Dylan P. Cliff

Fundamental movement skills in children and adolescents : review of associated health benefits

The mastery of fundamental movement skills (FMS) has been purported as contributing to children’s physical, cognitive and social development and is thought to provide the foundation for an active lifestyle. Commonly developed in childhood and subsequently refined into context- and sport-specific skills, they include locomotor (e.g. running and hopping), manipulative or object control (e.g. catching and throwing) and stability (e.g. balancing and twisting) skills. The rationale for promoting the development of FMS in childhood relies on the existence of evidence on the current or future benefits associated with the acquisition of FMS proficiency. The objective of this systematic review was to examine the relationship between FMS competency and potential health benefits in children and adolescents. Benefits were defined in terms of psychological, physiological and behavioural outcomes that can impact public health. A systematic search of six electronic databases (EMBASE, OVID MEDLINE, PsycINFO, PubMed, Scopus and Sport- Discus®) was conducted on 22 June 2009. Included studies were crosssectional, longitudinal or experimental studies involving healthy children or adolescents (aged 3–18 years) that quantitatively analysed the relationship between FMS competency and potential benefits. The search identified 21 articles examining the relationship between FMS competency and eight potential benefits (i.e. global self-concept, perceived physical competence, cardio-respiratory fitness [CRF], muscular fitness, weight status, flexibility, physical activity and reduced sedentary behaviour). We found strong evidence for a positive association between FMS competency and physical activity in children and adolescents. There was also a positive relationship between FMS competency and CRF and an inverse association between FMS competency and weight status. Due to an inadequate number of studies, the relationship between FMS competency and the remaining benefits was classified as uncertain. More longitudinal and intervention research examining the relationship between FMS competency and potential psychological, physiological and behavioural outcomes in children and adolescents is recommended.

Methodological considerations in using accelerometers to assess habitual physical activity in children aged 0–5 years

This paper reviews the evidence behind the methodological decisions accelerometer users make when assessing habitual physical activity in children aged 0-5 years. The purpose of the review is to outline an evidence-guided protocol for using accelerometry in young children and to identify gaps in the evidence base where further investigation is required. Studies evaluating accelerometry methodologies in young children were reviewed in two age groups (0-2 years and 3-5 years) to examine: (i) which accelerometer should be used, (ii) where the accelerometer should be placed, (iii) which epoch should be used, (iv) how many days of monitoring are required, (v) how many minutes of monitoring per day are required, (vi) how data should be reduced, (vii) which cut-point definitions for identifying activity intensity should be used, and (viii) which physical activity outcomes should be reported and how. Critique of the available evidence provided a basis for the development of a recommended users protocol in 3-5-year olds, although several issues require further research. Because of the absence of methodological studies in children under 3 years, a protocol for the use of accelerometers in this age range could not be specified. Formative studies examining the utility, feasibility and validity of accelerometer-based physical activity assessments are required in children under 3 years of age. Recommendations for further research are outlined, based on the above findings, which, if undertaken, will enhance the accuracy of accelerometer-based assessments of habitual physical activity in young children.

Fundamental movement skill interventions in youth: A systematic review and meta-analysis

BACKGROUND: Fundamental movement skill (FMS) proficiency is positively associated with physical activity and fitness levels. The objective of this study was to systematically review evidence for the benefits of FMS interventions targeting youth. METHODS: A search with no date restrictions was conducted across 7 databases. Studies included any school-, home-, or community-based intervention for typically developing youth with clear intent to improve FMS proficiency and that reported statistical analysis of FMS competence at both preintervention and at least 1 other postintervention time point. Study designs included randomized controlled trials (RCTs) using experimental and quasi-experimental designs and single group pre-post trials. Risk of bias was independently assessed by 2 reviewers. RESULTS: Twenty-two articles (6 RCTs, 13 quasi-experimental trials, 3 pre-post trials) describing 19 interventions were included. All but 1 intervention were evaluated in primary/elementary schools. All studies reported significant intervention effects for ≥1 FMS. Meta-analyses revealed large effect sizes for overall gross motor proficiency (standardized mean difference [SMD] = 1.42, 95% confidence interval [CI] 0.68–2.16, Z = 3.77, P < .0002) and locomotor skill competency (SMD = 1.42, 95% CI 0.56–2.27, Z = 3.25, P = .001). A medium effect size for object control skill competency was observed (SMD = 0.63, 95% CI 0.28–0.98, Z = 3.53, P = .0004). Many studies scored poorly for risk of bias items. CONCLUSIONS: School- and community-based programs that include developmentally appropriate FMS learning experiences delivered by physical education specialists or highly trained classroom teachers significantly improve FMS proficiency in youth.

Multi-site randomized controlled trial of a child-centered physical activity program, a parent-centered dietary-modification program, or both in overweight children: the HIKCUPS study

OBJECTIVE To evaluate whether a child-centered physical activity program, combined with a parent-centered dietary program, was more efficacious than each treatment alone, in preventing unhealthy weight-gain in overweight children. STUDY DESIGN An assessor-blinded randomized controlled trial involving 165 overweight/obese 5.5- to 9.9- year-old children. Participants were randomly assigned to 1 of 3 interventions: a parent-centered dietary program (Diet); a child-centered physical activity program (Activity); or a combination of both (Diet+Activity). All groups received 10 weekly face-to-face sessions followed by 3 monthly relapse-prevention phone calls. Analysis was by intention-to-treat. The primary outcome was change in body mass index z-score at 6 and 12 months (n=114 and 106, respectively). RESULTS Body mass index z-scores were reduced at 12-months in all groups, with the Diet (mean [95% confidence interval]) (-0.39 [-0.51 to 0.27]) and Diet + Activity (-0.32, [-0.36, -0.23]) groups showing a greater reduction than the Activity group (-0.17 [-0.28, -0.06]) (P=.02). Changes in other outcomes (waist circumference and metabolic profile) were not statistically significant among groups. CONCLUSION Relative body weight decreased at 6 months and was sustained at 12 months through treatment with a child-centered physical activity program, a parent-centered dietary program, or both. The greatest effect was achieved when a parent-centered dietary component was included.

Objectively measured sedentary behaviour and health and development in children and adolescents: systematic review and meta‐analysis

Sedentary behaviour has emerged as a unique determinant of health in adults. Studies in children and adolescents have been less consistent. We reviewed the evidence to determine if the total volume and patterns (i.e. breaks and bouts) of objectively measured sedentary behaviour were associated with adverse health outcomes in young people, independent of moderate‐intensity to vigorous‐intensity physical activity. Four electronic databases (EMBASE MEDLINE, Ovid EMBASE, PubMed and Scopus) were searched (up to 12 November 2015) to retrieve studies among 2‐ to 18‐year‐olds, which used cross‐sectional, longitudinal or experimental designs, and examined associations with health outcomes (adiposity, cardio‐metabolic, fitness, respiratory, bone/musculoskeletal, psychosocial, cognition/academic achievement, gross motor development and other outcomes). Based on 88 eligible observational studies, level of evidence grading and quantitative meta‐analyses indicated that there is limited available evidence that the total volume or patterns of sedentary behaviour are associated with health in children and adolescents when accounting for moderate‐intensity to vigorous‐intensity physical activity or focusing on studies with low risk of bias. Quality evidence from studies with robust designs and methods, objective measures of sitting, examining associations for various health outcomes, is needed to better understand if the overall volume or patterns of sedentary behaviour are independent determinants of health in children and adolescents.

Correlates of objectively measured physical activity in obese children.

The aim of this study was to identify potential correlates of objectively measured physical activity in a sample of obese children. A cross‐sectional design was used to assess 137 5–9‐year‐old obese children (mean ± s.d. age = 8.3 ± 1.1 years; mean BMI z‐score = 2.76 ± 0.70; 58% girls) from two regional cities in New South Wales, Australia, before commencement in a treatment trial. Correlates examined included age, BMI z, parental BMI, perceived competence, health‐related quality of life, daily minutes spent in small screen recreation (SSR), and fundamental motor skill (FMS) proficiency. Physical activity was assessed using accelerometers and values were calculated for % of monitored time spent in moderate‐ (MPA) and vigorous (VPA)‐intensity physical activity and mean counts per minute (CPM). Analyses were conducted separately for boys and girls. Motor skill proficiency was significantly correlated with a number of physical activity variables for boys and girls. For boys, regression analysis revealed object‐control proficiency predicted CPM (R2 = 0.25) and age was a predictor of %MPA (R2 = 0.56). Age and object‐control skill proficiency were salient predictors of %VPA (R2 = 0.34). For girls, age and daily minutes of SSR were the only significant predictors for CPM (R2 = 0.13). Age was the sole predictor of %MPA (R2 = 0.38) and %VPA (R2 = 0.15). The targeting of FMSs at an early age should be tested in experimental studies as potential strategies to increase physical activity among obese children, particularly for boys. Interventions aimed at reducing sedentary behaviors among obese girls should also be considered.

Predictive validity and classification accuracy of actigraph energy expenditure equations and cut-points in young children

Objectives Evaluate the predictive validity of ActiGraph energy expenditure equations and the classification accuracy of physical activity intensity cut-points in preschoolers. Methods Forty children aged 4–6 years (5.3±1.0 years) completed a ∼150-min room calorimeter protocol involving age-appropriate sedentary, light and moderate-to vigorous-intensity physical activities. Children wore an ActiGraph GT3X on the right mid-axillary line of the hip. Energy expenditure measured by room calorimetry and physical activity intensity classified using direct observation were the criterion methods. Energy expenditure was predicted using Pate and Puyau equations. Physical activity intensity was classified using Evenson, Sirard, Van Cauwenberghe, Pate, Puyau, and Reilly, ActiGraph cut-points. Results The Pate equation significantly overestimated VO2 during sedentary behaviors, light physical activities and total VO2 (P<0.001). No difference was found between measured and predicted VO2 during moderate-to vigorous-intensity physical activities (P = 0.072). The Puyau equation significantly underestimated activity energy expenditure during moderate-to vigorous-intensity physical activities, light-intensity physical activities and total activity energy expenditure (P<0.0125). However, no overestimation of activity energy expenditure during sedentary behavior was found. The Evenson cut-point demonstrated significantly higher accuracy for classifying sedentary behaviors and light-intensity physical activities than others. Classification accuracy for moderate-to vigorous-intensity physical activities was significantly higher for Pate than others. Conclusion Available ActiGraph equations do not provide accurate estimates of energy expenditure across physical activity intensities in preschoolers. Cut-points of ≤25counts⋅15 s−1 and ≥420 counts⋅15 s−1 for classifying sedentary behaviors and moderate-to vigorous-intensity physical activities, respectively, are recommended.

Movement skills and physical activity in obese children: randomized controlled trial

PURPOSE The purpose of this study was to evaluate the Hunter Illawarra Kids Challenge Using Parent Support physical activity program in overweight children. METHODS A multisite randomized controlled trial was conducted with three intervention arms: 1) child-centered physical activity skill development program (Activity), 2) parent-centered dietary modification program (DIET), or 3) both programs combined (PA+DIET). Movement skill proficiency, perceived athletic competence, accelerometer-assessed physical activity, and parent-reported time spent in screen behaviors were assessed at baseline, 6 months, and 12 months in 165 prepubertal children aged 5.5-9 yr (59% girls, 78% obese). Differences in changes in outcomes between groups were assessed using linear mixed models. RESULTS Compared with the diet group, the activity group (mean (95% confidence interval): +7.7 units (3.8-11.6 units)) and the activity + diet group (+6.7 units (2.9-10.5 units)) displayed 11%-13% greater improvement in overall movement skill proficiency (gross motor quotient) at 6 months. Perceived athletic competence increased across groups at follow-up (across groups: 6 months = +0.21 units (0.11-0.31 units), 12 months = +0.21 units (0.07-0.35 units)). Groups did not differ statistically for change in physical activity outcomes. Total screen time (min·wk(-1)) decreased in all groups at 6 months (across groups: -385.4 (-501.0 to -269.8)) and in the activity group (-261.8 (-470.5 to -53.1)) and activity + diet group (-340.5 (-534.6 to -146.4)) at 12 months. The diet group reported greater reductions in TV or DVD viewing time at 6 months compared with the activity group (248.6 (24.0-473.3)). CONCLUSIONS The activity and the activity + diet programs were efficacious in improving overweight childrens movement skill proficiency. All programs were efficacious in reducing time spent in screen behaviors. Other correlates may need to be targeted in addition to movement skills to increase physical activity among overweight children.

Adherence to physical activity and electronic media guidelines in Australian pre-school children

The aim of this study was to determine compliance with the National Association for Sport and Physical Education (NASPE) guideline for physical activity and American Academy of Pediatrics (AAP) recommendation for electronic media use among urban pre‐school children in two large cities on the East Coast of Australia. Cross‐sectional data were collected from 266 parents. Time spent using electronic media (watching television, DVDs or on the computer) and in physical activity were parent reported. The proportion who met each guideline was calculated. 56 per cent and 79% of children met the NASPE guideline on weekdays and weekends, respectively, while 73% and 70% met the AAP recommendation on weekdays and weekends, with no difference between boys and girls. A substantial minority do not meet physical activity and electronic media use recommendations, highlighting the need to better understand what factors contribute to physical activity and electronic media use among this group of pre‐schoolers.

Proficiency deficiency: mastery of fundamental movement skills and skill components in overweight and obese children

The purpose of this observational study was to compare the mastery of 12 fundamental movement skills (FMS) and skill components between a treatment‐seeking sample of overweight/obese children and a reference sample from the United States. Mastery of six locomotor and six object‐control skills (24 components in each subdomain) were video‐assessed by one assessor using the test of gross motor development‐2 (TGMD‐2). The 153 overweight/obese children (mean ± s.d. age = 8.3 ± 1.1 years, BMI z‐score = 2.78 ± 0.69, 58% girls, 77% obese) were categorized into age groups (for the underhand roll and strike: 7–8 years and 9–10 years; all other FMS: 6–7 years and 8–10 years) and mastery prevalence rates were compared with representative US data (N = 876) using χ2 analysis. For all 12 skills in all age groups, the prevalence of mastery was lower among overweight/obese children compared with the reference sample (all P < 0.05). This was consistent for 18 locomotor and upto 21 object‐control skill components (all P < 0.05). Differences were largest for the run, slide, hop, dribble, and kick. Specific movement patterns that could be targeted for improvement include positioning of the body and feet, the control or release of an object at an optimal position, and better use of the arms to maintain effective force production during the performance of FMS. Physical activity programs designed for overweight and obese children may need to address deficiencies in FMS proficiency to foster the movement capabilities required for participation in health‐enhancing physical activity.