1. Dr Darshana Bhattacharjee Paediatric Registrar (Bristol City Council) Dr Adrian Davis Public Health support to City Transport Bristol City Council

2.  To look at the strength of the evidence regarding the link between physical activity and academic attainment in school pupils.  To facilitate collaboration between Transport Planning and Education teams.  Ultimately to encourage active travel on the school journey.

4.  The school curriculum is becoming increasingly constrained.  The average child aged 5-17 years does not reach the recommended minimum daily levels of physical activity.  More children travel to school unnecessarily by car.

5.  Mayor’s vision  Bristol’s status as European Green Capital  Modeshift STARS programme

7. Do school aged children between 5 and 18 years (P) who undertake physical activity during the school day (including active travel) (I) compared to those children who undertake no or less physical activity (C) have improved academic performance (O)?

8.  Rapid review of literature  First search- predominantly biomedical databases  5 studies found.  Second search- sociological databases  60 papers found.  ~26 studies identified as relevant  15 studies included in briefing note.

9.  Summary of systematic reviews  (RCTs/cross-sectional studies not included)

10. StudyDesign Study population Results PA and cognitive outcomes meta- analysis. Fedewa & Ahn 2011 Systematic review- meta- analysis (60 studies) School aged children 3-18 years The overall weighted mean effect size was statistically significant, indicating that all PA programmes had a positive and significant impact on children’s cognitive outcomes and academic achievement. PA, academic performance and cognition in children. Haapala, 2012 Systematic review (9 studies) School aged children 7-18 years Single bouts of exercise improved concentration in the intervention group. Cardio-respiratory fitness may be related to more efficient executive control. Relationships of PA to brain health. Trudeau & Shephard, 2010 Systematic review School aged children The introduction of sport or PE into the school curriculum has a weak positive association with academic performance. PA in primary schools can be provided without adverse effects on academic achievement. PA and performance at school. Singh et al 2012. Systematic review (10 observational and 4 intervention studies) Children aged 0-18 years 2 high quality studies: (1) adolescent students who participated in a high number of school-based physical activities and more than 5 bouts of MVPA per week were more likely to achieve higher grades (2) elementary school children who took part in an additional 90 minutes of physical activity per week within school had better academic achievement scores. PA and cognition in adolescents. Esteban- Conejo et al, 2014 Systematic review (20 articles) Adolescents 13-18 years Overall, 75% of the studies showed positive associations between physical activity and cognition. One study found that active commuting to school was associated with better cognitive performance in girls but not in boys.

11. StudyDesign Study population Results PA and cognitive outcomes meta- analysis. Fedewa & Ahn 2011 Systematic review- meta- analysis (60 studies) School aged children 3-18 years The overall weighted mean effect size was statistically significant, indicating that all PA programmes had a positive and significant impact on children’s cognitive outcomes and academic achievement. PA, academic performance and cognition in children. Haapala, 2012 Systematic review (9 studies) School aged children 7-18 years Single bouts of exercise improved concentration in the intervention group. Cardio-respiratory fitness may be related to more efficient executive control. Relationships of PA to brain health. Trudeau & Shephard, 2010 Systematic review School aged children The introduction of sport or PE into the school curriculum has a weak positive association with academic performance. PA in primary schools can be provided without adverse effects on academic achievement. PA and performance at school. Singh et al 2012. Systematic review (10 observational and 4 intervention studies) Children aged 0-18 years 2 high quality studies: (1) adolescent students who participated in a high number of school-based physical activities and more than 5 bouts of MVPA per week were more likely to achieve higher grades (2) elementary school children who took part in an additional 90 minutes of physical activity per week within school had better academic achievement scores. PA and cognition in adolescents. Esteban- Conejo et al, 2014 Systematic review (20 articles) Adolescents 13-18 years Overall, 75% of the studies showed positive associations between physical activity and cognition. One study found that active commuting to school was associated with better cognitive performance in girls but not in boys.

12. StudyDesign Study population Results PA and cognitive outcomes meta- analysis. Fedewa & Ahn 2011 Systematic review- meta- analysis (60 studies) School aged children 3-18 years The overall weighted mean effect size was statistically significant, indicating that all PA programmes had a positive and significant impact on children’s cognitive outcomes and academic achievement. PA, academic performance and cognition in children. Haapala, 2012 Systematic review (9 studies) School aged children 7-18 years Single bouts of exercise improved concentration in the intervention group. Cardio-respiratory fitness may be related to more efficient executive control. Relationships of PA to brain health. Trudeau & Shephard, 2010 Systematic review School aged children The introduction of sport or PE into the school curriculum has a weak positive association with academic performance. PA in primary schools can be provided without adverse effects on academic achievement. PA and performance at school. Singh et al 2012. Systematic review (10 observational and 4 intervention studies) Children aged 0-18 years 2 high quality studies: (1) adolescent students who participated in a high number of school-based physical activities and more than 5 bouts of MVPA per week were more likely to achieve higher grades (2) elementary school children who took part in an additional 90 minutes of physical activity per week within school had better academic achievement scores. PA and cognition in adolescents. Esteban- Conejo et al, 2014 Systematic review (20 articles) Adolescents 13-18 years Overall, 75% of the studies showed positive associations between physical activity and cognition. One study found that active commuting to school was associated with better cognitive performance in girls but not in boys.

13. StudyDesign Study population Results PA and cognitive outcomes meta- analysis. Fedewa & Ahn 2011 Systematic review- meta- analysis (60 studies) School aged children 3-18 years The overall weighted mean effect size was statistically significant, indicating that all PA programmes had a positive and significant impact on children’s cognitive outcomes and academic achievement. PA, academic performance and cognition in children. Haapala, 2012 Systematic review (9 studies) School aged children 7-18 years Single bouts of exercise improved concentration in the intervention group. Cardio-respiratory fitness may be related to more efficient executive control. Relationships of PA to brain health. Trudeau & Shephard, 2010 Systematic review School aged children The introduction of sport or PE into the school curriculum has a weak positive association with academic performance. PA in primary schools can be provided without adverse effects on academic achievement. PA and performance at school. Singh et al 2012. Systematic review (10 observational and 4 intervention studies) Children aged 0-18 years 2 high quality studies: (1) adolescent students who participated in a high number of school-based physical activities and more than 5 bouts of MVPA per week were more likely to achieve higher grades (2) elementary school children who took part in an additional 90 minutes of physical activity per week within school had better academic achievement scores. PA and cognition in adolescents. Esteban- Conejo et al, 2014 Systematic review (20 articles) Adolescents 13-18 years Overall, 75% of the studies showed positive associations between physical activity and cognition. One study found that active commuting to school was associated with better cognitive performance in girls but not in boys.

14. StudyDesign Study population Results PA and cognitive outcomes meta- analysis. Fedewa & Ahn 2011 Systematic review- meta- analysis (60 studies) School aged children 3-18 years The overall weighted mean effect size was statistically significant, indicating that all PA programmes had a positive and significant impact on children’s cognitive outcomes and academic achievement. PA, academic performance and cognition in children. Haapala, 2012 Systematic review (9 studies) School aged children 7-18 years Single bouts of exercise improved concentration in the intervention group. Cardio-respiratory fitness may be related to more efficient executive control. Relationships of PA to brain health. Trudeau & Shephard, 2010 Systematic review School aged children The introduction of sport or PE into the school curriculum has a weak positive association with academic performance. PA in primary schools can be provided without adverse effects on academic achievement. PA and performance at school. Singh et al 2012. Systematic review (10 observational and 4 intervention studies) Children aged 0-18 years 2 high quality studies: (1) adolescent students who participated in a high number of school-based physical activities and more than 5 bouts of MVPA per week were more likely to achieve higher grades (2) elementary school children who took part in an additional 90 minutes of physical activity per week within school had better academic achievement scores. PA and cognition in adolescents. Esteban- Conejo et al, 2014 Systematic review (20 articles) Adolescents 13-18 years Overall, 75% of the studies showed positive associations between physical activity and cognition. One study found that active commuting to school was associated with better cognitive performance in girls but not in boys.

15.  The majority of studies reviewed showed a positive association between PA and academic achievement/cognitive performance in school-aged children.  PA and fitness levels in school pupils is associated with better academic scores and improved classroom behaviour.  PA is not detrimental to academic performance.

16.  There is variability between how PA is measured (objective vs subjective).  Few studies specifically looked at active travel to school.  Lack of RCTs  Ethnicity/social class difficult to adjust for.

17.  Raising profile of Bristol schools.  Making school travel plans an integral part of school policy.  Enhancement of road safety messages.  Promotion of better health and academic performance.  Providing incentives for schools to enhance facilities for active travel.

18. “Physical activity through active travel Briefing Note: A best available opportunity for enhancing academic attainment among school pupils?”  Dr D Bhattacharjee, February 2015.  Darshana.bhattacharjee@nhs.net Darshana.bhattacharjee@nhs.net