Effects of physical activity interventions on fundamental movement skills and cognitive function in early childhood: A systematic review and network meta-analysis

Health benefits have been reported for many physical activity (PA) interventions for improving fundamental movement skills (FMS) and cognitive function (CF), but the most effective type of PA interventions for enhancing FMS and CF in early childhood remain unknown. Thus, the study aims to determine the effects of PA interventions in enhancing FMS and CF among young children and to establish the optimal types of PA interventions. Six electronic databases (PubMed, Ovid, SPORTDiscus, Scopus, Web of Science, Cochrane Central Register of Controlled Trials) were searched for studies from inception to March 17, 2024. Randomized controlled trials (RCTs) were included in this study if they reported outcomes related to FMS, CF, or both associated with PA interventions. Effect sizes were calculated and performed as Hedges g. The hierarchy of competing interventions was established using the surface under the cumulative ranking curve (SUCRA). Risk of bias was independently assessed using the Cochrane Risk-of-Bias 2. This analysis included 38 studies with 5237 young children, with sample sizes ranging from 32 to 897 participants. The types of PA interventions analyzed included active play/free play/unstructured PA (AP), general structured PA (GSPA), fundamental movement skills-targeted PA programs (FMS-programs), cognitively-engaging PA programs (CPA), multilevel PA interventions (MPA), and exergaming. PA interventions had a large, pooled effect size for total FMS (g = 0.96; 95%CI: 0.45 - 1.46; p< 0.01; I² = 94%). For CF, a small-to-moderate pooled effect size was found (g = 0.39; 95% CI: 0.18 - 0.60; p < 0.01; I² = 88%). PA interventions longer than 3 months showed fewer benefits for FMS (P < 0.01). The network meta-analysis showed that FMS-programs (standardized mean difference (SMD) = 1.55, 95%CI: 0.98 - 2.11, SUCRA = 98.3%) and GSPA (SMD = 0.94, 95%CI: 0.05 - 1.85, SUCRA = 69.8%) significantly improved total FMS compared to AP. For locomotor skills (LMS), exergaming ranked highest (SUCRA = 79.3%), followed by FMS-programs (75.9%) and GSPA (61.6%). However, despite its top ranking, exergaming's effect estimate was not statistically significant (SMD = 1.38, 95%CI: -0.08 to 2.85). For object control skills (OCS), exergaming again ranked highest (SUCRA = 91.9%) and showed the largest significant effect (SMD = 2.38, 95%CI: 0.96 - 3.80), followed by FMS-programs (78.5%) and GSPA (53.7%). FMS-programs, GSPA, MPA, and UC also significantly improved OCS compared to AP. While no significant differences were observed across PA interventions for most CF domains, exergaming had a significant positive effect on working memory (SMD = 1.41, 95%CI: 0.07 - 2.75). The certainty of evidence varied from low to moderate. These findings emphasize the importance of PA interventions in improving FMS and CF in early childhood. FMS-programs and GSPA appear to be the most effective approaches for enhancing total FMS, while exergaming showed the highest ranking for LMS and OCS, with a significant impact on OCS but uncertainty in LMS improvements. Additionally, exergaming had a positive effect on working memory, suggesting its potential cognitive benefits.