indeed, they are cost-effective. Children and teachers enjoy them. They do not require additional teacher preparation time and improve academic achievement scores (5).
Limitations and Future Studies
Data obtained from accelerometers were not analyzed because of the limitation of this tool in detecting activities performed with the upper body (30). Furthermore, the studies included in the review present a wide variety of testing conditions and interventions, making the performance of a meta-analysis impossible. The sample background (physical activity participation outside the school, social status, or other influencing factors) was not detected, making the comparison even harder.
The study has been focused only on a specific population. It has been suggested by the literature (16) that children with learning disabilities also present improvements in academic abilities when physical activity interventions are adopted, making the study of these interventions also in this population even more important. There is a lack of heterogeneity among the study interventions, with differences not only in the length of the program, duration of the session, and frequency but also in the intervention methodology and in the subjects included in the programs. Differences were also in the outcome studies, both for physical activity and academic performance evaluation. Future studies should focus their attention on review of the literature about physical activity breaks during classroom time to improve physical fitness and academic performance. Attention should be focused also on interventions performed in nature, for two reasons: first, the intervention moves the children outside, and second, this intervention can help the children to understand the importance of nature.
Conclusion
All the interventions, despite differences in the protocols, have a common aspect: they improve physical activity and/or academic performance, making this kind of approach ideal in elementary schools.
Data Availability Statement
The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.
Author Contributions
GC and MB: conceptualization. CG: methodology. JB and FR: investigation. DLV: resources. LP: writing—original draft. ET and AS: writing—review and editing. MB: supervision. All authors contributed to the article and approved the submitted version.
Funding
This publication has been funded by Assessorato dell'Istruzione e della Formazione Professionale dlla Regione Sicilia within the Natural Moving project.
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's Note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
References
1. Zimmerman FJ, Christakis DA. Children's television viewing and cognitive outcomes: a longitudinal analysis of national data. Arch Pediatrics Adolescent Med. (2005) 159:619–25. doi: 10.1001/archpedi.159.7.619
2. Nielsen-Rodriguez A, Romance R, Dobado-Castaneda JC. Teaching methodologies and school organization in early childhood education and its association with physical activity. Int J Environ Res Public Health. (2021) 18. doi: 10.3390/ijerph18073836
3. van Stralen MM, Yildirim M, Wulp A, te Velde SJ, Verloigne M, Doessegger A, et al. Measured sedentary time and physical activity during the school day of European 10- to 12-year-old children: the ENERGY project. J Sci Med Sport. (2014) 17:201–6. doi: 10.1016/j.jsams.2013.04.019
4. Kriemler S, Meyer U, Martin E, van Sluijs EM, Andersen LB, Martin BW. Effect of school-based interventions on physical activity and fitness in children and adolescents: a review of reviews and systematic update. Br J Sports Med. (2011) 45:923–30. doi: 10.1136/bjsports-2011-090186
5. Donnelly JE, Lambourne K. Classroom-based physical activity, cognition, and academic achievement. Prev Med. (2011) 52(Suppl. 1):S36–42. doi: 10.1016/j.ypmed.2011.01.021
6. Jones RA, Hinkley T, Okely AD, Salmon J. Tracking physical activity and sedentary behavior in childhood: a systematic review. Am J Prev Med. (2013) 44:651–8. doi: 10.1016/j.amepre.2013.03.001
7. Tomporowski PD, Lambourne K, Okumura MS. Physical activity interventions and children's mental function: an introduction and overview. Prev Med. (2011) 52(Suppl. 1):S3–9. doi: 10.1016/j.ypmed.2011.01.028
8. Thomas E, Bianco A, Tabacchi G, Marques da Silva C, Loureiro N, Basile M, et al. Effects of a physical activity intervention on physical fitness of schoolchildren: the enriched sport activity program. Int J Environ Res Public Health. (2020) 17. doi: 10.3390/ijerph17051723
9. Timmons BW, Leblanc AG, Carson V, Connor Gorber S, Dillman C, Janssen I, et al. Systematic review of physical activity and health in the early years (aged 0-4 years). Appl Physiol Nutr Metab. (2012) 37:773–92. doi: 10.1139/h2012-070
10. Dudley D, Okely A, Pearson P, Cotton W. A systematic review of the effectiveness of physical education and school sport interventions targeting physical activity, movement skills and enjoyment of physical activity. Eur Phys Educ Rev. (2011) 17:353–78. doi: 10.1177/1356336X11416734
11. Battaglia G, Alesi M, Tabacchi G, Palma A, Bellafiore M. The development of motor and pre-literacy skills by a physical education program in preschool children: a non-randomized pilot trial. Front Psychol. (2018) 9:2694. doi: 10.3389/fpsyg.2018.02694
12. Pesce C, Masci I, Marchetti R, Vazou S, Sääkslahti A, Tomporowski PD. Deliberate play and preparation jointly benefit motor and cognitive development: mediated and moderated effects. Front Psychol. (2016) 7:349. doi: 10.3389/fpsyg.2016.00349
13. Sibley BA, Etnier JL. The relationship between physical activity and cognition in children: a meta-analysis. Pediatric Exercise Sci. (2003) 5:243–56. doi: 10.1123/pes.15.3.243
14. Singh AS, Saliasi E, van den Berg V, Uijtdewilligen L, de Groot RHM, Jolles J, et al. Effects of physical activity interventions on cognitive and academic performance in children and adolescents: a novel combination of a systematic review and recommendations from an expert panel. Br J Sports Med. (2019) 53:640–7. doi: 10.1136/bjsports-2017-098136
15. Alvarez-Bueno C, Pesce C, Cavero-Redondo I, Sanchez-Lopez M, Martinez-Hortelano JA, Martinez-Vizcaino V. The effect of physical activity interventions on children's cognition and metacognition: a systematic review and meta-analysis. J Am Acad Child Adolesc Psychiatry. (2017) 56:729–38. doi: 10.1016/j.jaac.2017.06.012
16. Fedewa AL, Ahn S. The effects of physical activity and physical fitness on children's achievement and cognitive outcomes: a meta-analysis. Res Q Exerc Sport. (2011) 82:521–35. doi: 10.1080/02701367.2011.10599785
17. Carson V, Hunter S, Kuzik N, Wiebe SA, Spence JC, Friedman A, et al. Systematic review of physical activity and cognitive development in early childhood. J Sci Med Sport. (2016) 19:573–8. doi: 10.1016/j.jsams.2015.07.011
18. Carlson JA, Sallis JF, Chriqui JF, Schneider L, McDermid LC, Agron P. State policies about physical activity minutes in physical education or during school. J Sch Health. (2013) 83:150–6. doi: 10.1111/josh.12010
19. Webster CA, Russ L, Vazou S, Goh TL, Erwin H. Integrating movement in academic classrooms: understanding, applying and advancing the knowledge base. Obes Rev. (2015) 16:691–701. doi: 10.1111/obr.12285
20. Martin R, Murtagh EM. An intervention to improve the physical activity levels of children: design and rationale of the 'Active Classrooms' cluster randomised controlled trial. Contemp Clin Trials. (2015) 41:180–91. doi: 10.1016/j.cct.2015.01.019
21. Erwin H, Fedewa A, Beighle A, Ahn S. A quantitative review of physical activity, health, and learning outcomes associated with classroom-based physical activity interventions. J Appl Sch Psychol. (2012) 28:14–36. doi: 10.1080/15377903.2012.643755
22. Stewart JA, Dennison DA, Kohl HW, Doyle JA. Exercise level and energy expenditure in the TAKE 10! in-class physical activity program. J Sch Health. (2004) 74:397–400. doi: 10.1111/j.1746-1561.2004.tb06605.x
23. Taras H. Physical activity and student performance at school. J Sch Health. (2005) 75:214–8. doi: 10.1111/j.1746-1561.2005.00026.x
24. Battaglia G, Giustino V, Tabacchi G, Alesi M, Galassi C, Modica C, et al. Effectiveness of a physical education program on the motor and pre-literacy skills of preschoolers from the training-to-health project: a focus on weight status. Front Sports Active Living. (2020) 2:579421. doi: 10.3389/fspor.2020.579421
25. Norris E, Shelton N, Dunsmuir S, Duke-Williams O, Stamatakis E. Physically active lessons as physical activity and educational interventions: a systematic review of methods and results. Prev Med. (2015) 72:116–25. doi: 10.1016/j.ypmed.2014.12.027
26. Niemi H. Active learning—a cultural change needed in teacher education and schools. Teach Teacher Educ. (2002) 18:763–80. doi: 10.1016/S0742-051X(02)00042-2
27. Routen AC, Johnston JP, Glazebrook C, Sherar LB. Teacher perceptions on the delivery and implementation of movement integration strategies: the CLASS PAL (Physically Active Learning) Programme. Int J Educ Res. (2018) 88:48–59. doi: 10.1016/j.ijer.2018.01.003
28. Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA Statement. Open Med. (2009) 3:e123–30. doi: 10.1371/journal.pmed.1000097
29. McMaster University: Effective Public Health Practice Quality Assessment Tool for Quantitative Studies. McMaster University School of Nursing. (2008). Available online at: http://www.ephpp.ca/PDF/Quality%20Assessment%20Tool_2010_2.pdf
30. Aadland KN, Ommundsen Y, Anderssen SA, Brønnick KS, Moe VF, Resaland GK, et al. Effects of the Active Smarter Kids (ASK) physical activity school-based intervention on executive functions: a cluster-randomized controlled trial. Scand J Educ Res. (2019) 63:214–28. doi: 10.1080/00313831.2017.1336477
31. Alhassan S, Nwaokelemeh O, Lyden K, Goldsby T, Mendoza A. A pilot study to examine the effect of additional structured outdoor playtime on preschoolers' physical activity levels. Child Care Prac. (2013) 19:23–35. doi: 10.1080/13575279.2012.712034
32. Bacon P, Lord RN. The impact of physically active learning during the school day on children's physical activity levels, time on task and learning behaviours and academic outcomes. Health Educ Res. (2021) 36:362–73. doi: 10.1093/her/cyab020
33. Bai P, Thornton A, Lester L, Schipperijn J, Trapp G, Boruff B, et al. Nature play and fundamental movement skills training programs improve childcare educator supportive physical activity behavior. Int J Environ Res Public Health. (2019) 17. doi: 10.3390/ijerph17010223
34. Bartholomew JB, Golaszewski NM, Jowers E, Korinek E, Roberts G, Fall A, et al. Active learning improves on-task behaviors in 4th grade children. Prev Med. (2018) 111:49–54. doi: 10.1016/j.ypmed.2018.02.023
35. Bartholomew JB, Jowers EM, Roberts G, Fall AM, Errisuriz VL, Vaughn S. Active learning increases children's physical activity across demographic subgroups. Transl J Am Coll Sports Med. (2018) 3:1–9. doi: 10.1249/TJX.0000000000000051
36. Braun HA, Kay CM, Cheung P, Weiss PS, Gazmararian JA. Impact of an elementary school-based intervention on physical activity time and aerobic capacity, Georgia, 2013-2014. Public Health Rep. (2017) 132:24s−32s. doi: 10.1177/0033354917719701
37. Brusseau TA, Hannon J, Burns R. The effect of a comprehensive school physical activity program on physical activity and health-related fitness in children from low-income families. J Phys Activity Health. (2016) 13:888–94. doi: 10.1123/jpah.2016-0028
38. Bugge A, Möller S, Tarp J, Hillman CH, Lima RA, Gejl AK, et al. Influence of a 2- to 6-year physical education intervention on scholastic performance: the CHAMPS study-DK. Scand J Med Sci Sports. (2018) 28:228–36. doi: 10.1111/sms.12902
39. Burns RD, Brusseau TA, Hannon JC. Effect of a comprehensive school physical activity program on school day step counts in children. J Phys Act Health. (2015) 12:1536–42. doi: 10.1123/jpah.2014-0578
40. Burns RD, Fu Y, Fang Y, Hannon JC, Brusseau TA. Effect of a 12-week physical activity program on gross motor skills in children. Percept Motor Skill. (2017) 124:1121–33. doi: 10.1177/0031512517720566
41. Christodoulos AD, Douda HT, Polykratis M, Tokmakidis SP. Attitudes towards exercise and physical activity behaviours in Greek schoolchildren after a year long health education intervention. Br J Sports Med. (2006) 40:367–71. doi: 10.1136/bjsm.2005.024521
42. Cradock AL, Barrett JL, Carter J, McHugh A, Sproul J, Russo ET, et al. Impact of the Boston active school day policy to promote physical activity among children. Am J Health Promotion. (2014) 28(3 Suppl.):S54–64. doi: 10.4278/ajhp.130430-QUAN-204
43. Dyrstad SM, Kvalø SE, Alstveit M, Skage I. Physically active academic lessons: acceptance, barriers and facilitators for implementation. BMC Public Health. (2018) 18:322. doi: 10.1186/s12889-018-5205-3
44. Egan CA, Webster C, Weaver RG, Brian A, Stodden D, Russ L, et al. Partnerships for Active Children in Elementary Schools (PACES): first year process evaluation. Eval Program Plann. (2018) 67:61–9. doi: 10.1016/j.evalprogplan.2017.12.002
45. Goh TL, Leong CH, Brusseau TA, Hannon J. Children's physical activity levels following participation in a classroom-based physical activity curriculum. Children. (2019) 6. doi: 10.3390/children6060076
46. Grieco LA, Jowers EM, Errisuriz VL, Bartholomew JB. Physically active vs sedentary academic lessons: a dose response study for elementary student time on task. Prev Med. (2016) 89:98–103. doi: 10.1016/j.ypmed.2016.05.021
47. Invernizzi PL, Crotti M, Bosio A, Cavaggioni L, Alberti G, Scurati R. Multi-teaching styles approach and active reflection: effectiveness in improving fitness level, motor competence, enjoyment, amount of physical activity, and effects on the perception of physical education lessons in primary school children. Sustainability. (2019) 11. doi: 10.3390/su11020405
48. Konijnenberg C, Fredriksen PM. The effects of a school-based physical activity intervention programme on children's executive control: the Health Oriented Pedagogical Project (HOPP). Scand J Public Health. (2018) 46:82–91. doi: 10.1177/1403494818767823
49. Martin R, Murtagh E. Active classrooms: a cluster randomized controlled trial evaluating the effects of a movement integration intervention on the physical activity levels of primary school children. J Phys Activity Health. (2017) 14:290–300. doi: 10.1123/jpah.2016-0358
50. Mattson RE, Burns RD, Brusseau TA, Metos JM, Jordan KC. Comprehensive school physical activity programming and health behavior knowledge. Front Public Health. (2020) 8:321. doi: 10.3389/fpubh.2020.00321
51. Mavilidi M, Okely AD, Chandler P, Cliff DP, Paas F. Effects of integrated physical exercises and gestures on preschool children's foreign language vocabulary learning. Educ Psychol Rev. (2015) 27:413–26. doi: 10.1007/s10648-015-9337-z
52. Mavilidi MF, Okely AD, Chandler P, Paas F. Infusing physical activities into the classroom: effects on preschool children's geography learning. Mind Brain Educ. (2016) 10:256–63. doi: 10.1111/mbe.12131
53. Mavilidi M-F, Okely A, Chandler P, Louise Domazet S, Paas F. Immediate and delayed effects of integrating physical activity into preschool children's learning of numeracy skills. J Exp Child Psychol. (2018) 166:502–19. doi: 10.1016/j.jecp.2017.09.009
54. Miller A, Christensen EM, Eather N, Sproule J, Annis-Brown L, Lubans DR. The PLUNGE randomized controlled trial: evaluation of a games-based physical activity professional learning program in primary school physical education. Prev Med. (2015) 74:1–8. doi: 10.1016/j.ypmed.2015.02.002
55. Mullender-Wijnsma MJ, Hartman E, de Greeff JW, Bosker RJ, Doolaard S, Visscher C. Moderate-to-vigorous physically active academic lessons and academic engagement in children with and without a social disadvantage: a within subject experimental design. BMC Public Health. (2015) 15:404. doi: 10.1186/s12889-015-1745-y
56. Mullender-Wijnsma MJ, Hartman E, de Greeff JW, Bosker RJ, Doolaard S, Visscher C. Improving academic performance of school-age children by physical activity in the classroom: 1-year program evaluation. J Sch Health. (2015) 85:265–371. doi: 10.1111/josh.12259
57. Norris E, Dunsmuir S, Duke-Williams O, Stamatakis E, Shelton N. Mixed method evaluation of the Virtual Traveller physically active lesson intervention: an analysis using the RE-AIM framework. Evaluation and program planning. (2018) 70:107–14. doi: 10.1016/j.evalprogplan.2018.01.007
58. Norris E, Dunsmuir S, Duke-Williams O, Stamatakis E, Shelton N. Physically active lessons improve lesson activity and on-task behavior: a cluster-randomized controlled trial of the “virtual traveller” intervention. Health Educ Behav. (2018) 45:945–56. doi: 10.1177/1090198118762106
59. Oliver M, Schofield G, McEvoy E. An integrated curriculum approach to increasing habitual physical activity in children: a feasibility study. J Sch Health. (2006) 76:74–9. doi: 10.1111/j.1746-1561.2006.00071.x
60. Pham VH, Wawrzyniak S, Cichy I, Bronikowski M, Rokita A. BRAINballs program improves the gross motor skills of primary school pupils in Vietnam. Int J Environ Res Public Health. (2021) 18. doi: 10.3390/ijerph18031290
61. Powell E, Woodfield LA, Nevill AM. Increasing physical activity levels in primary school physical education: the SHARP Principles Model. Prev Med Rep. (2016) 3:7–13. doi: 10.1016/j.pmedr.2015.11.007
62. Powell E, Woodfield LA, Powell AJ, Nevill AM. Assessing the wider implementation of the sharp principles: increasing physical activity in primary physical education. Sports. (2020) 8. doi: 10.3390/sports8010006
63. Reed JA, Einstein G, Hahn E, Hooker SP, Gross VP, Kravitz J. Examining the impact of integrating physical activity on fluid intelligence and academic performance in an elementary school setting: a preliminary investigation. J Phys Act Health. (2010) 7:343–51. doi: 10.1123/jpah.7.3.343
64. Resaland GK, Aadland E, Moe VF, Aadland KN, Skrede T, Stavnsbo M, et al. Effects of physical activity on schoolchildren's academic performance: the Active Smarter Kids (ASK) cluster-randomized controlled trial. Prev Med. (2016) 91:322–8. doi: 10.1016/j.ypmed.2016.09.005
65. Resaland GK, Moe VF, Bartholomew JB, Andersen LB, McKay HA, Anderssen SA, et al. Gender-specific effects of physical activity on children's academic performance: the Active Smarter Kids cluster randomized controlled trial. Prev Med. (2018) 106:171–6. doi: 10.1016/j.ypmed.2017.10.034
66. Riley N, Lubans DR, Morgan PJ, Young M. Outcomes and process evaluation of a programme integrating physical activity into the primary school mathematics curriculum: the EASY Minds pilot randomised controlled trial. J Sci Med Sport. (2015) 18:656–61. doi: 10.1016/j.jsams.2014.09.005
67. Robinson LE, Palmer KK, Webster EK, Logan SW, Chinn KM. The effect of CHAMP on physical activity and lesson context in preschoolers: a feasibility study. Res Q Exerc Sport. (2018) 89:265–71. doi: 10.1080/02701367.2018.1441966
68. Ruiter M, Loyens S, Paas F. Watch your step children! Learning two-digit numbers through mirror-based observation of self-initiated body movements. Educ Psychol Rev. (2015) 27:457–74. doi: 10.1007/s10648-015-9324-4
69. Schneller MB, Schipperijn J, Nielsen G, Bentsen P. Children's physical activity during a segmented school week: results from a quasi-experimental education outside the classroom intervention. Int J Behav Nutr Phys Act. (2017) 14:80. doi: 10.1186/s12966-017-0534-7
70. Schneller MB, Duncan S, Schipperijn J, Nielsen G, Mygind E, Bentsen P. Are children participating in a quasi-experimental education outside the classroom intervention more physically active? BMC Public Health. (2017) 17:523. doi: 10.1186/s12889-017-4430-5
71. Seljebotn PH, Skage I, Riskedal A, Olsen M, Kvalø SE, Dyrstad SM. Physically active academic lessons and effect on physical activity and aerobic fitness. The Active School study: a cluster randomized controlled trial. Prev Med Rep. (2019) 13:183–8. doi: 10.1016/j.pmedr.2018.12.009
72. Trawick-Smith J, Swaminathan S, Liu X. The relationship of teacher–child play interactions to mathematics learning in preschool. Early Child Dev Care. (2016) 186:716–33. doi: 10.1080/03004430.2015.1054818
73. Vazou S, Saint-Maurice PF, Skrade M, Welk G. Effect of integrated physical activities with mathematics on objectively assessed physical activity. Children. (2018) 5. doi: 10.3390/children5100140
74. Vazou S, Long K, Lakes KD, Whalen NL. “Walkabouts” integrated physical activities from preschool to second grade: feasibility and effect on classroom engagement. Child Youth Care Forum. (2021) 50:39–55. doi: 10.1007/s10566-020-09563-4
75. Vetter M, O'Connor HT, O'Dwyer N, Chau J, Orr R. ‘Maths on the move': Effectiveness of physically-active lessons for learning maths and increasing physical activity in primary school students. J Sci Med Sport. (2020) 23:735–9. doi: 10.1016/j.jsams.2019.12.019
76. Vetter M, O'Connor H, O'Dwyer N, Orr R. Learning “math on the move”: effectiveness of a combined numeracy and physical activity program for primary school children. J Phys Act Health. (2018) 15:492–8. doi: 10.1123/jpah.2017-0234
77. Weaver RG, Webster CA, Beets MW, Brazendale K, Schisler L, Aziz M. An intervention to increase students' physical activity: a 2-year pilot study. Am J Prev Med. (2018) 55:e1–10. doi: 10.1016/j.amepre.2018.03.005
78. Weaver RG, Webster CA, Egan C, Campos CMC, Michael RD, Vazou S. Partnerships for active children in elementary schools: outcomes of a 2-year pilot study to increase physical activity during the school day. Am J Health Promot. (2018) 32:621–30. doi: 10.1177/0890117117707289
79. Webster CA, Weaver RG, Egan CA, Brian A, Vazou S. Two-year process evaluation of a pilot program to increase elementary children's physical activity during school. Eval Program Plann. (2018) 67:200–6. doi: 10.1016/j.evalprogplan.2018.01.009
80. Williams CL, Carter BJ, Kibbe DL, Dennison D. Increasing physical activity in preschool: a pilot study to evaluate animal trackers. J Nutr Educ Behav. (2009) 41:47–52. doi: 10.1016/j.jneb.2008.03.004
81. Zachopoulou E, Trevlas E, Konstadinidou E. The design and implementation of a physical education program to promote children's creativity in the early years. Int J Early Years Educ. (2006) 14:279–94. doi: 10.1080/09669760600880043
82. Zippert EL, Eason SH, Marshall S, Ramani GB. Preschool children's math exploration during play with peers. J Appl Dev Psychol. (2019) 65. doi: 10.1016/j.appdev.2019.101072
83. Petrigna L, Pajaujiene S, Delextrat A, Gómez-López M, Paoli A, Palma A, et al. The importance of standard operating procedures in physical fitness assessment: a brief review. Sport Sci Health. (2021) 17. doi: 10.1007/s11332-021-00849-1
84. Daly-Smith AJ, Zwolinsky S, McKenna J, Tomporowski PD, Defeyter MA, Manley A. Systematic review of acute physically active learning and classroom movement breaks on children's physical activity, cognition, academic performance and classroom behaviour: understanding critical design features. BMJ Open Sport Exerc Med. (2018) 4:e000341. doi: 10.1136/bmjsem-2018-000341
85. Haapala E. Physical activity, academic performance and cognition in children and adolescents. A systematic review. Baltic J Health Phys Activity. (2012) 4:147–55. doi: 10.2478/v10131-012-0007-y
86. Goh TL, Hannon JC, Webster CA, Podlog L. Classroom teachers' experiences implementing a movement integration program: barriers, facilitators, and continuance. Teach Teacher Educ. (2017) 66:88–95. doi: 10.1016/j.tate.2017.04.003
87. Vazou S, Pesce C, Lakes K, Smiley-Oyen A. More than one road leads to Rome: a narrative review and meta-analysis of physical activity intervention effects on cognition in youth. Int J Sport Exerc Psychol. (2019) 17:153–78. doi: 10.1080/1612197X.2016.1223423
88. Singh A, Uijtdewilligen L, Twisk JW, van Mechelen W, Chinapaw MJ. Physical activity and performance at school: a systematic review of the literature including a methodological quality assessment. Arch Pediatrics Adolescent Med. (2012) 166:49–55. doi: 10.1001/archpediatrics.2012.337
89. Vazou S, Gavrilou P, Mamalaki E, Papanastasiou A, Sioumala N. Does integrating physical activity in the elementary school classroom influence academic motivation? Int J Sport Exercise Psychol. (2012) 10:251–63. doi: 10.1080/1612197X.2012.682368
90. Rickard KA, Gallahue DL, Gruen GE, Tridle M, Bewley N, Steele K. The play approach to learning in the context of families and schools: an alternative paradigm for nutrition and fitness education in the 21st century. J Am Diet Assoc. (1995) 95:1121–6. doi: 10.1016/S0002-8223(95)00304-5
91. MacQuarrie S. Everyday teaching and outdoor learning: developing an integrated approach to support school-based provision. Education. (2018) 46:345–61. doi: 10.1080/03004279.2016.1263968
92. Stone MR, Faulkner GE. Outdoor play in children: associations with objectively-measured physical activity, sedentary behavior and weight status. Prev Med. (2014) 65:122–7. doi: 10.1016/j.ypmed.2014.05.008
93. Mahar MT, Murphy SK, Rowe DA, Golden J, Shields AT, Raedeke TD. Effects of a classroom-based program on physical activity and on-task behavior. Med Sci Sports Exerc. (2006) 38:2086–94. doi: 10.1249/01.mss.0000235359.16685.a3
94. Trudeau F, Shephard RJ. Physical education, school physical activity, school sports and academic performance. Int J Behav Nutr Phys Act. (2008) 5:10. doi: 10.1186/1479-5868-5-10
95. Sallis JF, McKenzie TL, Kolody B, Lewis M, Marshall S, Rosengard P. Effects of health-related physical education on academic achievement: project SPARK. Res Q Exerc Sport. (1999) 70:127–34. doi: 10.1080/02701367.1999.10608030
96. Álvarez-Bueno C, Pesce C, Cavero-Redondo I, Sánchez-López M, Garrido-Miguel M, Martínez-Vizcaíno V. Academic achievement and physical activity: a meta-analysis. Pediatrics. (2017) 140. doi: 10.1542/peds.2017-1498
97. Lundy A, Trawick-Smith J. Effects of active outdoor play on preschool children's on-task classroom behavior. Early Childhood Educ J. (2021) 49:463–71. doi: 10.1007/s10643-020-01086-w
Keywords: preschool, infant, kindergarten, outdoor learning, nature, academic achievement, primary school
Citation: Petrigna L, Thomas E, Brusa J, Rizzo F, Scardina A, Galassi C, Lo Verde D, Caramazza G and Bellafiore M (2022) Does Learning Through Movement Improve Academic Performance in Primary Schoolchildren? A Systematic Review. Front. Pediatr. 10:841582. doi: 10.3389/fped.2022.841582
Received: 22 December 2021; Accepted: 17 January 2022;
Published: 08 March 2022.
Edited by:
Ivana M. Milovanovic, University of Novi Sad, SerbiaCopyright © 2022 Petrigna, Thomas, Brusa, Rizzo, Scardina, Galassi, Lo Verde, Caramazza and Bellafiore. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Ewan Thomas, ewan.thomas@unipa.itorcid.org/0000-0001-5991-8316