University of Groningen Movement, cognition and underlying brain functioning in children van der Fels, Irene

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Movement, cognition and underlying brain functioning in children

van der Fels, Irene

DOI:

10.33612/diss.109737306

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177 Summary of the ﬁ ndings

Aims of the thesis

The fi rst aim of this thesis was to investigate relations between gross motor skills and specifi c

aspects of cognitive functions in children and to investigate the proposed brain mechanisms

underlying relations between gross motor skills and executive functions. The second aim was

to explore the diff erential eff ects of acute aerobic and cognitively engaging physical activity

on response inhibition and attention. Third, the eff ects of longitudinal aerobic and cognitively

engaging physical activity on cardiovascular fi tness, gross motor skills, visuospatial working

memory, and underlying brain mechanisms were examined.

This thesis is part of a larger project, “Learning by Moving”, which is a cluster randomized controlled

trial (RCT) investigating the eff ects of aerobic physical activity and cognitively engaging physical

activity on cardiovascular fi tness, gross motor skills, cognitive functions, academic achievement,

brain structure, and brain functioning. Participants were 8-10-year-old children (n = 891) from 22

primary schools (grades three and four) in the Netherlands. Baseline measures were used for the

studies related to the fi rst aim of this thesis (Chapters 3 and 4). Baseline and posttest measures

were used for the studies related to the second and third aims of this thesis (Chapters 5 – 7).

Main fi ndings

Chapter 2 systematically reviewed literature on the relationship between motor skills and

cognitive functions to get a deeper insight into relations between specifi c domains of motor skills

and cognitive functions. There was either no correlation or insuffi cient evidence for or against

correlations between many aspects of motor skills and cognitive functions. However,

weak-to-strong evidence was found for some correlations between aspects of motor skills (e.g. fi ne motor

skills, bilateral body coordination, and timed performance in movements) and cognitive functions

(e.g. fl uid intelligence and visual processing). Furthermore, it was found that relations between

aspects of motor and cognitive functions were stronger in prepubertal children compared to

pubertal children (> 13 years). The results of this review imply that motor skills are particularly

related to higher-order cognitive functions in prepubertal children. However, this review also

highlights the need for more studies investigating specifi c relations between aspects of motor

skills and cognitive functions in children.

The relation between gross motor skills and four executive functions (verbal working memory,

visuospatial working memory, response inhibition and interference control) in 8-10- year-old

children was investigated in Chapter 3. The role of information processing and lapses of attention

were also examined. Baseline measures from all children from the “Learning by Moving” project

(n = 891) were used for this study. The results confi rmed previous fi ndings that gross motor

skills are related to specifi c aspects of executive functions. Gross motor skills were signifi cantly

related to verbal working memory, visuospatial working memory and response inhibition, but

not to interference control. However, after controlling for information processing and lapses of

attention, gross motor skills were only related to visuospatial working memory and response

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178 inhibition. Additionally, reduced lapses of attention were related to better performance on all

executive function tasks, whereas information processing speed was not. Processing variability

was only related to visuospatial working memory. The results imply that gross motor skills are

related to aspects of executive functions that are most directly involved in, and share common

underlying processes with, gross motor skills, e.g. visuospatial working memory and response

inhibition. Furthermore, the results underline the importance of taking into account lapses of

attention rather than processing speed and/or variability, when investigating the relationship

between gross motor skills and executive functions in children.

Chapter 4 investigated visuospatial working memory-related brain activity with functional

Magnetic Resonance Imaging (fMRI) in 8-10-year-old children. Additionally, relations of gross

motor skills and cardiovascular fitness with visuospatial working memory-related brain activation

were examined. A sub-sample of 92 children from the total sample in the “Learning by Moving”

project were initially included in this fMRI study, of which baseline data from 80 children were

complete and were used for this study. Visuospatial working memory-related brain activation

was shown in the angular gyrus (right hemisphere), the superior parietal cortex (bilateral) and

the thalamus (bilateral), whereas visuospatial working memory-related deactivation was shown

in the inferior and middle temporal gyri (bilateral). Gross motor skills and cardiovascular fitness

were both related to behavioral performance on the visuospatial working memory task. However,

these physical variables were not related to visuospatial working memory-related brain activation.

Therefore, we did not find evidence that brain activation patterns underlie the relations of both

gross motor skills and cardiovascular fitness with visuospatial working memory.

The effects of acute aerobic and cognitively engaging physical activity on response inhibition and

lapses of attention in 8-10-year-old children were investigated in Chapter 5. A sub- sample of 89

children from the total sample in the “Learning by Moving” project participated in this cluster RCT.

Children in the intervention groups followed either an acute aerobic physical education lesson,

focusing on activities performed at an intensity of moderate-to- vigorous physical activity (MVPA),

or an acute cognitively engaging physical education lesson, with the focus on team games that

require complex coordination of movements, strategic play, cooperation between children

and anticipating the behavior of teammates or opponents. The heart rate of the children was

monitored with Polar heart rate monitors during the intervention lessons. Children in the control

condition followed a seated academic classroom lesson with their regular teacher. The main

findings revealed no significant effects of acute physical activity, and no differences between

the two intervention groups on response inhibition and lapses of attention. Children exercised

on average 19 minutes in MVPA during both intervention lessons. However, the inter-individual

variability regarding the time that children exercised in MVPA was high (varying from 8 minutes

to 43 minutes). Therefore, an additional dose-response relation analysis was performed between

the time that children exercised in MVPA and the outcome variables. It was found that more time

in MVPA led to better response inhibition and reduced lapses of attention, without indication for

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179 diff erential eff ects of the type of physical activity. The results imply that acute physical activity can

enhance response inhibition and reduce lapses of attention, but that the eff ects are dependent

on the time that children exercise in MVPA.

The eff ects of longitudinal aerobic physical activity and cognitively engaging physical activity

on cardiovascular fi tness and gross motor skills were investigated in Chapter 6. All children

from the “Learning by Moving” project (n = 891) participated in this cluster RCT. Children in the

intervention groups followed the aerobic intervention or the cognitively engaging intervention.

The interventions were delivered four times per week for 14 weeks. Children in the control group

followed their regular physical education lessons, two times per week. The time that children

exercised in MVPA was measured with accelerometers. From the four lessons per week that were

prescribed in the intervention groups, children followed on average 3.2 lessons. Children in the

aerobic intervention exercised on average 35% of the intervention lessons in MVPA, whereas

children in the cognitively engaging intervention exercised on average 24% of the time in

MVPA. Children in the control group exercised on average 28% of the time in MVPA. The results

showed that the aerobic intervention and cognitively engaging interventions did not enhance

gross motor skills and cardiovascular fi tness at a group level. However, a dose-response relation

in the intervention groups was found. More time in MVPA during the interventions led to better

cardiovascular fi tness in both interventions and to better gross motor skills in the cognitively

engaging intervention. Furthermore, for cardiovascular fi tness, it was found that children with

lower baseline improved more after the cognitively engaging intervention than after the aerobic

intervention, while children with higher baseline improved more after the aerobic intervention

than after the cognitively engaging intervention or the control condition. The results of this study

show that baseline levels of cardiovascular fi tness and individual exposure to physical activity are

important factors that infl uence the eff ectiveness of physical activity interventions.

Chapter 7 investigated the eff ects of the longitudinal interventions on visuospatial working

memory-related brain activity. From the 92 children that were initially included in this fMRI

sub-study, baseline and posttest data from 62 children were complete and were used for this study.

There were no eff ects of the interventions on visuospatial working memory and on visuospatial

working memory-related brain activity when using mass univariate analysis. However, additional

explorative brain activation pattern analyses revealed baseline-posttest changes in brain

activation that diff ered between the three groups, mainly consisting of activation diff erences in

frontal, occipital, and parietal cortices. Although no overall eff ects were found when using mass

univariate analysis, the variability between children was high and further research is needed to

substantiate the results of the pattern analyses, the results of the explorative pattern analysis

indicate that there might be brain areas that are susceptible to change as a result of diff erent

types of physical activity.

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180 General discussion

Relations between gross motor skills, cognitive functions and underlying brain

functioning

Relations between motor skills and cognitive functions

The systematic review conducted in this thesis (Chapter 2) showed that relations between motor

skills and cognitive functions are not general, but that relations exist between aspects of motor

skills and specific cognitive functions. The results imply that the strongest relations exist between

complex motor skills and higher-order cognitive functions and that this relationship is stronger

for prepubertal children (< 13 years) compared to pubertal children.

Chapter 3 showed that gross motor skills are related to specific executive functions in prepubertal

children (8-10-year-olds). Gross motor skills were significantly related to visuospatial working

memory and response inhibition, but not to verbal working memory and interference control

(after controlling for information processing and lapses of attention). The results of this study

imply that gross motor skills are related to aspects of executive functions that are involved in, and

share more common underlying processes with, gross motor skills, because visuospatial working

memory and response inhibition have shown to be more involved in motor tasks and complex

sports than verbal working memory and interference control (Quinn, 1994; Salway & Logie, 1995;

Smyth, Pearson, & Pendleton, 1988).

Furthermore, we showed that attention is a crucial prerequisite for executive functioning, more

important than processing speed or variability (Chapter 3). Reduced lapses of attention were

significantly related to all aspects of executive functions. This finding supports the theory of

the worst performance rule, which states that in multi-trial tasks, e.g. the stop-signal task, worst

performance trials (e.g. slowest reaction times, indicating lapses of attention) predict cognitive

performance better than processing speed and variability (Coyle, 2003; Larson & Alderton, 1990;

Unsworth, Redick, Lakey, & Young, 2010). Therefore, maintaining attention on a task is extremely

important for cognitive functioning. This is important, as these results may also suggest that

interventions targeting to improve attention, could subsequently improve executive functions

in children.

Underlying brain functioning

We hypothesized that underlying brain mechanisms explain the relation between gross motor

skills and visuospatial working memory, because cortical regions involved in visuospatial working

memory, such as the prefrontal cortex, the parietal cortex, and the cerebellum are important

areas for the planning, execution, and control of movements (Desmond et al., 1997; Diamond,

2000; Goldberg, 1985). Therefore, we investigated whether gross motor skills were related to the

neural circuitry supporting visuospatial working memory in Chapter 4.

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181 Visuospatial working memory-related brain activation was shown in the angular gyrus (right

hemisphere), the superior parietal cortex (bilateral) and the thalamus (bilateral), whereas

visuospatial working memory-related deactivation was shown in the inferior and middle temporal

gyri (bilateral). Although children with better gross motor skills and cardiovascular fi tness

performed better on the visuospatial working memory task (as we also showed in Chapter 3),

there were no relations of gross motor skills and cardiovascular fi tness with visuospatial working

memory-related brain activation (Chapter 4). Therefore, we could not confi rm the hypothesis

that the neural circuitry supporting visuospatial working memory underlies the relations of gross

motor skills and cardiovascular fi tness with visuospatial working memory performance.

Eff ects of acute physical activity

Main eff ects

Chapter 5 investigated the eff ects of acute aerobic physical activity and acute cognitively

engaging physical activity on response inhibition and lapses of attention. The meta-analysis by

de Greeff , Bosker, Oosterlaan, Visscher, and Hartman (2018a) showed that acute physical activity is

eff ective for inhibition and attention, which was mainly based on studies performed in laboratory

settings (Chen, Yan, Yin, Pan, & Chang, 2014; Hillman, Buck, Themanson, Pontifex, & Castelli, 2009;

Pontifex, Saliba, Raine, Picchietti, & Hillman, 2013). We expected that our acute physical activity

interventions would be benefi cial for response inhibition and lapses of attention. However, we did

not fi nd positive eff ects of acute physical activity on response inhibition and lapses of attention.

Therefore, we showed that it is diffi cult to translate the positive eff ects of acute physical activity

that have been found in laboratory settings to ecologically valid learning environments, such as

physical education, for children.

Inter-individual variability

One of the challenges in ecologically valid settings for children is to control the intensity of

physical activity. There was high inter-individual variability between children regarding the time

that they exercised in MVPA. Children exercised on average 19 minutes in MVPA, but this varied

between 8 and 43 minutes. Therefore, a dose-response analysis between the time in MVPA and

the outcome variables was performed. This analysis showed that more time in MVPA was related

to better response inhibition and reduced lapses of attention, without indication for diff erential

eff ects between the two types of physical activity (aerobic versus cognitively engaging).

Underlying mechanisms

Our fi ndings show that the eff ects of acute physical activity are dependent on the time that

children exercise in MVPA. Although we did not test the mechanisms itself, this fi nding provides

some support for the physiological arousal mechanism, as this mechanism states that MVPA will

lead to physiological changes in the brain that in turn enhance cognitive performance (Audiff ren,

2009; Knaepen, Goekint, Heyman, & Meeusen, 2010). There were no diff erences between the

aerobic intervention and the cognitively engaging intervention. Therefore, we could not provide

support for the hypothesis that acute physical activity with cognitive engagement leads to

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182 stronger benefits than acute aerobic physical activity alone. In turn, our results imply that the

dose of MVPA (related to the physiological arousal mechanism) is more important than the type

of physical activity (related to the cognitive stimulation hypothesis) for beneficial effects of acute

physical activity.

Furthermore, we showed in Chapter 3 that maintaining attention is an important prerequisite

for executive functions, and therefore, lapses of attention may act as a mediator in the effects of

acute physical activity on inhibition. As also suggested in the physiological arousal mechanism,

acute physical activity leads to increased allocation of attention (and thus reduces lapses of

attention), which in turn can enhance cognitive performance (Audiffren, 2009). For future studies,

it is recommended to investigate whether attention acts as a mediator in the effects of physical

activity on inhibition to further explore the mechanisms by which acute physical activity enhances

cognitive functions.

Effects of longitudinal physical activity

The effects of longitudinal aerobic physical activity and cognitively engaging physical activity

on gross motor skills and cardiovascular fitness were investigated in Chapter 6. Additionally, it

was investigated whether intervention effects were dependent on baseline cardiovascular

fitness and gross motor skills and whether there was a dose-response effect of the time in MVPA

during the interventions on cardiovascular fitness and gross motor skills. The interventions had a

duration of 14 weeks, with a frequency of four times per week. The control group followed their

regular physical education lessons, two times per week. The dose of MVPA was measured with

accelerometers during two lessons (in all study conditions).

Main effects on gross motor skills and cardiovascular fitness

The aerobic intervention and the cognitively engaging intervention did not have effects on

gross motor skills and cardiovascular fitness, and there were no differences between the two

intervention groups. This was in contrast to our hypotheses and to the findings in meta- analyses

by Morgan et al. (2013) and Sun et al. (2013) showing that gross motor skills and cardiovascular

fitness can be enhanced through school-based physical activity interventions. The lack of

significant effects at a group level may be explained by variables related to the implementation

of the interventions, such as the frequency and intensity of the intervention lessons.

Implementation

The percentage of the time that children exercised in MVPA differed significantly between the

three study conditions. Children in the control group exercised on average 28% (i.e. 10.3 minutes)

of the physical education time in MVPA. Children in the aerobic intervention group exercised on

average 35% (i.e. 12.0 minutes) of the total time in MVPA, showing that the time that children

exercise in MVPA during physical education can be increased with intervention strategies focusing

on high-intensity activities, which confirms previous results (Lonsdale et al., 2013). However, only

12 minutes of MVPA in the aerobic intervention group of the ± 35 minutes of physical education

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183 is still low to increase cardiovascular fi tness. The time that children exercised in MVPA in the

cognitively engaging intervention group (24%; i.e. 9.2 minutes) was lower than in the control

group. Possibly, the cognitive engagement in the games and exercises have led to lower levels

of MVPA, because the complex games and exercises in this intervention required more time to

explain rules and more time for feedback and refl ection than in the control lessons or in the aerobic

intervention lessons, which consisted more of repetitive and automated exercises (Gallahue &

Ozmun, 2006). Furthermore, children in both intervention groups followed on average 3.2 from

the four prescribed intervention lessons per week. The combination of fewer intervention lessons

than prescribed and low percentages of MVPA during the lessons may explain why we did not

fi nd main eff ects on cardiovascular fi tness and gross motor skills.

Dose-response relations and eff ects of baseline levels

Although children within the intervention groups received equal instructions, the inter- individual

variability between the children within the intervention groups regarding the time that children

exercised in MVPA was high, as we also showed in the study in Chapter 5. The dose-response

analysis showed that a higher dose of MVPA was related to better cardiovascular fi tness after

both interventions. This was consistent with our hypothesis and confi rmed that the higher the

amount of physical activity, the greater the benefi ts on cardiovascular fi tness (Janssen & LeBlanc,

2010; Parikh & Stratton, 2011). Furthermore, a higher dose of MVPA was related to better gross

motor skills after the cognitively engaging intervention. This may indicate that children that

are more involved in the games and exercises in the cognitively engaging intervention have

more opportunities to practice gross motor skills, which in turn, results in better motor skills

(Willingham, 1998).

We also found that intervention eff ects were dependent on children’s baseline levels of

cardiovascular fi tness. Children with lower baseline cardiovascular fi tness benefi ted more from

the cognitively engaging intervention than from the aerobic intervention, whereas children with

higher baseline cardiovascular fi tness benefi tted more from the aerobic intervention than from

the cognitively engaging intervention or the control condition.

The results suggest that there are subgroups of children (depending on the baseline levels of

cardiovascular fi tness and the exposure to MVPA during the interventions) that may benefi t from

diff erent types of physical activity, whereas others do not (de Greeff et al., 2018a; Pesce, 2009;

Vazou, Pesce, Lakes, & Smiley-Oyen, 2016). Therefore, it is important to take into account baseline

levels of cardiovascular fi tness of children (Kristensen et al., 2010). One way to do this is to divide

children into groups based on their cardiovascular fi tness levels and to deliver diff erential activities

for the diff erent groups. Furthermore, it is important to challenge all children to engage highly in

MVPA during physical activity interventions to stimulate cardiovascular fi tness and gross motor

skills in all children. This can be done by the real-time monitoring of heart rate as in the study by

Gallotta et al. (2015). Target zones of MVPA can be set before the physical activity intervention. If

children exercise at an intensity below that zone, an alarm will sound to control the heart rate and

maintain high levels of MVPA during the intervention.

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184 Furthermore, it would be important to investigate which children engage highly in MVPA during

interventions and which do not. If certain characteristics of children (e.g. physical variables,

cognitive functions or background variables) can be obtained that predict whether children

engage highly in MVPA or not, these characteristics can be used to divide children in groups and

to develop and implement different activities for children with different characteristics in order to

extend the benefits of physical activity to a larger group of children.

Effects on visuospatial working memory-related brain activation

There were no effects of the aerobic intervention or the cognitively engaging intervention on

visuospatial working memory and visuospatial working memory-related brain activation when

using mass univariate analysis (Chapter 7). This was inconsistent with previous studies showing

effects of longitudinal aerobic physical activity on brain functioning, mainly in the prefrontal cortex

(Chaddock-Heyman et al., 2013; Davis et al., 2011a; Krafft et al., 2014). These studies investigated

the effects of physical activity interventions for eigth or nine months and the frequency was

higher (five times per week) than in the intervention developed for this thesis. This might

explain why we could not replicate the previous findings. Furthermore, the interventions did

not enhance cardiovascular fitness, gross motor skills (Chapter 6), executive functions (de Greeff

et al., 2018b), or academic achievement (de Bruijn et al., 2019) at a group level, but large

inter-individual differences in effects were found. As we showed in our study in Chapter 6, the effects

of interventions on gross motor skills and cardiovascular fitness are dependent on baseline levels

and on the amount of MVPA, which is highly variable between children. Such effects may also

be present for brain activation, but this needs to be further examined in brain studies with larger

samples.

Brain activation pattern analysis

We performed an explorative analysis by applying a subprofile model/principal component

analysis (SSM/PCA) method to obtain differences in brain activation patterns between the three

experimental groups. The SSM/PCA is a more sensitive method to investigate differences in brain

activity patterns than the mass univariate analysis. This SSM/PCA analysis showed that

baseline-posttest changes in brain activation patterns differed between the three groups, indicating that

there might be brain areas susceptible to change due to different types of physical activity.

In line with findings of the few previous studies focusing on the effects of aerobic physical activity

on children’s brain activation (Chaddock-Heyman et al., 2013; Davis et al., 2011a; Krafft et al.,

2014), the results of our pattern analyses suggest that the effects of aerobic physical activity are

most pronounced in the frontal and parietal areas. When comparing the cognitively engaging

intervention group to the control group, decreases in activity in the frontal and occipital areas

were found, together with increases in activity in the visual, parietal, and cingulate cortex. When

the cognitively engaging intervention was compared to the aerobic intervention, patterns

consisting of decreased activity in temporal and frontal areas, and increased activity in occipital

and parietal areas, thalamus, and cingulate cortex were obtained, suggesting that the cognitively

engaging intervention group had differential effects on brain activation compared to the aerobic

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185 intervention group.

Underlying mechanisms

The results of this pattern analysis give some support for the mechanism underlying eff ects of

physical activity on cognitive functions by showing that physical activity may lead to functional

changes in brain areas that are important for executive functions. However, the results of this

pattern analysis were unstable due to large inter-individual variability. Furthermore, there were

no eff ects on visuospatial working memory, which makes it diffi cult to relate the changes in brain

activation patterns to changes in behavioral performance. Therefore, no defi nite conclusions can

be drawn about the functional brain mechanism underlying the eff ects of physical activity on

executive functions. Still, the results provide interesting directions for future studies, as they show

which brain areas might be susceptible to change because of diff erent types of physical activity.

Strengths and limitations

A strong point of this thesis was that the “Learning by Moving” project was a large multi- center

cluster RCT assessing the eff ects of two types of physical activity on physical variables, cognitive

functions, academic achievement, brain structure and brain functioning. The development

of two intervention programs, namely an aerobic intervention and a cognitively engaging

intervention, made it possible to compare diff erent exercise types (both acute and longitudinal),

which was new and important for comparing qualitative aspects of interventions. Furthermore,

the inclusion of functional brain analysis was an important contribution to the knowledge about

the mechanisms underlying the relationship between gross motor skills and executive functions

and underlying eff ects of physical activity on cognitive functions.

However, there were also some limitations related to the test batteries, the study design and

the implementation measures. First, in our experimental studies, we used test batteries (the

BOT-2 and the KTK) that measure gross motor skills. As we showed in our systematic review in

Chapter 2, the strongest relations are found between complex motor skills (e.g. fi ne motor skills

or bilateral body coordination) and executive functions. At the neuropsychological level, it can be

argued that these complex motor skills require greater involvement of executive functions than

relatively simple motor skills (Best, 2010). This implies that complex forms of motor skills share

more overlapping neural networks with executive functions than gross motor skills. Therefore,

interventions that stimulate complex motor skills may be more eff ective to also enhance

executive functions. However, we were not aware of standardized motor skill tests that reliably

measure complex motor skills. Therefore, it would be interesting for future studies to develop

tests and interventions that measure and improve complex forms of motor skills instead of gross

motor skills as measured with the BOT-2 and KTK.

Second, the interventions that were developed for this thesis changed both the frequency and

the type of physical education. Therefore, it is impossible to make statements about whether

it was the frequency or the type of physical education, or both, that caused eff ects. For future

studies, it is important to change one parameter at a time to be able to investigate the frequency

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186 and type of physical education separately. However, we developed two interventions that were

both delivered four times per week, but that only differed in the type of activities. Therefore, it

was possible to compare the effects of the type of physical activity (aerobic versus cognitively

engaging).

Third, the amount of MVPA was only measured in two (of the 56 prescribed) physical education

lessons. Therefore, although the amount of MVPA was obtained in the two most representative

lessons, the total dose of MVPA was only an estimation for the amount of MVPA during the

interventions and in the control group. For future studies, it is recommended to obtain the

amount of MVPA more frequently during interventions to get a more precise estimation of MVPA.

Last, there is no standardized instrument available to measure the amount of cognitive

engagement or the amount of motor skill challenges during the interventions, which made it

impossible to compare the study conditions on the amount of cognitive engagement and motor

skill challenges and to investigate dose-response relations between cognitive engagement or

motor skill challenges and intervention effects. For future studies, it is recommended to develop

and standardize a tool to measure cognitive or motor skill engagement to be able to investigate

dose-response relations between cognitive and motor skill engagement and outcome measures.

Conclusions

Concluding, the results of this thesis showed that at a behavioral level, gross motor skills are

related to specific aspects of executive functions that are needed to perform motor tasks

adequately, namely visuospatial working memory and response inhibition. However, we could

not provide evidence for brain functioning mechanisms that underlie the relationship between

gross motor skills and executive functions. Secondly, acute physical activity did not enhance

response inhibition and lapses of attention at a group level. However, we found a dose-response

effect, indicating that more time in MVPA leads to better response inhibition and reduces lapses

of attention. Thirdly, there were no effects of the 14-week aerobic and cognitively engaging

interventions on gross motor skills and cardiovascular fitness at a group level. However, the

effectiveness of the interventions showed to be dependent on the dose of MVPA and baseline

levels of cardiovascular fitness of children. Lastly, there were no effects of the interventions on

visuospatial working memory and visuospatial working memory- related brain activation when

using mass univariate analysis. More insightful results were provided by exploratory pattern

analyses, as the results of these analyses suggest that there might be brain areas susceptible to

change as a result of different types of physical activity.

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