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

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

Unhealthy diet has been associated with overweight, obesity, increased cardiometabolic risk, and recently, to impaired cognition and academic performance. The aim of this review is to provide an overview of the associations between health behaviors and cognition and academic achievement in children and adolescents under 18 years of age with a special reference to diet quality. Dietary patterns with a low consumption of fish, fruits, and vegetables, and high in fast food, sausages, and soft drinks have been linked to poor cognition and academic achievement. The studies on the associations between the high intake of saturated fat and red meat and low intake of fiber and high-fiber grain products with cognition are limited. The available evidence and physiological mechanisms suggest that diet may have direct, indirect, and synergistic effects on brain and cognition with physical activity, sedentary behaviors, cardiometabolic health, and sleep, but the associations have been modest. Therefore, integrating a healthy diet, physically active lifestyle, and adequate sleep may provide optimal circumstances for brain development and learning. We conclude that most of the existing literature is contained in cross-sectional studies, which therefore highlights the need for longitudinal and intervention studies on the effects of diet, physical activity, sedentary behavior, and sleep on cognition and academic performance.

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

Environment, physical activity (PA) and motor development are tightly interwoven during childhood. We examined the associations of environmental factors with motor competence (MC) in children. Children (N = 945, 50.1% boys, age = 3–7 years, mean = 5.4 years) from 37 childcare centres in the Southern (n = 17), Central (n = 13) and Northern Finland (n = 7) participated. The environmental factors comprised the geographical location (Southern, Central and Northern Finland) and residential density (metropolitan area, city, rural area and countryside) of the childcare centres’ based on postal codes and the national population density registry. MC was measured using the Test of Gross Motor Development (TGMD)-3, as well as by quantifying time spent outdoors and participation in organised sports via parental questionnaire. It was found that children from the countryside had better MC and spent most time outdoors, while children from the metropolitan area most frequently engaged in organised sports. Gender comparisons revealed that girls outperformed boys in locomotor skills, while boys were better in object control skills, had higher TGMD-3 score and spent more time outdoors. Time spent outdoors and participation in organised sports were associated positively with MC, but not in children from the countryside. In conclusion, higher population density was associated with lower MC and less time spent outdoors. The findings suggest that versatile outdoor environments may support motor development through PA.

Background: The minimum intensity of physical activity (PA) that is associated with favourable body composition and cardiorespiratory fitness (CRF) remains unknown. Objective: To investigate cross-sectional associations of PA and sedentary time (ST) with body composition and CRF in mid-childhood. Methods: PA, ST, body composition and CRF were measured in a population-based sample of 410 children (aged 7.6 ± 0.4 years). Combined heart-rate and movement sensing provided estimates of PA energy expenditure (PAEE, kJ/kg/day) and time (min/day) at multiple fine-grained metabolic equivalent (MET) levels, which were also collapsed to ST and light PA (LPA), moderate PA (MPA) and vigorous PA (VPA). Fat mass index (FMI, kg/m²), trunk fat mass index (TFMI, kg/m²) and fat-free mass index (FFMI, kg/m^2.5) were derived from dual-energy X-ray absorptiometry. Maximal workload from a cycle ergometer test provided a measure of CRF (W/kg FFM). Linear regression and isotemporal substitution models were used to investigate associations. Results: The cumulative time above 2 METs (221 J/min/kg) was inversely associated with FMI and TFMI in both sexes (p < 0.001) whereas time spent above 3 METs was positively associated with CRF (p ≤ 0.002); CRF increased and adiposity decreased dose-dependently with increasing MET levels. ST was positively associated with FMI and TFMI (p < 0.001) but there were inverse associations between all PA categories (including LPA) and adiposity (p ≤ 0.002); the magnitude of these associations depended on the activity being displaced in isotemporal substitution models but were consistently stronger for VPA. PAEE, MPA and to a greater extent VPA, were all positively related to CRF (p ≤ 0.001). Conclusions: PA exceeding 2 METs is associated with lower adiposity in mid-childhood, whereas PA of 3 METs is required to benefit CRF. VPA was most beneficial for fitness and fatness, from a time-for-time perspective, but displacing any lower-for-higher intensity may be an important first-order public health strategy. Clinical trial registry number (website): NCT01803776 (https://clinicaltrials.gov/ct2/show/NCT01803776).