Jackson William M, Davis Nicholas, Sands Stephen A, Whittington Robert A, Sun Lena S
Departments of *Anesthesiology†Psychiatry‡Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY.
J Neurosurg Anesthesiol. 2016 Oct;28(4):373-380. doi: 10.1097/ANA.0000000000000349.
Is there an association between regular exercise, defined as a structured program of increased physical activity at least 1 month in duration, and improvements in measures of executive functions compared with children who engage in their normal daily activities?
The association between increased physical activity and changes in performance on tasks of executive functions have not been well elucidated in children. Executive functioning is important to intellectual development and academic success in children, and inexpensive, nonpharmacological methods for the treatment of executive dysfunction represent an attractive interventional target.
To estimate the effect of a structured regular exercise program on neuropsychological domains of executive function in children ages 7 to 12.
We performed a systematic review of English and non-English articles using Cochrane Library, EBSCO CINAHL, Ovid MEDLINE, PSYCInfo, Pubmed, and Web of Science, including all years allowed by each individual search engine. The search string used was "(exercise OR phys*) AND (cognit* OR executive) AND (child* OR preadolesc*)." The authors of the studies selected for review were contacted for any unpublished data.
Randomized controlled trials, which enrolled children between the ages of 7 and 12, with randomization to either normal activity or a structured physical activity intervention consisting of scheduled aerobic exercise, at least once per week, for a period of at least 1 month. Eligible studies must have included a neuropsychological battery of tests that measured at least 1 executive function both before and after the intervention was completed.
Two independent reviewers examined the screened studies in detail for potential inclusion. The results of the individual examinations were compared; if any discrepancies were present, a third party analyzed the study to determine if it should be included in the meta-analysis.
A total of 18 studies were identified by abstract as candidates for inclusion. From these 18 studies, 8 were independently selected by 2 authors for inclusion in the final analysis; there were no selection discrepancies between authors with regard to the studies to be included. In all, 770 subjects were included, 339 in the control group and 431 in the intervention group. All 8 studies contained a measure of inhibitory control; no other domain of executive function was measured frequently enough to perform meta-analysis, so only measures of inhibitory control were pooled and analyzed. A Cohen d effect size was calculated for each measure using the method of Morris for controlled pre-post control measurement studies. The studies were then combined in a random effects model using Comprehensive Meta Analysis software (Biostat, Englewood, NJ) for Windows (Microsoft, Redmond, WA). All studies showed a positive effect of regular exercise with improvements in measures of inhibitory control, but none were statistically significant for this measure. When pooled, the model revealed a combined Cohen d effect size of 0.2 (95% confidence interval, 0.03-0.37; P=0.021), indicating a small improvement of inhibitory control with long-term physical activity. Heterogeneity was very low (I=0).
Many studies used different neuropsychological tests to assess inhibitory control, which may have introduced unforeseen confounders. Other domains of executive functions were not measured frequently enough to perform meta-analysis. Despite attempts to gather unpublished data, positive results were observed in all of the included studies, raising the possibility of publication bias.
Increased regular physical activity is associated with a small and measurable, improvement in neuropsychological tests of executive functions, specifically inhibitory control. Executive functions play an important role in complex behavior, and may contribute to academic and career achievement as well as success in social interaction. This finding provides support for the important interaction between exercise and cognitive functioning.
与进行日常活动的儿童相比，将定期锻炼定义为持续时间至少1个月的有组织的体育活动增加计划，与执行功能测量指标的改善之间是否存在关联？
在儿童中，体育活动增加与执行功能任务表现变化之间的关联尚未得到充分阐明。执行功能对儿童的智力发展和学业成功很重要，用于治疗执行功能障碍的廉价、非药物方法是一个有吸引力的干预目标。
评估有组织的定期锻炼计划对7至12岁儿童执行功能神经心理领域的影响。
我们使用Cochrane图书馆、EBSCO CINAHL、Ovid MEDLINE、PSYCInfo、Pubmed和Web of Science对英文和非英文文章进行了系统综述，包括每个搜索引擎允许的所有年份。使用的搜索词是“(锻炼或体育*) AND (认知或执行) AND (儿童或青春期前*)”。与被选入综述的研究作者联系以获取任何未发表的数据。
随机对照试验，纳入7至12岁的儿童，随机分为正常活动组或结构化体育活动干预组，结构化体育活动干预包括每周至少一次的有氧锻炼，持续至少1个月。符合条件的研究必须包括一套神经心理测试，在干预完成前后测量至少1项执行功能。
两名独立评审员详细检查筛选出的研究以确定是否可能纳入。比较各自检查的结果；如果存在任何差异，由第三方分析该研究以确定是否应纳入荟萃分析。
通过摘要共确定了18项研究作为纳入候选。从这18项研究中，2名作者独立选择了8项纳入最终分析；在纳入的研究方面作者之间没有选择差异。总共纳入了770名受试者，对照组339名，干预组431名。所有8项研究都包含抑制控制的测量；执行功能的其他领域测量频率不足以进行荟萃分析，因此仅汇总并分析了抑制控制的测量。使用Morris方法对每项测量计算Cohen d效应量，用于对照前后对照测量研究。然后使用适用于Windows（微软，华盛顿州雷德蒙德）的综合荟萃分析软件（Biostat，新泽西州恩格尔伍德）将研究合并为随机效应模型。所有研究均显示定期锻炼对抑制控制测量指标有积极影响，但该测量指标均无统计学意义。汇总时，模型显示合并Cohen d效应量为0.2（95%置信区间，0.03 - 0.37；P = 0.021），表明长期体育活动使抑制控制有小幅改善。异质性非常低（I = 0）。
许多研究使用不同神经心理测试评估抑制控制，这可能引入了不可预见的混杂因素。执行功能的其他领域测量频率不足以进行荟萃分析。尽管试图收集未发表的数据，但在所有纳入研究中均观察到阳性结果，增加了发表偏倚的可能性。
增加定期体育活动与执行功能的神经心理测试中有小的但可测量的改善相关，特别是抑制控制。执行功能在复杂行为中起重要作用，可能有助于学业和职业成就以及社交互动的成功。这一发现为锻炼与认知功能之间的重要相互作用提供了支持。
