The direct and indirect effects of motor competence on adolescents' mental health through health-related physical fitness

Physical Fitness and Risk of Mental Disorders in Children and Adolescents

Importance

With the rising prevalence of mental disorders among children and adolescents, identifying modifiable associations is critical.

Objective

To examine the association between physical fitness and mental disorder risks.

Design, Setting, and Participants

This nationwide cohort study used data from the Taiwan National Student Fitness Tests and National Health Insurance Research Databases from January 1, 2009 to December 31, 2019. Participants were divided into 2 cohorts targeting anxiety and depression (1 996 633 participants) and attention-deficit/hyperactivity disorder (ADHD; 1 920 596 participants). Participants were aged 10 to 11 years at study entry and followed up for at least 3 years, had a nearly equal gender distribution, and an average follow-up of 6 years. Data were analyzed from October 2022 to February 2024.

Exposures

Assessments of physical fitness included cardiorespiratory fitness (CF), muscular endurance (ME), muscular power (MP), and flexibility, measured through an 800-m run time, bent-leg curl-ups, standing broad jump, and sit-and-reach test, respectively.

Main Outcomes and Measures

Kaplan-Meier method calculated the cumulative incidence of anxiety, depression, and ADHD across fitness quartiles. Additionally, multivariable Cox proportional hazards models were used that included all 4 fitness components and explored sex and income as modifiers.

Results

The anxiety and depression cohort had 1 996 633 participants (1 035 411 participants were male [51.9%], and the median [IQR] age was 10.6 [10.3-11.0] years), while the ADHD cohort had 1 920 596 (975 568 participants were male [51.9%], and the median [IQR] age was 10.6 [10.3-11.0] years). Cumulative incidence of mental disorders was lower among participants in better-performing fitness quartiles, suggesting a dose-dependent association. Gender-specific analyses, controlling for confounders, revealed that improved CF, indicated by a 30-second decrease in run times, was associated with reduced risks of anxiety, depression, and ADHD in female participants, and lower risks of anxiety and ADHD in male participants (adjusted hazard ratio [aHR] for ADHD risk for female participants, 0.92; 95% CI, 0.90-0.94; P < .001; for male participants, 0.93; 95% CI, 0.92-0.94; P < .001). Enhanced ME, marked by an increase of 5 curl-ups per minute, was associated with decreased risks of depression and ADHD in female participants, and lower anxiety and ADHD risks in male participants (aHR for ADHD risk for female participants, 0.94; 95% CI, 0.92-0.97; P < .001; for male participants, 0.96; 95% CI, 0.95-0.97; P < .001). Improved MP, reflected by a 20-cm increase in jump distance, was associated with reduced risks of anxiety and ADHD in female participants and reduced anxiety, depression, and ADHD in male participants (aHR for ADHD risk for female participants, 0.95; 95% CI, 0.91-1.00; P = .04; for male participants, 0.96; 95% CI, 0.94-0.99; P = .001).

Conclusions and Relevance

This study highlights the potential protective role of cardiorespiratory fitness, muscular endurance, and muscular power in preventing the onset of mental disorders. It warrants further investigation of the effectiveness of physical fitness programs as a preventive measure for mental disorders among children and adolescents.

Associations Between Motor Competence and Physical Activity, Physical Fitness and Psychosocial Characteristics in Adolescents: A Systematic Review and Meta-analysis

BACKGROUND

Motor competence is an integral component of the health and performance of youth. Numerous studies support the hypothesis that motor competence interacts with perceived motor competence and physical fitness during childhood to induce positive (e.g. healthy weight status) or negative (e.g. reduced physical activity engagement) trajectories. Yet, while adolescence is a key period of rapid growth and maturation, no systematic reviews and meta-analyses have examined the association between motor competence and physical activity, physical fitness and psychosocial characteristics solely within adolescents.

OBJECTIVES

This study aimed to (1) analyse the scientific literature evaluating associations between motor competence and physical activity, physical fitness and/or psychosocial characteristics amongst adolescents; (2) evaluate the associations between motor competence and physical activity, physical fitness characteristics and/or psychosocial characteristics amongst adolescents; and (3) investigate the impact of moderator variables (i.e., age, sex, type of motor competence assessment) on the associations.

METHODS

A systematic search of electronic databases was conducted, followed by a qualitative synthesis of study methods. Random-effects meta-analyses were performed to establish the magnitude and orientation of pooled correlation coefficients between motor competence and physical activity, physical fitness and psychosocial characteristics of adolescents, whilst considering potential moderators (i.e., age, sex, type of motor competence assessment).

RESULTS

Sixty-one studies were included, totalling 22,256 adolescents. Twenty-seven different assessments of motor competence were used, with 31 studies utilising product-orientated (i.e. outcome) motor competence assessments. Meta-analyses of 43 studies showed that motor competence was positively associated with physical activity (r = 0.20 to 0.26), some physical fitness characteristics (e.g. muscular strength, cardiovascular endurance; r = 0.03 to 0.60) and psychosocial characteristics (r = 0.07 to 0.34), and inversely associated with weight status (r =  - 0.36 to - 0.10), speed (r =  - 0.31) and agility (r =  - 0.37 to 0.41). Associations with flexibility were unclear.

CONCLUSIONS

The results of this systematic review and meta-analysis support the hypothesised interactions of motor competence with physical activity (positive), physical fitness (positive except for weight status, speed and agility) and psychosocial characteristics (positive) in adolescence. However, methodological approaches vary considerably (e.g. variety of motor competence assessments utilised), with limitations of the current literature including an inadequate assessment of motor competence, a lack of longitudinal observations and a failure to account for biological maturation. Future research assessing associations between motor competence and physical activity, physical fitness and psychosocial characteristics of adolescents should include longitudinal observations of a combined motor competence assessment (i.e. process and product) and account for biological maturation. Improved evaluation using these recommendations could provide more accurate data, leading to more targeted interventions to improve adolescents' physical and psychosocial outcomes.

CLINICAL TRIAL REGISTRATION

CRD42021233441 (PROSPERO ID).

Physical fitness of primary school children differs depending on their timing of school enrollment

Previous research has shown that children who were enrolled to school according to the legal key date (i.e., keyage children, between eight and nine years in third grade) exhibited a linear physical fitness development in the ninth year of life. In contrast, children who were enrolled with a delay (i.e., older-than-keyage children [OTK], between nine and ten years in third grade) exhibited a lower physical fitness compared to what would be expected for their age. In these studies, cross-sectional age differences within third grade and timing of school enrollment were confounded. The present study investigated the longitudinal development of keyage and OTK children from third to fifth grade. This design also afforded a comparison of the two groups at the same average chronological age, that is a dissociation of the effects of timing of school enrollment and age. We tested six physical fitness components: cardiorespiratory endurance, coordination, speed, power of lower and upper limbs, and static balance. 1502 children (i.e., 1206 keyage and 296 OTK children) from 35 schools were tested in third, fourth, and fifth grade. Except for cardiorespiratory endurance, both groups developed from third to fourth and from fourth to fifth grade and keyage children outperformed OTK children at the average ages of 9.5 or 10.5 years. For cardiorespiratory endurance, there was no significant gain from fourth to fifth grade and keyage and OTK children did not differ significantly at 10.5 years of age. One reason for a delayed school enrollment could be that a child is (or is perceived as) biologically younger than their chronological age at the school entry examination, implying a negative correlation between chronological and biological age for OTK children. Indeed, a simple reflection of chronological age brought the developmental rate of the chronologically youngest OTK children in line with the developmental rate observed for keyage children, but did not eliminate all differences. The mapping of chronological and biological age of OTK children and other possible reasons for lower physical fitness of OTK children remain a task for future research.

Effects of fundamental movement skills on health-related quality of life in Chinese school-age children: the mediating role of physical fitness level

Background

The primary purpose of this study is to analyze the relationship between school-age children's fundamental movement skills (FMS), physical fitness levels, and the health-related quality of life (HRQoL); To explore the mediating role of physical fitness levels between school-age children's FMS and HRQoL.

Methods

In the cross-sectional survey in 2021, 334 school-age children aged 6-10 (8.20 ± 1.16) were recruited from primary schools in Jinhua City, Zhejiang Province, China. Test of Gross Motor Development 2 (TGMD-2), National Standards for Students' Physical Health, and Pediatric Quality of Life Inventory TM Version 4.0 (PedsQL™ 4.0) were used to investigate the FMS, physical fitness level, and HRQoL of school-age children. Hierarchical regression was used to analyze the relationship among FMS, physical fitness levels, and HRQoL. Bootstrap is used to evaluate the mediating role of physical fitness levels in the relationship between FMS and HRQoL.

Results

The higher the FMS and physical fitness, the higher the school-age children's HRQoL, physical functioning, social functioning, and school functioning (r = 0.244-0.301, p < 0.01). In addition, developing children's FMS promotes physical fitness levels (r = 0.358, p < 0.01). The regression analysis results of controlling gender, age, and body mass index z (BMI-z) scores showed that FMS significantly positively predicted the physical functioning (β = 0.319, p < 0.01), social functioning (β = 0.425, p < 0.01), and school functioning (β = 0.333, p < 0.01) of school-age children. When the physical fitness level enters the regression equation, the absolute value of the regression coefficient of FMS decreases. However, it can still significantly predict the physical functioning (β = 0.211, p < 0.01) and school functioning (β = 0.142, p < 0.05) of school-age children. Simple intermediary analysis shows that physical fitness level plays an intermediary role between FMS, physical functioning (indirect effect = 0.089 [95% Confidence interval (CI) = 0.015,0.195]), and school functioning (indirect effect = 0.065 [95% CI = 0.007,0.150]).

Conclusion

This study shows that physical fitness levels mediate the relationship between FMS and HRQoL. Encouraging the development of FMS and promoting physical fitness levels of school-age children can effectively improve the HRQoL of school-age children.

Physical Exercise and Mental Health: The Routes of a Reciprocal Relation

Sport participation and exercise practice are considered to be beneficial for mental status, yielding an improved mood and better quality of life. On the other hand, good mental fitness is thought to lead to better physical status and sport performance. The key aim of this narrative review is to provide an unstructured overview on the topic with special considerations on the role of mental and physical health to summarize the evidence on their reciprocal influence. While very few papers describe the role of mental health measures in affecting physical performance, more evidence is available concerning the effect of exercise and sport in improving mental health outcomes. Furthermore, there is a consistent role of depressive and anxiety symptoms in influencing the risk of sport injury in either recreational or elite athletes. Moreover, the importance of investigating mental health issues in elite and retired athletes is highlighted. On the basis of the available literature, several biases were found to affect the provided evidence mainly because of the complexity of a proper study design in this field.

Healthier Minds in Fitter Bodies: A Systematic Review and Meta-Analysis of the Association between Physical Fitness and Mental Health in Youth

BACKGROUND

Physical fitness is an important marker of current and future health status, yet the association between physical fitness and indicators of mental health in youth has not been systematically reviewed and meta-analyzed.

OBJECTIVE

The aim of this work was to systematically review and meta-analyze the association between physical fitness components (i.e. cardiorespiratory fitness, muscular fitness, speed-agility, flexibility and fitness composite) and mental health indicators (i.e. psychological well-being and psychological ill-being) in preschoolers, children and adolescents.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

Systematic searches were conducted in PubMed, Web of Science and Scopus from database inception to May 2020.

ELIGIBILITY CRITERIA

Studies (cross-sectional, longitudinal and intervention designs) were included if they measured at least one physical fitness component and one mental health indicator in healthy youth (2-18 years).

RESULTS

A total of 58 unique studies (52 cross-sectional, 4 longitudinal and 4 intervention studies) met all eligibility criteria and were included. There was a significant positive overall association between physical fitness and mental health in children and adolescents (pooled r = 0.206, p < 0.001). We found suggestive evidence of moderation by age group, fitness components and socioeconomic status (all p < 0.08). No relevant studies focusing on preschoolers were identified. Evidence based on longitudinal and intervention studies was limited.

CONCLUSION

We observed a small to medium sized positive association between physical fitness and overall mental health in youth. However, as the majority of studies were cross-sectional, additional longitudinal and intervention studies are needed to provide evidence of causation.

TRIAL REGISTRATION

PROSPERO registration number CRD42017080005.

Association between physical fitness components and fluid intelligence according to body mass index in schoolchildren

Physical fitness is considered a protective factor for children's general health and has been related to enhanced cognitive functioning. However, it appears that cognition could be affected in children with overweight or obesity. The present study aimed to determine the relationship between physical fitness components and fluid intelligence in normal-weight and overweight/obese children. In this cross-sectional study, a total of 317 schoolchildren participated (165 boys, 52.05%), aged between six and 11 years old (1st to 5th grade), belonging to a public school in the south of Brazil. Psychologists evaluated fluid intelligence through the Raven's Colored Progressive Matrix Test. The physical fitness evaluation followed the procedures of the "Brazil Sports Project". Weight and height were measured to determine body mass index and generalized linear regression analyses were used with a 95% confidence interval. Our results showed that agility was inversely associated with fluid intelligence only in the overweight/obese group (β = -1.506; p = 0.01). Cardiorespiratory and muscular fitness were not associated with fluid intelligence. In conclusion, agility was the only physical fitness component related to fluid intelligence, and this relationship was found exclusively in overweight/obese schoolchildren.

Effects of School-Based Exercise Program on Obesity and Physical Fitness of Urban Youth: A Quasi-Experiment

(1) Purpose: The purpose of this study was to evaluate if an after-school intervention program could prevent obesity and promote the physical fitness of urban sedentary school children. (2) Methods: A 16-week after-school physical fitness program was provided to 36 middle school students (7th, 8th, and 9th graders) recruited from a middle school for three days a week. They were high-risk youth showing poor health status (level 4 or 5) in the regular physical fitness evaluation conducted. Their body mass index (BMI), cardiovascular endurance, muscular strength and endurance, quickness, and flexibility were evaluated. (3) Results: A paired sample t-test was used (α = 0.05). There were statistical differences ((x ± s), p < 0.05) between the pre-Progressive Aerobic Cardiovascular Endurance Run (PACER) (13.36 ± 4.98 (# of laps)) and post-PACER (18.64 ± 6.31 (# of laps)) (p < 0.001), between the pre-sit-up (18.06 ± 7.22 (# of sit-ups)) and post-sit-up (24.89 ± 7.52 (# of sit-ups)) (p < 0.001), and between the pre-Trunk Flexion (2.64 ± 3.49 ((cm))) and post-Trunk Flexion (5.97 ± 2.78 ((cm)) (p < 0.001). There was no statistical difference between the pre-50m-Run (10.74 ± 1.30 ((sec))) and post-50m-Run results (10.69 ± 1.25 (sec)) (p = 0.063) or between the pre-BMI (24.84 ± 3.97 (kg/m2)) and post-BMI (24.76 ± 3.61 (kg/m2)) (p = 0.458). Overall, the physical fitness measures improved, whereas BMI did not change after 16 weeks. (4) Conclusion: Sixteen weeks of the school-based Health-related Physical Fitness (HrPF) program can be effective in improving overall physical fitness levels of adolescents, although additional treatments would be required to change BMI, which showed no improvement in the present study. It is concluded that in order for adolescents to maintain and promote physical fitness and health, participation in a school-based HrPF program is recommended for at least 30 min a day, three days a week. In addition, schools should provide high-risk youth with easy access to physical activities that are similar to the objectives of the physical education curriculum. In order to promote the health of school-age children, each school should establish and operate school-based systematic intervention programs.

Association between cardiorespiratory fitness and depressive symptoms in children and adolescents: A systematic review and meta-analysis

Background Higher cardiorespiratory fitness (CRF) is associated with lower depressive symptoms in adults. However, no systematic review with meta-analysis assessed the cross-sectional associations between CRF and depressive symptoms in children and adolescents. Therefore, this meta-analysis assessed the relationship between CRF and depressive symptom in these populations. Methods Cross-sectional data evaluating the correlation between CRF and depression were searched, from database inception through 21/05/2020, on PubMed, PsycINFO, Web of Science, and SPORTDiscus. Age, sex, CRF and depression assessments, and correlations were extracted. A random-effects meta-analysis was conducted, and the potential sources of heterogeneity were also explored through meta-regression analysis. Results Across 14 effects of 11 unique studies, including a total of 7,095 participants (median age=12.49) with nearly equal sex distribution (median=53% females), it was found that higher CRF was associated with lower depressive symptoms in children and adolescents (r =-0.174, 95%CI -0.221 to -0.126, p<0.001, I²=75.09, Q value=52.19). No moderators were identified. Conclusion Available evidence supports the notion that higher CRF is inversely associated with depressive symptoms in children and adolescents. Physical activity and exercise interventions targeting improving CRF should be promoted for these populations. Further studies, including clinical populations, should be conducted to assess objective measures of aerobic fitness and body composition, while controlling for puberty status, to better characterize this association.

The association of physical fitness with mental health in children: A serial multiple mediation model

There is growing interest in the association between physical fitness and mental health. This study aimed to extend current knowledge by investigating the potential mediating roles of resilience and anxiety in the association between physical fitness and mental health in children. A total of 269 children were selected by stratified random sampling from three primary schools in China. Physical fitness was scored using the Chinese National Student Physical Fitness Standard. Resilience, anxiety, and mental health data were collected using the following questionnaires: Resilience Scale for Chinese Adolescents, Multidimensional Anxiety Scale for Children, and the Mental Health Test. The PROCESS macro developed by Hayes was used to conduct serial multiple mediation analysis. We found that physical fitness, resilience, anxiety, and mental health were significantly correlated. Children with higher physical fitness had lower mental health problems; however, this statistical significance was not detectable after controlling for resilience and anxiety. Serial multiple mediation analysis revealed that the association of physical fitness with mental health was partially mediated by resilience and anxiety. These results indicate that the positive association of physical fitness with mental health in children may be changed through resilience and anxiety, which appear to play serial multiple mediating roles in this association. These findings contribute to deeper understanding of the associations between these factors and suggest that promoting physical fitness independent of considering resilience and anxiety may be insufficient to achieve good mental health in children.

Physical Fitness Promotion among Adolescents: Effects of a Jump Rope-Based Physical Activity Afterschool Program

The major purpose of this study was to examine the effects of a jump rope-based physical activity afterschool program on middle school students’ physical fitness. Sixty students (M_age = 13.37, SD = 0.58; 53.3% female) participated in a 12-week jump rope-based afterschool program (45 min/time, three times/week). Participants were randomly assigned to three groups: (a) freestyle rope skipping (N = 20), traditional jump rope (N = 20), and a control group (N = 20). Physical fitness tests, including muscular strength (standing long jump, right-hand grip, and left-hand grip), flexibility, body composition, and bone mineral density (BMD) were measured in pre- and post-tests. A 2 (time) × 3 (groups) repeated measure multivariate analysis of variance (MANOVA) was performed. The results found significant improvements in muscular strength (standing long jump, right-hand grip, and left-hand grip) in both intervention groups (p < 0.001; ds = 0.2–0.44). Only the freestyle rope skipping group had increased BMD (p < 0.05, d = 0.33). Compared to the traditional jump rope, the freestyle rope skipping group showed significantly higher improvement in flexibility (p < 0.05, d = 0.83). These findings suggest that the jump rope-based afterschool program with freestyle rope skipping would be more effective than traditional jump rope to promote physical fitness performance among adolescents.

Ethnic Disparities in Mental Health and Movement Behaviors During Childhood: Examining the Longitudinal Developmental Patterns

PURPOSE

The purpose of this study was to examine the longitudinal developmental patterns of mental health (i.e., physical, psychosocial, and executive functioning) and movement behaviors (i.e., sedentary behavior and moderate-to-vigorous physical activity [MVPA]) between Hispanic and non-Hispanic children.

METHOD

We tracked 153 children for 3 years from kindergarten (time 1) to third grade (time 2; 91 Hispanic; mean age = 5.36, SD = .48). Physical, psychosocial, and executive functioning was assessed using validated surveys, while school-based sedentary behavior and MVPA were assessed by accelerometers.

RESULT

A 2 × 2 (time × ethnicity) factorial repeated measures MANCOVA (gender and SES as covariates) revealed significant ethnicity effect (p = .05) and time by ethnicity interaction effect (p < .05). Hispanic children reported lower physical (p < .05) and psychosocial functioning (p > .05) but higher executive functioning (p < .05) than non-Hispanic children in kindergarten, but the gaps narrowed in third grade. Results also revealed that children's sedentary behavior increased significantly (p < .05) and MVPA showed a declining trend (p > .05) over time.

CONCLUSION

Ethnic disparities in mental health between Hispanic and non-Hispanic children exist but may reduce from early to middle childhood. The longitudinal changes relative to ethnicity highlight the need for tailored interventions to address health disparities in mental health and movement behaviors between Hispanic and non-Hispanic children.

Effects of a Fundamental Motor Skill-Based Afterschool Program on Children's Physical and Cognitive Health Outcomes

Globally, more than half of school-aged children do not engage in the recommended 60 minutes of daily moderate to vigorous physical activity (MVPA). Given that developing sufficient fundamental motor skills (FMS) competence during early elementary school years is important for a child’s physical and cognitive development, the purpose of this study was to examine the effects of an 8-week FMS-based afterschool program on physical and cognitive health outcomes among elementary children. Participants were 31 K–2 students (19 girls, 12 boys; Mage = 6.65 ± 0.98) from three public elementary schools in the southwestern United States who were assigned to the intervention group (FMS-based afterschool program; n = 20) or the control group (traditional afterschool program; n = 11). A 2 × 2 repeated measures MANOVA showed significant changes in FMS competence and MVPA between the intervention and the control group over time. However, no significant changes were found in cognitive functioning. The 8-week FMS-based afterschool program showed significant improvements in FMS competence and MVPA, compared to a traditional afterschool program. This finding suggests that structured FMS-focused strategies (e.g., fun games and goal setting) can be a critical component when implementing a physical activity program to enhance children’s motor skills and physical activity behavior.