Registered on 13 October Peer Review reports. Several projects have been implemented both by municipalities and by larger sports organizations. Therefore, it seems timely to initiate scientific investigations into the effectiveness and potential benefits of such programs.
Consequently, there is evidence of many health benefits to be gained from an improvement in motor skills. For instance, it has been demonstrated that good motor skills positively influence cardiorespiratory fitness [ 2 , 5 ] and body weight [ 2 , 6 , 7 , 8 ] as well as sports participation [ 2 , 9 ], all suggesting that early competency in motor skills may have important health implications. Furthermore, there are indications of relationships with language development [ 10 , 11 , 12 , 13 , 14 ], executive function [ 15 ], and general wellbeing [ 16 ].
However, most of the existing studies of motor performance are either cross-sectional, and therefore do not provide evidence of a potential causal relationship, or they include only short-term follow-up. Thus, there is a real need for more longitudinal studies on the importance of motor skills with long-term follow-up, including both physical and psychological outcomes. There are indications that the level of motor skills remains stable over time [ 17 ] and motor development deficits observed in early childhood are still apparent in adolescence [ 18 ].
Therefore, toddler and preschool age appears to be a particularly important period for the development of motor skills. Early childhood is also the age where practicing fundamental movement skills is necessary to create a foundation for more complex movement activities of daily living, recreation, and sports in later childhood [ 1 ]. Consequently, this arena provides an ideal opportunity for all children, despite socioeconomic background, to develop and improve their motor skills.
This project was concluded in and, among other findings, demonstrated that more physical education in school improved bone development [ 21 ], reduced cardiovascular risk [ 22 ], reduced the prevalence of overweight [ 23 ], and improved physical fitness in those with a low baseline level [ 24 ]. As a result, more physical education lessons have been added to the schedule of all schools within the Municipality. The Municipality is comparable to the rest of Denmark in terms of age distribution, gender, and income, but with a slightly higher unemployment rate 5.
Once more, the Municipality is focused on increasing the evidence base through scientific investigation and has proposed a partnership where the Department of Sports Science and Clinical Biomechanics DSSCB at the University of Southern Denmark SDU develop and manage the scientific design and evaluation of the project — creating the unique research opportunities outlined in this protocol. The effectiveness of the intervention will be investigated in a cluster randomized controlled trial RCT focused on improvement in motor skills as well as several secondary effects.
Importantly, the extensive testing of these children at an early age will form the basis of a cohort with potential for long-term follow-up, which will enable investigations into the long-term development of motor skills, musculoskeletal disorders, physical activity, language, cognitive abilities, and social skills as well as the interrelations between these domains.
In addition, the predictive ability of early markers for child development and health within these domains can be assessed. Research plans for each of these individual domains are described in separate work packages WPs in Additional file 1.
The four overall aims of this research program are to: 1 establish a population-based cohort of 3—6-year-olds with a focus on the relationship between motor skills, health, cognition, and wellbeing; 2 establish population-based reference data on motor skills in 3—6-year-olds; 3 describe early development of musculoskeletal problems; and 4 investigate whether a structured program aimed at improving motor skills in 3—6-year-old children will improve current and future motor skills, health, cognition, and wellbeing.
Since this study includes both a cohort study and a RCT nested within that cohort, the method section is divided into two sections for clarity. The cohort will be described first, followed by the RCT.
Furthermore, a total of eight WPs have been developed representing different domains. WP 1: Effectiveness of a structured intervention for improving motor skills in Danish preschool children. WP 4: Motor skills influence on physical activity and overweight; and population-based motor skills reference data.
WP 8: Associations between motor skills, physical activity, cognition, psychological wellbeing, and language development for children at developmental risk. All the WPs are described in detail in Additional file 1 and this main protocol describes the general procedures creating the basis for the WPs. Determine incidence, prevalence, and patterns of development of musculoskeletal problems in children.
More detailed objectives are described in the WPs Additional file 1. In August , this involved children attending 32 preschools. In Denmark, children start preschool when they turn three years of age and leave preschool in July of the calendar year they turn six years, i. All parents received written information about the project and were invited to information meetings at local schools or preschools during the spring of Following the initial inclusion, there is running inclusion into the study.
Trained research staff will collect data from physical testing during test sessions. These test sessions will take place in gyms in the proximity of the preschools.
The children will either walk or be transported in buses, depending on the distance, and they will be accompanied by their known preschool staff. Other data will be collected via interviews, email surveys, or SMS-track as described in the individual WPs Additional file 1.
An overview of the investigated domains and their related measurements is presented in Table 1. Motor skills, physical fitness and functional performance, and anthropometry will be measured by trained research staff at baseline and after 6, 18, and 30 months, as long as the child attends preschool. For long-term follow-up, anthropometry will be measured regularly by the school nurse; academic examination grades, results from national academic tests as well as national tests of general wellbeing during the school years will be available.
If funding is procured, additional physical testing will be performed during the school years. This test battery assesses the developmental status of fundamental movement skills in children and includes eight individual test items measuring movement skills in three categories: manual dexterity skills; ball skills; and balance skills. Each item is rated on a six-point rating scale, where 0 indicates the best performance and 5 the weakest.
The revised version of the test is subdivided into three age bands 3—6, 7—10, and 11—16 years [ 26 ]; thus, the first age band will be used during the preschool years in this project. The revised version also has qualitative assessment added, but only the quantitative assessments will be used in this study.
The test both the original and the revised has been validated in several countries [ 27 , 28 , 29 , 30 , 31 ] and translated into several languages, including Danish, and is widely used in Denmark [ 32 ]. The cross-cultural validation, the availability in several European countries, and the simple test administration, facilitating large sample screening over a short period, are considered major advantages of this test [ 33 ].
Physical fitness and lower extremity functional performance will be tested by measuring two gross motor skills: the time taken to complete a m fast run and the distance of a horizontal jump standing long jump. The fast run will be measured in seconds and the horizontal jump in centimeters.
Handgrip strength using the non-digital version model of the TKK dynamometer 0— kg will be used to assess strength and functional performance of the upper extremity. Grip strength will be measured in kilograms.
Height, weight, and waist circumference will be measured using standard anthropometric methods with the children wearing normal light clothes.
Body mass index BMI , waist circumference, and waist to height ratio will be calculated as indicators of general and abdominal adiposity and are valid measures of adiposity in preschool children [ 34 ]. Several other variables will be collected for the different WPs. An overview is provided in Table 1 and more detailed descriptions in Additional file 1. Simple univariate statistics will be used to describe the outcomes, predictors, and covariates. Age-specific, sex-specific, and age- and sex-specific rates of the various outcomes will be presented.
In most instances, multilevel regression analyses will be used to determine if poor motor skills are associated with other domains after adjusting for relevant covariates. The choice of regression type, covariates and interactions is described in each WP in Additional file 1. Can language development be improved through a structured motor skills intervention in preschool?
How does a universally implemented motor skills intervention affect children with developmental difficulties? Children from all the 32 preschools in the municipality were included in the cohort study. The governing boards of 17 of these, representing children by August , agreed to be included in the RCT. Only children enrolled in the cohort before the end of January will be included in the RCT, as that represents the end of the baseline data collection.
By December 19, , children were included in the RCT. Participating preschools were randomized, stratified for socioeconomic background. A mean socioeconomic index for each preschool was developed based on family type, education, and income, and this was dichotomized to above or below the median for all the included kindergartens. This was done by a statistician at the SDU. The randomization resulted in eight preschools, including a total of children, in the intervention group and nine preschools, including a total of children, in the control group.
We are not aware of any previous studies using the same test in the same age groups and therefore a power calculation for the RCT was performed using data from related studies. The standard deviations of the change in motor skills was based on a study of Danish overweight children [ 32 ], which used the same motor assessment as in this study Movement Assessment Battery for Children , and the clustering effect was estimated based on a previous study in Danish preschools [ 35 ].
In general terms, the results show that boys had better performance in all the measurements oriented to the product of the movement and in the majority of the body components for the process-oriented measurements. After using the age at PHV as a covariant of MC, the magnitude of the difference between the sexes increased in most of motor skills for both types of measurements.
Differences between the sexes in MC are widely documented in the literature 6 6. A recent meta-analysis study presents strong evidence for the superiority of boys in object control skills, which was not confirmed to the skills of locomotor or stability 6 6. Ratifying the results of Barnet et al. Locomotor skills e.
De Meester et al. In line with the meta-analysis conducted by Barnet et al. In this study, the MC assessment counted on process- and product-oriented measurements, in locomotor and object control skills. The use of both types of measurements has been suggested in recent studies on the evaluation of motor skills 24 A holistic measurement model of movement competency in children.
J Sports Sci ;34 5 As to the measurement of product movement, our results initially showed that boys were significantly higher in all the skills assessed. As to the process of movement, boys were also superior in at least one body component of developmental sequences of movement. These findings differ from other studies with adolescents who have not found differences between the sexes in locomotor skills 12 These differences may be related to socio-cultural influences, i.
Additionally, the literature has suggested that the boys can benefit from advantages due to their anthropometric measurements and their physical capacities 6 6. Movement skill assessment. Advanced analysis of motor development.
It is widely recognized that the adolescence period is marked by biological constant changes greatly influenced by the maturation process 18 As expected, our results confirm that the boys reach the age at PHV later than girls see Table 1. Therefore, the present study used the maturity offset as a covariate to examine the difference between the sexes in MC, in order to balance potential benefits resulting from the maturation timing , particularly due to the girls to be more advanced in maturational terms.
The superiority of the boys demonstrated before the use of age at PHV as a covariate suggests that the girls seemed not to take advantage of the maturation benefit to achieve a higher MC. After the use of age at PHV as covariate, the magnitude of the differences between the sexes increased in most skills see Table 2 , and in both measures.
However, the skills used in the present study, also called ballistics 32 Association between sports participation, motor competence and weight status: A longitudinal study.
J Sci Med Sport ;19 10 Relationship between sports participation and the level of motor coordination in childhood: A longitudinal approach. J Sci Med Sport ;15 3 A developmental perspective on the role of motor skill competence in physical activity: An emergent relationship. Quest ;60 2 Considering that during the adolescence boys are also often more involved in the practice of sports 36 Sociocultural factors and physical activity level in early adolescence.
Rev Panam Salud Publica ;22 4 Confounding effect of biologic maturation on sex differences in physical activity and sedentary behavior in adolescents. Pediatr Exerc Sci ;22 3 : In addition, it is plausible to assume that, among the girls, some physical and physiological changes inherent in the puberty process, such as changes in body composition increase in the quantity of fat , proportions increase in the width of the hips , as well as discomfort with the establishment of the menstrual cycle may be associated with the decrease in the practice of physical and sports activities, disfavoring the development of MC 18 The present study has some limitations that should be reported.
First, the cross-sectional design used preclude the causal attribution for the differences, so as not it does not make it possible to know whether the differences tend to increase across time. Another limitation is regarding the use of an indirect measure for the maturation assessment.
Although there are different methods to assess the maturity e. Pediatr Exerc Sci ;28 3 Validation of maturity offset in a longitudinal sample of Polish girls. J Sports Sci ;32 14 Learning differences as well as performance differences seem to be related to the structure of the task, the task complexity, the task difficulty, and the familiarity level.
A common result of most studies is, as shown for studies focusing on motor functioning not learning , that there is a general tendency that the performance level is lower for older adults as compared with younger adults [ 2 , 7 , 26 , 30 , 39 , 48 , 49 , 55 , 57 , 58 , 64 , 68 , 69 ]. In addition, regardless of learning gains, older adults function on a lower level. Most studies revealed that performance gains in fine motor skills are diminished in older adults.
Thus, performance differences between younger and older adults even increased with practice [ 26 , 39 , 49 , 58 ]. Results of gross motor skill learning are contradictory. While Kirchner and Schaller [ 28 ] revealed the highest improvement in the oldest age group, Gershon [ 20 ], Perrot and Bertsch [ 37 ], and Tunney et al.
The studies by Carnahan et al. One explanation for the lack of age difference is that the tasks may not have been complex enough to identify age difference.
Motor control research suggests that as the task difficulty increases, the differences between young and old adults also increase [ 31 , 54 ]. In the study by Voelcker-Rehage and Willimczik [ 65 ], older participants revealed a lower initial performance in the lacrosse task with increasing age and a lower performance improvement due to practice, particularly from age 70—74 onwards, as compared with the juggling performance.
The different results in juggling and lacrosse might also point to specific task characteristics such as complexity and difficulty level. The lacrosse task might be more influenced by physical preconditions as compared to the juggling task. The lacrosse catching task required the participants to react to different flight curves and flight directions of the ball. The lacrosse task might be considered more complex. The physical fitness and motor abilities coupled with the mechanical requirements of the task might greatly influence the ability to move with control, skill, and confidence.
Hence, age-related performance differences are more visible in complex as compared to simple tasks. This holds true for both fine and gross motor skills. Apparently, relative age differences become enlarged when effortful resources are required for motor performance.
Thus, the decline in motor functioning and learning that accompanies aging is task specific and not absolute. It is striking that visuomotor performance seems to be adversely affected by age. For instance, Seidler [ 48 ] showed specific skill-learning deficits in older adults. Performance differences particularly occurred in a visuomotor adaptation task. Additionally, Breitenstein et al.
In a gross-motor-task study, Hedel and Dietz [ 24 ] showed that older adults rely more on visual control when acquiring and performing a precision locomotor task.
The level of familiarity seems to be another task characteristic that causes important age-related differences in motor-skill learning. The studies that focus on the learning of fine motor tasks use skills with a rather high familiarity level put in a new context , for example, hand movements aiming, sequencing, force modulation. It might be the case that in the fine motor tasks that investigated the refinement of known skills e. Whereas performance gains in the gross motor tasks are mostly recorded using outcome measures such as points, number of successful trials, etc.
This might be one reason for the higher amount of studies showing age-related differences in fine motor tasks as compared to gross motor tasks. In gross motor tasks, older adults might be more capable to activate reserve capacities, compensate for motor and cognitive weakness and, in turn, show learning gains comparable to younger adults.
In general, diminished motor-skill-learning gains are interpreted as a substantial age-related performance loss in older adults and a reduction in cognitive or motor plasticity, respectively.
Causes of the performance decreases in older age are hypothesized to be neuro-physiological and physiological changes [e. Mechanisms discussed in this context are, for example—on a central level—reduced nerve conduction speed and, in turn, reduced reaction speed, increased lateralization, and diminished inhibition processes, or—on a peripheral level—diminished tactile sensitivity e.
Age-related neurodegenerative and neurochemical changes are thought to underlie the decline in motor and cognitive performance, but compensatory processes in cortical and subcortical functions e. In brain-imaging studies, activation seen early in practice involves generic attentional and control areas—prefrontal cortex, anterior cingulate cortex, and posterior parietal cortex are the main areas considered to perform the scaffolding role together with changes seen in task-specific areas [ 25 ].
Particularly, the prefrontal and mediofrontal cortex and the frontostriatal network are shown to demonstrate highest age-related decline [ 9 ] for an overview. Individual differences in motor plasticity in old age might be strongly associated with sensory hearing and vision and cognitive functioning memory, speed, fluency, knowledge. It is shown in cognitive studies that participants who had a greater loss in perceptual speed showed a lower maximum performance level and less learning gains [ 5 ].
Results suggest that aging-induced biological factors are a prominent source of individual differences in cognitive and, in turn, motor plasticity. Motor and cognitive plasticity cannot be stated as being independent from each other. In particular, the early learning phase has been proven to be mainly influenced by cognitive processes [ 25 , 34 ] to understand the task and prepare strategies. Studies presented within this review indicate that regardless of performance decreases, considerable learning improvements are possible in older age.
The life-span perspective makes it possible to obtain an estimate of the size of age-related reductions in plasticity, and it underlines the high amount of remaining motor plasticity in older age. A typical comparison of younger mostly students versus older adults—as done in most cognitive and motor studies—often underestimates the performances of the older adults, particularly in learning of new gross motor skills.
The life-span study results indicate that the reduction in motor plasticity occurs not particularly in older age but also in young and middle age after a peak in youth and younger adulthood.
For example, the gross-motor-skill study by Gershon [ 20 ] illustrates that performance decrements start early in middle age and not in old age. Same is shown in the study by Voelcker-Rehage and Wilimczik [ 65 ]. However, results differ with regard to the task characteristics. Whereas juggling performance decreased between 19 and 35 years and remained stable until older age 69 years , lacrosse performance nearly linearly decreased from the age of 29 years onwards.
In all studies, there is a substantial decrease in the oldest old around 80 years. Only one study revealed that performance decreases start in older age, from the age of 62 onwards; motor learning was significantly slower in adults over 62 years of age [ 52 ].
Furthermore, one life-span study revealed no age-related differences with regard to motor learning across adulthood [ 17 ]. A limitation of studies on age-related differences is that the age-comparison is based on a mixed cross-sectional design.
Although performance changes due to practice are measured longitudinally in a pre-post-test design, the age comparisons are limited to age-related averages and evidence about long-term changes at the individual level is not available.
Particularly in older age, individuals vary considerably in their individual performance level [ 54 ] and probably also in their performance gains due to learning. Additionally, cross-sectional studies that cover a wide age span—whether it be a young—old comparison, or a comparison of multiple age groups across the life span—have the problem that they can be threatened by cohort effects.
Thus, age-related differences shown in the described studies may not only represent age-related differences but also reflect cohort-related preconditions.
A further limitation of aging studies is the sample selectivity. Furthermore, it is undeniable that the incidence of disability in older groups progressively increases. One of the ways other than age that two or more age groups in cross sectional research could be different is the incidence of disabilities that could impact performance [ 18 ]. In general, one can assume that all studies described above appoint comprehensive screenings before the start of the study to eliminate participants with health-related or cognitive impairments that could potentially influence the outcome of the study.
If we focus on motor-skill learning in older age, however, we need to take into consideration that this is a very broad age range covering about 30 years. Cognitive change in the very old, the so-called fourth age, proves special features and constraints: Sensory limitations, slower speed of processing, limits to independence, and motor limitations are common characteristics of both the start and the end of our lives.
Until now, performance gains in very old age have been investigated using only cognitive tasks. Singer et al. It was found that memory plasticity with the Method of Loci is still preserved in very old age, although to a limited degree. At the same time, the comparison of the acquisition functions of young and very old participants during the adaptive training period revealed an enlargement of age differences: Apparently, very old adults had a reduced ability to optimize their performance after instruction.
The evidence for age-related reduction of motor plasticity founded on the basis of the comparison of young and old participants and life-span studies could not be demonstrated within all the reviewed studies.
The findings show that although the performance of motor skills is greatly affected by age, acquisition of a skill is relatively unaffected by age. Adult capacities for extensive learning and change represent the open end of development. In the following, the term motor skill will be used in a broader sense referring to the inner and outer aspects of a movement. Adams JA Historical review and appraisal of research on the learning, retention, and transfer of human motor skills.
Psychol Bull — Article Google Scholar. Anshel MH Effect of aging on acquisition and short-term retention of a motor skill. Percept Mot Skills — Baltes PB Theoretical propositions of life-span developmental psychology: On the dynamics between growth and decline. Dev Psychol — Baltes PB, Kliegl R Further testing of limits of cognitive plasticity: negative age differences in a mnemonic skill are robust. Baltes PB, Lindenberger U Emergence of a powerful connection between sensory and cognitive functions across the adult life span: a new window to the study of cognitive aging.
Psychol Aging — In: Lerner RM ed Handbook of child development. Theoretical models of human development. Wiley, New York — Google Scholar. Z Gerontopsychol Psychiatr — Cabeza R Functional neuroimaging of cognitive aging. PubMed Article Google Scholar. Cereb Cortex — Kluwer, Netherlands, pp 41— Res Q Exerc Sport — Quest — Cratty BJ Movement behavior and motor learning. Adapted Phys Act Q — Arch Gerontol Geriatr — J Gerontol — Gershon EJ A study of age and sex differences in the acquisition of a complex motor skill.
Rev Educ Phys — Grady CL Functional brain imaging and age-related changes in cognition. Biol Psychol — Clin Neurophysiol — Psychol Sci — Magill RA Motor learning: Concepts and applications, 4th edn. Magill RA Motor learning and control, 7th edn. Mc Graw Hill, New York. Moreover, young athletes should be exposed to a range different stimuli, however, this must not be delivered in a random or poorly thought-out format.
Instead, the goal and focus of training sessions should be to develop gross athletic motor skill competencies Figure 1 through a challenging and playful environment. Figure 1. After puberty, strength increases develop differently between genders. However, it is important to understand that strength stills remains trainable as children mature.
As maximal strength seems to increase steadily for boys as they approach full adult maturity, girls tend to experience a plateau [3]. It has been reported that the gap between strength and power widens between genders in the years after puberty [4].
Despite this separation, both genders can expect significant increases in muscular strength and power following an appropriate short-term resistance training programme [12, 13]. Having said that, this increase in strength is highly individualised as certain children respond more favourably than others [14]. Resistance training can also bring about improvements in bone health [15], body composition [16], and self-esteem [17]. Strength training produces many benefits for maturing children and may also provide implications for reducing injury.
Until recently, common thought outside of the sport and exercise community was that resistance training in children and adolescents was a major safety risk and detrimental to natural growth. However, it has been shown that children are much more likely to get injured during competition then they would be performing an appropriately delivered strength and conditioning programme [18]. While exposure to strength and power are beneficial to the muscles, bones and soft-tissue, they may still be at-risk to overuse injuries.
Overuse injuries are a major problem for young athletes who are experiencing periods of rapid growth [19], and who are also being exposed to tremendous training loads. This can be brought about unintentionally by both sport coaches and practitioners who fail to recognise these important red flags i. While the timing and tempo of maturation differs for everyone, there are various methods to measure and accurately predict the growth of the human body.
However, this method is limited in its availability to coaches and large groups of athletes. The next best method is by using the Mirwald equation [20], which is based off anthropometric ratio measures of the body.
Specifically, the ratio of sitting height to leg length [20]. If you wish to predict the maturity status of your athletes using the Mirwald equation, then simply download your free maturity offset calculator using the form below. Genetics also play a huge role in estimating stature of the child. By using the height of both parents, you can calculate the mid-parent stature [21] of both boys and girls.
If you wish to use this method, then click here to download your free bio-banding calculator so you can predict the adult height of your athletes and then group them based on their maturity.
Similarly, Sherar et al. A more pragmatic and traditional approach could be through regularly monitoring the height and body mass of your young athletes.
Three-month intervals should be a suitable interval time-period at which you can monitor and detect rapid growth. Although a lot is already understood about maturation, there is still far more to research and discover about this natural process.
Such things include:. This process is highly individualised, although there are distinct differences between genders after puberty. Children and adolescents should be exposed to a strength and conditioning programme that introduces them to a plethora of movements and motor skills. There are several methods in which we can predict the stature of children [] as well as monitor them as they mature.
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