Physical Education Impact on Child Development

Background

Early childhood is a crucial time in the developmental trajectory of humans. It is at this point that multiplex bodily, cognitive and psychosocial development occurs. During the first few years before schooling (preschool years), children experience a rapid phase of growth resulting in a substantial increase in height, which produces a lean frame (Börnhorst et al., 2018). The unsynchronised linear and body weight growth reduces after the formative years to an all-time low around 6 years of age. Thereafter, body mass index (BMI) increases rapidly. This sudden increase in BMI after a period of slow lean growth is known as adiposity rebound (Peneau et al., 2016). Premature adiposity rebound is an important risk factor in the development of childhood obesity and can happen by the time most obese children reach 3 years (Kumar and Kelly, 2017; Amjad et al., 2018). Physical activity is assumed to play a role in the normal growth and development of children. However, its influence on alterations in body composition is still unknown.

Physical education (PE) is a class that is offered in schools to promote psychomotor learning. The subject aims at enhancing the physical competence, movement and safety of learners, as well as empowering them to utilise these skills in the development of a healthy and active lifestyle (Stojanović and Zdravković, 2018). Other benefits of physical education include building confidence in students and boosting their general skills such as communication, collaboration, critical thinking, innovativeness and appreciation of aesthetics (Capel and Blair, 2019; Pangrazi and Beighle 2019). Positive values and attitudes are also nurtured during physical education classes. Therefore, the subject lays a basis for lifelong learning in students.

From a health perspective, PE contributes to the mental and physical wellbeing of children. Obesity, which is the accumulation of undesirable fat in the body, is a global health issue all over the world (Ranjani et al., 2016). Childhood obesity is a public health threat because of its role as a risk factor in the development of chronic lifestyle diseases such as hypertension, type 2 diabetes, stroke, cardiovascular disease, hyperlipidaemia and certain types of malignancies as well as reduced life expectancy (Mishra and Acharya, 2017). Obesity also affects the mental health of children by lowering their self-esteem and body image perceptions. The disorder may be inherited from parents or can also arise from unhealthy eating habits and sedentary lifestyles (Kumar and Kelly, 2017). Therefore, a balanced caloric intake and regular physical activity are evidence-based and cost-effective strategies for the management of obesity.

For school-going children, PE is the first step towards leading active lives. Furthermore, children spend most of their time in school, which makes it an ideal place to exercise (Lind and Gray, 2017). Physical education informs children about the importance of exercise and inculcates discipline about cultivating a physically active lifestyle (D’Isanto, 2016). The recommended minimum level of physical exercise for children between the ages of 5 and 18 years is 60 minutes of moderate-intensity exercise per day (Schwarzfischer et al., 2017; Nordvall-Lassen et al., 2018). For an activity to be considered moderate exercise, it should cause an increase in breathing and heart rate to the extent of producing a palpable pulse, warmth and sweating on hot days. Currently, education systems are under pressure to increase the levels of physical activity because of the perception that school settings are central to promoting exercise.

This paper proposes a study to investigate the impact of physical education on child development with a focus on physical and cognitive development. Cognition is defined as a collection of mental processes of obtaining knowledge and comprehension that play a part in acuity, memory, intelligence and action (Allen, 2017). Cognitive functioning consists of several aspects, for example, executive function, intelligence quotient (IQ), language, learning, memory and attention.

Literature Review

Many studies have investigated the importance of physical exercise on children’s health, especially as it relates to the prevention of obesity (Kumar and Kelly, 2017; Amjad et al., 2018). Other studies have explored the role of exercise in development (Pesce et al., 2019). However, there is limited information regarding the optimal and feasible levels of daily physical activity for children in school settings. Previous reports by Chief Medical Officers in England encouraged the engagement of children in physical exercise based on the recommended levels of at least one hour of moderate exercise a day (Schwarzfischer et al., 2017). Nonetheless, the report did not state whether these targets were met or suggest possible ways of attaining the exercise goals within a school setting.

Howells et al. (2018) attempted to fill this knowledge gap by studying the effect of physical education lessons on school-going children aged between 6 and 7 years. The authors conducted longitudinal research that followed 10 children (boys and girls) for a year. Accelerometers were worn by the children all through school days that lasted approximately 7 hours. Physical education (PE) days were distinguished from non-PE days. Activity data were analysed by repeated-measures analysis of variance to compare the mean activity between PE and non-PE days across the two genders. Overall, boys attained higher levels of physical activity levels compared to girls on PE and non-PE days. The level of activity was lower for non-PE days than PE days. These differences were statistically significant. The authors concluded that boys were more active than girls and that PE lessons played a substantial role in the attainment of high physical activity levels. However, achieving the endorsed levels of daily activity was not feasible on typical school days with or without PE lessons. However, the authors did not examine the impact of PE on development.

In a separate study, Zeng et al. (2017) evaluated the literature to determine the effect of different physical activity regimens on the cognitive development and motor skills of preschool children. The target age group was 4 to 6 years. Out of the 15 studies that were reviewed, 10 of them explored the relationship between physical activity and motor skills. About 80% of these studies showed that physical activity resulted in positive motor performance, whereas 10% of the studies reported mixed outcomes. The remaining 10% of the papers showed that exercise did not result in any beneficial upshots. Four out of the five studies that explored the impact of physical activity on cognitive development indicated that exercise resulted in significant improvements in academic performance, working memory, attention and language learning. This study confirms the value of physical activity on child development with respect to cognitive and motor skills. However, further knowledge is still required regarding the dose-dependent effect of childhood physical activity on precise cognitive domains.

The issue of adiposity in the early stages of development has also been investigated to determine the role of exercise in alleviating the issue. Studies show that moderate-vigorous physical activity (MVPA) reduces adiposity in preschool children (Marques et al., 2016; Janz et al., 2017). Nonetheless, exercise did not affect the staging of the adiposity recoil. Therefore, Butte et al. (2016) investigated the relationship between constituents of physical activity, total energy expenditure, sleep, body size and body composition in children and adolescents. They also explored physical activity, sleep and total energy as predictors of body size and makeup in school children. Butte et al. (2016) noted that sedentary activity was positively correlated with fat-free mass and weight, whereas moderate to vigorous physical activity resulted in percent fat mass. The overall conclusion was that physical activity enhanced normal growth and accumulation of fat-free mass while the duration of sleep was not a reliable predictor of alterations in adiposity in pre-school children. While this study highlighted the interrelationships between physical activity, growth, sleep and adiposity, it focused mainly on pre-school children aged between 3 and 5, whereas the focus of this study is ages 5 to 7. Furthermore, it also introduces sleep as another dynamic.

Alvarez-Bueno et al. (2017) examined the impact of physical exercise on the cognition and metacognition of children aged between 4 and 18 years. The authors reviewed various randomised controlled trials on these parameters. The key observations were that physical activity boosted various domains of cognition and metacognition in children and adolescents. The most beneficial interventions were physical education regiments as well as regular physical activity. The authors suggested that the influence of physical activity on cognitive function was mediated by different mechanisms, for instance, the efficient delivery of glucose and oxygen to the brain, cerebral blood flow and changes in concentrations of neurotransmitters, structural alterations in brain volumes, angiogenesis and enhanced brain functioning (Alvarez-Bueno et al., 2017). Additionally, a combination of neurocognitive and social-cognitive machinery is thought to explain the pertinent connections between life skills and advanced executive functions. Such skills include goal setting, creativity and decision making, which are critical to healthy development in children. While this study underscored the value of physical activity with respect to cognitive advancement, it did not examine the physical development aspect. Furthermore, it focused on a wider age group than intended for this study.

Tandon et al. (2016) also reviewed the literature to determine the association between diet, physical exercise and cognitive development in children. Their findings confirmed what has been reported by previous studies that physical activity enhances cognitive development (Alvarez-Bueno et al., 2017). However, they also introduced an additional factor (diet) that influences the overall wellbeing and development in children. Suboptimal nutrition often has negative consequences on child development. Tandon et al. (2016) noted that physical exercise and healthy dietary patterns contributed to improved cognition. These findings highlight additional variables that should be considered when examining factors that influence child development. In the proposed study, the school diet will be expected to be uniform. However, the participants will be exposed to varying diets during the holidays, which may affect their development.

Research Questions and Hypotheses

The PICO question that summarises the entire study is ‘In school-going children between ages 5 to 7 (P), what is the impact of physical education lessons (I) on the physical and cognitive development (O) compared to holiday days (C)?’ However, additional specific questions that the study will answer include:

1. What are the differences in the physical activity levels of schoolchildren aged between 5 and 7 on school days and holidays?
2. What is the effect of physical education on the physical development of children between the ages of 5 and 7 years?
3. What is the impact of physical education on the cognitive development of children between the ages of 5 and 7 years?

The following null hypotheses correspond to the specific questions:

1. There are no differences in the physical activity levels of schoolchildren aged between 5 and 7 on school days and holidays.
2. Physical education does not affect the physical development of children between the ages of 5 and 7 years.
3. Physical education does not affect the cognitive development of children between the ages of 5 and 7 years.

Aims and Objectives

The main objective of the study is to determine the impact of physical education on the physical and cognitive development of children between the ages of 5 and 7 years. To attain the general objective, the researcher will explore the following specific goals:

1. To determine differences in the physical activity levels of schoolchildren aged between 5 and 7 on school days and holidays.
2. To ascertain the effect of physical education on the physical development of children between the ages of 5 and 7 years.
3. To determine how physical education affects children’s cognitive development between the ages of five and seven.

Methodology

The study will use a quantitative approach to research, which measures research with the aid of numerical data that can be converted to usable statistics. Quantitative research quantifies opinions, viewpoints, behaviours, phenomena and other delineated variables (Goertzen, 2017). Consequently, the findings obtained from a representative sample can be generalised to a bigger population. Quantitative research helps in the discovery of drifts in thoughts, opinions and phenomena, which may direct the formulation of new hypotheses concerning these occurrences.

A quantitative approach was chosen because physical education is not a personal experience that can be measured through subjective studies. Other advantages of quantitative studies include enhanced accuracy compared to qualitative studies that concentrate on the evaluation of non-numerical data. This research approach makes it possible to use a large sample size, which increases the reliability of the outcomes, hence the generalisability of the findings to the population. Statistical analysis provides depth to the resultant study outcomes and may generate additional data that answer the research question. Research can be carried out faster when using quantitative means than qualitative techniques. The validity and reliability of quantitative research can be verified because it is possible to duplicate the outcomes when precise experimental procedures are followed by independent investigators (Queirós, Faria and Almeida, 2017). The possibility of replication minimises arguments and controversies surrounding the results.

The precise quantitative method that will be used for the study is correlational research, which utilizes statistical information to measure the degree of association between two or more variables. The goal of correlational investigations is to look for relationships between phenomena and construe them. Therefore, patterns and trends in data can be identified (Curtis, Comiskey and Dempsey, 2016). However, the cause-effect relationship of the observed trends cannot be determined given that causation is not the basis of correlational research.

Sampling

Stratified sampling, which is a probabilistic approach to sampling, will be used to select the participants of the study. This method involves the classification of participants into groups that share a common trait, which is usually predetermined by the researcher. Stratified sampling is beneficial when a study focuses on a precise sub-group within the population. Therefore, a stratified sample provides better precision than a simple random sample of the same size. Other advantages of stratified sampling include requirements for small samples, which is economical in terms of financial resources without compromising the precision of the outcomes. Stratification protects against misleading samples, for instance, the selection of an all-female sample from a population containing mixed genders. During stratification, the researcher can make sure that they have adequate sample points to facilitate separate analyses of subgroups of the sample.

The study will involve 32 participants between the ages of 5 and 7 years attending a local elementary school. This age group corresponds to school children in grades 1 and 2 and was chosen because it is often underrepresented in physical activity investigations (Howells et al., 2017). A total of 16 students will be selected from grade 1 (8 boys and 8 girls) and another 16 (8 boys and 8 girls) from grade 2. All students will be sampled from one class to ensure the uniformity of data regarding physical activity levels in school. Nonetheless, participation in the study will be voluntary because the selection process will be done by the children’s class teacher. The names of all students in the selected classes will be written on pieces of paper, separated according to gender and placed in different baskets. The class teacher will then draw out names randomly from the baskets to ensure that both genders are represented equally. Such an approach will be deemed transparent and fair to the children. The random drawing of participants’ names will eliminate selection bias.

Data Collection

Physical activity will be measured using accelerometers by recording for a total of 30 days. Data will be collected on 15 school days (PE days and non-PE days) and 15 vacation days. Swimming lessons will be excluded from the data collection because of the inability to waterproof the accelerometers. The expected output of the monitor will include activity counts, vector magnitude and the number of steps. Programming of the accelerometers will be done to document activity counts in 60-second-cycle sampling intervals, which is also referred to as epoch sampling (Aadland et al., 2020). The participating children will be expected to wear the monitors throughout the study duration except during swimming or showering. This requirement is not expected to cause any problems because the monitors are compact and light in weight. The researcher will demonstrate to the children, their teachers and caregivers how to wear the monitors and provide a written guide containing directions for proper care.

Physical development will be measured by obtaining anthropometric parameters such as height, weight and BMI at the beginning and the end of the study. The subjects’ weight will be measured using a digital balance to the nearest 0.1 kilograms. In contrast, height will be measured to the nearest 1 millimetre with the aid of a stadiometer. Duplicate measurements will be obtained from which the average will be calculated. However, if differences of more than 0.2 kilograms or 0.5 centimetres are obtained for weight and height, the measurements will be repeated. Body mass index (BMI) will be calculated by finding the quotient of weight in kilograms and the square of height in metres. The BMI values will be used to classify the children as normal, overweight or obese based on the Centres for Disease Control and Prevention (2020) guideline as follows: BMIs in the 85^th percentile but less than 95^th percentile will be considered overweight, whereas BMIs in the 95th percentile will be regarded as obese.

Cognitive development will be determined through the average scores of the Stanford Binet (Early SB5) tool. This instrument will be administered to the participants at the beginning of the study, at the end of the schooldays sessions and the end of holiday sessions. The Early SB5 is customized to evaluate the overall thinking and reasoning dexterities of children between the ages of 2 and 7 years. Some of the factors that are tested by this tool include fluid reasoning, visual-spatial processing, quantitative reasoning, knowledge, working memory, verbal and non-verbal IQ. The full-scale IQ is the sum of all scores (Alfonso and Flanagan, 2017).

Data Analysis

The first step of the data analysis process will be to download the 60-second activity totals from the accelerometers and converting them into a Microsoft (MS) Excel file where an analysis of the accretion of the varying intensity levels will be done. The data will be imported into SPSS version 23.0 for further statistical analysis. Descriptive statistics will be done using numerical approaches such as kurtosis, skewness and Shapiro-Wilk test as well as graphical techniques, for example, QQ plots and histograms. The goal of this analysis will be to test for normality of the data to ensure the applicability of parametric tests in subsequent analyses (Mishra et al., 2019). Log transformation will be done in cases where the data will fail to meet the requirements for normality.

Student t-test will be done to compare the mean levels of physical activity on school days and during holidays. The effect of physical education on physical development will be done by comparing the anthropometric measures obtained in the course of school days and holidays using paired t-tests. Similarly, the impact of physical education on cognitive development will be determined by comparing the cognitive assessment tests within the two sessions. All statistical analyses will be done at 0.05 level of significance using SPSS software.

Validity, Reliability and Robustness

The validity and reliability of the study will be ensured through the use of accepted methodologies and procedures. Most studies that measure physical activity objectively use accelerometers, which facilitate the collection of reliable data as long as they are worn as instructed (Goode et al., 2017). The proposed 60-second epoch sampling approach is reliable when activity patterns are observed for protracted durations and circumvents the issue of limited recording time when shorter epochs are used (Aadland et al., 2020). The validity and reliability of the Early SB5 have been verified by several studies and found to yield dependable measures of cognitive development (Alfonso and Flanagan, 2017).

Rigor and Quality Considerations

Rigor in research refers to the extent of dependability and confirmability of the findings. The rigor of the study will be ensured by using an automated method of quantifying physical activity (accelerometers). The weight of the gadgets is negligible to avoid introducing other variables that may interfere with the findings. Furthermore, there will be no manipulation of any parameter. Instead, the natural processes of physical and cognitive development will be monitored over the study duration.

Ethics and Research Governance Issues

Key ethical issues that will affect the study are informed consent. The researcher will obtain permission and informed consent from the headteacher, class teacher, as well as parents and guardians of the children who will take part in the study. They will be briefed about the study before allowing them to sign prepared consent forms (Biros, 2018). Before conducting the study, the researcher will seek clearance from their institution’s Research Ethics Committee. The researcher will observe the ethical principles of beneficence and nonmaleficence throughout the study.

Beneficence implies that the researcher should have the interests of the participants at heart by lowering the chances of risks and maximising the probability of benefit to the researcher and the society. In contrast, nonmaleficence involves avoiding anything that will inflict harm to the subjects (Harriss, MacSween and Atkinson, 2019). The goal of the study is to investigate the impact of physical education on the development of preschool children. This information will benefit the children by directing the optimisation of exercise regimens to obtain maximum gains. Furthermore, the data collection process will not interfere with the normal activities of the children. They will only be expected to wear accelerometers as they go about their normal activities.

Implications of Results for Practice and Future Research

Physical activity studies show that sedentary lifestyles are common in children and teenagers. A review of the literature also shows that adequate levels of physical activity are needed for normal growth and development, building motor confidence, motor competence and a healthy self-image. Other benefits include normal mental functioning through physical fitness, psychosocial factors and general health. Physical activity is linked with improved cognition, which often results in better academic performance. In contrast, inadequate physical activity hampers psychosocial health in children and elevates the risk of cardiometabolic disorders. The findings of the proposed study will further clarify the benefits of physical education on physical and cognitive development.

Healthcare providers play a crucial role in health promotion and disease prevention through patient education. Differences between physical activity levels at home and school will highlight inadequacies with the achievement of optimal activity in these settings, which will inform clinicians on the best ways to help paediatric patients and their caregivers to achieve the recommended levels of physical activity at home. The findings of this study will also be important for policymakers in the design and formulation of novel strategies to not only enhance cognitive development in children, but also boost their mental health by diminishing anxiety and depressive disorders and increasing self-esteem. These strategies will also improve children’s academic performance and promote their physical wellbeing by precluding cardiovascular disease and other illnesses associated with sedentary lifestyles.

The expected findings of this study will strengthen practice guidelines in education and public health and neutralise efforts to cut down physical activity in schools. Future studies should look into other confounding factors that influence physical and cognitive development in children, for instance, diet and sleep patterns in and out of school (Vazou et al., 2016). Additional studies should consider following up on the subjects for prolonged periods to obtain better results.

Conclusion

Sedentary lifestyles such as those observed in young children are associated with obesity and other health complications. For preschool children, physical education provides an opportunity to engage themselves in motor activities. The main objectives of physical education include promoting physical activity, advancing sportsmanship, improving social skills and creating positive attitudes towards exercise. This study aims to determine the impact of physical education on physical and cognitive development in children aged between 5 and 7 years. It is expected that the outcomes of the study will inform health and educational policies for this age group.

Reference List

1. Aadland, E. et al. (2020) ‘Accelerometer epoch setting is decisive for associations between physical activity and metabolic health in children’, Journal of Sports Sciences, 38(3), pp. 256-263.
2. Alfonso, V.C. and Flanagan, D.P. (2017) ‘Best practices in the use of the Stanford-Binet Intelligence Scales, (SB5) with preschoolers’, in Bracken, B.A. and Nagle, R. (eds.) Psychoeducational assessment of preschool children. 10th edn. Philadelphia: Routledge, pp. 267-296.
3. Allen, C. (2017) ‘On (not) defining cognition’, Synthese, 194(11), pp. 4233-4249.
4. Alvarez-Bueno, C. et al. (2017) ‘The effect of physical activity interventions on children’s cognition and metacognition: a systematic review and meta-analysis’, Journal of the American Academy of Child and Adolescent Psychiatry, 56(9), pp. 729-738.
5. Amjad, M. et al. (2018) ‘Causes and implications of obesity in urban school going children’, International Journal of Medical and Health Sciences, 12(5), pp. 202-207.
6. Biros, M. (2018) ‘Capacity, vulnerability, and informed consent for research’, The Journal of Law, Medicine and Ethics, 46(1), pp. 72-78.
7. Börnhorst, C. et al. (2018) ‘Potential selection effects when estimating associations between the infancy peak or adiposity rebound and later body mass index in children’, Revue d’Épidémiologie et de Santé Publique, 66, pp. S422-S423.
8. Capel, S. and Blair, R. (2019) Debates in physical education. 2nd edn. Philadelphia: Routledge.
9. Centres for Disease Control and Prevention (2020) Defining childhood obesity. 
10. Curtis, E.A., Comiskey, C. and Dempsey, O. (2016) ‘Importance and use of correlational research’, Nurse Researcher, 23(6), pp. 20-25.
11. D’Isanto, T. (2016) ‘Pedagogical value of the body and physical activity in childhood’, Sport Science, 9(supplement 2), pp. 13-18.
12. Goertzen, M.J. (2017) ‘Introduction to quantitative research and data’, Library Technology Reports, 53(4), pp. 12-18.
13. Goode, A.P. et al. (2017) ‘The impact of interventions that integrate accelerometers on physical activity and weight loss: a systematic review’, Annals of Behavioral Medicine, 51(1), pp. 79-93.
14. Harriss, D.J., MacSween, A. and Atkinson, G. (2019) ‘Ethical standards in sport and exercise science research: 2020 update’, International Journal of Sports Medicine, 40(13), pp. 813-817.
15. Howells, K., Wellard, I. and Woolf-May, K. (2020) ‘Young children’s physical activity levels in primary (elementary) schools: what impact does physical education lessons have for young children?’ Early Child Development and Care, 190(5), pp. 766-777.
16. Janz, K.F. et al. (2017) ‘Physical activity, not sedentary time, predicts DXA-measured adiposity age 5–19 years’, Medicine and Science in Sports and Exercise, 49(10), pp. 2071-2077.
17. Keane, E. et al. (2017) ‘Physical activity, sedentary behavior and the risk of overweight and obesity in school-aged children’, Pediatric Exercise Science, 29(3), pp. 408-418.
18. Kumar, S. and Kelly, A.S. (2017) ‘Review of childhood obesity: from epidemiology, etiology, and comorbidities to clinical assessment and treatment’, Mayo Clinic Proceedings, 92(2), pp. 251-265.
19. Lind, G. and Gray, P. (2017) ‘The importance of physical activity in both physical and cognitive development’, New Zealand Physical Educator, 50(2), pp. 23-25.
20. Marques, A. et al. (2016) ‘Cross-sectional and prospective associations between moderate to vigorous physical activity and sedentary time with adiposity in children’, International Journal of Obesity, 40(1), pp. 28-33.
21. Mishra, A.K. and Acharya, H.P. (2017) ‘Factors influencing obesity among school-going children in Sambalpur district of Odisha’, Journal of Medical Society, 31(3), pp. 169-173.
22. Mishra, P. et al. (2019) ‘Descriptive statistics and normality tests for statistical data’, Annals of Cardiac Anaesthesia, 22(1), pp. 67-72.
23. Nordvall-Lassen, M. et al. (2018) ‘Leisure time physical activity in 9-to 11-year-old children born moderately preterm: a cohort study’, BMC Pediatrics, 18(1), pp. 1-6.
24. Pangrazi, R.P. and Beighle, A. (2019) Dynamic physical education for elementary school children. 19th edn. Champaign: Human Kinetics Publishers.
25. Peneau, S. et al. (2016) ‘Age at adiposity rebound: determinants and association with nutritional status and the metabolic syndrome at adulthood’, International Journal of Obesity, 40(7), pp. 1150-1156.
26. Pesce, C. et al. (2019) ‘Variability of practice as an interface between motor and cognitive development’, International Journal of Sport and Exercise Psychology, 17(2), pp. 133-152.
27. Queirós, A., Faria, D. and Almeida, F. (2017) ‘Strengths and limitations of qualitative and quantitative research methods’, European Journal of Education Studies, 3(9), pp. 369-386.
28. Ranjani, H. et al. (2016) ‘Epidemiology of childhood overweight and obesity in India: a systematic review’, The Indian Journal of Medical Research, 143(2) pp. 160-174.
29. Rosenberger, M.E. (2016) ‘24 hours of sleep, sedentary behavior, and physical activity with nine wearable devices’, Medicine and Science in Sports and Exercise, 48(3), pp. 457-465.
30. Schwarzfischer, P. et al. (2017) ‘BMI and recommended levels of physical activity in school children’, BMC Public Health, 17(595), pp. 1-9.
31. Stojanović, S. and Zdravković, D. (2018) ‘Educational standards-the evaluation of the importance of physical exercise for students’, Facta Universitatis, Series: Physical Education and Sport, 15(2), pp. 379-390.
32. Tandon, P.S. et al. (2016) ‘The relationship between physical activity and diet and young children’s cognitive development: a systematic review’, Preventive Medicine Reports, 3, pp. 379-390.
33. Vazou, S. et al. (2019) ‘More than one road leads to Rome: a narrative review and meta-analysis of physical activity intervention effects on cognition in youth’, International Journal of Sport and Exercise Psychology, 17(2), pp. 153-178.
34. Zeng, N. et al. (2017) ‘Effects of physical activity on motor skills and cognitive development in early childhood: a systematic review’, BioMed Research International, 2017, pp. 1-13.