International Journal of Pediatric Obesity, 2011; 6(S2): 42–46
ORIGINAL ARTICLE
Gross motor skill performance in a sample of overweight and non-overweight preschool children
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MILENA MORANO1,2, DARIO COLELLA1 & MARGHERITA CAROLI3 1Department
of Biomedical Sciences, University of Foggia, Foggia, Italy, 2Department of Human Movement and Sport Science, University Foro Italico, Rome, Italy, 3Unit of Nutrition, Department of Prevention, ASL Brindisi, Italy
Abstract Objective. The aim of the study was to examine the gross motor skill performance of overweight and non-overweight preschool children from South of Italy, and to investigate possible differences by gender. Methods. Participants were 38 boys and 42 girls (4.5 ⫾ 0.5 yr) categorized as overweight (n ⫽ 38) and non-overweight (n ⫽ 42), according to the IOTF body mass index (BMI) cut-off points. The Test of Gross Motor Development was used to assess seven locomotor skills (run, gallop, hop, leap, horizontal jump, skip and slide) and five object-control skills (two-hand strike, stationary bounce, catch, kick and overhand throw). The raw, standard and percentile scores and the Gross Motor Development Quotient (GMDQ) were calculated for each participant. ANOVA 2 (gender) x 2 (group) was conducted on the subtest standard scores and the GMDQ. Results. No differences in performance were found between boys and girls on the subscale standard scores and the GMDQ. Significant main effects (p ⬍ 0.001) were reported for group on the GMDQ, and the standard scores for locomotor and object-control skills, with overweight children reporting lower movement competence than their counterparts. Pearson’s correlations revealed relationships (p ⬍ 0.001) between BMI and locomotor (r ⫽⫺0.54) and object-control (r ⫽ ⫺0.48) skills, and between BMI and GMDQ (r ⫽ ⫺0.54). Conclusions. Findings indicate that childhood obesity might have adverse effects on gross motor development. Overweight participants showed poorer performance on locomotor and object-control tasks than their non-overweight peers. Interventions to promote physical activity in overweight children should be directed towards achieving a healthy weight and motor skill improvement. Key words: Fundamental motor skills, physical activity, childhood obesity, gross motor development
Introduction Over the past three decades, pediatric obesity has increased significantly with many negative short- and long-term health consequences (1). Research findings suggest that involvement in physical activity is a protective factor against the development of obesity (2) and a prerequisite to movement skill and achievement of physical fitness as well as its maintenance (3). Correlational studies showed that children with higher levels of physical activity have better motor skills (4–6), suggesting that gross motor development could be considered an important health correlate. However, despite the observed prevalence of childhood obesity and its inverse relationship to physical activity (7), little is known about the association between body mass index (BMI) and development of gross motor skills in preschool-age children.
Gross motor development can be defined as the gradual acquisition of skillful use of the total body in large muscle activities that require temporal and spacial coordination of movement of a number of body segments simultaneously (8). During the preschool years, most children acquire a repertoire of motor behaviours also known as “fundamental motor skills” (FMS), which in turn provide the basis for acquisition of future complex skills where greater emphasis can be placed on the health, fitness and behavioral components of physical activities (9). FMS are commonly considered the building blocks for more advanced lifetime movement skills, and are contingent upon the child’s acquiring an adequate base of motor development (10–12). Findings suggest that motor development delays frequently accompany childhood obesity condition,
Correspondence: Milena Morano, Università di Foggia, Scienze delle Attività Motorie e Sportive, Viale Virgilio, Quartiere CEP, 71100 Foggia, Italy. Tel: (⫹39)0881309337. Fax: (⫹39)0881309346. E-mail:
[email protected] ISSN Print 1747-7166 ISSN Online 1747-7174 © 2011 Informa Healthcare DOI: 10.3109/17477166.2011.613665
Gross motor skills in children and the BMI is negatively related to FMS (13,14). However, previous studies of whether obesity is associated with impaired motor development have focused largely on children of elementary school age (13,14), and research on preschoolers has been limited (15,16). Thus, the aim of the present investigation was to examine the relationship between BMI and gross motor performance in a sample of preschool boys and girls. It was hypothesized that overweight participants would display lower gross motor skill development than their non-overweight peers.
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Methods Participants A total of 80 children were recruited to participate in this pilot study, which arose from the PERISCOPE (Pilot European Regional Interventions for Smart Childhood Obesity Prevention in Early Age) project, aimed at preventing obesity between 3 and 6 years of age via a multi-component approach (17). Participants were 38 boys and 42 girls aged 4 to 5 years (4.5 ⫾ 0.5 yr), selected from two kindergartens located in a southeast region of Italy. Before assessment, informed written consent was obtained from the parents or guardians of children.
Anthropometric evaluation Body weight to the nearest 0.1 kg and standing height to the nearest 0.1 cm were determined using a balance scale (Seca 761, GmbH & Co., Hamburg, Germany) and a portable stadiometer (Seca 220, GmbH & Co., Hamburg, Germany), respectively. Measurements were taken by a trained staff, with the child wearing only underwear and no shoes. The height and mass measures were used to calculate the participant’s BMI (kg/m2), which is recommended for use in preschool children (18). Weight status was classified using the age- and gender-specific cut-off points of the International Obesity Task Force (IOTF) (19).
Evaluation of the gross motor performance Fundamental motor skill competence was assessed using the Test of Gross Motor Development (TGMD) (20), which consists of 12 items divided into locomotor (run, gallop, hop, leap, horizontal jump, skip and slide) and object-control (two-hand strike, stationary bounce, catch, kick and overhand throw) subtests. The locomotor and object-control skills are assumed to represent different aspects of the child’s ability to transfer own center of gravity from one point to
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another, and to project and receive objects, respectively. The test subject’s score for any skill is assessed as pass/fail (1 or 0) for each of three or four behavioral criteria, which qualitatively describe performance. The sum of all performance criteria across all skills within a subtest produces the raw score for each subtest. Higher scores indicate a better quality of movement patterns. Using norm tables, subtest standard scores, percentiles, and an overall Gross Motor Development Quotient (GMQD) can be obtained to determine a child’s gross motor skill performance compared to the test’s standardized population (20). Subtest standard scores and the GMQD are described as very superior, superior, above average, average, below average, poor and very poor (20). The TGMD was standardized on a normative sample of 909 children aged 3 to 10 years, living in eight states and stratified by gender, race, community size and geographical area (21). It is a reliable and valid measure of fundamental motor skill performance for preschool-aged children (21,22). The TGMD was individually administered to each participant by a trained research assistant. A verbal description of the test was followed by motor performance modeling. For each item children were required to demonstrate proficiency on two of three trials. In order to assure measurement consistency, the presence or absence of established performance criteria were observed and scored by the same tester. Test administration took approximately 15–20 min per child, and followed the standardized protocol (20).
Data Analyses Using the TGMD norm tables based on age (20), locomotor and object control raw scores were converted to subtest standard scores and percentiles for each participant; individual subtest standard scores were used to determine the GMQD. A 2 (gender) ⫻2 (group: non-overweight vs overweight) analysis of variance (ANOVA) was applied for both subtest standard scores and the GMDQ. Pearson’s productmoment correlations (r) were calculated between BMI and standard scores in both subtests, and between BMI and the GMQD. Data analysis was undertaken using the Statistical Package for the Social Science, version 17 (SPSS, Chicago, IL). Statistical significance was set at p ⬍ 0.05.
Results According to BMI cut-offs (19), 21 males and 21 females were identified as non-overweight (52.5%), 11 males and 14 females as overweight (31.25%), and 7 males and 6 females as obese (16.25%). Because
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Table I. Anthropometric characteristics of the participants. Boys (n ⫽ 38) Variable Height (cm) Weight (Kg) BMI (Kg/m2)
Girls (n ⫽ 42)
Group
Mean ⫾ SD
Min–Max
Mean ⫾ SD
Min–Max
NW OW NW OW NW OW
103.5 ⫾ 3.7 108.9 ⫾ 6.2 17.1 ⫾ 1.7 21.9 ⫾ 2.1 15.9 ⫾ 0.9 18.4 ⫾ 0.8
100.0⫺114.5 102.0⫺122.0 15.0⫺21.4 20.0⫺26.0 14.0⫺17.0 17.5⫺20.1
104.8 ⫾ 4.5 112.5 ⫾ 6.5 16.6 ⫾ 2.0 23.7 ⫾ 3.9 15.0 ⫾ 1.0 18.6 ⫾ 1.2
100.0⫺113.9 101.0⫺122.0 14.0⫺20.9 17.8⫺30.0 13.5⫺17.1 17.2⫺20.5
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SD: standard deviation; Min–Max: range; NW: non-overweight; OW: overweight
of the small sample size, overweight and obese children were included in a single group of overweight participants. Table I shows the anthropometric characteristics of the two groups. The TGMD raw, standard and percentile scores for locomotor and object-control skills are reported in Table II. No differences in performance were found between boys and girls on both subscales and the GMDQ. Significant main effects (p ⬍ 0.0001) were reported for group on the subtest standard scores (both F1,76 ⫽ 23.5, η2 ⫽ 0.2), with overweight children reporting lower movement competence on the locomotor (10.3 ⫾ 3.8 vs 13.9 ⫾ 2.6) and object-control (12.6 ⫾ 3.6 vs 15.8 ⫾ 2.1) skills than their counterparts. Consequently, they showed significantly (F1,76 ⫽ 26.6, p ⬍ 0.001, η2 ⫽ 0.3) a lower GMDQ mean (108.5 ⫾ 20.7 vs 129.1 ⫾ 13.7). According to the TGMD performance descriptors for subtest standard scores, non-overweight children would be not placed in the poor and very poor categories, contrarily to overweight participants (Figures 1 and 2). BMI was negatively related (p ⬍ 0.001) to the GMDQ (r ⫽ ⫺0.54), and the locomotor (r ⫽ ⫺0.54) and object-control (r ⫽ ⫺0.48) subtests.
Discussion This study examined the gross motor performance of overweight and non-overweight preschool boys and girls. As hypothesized, findings showed that overweight participants reported poorer performance on locomotor and object-control tasks than their leaner peers.Furthermore, increased BMI was correlated with poorer results in gross motor development, and no gender differences were found in the FMS, which contradicts previous studies (23,16). FMS has been previously related to body composition in preschool children; skinfold thickness was negatively associated with an index of balance, catch and jump for boys (24). However, Ellery (23) found no relationship between skinfold thickness and gross motor skill performance among young children. This discrepancy might be attributable to the differences in assessment techniques and in the number of movement skills assessed. In fact, these latter two studies assessed only a small number of FMS, and do not explain the extent to which gross motor performance differs in overweight and non-overweight children. Because the present investigation assessed a broader range of skills using process-oriented techniques and
Table II. Descriptive statistics of the TGMD scores by gender and weight status. Boys (n ⫽ 38) Variable Locomotor skills
Scores Raw Standard Percentile
Object control skills
Raw Standard Percentile
Girls (n ⫽ 42)
Group
Mean ⫾ SD
Min–Max
Mean ⫾ SD
Min–Max
NW OW NW OW NW OW
18.1 ⫾ 4.3 15.9 ⫾ 5.5 13.7 ⫾ 2.7 10.7 ⫾ 4.2 83.1 ⫾ 21.5 55.1 ⫾ 38.0
7⫺26 7⫺26 6⫺17 3⫺17 9⫺99 1⫺99
19.3 ⫾ 3.6 15.2 ⫾ 4.6 14.1 ⫾ 2.6 10.0 ⫾ 3.5 84.5 ⫾ 18.4 49.3 ⫾ 30.8
13⫺26 7⫺26 9⫺17 3⫺17 37⫺99 1⫺99
NW OW NW OW NW OW
12.0 ⫾ 3.2 10.6 ⫾ 4.4 16.1 ⫾ 1.7 13.2 ⫾ 3.5 96.3 ⫾ 5.0 76.2 ⫾ 29.6
7⫺18 3⫺17 13⫺19 6⫺19 84⫺99 9⫺99
11.8 ⫾ 3.2 9.2 ⫾ 3.8 15.5 ⫾ 2.5 12.1 ⫾ 3.6 91.9 ⫾ 11.2 68.1 ⫾ 30.8
7⫺18 2⫺16 11⫺19 5⫺18 63⫺99 5⫺99
SD: standard deviation; Min–Max: range; NW: non-overweight; OW: overweight
Gross motor skills in children Locomotor subtest standard scores (%) Very superior
5.3
Very superior
21.4 26.2 15.8
Above average
Poor
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Very poor
26.2 23.8
2.4 2.6 5.3
NW OW
Figure 1. Percentage of children achieving locomotor subtest standard scores, according to the TGMD performance descriptors. NW: non-overweight; OW: overweight; TGMD: Test of Gross Motor Development.
was conducted to examine the relationship between BMI and gross motor performance in preschool children, it further extends the previous findings. Although causality cannot be inferred from the data collected in this study, due to the cross-sectional design, findings confirm that childhood obesity might have adverse effects on gross motor skill development of preschoolers (15,16). However, obese children are generally considered to be less active than normal-weight peers (7). Therefore, the poor levels of FMS proficiency demonstrated by overweight participants might reflect the lack of physical activity experiences to support timely motor development. Harter (25) claimed that children’s motivation to participate in physical activity is influenced by their FMS proficiency, perception of competence, social support, and enjoyment of physical activity. One might speculate that moving a heavier body mass against gravity, in addition to poor perceived physical and social competence, may decrease the motivation of overweight children to be involved in physical activity programmes, which in turn negatively influences their gross motor skill performance. Many studies (4–6,24) found a significant but weak correlation between physical activity and FMS in preschool children, suggesting that increased activity provides more opportunities to promote neuromotor development, which in turn promotes gross motor development. In addition, Stodden et al. (26) argue that the association between physical activity and the development of motor skill competence is mediated by other factors including perceived skillfulness, physical fitness and obesity. In this perspective, it is paramount that opportunities and encouragement be provided for overweight children to develop their FMS in order to promote engagement and persistence in physical activity. Successful motor experiences, measured in terms of increased gross motor proficiency, are expected to enhance perceived motor skill competence, which
9.5 7.9
Below average Poor
28.6
39.5
Average
18.4
45.2
18.4 16.7
Above average
42.1
Average Below average
13.2
Superior
10.5
Superior
Object-control subtest standard scores (%) 18.4
45
2.6
NW OW
Very poor
Figure 2. Percentage of children achieving object-control subtest standard scores, according to the TGMD performance descriptors. NW: non-overweight; OW: overweight; TGMD: Test of Gross Motor Development.
might influence the relationship between physical activity and the development of actual motor skill competence over time. Furthermore, as suggested (14), intervention strategies focusing on the increased FMS might be also a key component to prevent “unhealthy” weight gain in children. Longitudinal studies should be designed to examine the relationship among perceived and actual motor skill competence, obesity and physical activity in early childhood, in order to inform the design and delivery of intervention programmes in helping overweight children establish lifelong physical activity patterns. Acknowledgements This study arises from the PERISCOPE (Pilot European Regional Interventions for Smart Childhood Obesity Prevention in Early Age) project, which has received funding from the European Union, in the framework of the Public Health Programme (Agreement number 2006341). We thank Dr Fausto Cino for assisting with the data collection. We also express our gratitude to the preschool directors, teachers, children and their families for making this study possible. Declaration of interest: All authors declare that they have no conflict of interest and that they have no competing interests.The authors alone are responsible for the content and writing of the paper. References 1. de Onis M, Blössner M. Prevalence and trends of overweight among preschool children in developing countries. Am J Clin Nutr. 2000;72:1032–9. 2. Maffeis C, Castellani M. Physical activity: an effective way to control weight in children? Nutr Metab Cardiovasc Dis. 2007;17(5):394–408.
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3. Marshall JD, Bouffard M. The effects of quality daily physical education on movement competency in obese versus nonobese children. Adapt Phys Act Q. 1997;14:222–37. 4. Butcher JE, Eaton WO. Gross and fine motor proficiency in preschoolers: Relationships with free play behavior and activity level. J Hum Mov Stud. 1989;16:27–36. 5. Sääkslahti A, Numminen P, Niinikoski H et al. Is physical activity related to body size, fundamental motor skills, and CHD risk factors in early childhood? Pediatr Exerc Sci. 1999;11:327–40. 6. Fisher A, Reilly JJ, Kelly LA et al. Fundamental movement skills and habitual physical activity in young children. Med Sci Sports Exerc. 2005;37:684–8. 7. Trost SG, Sirard JR, Dowda M et al. Physical activity in overweight and nonoverweight preschool children. Int J Obes Relat Metab Disord. 2003;27(7):834–9. 8. Williams HG. Perceptual and motor development. Englewood Cliffs, NJ: Prentice Hall; 1983. 9. Malina RM. Fitness and performance: adult health and the culture of youth, new paradigms? In: Park RJ, Eckert MH, editors. New possibilities, new paradigms? (American Academy of Physical Education Papers No. 24). Champaign, IL: Human Kinetics; 1991, p. 30–38. 10. Gabbard CP. Lifelong motor development (3rd ed.). Madison Dubuque, IA: Brown & Benchmark; 2000. 11. National Association for Sport and Physical Education. Active Start: A Statement of Physical Activity Guidelines for Children Birth to Five Years. Reston, VA: NASPE; 2002. 12. Williams HG, Monsma EV. Assessment of gross motor development. In: Bracken BA, Nagle RJ, editors. Psychoeducational assessment of preschool children (4th ed). Mahwah, NJ: Lawrence Erlbarum Associates; 2007, p. 397–434. 13. Graf C, Koch B, Kretschmann-Kandel E et al. Correlation between BMI, leisure habits and motor abilities in childhood (CHILT-Project). Int J Obes Relat Metab Disord. 2004; 28:22–6. 14. Okely AD, Booth ML, Chey T. Relationship between body composition and fundamental movement skills among
15.
16.
17.
18.
19.
20. 21. 22. 23.
24.
25. 26.
children and adolescents. Res Q Exerc Sport. 2004;75(3): 238–47. Du Toit D, Pienaar AE. Overweight and obesity and motor proficiency of 3- and 4-year old children. SAJR SPER. 2003;25(2):37–48. Mond JM, Stich H, Hay PJ et al. Associations between obesity and developmental functioning in pre-school children: a population-based study. Int J Obes (Lond). 2007;31(7):1068–73. Pilot European Regional Interventions for Smart Childhood Obesity Prevention in Early Age (PERISCOPE). http:// www.periscopeproject.eu. World Health Organization. WHO child growth standards: length/height-for-age, weight-for-age, weight-for-length, weight-for-height, and body mass index-for-age. Methods and development. Geneva: WHO; 2006. (http://www.who. int/childgrowth/standards/technical_report/en/index.html) Cole TJ, Bellizzi MB, Flegal MK et al. Establishing a standard definition for child overweight and obesity worldwide: international survey. BMJ. 2000;320:1240–3. Ulrich DA. TGM. Test di valutazione delle abilità grossomotorie. Trento: Edizioni Erickson; 1992. Ulrich DA. Test of Gross Motor Development. Austin, TX: PRO-ED; 1985. Langendorfer S. Review of the Test of Gross Motor Development. Adapt Phys Act Q. 1986;3:186–90. Ellery PJ. The relationship between gross motor skill performance and skinfold thickness, physical activity instruction, age, gender, and parental income in preschool age children. Diss Abstr Int. 1991;52(9):3216. McKenzie TL, Sallis JF, Broyles SL et al. Childhood movement skills: predictors of physical activity in Anglo American and Mexican American adolescents? Res Q Exerc Sport. 2002;73(3):238–44. Harter S. Effectance motivation reconsidered: toward a developmental model. Hum Dev. 1978;21:34–64. Stodden DF, Goodway JD, Langendorfer SJ et al. A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship. Quest. 2008; 60:290–306.
