Effects of physically active lessons and active breaks on cognitive performance and health indicators in elementary school children: A cluster randomized trial

Background This cluster-randomized trial investigated the effects of active breaks and physically active lessons on cognitive function and health indicators in elementary school children in Aracaju, SE. Methods Six schools were randomly divided into three groups: 1) active breaks (n = 61), which consisted of short physical activity intervals during classes; 2) physically active lessons (n = 77), which combined physical activity with educational content; and 3) control (n = 46), which followed the traditional curriculum. The interventions were conducted over eight weeks. Cognitive function was assessed via reaction time and correct responses on five computerized tests: visual search, Go/NoGo, mental rotation, cueing positive, and digit span. Physical activity was measured by pedometers and the Web-CAAFE questionnaire. Quality of life, daytime sleepiness, and school perception were also evaluated as secondary outcomes. Generalized estimating equation models were used, with a significance level of 5%. Results The physically active lesson group showed significant improvements in inhibitory control on the Go/NoGo test (∆ = -104.5 ms; p < 0.001; d = 0.50) and in working memory on the DigitSpan test (∆ = 0.62 hits; p < 0.001; d = 0.44). The physically active lessons and active breaks groups showed significant improvements in spatial reasoning on the mental rotation test (∆ = -1967.5 ms; p < 0.001; d = 0.72, and ∆ = -1477.8; p < 0.001; d = 0.54, respectively). All groups demonstrated significant improvements in spatial orientation on the Cueing Posner test, with the largest effect in the physically active lessons group (∆ = -386.4 ms; p < 0.001; d = 0.69). Conclusion The study concluded that physically active lessons improved various cognitive functions, whereas active breaks, although less impactful, are still a beneficial strategy without adverse effects. Trial registration: Brazilian Clinical Trials Registry (REBEC trial: RBR-10zxwdrh, retrospectively registered on 2025-01-09, https://ensaiosclinicos.gov.br/rg/RBR-10zxwdrh).