fundamental movement skill interventions in youth: a...

Fundamental Movement Skill Interventions in Youth:A Systematic Review and Meta-analysis

abstractBACKGROUND: Fundamental movement skill (FMS) proficiency is pos-itively associated with physical activity and fitness levels. The objectiveof this study was to systematically review evidence for the benefits ofFMS interventions targeting youth.

METHODS: A search with no date restrictions was conducted across 7databases. Studies included any school-, home-, or community-basedintervention for typically developing youth with clear intent to improveFMS proficiency and that reported statistical analysis of FMS compe-tence at both preintervention and at least 1 other postintervention timepoint. Study designs included randomized controlled trials (RCTs) usingexperimental and quasi-experimental designs and single group pre-posttrials. Risk of bias was independently assessed by 2 reviewers.

RESULTS: Twenty-two articles (6 RCTs, 13 quasi-experimental trials, 3pre-post trials) describing 19 interventions were included. All but 1intervention were evaluated in primary/elementary schools. Allstudies reported significant intervention effects for $1 FMS. Meta-analyses revealed large effect sizes for overall gross motorproficiency (standardized mean difference [SMD] = 1.42, 95%confidence interval [CI] 0.68–2.16, Z = 3.77, P , .0002) andlocomotor skill competency (SMD = 1.42, 95% CI 0.56–2.27, Z = 3.25,P = .001). A medium effect size for object control skill competency wasobserved (SMD = 0.63, 95% CI 0.28–0.98, Z = 3.53, P = .0004). Manystudies scored poorly for risk of bias items.

CONCLUSIONS: School- and community-based programs that includedevelopmentally appropriate FMS learning experiences delivered byphysical education specialists or highly trained classroom teacherssignificantly improve FMS proficiency in youth. Pediatrics 2013;132:e1361–e1383

AUTHORS: Philip J. Morgan, PhD,a Lisa M. Barnett, PhD,b

Dylan P. Cliff, PhD,c Anthony D. Okely, PhD,c Hayley A. Scott,PhD,a Kristen E. Cohen, BTeach/BHealth & PhysEd,a andDavid R. Lubans, PhDa

aPriority Research Centre in Physical Activity and Nutrition,Faculty of Education and Arts, University of Newcastle, Newcastle,Australia; bSchool of Health and Social Development, DeakinUniversity, Burwood, Australia; and cInterdisciplinary EducationalResearch Institute, Faculty of Social Sciences, University ofWollongong, Wollongong, Australia

KEY WORDSfundamental movement skills, children, systematic review, motorskills, intervention, physical activity

ABBREVIATIONSCI—confidence intervalFMS—fundamental movement skillsPE—physical educationPRISMA—preferred reporting items for systematic reviews andmeta-analysesRCT—randomized controlled trialSMD—standardized mean difference

Prof Morgan conceptualized the study and drafted the protocoland Introduction, Methods, and Discussion sections; checked alldecisions made in the initial cull of records by title andscreened all retrieved articles for inclusion; and revised themanuscript; Dr Barnett critically reviewed the systematic reviewprotocol, screened all retrieved articles for inclusion, andreviewed and revised the manuscript; Dr Cliff critically reviewedthe systematic review protocol, assessed the risk of bias in eachincluded study and conferred with Prof Okely to achieveconsensus on all discrepancies, and reviewed and revised themanuscript; Prof Okely critically reviewed the systematic reviewprotocol, independently assessed the risk of bias in eachincluded study and conferred with Dr Cliff to achieve consensuson all discrepancies, and reviewed and revised the manuscript;Dr Scott conducted the systematic database search, completedthe initial cull of citations by title and abstract, and reviewedand revised the manuscript; Ms Cohen extracted study datarelating to methodology, participant characteristics,intervention description, fundamental movement skill measureand the intervention effect on fundamental movement skills andreviewed and revised the manuscript; A/Prof Lubans criticallyreviewed the systematic review protocol, checked all extracteddata for the review, conducted meta-analyses and drafted theResults section, and reviewed and revised the manuscript; andall authors approved the final manuscript as submitted.

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PEDIATRICS Volume 132, Number 5, November 2013 e1361

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It is well established that physical ac-tivity is vitally important for the healthygrowth and development of children1;however, many children are not ade-quately active.2 Physical activity pro-vides not only an opportunity to expendenergy, but also a medium for the de-velopment of fundamental movementskills (FMS). Gallahue and Donnelly3

(2003) define a FMS as “an organizedseries of basic movements that involvethe combination of movement patternsof two or more body segments” (p. 52).According to Gallahue, Ozman andGoodway, these movements are com-monly categorized as locomotor (eg,running, jumping, and hopping; p. 448)and object control or gross manipula-tive skills (eg, catching, throwing, andkicking; p. 449).4 FMS are considered tobe the foundation skills that lead tospecialized movement sequences re-quired for participation in many orga-nized and nonorganized physicalactivities for children and adoles-cents.5 FMS are optimally developed inchildhood and then refined into contextand sport-specific skills.5 For instance,overarm throwing can be refined to“pitching” in baseball or a “serve” intennis. FMS mastery or motor compe-tence is more likely to be achieved withquality instruction and practice,4 whilechildren who are not provided withopportunities to develop FMS maydemonstrate developmental delays intheir gross motor ability.6,7

Children’s FMS proficiency is low ina number of countries,8–10 with manychildren entering adolescence havingnot mastered these basic movementskills.9 This is of particular concern, asa recent systematic review of thehealth benefits of FMS proficiencyfound consistent and positive associa-tions between FMS proficiency andphysical activity and fitness levels andan inverse association with weightstatus.11 There is also longitudinal evi-dence that motor skills track through

childhood12,13 and into adolescence.14,15

FMS proficiency has been associatedwith subsequent physical activity16 andalso with change in physical activityover time, highlighting that childrenwith high FMS proficiency show littledecline in physical activity.17 In addi-tion, positive associations have beenestablished between FMS proficiencyand objectively measured physical ac-tivity in overweight children.18

Efforts to promote physical activityin youth would benefit from a great-er understanding of evidence-basedstrategies to improve FMS prof-iciency. Recommendations for school-and community-based physical activityprograms from various countries haveFMSdevelopment as an integral aspectof physical education and school andcommunity sport.19–21 However, littleis known about the efficacy of inter-ventions designed to improve FMSproficiency in typically developingchildren and adolescents. Reithmuller,Jones, and Okely22 conducted a sys-tematic review of controlled trials onthe efficacy of motor developmentinterventions in young children (aged,5 years old) and reported the evi-dence base was limited in bothquality and quantity. Another recentreview and meta-analysis includedboth typically and nontypically de-veloping children but only includedstudies that used a qualitative FMSassessment (with only 1 instrumentmeeting inclusion criteria).23 Anotherlimitation recognized in this reviewwas that most studies in the meta-analysis included children that weredevelopmentally delayed and/or ofpreschool age.

Therefore, the aim of the current studywas to conduct a systematic review andmeta-analysis of the effectiveness ofinterventions designed to improve FMSproficiency in typically developingchildren and adolescents using bothprocess- and product-oriented FMS

assessment and including both ran-domized and nonrandomized trials.

METHODS

The conduct and reporting of this re-view adhered to the guidelines outlinedin the Preferred Reporting Items forSystematic Reviews and Meta-analysis(PRISMA) Statement.24

Eligibility Criteria

Types of Participants

Children were enrolled in primary/elementary, middle, or high school.The age rangeof children in these levelsof schooling may vary by country butin general covers the following ages:primary/elementary school (5–12years), middle school (12–14 years),high school (12–18 years or 14–18years in areas with middle schools).Studies targeting overweight/obesechildren or children from schools indisadvantaged areas were includedbut not those where participants haddevelopmental coordination delays (ie,where study inclusion criteria speci-fied these characteristics).

Types of Interventions

Any school-, home-, or community-based intervention for children andadolescents with clear intent to im-prove FMS proficiency.

Types of Outcome Measures

Studies were included if they reportedstatistical analyses of FMS competenceat both preintervention and aminimumof 1 other poststudy time point. Theremust have been process (ie, technique)or product (ie, outcome) assessment of$1 of the following: run, vertical jump,horizontal jump, hop, dodge, leap, gal-lop, side gallop (slide), skip, roll,throw (under or over arm), stationarydribble, catch, kick, 2-handed strike,forehand strike, static balance, orcategorized in groups of commonly

e1362 MORGAN et al



described similar skills such as loco-motor or object control skills, or globalFMS score.25

Types of Studies

Study designs included randomizedcontrolled trials (RCTs) using experi-mental andquasi-experimental designsand single group pre-post trials.

Studieswere excluded if theymet any ofthe following criteria: (1) participantswere targeted groups from specialpopulations (eg, children with dis-abilities such as cerebral palsy oridentified as having developmental co-ordination disorder or conditions suchas mental illness); (2) not published inEnglish; (3) used measurement bat-teries that incorporatedanassessmentof finemotor skills,motor coordination,motor ability or fitness or that includeda focus on a skill unique to a particularsport; and (4) participants were chil-dren who were enrolled in preschoolsor child care centers.

Information Sources and Search

Studies were identified by searchingelectronic databases and scanningreference lists of included articles.Seven electronic databases weresearched: Medline [Ovid], Embase,PsychInfo, SCOPUS Current ContentsConnect, Sports Discus, ERIC [Ovid], andInformit. No publication date restric-tions were imposed in any database,and the last search was completed inJune 2013. Search terms were dividedinto 3 groups: (1) population (eg, chil-dren OR child* OR youth* OR adolescentOR school OR primary OR elementaryOR high OR secondary); (2) study de-sign (eg, random* OR clinic* OR trial ORintervention OR evaluation OR experi-ment OR program* OR pilot OR feasi-bility); and (3) intervention type (eg,physical activity OR exercise OR motorskill OR movement skill OR fundamen-tal motor skill OR fundamental move-ment skill OR coordination OR motor

development). The Boolean phrase “AND”was used between groups and thephrase “OR” was used within groups.

Study Selection

After the search, 1 of the authors (HAS)removed all duplicates and screenedthe title and abstract of remainingrecords in a nonblinded standardizedmanner. Only articles published or ac-cepted for publication in refereedjournals were considered. A secondauthor (PJM) checked all decisions andany disagreements were resolved bydiscussion. If there was insufficientinformation available to make a de-cision, the article was retrieved forclarification. Consensus was reachedby discussion when disagreementarose. Full text articles were then re-trieved for all remaining records. Twoauthors (PJM and LMB) independentlyscreened these articles for inclusionwith a “yes, no, or maybe” approach.Both reviewers then conferred, andafter discussion, full consensus wasreached on all articles. The referencelist of each included study wassearched for additional studies.

Data Collection Process

One author (KC) extracted study datarelating to methodology, participant

characteristics, intervention de-scription, FMS measure, and the in-tervention effect on FMS. Anotherreviewer (DRL) checked the extracteddata.

Risk of Bias in Individual Studies

Risk of bias was independentlyassessed by 2 reviewers (DPC and ADO)using a 9-item tool adapted from theConsolidated Standards of ReportingTrials statement26 and previously usedquality criteria27 (see Table 1). As rec-ommended in the PRISMA statement,these items were not numericallysummarized to give a final score;rather, each criteria was considered inisolation.28 In accordance with empiri-cal evidence, criterion A, C, D, and Hwere regarded as the most significantitems in which bias could have an im-pact on results.28,29 Each item on thescale was coded as “explicitly de-scribed and present” (✓), “absent” (x)or “unclear or inadequately described”(?). Interrater reliability for the asses-sors was calculated on a dichotomousscale (✓ = 1 vs x or ? = 0) using per-centage agreement and Cohen’s k.Depending on the study design, someitems were coded as not applicable(N/A) and not included in agreementcalculations. Disagreements between

TABLE 1 Risk of Bias Checklist

Item Description

A Randomization (generation of allocation sequence, allocation concealment and implementation)clearly described and adequately completed

B Valid measures of FMS proficiency used (validation in same age group has been published orvalidation data were provided by the author)

C Blindedoutcomeassessment (positivewhen thoseresponsible forassessingFMSproficiencywereblinded to group allocation of individual participants)

D Participantsanalyzed ingrouptheywereoriginallyallocatedto,andparticipantsnotexcluded fromanalyses because of noncompliance to treatment or because of missing data

E Covariates accounted for in analyses (eg, baseline score, group/cluster for cluster RCTs, andotherrelevant covariates when appropriate such as age or sex)

F Power calculation reported for main FMS outcomeG Presentation of baseline characteristics separately for treatment groups (age + sex + $1 FMS

outcome measure)H Dropout for FMS measure described, with a#20% dropout for studies with follow-up of#6 mo

and #30% dropout for studies with follow-up .6 moI Summaryresults foreachgroup+estimatedeffectsize (differencebetweengroups)+ itsprecision

(eg, 95% CI)

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assessors were resolved by discus-sion.

Synthesis of Results

Data were first collated and describedin a narrative summary with emphasisgiven to results from RCTs. Meta-analyses were conducted for studiesthat provided composite scores (ie,$2 skills combined) for overall FMSproficiency, locomotor proficiency,and object control proficiency usingRevMan version 5.1.30 Studies that in-cluded a control or comparison groupand reported baseline and posttestvalues or change scores, along withmeasures of distribution (ie, SD orconfidence intervals) were included inthe meta-analyses. When studies com-pared multiple treatment groups witha single control group (n = 2), thesample size of the control group wasdivided to avoid double counting. Forstudies that included posttest andfollow-up assessments, the assess-ments completed at the end of the in-tervention period (ie, posttest) wereincluded in the meta-analyses. BecauseFMS proficiency was assessed usinga range of instruments, the standard-ized mean difference (SMD) with 95%confidence intervals (CI) was reported.Estimates were obtained using theDerSimonian-Laird31 random effectsestimator and studies were weightedby the inverse of their variance. Sta-tistical heterogeneity was examined viax2 and the I2 Index tests. The stan-dardized effect sizes were interpretedas small (0.3), medium (0.5), and large(0.8).32

RESULTS

Overview of Studies

The flow of studies through the re-view process and reasons for exclusionare displayed in Fig 1. The initial searchidentified 12 329 citations. Afterscreening the titles and abstracts ofpotential studies, 59 full-text articles

were retrieved. From this number, 22studies (representing 19 unique inter-ventions) were included.

Study Characteristics

Table 2 displays selected character-istics of eligible studies including FMSresults. Eight studies were publishedbetween 2010 and 2013,33–40 11 be-tween 2000 and 2009,41–51 2 between1990 and 1999,52,53 and 1 in 1989.54 Themajority of studies were conducted inthe United States,34,37,47,52–54 Aus-tralia,35,42,48,50,51 and Sweden.36,43,44,49

The majority of interventions wereevaluated in primary/elementaryschools among children, with only 1study in high school with adoles-cents.39 Two studies were community-based interventions targeting over-weight and obese children.35,42 Onestudy included boys only,41 1 girls

only,33 and the remaining were co-educational.

There were 6 RCTs33,35,45,46,48,53 (in-cluding 3 cluster RCTs45,48,53), 13 quasi-experimental studies,34,36–39,41,43,44,47,49–52

and 3 single group pre-post stud-ies.40,42,54 Seven studies included follow-up assessments after a period of nointervention.35–37,39,42,48,51 Ericsson43,44

did not include an immediate postin-tervention assessment her but did in-clude follow-up assessments at 1, 2,43,44

and 9 years36 after baseline. The samplesizes for the studies ranged from 1342 to1464,34 and 10 studies had a sample sizeof.250.34,36,39,40,43,44,48,50,51,53

Risk of Bias Within Studies

Table 3 displays the risk of biasassessments for all studies. Interraterreliability metrics for the risk of biasassessments indicated substantial

FIGURE 1PRISMA flowchart of studies through the review process.

e1364 MORGAN et al



TABLE2

StudyandFM

SInterventionCharacteristicsandFindings

Reference(author,

year,country)

Design

andSetting

Sample

ProgramLengthand

TotalM

inutes

InterventionGroups

and

Facilitator

aInterventionContent/Theory

orPedagogicalApproach

FMSMeasure

andOutcom

esPosttestandFollow-

UpDuration

RetentionandResults

Akbarietal(2009),

Iran

Quasi-experimental,

1primaryschool

N=40

boys,

aged

7–9y

8wk/1440

min

INT:Traditionalgames

CON:Usualdaily

activities

Facilitator:

INT:Notclear

CON:Notclear

INT:33

60-minsessions/wk

accordingtoaspecific

lesson

plan,including

(1)

warm-up;(2)traditional

games,culturally

appropriateandrelevant

forIran

with

multiple

skillspractices

forboth

locomotor

andobject

control;(3)cooldown;

CON:Activities

such

asfootball,computer

games,cycling.

Approach:

INT:Directinstruction

CON:Notdetailed

TGMD-2(locom

otor:run,

gallop,leap,jum

p,hop,

slide;objectcontrol:

throw,catch,kick,strike,

dribble,roll)

PT:8

wk;

FU:None

RET:Notclear;

PT:INT

.CONforgross

motor

skills(P

,.001),

locomotor

skills(P

,.001)andobjectcontrol

(P,

.001);

Adjustments/effectsby

sexb:

N/A(boysonly).

Bakhtiarietal

(2011),Iran

RCT,1primary

school

N=40

girls,

meanage=

8.96

0.5y,

thirdgrade

8wk/1080

min

INT:Selected

exercises;

CON:Notclear

Facilitator:

INT:Notclear

CON:Notclear

INT:33

45-minsessions

per

weekofselected

exercisesaccordingto

aspecificlesson

plan,

including(1)heating,(2)

selected

exercises,(3)

cooling:

CON:Notdescribed.

Approach:

INT:directinstruction

TGMD-2(locom

otor:run,

gallop,hop,leap

jump,

slide;objectcontrol:

throw,catch,kick,strike,

dribble,roll)

PT:8

wk;

FU:None

RET:100%

;PT:INT

.CONforlocomotor

skills(P

=.001),object

controlskills

(P=.001)

andoverallm

otor

developm

ent(P

=.001);


sexb:

N/A(girlsonly).

Boyle-Holmes

etal

(2010),United

States

Quasi-experimental,

16primary

schools

N=1464;(49%

girls);aged

8–12

y(m

ean

age=9.8y),

fourth

and

fifth

grades

2y/3060

minp/y

INT:Michigan’s

Exem

plaryPE

Curriculum

.CON:ExistingPE

curricula.

Facilitator:

INT:PE

teachers

CON:PE

teachers

INT:Adevelopm

entalPE

curriculum

thatfocuses

onteaching

and

cumulativeand

connectedmotor

skill

learning

progressions

thatstrongly

incorporated

assessment

andfeedback.Lessons

focusedpredom

inantly

onthefollowing3

standards:motor

skill

andmovem

ent,values

ofphysicalactivity

for

health

andenjoym

ent,

andregularphysical

activity.Fifty-onelessons

Measure

developedfor

study(locom

otor:leap;

objectcontrol:forehand

strike)

PT:6-mo,12-mo,

18-mo;

FU:None

RET:18-moPT—

1195/1464

(81.6%

).PT:Overallaverageeffects

over

time:INT.

CONfor

forehand

strike

(P,

.05).

INT.

CONforleap

(P,

.05)

forthefifth

-grade

cohort;


sex:

Notreported.

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TABLE2

Continued

Reference(author,

year,country)

Design

andSetting

Sample

ProgramLengthand

TotalM

inutes

InterventionGroups

and

Facilitator



FMSMeasure

andOutcom


UpDuration

RetentionandResults

pergradethroughoutthe

schoolyear,2

330-min

lessonsperweek.Dose

was

onaverage44

lessons/y(75%

).CON:Eclecticcollectionof

materials.Lessons

focusedpredom

inantly

on3standardsfrom

the

MichiganPE

content

standards:motor

skill

andmovem

ent,

movem

entconcepts,and

responsiblepersonaland

socialbehavior.48

lessons/y;similar

frequencyandduration

toINT.

Approach:

INT:directinstructionwith

developm

entalfocus;

CON:directinstruction

Cliff

etal(2011),

Australia

RCT,After-school

community

N=165(59%

girls);aged=

5.5–9y,

Overweight

orobese

children

(78%

obese)

6mo/900min

INT1:Physicalactivity

skilldevelopm

ent

program(PA).

INT2:Dietary

modification

program(DIET).

INT3:Com

binedphysical

activity

anddietary

modification

program(PA+DIET).

Facilitator:

INT1:Researchers(PE

qualified)

INT3:Researchers(PE

qualified)

INT1:Guided

byCM

T,10-wk

face-to-face

program

(weekly90-mingroup

sessionandweekly

“hom

echallenge”

activities)and

aminimal-

contact3-mo

maintenance

phase.

INT2:Parent-onlyprogram

focusedon

improving

food

behaviorsanddiet

quality.

INT3:Identicalversions

ofPA

andDIETinterventions,

with

parentsand

childrenparticipating

concurrently.

Approach:

INT1and3:Basedon

CMT.

Both

directinstruction,

movem

entexploration,

TGMD-2(locom

otor:run,

gallop,hop,leap,

horizontaljump,slide;

objectcontrol:strike,

dribble,catch,kick,

throw,roll)

PT:6-mo;

FU:12-mo

RET:PT,109/165

(66.1%

);FU,

89/165

(53.9%

);PT:INT1

andINT3.

INT2for

locomotor

subscale(P

,.01),objectcontrol

subscale(P

,.01),and

GMQ(P

,.001)(GMQ

gainsof11%to13%).

FU:There

wereno

significant

between-

groupdifferences

for

locomotor

subscale,

objectcontrolsubscale

orGM

Q.


sexb:

Nosignificant

sex

interactioneffectsin

models.

e1366 MORGAN et al



TABLE2

Continued

Reference(author,

year,country)

Design

andSetting

Sample

ProgramLengthand

TotalM

inutes

InterventionGroups

and

Facilitator



FMSMeasure

andOutcom


UpDuration

RetentionandResults

guided

discovery,and

independentp

ractice.

Cliff

etal(2007),

Australia

Singlegroup

pretest–posttest

design,After-

school

community

N=13

(64%

girls),

aged

8–12

y(m

eanage10.4

61.2y).

Overweight

orobese

children(BMI

24.816

3.1)

10wk/1200

min

INT:SHARK.

Facilitator:

INT:Researcher

(PEqualified)

INT:10-wkafterschool

programtodevelop6

locomotor

(run,gallop,

hop,leap,horizontal

jump,slide)

and6object

control(2-handed

strike,

stationary

dribble,catch,

kick,overhandthrow,

underhandroll)

skills.

Weekly2-hgroupsession

focusedon

2or

3skills

andincluded

introduction,skill-

developm

ent,andskill

applicationactivities;

debrief;and“hom

echallenge”

tasks.Each

lesson

used

TARG

ET(task,

authority,recognition,

grouping,evaluation,

time)

structure.

Approach:

INT:Mastery

motivational

climate,basedon

CMT.

TGMD-2(locom

otor:run,

gallop,hop,leap,



dribble,catch,kick,

throw,roll)

PT:10wk;

FU:9-mo

RET:PTandFU

11/13(84.6%

);PT:INT

significant

increase

inGM

Q(P

,.001).FU:INT

GMQ

remainedsignificantly

higher

(P=.019).


sexb:

Notreported.

deAraujoetal

(2012),Brazil

Quasi-experimental,

Posttestonly,2

primaryschools

N=41

(39%

girls),aged

9–11

y,fourth

grade

Notreported

INT:Extrem

esports

classes.

CON:Existingphysical

education.

Facilitator:

INT:PE

teacher

CON:PE

teacher

INT:33

extrem

esports

weeklyclasses(including

skateboarding,roller-

skating,climbing,

parkouractivities)and

23

weeklyPE

classes.

CON:23

weeklyPE

classes.

Approach:

INTandCON:Notclear

TGMD-2(locom

otor

and

objectcontrolsubtests)

PT:Notreported

FU:None

RET:Notclear;

PT:INT

.CONforlocomotor

skills(P

,.05);No

differencebetween

groups

forobjectcontrol

skills.


sexb:

Notreported.

Ericsson

(2008a,

2008b),Sweden

Quasi-experimental,

1primaryschool

N=251,aged

6y

Interventionlength

unclear,study

duration9y/

11700min/y

INT:MUG

Imotor

training

program.

CON:Existingphysical

education.

Facilitator:

INT:PE

teacher

CON:PE

teacher

INT:53

lessonsofphysical

educationandphysical

activities

perweek(3

3PE

lessonsandvarious

localsportsclubstook

23

physicalactivity

lessons),and,ifneeded,

13

extralesson

(45min)

ofmotor

training

per

week.MUG

Iincludes

MUG

Iobservationchecklist

(eye-handcoordination:

throwandcatch,bounce

ball,obstaclecourse;

balanceabilityand

bilateralcoordination:

skip,hop

ononeleg,

balanceon

oneleg,

involuntarymovem

ents,

PT:Schoolyear

2and3

RET:Notclear.

PT:Schoolyear2:INT.

CON

formotor

skills(P

,.05)

(Cramér’sindex=0.24).

PT:schoolyear3:INT.

CONformotor

skills

(Cramér’sindex=0.37)

andlargestinthe

variablebalance/

bilateralcoordination.

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TABLE2

Continued

Reference(author,

year,country)

Design

andSetting

Sample

ProgramLengthand

TotalM

inutes

InterventionGroups

and

Facilitator



FMSMeasure

andOutcom


UpDuration

RetentionandResults

motor

skillobservations,

inform

ationtoteachers

andparents,and

identificationand

additionalsupportfor

childrenwith

motor

skill

problems.Principles

ofMUG

Iinclude

(1)success

insteadoffailure;(2)

notraining

ofskillsthechild

cannotperform;(3)

automizationofskillsin

earlierdevelopm

ent.

CON:23

lessonsofschool’s

ordinary

PEperweek

(90min).

“skihop,”imitate

movem

ents)

Differences

betweenboys

andgirlsmotor

skillsin

CONincreased(46%

boys

83%girlshadgood

motor

skillsinyear

3).No

differences

betweenboys

andgirlsmotor

abilities

inINT(90%

boys

94%

girlshadgood

motor

skillsinyear

3).

Ericsson

(2011),

Sweden

Quasi-

experimental

prospective

controlled

longitudinal

study,2schools

N=263(51%

girls)

Approach:

INT:Hypothetic-deductive;

CON:Notclear

PT:Schoolyear9

RET:Schoolyear

9—245/263

(93.2%

);PT:Schoolyear9:INT.

CON

formotor

skills

(Cramér’sindex=0.62).

CON:42%boys

and33%

girlshadgood

motor

skills.INT:93%boys

and

92%girlshadgood

motor

skills.


sex:

Noadjustmentsor

interactions

reported.

Foweather

etal

(2008),England

ClusterRCT,After-

school(2primary

schoolsinareas

ofhigh

deprivation)

N=34

(62%

girls),aged

8–9y,fourth

grade

9wk/1080

min

INT:Multiskills

club.

CON:Norm

alroutines.

Facilitator:

INT:experienced

coacheswith

sports

coaching

qualifications

CON:N/A

INT:Semiweeklyafter-school

club

with

23

1hr

sessions

each

week(total

18h)

focusing

onFM

S(verticaljump,leap,

sprint

run,kick,catch,

throw,static

balance)

developm

ent.Program

consistedofavarietyof

games,drills

andself-

learning

activities.

CON:norm

alroutines

and

notengaged

inadditional

sportp

rogram

s.

Modified

checklist

developedusing

‘GetSkilled:GetActive’

(verticaljump,leap,

sprint

run,kick,catch,

throw,static

balance)

PT:9

wk;

FU:None

RET:34/47(72.3%

).Children

attended

80%ofsessions.

PT:INT

.CONforstatic

balance(P

=.005).


sex:

Preliminaryanalysis

revealed

intervention

effects“didnot

significantlydifferby

sex”

(Pvaluenotreported).

e1368 MORGAN et al



TABLE2

Continued

Reference(author,

year,country)

Design

andSetting

Sample

ProgramLengthand

TotalM

inutes

InterventionGroups

and

Facilitator



FMSMeasure

andOutcom


UpDuration

RetentionandResults

Approach:

INT:Directandself-learning;

CON:N/A

Ignico

(1991),

UnitedStates

Quasi-experimental,

1primaryschool

N=30,grade

K10

wk/480min

INT:Competency-based

assessmentand

instructional

program.

CON:Regularly

scheduledfree

play.

Facilitator:

INT:3upper-level

universitypreservice

teachers(PEmajors);

CON:N/A

INT:Studentsrotated

between3stations

(9-min

each).Received

instruction,

demonstration,and

feedback

onspecific

performance

criteriaof

12motor

skills.Student/

teacherratio

was

6:1.

Totalinstructiontim

e∼28

mindaily.Preservice

teachers

received

training

inmotor

skill

assessmentfor

3wk.

CON:Participateinfree

play

activities

(∼20–25

min

daily).

Approach:

INT:Directinstruction;

CON:Free

play

TGMD(locom

otor:run,hop,

jump,slide,gallop,skip,

leap;objectcontrol:

dribble,kick,throw

,catch,strike)

PT:10wk;

FU:None

RET:100%

.PT:INT

.CONforGM

Q(P

=.0001).


sexb:

Interventioneffectsdid

notdiffer

bysex(P

=.27).

Kalajaetal(2012),

Finland

Quasi-experimental,

3secondary

schools

N=446(52%

girls),aged

∼13

y,grade7

33wk/

825min

INT:Professional

developm

entfor

teachers

andFM

Straining

sessions

for

students.

CON:RegularschoolPE

program.

Facilitator:

INT:PE

teachers

(2–10

yexperience);

CON:PE

teachers

(5–15

yexperience)

INT:33-wkintervention

included

FMStraining

sessions

focusing

ondeveloping

1dimension

ofFM

S(ie,locomotion,

manipulation,or

balance).FMSsessions

were25

mininduration

andscheduledat

the

beginningofPE

class.

Sessions

included

differentiationand

prom

oted

amastery

climate.AftertheFM

Ssession,PE

teachers

followed

regularschool

PEprogram(involving

practicingsportskills,

such

asorienteering,

volleyball,andskiing).

CON:One90-minweeklyPE

lesson

for33

wk.

Flam

ingo

standing

test,

rolling

test,leaping

test,

shuttle

runtest,rope

jumping

test,accuracy

throwingtest,figure-8

dribblingtest

PT:10mo;

FU:17mo.

RET:Notclear.

PT:INT

.CONforflam

ingo

standing

test(P

=.001),

INT.

CONforrolling

test

(P=.000),INT.

CONfor

balanceskillsumscore

(P=.000),INT.

CONfor

movem

entskillssum

score(P

=.000).

FU:INT

.CONforflam

ingo

standing

test

(P=.046),INT.

CONfor

balanceskillsumscore

(P=.014).


sex:

Notreported.

REVIEW ARTICLE




TABLE2

Continued

Reference(author,

year,country)

Design

andSetting

Sample

ProgramLengthand

TotalM

inutes

InterventionGroups

and

Facilitator



FMSMeasure

andOutcom


UpDuration

RetentionandResults

Approach:

INT:Mastery

climate;

CON:Directinstruction

Karabourniotisetal

(2002),Greece

RCT,1primary

school

N=45

(47%

girls),m

ean

age=79

mo,

firstgrade

12wk/960min

INT:Skill-orientated

programwith

focus

onself-testing

activities.

CON:RegularPE

school

program.

Facilitator:

INT:PE

specialists;

CON:PE

specialists

INT:12-wkexperimental

movem

entskill

curriculum

with

anincreasing

allotm

entof

timespentonself-testing

activities

(including

FMS,

sportsskills,fitness

activities,activities

with

smalland

large

equipm

ent)thatallow

studentsopportunities

toperformindividually.Two

40-minsessions

per

week.

CON:PE

curriculum

12-wk

programoriginally

suggestedby

theGreek

MinistryofNational

EducationandReligious

Affairs(space

andtim

eperceptionactivities;

visual-motor

coordinationactivities;

staticanddynamic

balance;sideways

movem

ent).

Approach:

INT:Movem

entexploration

(mastery/self-testing);


TGMD(locom

otor:run,

gallop,hop,horizontal

jump,leap,skip,slide;

objectcontrol:throw,

catch,dribble,kick,

strike)

PT:12wk;

FU:None

RET:Notclear.

PT:INT

.CONfortotal

motor

score(P

,.001),

locomotor

subscale(P

,.001)andobjectcontrol

subscale(P

,.001).


sexb:

Notreported.

Martin

etal(2009),

UnitedStates

Quasi-experimental,

2primary

schools

(economically

disadvantaged)

N=64

(53%

girls),INT

meanage=

5.7y,CON

meanage=

5.4y,gradeK

6wk/900min

INT:Mastery

motivationalclim

ate.

CON:Lowautonomy

climate.

Facilitator:

INT:Researcher/PE

specialist(6y

experience);

CON:PE

specialist(8y

experience)

INT:Mastery

motivational

climatewhere

students

moved

freelythroughout

FMSstations

andhad

choice

inwhich

stations

tovisit,tim

e,leveloftask

difficulty,and

grouping.

Teacherprovided

private

individualfeedbackabout

effortor

progress.Thirty

30-minlessons.

TGMD-2(locom

otor:run,

gallop,hop,leap,jum

p,slide;objectcontrol:

strike,dribble,catch,

kick,throw

,roll)

PT:6

wk;

FU:None

RET:53/64(82.8%

)for

locomotor

subscale,54/

64(84.4%

)forobject

controlsubscale.

PT:INT

.CONforlocomotor

subscale(P

=.001)and

objectcontrolsubscale

(P=.001).


sexb:

Notreported.

e1370 MORGAN et al



TABLE2

Continued

Reference(author,

year,country)

Design

andSetting

Sample

ProgramLengthand

TotalM

inutes

InterventionGroups

and

Facilitator



FMSMeasure

andOutcom


UpDuration

RetentionandResults

CON:Low-autonom

yclimate

thatused

directteaching

methods,skilldrills,

sportskills

andlarge

groupactivities.Thirty3

30-minlessons.

Both

INTandCONlessons

consistedof3parts:(1)

3–5minintroduction,(2)

22–25

minofskill

instructionandpractice;

(3)2–3minclosure.

Approach:

INT:Mastery

motivational

climate;


Matvienko

etal

(2010),United

States

Quasi-experimental,

After-school,4

primaryschools

N=70

(50%

girls),grades

Kand1

4wk,2100

min

INT:NutriActive

(morning

walkand

after-school

program).

CON:Control.

Facilitator:

INT:PE

specialist;

CON:N/A

INT:Daily

15-minmorning

walkand90-minafter-

schoolphysicalactivity

lesson

with

anem

phasis

onmotor

skill

developm

ent(20min),

nutrition/health

lesson

(30min),snack,and

nonstructuredactive

play.

CON:Didnotreceive

any

intervention.

Approach:


CON:N/A

Fitnessgramthrowing

distance

test.Additional

measuresdevelopedfor

study:rope

jumping

(num

berofbasicjumps

over

thejumprope

in30-s);kicking(kicking

aballintothegoalfrom

a10-m

line)

PT:4

wk;

FU:4-mo

RET:PT,100%,FU—

59/70

(84.3%

).PT:INT

.CONforjumps

over

rope,throw

ingand

kicking(P

,.05).FU:INT

.CONforjumps

over

rope

(P,

.001)and

throwing(P

,.001).


sex:

Notreported.

McKenzieetal

(1998),United

States

ClusterRCT,7

primaryschools

N=709(50%

girls);m

ean

agegirls=

9.4y,boys

=9.6y;grades

4and5

6mo/

2160

min

INT1:PE

specialists;

INT2:Trainedteachers.

CON:UsualPE.

Facilitator:

INT1:PE

specialists1

additionalSPARK

training

(1had11

yexperience,others

newlycredentialed).

INT2:Trained

classroomteachers.

INT1:PE

specialists

implem

entedtheSPARK

PEcurriculum

-focused

onfitness(15min)and

motor

skills(15min)and

included

alllessonplans.

Three30-minlessons/wk.

Received

bimonthly

meetingsoffsite

including

review

andfeedback.

INT2:Classroomteachers

implem

entedtheSPARK

PEcurriculum

.Three

Overhand

throw(overhand

throwaballtohit

atarget);catch(catch

aballthatwas

tossed

underhand);kick(kick

astationary

ballinto

atarget)

PT:6-mo;

FU:None

RET:100%

(95removed

from

baselineanalysis,12

unavailable).

PT:INT

2.

CONforcatching

(P=.005)andthrowing

(P=.008).Fortotalskill

percentgains

INT1

increasedby

21%,INT

2by

19%andCONby13%.


sexb:

Significant

maineffectof

sexforallskillchanges

REVIEW ARTICLE




TABLE2

Continued

Reference(author,

year,country)

Design

andSetting

Sample

ProgramLengthand

TotalM

inutes

InterventionGroups

and

Facilitator



FMSMeasure

andOutcom


UpDuration

RetentionandResults

CON:Classroom

teachers.

30-minlesson

perweek.

Classroomteachers

received

training

(Classroom

Teacher

Professional

Developm

entP

rogram

.Year

1=32-hover

11sessions,year2

=9-hover

3sessions).Also

received

onsitesupportb

yPE

specialist(biweeklyto

bimonthly)including

observations,m

odeling,

feedback

etc.).

CON:Continuedwith

usualPE

programs.

Approach:


CON:Notd

etailed.

(allP,

.001).Both

improved

butboys

made

significantlygreater

motor

skillgainsthan

girls.Interventioneffects

didnotd

iffer

bysex.

Mitchelletal(2013),

NewZealand

Singlegroup

pretest-posttest

design,11

primaryschools

N=701,aged

5–12

y,grades

K–8

6wk

INT:TailoredFM

SPE

lessons.

Facilitator:

INT:Classroomteachers.

INT:ProjectEnergizeteam

mem

bers

provided

and

discussedtargeted

PEplanswith

classroom

teachers.M

aterialswere

sourcedfrom

theKiwidex

andSPARC,Developing

Fundam

entalM

ovem

ent

Skillsmanuals.Skills

and

activities

wereincluded

intheirPE

andfitness

classes.Afterbaseline

assessments,childrenset

theirow

ngoalsforskills

they

wantedtoimprove.

Approach:

INT:Notdetailed.

TGMD-2(locom

otor:run,

gallop,hop,leap,



dribble,catch,kick,

throw,roll)

PT:6

wk;

FU:None

RET:Notclear

PT:INT:Significant

increase

forallskills

(P,

.003).


sexb:

Notreported.

Ross

etal(1989),

UnitedStates

Singlegroup

pretest-posttest

design,1primary

school

N=120(45%

girls),aged=

5–14

y;grades

K–8

36wk/K–3:2160

min;grades4–8:

3240

min

INT:Dance/

movem

ent

education(D/M

E).

Facilitator:

INT:PE

specialist(10

yexperience)1

2danceteachers.

INT:D/MEinconjunctionwith

theschool’sregularPE

programinstructed

bytheschool’sregular

physicaleducator

incooperationwith

2dance

educators.D/ME

OhioStateUniversityScale

ofIntraGrossMotor

Assessment(SIGM

A)(running,stairclimbing,

jumping,hopping,

skipping)(onlyassessed

K–3n=63).TheShort

PT:9-mo;

FU:None

RET:Notclear.

PT:K–3boys

madegainsin

thenumberofmature

grossmotor

patterns

for

running,jumping

and

hopping(noPvalue

reported).K–3girls

e1372 MORGAN et al



TABLE2

Continued

Reference(author,

year,country)

Design

andSetting

Sample

ProgramLengthand

TotalM

inutes

InterventionGroups

and

Facilitator



FMSMeasure

andOutcom


UpDuration

RetentionandResults

emphasized

Laban’s

principles

offorce,space,

time,andflow

.Video

feedback

was

used

toaugm

entinstruction,two

30-minlessonsperweek

forK–3.Two45-min

lessonsperweekfor

grades

4–8.

Approach:

INT:Dance/movem

ent

education(teaching

specificmovem

ent

educationconcepts;

choreographing

and

rehearsing)+regularPE

Form

oftheBruininks-

OseretskyTestofMotor

Proficiency

(dynam

icbalance,staticbalance)

(assessedK–8,n=

120).

madegainsinthe

numberofmaturegross

motor

patterns

for

running,jumping,

hoppingandskipping

(no

Pvaluereported).K–5

boys

increaseddynamic

balance(P

#.05).K–2

girlsincreaseddynamic

balance(P

#.05).


sex:

Boys

andgirlsanalyzed

andreported

separately.

Salmon

etal(2008),

Australia

ClusterRCT,3

primaryschools

(low

socio-

econom

icstatus

areas)

N=306(51%

girls),m

ean

age10

y8mo,

grade5

9mo/

855min

(FMScondition)

INT1:Behavioral

modification(BM)

condition.

INT2:FM

Scondition.

INT3:CombinedBM

/FMS

condition.

CON:Control.

Facilitator:

INT:PE

specialist;

CON:Notd

etailed.

Interventions

guided

bySCT

andBCTanddelivered

inadditiontousualPEand

sportsclasses.

INT1:19

lessons(40–50

min)

weredelivered

inthe

classroomand

incorporated

self-

monitoring,health

benefitsofPA,awareness

ofhomeandcommunity

PAandsedentary

behavior

environm

ents,

decision-making,

identifying

alternate

activities,intelligentTV

view

ingandreducing

view

ingtim

e,advocacy

ofreducedscreen

time,use

ofpedometers,group

games,contracts,and

parent

newsletter.

INT2:19

lessons(40–50

min)focusedon

mastery

of6FM

S(run,dodge,

verticaljump,throw,

strike,kick)

with

anem

phasison

enjoym

ent

DepartmentofEducation

VictoriaFundam

ental

Motor

Skills:AManualfor

ClassroomTeachers

(locom

otor:dodge,sprint

run,verticaljump;object

control:overhand

throw,

2-handed

strike,kick)

PT:9

mo;

FU:12mo

RET:Notclear;

PTandFU:Nosignificant

interventioneffectson

FMSz-scores.


sex:

Somegroup3

sex

interactions

notedfor

FMS.INT1girls.

CON

girlsforFM

Szscores

(P,

.05);INT

2girls.

CON

girlsforFM

Szscores

(P,

.01).

REVIEW ARTICLE




TABLE2

Continued

Reference(author,

year,country)

Design

andSetting

Sample

ProgramLengthand

TotalM

inutes

InterventionGroups

and

Facilitator



FMSMeasure

andOutcom


UpDuration

RetentionandResults

andfunthroughgames

andmaximum

involvem

entfor

all

children.

INT3:Received

bothBM

and

FMS(2

319

lessons).

CON:Usualcurriculum.

Approach:

INT:Games

andskillsdrills;

CON:Notd

etailed.

Sollerhed

etal

(2008),Sweden

Quasi-experimental,

2primary

schools

N=132(45%

girls),age

=6–9y

3y/10,560

min/y

INT:Expanded

PElessons.

CON:Stipulated

curricular

time.

Facilitator:

INT:PE

specialistand

classroomteacher;

CON:Classroomteacher.

INT:Increase

ofallocated

timeforPE.Four40-min

PElessonsandone1h

outdoorphysical

activities

perwk.Obese

childrenhadoptionof1

extralesson

perwk.

Quality

oflessonsand

varietyofactivities

were

emphasized.One

PElesson

boys

andgirls

separate,the

otherwas

co-educational.

CON:Followed

thestipulated

curricular

time.One40-

minlesson

perweekfor

childrenaged

6–9yand2

40-minlessonsperweek

forchildrenaged

10–12

y.Approach:

INTandCONT:Notdetailed

EURO

FIT(platetapping,

shuttle

run,balance).

Testsconstructed(rope

skipping:num

berof

correctskips

with

the

rope

in30

s;ball

bouncing:num

berof

correctbouncecatchesin

30s)

PT:1

y,2y,and3y;

FU:None

RET:3yPT,126/132

(95.5%

).PT:3

y:INT.

CONformotor

skillindex(P

=.010).


sex:

Results

adjusted

forsex.

VanBeurdenetal

(2003),Australia

Quasi-experimental,

18primary

schools

N=1045

(47%

girls)Aged

7–10

y,grades

1y

INT:MoveItGroove

It(M

IGI)

CON:Control.

Facilitator:

INT:Trainedclassroom

teachers

and

preservice

teachers;

CON:Classroom

teachers.

INT:MoveItGroove

It:whole-

schoolapproach:school

projectteams;buddy

program(m

atchingthird-

year

preservice

teacher

with

generalistteachers);

professional

developm

entforteachers

(1tointroducestudy,1

midstudytoshare

progress,and

2to

improveteaching

ofFM

Sanddance);projectWeb

sitewith

lesson

plans,

‘GetSkilled

GetActive’

(locom

otor:static

balance,sprint

run,

verticaljump,hop,side

gallop;objectcontrol:

kick,catch,overhand

throw)

PT:1

yFU:6

yRET:Notclear

PT:INT

.CONforallskills

combined(P

,.0001).

INT.

CONforboys

for

sprint

run(P

,.001),

side

gallop(P

,.001),

kick

(P,

.001),throw

(P=.034),jump(P=.004)

andcatch(P

,.001).INT

.CONforgirlsforside

gallop(P=.049),kick

(P=

.023),throw(P

=.042),

jump(P

=.002),hop(P

=.037),catch(P

,.001).

e1374 MORGAN et al



TABLE2

Continued

Reference(author,

year,country)

Design

andSetting

Sample

ProgramLengthand

TotalM

inutes

InterventionGroups

and

Facilitator



FMSMeasure

andOutcom


UpDuration

RetentionandResults

ideasandactivities;and

fundingforpurchase

ofequipm

ent($AU375.00).

Included

allelements

recommendedby

Ottawa

CharterforHealth

Prom

otion.Included

5days

training

+4

professional

developm

entworkshops

forteachers.

Overall,16.8%

improvem

entforallskills

combined(z=9.64,P

,0.0001).

CON:Notd

escribed.

Barnettetal

(2009),

Australia

6-yfollow-up

Approach:

INT:Directinstruction.

CON:Notd

etailed.

‘GetSkilled

GetActive’

(catch,kick,throw,

verticaljump,side

gallop)

RET:FU—268/928(28.9%

).FU:INT

.CONforcatch

(P=.001).INTmaintained

advantagecompared

with

CONforside

gallop

andverticaljump.


sex:

Nointeractions

effects

reported

atposttest.

Results

adjusted

forsex

at6yfollow-up.

BCT,behavioralchoice

theory;CMT,competencemotivationtheory;CON

,control;FMS,fundam

entalm

ovem

entskills;FU,follow-up-assessm

entsconductedafterthecompletionoftheinterventionandtheinitialposttestassessments;GMQ,GrossMotor

Quotient;INT,intervention;K,kindergarten;M

UGI,MotoriskUtvecklingsomGrundförInlärning—

motor

skillsas

foundationforlearning;PE,physicaleducation;PT,posttest-assessmentsconductedafterbaselineassessmentsand/or

immediatelyafter

completionoftheintervention;p/y,peryear;RCT,randomized

controlledtrial;RET,retention;SCT,socialcognitive

theory;SHARK,Skills

Honing

andActiveRecreationforKids;TGM

D-2,TestforGrossMotor

Developm

ent;y,year;

aFacilitator

refers

totheindividual(s)who

delivered

theintervention.

bTGMDstandardized

scores

arealladjustedforageandsex.

REVIEW ARTICLE




TABLE3

Risk

ofBias

Assessmentin

InterventionStudiesExam

iningChangesin

FMSin

Youth

Study

Random

ization

ClearlyDescribed

andAdequately

Completed

Valid

Measure

ofFM

S

Assessor

Blinding

ParticipantsAnalyzed

inAllocatedGroupandNot

Excluded

BecauseofMissing

Dataor

Noncom

pliance

Covariates

Accountedforin

Analyses

Power

Calculation

Reported

for

FMS

BaselineResults

Reported

Separatelyfor

Each

Group

Dropout#20%for#6Mo

Follow-Upand#30%.6Mo

Follow-up

SummaryResults

Presented

+Estim

ated

EffectSizes+

PrecisionEstim

ates

Akbarietal

2009

N/A

✓3

?3

33

?3

Bakhtiarietal

2011

3✓

3✓

33

3✓

3

Barnettetal

2009

N/A

33

33

33

3✓

Boyle–Holmes

etal2009

N/A

3✓

3✓

33

✓3

Cliff

etal

2007

N/A

✓N/A

✓N/A

3✓

✓3

Cliff

etal

2011

✓✓

✓✓

✓3

✓3

✓

deAraujoetal

(2012)

N/A

✓3

N/A

33

3?

3

Ericsson

etal

2008a

N/A

✓3

?3

33

?3

Ericsson

etal

2008b

N/A

✓3

?3

33

?3

Ericsson

etal

2011

N/A

✓3

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2008

33

33

33

33

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1991

N/A

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Kalajaetal

(2012)

N/A

✓3

✓3

33

?3

Karabourniotis

etal2002

3✓

33

33

33

3

Martin

etal

2009

N/A

✓3

33

3✓

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Matvienko

etal

2010

N/A

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33

33

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McKenzieetal

1998

?✓

33

33

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3

Mitchelletal

2013

N/A

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?N/A

33

?3

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etal1989

N/A

3N/A

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33

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Salmon

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2008

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✓✓

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Sollerhed

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33

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N/A

33

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inadequatelydescribed;N/A,notapplicablebecauseofstudydesign.

e1376 MORGAN et al



agreement for all 187 items (percent-age agreement 95%, k = 0.84). Seven-teen of the 22 studies usedmeasures ofFMS proficiency that had publishedvalidity,14,33,35–44,46–49,52 and this was themost commonly reported item acrossthe studies. Nine studies met the criteriafor adequate retention.33,34,36,37,42,47,49,52,53

Assessor blinding was reported in 3studies;34,35,48 and in 6 studies, partic-ipants were analyzed in their alloca-ted group and were not excludedbecause of missing data or non-compliance.33,35,39,42,48,52 Of the 6 RCTs,the randomization procedure, includingsequence generation, allocation con-cealment, and implementation, wasadequately described in only 1 study.35

None of the studies reported a powercalculation for FMS outcomes.

Measurement of FMS

Studies used a combination of processand product measures to assess FMScompetency. The Test of Gross MotorDevelopment (TGMD) was the mostcommon measure of FMS with TGMDused in 2 studies 46,52 and TGMD-2 usedin 7 studies.33,35,38,40–42,47 The ‘GetSkilled Get Active’measure was used toevaluate 2 interventions.45,50,51 Mat-vienko et al37 and McKenzie et al53 de-veloped product measures designed toassess children’s catching, kickingdistance, and throwing accuracy.

Types of Interventions

Nearly all interventions were deliveredin the primary school setting, with 4conducted after school35,37,42,45 and 1 inhigh school.39 Most interventions weredelivered by physical education (PE)teachers34–39,42,43,44,46–49,53,54 or experi-enced coaches,45 with some usingtrained classroom teachers53 ortrained preservice teachers50,51,52 or PEspecialists to help classroom teach-ers.40,49 Interventions ranged in dura-tion from 4 weeks37 to 3 years.49 Onaverage, interventions offered between

8 and 195 hours of instruction andran for 12 weeks (median). Many ofthe interventions followed a struc-tured format and included a pre-scribed number of lessons per week,although a number did not providedetailed intervention descriptions(eg,33,41,45,52).

Some of the interventions had a greaterfocusonproviding teacherprofessionaldevelopment (eg,39,53) or additionalsupport to teachers (eg,40,50,51). Theseinterventions tended to be longer induration and often included multiplestrategies and intensive support forteachers.48,50,51,53 For example, theMove It Groove It intervention50,51 in-volved a whole-school approach, whichincluded school project teams, a buddyprogram with preservice teachers,professional development (5 days oftraining and 4 workshops), and a pro-ject Web site. Similarly, for the trainedclassroom teacher study arm in theSPARK intervention,53 teachers re-ceived 32 hours training in year 1 and 9hours in year 2 and also received on-site support by a PE specialist (bi-weekly to bimonthly) that includedobservations, modeling, feedback, andother assistance.

Theoretical Frameworks orPedagogical Approach Guiding theInterventions

A number of the PE-based interventionstested an “enhanced” PE curriculumwith a focus on optimal FMS de-velopment versus traditional PE34,39,46,47

or free play,52 whereas some comparedboth enhanced PE and additional timespent in PE36,38,43,44,48,50,51,53 or simplyevaluated the benefit of an increasedtime allotment for PE.49 Many of theinterventions did not provide detailabout the theoretical or pedagogicalapproach that the intervention wasbased on. Some were based on 1 ap-proach, and others used a combina-tion of approaches. The followingapproaches or theories were de-

scribed: mastery motivational cli-mate,42,46,47 competence motivationtheory,35,42 hypothetic-deductive,36,43,44

self-learning,45 and movement explora-tion and self-testing.46,54 Martin andcolleagues47 used a mastery motiva-tional climate that allowed students tomove freely throughout FMS stationsand were encouraged to self-regulatethe time spent at each station, thelevel of task difficulty, and their group-ing. Most other interventions werebased on direct instruction (teacher-ledactivities, games) or not described.

Evidence for FMS Outcomes

All studies reported statistically signifi-cant intervention effects for $1 FMS.Twelve studies reported significant in-tervention effects for overall motor skillcompetency,33,35,36,39–41,42,43,46,49,50,52 and 1study found improvements in girlsonly.48 Alternatively, McKenzie and col-leagues53 found that changes in totalskill competency among students inthe intervention groups were greaterbut not significantly different to thoseobserved in the control group whocontinued with their usual PE pro-grams.

Both short-term (ie, 4–8 weeks) andlong-term (.6 months) interventionswere successful in increasing FMScompetency. Of those studies thatreported results beyond post-intervention assessments,35–37,39,41,48,51

6 reported positive intervention effectson at least 1 outcome.36,37,39,42,48,51 BothBarnett et al51 and Ericsson36 reportedsignificant long-term effects after 6and 9 years, respectively. Some studiesreported their results separately forboys and girls or included sex as aninteraction term/covariate in theiranalysis.35,44,48–54 Some found bothboys and girls improved,44,50,52,54

others reported boys made greatergains in the intervention53 or controlgroup,44 and 1 found the interventionfavored girls.48

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Meta-analysis of FMS InterventionEffects

Because there was considerable het-erogeneity among interventions, therandomeffectsmodelswereusedforallanalyses. The meta-analyses revealed

large effect sizes for overall grossmotor skill proficiency (SMD=1.42, 95%CI 0.68–2.16, Z = 3.77, P , .0002; Fig 2)and locomotor skill competency (SMD= 1.42, 95% CI 0.56–2.27, Z = 3.25, P =.001; Fig 3). A medium effect size for

object control skill competency wasobserved (SMD = 0.63, 95% CI 0.28–0.98, Z = 3.53, P = .0004; Fig 4). A funnelplot to assess publication bias was notproduced as the meta-analyses in-cluded ,10 interventions.55

FIGURE 2Meta-analysis comparing the effects of FMS interventions on overall gross motor skill proficiency.

FIGURE 3Meta-analysis comparing the effects of FMS interventions on locomotor skill proficiency.

FIGURE 4Meta-analysis comparing the effects of FMS interventions on object control motor skill proficiency.

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DISCUSSION

Theaimof this systematic reviewwas tosynthesize the evidence on the effec-tiveness of FMS interventions amongtypically developing youth. Of the 22eligible studies (including 6 RCTs), 19unique interventions were evaluatedwith all reporting intervention effectsfor $1 FMS. Meta-analyses revealedstatistically significant interventioneffects for overall gross, locomotor,and object control motor skill pro-ficiency. Although these findings arepromising, there was a high risk of biasin many of the included studies.

The evaluation of FMS interventions isa relatively new area of research. Al-though the first study was conducted in1989,54 86% have been published since2000. There was considerable variationin both intervention design and dura-tion, but most were delivered in theprimary school setting by PE special-ists. Only 1 study was conducted withadolescents, which is not surprisinggiven that FMS are optimally developedand ideally targeted in childhood.However, the lack of studies is of con-cern, given the poor FMS proficiency ofmany children who are now enteringhigh school,9,10,56 and this may be animportant area for future work. In-tervention effects for $1 FMS out-comes were reported in all studies,with 12 reporting significant effects foroverall motor skill competence. Instudies conducting follow-up assess-ments beyond the postinterventionassessment, 6 reported positive in-tervention effects, including 2 that hadlong-term follow-up.36,51 However, sig-nificant effects were not observed forall FMS measured.

The effect sizes found in the currentreview were large and greater thanthose observed in a previous meta-analysis of FMS interventions inmostly younger children.23 However,there were only a relatively smallnumber of heterogeneous studies

included in the meta-analyses. Wefound the effect size for locomotorskills was greater than for object con-trol skills. This is in contrast to a recentmeta-analysis by Logan et al, whichfound no difference. This disparity maybe due to the different age groupssampled as Logan et al’s meta-analysisincluded mostly studies of childrenwith developmental delays or of pre-school age. Our findings may suggestthat object control skills are more dif-ficult to improve than locomotor skills.This may be due to the greater skillcomponent complexity and perceptualdemand of object control skills, whichmay require more intensive skill in-struction and practice.

Although the findings are positive forFMS improvements, these resultsshould be interpreted with some cau-tion because of the high risk of biasidentified and because less than one-third of studies were RCTs. The highrisk of bias was similar to a recentreview of FMS interventions in youngchildren,22 although the number ofstudies demonstrating significant in-tervention effects was higher in thecurrent review. In the current review,most studies used a valid FMS mea-sure, but no studies reported a pow-er calculation for an FMS outcome.Moreover, studies scored poorly forrisk of bias items that aremost likely tobias the estimate of an intervention’seffectiveness,28,29 particularly for as-sessor blinding, participants beingexcluded because of missing data, re-tention, and poor descriptions of therandomization process for the RCTs.

Evidence From RCTs

Forall RCTs, the effect on FMSoutcomeswas in favor of the intervention group.The risk of bias was lower than theother studiesbut still quitehigh for two-thirds of studies. The RCTs evaluated 5programs in the primary school33,46,48,53

or after school settings45 in 5 countries

and 1 study for overweight children ina community setting.35 The school-based RCTs were conducted with gen-erally small samples (,100) anddiffered slightly in terms of their FMSimpact, with some reporting effects onoverall motor competence (both loco-motor and object control),33,46,53 andothers having an impact on a selectnumber of individual skills45 or ina subgroup analysis favoring girls.48

FMS Intervention Characteristicsand Pedagogical Approaches

Many studies did not describe theirintervention sessions or teachingstrategies in detail (eg,33,38,41,45,52), andalthough intervention componentsvaried across studies, they generallyinvolved multiple lessons per week.Similar heterogeneity was also foundin the review of young children.22 Anumber of the PE-based interventionstested an “enhanced” PE curriculumwith a focus on optimal FMS de-velopment versus traditional PE34,39,46,47

or free play,52 whereas some comparedboth enhanced PE and additional timespent in PE36,38,43,44,48,50,51,53 or simplyevaluated the benefit of an increasedtime allotment for PE.49

Of those studies that compared en-hanced PE (ie, targeting FMS de-velopment) versus typical PE (eg,games)34,39,46,47 or free play,52 findingsdemonstrated the benefits of peda-gogical approaches that enabled thelearner to experience autonomy, de-velopmentally appropriate tasks, andmastery and receive individualizedfeedback. This is of note, given that thecontrol groups in these studies re-ceived the same time in PE or “dose” asthe intervention group and both in-tervention and control groups had PEspecialists deliver the respective pro-grams. For example, Karabourniotiset al46 demonstrated the benefits ofa motor skill-focused program char-acterized by self-testing activities and

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many opportunities for individualpractice, compared with usual PE les-sons using a games approach. Martinet al47 showed greater gains in FMSproficiency of children in a masteryclimate comparedwith a low-autonomygroup, although as the interventionwas delivered by the research team, itis possible that a teacher effect mayhave contributed to the group differ-ences. However, a mastery climate, fo-cusing on success, optimal challenge,and autonomy led to improvements inFMS in multiple other studies,39,42,46,52

highlighting the benefits of this peda-gogical approach. Although researchin PE pedagogy has demonstratedthe value of direct instruction,57,58

student-centered approaches in whichstudents are given choice may en-hance intrinsic motivation,59 on-taskbehavior, effort, and FMS proficiency.However, more research is neededto determine optimal pedagogicalapproaches.

Other studies in our review comparedthe effects of additional teacher trainingand/or timeforPElessons36,38,43,44,48–50,51,53

with usual PE practice and demon-strated improved FMS outcomes. Forexample, McKenzie et al53 demonstratedthat classroom teachers who receivedextensive training and ongoing supporthad a meaningful impact on their stu-dents’ FMS. Ericsson36,43,44 found supe-rior FMS gains froma greater dose of PE(5 lessons per week) compared withthe school’s ordinary PE (2 lessons perweek).

Given the issues identified in primaryschool PE internationally, including theconstraints of a “crowded curricu-lum”60–63, further strategies to in-tegrate FMS learning beyond theschool may have merit. This wasa successful strategy used in 4 studiesin the after-school setting35,37,42,45 andby using supplementary home-basedFMS tasks.35,42,53 Matvienko et al37

found a short, intense after-school

program produced significant andsustained FMS changes in the shortterm. Few studies35,42,43 reported usingparents as part of the intervention, asalso found in Reithmuller’s et al22 FMSreview in young children. Given thelimited PE curriculum time in primaryschools, strategies to engage parentsin both school-based lessons and tosupport practice opportunities outsideof school may be a worthwhile targetfor future interventions.

Overall, it is difficult to ascertain whichintervention characteristics were mostimportant given the differences in de-sign, program length and limited detailprovided.Most studiesdidnotdetail the“dose” received (eg, attendance, FMSon-task time). Interestingly, the Loganet al review23 found no associationbetween FMS effect size and in-tervention duration, likely because ofa disparity between intervention lengthand dose, with most studies notreporting actual FMS on-task time (ie,the actual time a child is engaged in anactivity in which he or she is practicingor applying a FMS). This is an impor-tant area for future research becausemotor skill development theory showsthat a key factor is the number ofcorrect practice trials a child com-pletes.57

In addition, a longer intervention maynot result in better FMS outcomes be-cause some children (particularlyolder) may experience a “ceiling effect”with some FMS measures. Process-oriented assessment batteries distin-guish well at the lower end of skillability but not as well at the higher end.As children grow and develop, they aremore likely to be proficient in an FMS,or even excel at it, but the child who“excels”may score the same as a childwho simply displays proficiency in thecore skill components. Ceiling effectsare less likely to occur with productassessments because there is alwaysthe possibility to perform better when

the scoring is related to speed, dis-tance, or accuracy.

Implications andRecommendations

Quality of instruction and time spent inpractice are of utmost importance inimproving FMS competence.4 PE isa critical medium for providing thisopportunity and is recognized as oneof the most influential factors in FMSdevelopment.64 Most of the school-based interventions targeted PE andPE specialists as facilitators. Theinterventions that used classroomteachers40,50,51,53 involved substantialprofessional development. Becausemany countries employ classroomteachers to deliver primary school PE,it is critical that FMS lessons are de-livered appropriately and frequently.65

Many studies have confirmed the ten-dency of classroom teachers to deliverPE programs consisting of inap-propriate lesson content includinglarge-sided team games or free play.66,67

Therefore, schools should ensure FMSlessons are delivered in a pedagogicallyappropriate manner60 and that PE spe-cialists are engaged. Given that theprimary school years are consideredthe optimal time to develop FMS4 andcurrent issues with FMS learning con-texts in primary schools,68 training andresources need to be prioritized so thatchildren can receive quality instruction.Researchers and education authoritiesmay also need to consider the adoptionof evidence-based programs and de-termine how these could be translatedand sustained without researcher sup-port.

Although risk of biaswas high overall, itis possible that studies were in-adequately reported rather than con-ducted, and thus actual study qualitymay have been underestimated. Futureresearch should use the ConsolidatedStandards of Reporting Trials andTransparent Reporting of Evaluations

e1380 MORGAN et al



With Nonrandomized Designs state-ments. Inparticular, it is imperative thatresearchers report their interventionsin greater detail (eg, intensity, durationand fidelity of FMS tasks, character-istics of facilitators and participants)69.More evidence is needed to determinewhich pedagogic approach and pro-gram components are associated withenhanced FMS competence and theoptimal dose, duration, and intensity ofinterventions. In addition, becausemost of the studies only includedassessments immediately after theintervention, future studies shouldinclude follow-up assessments be-yond the postintervention time pointto determine any sustained or long-term effects. Additional studies areneeded that report results separatelyby sex given established differences in

FMS proficiency between boys andgirls9,15 and that findings from a fewstudies highlighted the need for in-creased attention on girls’ FMS pro-ficiency.53

Strengths and Limitations

This review has a number of strengths:(1) a comprehensive search strategyacross multiple databases with no daterestrictions, (2) extensive study detailextracted and broad inclusion criteria,(3) high agreement levels for risk ofbias assessments, and (4) alignmentwith the PRISMA Statement.28 Limi-tations included the following: (1)studies were required to be publishedin English, (2) inclusion of a generallymodest number of heterogeneousstudies, (3) inability to rule out publi-cation bias, and (4) potential study

comparison difficulties due to the dif-ferent types of FMS measures used.

Conclusions

Given the established associations be-tween FMS and a range of health-related benefits,11,56 future researchis needed to evaluate high-quality trialswith long-term follow-up. We found ev-idence for the positive influence ofprograms of enhanced PE to improveFMS proficiency of children. Althoughthe evidence-base is promising, resultsmust be treated with some cautiongiven the high risk of bias identified inmany studies. It is clear that PE hasa vital role to play in developing FMS forchildren and that PE specialists orclassroom teachers with extensive andongoing professional development arerequired to deliver such programs.

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(Continued from first page)

www.pediatrics.org/cgi/doi/10.1542/peds.2013-1167

doi:10.1542/peds.2013-1167

Accepted for publication Sep 3, 2013

Address correspondence to Philip Morgan, PhD, Priority Research Centre in Physical Activity and Nutrition, Faculty of Education and Arts, University of Newcastle,Callaghan NSW, Australia 2308. E-mail: [email protected]

PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).

Copyright © 2013 by the American Academy of Pediatrics

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.

FUNDING: No external funding.

POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.

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DOI: 10.1542/peds.2013-1167 originally published online October 28, 2013; 2013;132;e1361Pediatrics

Scott, Kristen E. Cohen and David R. LubansPhilip J. Morgan, Lisa M. Barnett, Dylan P. Cliff, Anthony D. Okely, Hayley A.

Meta-analysisFundamental Movement Skill Interventions in Youth: A Systematic Review and

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DOI: 10.1542/peds.2013-1167 originally published online October 28, 2013; 2013;132;e1361Pediatrics

Scott, Kristen E. Cohen and David R. LubansPhilip J. Morgan, Lisa M. Barnett, Dylan P. Cliff, Anthony D. Okely, Hayley A.

Meta-analysisFundamental Movement Skill Interventions in Youth: A Systematic Review and

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ISSN: . 60007. Copyright © 2013 by the American Academy of Pediatrics. All rights reserved. Print American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois,has been published continuously since . Pediatrics is owned, published, and trademarked by the Pediatrics is the official journal of the American Academy of Pediatrics. A monthly publication, it


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