Systematic review: School health promotion interventions targeting physical activity and nutrition can improve academic performance in primary‐ and middle school children

Abstract

Purpose: A systematic review of effects and mediators was conducted to determine whether school health promotion interventions (SHPIs) can enhance children's academic performance (AP). Design/methodology/approach: PubMed and PsycINFO database searches and subsequent reference list reviews were conducted for papers published before 18 January 2012 with a standard form of eligibility criteria encompassing standardized measures of AP (e.g. grade‐point averages, end of year marks) and methodology sound studies (e.g. randomized controlled trials, cross‐over controlled trials, quasi‐experimental designs with pre‐ and posttest) of interventions addressing healthy lifestyles in the general school population. Information for the study description was extracted from the original article (e.g. country, study purpose, research design, effects on AP measures, components of Health Promoting School, author's explanations for observed effects). Effect sizes were calculated for effects on AP measures. Findings: Remaining SHPIs targeted exclusively the maintenance of energy balance (physical activity (PA) and nutrition) and had small to large positive effects on AP; no negative effects were reported. Effects of different kinds of interventions varied across academic domains. One PA intervention reported large effects of vigorous activity on mathematics; another PA intervention had small to medium impact on language scores. Small to medium effects were found for interventions combining nutrition and PA elements; one affected mathematics and another both mathematics and language scores. Slight improvements in language scores were observed for breakfast provision in schools. Limitations: The small number of interventions, little homogeneity in intervention components (content, length and measurement instruments), reporting bias and some inconsistent results should be considered when interpreting our results. Our review did not allow definite conclusions concerning mechanisms responsible for effects of SHPIs on AP. Practical implications: Planned development of school health promotion will need to be based on evidence. Measures of AP should be included in evaluations of SHPIs. Schools and health professionals should be made aware of the importance of these measures. Originality/value: We provide evidence that SHPIs promoting energy balance can affect AP, also if they do not target children at risk or with specific symptoms, nor employ elements directly connected to school education.