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Motor skill development in low-income, at-risk preschoolers: A community-based longitudinal intervention study

      Abstract

      Objectives

      This study aimed to: (1) determine the status of fundamental movement skill (FMS) performance in low-income, at-risk preschoolers; and (2) evaluate the impact of the Food Friends Get Movinwith Mighty Moves (MM) program on improving children’s FMS at two-year follow-up.

      Design

      Longitudinal, quasi-experimental study with matched controls.

      Methods

      The Colorado LEAP study was conducted in four Head Start/preschools (two intervention, two control) serving children aged 3–5 years. MM was delivered to the intervention group during preschool. The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) subtests for balance, running speed and agility, upper-limb coordination (object control (OC) skills) and strength were administered to children at baseline, post-intervention in preschool, one-year follow-up (kindergarten), and two-year follow-up (first grade).

      Results

      Compared to the normative sample’s mean, the mean scaled score for all participants at baseline was significantly lower for balance (p = 0.016) and OC skills (p < 0.001). At two-year follow-up, the means of balance for all participants and OC skills for just the control group were significantly lower than those of the normative sample (p ≤ 0.001). Hierarchical linear regression analyses revealed a significant intervention effect for OC skills with the overall model accounting for 41% of variance at two-year follow-up, F(6,165) = 20.45, p < 0.001. No intervention effects were found for the other three BOT-2 subtests.

      Conclusions

      Delivering the MM program in preschool confers a lasting impact on FMS, specifically OC skills, in at-risk elementary school children. Results suggest that at-risk preschoolers are already behind in FMS development and these delays will continue through first grade.

      Keywords

      1. Introduction

      Fundamental movement skills (FMS) are the basic building blocks required for mastering the complex, task-specific movements needed for participation in sports, dance, and other activities.
      • Clark J.E.
      From the beginning: a developmental perspective on movement and mobility.
      FMS consist of object control (e.g., throwing or catching a ball or ball skills), locomotor (e.g., running, hopping, skipping), and stability (e.g. balance) skills.
      • Stodden D.F.
      • Goodway J.D.
      • Langendorfer S.J.
      • et al.
      A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship.
      FMS development occurs during early childhood; however, FMS do not develop naturally with age. Rather, different environmental factors influence children’s FMS resulting in the divergence of FMS development and mastery at a young age.
      • Clark J.E.
      From the beginning: a developmental perspective on movement and mobility.
      • Stodden D.F.
      • Goodway J.D.
      • Langendorfer S.J.
      • et al.
      A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship.
      FMS are also related to children’s physical,
      • Lubans D.R.
      • Morgan P.J.
      • Cliff D.P.
      • et al.
      Fundamental movement skills in children and adolescents: review of associated health benefits.
      social,
      • Bart O.
      • Hajami D.
      • Bar-Haim Y.
      Predicting school adjustment from motor abilities in kindergarten.
      and cognitive
      • Bart O.
      • Hajami D.
      • Bar-Haim Y.
      Predicting school adjustment from motor abilities in kindergarten.
      development. Therefore, early childhood is a critical window for the development and mastery of FMS in order to promote children’s optimal physical, social, and cognitive development.
      The relationship between FMS proficiency and physical activity is of particular interest due to long-term implications of physical activity on health and disease risk. Several studies found a positive cross-sectional relationship between children’s FMS proficiency and participation in physical activity.
      • Foweather L.
      • Knowles Z.
      • Ridgers N.D.
      • et al.
      Fundamental movement skills in relation to weekday and weekend physical activity in preschool children.
      • Iivonen K.S.
      • Saakslahti A.K.
      • Mehtala A.
      • et al.
      Relationship between fundamental motor skills and physical activity in 4-year-old preschool children.
      • Robinson L.E.
      • Wadsworth D.D.
      • Peoples C.M.
      Correlates of school-day physical activity in preschool students.
      Further, two studies suggest that preschoolers with better FMS participate in more physical activity over the long term.
      • Lopes V.P.
      • Rodrigues L.P.
      • Maia J.A.
      • et al.
      Motor coordination as predictor of physical activity in childhood.
      • Barnett L.M.
      • van Beurden E.
      • Morgan P.J.
      • et al.
      Childhood motor skill proficiency as a predictor of adolescent physical activity.
      The majority of studies show a positive relationship between locomotor skills and physical activity,
      • Foweather L.
      • Knowles Z.
      • Ridgers N.D.
      • et al.
      Fundamental movement skills in relation to weekday and weekend physical activity in preschool children.
      • Iivonen K.S.
      • Saakslahti A.K.
      • Mehtala A.
      • et al.
      Relationship between fundamental motor skills and physical activity in 4-year-old preschool children.
      • Robinson L.E.
      • Wadsworth D.D.
      • Peoples C.M.
      Correlates of school-day physical activity in preschool students.
      though there are studies showing either no relationship
      • Barnett L.M.
      • Ridgers N.D.
      • Salmon J.
      Associations between young children’s perceived and actual ball skill competence and physical activity.
      or a negative relationship
      • Cliff D.P.
      • Okely A.D.
      • Smith L.M.
      • et al.
      Relationships between fundamental movement skills and objectively measured physical activity in preschool children.
      between locomotor skills and physical activity. Despite mixed results regarding the association between locomotor skills and physical activity, recent data indicate that object control (OC) skills are related to participation in physical activity. For instance, Barnett et al. found that children who were proficient in OC skills were 10–20% more likely to participate in vigorous activity as adolescents.
      • Barnett L.M.
      • van Beurden E.
      • Morgan P.J.
      • et al.
      Childhood motor skill proficiency as a predictor of adolescent physical activity.
      Additional studies found positive associations between OC skills and total physical activity
      • Iivonen K.S.
      • Saakslahti A.K.
      • Mehtala A.
      • et al.
      Relationship between fundamental motor skills and physical activity in 4-year-old preschool children.
      and moderate-to-vigorous physical activity (MVPA).
      • Foweather L.
      • Knowles Z.
      • Ridgers N.D.
      • et al.
      Fundamental movement skills in relation to weekday and weekend physical activity in preschool children.
      • Iivonen K.S.
      • Saakslahti A.K.
      • Mehtala A.
      • et al.
      Relationship between fundamental motor skills and physical activity in 4-year-old preschool children.
      Finally, Cliff et al.’s study suggests that OC skills explain 13.7% of variance in total physical activity.
      • Cliff D.P.
      • Okely A.D.
      • Smith L.M.
      • et al.
      Relationships between fundamental movement skills and objectively measured physical activity in preschool children.
      Overall, locomotor and OC skills appear to be cross-sectionally
      • Foweather L.
      • Knowles Z.
      • Ridgers N.D.
      • et al.
      Fundamental movement skills in relation to weekday and weekend physical activity in preschool children.
      • Iivonen K.S.
      • Saakslahti A.K.
      • Mehtala A.
      • et al.
      Relationship between fundamental motor skills and physical activity in 4-year-old preschool children.
      • Robinson L.E.
      • Wadsworth D.D.
      • Peoples C.M.
      Correlates of school-day physical activity in preschool students.
      and longitudinally
      • Stodden D.F.
      • Goodway J.D.
      • Langendorfer S.J.
      • et al.
      A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship.
      • Lopes V.P.
      • Rodrigues L.P.
      • Maia J.A.
      • et al.
      Motor coordination as predictor of physical activity in childhood.
      • Barnett L.M.
      • van Beurden E.
      • Morgan P.J.
      • et al.
      Childhood motor skill proficiency as a predictor of adolescent physical activity.
      related to participation in physical activity; therefore, mastering FMS may be vital for children’s short- and long-term participation in physical activity and for their overall health.
      In order to further understand FMS development, there is a need to discern the environmental factors known to affect FMS. One of these factors is socioeconomic status (SES). Studies suggest that preschoolers from high SES families appear to perform better on FMS compared to preschoolers from low SES families.
      • Morley D.
      • Till K.
      • Ogilvie P.
      • et al.
      Influences of gender and socioeconomic status on the motor proficiency of children in the UK.
      • Venetsanou F.
      • Kambas A.
      Environmental factors affecting preschoolers’ motor development.
      Low-income, at-risk children may also be developmentally delayed in their FMS.
      • Goodway J.D.
      • Robinson L.E.
      • Crowe H.
      Gender differences in fundamental motor skill development in disadvantaged preschoolers from two geographical regions.
      Children are often defined as ‘at-risk’ if they are from low-income families because these children consistently demonstrate delays in both cognitive and behavioral development compared to children from higher-income families.

      Robbins T, Stagman S, Smith S. Young children at risk. National and state prevalence of risk factors. Available at: http://www.nccp.org/publications/pub_1073.html. Accessed 9 May 2016.

      Several studies have shown that preschoolers who were at-risk based on SES and/or ethnicity were developmentally delayed in their overall FMS,
      • Goodway J.D.
      • Robinson L.E.
      • Crowe H.
      Gender differences in fundamental motor skill development in disadvantaged preschoolers from two geographical regions.
      • Liu T.
      • Hamilton M.
      • Smith S.
      Motor proficiency of the head start and typically developing children on mabc-2.
      locomotor,
      • Goodway J.D.
      • Robinson L.E.
      • Crowe H.
      Gender differences in fundamental motor skill development in disadvantaged preschoolers from two geographical regions.
      balance,
      • Liu T.
      • Hamilton M.
      • Smith S.
      Motor proficiency of the head start and typically developing children on mabc-2.
      and OC skills.
      • Goodway J.D.
      • Robinson L.E.
      • Crowe H.
      Gender differences in fundamental motor skill development in disadvantaged preschoolers from two geographical regions.
      • Pope M.L.
      • Liu T.
      • Getchell N.
      Object-control skills in Hispanic preschool children enrolled in head start.
      These data suggest the need for interventions addressing FMS development in low-income, at-risk preschoolers, like those attending Head Start. While previous short-term interventions have focused on FMS development in at-risk preschoolers attending Head Start or similar preschools,
      • Draper C.E.
      • Achmat M.
      • Forbes J.
      • et al.
      Impact of a community-based programme for motor development on gross motor skills and cognitive function in preschool children from disadvantaged settings.
      • Logan S.W.
      • Robinson L.E.
      • Wilson A.E.
      • et al.
      Getting the fundamentals of movement: a meta-analysis of the effectiveness of motor skill interventions in children.
      • Veldman S.L.
      • Palmer K.K.
      • Okely A.D.
      • et al.
      Promoting ball skills in preschool-age girls.
      longitudinal studies have not been conducted to determine if these delays in FMS persist beyond preschool. Head Start programs serve children from birth to five years who are from families with incomes below the federal poverty line,
      • Department of Health and Human Services
      2010 poverty guidelines for the 48 contiguous states and the district of Columbia.
      as well as homeless children, and children with disabilities.

      U.S. Department of Health and Human Services. Poverty guidelines and determining eligibility for participating in head start programs. Available at: https://eclkc.ohs.acf.hhs.gov/hslc/tta-system/operations/mang-sys/ersea/PovertyGuideline.htm. Accessed 18 August 2016.

      Interventions addressing FMS development may be of particular importance for at-risk children’s long-term health since FMS are associated both with participation in physical activity and with other health-related variables, such as physical fitness
      • Lubans D.R.
      • Morgan P.J.
      • Cliff D.P.
      • et al.
      Fundamental movement skills in children and adolescents: review of associated health benefits.
      and overweight/obesity.
      • Lubans D.R.
      • Morgan P.J.
      • Cliff D.P.
      • et al.
      Fundamental movement skills in children and adolescents: review of associated health benefits.
      • Cliff D.P.
      • Okely A.D.
      • Morgan P.J.
      • et al.
      Proficiency deficiency: mastery of fundamental movement skills and skill components in overweight and obese children.
      • Lopes V.P.
      • Stodden D.F.
      • Bianchi M.M.
      • et al.
      Correlation between BMI and motor coordination in children.
      Preschool programs for at-risk preschoolers, such as Head Start, may provide an optimal venue for children to engage in developmentally appropriate movement programs aimed at improving motor development.
      The Food Friends Get Movin’ with Mighty Moves is a preschool-based intervention focused on increasing structured physical activity opportunities and enhancing FMS development in young children.
      • Bellows L.L.
      • Davies P.L.
      • Anderson J.
      • et al.
      Effectiveness of a physical activity intervention for head start preschoolers: a randomized intervention study.
      • Bellows L.
      • Anderson J.
      The food friends get movin’ with mighty moves: a physical activity program for preschoolers.
      Mighty Moves has successfully increased FMS in low-income, at-risk preschoolers enrolled in Head Start.
      • Bellows L.L.
      • Davies P.L.
      • Anderson J.
      • et al.
      Effectiveness of a physical activity intervention for head start preschoolers: a randomized intervention study.
      The Colorado Longitudinal Eating And Physical activity (LEAP) Study further explored whether the positive effects of Mighty Moves on FMS development in preschool were sustained through early elementary school at two-year follow-up.
      • Bellows L.L.
      • Johnson S.L.
      • Davies P.L.
      • et al.
      The colorado leap study: rationale and design of a study to assess the short term longitudinal effectiveness of a preschool nutrition and physical activity program.
      This paper contributes to the literature by addressing the need for longitudinal studies examining the effects of FMS interventions in low-income, at-risk preschoolers by reporting on the following two aims: (1) to determine the status of FMS performance in low-income, at-risk preschool children compared to normative samples across a two-year longitudinal follow-up study; and (2) to evaluate the impact of the Mighty Moves program on improving children’s FMS at two-year follow-up compared to a matched control group.

      2. Methods

      The Colorado LEAP project is a cohort study with one year of intervention and two years of longitudinal follow-up utilizing a controlled quasi-experimental design in four rural Colorado Head Start centers. Two centers served as intervention sites and two served as matched controls based on community demographics, Head Start Program Information Reports, and geographic location (rural plains, rural mountains). Children were excluded from the study if they were diagnosed with developmental disabilities (e.g. cerebral palsy or Down syndrome) or if they were not expected to enter kindergarten the following school year. This study was approved by the institutional review board at Colorado State University. Written parental consent was obtained at baseline and verbal child assent was obtained at each assessment time point. Children were asked if they were willing to complete the tasks, and if they were not willing to complete the tasks, they returned to their classrooms.
      Data were collected on a total of 250 preschoolers (see Supplemental Fig. 1S). The intervention group consisted of 143 participants, 56.6% girls, Mage = 56.1 ± 3.8 months, 45.5% Hispanic, and MBMI z-score = 0.59 ± 1.17. The control group consisted of 107 participants, 47.7% girls, Mage = 55.5 ± 5.0 months, 36.1% Hispanic, and MBMI z-score = 0.48 ± 1.08. While the sample sizes of the two groups differed due to lower study enrollment in control sites, there were no significant between-group differences for sex (Chi-square), age (Mann–Whitney U-test), ethnicity (Chi-square), or BMI z-score (independent samples t-test).
      Intervention sites received The Food Friends Fun with New Foods nutrition and Mighty Moves
      • Bellows L.L.
      • Johnson S.L.
      • Davies P.L.
      • et al.
      The colorado leap study: rationale and design of a study to assess the short term longitudinal effectiveness of a preschool nutrition and physical activity program.
      physical activity programs in preschool and ‘booster’ programming in kindergarten and first grade. Mighty Moves was implemented by classroom teachers 4 days a week for 15–20 min/day over 18 weeks, for a total of 72 lessons. Each week focused on a specific FMS – stability, locomotor, or object control skills – and movement concepts were integrated into daily activities (see Supplemental material for further description).
      • Bellows L.L.
      • Davies P.L.
      • Anderson J.
      • et al.
      Effectiveness of a physical activity intervention for head start preschoolers: a randomized intervention study.
      • Bellows L.
      • Anderson J.
      The food friends get movin’ with mighty moves: a physical activity program for preschoolers.
      • Bellows L.L.
      • Johnson S.L.
      • Davies P.L.
      • et al.
      The colorado leap study: rationale and design of a study to assess the short term longitudinal effectiveness of a preschool nutrition and physical activity program.
      Five monthly ‘booster’ activities were conducted in the kindergarten and first grade classrooms (15–20 min) by student research assistants and Extension (e.g. community) educators in an effort to sustain behavior changes made in preschool. All children, regardless of study enrollment, participated in activities. Messages with graphics of the Food Friends characters (e.g., I am a Mighty Mover because…) were displayed on posters, banners, and other materials in the school cafeteria, gym, and hallways. Preschool teachers self-reported, via weekly logs, the number of minutes Mighty Moves was conducted in the classroom each day. Over 18 weeks, logs captured 91% of the days school was in session and 94% of teachers indicated implementing Mighty Moves for between 10 and 30 min per day (mean = 16.1 +/− 0.1). Assessments were administered four times—preschool in the fall (baseline) and in the spring (post-intervention) and once in the spring of both kindergarten (one-year follow-up) and first grade (two-year follow-up). Direct measures of the children’s FMS, height, and weight were conducted in schools by trained research staff and parent/home measures were sent home and returned to school via the child.
      The Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)
      • Bruininks R.
      • Bruininks B.
      Bruininks-Oseretsky Test of Motor Proficiency.
      was used to assess FMS. The BOT-2 is a standardized, norm-referenced measure for children ages 4 through 21 years of age.
      • Bruininks R.
      • Bruininks B.
      Bruininks-Oseretsky Test of Motor Proficiency.
      Four of the six subtests (i.e., Balance, Running Speed and Agility (locomotor skills), Upper-Limb Coordination (OC skills) and Strength) were administered by trained research staff to intervention and control children at all four time points. The test required 25–35 min per child to administer. Inter-rater reliability was conducted on 17% of all BOT-2 assessments obtained across the four time points (i.e. 140 of 815 total assessments). Inter-rater reliability using Pearson product-moment correlations was high for each of the subtests, ranging from 95% for running speed and agility to 99% for OC skills. Both the total point score and the scaled score for each of the subtests were used in analyses. The total point score was used to assess changes in FMS over time, while the scaled score was used to compare the Colorado LEAP study sample to the BOT-2 norm-referenced sample.
      • Bruininks R.
      • Bruininks B.
      Bruininks-Oseretsky Test of Motor Proficiency.
      Descriptive statistics (means and standard deviations) were performed separately for both total point scores and scaled scores to describe both groups at all four assessment periods. Not all children completed testing at each time point and when this occurred the participant was removed for that particular analysis. Thus, the number of participants assessed are specified for each time point and statistical test. A repeated-measures analysis of variance (ANOVA) using group (Intervention, Control) as the between factor and total point score for the BOT-2 subtest at each assessment period as the repeated variable was conducted to assess changes in FMS over time. Effect size (η2p) was also calculated. Homogeneity of variance was not violated for any of these ANOVAs. When sphericity was violated, the Greenhouse-Geisser statistic was used. Participants’ performance on each of the BOT-2 subtests (using scaled scores adjusted for age and sex) were compared to the BOT-2 norm-referenced mean scaled scores for each respective subtest
      • Bruininks R.
      • Bruininks B.
      Bruininks-Oseretsky Test of Motor Proficiency.
      using one-sample t-tests. Five one-sample t-tests were run and a Bonferroni correction was employed (0.05/5 tests) resulting in the test-wise alpha = 0.01.
      Hierarchical linear regression analyses were conducted for each of the four BOT-2 subtests to investigate the amount of variance in total point scores at two-year follow-up explained by the Mighty Moves intervention. Each analysis controlled for the following independent variables: ethnicity, sex, age, BMI z-score, and baseline total points for the given BOT-2 subtest at two-year follow-up. All control variables were entered in the first block of independent variables. Group assignment (intervention or control) was entered in the second block of independent variables. Total points for the given BOT-2 subtest at two-year follow-up was the dependent variable. Statistical Package for the Social Sciences (SPSS) 23.0.1 (IBM Corporation, Armonk, NY) was used, and alpha was set at p < 0.05 for all analyses.

      3. Results

      Children in both groups significantly improved FMS over time as shown by a significant increase in mean total points in all four BOT-2 subtests (see Supplemental Table 1S). The ANOVA revealed a significant main effect of time for balance (F(3,462) = 163.83, p < 0.001, η2p = 0.52), running speed and agility (F(3,465) = 290.89, p < 0.001, η2p = 0.65), strength (F(3,459) = 254.48, p < 0.001, η2p = 0.63), and OC skills (F(3,462) = 483.04, p < 0.001, η2p = 0.76). Pairwise comparisons between each of the assessment periods were significant for all four BOT-2 subtests (p < 0.01 for all pairwise tests). These results are evaluated by a test-wise alpha of 0.01.
      Table 1 reports the mean and standard deviation of the scaled scores for each BOT-2 subtest across the four assessment times. When comparing the mean scaled score of the BOT-2 norm-referenced sample to the total LEAP sample at baseline, the total LEAP sample was significantly lower in balance, t(225) = −2.43, p = 0.016 and OC skills, t(226) = −6.13, p < 0.001; whereas, they were significantly higher in strength, t(224) = 5.46, p < 0.001. There were no significant differences for running speed and agility (locomotor skills).
      Table 1Participants’ mean scaled scores versus norm-referenced mean scaled scores on the BOT-21 subtests.
      Mean scaled scores (SD)Norm-referenced mean scaled scores (SD)1
      BaselinePost-intervention1-year follow-up2-year follow-up
      Age in years (SD)Total sample4.65 (0.36)5.20 (0.34)6.19 (0.33)7.17 (0.32)
      BOT-2 subtest balance2Total sample14.3 (4.2)
      p<0.05.
      13.6 (3.9)
      p<0.001.
      14.2 (4.4)
      p<0.05.
      13.5 (4.6)
      p<0.001.
      15.0 (4.9)
      n226217185175
      Running speed and agility2Total sample15.3 (4.2)14.0 (3.8)
      p<0.001.
      14.8 (4.1)14.6 (3.8)15.0 (4.8)
      n227217185175
      Strength2Total sample16.3 (3.6)
      p<0.001.
      14.9 (3.6)15.6 (4.1)14.7 (4.0)15.0 (4.9)
      n225216185175
      Object control skills3Total sample13.1 (4.6)
      p<0.001.
      13.1 (4.7)
      p<0.001.
      12.7 (5.1)
      p<0.001.
      13.8 (4.2)
      p<0.05.
      14.9 (4.8)
      n227216185175
      Control12.8 (4.8)
      p<0.001.
      12.6 (4.6)
      p<0.001.
      12.4 (5.4)
      p<0.001.
      12.6 (4.1)
      p<0.001.
      14.9 (4.8)
      n92907266
      Intervention13.2 (4.4)
      p<0.001.
      13.4 (4.7)
      p<0.001.
      13.0 (5.0)
      p<0.001.
      14.5 (4.2)14.9 (4.8)
      n135126113109
      p-Values are based on one sample t-tests comparing study participants’ mean scaled scores to the 1Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) norm-referenced mean scaled scores as reported in the BOT-2 manual in table 5.11, p. 49.
      • Bruininks R.
      • Bruininks B.
      Bruininks-Oseretsky Test of Motor Proficiency.
      Norm-referenced mean scaled scores are for male and female children ages 4–7 years as the distribution of scores was nearly identical across this age range. 2Balance, running speed and agility (locomotor skills), and strength data not separated by control and intervention due to lack of significance. 3Object control skills were separated by control and intervention groups due to significant intervention effects. Post-intervention and 1-year follow-up data are provided for the reader’s reference but are not discussed in this manuscript.
      a p < 0.05.
      b p < 0.001.
      At two-year follow-up, when comparing the mean scaled score of the BOT-2 norm-referenced sample to the total LEAP sample, the total LEAP sample remained significantly lower in balance, t(174) = −4.33, p < 0.001 (Fig. 1A) and OC skills, t(174) = −3.47, p = 0.001. When OC skills were analyzed by group, only the control group had a significantly lower mean scaled score than the norm-referenced sample, t(65) = −4.5, p < 0.001 (Fig. 1B). The difference between the intervention group and the norm-referenced sample was not significant, t(108) = −0.99, p = 0.32 (Fig. 1B). There were no significant differences for running speed and agility (locomotor skills) or strength (see Table 1).
      Fig. 1
      Fig. 1(A and B) Mean standardized scores for balance skills and object-control skills over time compared to norm-referenced mean standardized scores.
      • Robinson L.E.
      • Goodway J.D.
      Instructional climates in preschool children who are at-risk. Part I: object-control skill development.
      Note: ap < 0.001. Balance skills data not separated by control and intervention due to lack of significant differences between groups.
      Results of the regression analyses revealed a significant intervention effect on OC skills (see Table 2). The overall model accounted for 41% of the variance in two-year follow-up OC skills mean total points, F(6,165) = 20.45, p < 0.001. The control variables accounted for 38% of the variance in OC skills at two-year follow-up with baseline mean total points for OC skills being the only significant predictor, accounting for 32% of the variance, F(5,165) = 21.10, p < 0.001. Ethnicity, sex, age, and BMI z-score were not significant predictors of OC skills at two-year follow-up. Group membership significantly predicted OC skills at two-year follow-up, accounting for 4% of variance, F change(1,159) = 10.77, p = 0.001. The regression analyses for the BOT-2 subtests for balance, locomotor, and strength skills were not significant (data not shown).
      Table 2Intervention and child level variables associated with children’s object control skills at 2-year follow-up (n = 166).
      Values are unstandardized coefficients (B) (95% CIs), standard error of the unstandardized coefficient (SE B), and standardized β. Multiple hierarchical linear regression analyses were performed with change in variance explained (ΔR2) between steps tested at α=0.05.
      B (95% CI)SE Bβ
      Model 1
      Intercept22.62 (1.13, 44.11)10.88
      Sex
      Sex was coded as male=0, female=1.
      −1.02 (−2.83, 0.80)0.92−0.07
      Ethnicity
      Ethnicity was coded as Hispanic=0, non-Hispanic=1.
      −0.12 (−1.93, 1.70)0.92−0.01
      Age (months)
      Age and BMI z-score at 2-year follow-up.
      −0.04 (−0.29, 0.21)0.13−0.02
      BMI z-score
      Age and BMI z-score at 2-year follow-up.
      −0.23 (−1.10, 0.64)0.44−0.03
      Baseline object control skills
      Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)31 used to determine mean total points for object control skills.
      0.87 (0.68, 1.06)0.090.62
      p<0.001.
      R2 change0.4
      F change21.1
      p<0.001
      Adjusted R20.38
      Model 2
      Intercept18.96 (−2.02, 39.94)10.62
      Sex
      Sex was coded as male=0, female=1.
      −1.29 (−3.06, 0.48)0.9−0.09
      Ethnicity
      Ethnicity was coded as Hispanic=0, non-Hispanic=1.
      0.04 (−1.72, 1.81)0.90
      Age (months)
      Age and BMI z-score at 2-year follow-up.
      −0.02 (−0.26, 0.23)0.12−0.01
      BMI z-score
      Age and BMI z-score at 2-year follow-up.
      −0.36 (−1.21, 0.49)0.43−0.05
      Baseline object control skills
      Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)31 used to determine mean total points for object control skills.
      0.85 (0.67, 1.04)0.090.61
      p<0.001.
      Intervention group
      Group was coded as control=0, intervention=1.
      2.94 (1.17, 4.72)0.90.20
      p<0.001.
      R2 change0.04
      F change10.77
      p0.001
      Adjusted R20.41
      a p < 0.001.
      b Values are unstandardized coefficients (B) (95% CIs), standard error of the unstandardized coefficient (SE B), and standardized β. Multiple hierarchical linear regression analyses were performed with change in variance explained (ΔR2) between steps tested at α = 0.05.
      c Sex was coded as male = 0, female = 1.
      d Ethnicity was coded as Hispanic = 0, non-Hispanic = 1.
      e Age and BMI z-score at 2-year follow-up.
      f Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2)31 used to determine mean total points for object control skills.
      g Group was coded as control = 0, intervention = 1.

      4. Discussion

      The Colorado LEAP study intervened in at-risk preschoolers enrolled in rural Head Start programs. Baseline results revealed that, compared to a norm-referenced sample,
      • Bruininks R.
      • Bruininks B.
      Bruininks-Oseretsky Test of Motor Proficiency.
      the at-risk preschoolers in this study were developmentally delayed in both balance and OC skills. Intervention with the Mighty Moves program during preschool resulted in significant longitudinal improvements in children’s OC skills such that, by the end of first grade, intervention children’s OC skills were similar to the norm-referenced sample.
      • Bruininks R.
      • Bruininks B.
      Bruininks-Oseretsky Test of Motor Proficiency.
      In contrast, children in the control group remained significantly developmentally delayed in OC skills at the end of first grade, and both intervention and control children were developmentally delayed in balance skills at the end of first grade. There were no intervention effects on running speed and agility (representative of locomotor skills) or strength skills.
      The finding that the Colorado LEAP study participants were developmentally delayed in balance and OC skills at baseline is consistent with previous literature suggesting that at-risk preschoolers are delayed in total FMS,
      • Morley D.
      • Till K.
      • Ogilvie P.
      • et al.
      Influences of gender and socioeconomic status on the motor proficiency of children in the UK.
      • Venetsanou F.
      • Kambas A.
      Environmental factors affecting preschoolers’ motor development.
      • Liu T.
      • Hamilton M.
      • Smith S.
      Motor proficiency of the head start and typically developing children on mabc-2.
      locomotor,
      • Goodway J.D.
      • Robinson L.E.
      • Crowe H.
      Gender differences in fundamental motor skill development in disadvantaged preschoolers from two geographical regions.
      balance,
      • Liu T.
      • Hamilton M.
      • Smith S.
      Motor proficiency of the head start and typically developing children on mabc-2.
      and OC skills.
      • Morley D.
      • Till K.
      • Ogilvie P.
      • et al.
      Influences of gender and socioeconomic status on the motor proficiency of children in the UK.
      • Goodway J.D.
      • Robinson L.E.
      • Crowe H.
      Gender differences in fundamental motor skill development in disadvantaged preschoolers from two geographical regions.
      • Pope M.L.
      • Liu T.
      • Getchell N.
      Object-control skills in Hispanic preschool children enrolled in head start.
      Cross-sectional studies by both Morley et al.
      • Morley D.
      • Till K.
      • Ogilvie P.
      • et al.
      Influences of gender and socioeconomic status on the motor proficiency of children in the UK.
      and Venetsanou and Kambas
      • Venetsanou F.
      • Kambas A.
      Environmental factors affecting preschoolers’ motor development.
      suggest that preschoolers from high SES families perform better on FMS than preschoolers from low SES families. Goodway et al. found that 84% of disadvantaged Hispanic and African American preschoolers were developmentally delayed in their locomotor and OC skills,
      • Goodway J.D.
      • Robinson L.E.
      • Crowe H.
      Gender differences in fundamental motor skill development in disadvantaged preschoolers from two geographical regions.
      and Pope et al. identified 83% and 17% of Hispanic preschoolers enrolled in Head Start as ‘poor’ or ‘very poor’ in their OC skills, respectively.
      • Pope M.L.
      • Liu T.
      • Getchell N.
      Object-control skills in Hispanic preschool children enrolled in head start.
      Finally, Liu et al. reported that Hispanic children enrolled in Head Start performed significantly poorer in balance and overall motor skills compared to aged-matched peers not enrolled in Head Start.
      • Liu T.
      • Hamilton M.
      • Smith S.
      Motor proficiency of the head start and typically developing children on mabc-2.
      Due to the fact that LEAP study participants were at-risk preschoolers enrolled in Head Start, developmental delays in FMS were anticipated; however, it is concerning that, despite the Mighty Moves intervention, delays in balance skills continued through the end of first grade. These findings reinforce the assertion that at-risk preschoolers are delayed in their FMS development, and imply that at-risk children may require early intervention, before the age of four, to address developmental delays in FMS.
      Several previous interventions have effectively improved at-risk preschoolers’ total FMS,
      • Draper C.E.
      • Achmat M.
      • Forbes J.
      • et al.
      Impact of a community-based programme for motor development on gross motor skills and cognitive function in preschool children from disadvantaged settings.
      • Logan S.W.
      • Robinson L.E.
      • Wilson A.E.
      • et al.
      Getting the fundamentals of movement: a meta-analysis of the effectiveness of motor skill interventions in children.
      locomotor,
      • Draper C.E.
      • Achmat M.
      • Forbes J.
      • et al.
      Impact of a community-based programme for motor development on gross motor skills and cognitive function in preschool children from disadvantaged settings.
      • Goodway J.D.
      • Crowe H.
      • Ward P.
      Effects of motor skill instruction on fundamental motor skill development.
      • Goodway J.D.
      • Branta C.F.
      Influence of a motor skill intervention on fundamental motor skill development of disadvantaged preschool children.
      and OC skills.
      • Veldman S.L.
      • Palmer K.K.
      • Okely A.D.
      • et al.
      Promoting ball skills in preschool-age girls.
      • Goodway J.D.
      • Branta C.F.
      Influence of a motor skill intervention on fundamental motor skill development of disadvantaged preschool children.
      • Robinson L.E.
      • Goodway J.D.
      Instructional climates in preschool children who are at-risk. Part I: object-control skill development.
      However, these interventions were short-term in nature (lasting 9–12 weeks) and were not assessed for long-term effects beyond seven months post-intervention.
      • Draper C.E.
      • Achmat M.
      • Forbes J.
      • et al.
      Impact of a community-based programme for motor development on gross motor skills and cognitive function in preschool children from disadvantaged settings.
      Therefore, the Colorado LEAP study is unique in being a longitudinal study examining the effects of an FMS intervention in low-income, at-risk preschoolers through the end of first grade.
      • Iivonen K.S.
      • Saakslahti A.K.
      • Mehtala A.
      • et al.
      Relationship between fundamental motor skills and physical activity in 4-year-old preschool children.
      • Barnett L.M.
      • Ridgers N.D.
      • Salmon J.
      Associations between young children’s perceived and actual ball skill competence and physical activity.
      • Cliff D.P.
      • Okely A.D.
      • Smith L.M.
      • et al.
      Relationships between fundamental movement skills and objectively measured physical activity in preschool children.
      A novel finding of the Colorado LEAP study is that the Mighty Moves intervention resulted in longitudinal improvements in preschooler’s OC skills; however, Mighty Moves did not improve balance or locomotor skills. The longitudinal effects on OC skills are encouraging because OC skills in particular appear to be cross-sectionally
      • Iivonen K.S.
      • Saakslahti A.K.
      • Mehtala A.
      • et al.
      Relationship between fundamental motor skills and physical activity in 4-year-old preschool children.
      and longitudinally
      • Barnett L.M.
      • van Beurden E.
      • Morgan P.J.
      • et al.
      Childhood motor skill proficiency as a predictor of adolescent physical activity.
      associated with participation in MVPA and may account for a significant amount of variance in preschooler’s total physical activity.
      • Cliff D.P.
      • Okely A.D.
      • Smith L.M.
      • et al.
      Relationships between fundamental movement skills and objectively measured physical activity in preschool children.
      Future FMS interventions in at-risk preschoolers should likely include OC skills because of the potential for positive long-term effects on both physical activity and OC skill development.
      Other findings from the current study support the need for early interventions focused on FMS in at-risk preschoolers. First, results demonstrate that early delays in FMS sustain over time, with FMS continuing to decline through early elementary school. Second, findings support that FMS skills at baseline accounted for significant variance in FMS skills at two-year follow-up. Baseline OC skills accounted for a significant amount of variance in OC skills at two-year follow-up (32.0%; p < 0.001) and baseline skills for balance, running speed and agility (locomotor skills), and strength also accounted for a significant amount of variance in those skills at two-year follow-up (27.5%, p < 0.001; 17.7%, p < 0.001; and 19.7%, p < 0.001, respectively, data not shown). This suggests that at-risk children may require FMS interventions earlier in life than previously believed in order to prevent both short- and long-term delays in FMS development.
      Helping at-risk children achieve normal FMS is particularly important due to the fact that FMS are related to children’s physical,
      • Lubans D.R.
      • Morgan P.J.
      • Cliff D.P.
      • et al.
      Fundamental movement skills in children and adolescents: review of associated health benefits.
      social,
      • Bart O.
      • Hajami D.
      • Bar-Haim Y.
      Predicting school adjustment from motor abilities in kindergarten.
      and cognitive development.
      • Bart O.
      • Hajami D.
      • Bar-Haim Y.
      Predicting school adjustment from motor abilities in kindergarten.
      The positive relationship between FMS and both cross-sectional
      • Foweather L.
      • Knowles Z.
      • Ridgers N.D.
      • et al.
      Fundamental movement skills in relation to weekday and weekend physical activity in preschool children.
      • Iivonen K.S.
      • Saakslahti A.K.
      • Mehtala A.
      • et al.
      Relationship between fundamental motor skills and physical activity in 4-year-old preschool children.
      • Robinson L.E.
      • Wadsworth D.D.
      • Peoples C.M.
      Correlates of school-day physical activity in preschool students.
      and longitudinal
      • Stodden D.F.
      • Goodway J.D.
      • Langendorfer S.J.
      • et al.
      A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship.
      • Lopes V.P.
      • Rodrigues L.P.
      • Maia J.A.
      • et al.
      Motor coordination as predictor of physical activity in childhood.
      • Barnett L.M.
      • van Beurden E.
      • Morgan P.J.
      • et al.
      Childhood motor skill proficiency as a predictor of adolescent physical activity.
      participation in physical activity, as well as the negative relationship between FMS and overweight/obesity
      • Lubans D.R.
      • Morgan P.J.
      • Cliff D.P.
      • et al.
      Fundamental movement skills in children and adolescents: review of associated health benefits.
      • Cliff D.P.
      • Okely A.D.
      • Morgan P.J.
      • et al.
      Proficiency deficiency: mastery of fundamental movement skills and skill components in overweight and obese children.
      • Lopes V.P.
      • Stodden D.F.
      • Bianchi M.M.
      • et al.
      Correlation between BMI and motor coordination in children.
      imply that early interventions to improve at-risk preschoolers’ FMS could contribute to a multitude of positive outcomes in these children. Early childhood programs, such as Head Start, should consider the potential for FMS interventions to promote at-risk children’s FMS and to confer short- and long-term benefits to overall development and health. Such programs should develop policies supporting FMS programming early in childhood to encourage optimal FMS development and long-term outcomes in at-risk preschool children.
      This was one of the first longitudinal studies examining the effects of an FMS intervention on preschoolers’ FMS across time, which is a major strength of this study. Other strengths included the relatively large sample size and proportion of Hispanic participants. A limitation of this study was our lack of ability to calculate a gross motor composite score (missing bilateral coordination) due to administering only the four most relevant subtests for our research questions, limits on the assessment time allotted by schools, and resources available. Further, this study used a quasi-experimental design, and thus the lack of randomization at the school and classroom level is a limitation. Teacher self-report of minutes of Mighty Moves program implementation is subject to social desirability bias. Finally, children’s physical activity outside of school was not measured and it is possible there were differences between groups in overall physical activity, which could have impacted our outcome measures.

      5. Conclusion

      Delivering the Mighty Moves program in preschool has demonstrated a lasting advantage for enhanced OC skills in elementary school children. Study results suggest at-risk preschool children may already be behind in FMS development and will likely fall even further behind in elementary school. This has important implications for policy, as movement programs, particularly those including OC skills, should be incorporated into preschool curriculum, especially for programs serving at-risk children, such as Head Start.

      Practical implications

      • Preschoolers from low-income families are delayed in their FMS compared to other children their age.
      • Children from low-income families who are delayed in FMS proficiency in preschool remained delayed in their FMS proficiency through the end of first grade.
      • Mighty Moves is an effective intervention for improving long-term performance in ball skills of low-income preschoolers through the end of first grade.
      • Early interventions may be important for addressing FMS development in low-income preschoolers.

      Acknowledgments

      The LEAP Study was funded by Agriculture and Food Research Initiative Competitive Grant # 2010-85215-20648 from the USDA National Institute of Food and Agriculture . This trial is registered at ClinicalTrials.gov: NCT01937481. The authors would like to thank the participating Head Start centers and research staff who participated in the study.

      Appendix A. Supplementary data

      References

        • Clark J.E.
        From the beginning: a developmental perspective on movement and mobility.
        Quest. 2005; 57: 37-45
        • Stodden D.F.
        • Goodway J.D.
        • Langendorfer S.J.
        • et al.
        A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship.
        Quest. 2008; 60: 290-306
        • Lubans D.R.
        • Morgan P.J.
        • Cliff D.P.
        • et al.
        Fundamental movement skills in children and adolescents: review of associated health benefits.
        Sports Med. 2010; 40: 1019-1035
        • Bart O.
        • Hajami D.
        • Bar-Haim Y.
        Predicting school adjustment from motor abilities in kindergarten.
        Infant Child Dev. 2007; 16: 597-615
        • Foweather L.
        • Knowles Z.
        • Ridgers N.D.
        • et al.
        Fundamental movement skills in relation to weekday and weekend physical activity in preschool children.
        J Sci Med Sport. 2014; 18: 691-696
        • Iivonen K.S.
        • Saakslahti A.K.
        • Mehtala A.
        • et al.
        Relationship between fundamental motor skills and physical activity in 4-year-old preschool children.
        Percept Mot Skills. 2013; 117: 627-646
        • Robinson L.E.
        • Wadsworth D.D.
        • Peoples C.M.
        Correlates of school-day physical activity in preschool students.
        Res Q Exerc Sport. 2012; 83: 20-26
        • Lopes V.P.
        • Rodrigues L.P.
        • Maia J.A.
        • et al.
        Motor coordination as predictor of physical activity in childhood.
        Scand J Med Sci Sports. 2011; 21: 663-669
        • Barnett L.M.
        • van Beurden E.
        • Morgan P.J.
        • et al.
        Childhood motor skill proficiency as a predictor of adolescent physical activity.
        J Adolesc Health. 2009; 44: 252-259
        • Barnett L.M.
        • Ridgers N.D.
        • Salmon J.
        Associations between young children’s perceived and actual ball skill competence and physical activity.
        J Sci Med Sport. 2015; 18: 167-171
        • Cliff D.P.
        • Okely A.D.
        • Smith L.M.
        • et al.
        Relationships between fundamental movement skills and objectively measured physical activity in preschool children.
        Pediatr Exerc Sci. 2009; 21: 436-449
        • Morley D.
        • Till K.
        • Ogilvie P.
        • et al.
        Influences of gender and socioeconomic status on the motor proficiency of children in the UK.
        Hum Mov Sci. 2015; 44: 150-156
        • Venetsanou F.
        • Kambas A.
        Environmental factors affecting preschoolers’ motor development.
        Early Child Educ J. 2010; 37: 319-327
        • Goodway J.D.
        • Robinson L.E.
        • Crowe H.
        Gender differences in fundamental motor skill development in disadvantaged preschoolers from two geographical regions.
        Res Q Exerc Sport. 2010; 81: 17-24
      1. Robbins T, Stagman S, Smith S. Young children at risk. National and state prevalence of risk factors. Available at: http://www.nccp.org/publications/pub_1073.html. Accessed 9 May 2016.

        • Liu T.
        • Hamilton M.
        • Smith S.
        Motor proficiency of the head start and typically developing children on mabc-2.
        J Child Adolesc Behav. 2015; 3
        • Pope M.L.
        • Liu T.
        • Getchell N.
        Object-control skills in Hispanic preschool children enrolled in head start.
        Percept Mot Skills. 2011; 112: 193-200
        • Draper C.E.
        • Achmat M.
        • Forbes J.
        • et al.
        Impact of a community-based programme for motor development on gross motor skills and cognitive function in preschool children from disadvantaged settings.
        Early Child Dev Care. 2012; 182: 137-152
        • Logan S.W.
        • Robinson L.E.
        • Wilson A.E.
        • et al.
        Getting the fundamentals of movement: a meta-analysis of the effectiveness of motor skill interventions in children.
        Child Care Health Dev. 2012; 38: 305-315
        • Veldman S.L.
        • Palmer K.K.
        • Okely A.D.
        • et al.
        Promoting ball skills in preschool-age girls.
        J Sci Med Sport. 2016; 20: 50-54
        • Department of Health and Human Services
        2010 poverty guidelines for the 48 contiguous states and the district of Columbia.
        Fed Regist. 2010; 75: 2
      2. U.S. Department of Health and Human Services. Poverty guidelines and determining eligibility for participating in head start programs. Available at: https://eclkc.ohs.acf.hhs.gov/hslc/tta-system/operations/mang-sys/ersea/PovertyGuideline.htm. Accessed 18 August 2016.

        • Cliff D.P.
        • Okely A.D.
        • Morgan P.J.
        • et al.
        Proficiency deficiency: mastery of fundamental movement skills and skill components in overweight and obese children.
        Obesity (Silver Spring). 2012; 20: 1024-1033
        • Lopes V.P.
        • Stodden D.F.
        • Bianchi M.M.
        • et al.
        Correlation between BMI and motor coordination in children.
        J Sci Med Sport. 2012; 15: 38-43
        • Bellows L.L.
        • Davies P.L.
        • Anderson J.
        • et al.
        Effectiveness of a physical activity intervention for head start preschoolers: a randomized intervention study.
        Am J Occup Ther. 2013; 67: 28-36
        • Bellows L.
        • Anderson J.
        The food friends get movin’ with mighty moves: a physical activity program for preschoolers.
        J Nutr Educ Behav. 2013; 45: 473-475
        • Bellows L.L.
        • Johnson S.L.
        • Davies P.L.
        • et al.
        The colorado leap study: rationale and design of a study to assess the short term longitudinal effectiveness of a preschool nutrition and physical activity program.
        BMC Public Health. 2013; 13: 1146
        • Bruininks R.
        • Bruininks B.
        Bruininks-Oseretsky Test of Motor Proficiency.
        second edition. Pearson Assessments, Minneapolis, MN2005
        • Goodway J.D.
        • Crowe H.
        • Ward P.
        Effects of motor skill instruction on fundamental motor skill development.
        Adapt Phys Activ Q. 2003; 20: 298-314
        • Goodway J.D.
        • Branta C.F.
        Influence of a motor skill intervention on fundamental motor skill development of disadvantaged preschool children.
        Res Q Exerc Sport. 2003; 74: 36-46
        • Robinson L.E.
        • Goodway J.D.
        Instructional climates in preschool children who are at-risk. Part I: object-control skill development.
        Res Q Exerc Sport. 2009; 80: 533-542