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Research Article

Effects of School-Based Physical Training on Cognitive Function and Physical Fitness in Children with Developmental Coordination Disorder

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DOI:

10.3791/70168

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September 1st, 2026

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1Department of Physical Education, Shanghai University of Medicine and Health Sciences

In This Article

Summary

This controlled intervention study evaluated the effects of a 12-week school-based exercise program on cognitive function and physical fitness in children with developmental coordination disorder. Significant improvements were observed in executive function, mental rotation performance, sprint ability, and lower-limb strength, particularly among children with probable developmental coordination disorder (pDCD).

Abstract

This controlled intervention study investigated the effects of a 12-week school-based physical training program on cognitive function and physical fitness in children with probable developmental coordination disorder (pDCD). A total of 116 children with pDCD and 60 typically developing (TD) children underwent pre- and post-intervention assessments. The training group (TG) and TD group participated in the exercise intervention, whereas the control group (CG) did not receive training. Cognitive outcomes included executive function and mental rotation performance, while physical fitness outcomes included standing broad jump (SBJ), 50 m sprint, and 50 m × 8 shuttle run performance. Baseline findings demonstrated significantly lower cognitive and motor performance among children with pDCD compared with TD children. Significant group-dependent improvements were observed following the intervention. Children with pDCD demonstrated significant gains in executive function, mental rotation performance, sprint ability, and lower-limb explosive strength, with greater cognitive improvements than TD children in several domains. These findings support the beneficial role of structured school-based physical activity programs in improving cognitive and physical performance in children with pDCD.

Introduction

Developmental coordination disorder (DCD) is a neurodevelopmental condition characterized by significant motor impairment in children, which negatively affects motor skill acquisition and broader developmental functioning1. Globally, approximately 5–6% of school-aged children are affected by DCD2. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classification, DCD is associated with difficulties in performing a variety of daily tasks and functional activities, including participation in leisure activities, recreational events, and academic tasks within school settings3. This developmental disorder commonly manifests during childhood as impaired self-care abilities and reduced participation in physical activities4. Beyond motor difficulties, increasing evidence suggests that DCD is also associated with impairments in several cognitive domains that contribute to motor planning, learning, and everyday functioning.

Researchers have proposed that DCD involves a lack of predictive control and manifests in effector systems5. Previous studies suggest that children with DCD have significant cognitive deficits, especially in spatial cognition and executive function6,7,8. These impairments may affect spatiotemporal integration, object localization, movement planning, and motor coordination compared with typically developing (TD) peers. Mental rotation is the ability of the human brain to manipulate objects in space; these objects change position in space and constitute an integral component of spatial cognition9. Mental rotation ability has additionally been recognized as a predictor of motor and sports performance10. Therefore, assessment of mental rotation performance may provide important insight into cognitive functioning and visuospatial processing deficits in children with probable developmental coordination disorder (pDCD). In addition to spatial cognition, executive function has emerged as another important area of cognitive functioning that may influence motor performance and adaptive behavior in children with DCD.

At the same time, studies have shown that children with DCD also have deficits in executive function11. Executive functions are higher-order cognitive processes involved in attention regulation, inhibitory control, working memory, and cognitive flexibility. These functions are essential for academic achievement and daily functioning12. However, despite increasing evidence regarding cognitive dysfunction in DCD, it remains unclear whether exercise intervention can similarly improve executive functioning and spatial cognition in children with pDCD compared with TD peers. Because cognitive and motor functions are closely interconnected, these impairments may also contribute to reduced participation in physical activity and lower physical fitness levels among children with DCD.

Children's physical fitness level is an important independent predictor of health outcomes13. Recent studies suggest that children who have been diagnosed with DCD generally exhibit lower levels of physical fitness when compared with their typically developing peers. A study by Farhat et al. observed that these children demonstrated diminished aerobic capacity, which appeared to be linked to reduced pulmonary function and altered muscular responses14. Previous studies also reported differences in muscle endurance and explosive whole-body movements among children with pDCD, although findings regarding upper-body strength remain inconsistent15,16. Therefore, understanding the relationship between physical fitness deficits and exercise-related improvements in children with pDCD remains clinically important.

Although previous studies have separately examined cognitive impairments, motor deficits, and exercise-related benefits in children with DCD, there is limited evidence for simultaneously evaluating cognitive function and physical fitness outcomes following a structured school-based exercise intervention. In particular, the extent to which children with pDCD demonstrate responsiveness to exercise intervention compared with TD peers remains insufficiently understood. Therefore, the present controlled intervention study evaluated the effects of a 12-week school-based exercise intervention on executive function, spatial cognition, and physical fitness outcomes in children with pDCD compared with TD children. The study additionally compared intervention-related changes between children with pDCD and TD children. It was hypothesized that children with pDCD would demonstrate significant exercise-related improvements in cognitive and physical fitness outcomes following intervention, although the magnitude of improvement may differ from that observed in TD children.

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Protocol

Ethical approval for the study was obtained from the Ethics Committee of Shanghai University of Medicine and Health Sciences (Approval No. 2021-NFC-10-150203198809). The study was prospectively registered on ClinicalTrials.gov (ID. NCT06544317).

Study population and recruitment

Participants were recruited from primary schools located in three different districts of Shanghai. Before initiating the recruitment process, the researchers distributed recruitment letters to the children's parents. The letters provided the objectives of the study, its significance, and methodology, along with a consent form. Parents who agreed to participate were asked to sign a consent form and complete an online questionnaire accessible via a QR code. The information included the Developmental Coordination Disorder Questionnaire (DCDQ), the ADHD Rating Scale-VI, and other demographic information about participants. Questionnaire responses were accessible only to the research team. The lead researcher's contact details were also provided in the form to address parents' inquiries.

A total of 2,761 children and their parents volunteered to be included in this study. The children were initially screened with the Developmental Coordination Disorder Questionnaire (DCDQ)17,18. Based on teachers’ assessments, those identified as potentially having pDCD but showing no signs of intellectual or cognitive impairments were selected for further evaluation. These candidates subsequently underwent an assessment using the Movement Assessment Battery for Children, Second Edition19. A total of 194 children were identified as potential pDCD candidates during screening. After exclusion of 78 children who did not meet the eligibility criteria, 116 children met the study criteria for pDCD and were randomly allocated to either a training group (TG; n = 58) or a control group (CG; n = 58) using computer-generated random number allocation performed by an independent researcher not involved in outcome assessment. Allocation results were concealed from outcome assessors during baseline and post-intervention testing. In addition, a group of typically developing children (TD; mean age 10.35 ± 1.87 years; 48 boys and 12 girls) was included as a comparison group, matched for gender. Both the TG and TD groups participated in a 12-week physical training program, whereas the CG group did not undergo any training intervention. An overall schematic representation of the study design and experimental workflow is presented in Figure 1.

Eligibility criteria

The inclusion criteria used for the group of children who had pDCD were as follows: (1) DCDQ scores as follows: 8–9 years: < 56 points; 10–12 years: < 58 points; (2) identification of motor problems using Movement Assessment Battery for Children, Second Edition (MABC-2) (a percentile rank below 15% in at least one subitem of the MABC-2); (3) age 9 to 11 years old (elementary school age); (4) children with known intellectual disability, neurological disorders, or clinically diagnosed cognitive impairment reported by school records, parents, or teachers were excluded from participation; (5) no reports or history of other neurodevelopmental conditions (e.g., ADHD) by parents. Before testing, the researchers ensured that the parents filled out the Attention Deficit/Hyperactivity Disorder (ADHD) Rating Scale-VI20. Children whose ADHD Rating Scale-VI scores exceeded the age- and sex-adjusted 98th percentile cutoff were excluded from participation, per established screening criteria for ADHD21. Children included in the TD group additionally met the same exclusion criteria applied to the pDCD group, including absence of ADHD, neurological disorders, intellectual disability, or other neurodevelopmental conditions.

The second edition of the Movement Assessment Battery for Children (MABC-2) is intended for use with children aged 3–16 years19. It comprises eight specific tasks that assess a range of abilities. This includes fine motor control, gross motor skills, balance, and related functions. Each task produced a raw score, which was standardized for the child’s age. These standardized scores are summed across three subcomponents to calculate a motion subdomain score. A higher score indicates better motor coordination. The MABC-2 has shown strong internal consistency (α = 0.90) and reliable test–retest total scores (ICC = 0.97)22, in addition to demonstrating discriminant validity for identifying motor disorders23.

Randomization and group allocation

All the children were right-handed, as assessed using the Edinburgh Handedness Scale24. A total of 116 children with pDCD (98 boys and 18 girls) and 60 TD children (48 boys and 12 girls) were included in the final analysis. Details regarding participant screening, eligibility assessment, randomization, and group allocation are provided in the Study Population and Recruitment subsection and summarized in Figure 1.

Assessment personnel and blinding

The experimental setup of this study was carefully designed according to the standard assessment tool, MABC-2, and the experimenters were trained and licensed researchers. The entire study was conducted in consultation and collaboration with sports rehabilitation experts with pDCD training experience. The coaches and trainers in the study were physical education teachers with more than 5 years of teaching experience. Each group had ten children, with one coach explaining the movements and two caring for the children during training. Five undergraduate physical therapy students were present for all the tests to ensure that the participants in the two tests were identical. Outcome assessors responsible for cognitive and physical fitness testing were blinded to participant group allocation. Due to the nature of the exercise intervention, coaches supervising training sessions could not be blinded.

Testing schedule

All pretests were completed within three days before the children started the exercise intervention, while post-tests were completed within three days after the last training session (depending on the group's training time). This study used a prospective controlled intervention design.

Procedure

The study evaluated 176 participants (116 children with pDCD and 60 TD children) on cognitive and physical fitness assessments before and after the intervention. Refer to Table 1 for the motor skills training program. A series of 90 min after-school physical training sessions, three times a week for 12 weeks, was administered. Each session began with a 20 min warm-up, followed by 60 min of three or four tasks targeting the specific skill to be developed (aerobic training, resistance training, motor skills and balance activities, stretching and flexibility exercises, and core strength and posture exercises), and concluded with a 10 min cool-down. The children were divided into six groups, each consisting of eight to twelve participants. The intervention program was standardized across sessions and progressively adjusted according to participant tolerance and motor performance. Exercise intensity was monitored by supervising physical education teachers using session completion and participation monitoring. Attendance was recorded throughout the intervention period.

Testing procedures and instrumentation

Physical fitness and anthropometric measures

Three physical fitness tests were conducted, including the standing broad jump (SBJ), the 50 m sprint, and the 50 m × 8 shuttle run25. Students were instructed to start in a standing position and complete the 50 m sprint with maximum effort. The test was performed twice, and the fastest result was recorded. The SBJ test was administered on a flat surface to test the explosive strength of the lower limbs. The shuttle run was used to assess children’s speed, agility, and endurance26; children were instructed to run back and forth between two points as quickly as possible. The participants' heights were measured to the nearest 0.1 cm with a stadiometer, and their weights were measured to the nearest 0.1 kg with the same device. Children were weighed in light school uniforms without shoes, and all anthropometric measurements were performed by the same trained assessor.

Cognitive function

Cognitive tasks were computerized and administered in a standardized laboratory setting. Reaction time and response accuracy were recorded for each trial. Participants completed familiarization trials before formal testing. Stimulus presentation order was randomized across trials.

Mental rotation tasks

Children were instructed to use object-based mental rotation strategies by keeping their bodies still and mentally manipulating visual stimuli from a stationary perspective to apply object-based transformations27. Two pictures of “giraffes” were presented simultaneously, with the left image fixed as the main focus while the right image displays angular or mirror differences. Set angular disparities at 0°, 60°, 120°, or 180°. Children were asked to determine, as quickly and accurately as possible, if the two images were identical.

Modified Stroop task

A computerized modified Stroop task, with two conditions: naming (non-execution) and execution, was used28. In the naming condition, display a colored “XXX” on the screen and instruct children to press the key corresponding to the displayed color. In the execution condition, present a distracting-colored Chinese character in blue or red, and instruct children to press the key matching the color of the word rather than its meaning. Define the condition as congruent when the color and meaning are consistent, and incongruent when they are inconsistent.

Statistical analysis

Physical fitness analyses

A mixed-design analysis of variance (ANOVA) was conducted for each variable, with three groups (TG, CG, and TD) completing pre- and post-test measurements to determine the efficacy of the school-based exercise intervention. In physical fitness tests, a 3 × 2 (Group [TG, CG, and TD] × Time [baseline and post-intervention]) mixed-design repeated-measures ANOVA was used to analyze the results. Paired t-tests were also used to assess each group's results before and after the intervention. Post-hoc pairwise group comparisons were conducted following significant ANOVA effects.

Statistical assumptions

Normality of data distribution was assessed using the Shapiro–Wilk test, while homogeneity of variance was evaluated using Levene’s test. Sphericity assumptions for repeated-measures factors were examined using Mauchly’s test, and Greenhouse–Geisser corrections were applied when violations of sphericity were detected.

Cognitive task analyses

Computerized cognitive testing software was used to collect reaction time and correct rate data in children's cognitive tasks. All incorrect trials and trials with more than three standard deviations were removed as outliers. A 3 × 2 × 2 mixed-design ANOVA (Group [TG, CG, and TD] × Time [baseline and post-intervention] × 2 Conditions [non-executive conditions, and execution conditions]) mixed-design analysis was conducted to examine the RT and correct rate in the Stroop task for each group. In the mental rotation tasks, a 3 × 2 × 4 mixed-design ANOVA (Group [TG, CG, and TD] × Time [baseline and post-intervention] × Angular disparity [0°, 60°, 120°, or 180°]) was conducted to assess reaction time and error rate variables. Post hoc pairwise comparisons were performed, where appropriate, following significant interactions or group effects. Before the formal experiment, children were made familiar with the testing procedures and were asked to practice them a certain number of times. When the accuracy reached 75%, the test began; across all conditions, the study did not observe a notable difference in accuracy between the two groups. Finally, the researchers set the significance threshold to p < 0.05.  Effect sizes were reported using partial eta squared (η2). The researchers analyzed and statistically compared all data using statistical analysis software.

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Results

Participant characteristics

The study demonstrated significant differences in the MABC-2 and DCDQ scores between the pDCD and TD groups. As expected, post-hoc least significant difference (LSD) comparisons revealed a significant difference between TG and TD, but no significant differences between TG and CG (Table 2).

Intervention adherence and compliance

Attendance and participation were ...

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Discussion

This study compared the inhibitory function, mental rotation, and motor skills between pDCD and TD children. Simultaneously, this study compared changes in performance across the two groups of children in each function after participating in the same 12-week school-based exercise intervention. The study found that, before the exercise intervention, the cognitive functions of children with pDCD were lower than those of TD children, especially on high mental rotation angles and high-inhibition tasks. In the exercise test, ...

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Disclosures

The authors have no conflicts of interest to disclose.

Acknowledgements

The authors gratefully acknowledge the financial support provided by the Education and Scientific Research Project of Shanghai (Grant No. C2022009).

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Materials

List of materials used in this article
NameCompanyCatalog NumberComments
ADHD Rating Scale-VIGuilford Press9781609180751Behavioral screening
Computerized cognitive testing software (E-Prime v1.1)Psychology Software ToolsE-Prime 1.1Reaction time assessment
Cones/markersDecathlonTraining Marker Cone SetShuttle run setup
Desktop/laptop computerLenovo/Dell/HPN/ACognitive task administration
Developmental Coordination Disorder Questionnaire (DCDQ)CanChild Centre for Childhood Disability ResearchDCDQ’07Screening questionnaire
Digital weighing scaleSeca GmbHSeca 813Weight measurement
Edinburgh Handedness InventoryN/AN/AHandedness assessment
Measuring tapeStanley Tools33-425Standing broad jump measurement
Movement Assessment Battery for Children, Second Edition (MABC-2)Pearson Assessment9780749136086Motor assessment
StadiometerSeca GmbHSeca 213Height measurement
Statistical analysis softwareIBMSPSS Statistics v27Statistical analyses
StopwatchCasioHS-80TW-1DFSprint timing

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