Do our movement skills impact our cognitive skills? Exploring the relationship between cognitive function and fundamental movement skills in primary school children Journal of Science and Medicine in Sport

Objectives: Theliteraturesuggeststhatthereisarelationshipbetweenmotorfunctionandcognitivedevelopment however, few studies have explored the speci ﬁ c role of Functional Movement Skills on cognitive function. This research aimed to determine if Functional Movement Skills predict cognitive function, when accounting for confounding factors, in a sample of primary school children in Ireland. Design: Cross-sectional. Methods: Sixtyprimaryschoolchildren(51.7%girls,agerange7 – 12years,meanage9.9±1.28)wereassessedin their Functional Movement Skill pro ﬁ ciency using the Test of Gross Motor Development — 3rd Edition and a sub- testoftheBruininks – OseretskyTestofMotorPro ﬁ ciency2ShortForm(toassessbalance).Participantsalsocom-pleted a series of cognitive tests which formed part of the Cambridge Neuropsychological Test Automated Battery. Results: A series of hierarchical regression analyses were conducted whilst controlling for covariates (Age; Gender; SocioEconomicStatus).AttentionSwitching,ReactionTime,andEmotionalRecognitionwerefoundtobeassociated withOverallFunctionalMovementSkills(Locomotor,ObjectControl,Stability).OverallFunctionalMovementSkills signi ﬁ cantly accounted for 4.7 % of the variance in Simple Reaction Time ( Δ R 2 = 0.032; p = 0.13) whilst Stability signi ﬁ cantly accounted for 5.5 % ( Δ R 2 = 0.055; p = 0.04) and 12.9 % ( Δ R 2 = 0.129; p = 0.00) of the variance in Simple Reaction Time and Emotional Recognition, respectively, after controlling for covariates. Conclusions: Overall Functional Movement Skills may be more related to reaction time than attention and spatial working memory, whilst stability may be more associated with emotional recognition. Further research is war-ranted. Greater comprehension of the impact of Functional Movement Skills on cognitive function in children can contribute to the development ofmoreeffectiveand ef ﬁ cient physical activity programmes,which can in turn contribute to and promote holistic child development. © 2022 The Authors. Published by Elsevier Ltd on behalf of Sports Medicine Australia. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).


Introduction
Fundamental movement skills (FMSs) are an essential component of a child's overall development 1 and act as building blocks for adequate participation in multiple physical activities for children, adolescents, and adults. Commonly developed in childhood, FMSs include locomotor (e.g., running and hopping), object control (e.g., catching and throwing), and stability (e.g., balancing and twisting) skills. These skills play a considerable role and are used in practically every aspect of daily life. As well as providing the foundation for an active lifestyle, there is a growing body of evidence suggesting that the development of motor skills is directly associated with other aspects of development in early and middle life such as social, emotional, and cognitive development. 1,2 According to the research, motor skills are linked with cognitive development and function. 3,4 Cognitive functioning refers to an individual's ability to acquire, organise and use knowledge and is essential for everyday behaviour. It permits us to understand and relate to the world around us. Cognitive development of higher order cognitive skills (e.g., executive functionsresponse inhibition, planning, attention, working memory, cognitive flexibility) are key components that are important in the development of a child, through adolescence and into adulthood. 5 These components give children the ability to pay attention, retain and manipulate information appropriately, process information and respond quickly and accurately and alternate between task conditions. 6 These cognitive skills are purported to be associated with motor skills 3,4 with better motor skills found to be related to more efficient cognitive functions such as inhibitory control and working memory. 7 The notion is supported by the idea that sensory and motor functioning regions of the brain are typically first to mature. 3 Moreover, both motor and cognitive skills have several mutual fundamental processes such as sequencing, monitoring, and planning and are purported to have similar developmental timetables which are accelerated during childhood. 4 According to Piaget's 'Cognitive Development Theory', motor development and cognitive development are related through "thinking by bodily movement" in which cognitive processes are enhanced by action created by the body. Roebers & Kauer 4 examined over one hundred 7-year-olds with several cognitive executive tasks and motor coordination tasks. Performance in both types of tasks was found to be significantly interrelated, even when controlling for age. Moreover, neuroimaging studies have highlighted that regions of the brain formerly thought to be exclusively associated with motor activity (i.e., cerebellum and basal ganglia) or with cognition (i.e., prefrontal cortex) are in fact co-activated during the execution of specific cognitive or motor activities, 18 thus further supporting the notion of a close relationship between motor and cognitive functions.
Bushnell and Boudreau 9 proposed that motor development may act as a 'control parameter' for further development, such that some motor functions may act as a criterion for the successful acquisition of other developmental functions (i.e., perceptual and cognitive abilities). In their longitudinal study, Piek and colleagues 2 found that among a sample of Australian children aged 4 months-12 years, gross motor skills served as a significant predictor for subsequent cognitive performance (i.e., working memory and processing speed), after controlling for socioeconomic status. When using the Bruininks-Oseretsky Test of Motor Proficiency (BOT-2), Niekerk et al. 10 found that the motor competency (fine and gross motor abilities) of 13-to 14-year-olds in South Africa was significantly related to academic performance (i.e., English and Mathematics). Moreover, Lopes et al. 11 found that among Portuguese children aged 9-11 years, those with low gross motor coordination had a higher probability of having low academic achievement, after adjusting for cardiorespiratory fitness, body mass index, and socio-economic status.
The literature suggests that there is a relationship between motor function and cognitive development however, few studies have explored the specific impact of FMSs on cognitive function. 1 According to Carson et al.,12 in childhood, one should begin to acquire and develop the ability to regulate one's attention, working memory, flexibility, and executive function. Therefore, the purpose of this research was to determine if FMS ability predicts cognitive function, specifically attention, reaction time, spatial working memory, and emotional recognition, when controlling for age, gender, and other confounding factors, in a sample of primary school children in Ireland. A greater understanding of the nature of this relationship may provide insights to teachers and movement specialists during the fundamental movement development phase in children.

Methods
The participants involved in this study were part of a wider physical literacy study known as "Moving Well-Being Well" (n = 2098, 47 % girls, age range 5-12 years). There were 44 schools involved across 12 counties (56 % rural, 44 % urban) in Ireland and Northern Ireland. Areas classed as "socioeconomically disadvantaged" qualify for the Delivering Equality of Opportunity in Schools (DEIS) programme in Irish primary schools, and this study's sample includes 25.0 % DEIS schools (n = 15 DEIS schools, n = 45 non-DEIS schools). A subsample of schools and participants that captured demographics was selected, with 13 schools ranging across the primary school spectrum chosen which included 60 participants (n = 29 boys, n = 31 girls, age range 7-12 years, mean age 9.9 ± 1.28). The subsample of schools was selected in an effort to best represent the primary school landscape in Ireland, with an appropriate mix of urban, rural, DEIS and non DEIS schools participating. Ethical approval from the institution's Research Ethics Committee was obtained (DCU/REC/2017/029). Parental consent and participant assent were obtained. A unique numerical code was assigned to all participants to ensure that their anonymity was maintained. Data collection was conducted March through June 2017 across typically developing junior infants to sixth class children.
Participants' proficiency in FMSs was assessed using the Test of Gross Motor Development-3rd Edition (TGMD-3). The TGMD-3 comprises of a locomotor (run, skip, gallop, slide, hop, and horizontal jump) and an object-control assessment (catch, overhand throw, underhand roll, kick, two-handed strike, one-handed strike, and stationary dribble). 13 A vertical jump test was also included, due to its context in Irish sport participation. 14 Previous research has used these measurement tools repeatedly and both have a high degree of validity and reliability. 15 These are performance based assessments, with both the TGMD-3 and the vertical jump test assessing the performance of skill components, rather than the outcome or product of the performance. Again, both have established validity and reliability (α = 0.81) in this age cohort. 15 As mentioned, the TGMD is a common assessment tool and has been employed in numerous studies, but a common criticism would highlight the lack of a stability component. In order to assess FMSs in the most complete way possible, a subtest of the Bruininks-Oseretsky Test of Motor Proficiency 2 (BOT-2) Short Form was used to assess the participants' balance. The BOT-2 Short Form is a motor competence battery originally designed to identify individuals with mild to severe motor problems. It has proven validity and reliability (α = 0.92), and has been widely used in past research. 15 The test consists of two tasks, walking forward along a straight line, and standing on one leg on a balance beam with eyes open. These assessments are scored on the outcome of the performance, in contrast to the TGMD-3, and participants score between 0 and 4 for each task.
The Cambridge Neuropsychological Test Automated Battery is a battery of computerised neuropsychological tests by the University of Cambridge, England 16 which was used to assess participants' cognitive function. The CANTAB tests depend on touch screen technology, which provides rapid and non-invasive cognitive assessment and have been previously employed in other studies evaluating the cognitive functions of children from 4 to 12. 17 Five tests from CANTAB were used to assess the cognitive functions of the participants, namely: i) attention switching (AST); ii) reaction time (RTI); iii) rapid visual information processing (RVP); iv) spatial working memory (SWM); and v) emotion recognition (ERT). Please see Table 1 for a breakdown of the cognitive constructs and their acronyms. A detailed technical description of the tests can be found on the Cambridge Cognition's website: http://www.cantab.com.
Each member of the research team underwent formal training in order to ensure familiarity and consistency with the assessments. In order to ensure consistency in the FMS measurement, all were required to meet a 95 % inter-observer agreement on a pre-coded data set, whilst being blind to the conditions of coding. A visual demonstration of the skill was performed prior to the assessment, by a trained member of the research team. This is consistent with the protocols identified by Ulrich, 13 and mirrors the methods widely used throughout the literature. 13,15 No verbal feedback or cues were given, whilst participants were unaware of the components being assessed. Each participant first completed a practice trial to familiarise themselves, before being asked to perform every skill twice. The number of skill criteria varies from three to six across the various tests, with a score of one noted if the participant fulfilled the necessary criteria. A zero indicates that they failed to meet these criteria. The participants' raw score per skill was calculated from totalling scores from both trials. Upon completion of all skill assessments, the locomotor, object control, and balance skills were combined to give a raw Overall FMS score.
The first balance subtest, walking forward on a straight line, is graded based on the amount of steps a participant takes whilst adhering to strict criteria of the Bruininks-Oseretsky Test of Motor Proficiency. Points were awarded to the participant in line with the number of steps taken, e.g. six continuous steps equal four points. Standing on one leg on the balance beam was scored based on the time a child could maintain their balance whilst adhering to the prescribed criteria. Again, points were awarded based on the time a participant kept their balance, e.g. over 10 s equals four points. If a participant scored maximum points in the first trial, there was no need to complete a second trial.
FMS assessments are traditionally measured using the pen and paper method. 13 A similar pen and paper method has been used in the past for the balance test. Before any statistical analyses can be undertaken, all results must be input into a database. This time-consuming method doubles the opportunity for human error during data entry. To alleviate this problem, a unique iPad application was developed to collect the data. The equivalent of the paper version was created in the iPad application. Further details are outlined in previous studies. 18 The cognitive tests were administered and supervised by the lead psychologist and one other member of the research team, with a maximum of 8 participants per session. The tests were administered on iPad Air 2 (model: A1566, dimensions: 9.7 inch retina display) and were completed within 30 min. All participants received a detailed explanation on how to undertake each cognitive test and the tests were all carried out in the same sequence for each of the participant.
All data were analysed using SPSS version 24. A series of hierarchical regression analyses were conducted to determine whether the Overall FMSs (Total Overall FMS Score including Balance) along with its associated scores (Locomotor Skills (Raw Locomotor Score with Vertical Jump), Object Control Skills (Raw Object Control Score with One-Handed Strike), and Stability) accounted for incremental variance in cognitive functioning specifically attention switching, reaction time, rapid visual information processing, spatial working memory, and emotion recognition, after controlling for covariates (Age; Gender; Socio Economic Status (SES)). In this hierarchical regression analysis, ΔR 2 represented the increase in the proportion of variance in the criterion variable explained from step N − 1 to step N. The sample size of 60 was sufficient to detect moderate to large relationships (i.e., f 2 = 0.23) between the criterion variables and the primary predictors. 19 3. Results Table 2 shows the means, standard deviations, and ranges for the study variables.
The correlations between the criterion variables, predictors, and control variables are shown in Table 3.  As expected, there were strong correlations between Overall FMSs and Locomotor Skills, Object Control Skills, and Stability, respectively (see Table 3). Overall FMSs and each of its associated scores were included in each of the models. Only those proposed covariates (i.e., age; gender; SES) that were significantly associated with Locomotor Skills, Object Control Skills, Stability, and/or Overall FMSs were included in the hierarchical regression analyses. Age was entered first (SES was also included for the RTIFMDRT variable) ( Table 3 indicates that these were the only covariates) followed by Overall FMSs, Locomotor Skills, Object Control Skills, or Stability, respectively.
Reaction time. After controlling for age, Overall FMS score explained a significant 5.5 % of the variance in reaction time in the median simplechoice reaction time task (RTISMDMT) (ΔR 2 = 0.055; p = 0.04). Locomotor Skills and Object Control Skills were not found to explain any additional variance over and above that already explained by age in RTISMDMT, ΔR 2 = 0.034; p = 0.16 and ΔR 2 = 0.019; p = 0.24,  respectively. Although not quite significant (p = 0.05), Stability was found to explain a significant 5.9 % of the variance in RTISMDMT (ΔR 2 = 0.059; p = 0.05). Table 4 summarises the regression results for the reaction time task. After controlling for the two covariates (SES was found to be correlated with reaction time in the median five-choice reaction time task (RTIFMDMT)), Overall FMSs explained no additional variance in RTIFMDMT (ΔR 2 = 0.037; p = 0.10). Similarly, Locomotor Skills, Object Control Skills, or Stability was not found to explain any additional variance over and above that already explained by the covariates in RTIFMDMT, ΔR 2 = 0.012; p = 0.40, ΔR 2 = 0.001; p = 0.80, ΔR 2 = 0.026; p = 0.20, respectively (Table 5).
Emotional recognition. After controlling for age, Overall FMSs explained no additional variance in ERTTH (ΔR 2 = 0.037; p = 0.10). Locomotor Skills and Object Control Skills were not found to explain any additional variance over and above that already explained by age in ERTTH, ΔR 2 = 0.012; p = 0.40 and ΔR 2 = 0.001; p = 0.80, respectively. However, Stability was found to explain a significant 12.9 % of the variance in ERTTH (ΔR 2 = 0.129; p = 0.00). Table 6 summarises the regression results for the emotional recognition task.

Discussion
The present study aimed to determine if FMSs predicted cognitive function among a sample of primary school children in Ireland. It was found that Overall FMSs accounted for a significant proportion of the variance in simple reaction time (5.5 %) but not in attention, spatial working memory, emotional recognition, or choice reaction time when accounting for age, gender, and SES. Stability was also found to account for a significant proportion of the variance in emotional recognition (12.9 %). These results suggest that Overall FMSs may be more closely related to reaction time than attention and spatial working memory whilst stability may be particularly associated with emotional recognition.
Object Control Skills, Stability and Overall FMSs were all found to be significantly moderately negatively associated with both simple and choice reaction times. However, FMSs were found to predict simple reaction time but not choice reaction time. Reaction times, the intervals between exposure to an external stimulus and a response, are considered at the most basic level an indicator of the processing speed of the nervous system. 20 Reaction speeds involve a combination of consistently attending and efficiently engaging the motor system. 20 As such, it is reasonable to propose that those with better FMSs as well as better Stability skills would have faster response times due to their ability to sense shifts in body positions and rapidly adjust and maintain equilibrium within the body in response to compensating movements. 21 In their longitudinal study on children aged 5-7 years with and without motor coordination impairments, Michel et al. 22 found that children with poor motor coordination were not slower in a simple reaction time task. Moreover, it was found that performance on cognitive tasks  was not less accurate but overall slower compared to those without motor coordination impairments, with the authors purporting that those in the impairment group performed slower because of the complex task demands, including the necessity to react as fast and as accurate as possible.
In line with the existing literature, performance on the attention switching task was found in this study to be moderately positively associated with both Object Control Skills and Overall FMSs. In their study of 238 children aged between 6 and 15 years, Piek and colleagues 23 found a strong association between attention and motor control. Michel et al. 22 also found that children with poorer motor coordination performed worse in an attention switching task (Cognitive Flexibility task). Furthermore, children with motor problems often have attentional issues and vice versa 24 thus suggesting a close interaction between the two variables. Whilst FMS was associated with attention switching, it was not found to predict performance on the attention switching task in the current study. However, the close association between attention and motor coordination potentially suggests that they may share some common underlying neurocognitive mechanism. 23 The neural circuits recruited by both motor coordination and executive attention comprise the prefrontal cortex (PFC) 8 and are purported to be co-activated and significantly interrelated. 4,8 According to Roebers and Kauer,4 this interrelation may indicate common processes in complex cognitive and motor actions potentially suggesting that there are shared higher order cognitive processes involved in cognitive executive tasks and motor coordination tasks.
Stability is considered the most basic skills within the FMS family and is defined as the ability to sense a shift in the relationship of the body parts that alter one's balance. 21 In the present study, Stability was found to explain a significant 12.9 % of the variance in the emotional recognition task. Interestingly, King-Dowling and colleagues 25 found that children aged 3-6 years who were found to have poor motor coordination also tended to have more emotional and behavioural problems (e.g., increased aggression, withdrawn symptoms) compared with their typically developing peers. James and colleagues 26 conducted an exploratory study to assess the impact of the Move 2 Smile programme on FMSs and social-emotional learning with parents reporting considerable positive impacts of the programme on ability to recognise and also express emotions. Functional neuroimaging studies on humans found that motor skill learning was associated with activation of many brain areas in the frontoparietal cortices, an area of the brain particularly associated with recognition of emotions. 28 In another study among thirty 10-13-year-old boys, it was found that those with greater emotional intelligence were found to have greater motor proficiency. 27 Furthermore, Piek et al. 29 found that between the ages of 4 months and 4 years, gross motor skill development is significantly related to anxiety and depression scores and that failure to achieve specific motor millstones results in greater anxiety and depression in school-aged children.
The current study has some limitations. This research cannot determine the directional relationship between the motor and cognitive domains. There is some evidence to suggest that motor development may predict cognitive performance however, further longitudinal research is warranted. It is also important to note that in attempting to interpret the results from this study, other variables may have played an influencing role (e.g., processing speed, motivation) which could have impacted results. 3 Whilst the current sample size was sufficient to detect some relationships, it is suggested that research could benefit from exploring these relationships with a greater sample size. However, whilst a larger sample size would be desirable, the time intense nature of the assessment for both the participant and assessor, as well as the assessment costs per user, must be considered.

Conclusion
The findings from this research suggest specific relationships between Overall FMSs and its associated skills, and cognitive function specifically attention switching, reaction time, and emotional recognition. It is possible that the specific relationships found in the present study may be assumed through shared neural mechanisms, namely, cerebellar processes. Only simple reaction time and emotional recognition were found to significantly predict FMSs. The current results have practical implications when considering interventions for some FMSs and/or cognitive functioning. Further research on the collective relations between FMSs and a broad range of developmental outcomes (i.e., cognitive development; social-emotional development) is warranted. Greater comprehension of the impact of skills such as spatial working memory and emotional recognition on learning and cognition in children can contribute to the design and development of more effective and efficient physical exercise programmes which can contribute and promote not just physical and social development but also enhance children's cognition.

Funding information
This publication has emanated from research supported in part by a research grant from Science Foundation Ireland (SFI) under Grant Number SFI/12/RC/2289, co-funded by the European Regional Development Fund, with assistance from the GAA's Research and Games Development department and Dublin GAA.

Declaration of interest statement
None.

Confirmation of ethical compliance
Ethical approval from the institution's Research Ethics Committee was obtained (DCU/REC/2017/029). Parental consent and participant assent were obtained. A unique numerical code was assigned to all participants to ensure that their anonymity was maintained.