Physical fitness in children with movement difficulties

Which outcomes are key to the pre-intervention assessment profile of a child with developmental coordination disorder? A systematic review and meta-analysis

BACKGROUND

Purpose of this study was to determine what key aspects of function should be incorporated to make up a pre-intervention assessment profile of a child with Developmental Coordination Disorder (DCD); more specifically, what aspects of functioning are implicated in DCD and what is their relative impact?

METHODS

A systematic review and meta-analysis were conducted, for which Pubmed, Web of Science, Scopus and Proquest were searched (last update: April 2023, PROSPERO: CRD42023461619). Case-control studies were included to determine point estimates for performances on field-based tests in different domains of functioning. Risk of bias was assessed, and level of evidence estimated. Random-effect meta-analyses were performed to calculate the pooled standardized mean differences for domains of functioning and subgrouping was done for clinically relevant subdomains. Heterogeneity was determined with I2.

RESULTS

121 papers were included for analyses. Data of 5 923 children with DCD were included (59.8% boys) and 23 619 Typically Developing (TD) children (45.8% boys). The mean (SD) age of the DCD group was 10.3y (1.2) and 9.3y (1.3) for the TD children. Moderate evidence was found for motor performance, executive functions, sensory processing and perceptions, cognitive functions and sports and leisure activities to be affected in children with DCD.

CONCLUSION

Differences between the two groups varied per domain of functioning. This emphasizes the diversity present within children with DCD and provides a rationale for explaining the heterogeneity in this patient group. Yet, results highlight the potential involvement of all these domains and call for clinicians to be alert not only to examine motor skill difficulties but also other aspects of function. Results indicate the need to develop an individualized pre-intervention multi-dimensional assessment profile for each child with DCD. It also supports the important role that clinicians play in an interdisciplinary team to tackle the difficulties encountered by children with DCD.

Associations Between Motor Competence and Physical Activity, Physical Fitness and Psychosocial Characteristics in Adolescents: A Systematic Review and Meta-analysis

BACKGROUND

Motor competence is an integral component of the health and performance of youth. Numerous studies support the hypothesis that motor competence interacts with perceived motor competence and physical fitness during childhood to induce positive (e.g. healthy weight status) or negative (e.g. reduced physical activity engagement) trajectories. Yet, while adolescence is a key period of rapid growth and maturation, no systematic reviews and meta-analyses have examined the association between motor competence and physical activity, physical fitness and psychosocial characteristics solely within adolescents.

OBJECTIVES

This study aimed to (1) analyse the scientific literature evaluating associations between motor competence and physical activity, physical fitness and/or psychosocial characteristics amongst adolescents; (2) evaluate the associations between motor competence and physical activity, physical fitness characteristics and/or psychosocial characteristics amongst adolescents; and (3) investigate the impact of moderator variables (i.e., age, sex, type of motor competence assessment) on the associations.

METHODS

A systematic search of electronic databases was conducted, followed by a qualitative synthesis of study methods. Random-effects meta-analyses were performed to establish the magnitude and orientation of pooled correlation coefficients between motor competence and physical activity, physical fitness and psychosocial characteristics of adolescents, whilst considering potential moderators (i.e., age, sex, type of motor competence assessment).

RESULTS

Sixty-one studies were included, totalling 22,256 adolescents. Twenty-seven different assessments of motor competence were used, with 31 studies utilising product-orientated (i.e. outcome) motor competence assessments. Meta-analyses of 43 studies showed that motor competence was positively associated with physical activity (r = 0.20 to 0.26), some physical fitness characteristics (e.g. muscular strength, cardiovascular endurance; r = 0.03 to 0.60) and psychosocial characteristics (r = 0.07 to 0.34), and inversely associated with weight status (r =  - 0.36 to - 0.10), speed (r =  - 0.31) and agility (r =  - 0.37 to 0.41). Associations with flexibility were unclear.

CONCLUSIONS

The results of this systematic review and meta-analysis support the hypothesised interactions of motor competence with physical activity (positive), physical fitness (positive except for weight status, speed and agility) and psychosocial characteristics (positive) in adolescence. However, methodological approaches vary considerably (e.g. variety of motor competence assessments utilised), with limitations of the current literature including an inadequate assessment of motor competence, a lack of longitudinal observations and a failure to account for biological maturation. Future research assessing associations between motor competence and physical activity, physical fitness and psychosocial characteristics of adolescents should include longitudinal observations of a combined motor competence assessment (i.e. process and product) and account for biological maturation. Improved evaluation using these recommendations could provide more accurate data, leading to more targeted interventions to improve adolescents' physical and psychosocial outcomes.

CLINICAL TRIAL REGISTRATION

CRD42021233441 (PROSPERO ID).

Relationship between perceived competence and performance during real and virtual motor tasks by children with developmental coordination disorder

PURPOSE

(i) To compare children with DCD and typically developing participants via standard motor assessments, two interactive virtual games, measures of physical, social and cognitive self-competence and feedback while playing the virtual games and (ii) To examine the contribution of age and each motor assessment to predict self-competence.

METHODS

Participants were 25 boys with DCD and 25 typically developing boys, aged 5-9 years. They completed the M-ABC-2, the Pictorial Scale of Perceived Competence, the 6-Minute Walk Test, and then played the two Kinect games and completed the Short Feedback Questionnaire for Children.

RESULTS

Children with DCD showed lower physical competence and lower performance than the typical controls in all standard motor assessments. This performance significantly correlated with the children achievements in part of virtual games and with their self-perceived experience while performing within virtual environments. Among the DCD group, Kinect Running game significantly predicted physical and social competence.

CONCLUSIONS

The significant correlations between the virtual games and standard motor assessments support the feasibility of using these games when evaluating children with DCD for the richer profile they provide. Implications for rehabilitation Clinicians should refer to the impacts of DCD on child's self-competence and daily life. Technological rehabilitation and the use of VR games have the potential to improve self-competence of children with DCD. By including VR games that simulate real life in the intervention for DCD, clinicians may raise child's enjoyment, self-competence and involvement in therapy.

The relationship between children's motor proficiency and health-related fitness

AIMS

The overall purpose of this study was to examine the relationship between motor proficiency and health-related fitness in children. In addition, the study aimed to determine if particular combinations of motor skills have a stronger relationship with individual health-related fitness measures.

METHODS

Seventy-seven children (F:28, M:49) (mean age: 11.19 ± 2.74 years) participated in this prospective cohort study. Physical measures included the following: motor proficiency (Bruininks-Oseretsky Test of Motor Proficiency, Second Edition), body mass index (BMI), waist circumference, blood pressure, heart rate and VO(2) peak (mL/kg/min).

RESULTS

After factoring in age, motor proficiency as a combined total score had a strong negative relationship with the health-related fitness measures of BMI (r (2)  = 0.62, P < 0.001) and waist circumference (r (2)  = 0.72, P < 0.001) and a strong positive relationship with VO2 peak (r (2)  = 0.78, P = 0.002). Children with lower motor proficiency (≤25th percentile) had a significantly larger mean waist circumference (M = 13.85 cm, 95% confidence interval (CI) (2.05, 25.66), P = 0.01), heavier weight (M = 22.17 kg, 95% CI (2.44, 41.91), P = 0.02) and higher BMI (M = 5.10 kg/m(2) , 95% CI (0.33, 9.87), P = 0.03) than children with higher motor proficiency (≤75th percentile).

CONCLUSIONS

Motor proficiency, once corrected for age, is significantly related to a number of health-related measures in children and should therefore be considered a focus for investigation for children with poor health-related fitness (e.g. high BMI and waist circumference percentiles or low cardiorespiratory fitness), as motor incompetence could be an underlying contributing factor to a child's poor physical health.

Motor Skill Development in Italian Pre-School Children Induced by Structured Activities in a Specific Playground

This study examined the effects and specificity of structured and unstructured activities played at the playground Primo Sport 0246 in Northern Italy on motor skill competence in five years old children. The playground was specifically designed to promote gross motor skills in preschool children; in this study 71 children from local kindergartens came to the park once a week for ten consecutive weeks and were exposed to 30 minutes of free play and 30 minutes of structured activities. Before and after the ten visits, each child completed nine tests to assess levels of motor skills, three for fine-motor skills and six for gross-motor skills. As control, motor skills were also assessed on 39 children from different kindergartens who did not come to the park. The results show that the experimental group who practiced gross-motor activities in the playground for 1 hour a week for 10 weeks improved significantly in 4 out of the 6 gross motor tasks and in none of the fine motor tasks. The data indicate that limited transfer occurred between tasks referring to different domains of motor competences while suggesting cross feeding for improvement of gross-motor skills between different exercises when domains related to physical fitness and strength of specific muscle groups are involved. These results are relevant to the issue of condition(s) appropriate for maintaining and developing motor skills in this age group as well as for the planning, organization and implementation of play and physical activities in kindergartens.

The effects of 8 weeks of motor skill training on cardiorespiratory fitness and endurance performance in children with developmental coordination disorder

Interventions based on everyday motor skills have been developed to be effective in children with developmental coordination disorder (DCD). The purpose of the present study was to examine the effects of motor skill training on exercise tolerance and cardiorespiratory fitness in children with DCD. Children were assigned to 3 groups: an experimental training group comprising 14 children with DCD, a control nontraining group comprising 13 children with DCD, and a control nontraining group comprising 14 typically developed children. All participants were tested twice with an interval of 8-weeks on a cardiopulmonary exercise test, pulmonary function testing, and a 6-min walk test. After the training program the maximal power output was significantly increased for DCD group at anaerobic threshold (p < 0.05) and at peak level (maximal oxygen uptake, p < 0.001). Improvement in power output was more pronounced at the anaerobic threshold (t (13) = −5.21, p < 0.001) than at the maximal intensity (maximal oxygen uptake, t (13) = −3.08, p < 0.01) in the DCD training group. Children with DCD that participated in the training program improved their walking distance (t (13) = −9.08, p < 0.001), had a higher maximum heart rate (t (13) = −3.41, p < 0.01), and reduced perceived exertion (t (13) = 2.75, p < 0.05). The DCD nontraining group and the typically developed group did not change on any of the measures. In conclusion, training delayed reaching the anaerobic threshold and improved aerobic endurance and exercise tolerance in children with DCD.

Assessment of physical fitness and exercise tolerance in children with developmental coordination disorder

Children with developmental coordination disorder (DCD) have been shown to be less physically fit when compared to their typically developing peers. The purpose of the present study was to examine the relationships among body composition, physical fitness and exercise tolerance in children with and without DCD. Thirty-seven children between the ages of 7 and 9 years participated in this study. Participants were classified according to results obtained on the Movement Assessment Battery for Children (MABC) and were divided in 2 groups: 19 children with DCD and 18 children without DCD. All children performed the following physical fitness tests: The five-jump test (5JT), the triple-hop distance (THD) and the modified agility test (MAT). Walking distance was assessed using the 6-min walking test (6MWT). Children with DCD showed higher scores than children without DCD in all MABC subscale scores, as well as in the total score (p<0.001). Participants with DCD were found to perform significantly worse on the MAT (p<0.001), the THD (p<0.001) and 5JT (p<0.05). Moreover, children with DCD had poorer performance on the 6MWT than children without DCD (p<0.01). Our results found significant correlations among body mass index (BMI), THD (r=0.553, p<0.05), 5JT (r=0.480, p<0.05) and 6MWT (r=0.544, p<0.05) only in DCD group. A significant correlation between MAT and 5JT (r=-0.493, p<0.05) was found. Similarly, THD and 5JT (r=0.611, p<0.01) was found to be correlated in children with DCD. We also found relationships among 6MWT and MAT (r=-0.522, p<0.05) and the 6MWT and 5JT (r=0.472, p<0.05) in DCD group. In addition, we found gender specific patterns in the relationship between exercise tolerance, explosive strength, power, DCD, and BMI. In conclusion, the present study revealed that BMI was indicative of poorer explosive strength, power and exercise tolerance in children with DCD compared to children without DCD probably due to a limited coordination on motor control.

Motor competence and physical fitness in adolescents

PURPOSE

In this study we examined the relationship between physical fitness and motor competence in adolescents aged 15 to 16 years.

METHODS

A sample of 94 adolescents participated in the study. To test motor competence, the Movement Assessment Battery for Children-2 was used. Physical fitness was assessed using the following test items: standing broad jump, 20-m dash, reduced Cooper test, and sit-and-reach test.

RESULTS

The results revealed a significant but weak relationship (0.248) between motor competence and physical fitness for the whole sample. More specifically, the correlation between the 2 variables was significant for girls (0.353) but not for boys (0.248).

CONCLUSIONS

The relatively weak relationship between motor competence and physical fitness suggests that motor competence might not be critical in adolescents to maintain their physical fitness.

Crianças com dificuldades motoras apresentam baixos níveis de aptidão física?

O presente estudo tem como objetivo analisar se crianças com dificuldades motoras apresentariam baixos níveis de aptidão física relacionada à saúde em relação aos seus pares sem dificuldades. Dezesseis crianças com dificuldades motoras com aproximadamente oito anos foram pareadas em gênero e idade com outras 16 sem dificuldades motoras. Os participantes completaram os testes de aptidão física (sentar e alcançar, salto em distância parado, puxada em suspensão na barra modificado, abdominal e corrida de 9 minutos) e os de coordenação motora (MABC-2). Os resultados indicaram diferenças significativas no salto em distância parado, puxada em suspensão na barra modificado, abdominal, mas não para sentar e alcançar e corrida de 9-m. Os resultados são semelhantes aos publicados na literatura internacional, com exceção da corrida de 9 minutos. A ideia de que em algum grau a coordenação é necessária para executar tarefas de aptidão física e pode impactar no desempenho da aptidão física é discutida no presente trabalho.

The relationship between motor competence, physical fitness and self-perception in children

AIM

The aim of the current research was to explore the relationship between motor competence, physical fitness and self-perception, and to study to which extent this relationship may vary by gender.

METHODS

A sample of 67 children (mean age 11.46 years, SD 0.27) completed Harter's Self-Perception Profile for Children (SPPC), the Movement Assessment Battery for Children (MABC) and the Test of Physical Fitness (TPF) to assess self-perception, motor competence and physical fitness.

RESULTS

The SPPC was stronger related to total score on TPF than to total score on MABC. However, when looking at boys and girls separately, this result was found for the boys only. In the group in general, total scores on both TPF and MABC correlated significantly with three of the domains of SPPC (social acceptance, athletic competence and physical appearance) and general self-worth. This relationship varied by gender. Interestingly, TPF was highest correlated with perception of athletic competence in boys but with perception of social acceptance in girls. A high and significant correlation was found between physical fitness and motor competence for both genders.

CONCLUSION

The results indicated a strong relationship between physical fitness, motor competence and self-perception in children that varied by gender. This implies that all these factors are essential contributions in order to facilitate participation in physical activity in children.

A prospective cohort study comparing workload in children with and without developmental coordination disorder

The purpose of this prospective cohort study was to assess how cardiorespiratory fitness (CRF) of children with probable developmental coordination disorder (DCD) changes over a period of 4.7 years relative to a group of typically developing controls. A school-based sample of children in a large region of Ontario, Canada with 75 out of a possible 92 schools consented to participate. Children enrolled in Grade 4 (mean = 9.9 years, SD = 0.35) at baseline (n = 2278) were followed over the course of 56 months. A total of eight waves of data collection were carried out throughout the study period. The short form of the Bruininks-Oseretsky test of motor proficiency was used to identify children with probable DCD and the maximal speed attained on the Léger 20-m shuttle run to measure CRF. Mixed-effects modeling was used to estimate the change over time in maximal Leger run speed for both groups adjusting for relevant covariates (e.g., gender, BMI, school, activity level, predilection for activity). Children with pDCD had consistently lower maximal run speed relative to controls. The trajectories of run speed in children with probable DCD and those without the disorder differed by gender with pDCD females demonstrating the lowest scores over time. Both genders with probable DCD showed a greater rate of decline in CRF over time relative to the controls. In conclusion, the difference in CRF between children with and without probable DCD is substantial, and it tends to increase over time. This adds to the argument suggesting that interventions intended to improve CRF may be appropriate and necessary for children with motor difficulties.

Physical activity and fitness in children with developmental coordination disorder: a systematic review

Developmental coordination disorder (DCD) is a neurodevelopmental condition characterized by poor motor proficiency that interferes with a child's activities of daily living. Activities that most young children engage in such as running, walking, and jumping are important for the proper development of fitness and overall health. However, children with DCD usually find these activities challenging. A systematic review of the literature was conducted to synthesize the recent available data on fitness and physical activity in children with DCD, and to understand the extent of the differences between children with DCD and their typically developing peers. Systematic searches of electronic databases and reference lists identified 40 peer-reviewed studies meeting the inclusion criteria. These studies were reviewed in terms of: (a) study design, (b) population, (c) assessment tools, (d) measures, and (e) fitness and physical activity outcomes. It has been demonstrated that body composition, cardiorespiratory fitness, muscle strength and endurance, anaerobic capacity, power, and physical activity have all been negatively associated, to various degrees, with poor motor proficiency. However, differences in flexibility were not conclusive as the results on this parameter are mixed. Studies' limitations and the impact of results on future work are discussed.

Assessment of body composition using whole body air-displacement plethysmography in children with and without developmental coordination disorder

Developmental coordination disorder (DCD) is a neuro-developmental disorder characterized by poor fine and/or gross motor coordination. Children with DCD are hypothesized to be at increased risk for overweight and obesity from inactivity due to their motor coordination problems. Although previous studies have found evidence to support this hypothesis, their reliance on field-based measures, most notably body mass index (BMI), to determine body composition is problematic. Moreover, there has been no research to date that has examined whether THERE ARE differences in lean tissue mass between children with and without coordination. Differences in muscle mass, the main component of lean tissue, may be a contributing factor to both coordination problems and the development of overweight and obesity, but has only been indirectly examined at this time. In this study, whole-body air displacement using a dual chamber plethysmograph was used to estimate fat mass, fat free mass and body fat in children with probable DCD (pDCD) and a group of typically developing children. Consistent with previous research using field-based assessments of relative body weight, the results show that children with pDCD have much higher body fat than their peers, and that this difference increases with the severity of observed motor coordination difficulties. There was no difference in lean tissue mass between groups. The demonstration of an association between pDCD and body fat using a more sensitive measure of body composition, and evidence showing a dose-response in this relationship, further supports the hypothesis that DCD may be a risk factor for obesity in children.

Comparison of VO2 maximum obtained from 20 m shuttle run and cycle ergometer in children with and without developmental coordination disorder

Oxygen consumption at peak physical exertion (VO(2) maximum) is the most widely used indicator of cardiorespiratory fitness. The purpose of this study was to compare two protocols for its estimation, cycle ergometer testing and the 20 m shuttle run, among children with and without probable developmental coordination disorder (pDCD). The shuttle run test was conducted during regular school hours, usually in the gymnasium. Children were then invited to a lab to complete the cycle ergometer protocol. Children were categorized as possible cases of DCD using the Movement-ABC-2. The analysis was performed using cut-points at both the 5th (n=38) and 15th (n=51) percentiles. The average age of children in the study was 12 years (SD=0.5). Children with pDCD had poorer VO(2) maximum when compared to typically developing children based on both the shuttle run and the cycle ergometer. The correlation between tests is in the moderate to high range (r=0.71, p<0.001); 0.78 for girls, and 0.73 for boys. The overall difference in correlations between typically developing children and children with pDCD based on the 15th percentile was 0.12 (p=0.27). For children with pDCD based on the 5th percentile however, the difference between groups was larger (difference in r=0.25), and was statistically significant (p=0.02). In multivariate analyses, there was no difference in the effect of the shuttle run results in predicting VO(2) maximum obtained through the cycle ergometer test for children with pDCD compared to those without the condition. Regardless of the test, the patterns of association between children with pDCD and typically developing children were the same reinforcing the findings of previous field-based reports. Moderate to good correlations, at the 15th percentile cut-point, between tests suggests that the shuttle run test is a reliable substitute in this population when lab based assessments of VO(2) maximum are not feasible.

Physical fitness in children with high motor competence is different from that in children with low motor competence

BACKGROUND

Physical therapists often treat children with low motor competence. Earlier studies have demonstrated poor physical fitness outcomes and a reduced level of physical activity for these children compared with their peers with normal motor skills.

OBJECTIVE

The aim of this study was to examine how physical fitness developed over time in 2 groups of children: those with a low level of competence in motor skills (low motor competence [LMC]), and those with a high level of competence in motor skills (high motor competence [HMC]).

DESIGN AND METHODS

From an initial sample of 67 children, a group of 18 was identified as having HMC or LMC on the Movement Assessment Battery for Children and was selected for the present study. Eight children (3 girls and 5 boys) comprised the LMC group, and 10 children (4 girls and 6 boys) made up the HMC group. A longitudinal design was implemented, and physical fitness in the 2 groups was evaluated by measuring different fitness components over a period of 32 months.

RESULTS

A mixed-effects analysis of variance revealed significant main effects for group and for time but no group x time interaction effect. The LMC group performed less well on all physical fitness measures than the HMC group, and both groups scored significantly higher on the physical fitness test after a period of 32 months. The lack of a significant interaction effect indicated that the relative differences in physical fitness outcomes between the groups were relatively constant over time.

LIMITATIONS

This study was limited by the small sample size and lack of assessment of anthropometric variables and children's perceived self-efficacy.

CONCLUSIONS

Children with LMC are likely to have poor physical fitness compared with children with HMC. The differences in physical fitness outcomes between the groups were relatively constant over time. Given that various physical fitness components are linked to different health outcomes, these consequences are matters of concern for both current health status and later health status in children with LMC.