children are less likely to access the range of physical activity options available to establish an active lifestyle (Bouffard et al., 1996; Lubans et al., 2010; Stodden ...
Adapted Physical Activity Quarterly, 2014, 31, 67-78 http://dx.doi.org/10.1123/apaq.2013-0048 © 2014 Human Kinetics, Inc.
Long-Term Importance of Fundamental Motor Skills: A 20-Year Follow-Up Study Meghann Lloyd University of Ontario Institute of Technology
Travis J. Saunders Children’s Hospital of Eastern Ontario Research Institute, Healthy Active Living and Obesity Research Group University of Ottawa
Emily Bremer University of Ontario Institute of Technology
Mark S. Tremblay Children’s Hospital of Eastern Ontario Research Institute, Healthy Active Living and Obesity Research Group University of Ottawa The purpose of this study was to investigate the potential long-term association of motor skill proficiency at 6 years of age and self-reported physical activity (PA) at age 26. Direct motor performance data were collected in 1991 with a follow-up study occurring in 1996, and then indirect questionnaires (self-report) administered in 2001 and 2011. In 2011, 17 participants who were identified as either having high motor proficiency (HMP) or low motor proficiency (LMP) in 1991 completed a series of 4 questionnaires. Analyses were conducted to determine whether there were differences between groups for motor skill proficiency, PA, or sedentary behavior, and whether these outcomes were related across ages. Motor skill proficiency at age 6 was related to self-reported proficiency at age 16 (r = .77, p = .006), and self-reported proficiency between 16 and 26 years (r = .85, p = .001). Motor skill proficiency at age 6 was positively associated with leisure time PA at age 26 in females and participants in the HMP group. The results may provide preliminary evidence about the importance of how early motor skill proficiency relates to long-term PA. More research with larger sample sizes is needed to investigate the importance of motor skills over time. Keywords: movement difficulties, fundamental movement skills, physical activity, children, adults, mixed longitudinal sample Meghann Lloyd and Emily Bremer are in the Faculty of Health Sciences at the University of Ontario Institute of Technology. Travis J. Saunders and Mark S. Tremblay are with the Children’s Hospital of Eastern Ontario Research Institute and the Faculty of Health Sciences at the University of Ottawa. 67
68 Lloyd et al.
Fundamental movement skills are the foundation movements, or precursor patterns, to more specialized, complex skills in games, sports, dance, and recreational activities (Bouffard, Watkinson, Thompson, Causgrove Dunn, & Romanow, 1996; Clark & Metcalfe, 2002; Lubans, Morgan, Cliff, Barnett, & Okely, 2010; Stodden et al., 2008). Without competence in locomotor skills such as running, jumping and hopping, and object control skills such as kicking, catching, and throwing, children are less likely to access the range of physical activity options available to establish an active lifestyle (Bouffard et al., 1996; Lubans et al., 2010; Stodden et al., 2008). Recent research has demonstrated positive cross-sectional relationships between fundamental movement skills and physical activity in children (Lubans et al., 2010). As the evidence documenting the importance of fundamental motor skills accumulates it is important to investigate the long-term consequences of ineffective or inefficient motor skills. Children with movement difficulties do not perform culturally normative motor skills with acceptable proficiency for one’s age and intellectual ability, and the difficulties are unrelated to any other known neurological motor impairment or intellectual disorder (American Psychiatric Association, 2000; Wall, 1982, 2004). Today, many children with movement difficulties are diagnosed with developmental coordination disorder (DCD); however, diagnostic criteria for DCD were only included in the DSM-IV-TR in 2000 (American Psychiatric Association, 2000). Therefore, we are referring to the population in this study as children with movement difficulties, not children with DCD, because the participants are based on a cohort originally identified in 1991. The consequences of ineffective motor skills during childhood are far-reaching and may have a significant impact on activity participation over the lifespan. Cairney and colleagues (2010) followed children with motor coordination difficulties for 3 years, and Hands (2008) followed young children with motor coordination difficulties for 5 years and they both concluded that low motor competence has a negative impact over time. What limited longitudinal research exists indicates that children with movement difficulties often do not grow out of these motor problems (Cousins & Smyth, 2003; Fitzpatrick & Watkinson, 2003; Missiuna, Moll, King, Stewart, & Macdonald, 2008). The literature on the childhood consequences of DCD are well established (Cairney, Hay, Faught, & Hawes, 2005; Missiuna et al., 2008); however, the long-term consequences into adulthood are less clear (Cousins & Smyth, 2003; Missiuna et al., 2008). Conducting longitudinal research on this population has been challenging due to the changing nature of the definition and identifying criteria over the past 30 years (American Psychiatric Association, 2000; Wall, 2004). To our knowledge, no studies have followed the same group of children with and without movement difficulties as they transition from childhood through adolescence into adulthood. Other studies have examined the development of motor skills over time; however, this is the first with a specifically identified group of children with movement difficulties, as well as the first to assess physical activity levels in adulthood (Branta, Haubenstricker, & Seefeldt, 1984). Longitudinal studies that track the relationship between physical activity and motor proficiency from childhood into adulthood are needed in the published literature. Thus, the purpose of this study was to investigate the potential long-term association of motor skill proficiency at age 6 and selfreported physical activity at age 26 in a mixed longitudinal cohort.
Long-Term Importance of Fundamental Motor Skills 69
Method Procedural History In 1991, the Test of Gross Motor Development (TGMD; Ulrich, 1985) was administered to 699 first-grade children. Results of this screening were used to identify two groups of children: a low motor proficiency (LMP) group which scored ≤ 10th percentile (poor or very poor motor skill classification in the TGMD manual) and a high motor proficiency (HMP) group which scored ≥ 84th percentile (above average, superior and very superior classifications in the TGMD manual; Ulrich, 1985). The TGMD was one of the only normed and valid motor skill assessments at the time; it is also one of the most widely used tests in both physical education and research. Therefore, identifying the lowest 10% and the highest 15% on the TGMD was an appropriate way to identify those with LMP and HMP at the time (Ulrich, 1985). After screening, written parental consent was received for further study on 43 children in the LMP group and 57 children in the HMP group (Deschenes, 1994). Cross-sectional results showed that the children in the LMP group had lower healthrelated and performance-related fitness and higher body mass indexes (BMIs) than the children in the HMP group at the age of 6 years (Table 1). In 1996, a five-year follow-up was conducted on the original participants (LMP n = 25; HMP n = 35; Tremblay, Inman, Deschenes, & Bothwell-Myers, 1997). Motor skills were retested using the TGMD (Ulrich, 1985) and physical activity levels were measured using the Physical Activity Questionnaire for Children (PAQ-C; Kowalski, Crocker, & Donen, 2004). The children in the LMP group at baseline (at the age of 6) continued to score behind their HMP peers on motor skills (as measured by the TGMD raw scores) and reported lower levels of physical activity (Table 1). A 10-year follow-up was conducted in 2001 (LMP n = 13; HMP n = 30). Perceived physical activity behavior was assessed using the Physical Activity Questionnaire for Adolescents (PAQ-A; Kowalski et al., 2004). The findings demonstrated that the participants who had the highest motor skill proficiency scores at age 6 and at the five year follow-up (age 11) reported the highest levels of self-reported physical activity in adolescence (Table 1).
Current Sample: 20-Year Follow-up All stages of this 20-year follow-up were reviewed and approved by an official Research Ethics Board. As part of the previous mixed longitudinal research, participants and their parents/guardians had granted permission to be contacted in the future for further follow-up studies. Attempts to contact those participants using their last known address and phone number were made, as well as online searches using social media and phone directories to contact as many participants as possible. A minimum of two attempts were made to contact each of the 100 participants (57 HMP, 43 LMP) who had participated in the original study in 1991. Contact was made with 36 former participants while 64 did not respond (37 HMP and 27 LMP). Of those who responded, 30 former participants (17 HMP, 13 LMP) indicated an interest in participating in the current study, while 6 (3 HMP, 3 LMP) were unable or uninterested in continuing their participation. Questionnaires and consent forms were sent to interested individuals by mail and/or email and returned by mail, email,
70 Lloyd et al.
or fax. Of the 30 participants who expressed interest in participating, 17 packages were returned. The sample for the 20-year follow-up involved 6 individuals in the original LMP group and 11 individuals in the original HMP group (mean age: 26.8 ± 0.45 years; see Table 1). Therefore, attrition rate between the initial study and the 20-year follow-up was 86% in the LMP group and 81% in the HMP group. There were no statistically significant differences between the original and current samples in regard to gender or motor skills. Although the original sample consisted of 55.4% males and the current sample is composed of 29.4% males, analyses revealed that sex and motor skills did not predict attrition. All 17 individuals participated in the original 1991 study (LMP n = 6; HMP n = 11). Table 1 Descriptive Characteristics, Motor Skills, and Physical Activity by Group and Time Low Motor Proficiency (mean, SD)
Year 1991
Sex (male, female)
p value
1 M, 5 F
4 M, 7 F
.426
Age (years)
6.8 ± 0.22
6.8 ± 0.54
.954
Height (m)
1.17± 0.33
1.23 ± 0.78
.444
Weight (kg)
23.11 ± 2.54
24.51 ± 2.40
.715
2
BMI (kg/m )
16.63 ± 1.77
16.03 ± 0.82
.349
TGMD locomotor raw score
18.50 ± 3.21
22.91 ± 2.74
.009
TGMD1 object control raw score
9.50 ± 1.52
15.27 ± 2.65
< .000
TGMD1 sum of raw scores
26.33 ± 2.34
38.18 ± 2.56
< .000
Sex (male, female)
2F
4 M, 4 F
.242
Age (years)
11.7 ± 0.33
11.9 ± 0.37
.525
Height (m)
1.49 ± 0.57
1.54 ± 0.05
.750
Weight (kg)
42.73 ± 7.71
45.80 ± 2.77
.012
2
BMI (kg/m )
19.16 ± 2.02
19.28 ± 0.61
.871
TGMD locomotor raw score
24.00 ± 1.41
24.63 ± 1.30
.565
TGMD1 object control raw score
12.50 ± 0.71
16.13 ± 2.48
.084
TGMD1 sum of raw scores
36.50 ± 2.12
40.75 ± 2.96
.098
1
1996
High Motor Proficiency (mean, SD)
1
Low Motor Proficiency (mean, SD)
Year 2001
Sex (male, female)
High Motor Proficiency (mean, SD)
p value
1 M, 4 F
3 M, 5 F
.546
Age (years)
16.7 ± 0.23
16.8 ± 0.35
.410
Height (m)
1.64 ± 0.06
1.71 ± 0.06
.970
Weight (kg)
61.50 ± 9.05
69.30 ± 8.22
.896
BMI (kg/m2)
22.79 ± 3.03
23.55 ± 1.94
.588
2011* Sex (male, female)
1 M, 5 F
4 M, 7 F
.426
Age (years)
26.8 ± 0.22
26.8 ± 0.54
.954
Height (m)
1.66 ± 6.36
1.74 ± 7.05
.213
Weight (kg)
70.23 ± 10.35
74.52 ± 16.25
.481
BMI (kg/m )
25.47 ± 3.05
24.49 ± 4.15
.622
DCDQ teen recall
79.20 ± 7.5
91.80 ± 8.5
.015
DCDQ adult
89.60 ± 7.1
93.60 ± 4.9
.219
Leisure time moderate physical activity (min/ week)
31.67 ± 60.14
62.73 ± 57.64
.312
Leisure time vigorous physical activity (min/ week)
121.67 ± 141.20
272.73 ± 210.20
.138
Total leisure time physical activity (min/week)
413.33 ± 292.96
526.36 ± 343.72
.507
Active transportation (min/week)
150.83 ± 84.52
200.91 ± 160.17
.490
Total physical activity (min/week)
1178.33 ± 1011.15
1206.82 ± 887.73
.953
301.67 ± 237.77
163.50 ± 229.21
.269
2981.67 ± 1633.13
2524.50 ± 1088.7
.510
2
2 2
Total motor vehicle time (min/week) Total sedentary time (min/week)
*All measures were self-reported in 2011. 1 Test of Gross Motor Development 2 Developmental Coordination Disorder Questionnaire
Measurements All 17 participants answered a series of four questionnaires related to their health status, physical activity level, sedentary behavior, and coordination. Health was assessed using a questionnaire which was taken from the Household Questionnaire from the Canadian Health Measures Survey (Tremblay, Wolfson, & Connor Gorber, 71
72 Lloyd et al.
2007). Physical activity and sedentary behavior were assessed using the International Physical Activity Questionnaire (IPAQ; Craig et al., 2003). The Developmental Coordination Disorder Questionnaire for Adults (DCDQ-A; Cantell, Crawford, & Doyle-Baker, 2008) was administered to determine if the participants who were identified as being in the LMP group in the initial study continued to experience difficulties in the motor domain as adults, and if the participants in the HMP group still felt they had proficient motor skills. Participants also were asked to complete the DCDQ-A a second time in a recall fashion thinking back to their teenage years. The DCDQ is a valid and reliable tool used to screen for coordination disorders in children 5–15 years of age (Wilson et al., 2009; Wilson, Kaplan, Crawford, Campbell, & Dewey, 2000). The adult and teenage versions of this questionnaire, which were used in this study, are currently unpublished manuals available from the authors of the original DCDQ and have been used reliably in the study from Cantell and colleagues (2008) of the physical fitness and health of adolescents and adults with high and low motor competence. The measures described here were in addition to the measures taken in the earlier three studies. For the purpose of this study, TGMD raw scores are used to describe motor skill proficiency, and height and weight were directly measured in the three earlier studies but were self-reported at the final time point. All questionnaires were completed between April–July 2011.
Statistical Analyses Descriptive characteristics were calculated on all variables using SPSS Version 19 (SPSS Inc., Chicago, IL). To determine differences between the LMP and HMP groups, independent t tests were calculated. A repeated measures group differences analysis across the four time points was not possible because the dependent measures changed across the four time points (e.g., motor skill proficiency was assessed by the TGMD and then by questionnaire). Pearson product moment correlation analyses were calculated to determine whether motor skill proficiency, physical activity and sedentary behavior were related at different time points. Correlations were calculated between sex and group first, the groups were later combined to determine relationships when no relationships were found by sex or group individually. Our current sample size of 17 participants provides greater than 80% power to detect associations of 0.65 or higher at an alpha level of p < .05. However, we would require at least 84 participants to have a similar level of power to detect an association of 0.3.
Results Descriptive statistics of the participants at all 4 time points are presented in Table 1. No statistical differences were found between the motor proficiency groups in current physical activity levels and sedentary behavior in 2011. There were statistically significant differences between the groups at baseline in 1991 (i.e., at 6 years of age), as well as in their recall of their self-perceived motor skills as adolescents (Table 1). In 1996 (age 11), the HMP group was significantly heavier than the LMP group, but there were no significant differences in BMI. There were no other significant differences between groups at any time point.
Long-Term Importance of Fundamental Motor Skills 73
Motor Skill Proficiency and Perceived Proficiency When both groups were combined for analysis, there were significant positive correlations between motor skill proficiency in 1991 at age 6 and perceived motor skill proficiency as a teenager (r = .65, p = .009). In addition, perceived motor skill proficiency as a teenager was positively associated with current perceived motor skill proficiency at age 26 (r = .65, p = .014). Locomotor proficiency in 1991 was positively associated with reported active transportation in 2011 (r = .59, p = .013) and negatively associated with reported time spent in a motor vehicle 20 years later in 2011 (r = -.55, p = .028) (Table 2). In the HMP group, overall motor skill proficiency at age 6 in 1991 was positively associated with self-reported leisure-time moderate physical activity at age 26 in 2011 (r = .77, p = .006). In addition, locomotor proficiency in 1991 positively correlated with active transportation in the HMP group 20 years later in 2011 (r = .64, p = .035). Locomotor skills in the HMP group in 1991 were also positively related to leisure time moderate physical activity in 2011 (r = .78, p = .005). In females, overall motor skill proficiency in 1991 was positively associated with self-reported leisure time moderate (r = .85, p = .001) and vigorous (r = .63, p = .029) physical activity in 2011 at the age of 26. Perceived motor skill proficiency by female adults was negatively correlated with total sedentary time (r = -.64, p = .047). In males, locomotor proficiency in 1991 positively correlated with self-reported active transportation in 2011 (r = 90, p = .036), and locomotor proficiency in 1996 (age 11) was positively correlated with vigorous leisure time physical activity in 2011 (r = .98, p = .016).
Discussion The purpose of this study was to investigate whether long-term associations existed between actual motor skill proficiency at age 6 and self-reported physical activity at age 26 among a mixed longitudinal cohort. Despite the relatively small sample size, this was a unique opportunity to capitalize on an existing cohort with directly measured fundamental motor skills at the age of 6. The original cohort was split into two motor skill proficiency groups (HMP and LMP) in 1991, based on scores from the TGMD (Ulrich, 1985). We also found a significant difference between the LMP and HMP groups in their self-reported motor skill proficiency during adolescence with the HMP group reporting significantly higher perceived motor proficiency. We interpret this to indicate the LMP participants felt their motor skills were below their peers during adolescence. Fitzpatrick and Watkinson (2003) and Missiuna and colleagues (2008) both successfully used a recall methodology to identify adult participants who experienced motor coordination difficulties in childhood and adolescence. They established that it is possible for recall methodology to be used to report on perceptions of motor competence earlier in life when asked as an adult. Interestingly, no differences were found based on the participants’ report of their current motor skills at the age of 26 between the LMP and HMP groups. It is unclear whether the motor skills for those with low motor proficiency were more proficient as young adults, or if their perspective of their motor proficiency has shifted due to fewer opportunities for
74
.68**
.80**
.65**
.35
.09
.39
-.25
-.37
Locomotor 1991
Object control 1991
DCDQ1 teen recall
DCDQ adult 2011
Total physical activity 2011
Active transport 2011
Total sedentary time 2011
Motor vehicle time 2011
-.55*
-.37
.59
.34
.21
.22
.29
1
Locomotor 1991
* Correlation is significant at the 0.05 level. ** Correlation is significant at the 0.01 level. 1 Developmental Coordination Disorder Questionnaire
1
Sum of raw scores 1991
Sum of Raw Scores 1991
-.12
.10
.05
-.25
.26
.59*
1
Object Control 1991
-.07
-.05
-.15
-.22
.64*
1
DCDQ Teen Recall
.04
-.47
.04
.17
1
DCDQ Adult 2011
-.16
-.66**
.67
1
Total Physical Activity 2011
-.47
.67
1
Active Transport 2011
.30
1
Total Sedentary Time 2011
1
Motor Vehicle Time 2011
Table 2 Correlation of Motor Skills, BMI, and Physical Activity in the Complete Sample (Low Motor Proficiency and High Motor Proficiency Groups Combined)
Long-Term Importance of Fundamental Motor Skills 75
comparisons (e.g., physical education class or sport participation). It is also possible that the small group that participated in the 20-year follow-up were not truly representative of the larger LMP group. It has been hypothesized that proficient fundamental motor skills facilitate physical activity, and this relationship has been demonstrated in several crosssectional studies (Lubans et al., 2010; Stodden et al., 2008). This is the first study that has tracked a mixed longitudinal sample over 20 years and demonstrated the long-term effects; Cairney and colleagues (2010) and Hands (2008) employed shorter follow up time periods (e.g., 3 years or 5 years) in their studies. More longitudinal research is needed using a larger sample to track objectively measured physical activity and health variables over time to fully understand this relationship in males and females as well as those with lower movement skill proficiency and those with more advanced movement proficiency. The existing evidence is consistent in finding that females of different ages participate in less physical activity than males of comparable ages (Colley et al., 2011a, 2011b). The findings of this study are therefore of particular interest because we found that motor skill proficiency in girls in 1991 at the age of 6 was related to both moderate and vigorous leisure time physical activity as young women in 2011. In addition, the women who reported that they perceived their motor skills to be higher as an adult also spent less time in sedentary behaviors. Hardy and colleagues (2012) recently found that adolescent girls with inefficient locomotor skills were two times as likely to be physically inactive than females with more proficient locomotor skills. We interpret this to indicate that increased emphasis on the development of motor skill proficiency in young females might have a positive impact on physical activity participation over time. Given that most research on this topic to date has involved correlational studies, these preliminary findings suggest a need for interventions and randomized controlled trials examining the impact of motor skill interventions on physical activity levels in the pediatric age group.
Limitations It is important to acknowledge the limitations of the current study. The first limitation is the use of self-report rather than direct measures of motor skill proficiency and physical activity at the 10- and 20-year time points because individuals may not have accurately reported their physical activity or sedentary behavior in 2011 (Adamo, Prince, Tricco, Connor-Gorber, & Tremblay, 2009), and the use of the DCDQ-A as a recall measure during adolescence may limit the precision or generalizability of the results related to that measure. Evidence of the inherent limitations of self-reported data can be seen in the relatively high amount of vigorous physical activity reported in the current sample. Another limitation is the small sample size which affected the statistical power and the imbalance between the groups in terms of size as well as sex. This study had fewer males than females, and the literature indicates that movement difficulties are more common in males (Cairney et al., 2010); therefore, the sample might not be representative of individuals with movement difficulties. Attrition rate was high; however, this is the first study to follow the same group of children where motor skill proficiency was objectively measured in childhood and then followed over a 20-year time period. A larger sample, studied over time,
76 Lloyd et al.
would add strength to the findings and help to make the results more generalizable. We also were limited by the initial study design, which focused only on children with high or low motor skill proficiency. The children in the original 1991 cohort were selected specifically because their motor skills were at the high and low ends of the spectrum as per the research questions at the time. In subsequent follow up studies, a group who scored in the 50th percentile were added to the protocol. Their lack of baseline data precluded them from being included in the present analysis. We recommend that future longitudinal cohort studies include the full spectrum of motor skill proficiency. Further, it is worth noting that all of the above limitations are likely to have biased our findings toward the null hypothesis; however, we did still find some relationships in this small sample indicating this area of inquiry is worth pursuing further with a more rigorous design. That we still observed associations between childhood motor skills and adult behavior suggests that this is an area worthy of more thorough investigation. In conclusion, these preliminary data in a small mixed longitudinal sample add to the existing evidence that levels of childhood motor proficiency may be related to physical activity as an adult. Specifically, our results suggest that motor skill proficiency in childhood may be associated with important aspects of physical activity in adulthood, especially among females. These results imply that females with inefficient motor skills in childhood may be less physically active in adulthood. Therefore, we recommend that an increased emphasis be placed on the development of proficient motor skills for all children to promote physical activity across the lifespan.
References Adamo, K.B., Prince, S.A., Tricco, A.C., Connor-Gorber, S., & Tremblay, M.S. (2009). A comparison of indirect versus direct measures for assessing physical activity in the pediatric population: a systematic review. International Journal of Pediatric Obesity, 4(1), 2–27. doi:10.1186/1479-5868-5-56 American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders: DSM-IV-TR. Washington, DC: American Psychiatric Association. Bouffard, M., Watkinson, J.E., Thompson, L.P., Causgrove Dunn, J.L., & Romanow, S.K.E. (1996). A test of the activity deficit hypothesis with children with movement difficulties. Adapted Physical Activity Quarterly, 13, 61–73. Branta, C., Haubenstricker, J., & Seefeldt, V. (1984). Age changes in motor skills during childhood and adolescence. Exercise and Sport Sciences Reviews, 12, 467–520. PubMed doi:10.1249/00003677-198401000-00015 Cairney, J., Hay, J.A., Faught, B.E., & Hawes, R. (2005). Developmental coordination disorder and overweight and obesity in children aged 9-14 y. International Journal of Obesity, 29(4), 369–372. PubMed doi:10.1038/sj.ijo.0802893 Cairney, J., Hay, J.A., Veldhuizen, S., Missiuna, C., & Faught, B.E. (2010). Developmental coordination disorder, sex, and activity deficit over time: a longitudinal analysis of participation trajectories in children with and without coordination difficulties. Developmental Medicine and Child Neurology, 52(3), e67–e72. PubMed doi:10.1111/j.14698749.2009.03520.x Cantell, M., Crawford, S.G., & Doyle-Baker, P.K. (2008). Physical fitness and health indices in children, adolescents and adults with high or low motor competence. Human Movement Science, 27(2), 344–362. PubMed doi:10.1016/j.humov.2008.02.007
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Clark, J.E., & Metcalfe, J.S. (2002). The mountain of motor development: A metaphor. In J.E. Clark & .J.H. Humphrey (Eds.), Motor development: Research and reviews (Vol. 2). Reston, VA: National Association of Sport and Physical Education. Colley, R.C., Garriguet, D., Janssen, I., Craig, C.L., Clarke, J., & Tremblay, M.S. (2011a). Physical activity of Canadian adults: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Reports, 22(1), 7–14. PubMed Colley, R.C., Garriguet, D., Janssen, I., Craig, C.L., Clarke, J., & Tremblay, M.S. (2011b). Physical activity of Canadian children and youth: accelerometer results from the 2007 to 2009 Canadian Health Measures Survey. Health Reports, 22(1), 15–23. PubMed Cousins, M., & Smyth, M.M. (2003). Developmental coordination impairments in adulthood. Human Movement Science, 22(4-5), 433–459. PubMed doi:10.1016/j. humov.2003.09.003 Craig, C.L., Marshall, A.L., Sjostrom, M., Bauman, A.E., Booth, M.L., Ainsworth, B.E., . . . Oja, P. (2003). International physical activity questionnaire: 12-country reliability and validity. Medicine and Science in Sports and Exercise, 35(8), 1381–1395. PubMed doi:10.1249/01.MSS.0000078924.61453.FB Deschenes, A. (1994). The physical fitness and gross motor performance of children with DCD. Fredericton: The University of New Brunswick. Fitzpatrick, D.A., & Watkinson, E.J. (2003). The lived experiences of physical awkwardness: Adults’ retrospective views. Adapted Physical Activity Quarterly, 20(3), 279–297. Hands, B. (2008). Changes in motor skill and fitness measures among children with high and low motor competence: a five-year longitudinal study. Journal of Science and Medicine in Sport, 11(2), 155–162. PubMed doi:10.1016/j.jsams.2007.02.012 Hardy, L.L., Reinten-Reynolds, T., Espinel, P., Zask, A., & Okely, A.D. (2012). Prevalence and correlates of low fundamental movement skill competency in children. Pediatrics, 130(2), e390–e398. PubMed doi:10.1542/peds.2012-0345 Kowalski, K., Crocker, P., & Donen, R. (2004). The physical activity questionnaire for older children (PAQ-C) and adolescents (PAQ-A) manual. Saskatoon, SK: University of Saskatchewan. Lubans, D.R., Morgan, P.J., Cliff, D.P., Barnett, L.M., & Okely, A.D. (2010). Fundamental movement skills in children and adolescents: review of associated health benefits. Sports Medicine (Auckland, N.Z.), 40(12), 1019–1035. PubMed doi:10.2165/11536850000000000-00000 Missiuna, C., Moll, S., King, G., Stewart, D., & Macdonald, K. (2008). Life experiences of young adults who have coordination difficulties. Canadian Journal of Occupational Therapy, 75(3), 157–166. PubMed doi:10.1177/000841740807500307 Stodden, D.F., Goodway, J.D., Langendorfer, S.J., Roberton, M.A., Rudisill, M.E., Garcia, C., & Garcia, L.E. (2008). A developmental perspective on the role of motor skill competence in physical activity: An emergent relationship. Quest, 60, 290–306. doi:1 0.1080/00336297.2008.10483582 Tremblay, M.S., Inman, J.W., Deschenes, A., & Bothwell-Myers, C. (1997). Persistence of fitness variables in children with contrasting motor abilities. Paper presented at the International symposium of pediatric work physiology, Exeter. Tremblay, M.S., Wolfson, M., & Connor Gorber, S. (2007). Canadian health measures survey: rationale, background and overview. Health Reports (Stastics Canada, Catalogue, 82-003), 18(Suppl.1), 7–20. Ulrich, D.A. (1985). Test of Gross Motor Development. Austin, TX: Pro-Ed. Wall, A.E. (1982). Physically awkward children: A motor development perspective. In J.P. Das, R.F. Mulcahy, & A.E. Wall (Eds.), Theory and research in learning disabilities (pp. 253–268). New York: Plenum Press. Wall, A.E. (2004). The developmental skill-learning gap hypothesis: Implications for children with movement difficulties. Adapted Physical Activity Quarterly, 21(3), 197–218.
78 Lloyd et al.
Wilson, B.N., Crawford, S.G., Green, D., Roberts, G., Aylott, A., & Kaplan, B.J. (2009). Psychometric properties of the revised Developmental Coordination Disorder Questionnaire. Physical & Occupational Therapy in Pediatrics, 29(2), 182–202. PubMed doi:10.1080/01942630902784761 Wilson, B.N., Kaplan, B.J., Crawford, S.G., Campbell, A., & Dewey, D. (2000). Reliability and validity of a parent questionnaire on childhood motor skills. The American Journal of Occupational Therapy., 54(5), 484–493. PubMed doi:10.5014/ajot.54.5.484
