A critical systematic review of the impact of sedentarism and physical inactivity on the cognitive performance of children

OBJECTIVE: Sedentarism and physical inactivity are growing concerns for global health institutions, especially with the rising number of adolescents failing to meet daily physical activity guidelines. These inactive lifestyles can adversely affect cognitive functions during development. Thus, a systematic review of observational studies was conducted to evaluate the impact of sedentary behavior and physical inactivity on cognitive performance in children aged 6 to 12. METHODS: Eligible studies included English-language observational designs (such as cohort and case-control studies), enrolling neurotypical children classified as sedentary, insufficiently active, or physically inactive (experimental group), compared to active children (control group), according to ACSM recommendations. Studies were also required to report outcomes related to executive functions, academic performance metrics, memory, and attention. Systematic searches were conducted in MEDLINE (PubMed), Embase, Cochrane Library, Web of Science, and Scopus, from inception to February 2026. Risk of bias was assessed using the Risk Of Bias In Non-randomised Studies-of Exposure (ROBINS-E) tool. Data were synthesized through a narrative method. RESULTS: Of the 5438 articles initially identified, two studies directly compared inactive and active groups with contrasting results. One showed negative associations between light, moderate physical activity, and total activity time with verbal and perceptual skills in the active group, alongside positive effects of vigorous PA and sedentary behavior on verbal skills. The other pointed positive dose-response effects of sustained moderate-to-vigorous PA trajectories on academic achievement (reading, mathematics, language). However, caution is advised when interpreting these results due to the high risk of bias in both studies, lack of control for confounding variables, and insufficient information on missing data and blinding procedures. While other studies show significant associations between physical activity and cognitive measures, it is crucial to question whether group compositions accurately reflect the cognitive effects of exercise. Given the limited number of articles meeting international physical activity organization criteria, caution is recommended when interpreting the cognitive effects of physical activity-related exposures in children. CONCLUSIONS: This review introduces a novel data analysis approach that classified groups based on established physical activity recommendations, aiming to standardize group criteria. This method potentially sparks essential debates on group definitions and contributes to enhancing the methodological quality of future observational or experimental studies, enabling more robust and reliable data interpretation.