Playing Active Video Games may not develop movement skills: an intervention trial

Background: To investigate the impact of playing sports Active Video Games on children's actual and perceived object control skills. Methods: Intervention children played Active Video Games for 6. weeks (1. h/week) in 2012. The Test of Gross Motor Development-2 assessed object control skill. The Pictorial Scale of Perceived Movement Skill Competence assessed perceived object control skill. Repeated measurements of object control and perceived object control were analysed for the whole sample, using linear mixed models, which included fixed effects for group (intervention or control) and time (pre and post) and their interaction. The first model adjusted for sex only and the second model also adjusted for age, and prior ball sports experience (yes/no). Seven mixed-gender focus discussions were conducted with intervention children after programme completion. Results: Ninety-five Australian children (55% girls; 43% intervention group) aged 4 to 8. years (M 6.2, SD 0.95) participated. Object control skill improved over time (p=0.006) but there was no significant difference (p=0.913) between groups in improvement (predicted means: control 31.80 to 33.53, SED=0.748; intervention 30.33 to 31.83, SED=0.835). A similar result held for the second model. Similarly the intervention did not change perceived object control in Model 1 (predicted means: control: 19.08 to 18.68, SED=0.362; intervention 18.67 to 18.88, SED=0.406) or Model 2. Children found the intervention enjoyable, but most did not perceive direct equivalence between Active Video Games and 'real life' activities. Conclusions: Whilst Active Video Game play may help introduce children to sport, this amount of time playing is unlikely to build skill.

Improvements in fundamental movement skill competency mediate the effect of the SCORES intervention on physical activity and cardiorespiratory fitness in children

Numerous studies have identified a positive association between fundamental movement skill (FMS) competency and physical activity in children; however, the causal pathways have not been established. The aim of this study is to determine if changes in FMS competency mediated the effect of the Supporting Children's Outcomes using Rewards, Exercise and Skills (SCORES) intervention on physical activity and cardiorespiratory fitness in children. Eight primary schools (25 classes) and 460 children (aged 8.5 ± 0.6, 54% girls) were randomised to the SCORES intervention or control group for the 12-month study. The outcomes were accelerometer-determined moderate-to-vigorous physical activity (MVPA) and cardiorespiratory fitness. The hypothesised mediators were actual FMS competency and perceived sport competence. Mediation analyses were conducted using multilevel linear analysis in MPlus. From the original sample, 138 (30.0%) and 370 (80.4%) children provided useable physical activity and cardiorespiratory fitness data at post-test assessments. There were significant treatment effects for locomotor skills and overall FMSs. Changes in MVPA were associated with changes in object-control skills, overall FMSs and perceived competence. The overall FMSs had a significant mediating effect on MVPA (AB = 2.09, CI = 0.01-4.55). Overall FMSs (AB = 1.19, CI = 0.002-2.79) and locomotor skills (AB = 0.74, CI = 0.01-1.69) had a significant mediating effect on cardiorespiratory fitness. The results of this study conclude that actual but not perceived movement skill competency mediated the effect of the SCORES intervention on physical activity and cardiorespiratory fitness.

Comparison of performance on process- and product-oriented assessments of fundamental motor skills across childhood

Process-oriented motor competence (MC) assessments evaluate how a movement is performed. Product-oriented assessments evaluate the outcome of a movement. Determining the concurrent validity of process and product assessments is important to address the predictive utility of motor competence for health. The current study aimed to: (1) compare process and product assessments of the standing long jump, hop and throw across age groups and (2) determine the capacity of process assessments to classify levels of MC. Participants included 170 children classified into three age groups: 4–5, 7–8 and 10–11 years old. Participants’ skills were examined concurrently using three process assessments ((Test of Gross Motor Development-2nd edition [TGMD-2]), Get Skilled; Get Active, and developmental sequences) and one product measure (throw speed, jump and hop distance). Results indicate moderate to strong correlations between (1) process assessments across skills and age groups (r range = .37–70) and (2) process and product assessments across skills and age groups (r range = .26–.88). In general, sensitivity to detect advanced skill level is lowest for TGMD-2 and highest for developmental sequences for all three skills. The use of process and product assessments is suggested to comprehensively capture levels of MC in human movement.

Promoting Fundamental movement skill development and physical activity in early childhood settings : a cluster randomized controlled trial

The aim of this study was to assess the feasibility, acceptability and potential efficacy of a physical activity program for preschool children. A 20-week, 2-arm parallel cluster randomized controlled pilot trial was conducted. The intervention comprised structured activities for children and professional development for staff. The control group participated in usual care activities, which included designated inside and outside playtime. Primary outcomes were movement skill development and objectively measured physical activity. At follow-up, compared with children in the control group, children in the intervention group showed greater improvements in movement skill proficiency, with this improvement statically significant for overall movement skill development (adjust diff. = 2.08, 95% CI 0.76, 3.40; Cohen’s d = 0.47) and significantly greater increases in objectively measured physical activity (counts per minute) during the preschool day (adjust diff. = 110.5, 95% CI 33.6, 187.3; Cohen’s d = 0.46). This study demonstrates that a physical activity program implemented by staff within a preschool setting is feasible, acceptable and potentially efficacious.

Adolescents' perception of the relationship between movement skills, physical activity and sport

Movement skill competence is important to organised youth physical activity participation, but it is unclear how adolescents view this relationship. The primary aim of this study was to explore adolescents’ perception of the relationship between movement skills, physical activity and sport, and whether their perceptions differed according to extent of participation in organised physical activities. We recruited 33 (17 male) Grade 11 and 12 students (aged 16 to 18) from two secondary schools in Australia. Focus groups were allocated according to whether or not students participated in organised physical activity, where ‘organised activity’ was defined as activity which involved regular classes, training or competition, was reasonably structured or formal, or had a teacher, instructor or coach. There were three all-male ‘organised’ groups, one mixed-gender ‘organised’ group and one all-female ‘not-organised’ group. Students were asked about their attitudes towards physical activity and sport, the relationship between childhood skill proficiency and later physical activity and their perceptions of the appropriate time taken to learn movement skills. Group discussions lasted for approximately 50 minutes, were recorded and were then transcribed verbatim. Transcripts were read using a constant comparison method, in which quotes were continually compared to other quotes. A thematic analysis was conducted in which the transcripts were analysed inductively. Participation in organised sport had no bearing on opinions regarding whether lack of childhood skill development would negatively impact latter participation. It did, however, subtly influence opinions regarding whether skill could be successfully acquired later in life. When asked whether not having well-developed skills as a child would negatively impact on participation in sport/physical activity later in life, the response was mixed, but this was not related to their involvement in organised sport or activities. Students who believed early skill proficiency related to subsequent activity thought this was due to skill ability and motivation. An alternate view was that subsequent activity did not need to be based on skill proficiency; also, one’s environment might change, resulting in differing opportunities/constraints. Students felt skills could be learnt at any time in life (dependent on motivation), but that learning skills at a younger age would be easier and that skills learnt later would not be as developed. Fear of failure was identified as a barrier to learning when older. We conclude that motivation towards participation in sport and physical activity is affected by adolescents’ perception of their own movement skill ability. Therefore, developing children’s actual and perceived movement skills may help to increase adolescent physical activity. Since those with intrinsic achievement orientations were not as inclined towards organised activity, we may also need to provide physical activity options that resonate with intrinsic achievement motivations.

A holistic measurement model of movement competency in children

Different countries have different methods for assessing movement competence in children; however, it is unclear whether the test batteries that are used measure the same aspects of movement competence. The aim of this paper was to (1) investigate whether the Test of Gross Motor Development (TGMD-2) and Körperkoordinations Test für Kinder (KTK) measure the same aspects of children’s movement competence and (2) examine the factorial structure of the TGMD-2 and KTK in a sample of Australian children. A total of 158 children participated (M age = 9.5; SD = 2.2). First, confirmatory factor analysis examined the independent factorial structure of the KTK and TGMD-2. Second, it was investigated whether locomotor, object control and body coordination loaded on the latent variable Movement Competency. Confirmatory factor analysis indicated an adequate fit for both the KTK and TGMD-2. An adequate fit was also achieved for the final model. In this model, locomotor (r = .86), object control (r = .71) and body coordination (r = .52) loaded on movement competence. Findings support our hypothesis that the TGMD-2 and KTK measure discrete aspects of movement competence. Future researchers and practitioners should consider using a wider range of test batteries to assess movement competence.

Construct validity of the pictorial scale of perceived movement skill competence

Objectives: The Pictorial Scale of Perceived Movement Skill Competence (PMSC) assesses young children's perceptions of movement skill competence: 12 perceived Fundamental Movement skills (FMS; based on the Test of Gross Motor Development 2nd edition TGMD-2) and six Active Play activities (e.g. cycling). The main study purpose was to assess whether children's movement perception scores fit within the imposed constructs of Active Play and FMS by testing the latent structure and construct validity of the PMSC.

Design: Construct validation study.

Methods: Participants were part of the Melbourne Infant Feeding, Activity and Nutrition Trial (InFANT). The latent structure of the PMSC responses was tested through confirmatory factor analysis (CFA) and Bayesian Structural Equation Modeling (BSEM). Internal consistency was conducted using polychoric correlation-based alphas.

Results: The 303 children (boys 53.1%, n = 161) were aged 4-5 years (M = 4.7, SD = 0.46). The final model had an 18 item 3-factor solution with good fit indices (using CFA and BSEM). Factors were: Active Play (Bike, Board Paddle, Climb, Skate/Blade, Scooter, and Swim), Object Control - Hand Skills (Bounce, Catch, Hit, Throw), and FMS skills with a leg action (Gallop, Hop, Jump, Leap, Run, Step Slide, Kick, Roll). Alpha reliability values were: Active Play (0.78), Object Control-Hand Skills (0.76) and FMS-Dynamic Leg (0.84).

Conclusion: Young children can distinguish between movement perceptions. The factors reflect the hypothesized structure in terms of FMS being distinguished from Active Play. Further research should investigate how and if these constructs change in children over time.

Children's movement skills when playing active video games

Active video games (AVGs) may be useful for movement skill practice. This study examined children's skill execution while playing Xbox Kinect™ and during movement skill assessment. Nineteen children (10 boys, 9 girls; M age = 7.9 yr., SD = 1.4) had their skills assessed before AVG play and then were observed once a week for 6 wk. while playing AVGs for 50 min. While AVG play showed evidence of correct skill performance (at least 30-50% of the time when playing table tennis, tennis, and baseball), nearly all skills were more correctly performed during skill assessment (generally more than 50% of the time). This study may help researchers to better understand the role AVGs could play in enhancing real life movement skills.

Outcomes of a group-randomized trial to prevent excess weight gain, reduce screen behaviours and promote physical activity in 10-year-old children : switch-play

Objectives : To evaluate the effectiveness of an intervention to prevent excess weight gain, reduce time spent in screen behaviours, promote participation in and enjoyment of physical activity (PA), and improve fundamental movement skills among children.

Participants : In 2002, 311 children (78% response; 49% boys), average age 10 years 8 months, were recruited from three government schools in low socioeconomic areas of Melbourne, Australia.

Design : Group-randomized controlled trial. Children were randomized by class to one of the four conditions: a behavioural modification group (BM; n=66); a fundamental movement skills group (FMS; n=74); a combined BM/FMS group (BM/FMS; n=93); and a control (usual curriculum) group (n=62). Data were collected at baseline, post intervention, 6- and 12-month follow-up periods.

Results : BMI data were available for 295 children at baseline and 268 at 12-month follow-up. After adjusting for food intake and PA, there was a significant intervention effect from baseline to post intervention on age- and sex-adjusted BMI in the BM/FMS group compared with controls (-1.88 kg m-2, P<0.01), which was maintained at 6- and 12-month follow-up periods (-1.53 kg m-2, P<0.05). Children in the BM/FMS group were less likely than controls to be overweight/obese between baseline and post intervention (adjusted odds ratio (AOR)=0.36, P<0.05); also maintained at 12-month follow-up (AOR=0.38, P<0.05). Compared with controls, FMS group children recorded higher levels and greater enjoyment of PA; and BM children recorded higher levels of PA and TV viewing across all four time points. Gender moderated the intervention effects for participation in and enjoyment of PA, and fundamental movement skills.

Conclusion : This programme represents a promising approach to preventing excess weight gain and promoting participation in and enjoyment of PA. Examination of the mediators of this intervention and further tailoring of the programme to suit both genders is required.

Can we skill and activate children through primary school physical education lessons? "Move it Groove it" - a collaborative health promotion intervention

Background: Physical education (PE) lessons are an ideal setting to improve child fundamental movement skills (FMSs) and increase physical activity (PA) for optimal health. Despite this, few studies have assessed the potential to do both simultaneously. The “Move It Groove It” primary school intervention in New South Wales, Australia, had this opportunity.

Methods: A whole school approach to implementation included establishment of school project teams, a teacher “buddy” system, project Web site, teacher training workshops, and small grants for equipment. The quasi-experimental evaluation involved 1,045 year 3 and 4 children (aged 7 to 10 years) in nine intervention and nine control rural primary schools (53% boys/47% girls). It utilised pre- and postobservational surveys of (1) mastery or near mastery levels for each of eight FMSs, (2) proportion of PE lesson time spent in moderate to vigorous PA (MVPA) and vigorous PA (VPA), and (3) teacher- and lesson-related contextual covariates. Data were analysed by hierarchical logistic multiple regression.

Results: For FMSs, overall mastery or near mastery level at baseline was 47% ranging from 22.7% for the overarm throw among girls to 75.4% for the static balance among boys. The intervention delivered substantial improvements in every FMS for both genders ranging from 7.2% to 25.7% (13 of 16 comparisons were significant). For PA level, mean MVPA at baseline was 34.7%. Baseline MVPA for boys was 38.7% and for girls was 33.2%. The intervention was associated with a nonsignificant 4.5% increase in MVPA and a significant 3.0% increase in VPA. This translates to a gain of <1 minute of MVPA per average 21-minute lesson.

Conclusions: This is the first study to show that by modifying existing PE lessons, significant improvements in FMS mastery can be gained without adversely affecting children’s MVPA and VPA. To increase PA levels, we recommend increasing the number of PE lessons per week.

Evaluating the feasibility, effectiveness and acceptability of an active play intervention for disadvantaged preschool children : a pilot study

Australian children from disadvantaged families are at increased risk of delays in acquiring fundamental movement skills, with physical inactivity and increased risk of the potential consequences of obesity. The aims of this pilot study were to: 1) assess the fundamental movement skills of disadvantaged children; 2) evaluate the feasibility and effectiveness of adapting an existing parenting and child development program to incorporate additional weekly play activities (the intervention); and 3) examine the acceptability of the intervention. Children aged 1.5-5 years were assessed pre-intervention (n = 26) and postintervention (n = 16) over a period of 22 weeks using the gross motor component of the Peabody Developmental Motor Scales - 2nd Edition (PDMS-2) (Folio & Fewell, 2000). Parents completed a demographic and environmental survey and those implementing the intervention were interviewed to assess the feasibility and acceptability of the intervention. Pre-intervention the children from disadvantaged families had locomotion, object manipulation and Gross Motor Quotient (GMQ) scores significantly below the norm-referenced standards of the PDMS-2 (p < 0.05). The intervention was associated with improvements in the locomotion (8.35 to 9.5; p = 0.009), and object manipulation (8.6 to 9.6; p = 0.04) subtest scores and the GMQ scores (92.6 to 99.3; p < 0.01). The intervention was deemed feasible and acceptable by those implementing the program. Low levels of physical activity in disadvantaged communities may be related to delayed acquisition of fundamental movement skills in childhood. This pilot study raises the possibility of correcting this deficit in early childhood, and improving the potential for all children to lead an active life.

Interventions for preventing obesity in children (review)

Background

Prevention of childhood obesity is an international public health priority given the significant impact of obesity on acute and chronic diseases, general health, development and well-being. The international evidence base for strategies that governments, communities and families can implement to prevent obesity, and promote health, has been accumulating but remains unclear.
Objectives

This review primarily aims to update the previous Cochrane review of childhood obesity prevention research and determine the effectiveness of evaluated interventions intended to prevent obesity in children, assessed by change in Body Mass Index (BMI). Secondary aims were to examine the characteristics of the programs and strategies to answer the questions "What works for whom, why and for what cost?"
Search methods

The searches were re-run in CENTRAL, MEDLINE, EMBASE, PsychINFO and CINAHL in March 2010 and searched relevant websites. Non-English language papers were included and experts were contacted.
Selection criteria

The review includes data from childhood obesity prevention studies that used a controlled study design (with or without randomisation). Studies were included if they evaluated interventions, policies or programs in place for twelve weeks or more. If studies were randomised at a cluster level, 6 clusters were required.
Data collection and analysis

Two review authors independently extracted data and assessed the risk of bias of included studies. Data was extracted on intervention implementation, cost, equity and outcomes. Outcome measures were grouped according to whether they measured adiposity, physical activity (PA)-related behaviours or diet-related behaviours. Adverse outcomes were recorded. A meta-analysis was conducted using available BMI or standardised BMI (zBMI) score data with subgroup analysis by age group (0-5, 6-12, 13-18 years, corresponding to stages of developmental and childhood settings).
Main results

This review includes 55 studies (an additional 36 studies found for this update). The majority of studies targeted children aged 6-12 years. The meta-analysis included 37 studies of 27,946 children and demonstrated that programmes were effective at reducing adiposity, although not all individual interventions were effective, and there was a high level of observed heterogeneity (I2=82%). Overall, children in the intervention group had a standardised mean difference in adiposity (measured as BMI or zBMI) of -0.15kg/m2 (95% confidence interval (CI): -0.21 to -0.09). Intervention effects by age subgroups were -0.26kg/m2 (95% CI:-0.53 to 0.00) (0-5 years), -0.15kg/m2 (95% CI -0.23 to -0.08) (6-12 years), and -0.09kg/m2 (95% CI -0.20 to 0.03) (13-18 years). Heterogeneity was apparent in all three age groups and could not explained by randomisation status or the type, duration or setting of the intervention. Only eight studies reported on adverse effects and no evidence of adverse outcomes such as unhealthy dieting practices, increased prevalence of underweight or body image sensitivities was found. Interventions did not appear to increase health inequalities although this was examined in fewer studies.
Authors' conclusions

We found strong evidence to support beneficial effects of child obesity prevention programmes on BMI, particularly for programmes targeted to children aged six to 12 years. However, given the unexplained heterogeneity and the likelihood of small study bias, these findings must be interpreted cautiously. A broad range of programme components were used in these studies and whilst it is not possible to distinguish which of these components contributed most to the beneficial effects observed, our synthesis indicates the following to be promising policies and strategies:

· school curriculum that includes healthy eating, physical activity and body image

· increased sessions for physical activity and the development of fundamental movement skills throughout the school week

· improvements in nutritional quality of the food supply in schools

· environments and cultural practices that support children eating healthier foods and being active throughout each day

· support for teachers and other staff to implement health promotion strategies and activities (e.g. professional development, capacity building activities)

· parent support and home activities that encourage children to be more active, eat more nutritious foods and spend less time in screen based activities

However, study and evaluation designs need to be strengthened, and reporting extended to capture process and implementation factors, outcomes in relation to measures of equity, longer term outcomes, potential harms and costs.

Childhood obesity prevention research must now move towards identifying how effective intervention components can be embedded within health, education and care systems and achieve long term sustainable impacts.