Effectiveness of school-based active breaks on classroom behavior, executive functions and physical fitness in children and adolescent: a systematic review

Introduction: The classroom environment is ideal for promoting physical activity interventions since children spend most of their day there but often engage in sedentary behavior. Given this context, an emerging trend to promote physical activity is active breaks at school. This systematic review evaluated the effects of school-based physical activity interventions involving active breaks on children and adolescents’ classroom behavior, executive functions, and physical fitness.

Methods: This review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A literature search was conducted using PubMed, Web of Science, Scopus, and EBSCOhost. Studies published between January 2010 and August 31, 2023, including participants aged 5 to 18, were included. Interventions involving active breaks and outcomes related to classroom behavior, executive functions, and physical fitness were considered.

Results: Initially, 145 studies were identified, with 22 duplicates excluded. After screening 123 articles by title and abstract, 86 were excluded. Subsequently, 37 articles underwent full-text screening, resulting in 22 included studies. Six studies showed positive effects on classroom behavior; five studies showed improvements in executive functions, and only two studies indicated increases in physical fitness.

Discussion: This review suggests incorporating active breaks during school hours can improve classroom behavior in children and adolescents. However, the effects of active breaks on executive functions and physical fitness are unclear. More research is needed to fully understand the benefits of implementing active break programs in the classroom.

Systematic review registration: PROSPERO, CRD42023448267, available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023448267.

1 Introduction

Regular and systematic physical activity (PA) in children and adolescents is positively associated with physiological and cognitive benefits, such as cardiorespiratory fitness and executive function (1, 2). However, there are still insufficient systematic reviews that consolidate studies on the effects of active breaks (ABs) interventions on classroom behavior, executive function, and physical fitness in children and adolescents (3).

Regarding classroom behavior, a positive relationship has been reported between higher PA levels and better on-task behavior during childhood lessons, which is significant for the learning process (4). Cognitive skills are crucial for school readiness. This developmental window provides a great opportunity for PA to positively influence cognition and enrich the educational process (5).

According to the World Health Organization, children and adolescents aged 5–17 should engage in at least 60 min of moderate-to-vigorous physical activity (MVPA) daily. However, the Global Matrix 3.0 Physical Activity Report Card Grades for Children and Youth, which evaluates physical activity levels in children and youth from 49 countries, revealed a mean letter grade of C for the percentage of children and youth meeting the physical activity recommendation of 60 min of MVPA per day, representing only 27–33% of children and youth (6).

Current evidence (7) suggests that the focus and priority should be on identifying strategies to increase and maintain PA levels in children and adolescents in school, as it is one of the primary environments where they spend much of their time. A significant decrease in total daily PA was observed during the transition from primary to secondary school, highlighting the need to increase opportunities for adolescents to be physically active, particularly during this transitional period (8, 9). Contemporary school settings are key environments for promoting various PA opportunities to enhance PA participation and wellbeing. However, the school environment, including class time and after-school hours, contributes to most children’s sedentary time due to prolonged sitting and long periods of sedentary behavior during class hours (10). Consequently, current school settings may facilitate an adequate amount of PA for children and adolescents (11).

Classroom-based PA interventions involve incorporating PA during class time or between lessons with the participation of regular teachers and have emerged as a potential solution (4). In this context, classroom-based PA interventions, known as ABs, incorporate brief periods of PA into school routines and have been investigated as potential strategies to increase PA during school hours without reducing educational time or interfering with the educational process (11–14). ABs are 5–15 min sessions of moderate-to-vigorous PA intensity led by teachers who introduce short bursts of PA into academic lessons (15). ABs can be implemented in any school context because they do not require special spaces, equipment, or specialized personnel (3, 12). Moreover, a recent systematic review with a meta-analysis of the effects of AB interventions on attentional outcomes found some positive acute and chronic effects, especially on selective attention (15–17), reporting a positive impact of ABs on classroom behavior (time on task) (16) and a potential benefit on cognitive functions. Regarding the relationship between the chronic practice of ABs and the level of physical fitness and general cognitive functioning, evidence suggests that these benefits are based on increased cardiorespiratory fitness (CRF). Thus, the cognitive functional benefits associated with regular exercise are mediated by improved physical fitness. Additionally, physiological adaptations attributed to chronic PA have been linked to brain-level adaptations, which positively impact cognitive performance (18–20). Therefore, the regular practice of ABs should improve physical fitness and cognitive performance. However, existing literature on ABs shows high levels of heterogeneity in samples, intervention characteristics, and outcomes (14). In this regard, the present review aims to systematically analyze the application times, types of exercises, and study quality in ABs interventions, while presenting results for each of the study variables.

The following questions were posed to conduct this systematic review: What is the current scientific evidence regarding the effects of ABs on classroom behavior, executive function, and physical fitness in children and adolescents? What are the application times and types of exercises used in ABs? What are the effects of ABs on each variable, and how is the quality of the studies evaluated? This study aimed to evaluate the effects of school-based PA interventions based on ABs on classroom behavior, executive function, and physical fitness in children and adolescent students.

2 Materials and methods

2.1 Search strategy

This review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (21) and registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number: CRD42023448267). The search used four electronic databases: PubMed, Web of Science, Scopus, and EBSCOhost.

The search for studies included in this systematic review was conducted between August 1 and August 31, 2023. Only studies published between January 2010 and August 31, 2023, were included as ABs have been an emerging topic of scientific interest during the last decade (22).

The search terms (MESH) and keywords used in all databases were: [active breaks OR activity break OR brain break OR classroom break] AND [children OR child OR adolescent OR schoolchildren OR students] AND [physical fitness OR physical conditioning OR cardiorespiratory fitness OR muscular fitness] AND [classroom behavior OR on-task behavior OR off-task behavior OR time-on-task] AND [cognitive function OR executive function OR executive control OR working memory OR inhibitory control OR cognitive flexibility].

2.2 Eligibility criteria

Studies were considered eligible if they met all of the following criteria: (a) the research involved AB interventions carried out inside the classroom (acute [single class] or chronic classes [weeks or months]), (b) the AB characteristics (e.g., the type of movements involved, intensity, work-to-recovery ratio [WRR]), and the single class or week frequency duration of the intervention were provided; (c) randomized controlled trials (RCT) and control trials (CT) were considered; (d) the research focused on different subcomponents of physical fitness (CRF, muscular fitness, flexibility, and body composition), classroom behavior (on-task behavior and time on task), and executive function (working memory, inhibitory control, and cognitive flexibility); (e) participants were aged 5–18 without diagnosed diseases or mental disorders; (f) only articles published in scientific journals were considered; (g) only research involving humans and written in English were considered.

Study protocols, articles focusing on sports, reviews, papers published in conferences, dissertations, theses, and non-peer-reviewed journals were excluded.

2.3 Study selection

The selection criteria were based on the PICOS criteria used to define the characteristics of the included studies (23). Population: Studies including participants aged 5 to 18 were included; Intervention with ABs: Studies evaluating the effect of acute or chronic ABs on classroom behavior, executive function, and physical fitness providing clear ABs protocols were included; Comparator: Studies comparing active control (e.g., other exercise protocols) or passive control (e.g., sitting and resting) were included; Outcomes: Studies assessing physical fitness, classroom behavior, or executive function were included; Study design: RCTs, CTs, and repeated crossover studies were included. Two authors completed the screening and selection of the studies in September 2023. First, duplicates were removed, and titles and abstracts were examined to identify studies that met the inclusion criteria. Second, the full texts of eligible studies based on the screened studies were read by three authors (TRA, EM, and FSF) to determine their final inclusion. Disagreements between the two reviewers were resolved through a consensus meeting among the three authors in September 2023. Finally, articles on acute and chronic AB interventions and their effects on physical fitness, classroom behavior, and executive function were included in this review.

2.4 Data extraction process and data synthesis

The full texts were analyzed, and after confirming the eligibility criteria, the following data were extracted: (a) first author’s name, publication year, and country of data collection; (b) sample size, participants’ age and sex; (c) study design and/or group assignment; (d) details about ABs intervention (such as exercise intensity, work/rest ratio, session time, frequency, duration of intervention, and modality); (e) subcomponents of physical fitness, classroom behavior, and executive functions assessed; and (f) main findings. Outcome data were extracted as pre- and postintervention means and standard deviations (SD). The dependent variables were reported in repetitions or milliseconds (if relative values were not reported). In studies that reported intermediate and post-intervention values, only the final executive function values were compared with baseline values. Data from the included studies were independently extracted by two reviewers (TRA and EM), and any discrepancies were resolved by consulting a third reviewer (FSF).

2.5 Methodological quality assessment

Three authors analyzed and studied the PEDro scale (24) (TRA, EM, and FSF), and then two authors (TRA and EM) assessed the study quality according to the PEDro scale for 1 week. Any disagreements were discussed with a third reviewer (FSF) until a consensus was reached. Eleven criteria of the PEDro scale were analyzed to comply with the requirements of the PRISMA protocol, as previously described (4, 17). The results were obtained using the criteria and general score for each article.

The total PEDro score was obtained by adding points describing the quality of papers, such as 9–10 (excellent), 6–8 (good), 4–5 (fair), and ≤3 (poor) (24).

Studies that are not RCT or CT were analyzed with the Risk of Bias Assessment Tool for Non-randomized Studies (RoBANS) (25).

3 Results

A total of 145 studies were initially identified in PubMed, Web of Science, Scopus, and EBSCOhost. Of these, 22 duplicates were excluded from the analysis. Accordingly, 123 articles were screened by title and abstract, of which 86 were excluded. After the first screening stage, 37 articles were selected for full-text screening, resulting in 22 full-text articles for data extraction and reporting. As the search was conducted 11 months previously, an updated review (without finding new studies according to the eligibility criteria) was performed to further refine the study findings. The flow diagram of the study selection process, following the PRISMA guidelines (21), is shown in Figure 1. Table 1 summarizes the characteristics and results of the study.

Figure 1

Figure 1. PRISMA flow diagram of each stage of the studies selection.

Table 1

Table 1. Summary and description of the studies included in the review.

3.1 Studies description

All included studies evaluated the effects of an intervention with ABs. A summary of the included studies is provided in Table 1. The present review found that the number of participants in each study ranged from 35 to 512 (total participants: 3,615), ranging in age from 5 to 18 years.

These studies were conducted in various countries, including Canada (15, 16, 26, 27), Spain (28–30), the United States (31–36), Norway (37), Italy (38, 39), Switzerland (40), Australia (41, 42), England (43, 44) and the Netherlands (45). Fifteen studies were RCTs (26–28, 31–34, 36, 37, 40–45), five were CTs (29, 30, 35, 38, 39), and two were repeated crossovers (15, 16).

The studies included between two and four intervention groups: 14 studies used two groups (15, 16, 29–31, 35, 37–43, 45), five studies used four groups (26, 28, 32, 34, 44), and three studies used three groups (27, 33, 36). The studies used different modalities in the application of their interventions. Six studies performed ABs based on active games (27, 32, 33, 35–37), seven studies used moderate to high-intensity physical activity (26, 29, 31, 34, 38, 42, 45), three studies applied activities based on high-intensity interval training (30, 39, 41), two studies implemented activities based on active videos (28, 43), one studies used coordination activities (40), two studies used FUNterval activities (15, 16); and one study applied resistance exercise (44). In eight studies (27, 29, 31, 32, 34, 40, 41, 45), the intensity of the activities was monitored using heart rate; two studies used the Rate of Perceived Exertion (38, 44), two studies used accelerometers (28, 39), and 10 studies did not report intervention intensity (15, 16, 26, 30, 33, 35–37, 42, 43).

The duration of the ABs varied between 3 and 20 min. Thirteen studies applied ABs for 10 min (27, 28, 30, 31, 33–35, 37, 39, 41–43, 45), five studies performed 4 min (15, 16, 26, 29, 36), two studies used ABs for 20 min (38, 40), and two studies applied 6 min (32, 44). The duration of chronic interventions in the included studies lasted from 3 weeks (15, 16) to 78 weeks (39). One study 4 weeks (44); three studies 6 weeks (36, 42, 43); three studies 8 weeks (29, 35, 40); one study lasted 9 weeks (45); two studies lasted 12 weeks (38, 41); one study lasted 14 weeks (31); one study lasted 17 weeks (30); one study lasted 20 weeks (33); and one study lasted 40 weeks (37). Five studies described acute sessions with ABs (26–28, 32, 34).

Exercise training sessions were conducted twice a week in three studies (36, 38, 41), three times a week in six studies (16, 30, 31, 35, 43, 44), five times a week in seven studies (29, 33, 37, 39, 40, 42, 45), and one intervention per group was reported in six study (15, 26–28, 32, 34).

The evaluations used in the studies focused on three variables: classroom behavior, executive function, and physical fitness. For classroom behavior, the Behavioral Observation of Students in Schools (BOSS) (15, 16, 26, 41, 44), A Go/No-Go task (36) Momentary Time Sampling test (31), Systematic Classroom Observations test (36), and Observing Teachers and Pupils in Classrooms (OPTIC) (43) were used. For executive function, the Flanker Task (28, 32, 33, 44), Trail Making Test (TMT) (27, 34, 37, 42), Stroop color-word Task (27, 40, 45), Stroop Golden Color Word (37), Attention Test (44), Attention Network Task (45), D2 test (15, 29, 45), Working Memory Cognitive Test (39), Backward Color Recall task (32, 33), Digit Span (37) The Forward Memory Span (27), Toolbox List Sorting Working Memory Test (36), Digit Recall (34) One-Minute Ad Hoc Test (29), Toolbox Cognition Battery (28, 44), and NIH-EXAMINER battery (30) were used. For physical fitness, Standing Long Jump (27, 39), the Shuttle Run Test (27, 35, 45), 10-min interval running test (37), 6 min walking test (39), Eurofit program (35), Motor test (38), 90° push-up test, 30 s Maximal Repetition Squat to Chair test, plank-hold test (44), and body mass index (BMI) (37–39) were used.

The results of the AB interventions are grouped as follows:

1. Classroom behavior: Positive effects were shown with the application of ABs (15, 16, 26, 41, 43, 44), and one study did not show significant differences (31).

2. Executive functions: (A) Inhibitory control showed improvements (27, 30, 36, 40), but four studies did not show significant effects (28, 32, 33, 45). (B) Cognitive flexibility: Three studies showed increases (27, 30, 44), but four did not show improvement (28, 34, 42, 45). (C) Working memory: AB interventions showed improvements (30, 39, 44), but two studies did not report an increase (29, 36).

3. Physical fitness: (A) Muscular fitness improved with AB interventions (38, 39), whereas three studies did not show an increase (27, 35, 44). (B) Cardiorespiratory fitness improved in two studies (38, 39), whereas four studies did not report a significant increase (27, 35, 37, 45). (C) Anthropometric outcomes showed improvements in AB interventions (38, 39), with only one study not showing improvement (37).

Following the descriptive analysis, we assessed the risk of bias in each study (Table 2). Study quality was assessed using the PEDro Scale (46). According to the PEDro scale criteria, the studies were categorized as follows: Criteria 1 (eligibility criteria were specified) (29, 33, 36–40, 45); Criteria 2 (subjects were randomly allocated to groups) (28, 32–34, 36–38, 40, 41, 43–45); Criteria 3 (allocation was concealed) (41, 45); Criteria 4 (the groups were similar at baseline regarding the most important prognostic indicators) (27–29, 31–45); Criteria 5 (there was blinding of all subjects) (45); Criteria 6 (there was blinding of all therapists who administered the therapy) (45); Criteria 7 (there was blinding of all assessors who measured at least one key outcome) (33, 45); Criteria 8 (measures of at least one key outcome were obtained from more than 85% of the subjects initially allocated to groups) (29, 34–41, 43–45); Criteria 9 (all subjects for whom outcome measures were available received the treatment or control condition as allocated or, where this was not the case, data for at least one key outcome were analyzed by “intention to treat”) (28, 38, 41, 44, 45); Criteria 10 (the results of between-group statistical comparisons are reported for at least one key outcome) (26–45); Criteria 11 (the study provides both point measures and measures of variability for at least one key outcome) (26–45). The overall results were: Five studies were scored as “Poor Quality” (26, 27, 31, 38, 42), 11 articles were scored as “Fair” (28, 29, 32–37, 39, 40, 43), three studies were categorized as “Good” (38, 41, 44), and one article was “Excellent” (45). Two articles were assessed using RoBANS, presenting a high quality and low risk of bias (15, 16). None of the articles in this review reported dropouts or adverse events.

Table 2

Table 2. Assessment of risk of bias/PEDRo scale.

4 Discussion

This systematic review aimed to evaluate the effects of school-based PA interventions based on ABs on classroom behavior, executive function, and physical fitness in children and adolescent students. This review expands the evidence from recent reviews by addressing the effect of ABs conducted only in a classroom setting on classroom behavior, executive functions, and physical fitness, in contrast to previous studies (12, 17, 47). A systematic literature search found 22 studies that assessed the effects of AB interventions on classroom behavior, executive function, and physical fitness in children and adolescent students. Discussions were conducted according to the three outcomes of the study.

4.1 Classroom behavior

Regarding the effects of ABs on classroom behavior, six articles showed positive effects of the application of ABs. This aligns with other systematic reviews (3, 12), showing that it enhances the time spent on tasks. However, one study showed no significant differences, which contradicts findings suggesting that teachers can enhance post-break time-on-task for students with ABs in the classroom, particularly among those who are the most off-task (48). Studies that performed moderate-to-vigorous-intensity activities reported better on-task behavior, which is consistent with a study that demonstrated higher intensities of PA have a positive effect on children’s behavior (49).

4.2 Executive function

In relation to executive functions regarding inhibitory control, our results were unclear because four studies showed improvement, while the other four articles did not show a significant effect. This result is in the same direction as a meta-analysis that analyzed the same variables (17). Nevertheless, another experimental study reported significant effects on a specific subject (50, 51). Regarding working memory, the AB intervention showed improvements in three studies, which agrees with research on the significant effects of ABs on working memory in children (30, 52). However, other studies do not show an increase, although physical activity positively affects executive functions (53), especially working memory (2). Some studies still show that the effects are not clear, depending on the type and time of intervention (54). Our results are inconclusive about the effects of ABs on executive function, which is consistent with other similar studies (3, 12), possibly due to the lack of integration of ABs as a key aspect of learning and cognitive engagement (4).

4.3 Physical fitness

Regarding physical fitness, muscular fitness improved with AB intervention in two articles; this result aligns with other studies (55, 56). However, three studies did not show increases despite evidence showing improvements in muscle fitness. Regarding CRF, two studies showed improvement, while the other four studies did not report significant increases, which is unclear and does not agree with the current evidence (56, 57). Intervention with ABs improved anthropometric outcomes in two studies. These findings do not coincide with those of other studies (57, 58), but do coincide with the results of a study that did not report any improvements. One study found positive effects on flexibility, balance, and speed (35), consistent with another study; however, the evidence is limited (58). Overall, these results are unclear, which agrees with other studies conducted in the same population (59, 60).

However, the diversity of modalities reported by this study to evaluate the variables analyzed does not allow a clear discussion. Therefore, this study opens a new area of research, as homogeneity in the measurement approach is crucial for determining the effect of an intervention (9). Furthermore, based on the quality analysis of the studies, most are of poor or fair quality, which limits the robustness of the results. This is a key point to address in order to contribute to the collective construction of knowledge in the field of ABs within the school environment.

The present study showed that interventions with ABs for 4–10 min three times a week for 3 weeks or more, improved classroom behavior, while interventions for 1 year or more improved physical fitness. These results suggest that long-term ABs may improve attention and concentration during the academic task and, furthermore, contribute to reduction in cardiometabolic risk factors (17, 57). In this regard, according to the findings of this systematic review, North America (10 studies) and Europe (10 studies) are the regions where the most studies on this topic have been conducted. Therefore, the benefits of incorporation ABs would likely be most pronounced in these child population. On the other hand, the effects of ABs interventions on executive function are unclear. The incorporation of PA during school hours in children and adolescents is very scarce; therefore, promoting PA in school settings is essential (11). In this sense, ABs in our study did not show interventions with adverse effects; thus, it continues to be a viable, evidence-based formula to be incorporated into the school day (3) because currently, the school setting is considered the privileged context for children to acquire knowledge of PA habits for an integral educational process (13). The outcomes of this systematic review are important because they indicate the potential for the practical application of ABs in the school context, which can become a tool for teachers of different subjects when incorporating PA into the learning process (14).

5 Limitations

The limitations of this study are related to the variability in the study measures used for classroom behavior, executive functions, and physical fitness, which made it difficult to analyze the effects of ABs. Additionally, differences in the number of participants between the studies and the various modalities of AB application limited the analysis of the results. Furthermore, the quality of the studies was poor or fair; therefore, the findings should be interpreted with caution.

6 Conclusion

Our study provides evidence suggesting that the incorporation of ABs during school hours can improve classroom behavior in children and adolescents. These findings have important implications, especially for those seeking time-efficient PA designs aimed at improving the learning process. However, the effects of ABs on EFs and physical fitness remain unclear. According to the results, more research is needed to clarify all the effects related to the implementation of ABs programs and determine the benefits of incorporating ABs into the classroom. Lastly, it is recommended that future studies provide more detailed information about the interventions and focus on quality criteria. Additionally, it is suggested to develop a common protocol for the implementation of ABs and the measurement of their effects.

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

TR-A: Writing – review & editing, Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft. GS-G: Conceptualization, Data curation, Formal analysis, Writing – original draft, Writing – review & editing. EM: Conceptualization, Data curation, Formal analysis, Writing – original draft, Writing – review & editing. CO-F: Conceptualization, Data curation, Formal analysis, Writing – original draft, Writing – review & editing. JI-M: Conceptualization, Data curation, Formal analysis, Writing – original draft. NG-Á: Conceptualization, Data curation, Writing – review & editing. HC-B: Conceptualization, Data curation, Writing – review & editing. JP-H: Conceptualization, Data curation, Writing – review & editing. JH-A: Conceptualization, Data curation, Methodology, Writing – review & editing. RY-S: Formal analysis, Methodology, Writing – review & editing. RZ-L: Data curation, Methodology, Writing – review & editing. FS-F: Data curation, Methodology, Writing – review & editing, Conceptualization, Formal analysis, Writing – review & editing. JO-A: Writing – review & editing. JM: Conceptualization, Supervision, Writing – original draft, Writing – review & editing.

Funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This research was funded by the General Directorate of Research at the University of Playa Ancha. Decree 0205/2023, article processing charges, APC.

Acknowledgments

The authors appreciate the work of the students of the Physical Activity Sciences Observatory (OCAF) of the Universidad de Playa Ancha, who, with their work and critical feedback, contributed greatly to the study.

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.

Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2025.1469998/full#supplementary-material

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