Effects of the FITKids Randomized Controlled Trial on Executive Control and Brain Function
Open accessAbstract
OBJECTIVE: To assess the effect of a physical activity (PA) intervention on brain and behavioral indices of executive control in preadolescent children. METHODS: Two hundred twenty-one children (7–9 years) were randomly assigned to a 9-month afterschool PA program or a wait-list control. In addition to changes in fitness (maximal oxygen consumption), electrical activity in the brain (P3-ERP) and behavioral measures (accuracy, reaction time) of executive control were collected by using tasks that modulated attentional inhibition and cognitive flexibility. RESULTS: Fitness improved more among intervention participants from pretest to posttest compared with the wait-list control (1.3 mL/kg per minute, 95% confidence interval [CI]: 0.3 to 2.4; d = 0.34 for group difference in pre-to-post change score). Intervention participants exhibited greater improvements from pretest to posttest in inhibition (3.2%, 95% CI: 0.0 to 6.5; d = 0.27) and cognitive flexibility (4.8%, 95% CI: 1.1 to 8.4; d = 0.35 for group difference in pre-to-post change score) compared with control. Only the intervention group increased attentional resources from pretest to posttest during tasks requiring increased inhibition (1.4 µV, 95% CI: 0.3 to 2.6; d = 0.34) and cognitive flexibility (1.5 µV, 95% CI: 0.6 to 2.5; d = 0.43). Finally, improvements in brain function on the inhibition task (r = 0.22) and performance on the flexibility task correlated with intervention attendance (r = 0.24). CONCLUSIONS: The intervention enhanced cognitive performance and brain function during tasks requiring greater executive control. These findings demonstrate a causal effect of a PA program on executive control, and provide support for PA for improving childhood cognition and brain health.
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Several studies have identified a positive relationship between cardiorespiratory fitness, weight and AP, or with overall physical fitness.
“Several studies have identified a positive relationship between cardiorespiratory fitness, weight and AP (46–49) or with overall physical fitness (82).”
From Children's Physical Activity, Academic Performance, and Cognitive Functioning: A Systematic Review and Meta-Analysis (2020) · cites this paper as [49]
The Discussion reports improved aerobic fitness and executive control in the FITKids trial, and cites a previous exercise study that found benefits for math achievement among overweight children. But this paper does not establish the claimed positive relationship among cardiorespiratory fitness, weight, and academic performance; its own outcomes concern executive control, not academic performance. (LLM, conf=0.82)
Experimental — accuracy not yet measuredChildren who engage in moderate-to-vigorous physical activity exhibit stronger neural activation during cognitive tasks, resulting in superior performance on mathematical reasoning tests.
“Hillman et al. (2014) found that children who engage in moderate-to-vigorous physical activity exhibit stronger neural activation during cognitive tasks, resulting in superior performance on mathematical reasoning tests.”
From The impact of physical activity on academic performance in children and adolescents: a meta-analysis (2026) · cites this paper as Hillman et al., 2014
The PA Intervention and Figure 3 sections (page numbers unavailable) report moderate-to-vigorous activity and greater P3 amplitude during demanding cognitive tasks in the intervention group. The Cognitive Tasks section measures inhibition and cognitive flexibility, not mathematical reasoning; the Discussion mentions math achievement only when describing a different study. This paper does not establish that the neural change resulted in superior performance on mathematical reasoning tests. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSeveral randomized controlled trials have become available, aimed at investigating the effects of acute physical activity and longitudinal physical activity programs on cognitive functioning in preadolescent children.
“More recently, several randomized controlled trials have become available, aimed at investigating the effects of acute physical activity and longitudinal physical activity programs on cognitive functioning in preadolescent children.20,25,26”
From Effects of physical activity on executive functions, attention and academic performance in preadolescent children: a meta-analysis (2018) · cites this paper as [26]
The Discussion describes FITKids as a 9-month randomized physical-activity intervention that assessed executive control in children, and it discusses other trials of activity programs. This supports the longitudinal-program portion of the sentence, but our copy does not establish the portion about randomized trials of acute physical activity. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPhysical activity has small but positive effects on a range of cognitive and mental health outcomes in youth.
“Although there may be a bi-directional relationship between physical activity and mental health, experimental studies conducted with youth have demonstrated that increasing physical activity has small but positive effects on a range of cognitive and mental health outcomes. 6-9”
From Physical Activity for Cognitive and Mental Health in Youth: A Systematic Review of Mechanisms (2016) · cites this paper as [7]
The Discussion reports that the nine-month physical activity intervention improved executive control in prepubertal children, and Changes in Cognitive Flexibility reports small positive effect sizes for some cognitive measures. The paper does not report improvements in mental health outcomes; its findings are selective to particular cognitive tasks, rather than a broad range of outcomes. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe Davis study involved overweight/obese children and used the anticascade task, while the Hillman study participants were of healthy weight status and used a flanker task.
“It is important to note that the study conducted by Davis and colleagues involved overweight/obese children and used the anticascade task, while the participants in the Hillman study were of a healthy weight status and a flanker task was used.”
From Physical Activity for Cognitive and Mental Health in Youth: A Systematic Review of Mechanisms (2016) · cites this paper as [7]
The Cognitive Tasks section confirms that the Hillman study used a modified flanker task. But the discussion following Figure 3 describes its participants as a “large heterogeneous sample of children with varying weight status,” not as exclusively healthy-weight children. The Davis study is a separate work, so this verdict concerns the Hillman comparison attributed to this paper. (LLM, conf=0.89)
Experimental — accuracy not yet measured
Hillman and colleagues reported more improvement from pre-test to post-test in some aspects of cognitive performance and measures of brain function in children aged 8 to 9 years who followed the FITKids intervention versus a control group.
“Hillman and colleagues 50 reported more improvement from pre-test to post-test in some aspects of cognitive performance and measures of brain function in children aged 8 to 9 years who followed the FITKids intervention versus a control group.”
Of the 11 high-quality studies, four reported outcomes on cognitive performance, six on academic performance, and one on both.
“Of the 11 high-quality studies, four reported outcomes on cognitive performance, 36 50 54 65 six on academic performance, 30 38 41 42 51 83 and one on both. 70”
A small number of studies examined functional brain correlates that may underlie the effects of physical activity on cognitive performance.
“A small number of studies examined functional brain correlates that may underlie the effects of PA on cognitive performance.49 50 57 58”
A 9-month physical activity intervention aimed at improving cardio-respiratory fitness resulted in improved performance and increased attentional resources on tasks requiring increased inhibition and cognitive flexibility.
“Hillman et al. 7 found that a 9-month physical activity intervention aimed at improving cardio-respiratory fitness resulted in improved performance as well as increased attentional resources on tasks requiring increased inhibition and cognitive flexibility.”
From Physical Activity for Cognitive and Mental Health in Youth: A Systematic Review of Mechanisms (2016) · cites this paper as [7]
Previous studies have shown that regular physical activity could produce changes in structural brain volumes and improve brain functioning.
“Similarly, previous studies have shown that regular PA could produce changes in structural brain volumes and improve brain functioning [7,55,56].”
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- Authors
- Hillman, C. H., Pontifex, M. B., Castelli, D. M., Khan, N. A., Raine, L. B., Scudder, M. R., Drollette, E. S., Moore, R. D., Wu, C.-T., & Kamijo, K.
- Affiliations
- University of Illinois Urbana-Champaign (US)
- Michigan State University (US)
- The University of Texas at Austin (US)
- Schreiner University (US)
- Waseda University (JP)
- ORCID
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2014-10-01
- Volume
- 134
- Issue
- 4
- Pages
- e1063-e1071
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC4179093
- OpenAlex
- W2129893863
- Semantic Scholar
- 69284f7bd5a80b16da4bf01cd0eff0831883d0be
- Cited by
- 661
- References
- 44
- Citations by year
- 2026: 35 · 2025: 49 · 2024: 52 · 2023: 63 · 2022: 58 · 2021: 69 · 2020: 61 · 2019: 62 · 2018: 60 · 2017: 49 · 2016: 55 · 2015: 39 · 2014: 5 · 2013: 2
- FWCI
- 32.80
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- PEDIATRICS (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD055352)
- Topics
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neural and Behavioral Psychology Studies
- Social Sciences › Psychology › Developmental and Educational Psychology › Children's Physical and Motor Development
- Keywords
- physical activity interventions, executive function, preadolescents, P3 event-related potential, attentional inhibition, cognitive flexibility, cardiorespiratory fitness, brain function, children's cognition, reaction time
- MeSH terms
- Body Weight, Brain, Child, Cognition, Female, Humans, Male, Physical Fitness, Psychomotor Performance, Reaction Time, Exercise, Executive Function
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