children

Review
Associations between Fundamental Movement Skills, Physical
Fitness, Motor Competency, Physical Activity, and Executive
Functions in Pre-School Age Children: A Systematic Review
Chipo Malambo 1 , Aneta Nová 1 , Cain Clark 2 and Martin Musálek 1, *

1 Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic;
cmalambo@yahoo.com (C.M.); anetnova1@seznam.cz (A.N.)
2 Centre for Intelligent Healthcare, Coventry University, Coventry CV1 5FB, UK; ad0183@coventry.ac.uk
* Correspondence: musalek.martin@seznam.cz; Tel.: +420-6-0234-4858

Abstract: Previous empirical research and reviews have suggested that the level of fundamental
movement skills (FMS), motor competence (MC), physical activity (PA), or physical fitness seem to
directly influence the executive functions (EFs) in school aged children. However, there is no available
comprehensive review of whether the exact links between motor constructs and EFs also exist in the
preschool period, even though preschool age is the critical period for developing EFs. Therefore,
this study aimed to systematically review the evidence on the association between FMS, MC, PA, PF,
and EFs. To conduct the systematic review, we utilized searches using Web of Science, PubMed, and
EBSCO (including SPORTDiscus and Academic Search Premier). We included studies that examined
associations between one or all of the four motor constructs with EFs among typically developing
children aged 3–6 years, published between January 2010 and October 2021. A total of 15 studies
met the inclusion criteria, of which four were randomized controlled trials, three were longitudinal
Citation: Malambo, C.; Nová, A.;
studies, four were cohort studies, and four were cross-sectional studies. We found weak correlations
Clark, C.; Musálek, M. Associations
or insufficient evidence for associations between FMS, PA, PF, and EFs. However, there was strong
between Fundamental Movement
Skills, Physical Fitness, Motor
evidence for a moderately strong association between MC and working memory, a moderately weak
Competency, Physical Activity, and association between MC and inhibition, and inadequate evidence for a weak to moderate association
Executive Functions in Pre-School between MC and shifting. In addition, only half of the included studies were methodologically
Age Children: A Systematic Review. high-quality studies. Specifically, a questionable design selection of research samples might bias
Children 2022, 9, 1059. https:// the strength of evaluated associations. We also found significant diversity in the diagnostic tools
doi.org/10.3390/children9071059 used for assessing and measuring motor and EFs domains. Our findings support the assumption
Academic Editors: Matthieu Lenoir
that motor competencies level, which contains physical capacity and cognitive components, could
and Eva D’Hondt be significantly linked to EF development from a preschool age. Therefore, we suggest that future
studies focus more on clinical trial design, combining movement interventions with different levels
Received: 10 June 2022
of cognitive components, for the purposive development of EFs in preschool-aged children.
Accepted: 12 July 2022
Published: 15 July 2022
Keywords: fundamental movement skill; motor competence; physical activity; physical fitness;
Publisher’s Note: MDPI stays neutral preschool; association
with regard to jurisdictional claims in
published maps and institutional affil-
iations.

1. Introduction
Studies have examined the association between different motor abilities and executive
Copyright: © 2022 by the authors.
functions [1,2]. Motor ability, specifically, has been defined by some authors as an inherited,
Licensee MDPI, Basel, Switzerland. relatively enduring trait of an individual that supports different kinds of cognitive activi-
This article is an open access article ties or skills [3]. It covers task requirements, general body coordination, and well-timed
distributed under the terms and movements in response to interactions with practice conditions [4–6]. Previous research
conditions of the Creative Commons that verified the structure of motor ability using factor analysis led to the identification of
Attribution (CC BY) license (https:// two basic motor-related factors. The first factor contained performance abilities that con-
creativecommons.org/licenses/by/ tribute to motor performance (dynamic strength, static strength, dynamic flexibility), and
4.0/). the second factor contained psychomotor abilities (response orientation, control precision,

Children 2022, 9, 1059. https://doi.org/10.3390/children9071059 https://www.mdpi.com/journal/children

Children 2022, 9, 1059 2 of 17

multi-limb coordination) [4,7]. These two motor abilities factors shared only a tiny portion
of the variance; therefore, it was posited that motor ability manifestation is significantly
determined by task specificity [8]. The measurement of these tasks among the general
population or preschoolers can be noticed in different assessments that measure presumed
motor abilities. Motor abilities can be observed through physical activity (PA), physical
fitness level (PF), fundamental movement skills level (FMS), and motor competencies level
(MC). For instance, PA, mostly measured through actigraphy, is defined as any bodily
movement produced by skeletal muscles that result in energy expenditure measured in
the level of intensity from sedentary to vigorous PA [9]. Physical fitness can be health- or
performance-oriented and is described as participation in daily activities (or sports) without
undue fatigue [10]. Some of the test batteries used to measure PF among preschoolers
include the PREFIT and the EUROFIT. Fundamental movement skills, measured using
the Test of Gross Motor Development (TGMD-2) battery [11], include movement such
as running, leaping, catching, and kicking, which represent the essential foundations for
future movement and PA, while MC means having proficiency (or competency) in FMS
and can be assessed using the Motor Competence Assessment (MCA) battery [12,13]. All
mentioned motor abilities are important health parameters and play a key role in human
development, including the development of executive functions (EFs) [14–17].
Executive functions are understood as important skills for learning development;
they are considered top-down control processes of human behavior, the primary role
of which is to enable a person to participate in independent, goal-directed, self-serving
behavior [18,19]. Diamond et al. [20] describe three basic executive functions, namely,
working memory (the ability to retain and use separate pieces of information over short
periods), cognitive flexibility (the ability to maintain or change attention in response to a
variety of demands or to apply different rules in a variety of situations), and inhibition
(the ability to prioritize tasks and avoid impulsive actions or reactions). These interact to
form what are termed higher executive functions, namely, planning, problem-solving, and
logical and abstract reasoning [19,21]. Psychologists propose that in humans, including
children, there is a strong positive link that exists between different motor abilities and
psychological benefits [22].
In expanding on the cognitive development of children, Piaget [23] explained that
the rich interplay between biological processes of maturation and neural development of
the central nervous system leads to cognitive development. This process, combined with
a child’s physical maturation, and sensory-motor development, helps the child actively
experience and discover the physical world [24]. Motor development in early infancy
is typically seen through rudimentary movement sequences, increases in PA, and the
ability to fix the stimulus of interest, all of which positively influence attention [25]. In
addition, improving locomotion during infancy, mainly by bipedal walking, has been
shown to be related to cognitive flexibility [26]. Therefore, early motor exploration, known
as “learn to learn”, seems to influence complex EF development [27]. Furthermore, at
the central nervous system (CNS) level, gross motor skills are controlled from the same
regions, e.g., frontal and parietal, as EFs [28,29]. Therefore, at baseline, children with better
motor skills, which may be comprised of PA, PF, FMS (the fundamental building blocks of
movement), and MC (the competency with which one performs FMS), are predicted to have
better attentional and preparatory processes during working memory tasks. In addition,
PA enhances brain functioning in the premotor and motor cortex and the frontoparietal
network, which results in better working memory [2,30].
Previous studies have shown that physical exercise, described as voluntary, inten-
tional activity, also measured through PA, PF, or FMS level, causes specific biochemical and
hormonal changes, such as increasing oxygen saturation and glucose delivery, improving
cerebral blood flow, and increasing neurotransmitters levels, such as brain-derived neu-
rotropic factor (BDNF) or neurotrophic growth factor (NGF) [31,32]. These changes have
been shown to enhance mental and academic performance, among many other positive
outcomes [1,33,34]. In pre-adolescents and adolescents, the positive effects of acute and
Children 2022, 9, 1059 3 of 17

chronic aerobic PA, PF, and MC on executive functioning and academic achievement have
been documented [35–38]. However, these relationships in early childhood are unclear or
inconsistent [39,40], especially regarding the degree and stability of these associations.
Studies on preschoolers have shown that those with greater PA, FMS, PF, or MC had
better working memory, attention, and/or inhibitory control [41–45]. Völgyi et al. [46]
found that PA level in preschool-age children is strongly related to power in the alpha band
(8–12 Hz) in the left and right central brain region, which relates to cognitive performance.
However, in empirical studies, the strength of associations between motor ability and
cognitive development has been found to be equivocal. For instance, Wen et al. [40] found
no significant differences between PA, working memory, and cognitive flexibility after
post-intervention. In addition, Zysset et al. [47] suggested that there are several factors that
can predict EFs in preschool-age, including individual variables such as sex, social and
economic status, visual perception, and fine motor skills.
Recent literature has reviewed the relationship between PA and cognitive development
in early childhood [48–50], albeit mostly focusing on primary school-going children and
older children [51,52].
Van der Fels et al. [52] found no correlation in the literature or insufficient evidence
for or against motor skills and cognitive skills. However, a stronger relationship between
underlying motor and cognitive skills categories was found in prepubertal children, as com-
pared to pubertal children (older than 13 years). Current evidence suggests relationships
between different motor constructs and executive functions in preschool-aged children;
however, we are not aware of any reviews that have comprehensively examined FMS, MC,
PA, PF, and executive functions in preschool children. Development in this age group is of
paramount importance. Therefore, it is vital to elucidate these relationships, particularly
for effective program implementation. In addition, this would result in the development of
a sound motor–cognitive model that would work as a theoretical foundation for training
and interventions. Subsequently, the purpose of this review was to systematically review
the evidence on the association between FMS, MC, PA, PF, and executive functions. Based
on the lack of reviews on this topic, this study provides a hitherto unavailable and more
comprehensive outlook. We included studies from various databases, and all studies were
evaluated for methodological quality. Furthermore, we analyzed the general relationship
between each motor construct and other executive functions.

2. Materials and Methods

The Preferred Reporting Items for the Systematic Reviews and Meta-analysis (PRISMA)
statement guidelines [53] were followed in completing this review.
Search strategy
The databases used for the literature search included PubMed, Web of Science, EB-
SCOhost, and SPORTDiscus. They were searched for records that contained one of the
following combinations of terms: (#1 AND #2 AND #3 AND #4 AND #5) (1) Preschool *
OR Kindergarten* OR “early childhood*” OR “young child”; (2) “motor skill” OR “Motor
competence” OR “movement assessment battery” OR “fundamental motor skills” OR
“physical fitness” OR “motor performance” OR “movement assessment battery” OR “fine
motor development” OR “gross motor development”; (3) Physical activity* OR Physi-
cal performance*; (4) Executive function* OR Cognitive function* OR cognitive abilities;
(5) Relate* OR Predict* OR effect* OR correlate* or associate* OR difference*. This review
collected original articles published from January 2010 to October 2021 in English. The
search strategy was applied in September 2021 and updated in November 2021. Later, we
conducted a manual search of reference lists of included studies to find additional articles
that might have been missed by the database search strategy.
Children 2022, 9, 1059 4 of 17

Eligibility criteria
Research type
We included only quantitative empirical studies (cross-sectional, longitudinal, experi-
mental). We excluded systematic reviews and meta-analyses.
Area of interest
For this review, we explored studies that investigated associations between FMS, MC,
PA, PF, and EFs in children aged 3 to 6 y. The outcomes of the studies had to be objectively
measured and report at least one executive function and at least one motor domain. The
studies had to report a prediction, an association, correlation, and/or regression analysis
between FMS and cognitive function.
Population
Studies were deemed eligible if they focused on neurotypical preschool children.
Studies that included neurodivergent children and/or with other health conditions were
excluded. Studies with children younger than 3 or older than 6 years were not included.
Language
Only studies published in English were considered for this review.
Selection of studies and data extraction
The flow of the study selection process is depicted in Figure 1 [53]. Initially, duplicate
articles were removed, and then the research results were screened via title and abstract
using predefined inclusion and exclusion criteria. Final studies were selected after retrieval
of full texts for evaluation. One reviewer screened the titles and abstracts and conducted
a full-text review. Half of the articles were reviewed by an independent reviewer. In the
event of disagreement between reviewers, a decision on article inclusion was attained via
discussion. This process resulted in 15 articles included for analysis.
Assessment of methodological quality
We used the Quality Assessment Tool for Studies with Diverse Designs (QATSDD
by Sirriyeh et al. [54] to evaluate the methodological quality of the articles. This quality
assessment tool has been reported to have good reliability and validity. According to
standard procedure recommended by the instrument developers [54], when disagreements
between the authors arose, they were discussed until issues were resolved.
This tool has 16 items, which address both qualitative and quantitative studies. This
review, however, only focused on quantitative studies; therefore, we assessed studies based
on 14 items. Evaluation of the studies was based on a scale of 0 to 3 for each item, resulting
in total scores ranging from 0 to a maximum score of 42. The sum obtained determined
the study quality score, which was presented as a percentage of the possible maximum
score [54]. The methodological quality of each paper was rated using a quartile system:
0–24% (poor), 25–50% (below average), 51–75% (average), and 76–100% (above average).
Data Extraction and Synthesis
We extracted the following information from the 15 articles: the first author, year of
publication, participant details, assessments and measurements of motor domains and
executive function, and the study findings. Separate evaluations were made by independent
authors, and the results were then compared to remove any possible inaccuracies in the
information reported.
Children
Children 2022,
2022, 9,
9, x FOR PEER REVIEW
1059 5 5ofof 19
17

Figure
Figure 1. The
The process
process of
of article
article retrieval.

To interpret the levels of evidence, the following

To following guidelines
guidelines were
were used
used [55,56]:
[55,56]:
1. Strongevidence:
1. Strong evidence:at atleast
leastthree
threehigh-quality
high-qualitystudies
studies(quality
(qualityscore
scoreofof 76%
76% and
and above)
above)
with consistent
with consistent results,
results, where
where>66%
>66%findfindaasignificant
significantassociation
association in in
thethe
same
same direction
direc-
and and
tion no more thanthan
no more 25%25% findfind
an opposing
an opposing association.
association.
2. Weak
2. Weak evidence:
evidence: atatleast
least33average
average oror below
below average
average quality
quality studies
studies with
with consistently
consistently
positive results for or against the relationship of motor and cognitive
positive results for or against the relationship of motor and cognitive skills skills.
3. Insufficient
3. Insufficientevidence:
evidence:fewer
fewerthan
than33studies
studiesof of whatever
whatever quality
quality oror below
below average
average oror
inadequate quality studies with inconsistent results for an association
inadequate quality studies with inconsistent results for an association between motor between motor
andcognitive
and cognitiveskills.
skills.
4. No
4. Noevidence:
evidence:when
whenthere
therewas
wasonly
onlyone
onestudy
studyshowing
showing anan association
association between
between motor
motor
and cognitive skills.
and cognitive skills.
In this
In this review,
review, the
the highest
highest quality
quality study
study was
was one
one that
that was
was rated
rated in
in the
the fourth
fourth quartile
quartile
(quality score of 76% and above).
(quality score of 76% and above).
Motor skills in this review were divided into 4 domains; these included fundamental
motor skills, motor competence, PA, and physical fitness. In this review, strengths of
Children 2022, 9, 1059 6 of 17

associations were reported based on the type of data analysis used and reported in each
individual study.

3. Results
Figure 1 shows the PRISMA flow diagram; these included the identification of litera-
ture, screening of studies, eligibility assessment, and final included articles. Accordingly,
the initial search generated 137 potential records. Forty-two full-text articles were retrieved,
after removing duplicates and screening titles and abstracts. Among the 42 articles, 15 stud-
ies met the inclusion criteria (4 RCTs, 3 longitudinal, 4 cohort, and 4 cross-sectional studies;
Table 1).
The studies included were published between 2014 and 2021 [19,39,40,42,43,45,47,57–64].
These studies were conducted in Italy [57,60], Estonia [63], Russia [45], Switzerland [19,42,47,61],
China [40], Germany [39], Canada [59], South Africa [58], Australia [43], Mexico [62], and
Belgium [64]. Moreover, the sample size of participants ranged from 54 [64] to 555 [47], and
only three studies [19,63,64] were longitudinal.
Methodological Quality of Studies
Table 2 shows that a total of 7 studies [19,42,43,57,60,62,64] had high scores, whilst
8 studies [39,40,45,47,58,59,61,63] were listed as being average. Final scores were discussed
among the authors, and a consensus was reached in all cases.
For Table 2, the score range is (0–3), where 0 = not at all; 1 = very slightly; 2 = moder-
ately; 3 = complete; the total possible score for quantitative studies is 42 and for qualitative
studies is 39 [54].
Item 1: Explicit theoretical framework. Item 2: Statement of aims/objectives in
main report. Item 3: Clear description of research setting. Item 4: Evidence of sample
size considered in terms of analysis. Item 5: Representative sample of target group of a
reasonable size. Item 6: Description of procedure for data collection. Item 7: Rationale
for choice of data collection tool(s). Item 8: Detailed recruitment data. Item 9: Statistical
assessment of reliability and validity of measurement tool(s) (quantitative studies only).
Item 10: Fit between research question and method of data collection (quantitative studies
only). Item 11: Fit between research question and format and content of data collection tool,
e.g., interview schedule (qualitative studies only). Item 12: Fit between research question
and method of analysis (quantitative studies only). Item 13: Good justification for analytic
method selected. Item 14: Assessment of reliability of analytic process (qualitative studies
only). Item 15: Evidence of user involvement in design. Item 16: Strengths and limitations
critically discussed.
Children 2022, 9, 1059 7 of 17

Table 1. General characteristics of the studies included in the systematic review.

Reference (Author, Sample (Size (n), Age, Motor Assessment Executive Function Outcomes
Year, Country) Study Design % Girls) Assessment
Regression: Motor task a significant predictor of behavior
110 (47 girls, 63 boys), subscale [F(1,165) = 8.61, p < 0.01, η2 p = 0.05], motor activity
5.23 ± 0.45 years subscale [F(1,172) = 8.54, p < 0.01, η2 p = 0.05], linguistic
[57], Italy RCT EYMSC IPDA
64 (30 girls, 34 boys), comprehension subscale, [F(1,165) = 11.13, p < 0.01, η2 p = 0.06],
5.18 ± 0.45 years oral expression subscale, [F(1,165) = 7.98, p = 0.01, η2 p = 0.05],
metacognition subscale, [F(1,165) = 14.37, p < 0.01, η2 p = 0.08
Regression: LPA (p = 0.017), MPA (p = 0.006), VPA (p = 0.011),
Actigraph MVPA (p = 0.007), and TPA (p = 0.012) at 6.6 years were
147 children (51% boys),
[63], Estonia Longitudinal PREFIT Boehm-3 associated with higher conceptual skills at 7.6 years.
6.6 and 7.6 years EUROFIT No significant associations between PA and verbal or
perceptual ability.
Regression: Inhibitory control (p = 0.002) and working memory
261 (boys n = 130, girls Broad jump; sit and (visual p = 0.02 and verbal p = 0. 03)) positively linked
[45], Russia Cohort n = 131), reach test; shuttle run DCCS
5.77 ± 0.32 years 4×5m with physical fitness. Cognitive flexibility (p = 0.12) was not
associated with PF.
134 children (68 girls Flanker task; Correlation: PF predicts academic achievement (AA) indirectly
MABC-2
[19], Switzerland Longitudinal and 66 boys), KTK Backward color recall task; through EFs.
6.42 ± 0.32 years Heidelberger Rechentest Significant association between PF and EFs r = 0.71 p < 0.05.
FIS
57 (31 boys and 26 girls), WMS Regression: No significant influence on inhibitory control,
[40], China RCT Actigraph
4.40 ± 0.29 years GNG working memory, and cognitive flexibility with PA p > 0.05.
SCA
555 (52.8% boys), Actigraph IDS-P Regression: PA had no effect on EFs.
[47], Switzerland Cohort 3.9 ± 0.7 years ZNA 3-5 NEPSY Fine motor skills with EFs (β = 0.17)
156 (51% girls), MABC-2 Flanker task Correlation: Both gross motor skills (r = 0.75) and fine motor
[61], Switzerland Cohort 6.5 ± 4 years KKT Backward color recall task skills (r = 0.67) correlated significantly with executive functions.
101 (IG—48, 6 ± 0.43 Simon-says task; Correlation: Effect of acute coordinative exercise is temporally
years, 50% boys;
[39], Germany RCT CG—53, 6 ± 0.6 years, MABC-2 computer-based limited and emerges only for motor inhibition but not for
45% boys) hearts-and-flowers task cognitive inhibition or shifting.

Regression: Movement behavior compositions were significantly

95 (69.5% boys), Actigraph EYT
[59], Canada Cross-sectional 4.5 ± 0.7 years TGMD-2 associated with working memory (p = 0.01) and vocabulary
(p = 0.00).
Children 2022, 9, 1059 8 of 17

Table 1. Cont.

Reference (Author, Sample (Size (n), Age, Motor Assessment Executive Function Outcomes
Year, Country) Study Design % Girls) Assessment
129 (64 urban children Regression: Inhibition (locomotor, p = 0.047 and object control
(47% girls), mean age skills, p = 0.02) and working memory (p = 0.039), but not shifting,
[58], South Africa Cross-sectional 4.4 years; 65 rural TGMD-2 EYT were associated with gross motor skills. PA was not associated
children (59% girls), with inhibition and shifting but was negatively associated with
mean age 4.9 years working memory.
n = 111 (64 boys;
Mage = 4.94 ± 0.56 years);
integrated condition
(n = 31), nonintegrated Free-Recall and Cued Recall Regression: Children in the integrated physical exercise
[43], Australia RCT Actigraph
condition (n = 23), Tests condition achieved the highest learning outcomes.
gesturing condition
(n = 31), conventional
condition (n = 26)
65 children (32 boys CMP, PRT; Quaiser, the
4.86 ± 1.04 years, and Corsi block tapping test, the Correlation: A high correlation between two working memory
[60], Italy Cross-sectional MABC-2
33 girls digit tests and both mental rotation and balance was shown.
5.13 ± 0.89 years) span test
Correlation: The findings demonstrate that the challenges and
124 children (54% girls) demands inherent in any motor task influence the magnitude of
MABC-2 OpenSesame Flanker task
[42], Switzerland Cross-sectional aged 5 to 6 years KTK DCCS the motor–EFs link. That is, difficult (i.e., less automated) motor
(M = 5.9 ± 0.48) tasks require EFs more substantially than easy (i.e., more
automated) motor tasks.
148 (56.76% boys) age Regression: Early motor performance contributes to the
[62], Mexico Cohort 21.5 ± 3.7 Peabody Motor Scale McCarthy Scales
establishment of cognitive abilities at 5 years.
The Dutch version of the
Automated Working Regression: Performance on a measure of the visuospatial
54 (age kindergarten Memory Assessment;
sketchpad, the central executive, and fluency was predicted by
[64], Belgium Longitudinal 5.98 ± 0.26; age first Pedometer Flanker Task,
Developmental children’s amount of daily PA after controlling for initial
grade 6.95 ± 0.26
Neuropsychological task performance.
Assessment
Notes: RCT: randomized control trial; EYMSC: Early Years Movement Skills Checklist; IPDA: Questionario per l’Identificazione Precoce delle Difficoltà di Apprendimento; PREFIT:
Assessing FITness in PREschoolers; EUROFIT: European Physical Fitness Test Battery; Boehm-3: Boehm Test of Basic Concepts; DCCS: The Dimensional Change Card Sort; MABC-2:
The Movement Assessment Battery for Children; KTK: The Körperkoordinationstest für Kinder; FIS: Flexible item selection task; WMS: working memory span task; GGG: Animal
Go/NoGo task; SCA: Spatial conflict arrow task; TGMD-2: Test of gross motor development second edition; YET: Early Years Toolbox; CMP: Colored progressive matrices test; PRT:
Picture rotation test.
Children 2022, 9, 1059 9 of 17

Table 2. Methodological quality appraisal according to the QATSDD.

Criteria
Study
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Score %
Alesi 2021 2 3 3 1 3 3 3 1 3 2 n/a 2 2 n/a 1 1 31 74%
Reisberg 2021 2 1 3 2 3 3 3 2 2 2 n/a 3 3 n/a 1 2 32 76%
Veraksa 2021 3 3 3 2 2 2 3 2 3 2 n/a 3 3 n/a 1 0 32 76%
Oberer 2018 3 3 3 1 2 3 2 2 2 3 n/a 3 2 n/a 1 1 31 74%
Wen 2018 2 2 3 3 3 3 2 2 2 3 n/a 3 3 n/a 2 2 35 83%
Zysset 2018 3 3 3 1 2 3 2 2 3 3 n/a 3 3 n/a 2 1 34 81%
Oberer 2017 3 2 3 1 2 3 3 2 3 2 n/a 2 2 n/a 2 3 33 79%
Stein 2017 3 3 3 2 2 3 2 3 2 3 n/a 3 3 n/a 2 2 36 86%
Kuzik 2020 1 1 2 2 3 3 3 3 3 3 n/a 3 3 n/a 2 3 35 83%
Cook 2019 2 3 3 3 3 3 3 3 3 2 n/a 3 3 n/a 1 3 38 90%
Mavilidi 2015 2 3 3 2 2 3 2 3 1 1 n/a 2 1 n/a 1 2 28 67%
Lehmann 2014 2 3 2 1 3 3 3 2 3 2 n/a 3 2 n/a 1 0 30 71%
Maurer 2019 2 2 3 2 2 3 1 3 1 2 n/a 2 2 n/a 1 3 29 69%
Osorio Valencia 2018 2 2 3 2 2 3 1 3 1 2 n/a 2 2 n/a 2 0 27 64%
Vandenbroucke 2016 2 2 2 2 3 1 2 2 2 2 n/a 1 2 n/a 1 2 26 62%
Abbreviations: N/A, not applicable; QATSDD, Quality Assessment Tool for Studies with Diverse Designs.

Assessment of FMS/MC, PA, and Executive function

Assessment of constructs from the motor domain
- To assess FMS, two studies used the TGMD-2 battery [58,59]. and one study used the
EYMSC battery [57].
- To assess motor competence, four studies used the MABC-2 [39,42,60,61], two studies
used KTK [42,61], and one study each used the Peabody motor scale [62] and ZNA-3 [47].
- To assess PA, five studies [40,43,47,59,63] used Actigraphs, while one study [64] used
a pedometer.
- To assess physical fitness, PREFIT and EUROFIT test batteries were used in two
studies [45,63] and KTK [19].
Executive function assessment
There was a range of assessments used to measure cognitive functions, as shown in
Table 1. We found that most studies assessed working memory, inhibition, shifting, and, to
a lesser degree, verbal skills [43,59,62,63] and perception [63]. The most used tests were the
flanker task [19,42,61,64] and the EYT [58,59]. In addition, the majority of studies used a
combination of different assessments for executive functions.
Relationship between FMS and executive functions
In assessing the associations between FMS and executive functions, we included three
studies. Two of the studies [58,59] were cohort studies, consisting of 95 and 129 children,
respectively. A study by Alesi et al. [57], however, adopted an RCT approach, with a
total sample of 174. Cook et al. [58] and Kuzik et al. [59] were deemed to be of above
average methodological quality, while Alesi et al. [57] was scored as average. Although
Alesi et al. [57] assessed FMS with the product-oriented, EYMSC test battery, and two other
studies [58,59] used the TGMD-2, which is a process-oriented test, nevertheless, only weak
evidence for a strong association between FMS and working memory was demonstrated.
Furthermore, Cook et al. [58] found no evidence for a strong association between FMS and
Children 2022, 9, 1059 10 of 17

inhibition [58], shifting, and verbal skills [59]. In general, the results point to weak or null
evidence regarding a strong association between FMS level and performance in assessed
executive functions in preschool aged children.
Relationship between MC and executive functions
In the MC category, we included six studies; three of the studies [47,61,62] were co-
hort studies, two were cross sectional [42,60], and one was an RCT [39]. Zysset et al. [47]
reported the largest sample size of 555 preschoolers, with the lowest being Lehmann et al.,
2014 with 65. All six articles used product-oriented tests to measure MC, where four stud-
ies [39,42,60,61] used the MABC-2, while Osorio-Valencia et al. [62] and Zysset et al. [47]
used the Peabody motor scale and ZNA-3-5, respectively. There was no uniformity in
tests used to measure EFs, as all articles used different measures. Only two articles [39,47]
were judged to be of above average methodological quality. Tables 2 and 3 detail strong
evidence for a moderately strong association between motor competence and working
memory [42,47,60–62]. Moreover, there was weak evidence of a moderately weak associa-
tion between MC and inhibition [39,42,47,62]. We also found that there was weak evidence
for a weak to moderate association between MC and shifting [39,42,47,62]. Finally, there
was insufficient evidence to confirm an association between MC and verbal skills [62].

Table 3. Summary of systematic review of the relationships between motor skills and executive
functions.

No Weak Moderate Strong

Motor Skill Cognitive Skill Evidence
Association Association Association Association
Working-memory [57–59] a Strong (strong correlation)
Fundamental Inhibition [58] No
motor skills Shifting [58] No
Verbal skills [59] a No
Working-memory [47] b [42] [60–62] Strong (moderately strong)
Motor Inhibition [39,47] b [42] [61] Weak (weak moderate
competency Shifting [39,47] b [42] [61] Weak (weak moderate)
Verbal skills [62] No
Working-memory [40,47] [59] a [64] Weak (weak)
Inhibition [40,47,64] b Weak (weak)
PA Shifting [40] [64] Insufficient
Verbal skills [63] c b [43] Weak (weak)
[59]
Perception [63] c No
Working-memory [61] [45] Insufficient
Physical fitness Inhibition [19] [45] Insufficient
Shifting [45] [19] Insufficient
Verbal skills [63] c No
a Studies of Kuzik et al. (2020) reporting with the same sample size. b Studies of Zysset et al. (2018) reporting with
the same sample size. c Studies of Reisberg et al. (2021) reporting with the same sample size.

Relationship between PA and executive functions

In the category for PA, we included six articles. Two studies were longitudinal [63,64],
two were RCTs [40,43], while Kuzik et al. [59] and Zysset et al. [47] were cross-sectional
and cohort studies, respectively. Zysset et al. [47] had the highest sample size of 555,
while Wen et al. [40] had the lowest with 57 preschoolers. All of the noted studies used
accelerometers (Actigraphs) to monitor PA, except Vandenbroucke et al. [64], who utilized
Children 2022, 9, 1059 11 of 17

a pedometer. Our results indicate that there was a variety of tests used to measure EFs.
Only three articles [40,47,59] had above average methodological quality, and three articles
had average methodological quality. Tables 2 and 3 show weak evidence for a weak to
moderate association between PA and working memory [40,59,64]. There was also weak
evidence for an association between PA and inhibition [40,47,64] and between PA and
shifting [40,47,64]. Further, our results also showed weak evidence for a weak to moderate
association between PA and verbal skills [43,59,63], whilst no evidence was found for a
relation between PA and perception [63].
Relationship between PF and executive functions
Three articles were included in the category of physical fitness, where two studies
were longitudinal [19,63], and one study [45] used a cohort study design. Veraksa et al. [45]
had the largest sample of size of 261 preschool children, while Oberer et al. [19] and
Reisberg et al. [63] reported sample sizes of 134 and 147 preschoolers, respectively. All
three studies used different measures for PF, where Oberer et al. [19] used the KTK battery,
Reisberg et al. [63] used both the PREFIT and EUROFIT, and Veraksa et al. [45] reported
only using components of PREFIT tests. All the studies used different tests to measure
EFs, and only one article [19] had an above-average methodological quality. There was
insufficient evidence found for PF and working memory [19,45], PF and inhibition [19,45],
and PF and shifting [19,45]. In addition, there was no evidence for an association between
PF and verbal skills [63].

4. Discussion
This study sought to systematically review evidence pertaining to the associations
between FMS, MC, PA, and PF in typically developing preschool-aged children. To our
knowledge, this study is the first review to synthesis and analyze the associations between
different motor skills and specific EFs in children of this age group. Accordingly, 15 studies
met the eligible criteria, including n = 4 RCTs, n = 3 longitudinal studies, n = 4 cohort
studies, and n = 4 cross-sectional studies. Eight studies were evaluated to be of above
methodological quality, and eight were judged to be of average quality. In summary, there
was weak or null evidence regarding the presence of a strong association between FMS level
and the performance in assessed executive functions in preschool-aged children. Regarding
the association between MC and EFs, we found strong evidence for a moderately strong
association between motor competence and working memory, a moderately weak associa-
tion between MC and inhibition, and weak evidence for a weak to moderate association
between MC and shifting.
In the results pertaining to the associations between PA and EFs, we found weak
evidence for a weak to moderate association between PA and working memory, and weak
evidence for an association between PA and inhibition and shifting. Further, the results
also showed weak evidence for a weak to moderate association between PA and verbal
skills, whilst no evidence was found for a relation between PA and perception. Finally,
in this review, we found that there was also insufficient evidence for PF and working
memory, PF and inhibition, and PF and shifting. In addition, there was no evidence for an
association between PF and verbal skills. The findings in our review are essential because
it is paramount to understand the specific relationships between the various motor skills
(FMS, MC, PA, and PF) and specific EFs, as they may be significant for EF development
and later academic achievement.
In FMS and EFs, the associations were uncertain due to limited evidence. Indeed,
there are few data in the literature that explore these relationships to elucidate a clear
picture. Our study only found three studies that examined this relationship. However, it is
important to note that the studies by Cook et al. [58] and Kuzik et al. [59] did show that
gross motor skills were associated with better working memory, but not inhibition and
cognitive flexibility. It has been demonstrated that FMS likely plays an important role in
PA [65] and that attention and working memory are the first to emerge after birth [66]. It
is, therefore, possible to speculate that better FMS would lead to better, more diverse PA,
Children 2022, 9, 1059 12 of 17

that would, in turn, predict better attention or working memory. However, a definitive
conclusion cannot be made due to the lack of sufficient evidence currently available.
This review showed a strong level of evidence to support a moderately strong asso-
ciation between motor competence and working memory. This finding is consistent with
Ludyga et al. [2] and Ludyga et al. [30], where the authors mention that children with better
motor skills are predicted to have better attentional and preparatory processes during work-
ing memory tasks. In trying to understand this evidence, we looked to the Stodden model,
in which Stodden et al. [13] state that PA may drive the development of MC, in addition
to the fact the aforementioned model posits the potential of a bi-directional relationship
between MC and PA, so a causal pathway remains difficult to ascertain. Nevertheless,
children with better MC might plausibly have better working memory. However, as noted
in the previous literature, PA enhances brain functioning in the premotor and motor cortex
and the frontoparietal network, which results in better working memory [2]. However, our
results found weak evidence for a weak to moderate association between PA and working
memory. We explored the evidence for the proposed hypothesis by Stodden et al. [13],
and we found that Xin et al. [67] found insufficient evidence to support this hypothesis.
Therefore, other factors, mainly the inclusion of PA, could be at play, as noted later in
this discussion.
Regarding PA and EFs, we found overall weak evidence for such associations. These
results are consistent with previous findings that show inconsistent results. Indeed, it
has been demonstrated that PA level in preschool-aged children is strongly related to
the alpha band related to cognitive performance [46], while Wen et al. [40] showed no
significant associations between PA and EFs post-intervention. Moreover, the effect size
of the link between PA and EFs in children seems to be more significant when complex
PA interventions involving strength coordination or high demand coordination motor
tasks are used [68,69]. Therefore, we suggest that the inclusion of PA can significantly
influence the strength of association between PA and EF. Zach and Shalom [70] pointed out
that coordination (agility, manipulation) demanded PA; for example, sport games acutely
increase working memory significantly more in comparison to locomotion-orientated PA
such as running or walking. The concentration of neurotransmitters and brain functional
concentration was also found to be higher in the high demanded coordination motor task
of moderate-intensity [71]. Therefore, only information about intensity of PA may not
explain accurately the link between PA and EFs. We also sought to speculate the reasons for
this weak association, and using current developmental prospects, we found that several
factors can purportedly influence the relationship between PA and EFs, such as biological,
personal, psychosocial, and environmental (these would include parental influence and
their PA habits, physical education programs) [47,72]. The mediating role of these variables
needs to be considered, as they might promote or hinder how much a child participates in
PA. The studies in our review did not account for most of these critical mediating variables,
which might explain the inconsistency in the results. It is essential to always factor in the
roles of the mediating factors in future studies to clarify the mechanism of the relationship
between PA and EFs. However, this age group’s positive but weak association indicates an
emerging developmental relationship.
The associations between PF and EFs showed that there was generally insufficient
evidence for these associations. One of the reasons is that we only had three studies that
explored this relationship, and only one of the studies had an above-average methodological
quality. Nevertheless, Veraksa et al. [45] found that inhibition, working memory, and verbal
skills were positively linked to PF, while Oberer et al. [19] found that PF predicts academic
achievement indirectly through EFs. However, due to insufficient evidence, it is infeasible
to say if there is a relationship between these two variables.
In trying to understand further, we identified potential factors that might influence
the level of evidence found for each category and areas that future studies should incor-
porate. These are, namely, types of study and methodological quality, sample size, and
measurements used in assessing motor skills and EFs, in addition to considering the subtle
Children 2022, 9, 1059 13 of 17

differences between FMS (the basic building blocks of movements/activities) vs. MC (one’s
proficiency in conducting FMS). Firstly, in this review, only 50% of the studies had above
average methodological quality, and of the 15 studies, we only found three longitudinal
studies, and only two of these had above average methodological quality. The rest of the
studies were either cohort, RCTs, or cross-sectional. All types of studies are important;
however, more longitudinal studies on this subject are paramount to facilitate sufficient
information about developmental trajectories. Such importance is reiterated by Himes [73],
who mentions that growth studies provide an opportunity to yield suitable results for
developing a growth reference or standard for childhood, in this case, the developmental
association between motor skills and executive function.
Next, due to the variability in this study, we found a notable range in the sample sizes
used across studies. In this review, the highest number of participants (555) was in a study
by Zysset [47], and the lowest (54) was in a longitudinal survey by Vandenbroucke [64].
Considering this fact, it is important to be cautious in drawing conclusions, as the different
sample sizes may give different population estimates. Some studies have pointed to the
importance of larger sample sizes to obtain desired nominal power. For instance, the sample
size used in Vandenbroucke’s [64] longitudinal study can be defended if it is sufficient for a
growth-focused study. Nevertheless, this is an area that future research should consider
when designing study methods.
Lastly, we observed wide variety used in the assessment of executive functions. Each
study used one or two tools to assess executive functions, whilst most studies did not report
validations for their choice of tools to assess EFs. However, it is important to remember
that most of these studies were carried out in different countries, which might prove
challenging regarding access to normative tools. How the heterogeneity of tests used, and
the other assessment procedures, might impact outcome measures is practically challenging
to discern. Thus, the question then is, how do we develop a narrowed down version of
test batteries that can be used to assess EFs concerning motor skills? Hopefully, this is a
matter that future studies can address. Indeed, it is important to note that the assessment
of motor skills, such as FMS, MC, PA, and PF, might be influenced by the orientation
of the assessment tool. It has been documented that process-oriented assessments often
result in ceiling effects and floor effects, reducing validity. In contrast, product-oriented
assessments do not observe the developmental movement process related to the movement
product [13]. Therefore, it is important to use a multidimensional method to understand
FMS, MC, PA, and PF to deepen our understanding of the relationship between these motor
skills and EFs. Working memory level seems to be in preschoolers a stable EF parameter
significantly associated with MC and FMS level. Surprisingly, other EF parameters, such
as inhibition, shifting, verbal skills, and perception, were not strongly related to any of
the selected motor constructs. One of the reasons might be the specific role of working
memory, which is a predictor for other higher-order cognitive tasks, and that in pre-school
age may be also the most stable part of EFs. Practically, the findings from this review
could be utilized and implemented by key stakeholders, in particular pre-school care
givers and parents/guardians, by considering the range of association between EFs and
holistic movement/activity, such that the encouragement and facilitation of both motor
and cognitively stimulating tasks should be made concurrently. Implementing a focus
on developing motor and cognitive skills independently and concomitantly will likely
positively influence motor and cognitive skill trajectories through childhood; of course, this
is speculative, and requires empirical clarification.
Our review has several strengths. Firstly, we analyzed the associations between
different motor skills and specific EFs in preschool-aged children in a more in-depth
manner than in previous studies. Secondly, we conducted a broad scope of analysis
that has not been done before and analyzed four motor skills related to three executive
functions; we believe that these associations are important in coming up with program
interventions. Furthermore, this review had at least half of the studies included with above-
average methodological quality; thus, some strong evidence for the moderate association
Children 2022, 9, 1059 14 of 17

or weak evidence for weak associations for relationships between some motor skills and
EFs were identifiable. However, there is insufficient literature or evidence for or against
many associations between some motor skills and executive functions. Despite some
indications of associations between certain motor skills and EFs, there were not enough
studies providing evidence to this effect. Notwithstanding the aforementioned strengths,
this study also has limitations. Firstly, we analyzed the various skills reported in multiple
studies; therefore, we did not consider that these motor skills are not necessarily mutually
exclusive. Secondly, we did not conduct a meta-analysis because there was a lack of
adequate studies and heterogeneity of the studies in our review. Thirdly, we solely explored
the relationship between FMS, MC, PA, PF, and EFs without factoring in mediating factors,
such as demographics, personal, biological, and psychosocial variables.

5. Conclusions
This study systematically reviewed the associations between FMS, MC, PA, PF, and EFs
in typically developing preschool-aged children. There is either no association in the current
literature or insufficient evidence for or against many associations between FMS, MC, PA,
PF, and EFs. However, weak to strong evidence was found for some associations, such
as MC, PA, and working memory. These results suggest a complex relationship between
these motor skills and EFs, where some personal, biological, and psychosocial factors could
play a mediating role. However, most studies in this review did not account for most of
these factors. Further, future studies need to be longitudinal to help understand these
developmental trajectories more clearly. The findings from this review must be interpreted
with caution due to the different study types and methodologies and methodological
quality of the studies used.
Despite the lack of overarching strong evidence, we did find that there is some evidence
to show that the relationship between motor skills and executive functions occurs during
child development in preschool-aged children. This is interesting, because it means we
can explore further to optimize motor and executive development in children through
evidence-based interventions that are developmentally appropriate. Furthermore, our
results suggest that highly coordination-demanding physical activities connecting physical
capacity and cognitive components should be purposively involved in pre-school daily
routines. We recommend that larger sample sizes be used in the future, using validated
tools for EFs, and a uniform or multidimensional method for assessing motor skills.

Author Contributions: Conceptualization, M.M. and C.M.; methodology, M.M., C.M. and C.C.;
investigation, C.M., A.N. and M.M.; data curation, C.M. and A.N.; writing—original draft preparation,
C.M.; writing—review and editing, C.C. and M.M.; supervision, M.M. All authors have read and
agreed to the published version of the manuscript.
Funding: This research received no external funding.
Institutional Review Board Statement: Not applicable.
Informed Consent Statement: Not applicable.
Data Availability Statement: Not applicable.
Acknowledgments: This study was supported by the Grant Agency of Charles University GAUK,
No. 36401, and Charles University project Cooperatio Social Science.
Conflicts of Interest: The authors declare no conflict of interest.

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