Effects of aerobic exercise and cognitively engaging exercise on cardiorespiratory fitness and motor skills in primary school children: A cluster randomized controlled trial

Figures & data

Figure 1. Flow chart with the number of children in each stage of the study.

Table 1. Descriptive statistics of the included population.

	Aerobic exercise group	Cognitively engaging exercise group	Control group	p-value
Age^a (years); range	9.3 ± 0.7; 7–10**	9.1 ± 0.6; 7–10	9.2 ± 0.7; 7–11	< 0.01 ^c
Sex^b (% boys)	48.9	47.1	50.9	0.62^d
Grade^b (% 3rd grade)	44.3*	51.2*^#	54.7	< 0.05^d
Height^a (cm)	139.4 ± 6.6	138.6 ± 7.0	138.8 ± 6.6	0.41 ^c
Weight^a (kg)	33.0 ± 6.0	32.7 ± 6.8	32.1 ± 6.3	0.18 ^c
BMI^a,e (kg/m^2)	16.9 ± 2.4	16.9 ± 2.5	16.6 ± 2.4	0.14 ^c
Overweight^b,f (n (%))	30 (13.6)	32 (13.3)	47 (10.9)	0.41^d
Obesity^b,f (n(%))	5 (2.3)	8 (3.3)	11 (2.6)
SES^a,g	4.4 ± 0.9	4.7 ± 1.1^##	4.5 ± 1.0	0.01 ^c
Participation in organized sports (%)^h	86.8	89.6	89.9	0.50^d
Participation in organized sports (minutes/week)^h	147.1 ± 136.2	141.9 ± 112.4	150.1 ± 103.5	0.69 ^c

^amean ± standard deviation; ^bn(%); ^cOne-way analysis of variance; ^dNon-parametric χ² test; ^eBody mass index, calculated by weight(kg)/height(m)^{2; f}based on reference values by (Cole & Lobstein, 2012); ^gSocioeconomic Status, calculated by the average education level of both parents (Schaart et al., 2008); ^hpercentage of children that participate in organized sports, obtained by a parent questionnaire; ⁱParticipation in sports, defined as weekly participation in organized sports in minutes, not including physical education, transport to school and playing outside, obtained by a parent questionnaire; *Significantly different from control group (p < 0.05); **Significantly different from the control group (p < 0.01); ^#Significantly different from the aerobic exercise group (p < 0.05); ^##Significantly different from the aerobic exercise group (p < 0.01).

Table 2. Overview of baseline and post-test scores on cardiorespiratory fitness and motor skills for the three study conditions.

		N	Aerobic exercise group	N	Cognitively engaging exercise group	N	Control group
Cardiorespiratory fitness^a	Baseline	209	4.6 ± 1.8	228	4.3 ± 1.8	403	4.5 ± 1.9
	Post-test	206	5.3 ± 2.2	230	5.1 ± 2.0	395	5.1 ± 2.1
Jumping sideways^b	Baseline	211	49.3 ± 15.2	230	48.1 ± 15.4	405	49.5 ± 15.8
	Post-test	205	61.5 ± 15.6	229	55.6 ± 16.0	396	57.4 ± 16.3
Moving sideways^c	Baseline	211	34.1 ± 9.3	232	35.6 ± 9.2	407	33.3 ± 8.8
	Post-test	206	37.5 ± 8.2	231	37.0 ± 8.9	405	37.5 ± 9.4
Backwards balancing^d	Baseline	212	40.1 ± 12.4	232	40.7 ± 13.6	410	40.7 ± 14.2
	Post-test	206	44.6 ± 13.7	229	45.0 ± 13.3	399	44.1 ± 13.6
Upper limb coordination^e	Baseline	211	31.1 ± 5.2	223	29.9 ± 5.3	403	31.0 ± 5.2
	Post-test	207	32.4 ± 4.1	230	31.2 ± 4.5	402	32.1 ± 4.3
Gross motor skills (factorscore)^f	Baseline	205	−0.22 ± 1.0	218	−0.26 ± 1.0	393	−0.25 ± 0.9
	Post-test	199	0.39 ± 0.9	225	0.16 ± 1.0	385	0.23 ± 1.0

Values are expressed as mean ± standard deviation; ^aNumber of completed stages; ^bTotal number of jumps in 15 seconds in two trials; ^cTotal points in 20 seconds of two trials; ^dTotal number of steps on three wooden beams (resp. 6 cm, 4.5 cm, and 3 cm wide), with three trials per beam and a maximum of eight steps per trial, resulting in a maximum score of 72; ^eTotal score of seven activities executed with a tennis ball (maximum score is 39 points); ^fBartlett factor score calculated from the standardized scores of the four motor skill tests (jumping sideways, moving sideways, backwards balancing, and upper limb coordination; baseline and post-test combined).

Table 3. Implementation measures.

				Control group – aerobic exercise group		Control group – cognitively engaging exercise group		Aerobic exercise group – Cognitively engaging exercise group
	Aerobic exercise group	Cognitively engaging exercise group	Control group	Mean difference (90% CI)	p-value	Mean difference (90% CI)	p-value	Mean difference (90% CI)	p-value
Duration physical education lesson (minutes)	34.5 ± 3.7	39.2 ± 6.5	36.9 ± 5.6	2.43 (1.73–3.13)	<0.01 ^c	−2.24 (−2.92 – −1.56	<0.01 ^c	−4.67 (−5.46 – −3.89)	<0.01 ^c
Amount of MVPA (percentage)^a	34.9 ± 8.4	23.5 ± 6.1	27.9 ± 8.4	−6.95 (−8.08 – −5.83)	<0.01 ^c	4.41 (3.29–5.53)	<0.01 ^c	11.36 (10.08–12.65)	<0.01 ^c
Number of lessons followed by the child	45.6 ± 5.7	44.9 ± 7.1						0.76 (−0.22–1.77)	0.20^d
Total dose of MVPA (hours)^b	9.3 ± 2.5	7.0 ± 2.1						2.31 (1.93–2.69)	<0.01^d

Values are expressed as mean ± standard deviation; MVPA = moderate-to-vigorous physical activity; CI = Confidence Interval; ^aAverage amount of MVPA of the two observed physical education lessons; ^bCalculated by multiplying the average time in MVPA with the number of lessons followed by the child; ^cOne-way analysis of variance; ^dIndependent samples t-test.

Table 4. Results of the multilevel analysis for cardiorespiratory fitness and motor skills.

	Cardiorespiratory fitness				Motor skills
Fixed effects	B	SE	q^c	90% CI	B	SE	q^c	90% CI
Random intercept	3.63	0.46	<0.01	2.88–4.39	0.68	0.23	<0.01	0.31–1.05
Corresponding baseline score	0.79	0.03	<0.01	0.74–0.83	0.79	0.03	<0.01	0.79–0.83
Sex^a	−0.31	0.10	<0.01	−0.46 – −0.15
SES					0.06	0.02	0.02	0.02–0.10
BMI	−0.12	0.02	<0.01	−0.16 – −0.09	−0.03	0.01	0.01	−0.05 – −0.01
Aerobic exercise group^b	0.12	0.28	0.66	−0.34–0.59	0.11	0.11	0.66	−0.07–0.29
Cognitively engaging exercise group^b	0.35	0.28	0.33	−0.11–0.82	−0.11	0.11	0.33	−0.29–0.08
Random effects
Variance classes	0.49	0.12	<0.01		0.07	0.02	<0.01
Variance students	1.39	0.07	<0.01		0.31	0.02	<0.01
Deviance	2529.04				1164.31
Deviance covariates model	2530.61				1167.21

^a,bRespectively boys and control group were the reference categories; ^csignificance after FDR correction; Chi-squared test between aerobic exercise group and cognitively engaging exercise group: cardiorespiratory fitness: χ²(1) = 0.51, q = 0.48, Motor skills: χ²(1) = 2.89, q = 0.18; SES = socioeconomic status; CI = Confidence Interval.

Figure 2. The effects of the total dose of moderate-to-vigorous physical activity (MVPA) on cardiovascular fitness (a) and gross motor skills (b). Cardiovascular Fitness is shown adjusted for sex, baseline score, BMI, condition, and total dose of MVPA. Gross motor skills score is shown adjusted for socioeconomic status, BMI, baseline score, condition, total dose of MVPA, and the interaction between study condition (aerobic exercise vs cognitively engaging exercise) and the total dose of MVPA.

Cole, T. J., & Lobstein, T. (2012). Extended international (IOTF) body mass index cut-offs for thinness, overweight and obesity. Pediatric Obesity, 7(4), 284–294. https://doi.org/10.1111/j.2047-6310.2012.00064.x

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Schaart, R., Mies, M. B., & Westerman, S. (2008). The Dutch standard classification of education, SOI 2006. Statistics Netherlands.

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