BMJ Open Exerc Med: first published as 10.1136/bmjsem-2015-000067 on 4 January 2016. Downloaded from Open Access Research Efficacy of gross interventions in young children: an updated systematic review

Sanne L C Veldman,1 Rachel A Jones,1 Anthony D Okely1,2

To cite: Veldman SLC, ABSTRACT What are the new findings Jones RA, Okely AD. Efficacy Objective: The objective of this study was to provide of gross motor skill an update of the evidence on the efficacy of gross ▪ interventions in young The quality of the intervention studies has motor development interventions in young children (0– children: an updated improved, but not the quantity since only seven systematic review. BMJ Open 5 years) from 2007 to 2015. studies have examined gross motor skill inter- Sport Exerc Med 2016;2: Methods: Searches were conducted of six electronic ventions in young children (>5 years) over the e000067. doi:10.1136/ databases: PUBMED, Medline (Ovid), ERIC (Ebsco), past 8 years. bmjsem-2015-000067 Embase, SCOPUS and Psychinfo. Studies included any ▪ Professional development of the educators in the childcare-based, -based, home-based, or area of gross motor skills development should ▸ Prepublication history for community-based intervention targeting the be an important component in future interven- this paper is available online. development of gross motor skills including statistical tions to increase the quality of their practice in To view these files please analysis of gross motor skill competence. Data were settings. visit the journal online extracted on design, participants, intervention ▪ Parent involvement in interventions is recom- (http://dx.doi.org/10.1136/ components, methodological quality and efficacy. mended given their important role in developing bmjsem-2015-000067). Results: Seven articles were included and all were gross motor skills through role modelling and

delivered in early childhood settings. Four studies had providing opportunities, encouragement and by copyright. Accepted 17 November 2015 high methodological quality. Most studies used trained support. staff members/educators to deliver the intervention (86%) and five studies lasted 18 weeks or more. Six studies reported statistically significant intervention conducted a systematic review, which assessed effects. the efficacy of interventions designed to Conclusions: Despite the proven importance of gross increase GMS in young children (<5 years). motor skill development in young children and the Seventeen articles were included, of which recommendations made in the previous review, this most were controlled trials (65%) and imple- review highlights the limited studies evaluated to mented in early childhood settings (65%).

improve such key life skills in young children over the More than half of the studies reported http://bmjopensem.bmj.com/ past 8 years. statistically significant improvements (60%). Trial registration number: CRD42015015826. The review highlighted the limited quantity and quality of interventions in young chil- dren and the lack of high-quality evidence in INTRODUCTION this area. Fundamental or gross motor skills (GMS) In recent years, several studies have are the foundation for many and phys- reported on the relationship between GMS ical activities. From a health perspective, and other important developmental areas

higher levels of GMS are associated with adding evidence to the importance of GMS on September 29, 2021 by guest. Protected lower body mass index1 better cardiorespira- development. Jenni et al13 found positive cor- 1Early Start Research tory fitness2 and physical activity3 as well as relations between motor and intellectual Institute, Faculty of Social enhanced cognitive development45social functions, and Leonard and Hill6 high- Sciences, University of development and language skills.6 Moreover, lighted the significant relationship with the Wollongong, Wollongong, New South Wales, Australia children with poor GMS are more likely to development of social skills and language. As 78 2Illawarra Health and Medical have lower self-esteem and higher levels of this is an area of interest internationally, Research Institute, University anxiety.9 there is a need for a further review which of Wollongong, Wollongong, GMS proficiency in young children is sub- updates the evidence in this area and gives New South Wales, Australia optimal10 11 and given the short-term and directions for further research to promote Correspondence to long-term consequences of poor skills, inter- GMS development. The aim of the current Sanne L Veldman; ventions targeting the improvement of these review was to provide an update of the evi- [email protected] skills are needed. In 2009, Riethmuller et al12 dence on the efficacy of gross motor

Veldman SLC, et al. BMJ Open Sport Exerc Med 2016;2:e000067. doi:10.1136/bmjsem-2015-000067 1 BMJ Open Sport Exerc Med: first published as 10.1136/bmjsem-2015-000067 on 4 January 2016. Downloaded from Open Access development interventions in young children (0– discussion followed when there were any disagreements. 5 years) and to provide recommendations for further The full text for the remaining articles was retrieved. research in this area. Data collection process After the study selection process, one author (SLV) METHODS extracted data on methodology, characteristics of partici- This review followed the guidelines in the Preferred pants, interventions programme, GMS measurement Reporting Items for Systematic Review and Meta-analysis and results from the selected studies. These data were (PRISMA) statement.14 checked by another author (RAJ). Eligibility criteria Methodological quality Types of participants Methodological Quality was assessed by using a 10-item Children between the ages of 0 and 5 years (mean age quality assessment scale (see table 1) adapted from pre- >5 years) enrolled in kindergarten, childcare centres, viously used methodological assessments.15 16 Each preschool or community services, but not yet at school. included article was assessed by two authors (ADO/SLV) individually. Any disagreements between the authors Types of intervention were resolved by discussion. An article was classified as Any childcare-based, preschool-based, home-based or high methodological quality when it scored ≥5 for a community-based intervention targeting the develop- controlled trial and ≥6 for a randomised controlled ment of GMS. Targeted skills could include locomotor trial.16 and object control skills. Synthesis of results Types of outcome measures The following data were extracted from the articles: Studies were included if they reported statistical analysis research design and setting, sample size and mean age, of GMS competence with measurements taken pre- and total duration of the intervention in weeks, intervention at least once postintervention and included either groups, intervention content, measurement of motor process (knowledge of performance) or product (knowl-

skills and results. by copyright. edge of results) assessments of at least one skill.

Types of studies RESULTS Randomised controlled trials (RCTs) with experimental Overview of studies and quasi-experimental designs and single group pretest Study selection is displayed in figure 1. The initial search and post-test designs. Studies were excluded if they: (1) identified 5829 hits. After removing duplicates (n=1336) targeted groups from special populations (eg, children and screening of titles and abstracts (n=4493), 10 articles with or autism); (2) no full text was avail- remained. The full-texts of these articles were retrieved able; (3) the research was not published in English. and seven articles were included. http://bmjopensem.bmj.com/ Information sources and search Study characteristics Six electronic databases were searched: PUBMED, Table 2 shows characteristics of the studies. Five studies – Medline (Ovid), ERIC (Ebsco), Embase, SCOPUS and were published between 2011 and 2014.17 21 Three Psychinfo with a restriction on the start of the publica- studies were conducted in the USA17 18 22 two studies tion date to 2007 and before given the previous system- were conducted in Australia20 23 and the others were atic review.12 The search was performed in January 2015. conducted in Switzerland19 and Greece.21 Some studies The following search terms were used: OR - recruited centres based on region19 21 or within an exist- care OR day care OR preschool* OR ‘early childhood’ ing program17 while others worked together with the OR ‘community-based’ AND random* OR trial OR (local) government23 or childcare organisations.18 20 22 on September 29, 2021 by guest. Protected evaluation OR programme OR pilot AND ‘motor skill*’ Two studies involved parents. – OR ‘movement skill*’ OR ‘motor development’. There were six randomised controlled trials17 19 20 22 23 Additional studies were found through scanning refer- and one quasi-experimental study.21 The sample size of ence lists of included articles. the studies varied from 7117 to 835 participants.19

Study selection Implementation After searching the databases, one of the authors (SLV) All interventions took place in early childhood settings – removed all duplicates and two authors (RAJ/SLV) and most were delivered by setting staff.17 19 20 23 screened all titles and abstracts in a non-blinded standar- Professional development sessions were offered prior to dised way. These were screened for inclusion, by dividing the interventions (1–5 sessions). One study used the them into three groups: ‘yes, no, or maybe’. All deci- researcher and a doctoral student to deliver the pro- sions were checked by another author (ADO) and a gramme.22 The length of the interventions varied from

2 Veldman SLC, et al. BMJ Open Sport Exerc Med 2016;2:e000067. doi:10.1136/bmjsem-2015-000067 BMJ Open Sport Exerc Med: first published as 10.1136/bmjsem-2015-000067 on 4 January 2016. Downloaded from Open Access

duration.19 24 Six interventions consisted of a structured Table 1 Methodological quality assessment items15 programme and included: implementing only one GMS Item Description per session;17 focusing on a different GMS each week;18 A Key baseline characteristics are presented providing a circuit in which children chose their own separately for treatment groups (age, and at least task and difficulty;23 or a structured programme in com- one outcome measure) and for cluster randomised bination with either supervised free play or unstructured controlled trials and controlled trials, positive if activities.20 Two studies involved parents in the baseline outcomes were statistically tested and intervention.18 19 results of tests were provided B Randomisation procedure clearly and explicitly described and adequately carried out (generation of Efficacy allocation sequence, allocation concealment and The Test of Gross Motor Development 2 (TGMD-2) was – implementation) the most common measure.17 21 24 Six studies reported C Validated measures of motor development used a statistically significant effect of the intervention.17 18 – (validation in same age group reported and/or cited) 20 23 Three studies reported a significant effect on the ≤ D Drop out described and 20% for <6-month total scores of motor skills18 20 21 and three studies follow-up or ≤30% for ≥6-month follow-up reported significant effects on either locomotor skills, E Blinded outcome assessments (positive when 17 20 22 23 those responsible for assessing motor development object control skills or on individual skills. at outcome were blinded to group allocation of individual participants) Methodological quality F Motor development assessed a minimum of Table 3 displays the methodological quality assessment 6 months after pretest outcomes. Agreement was on 85% of the 60 items. Four G Intention to treat analysis for motor development studies had high methodological quality.17 19 20 23 outcomes(s) (participants analysed in group they were originally allocated to, and participants not excluded from analyses because of non-compliance DISCUSSION to treatment or because of some missing data) H Potential confounders accounted for in motor This review examined literature published between June development analysis (eg, baseline score, group/ 2007 and January 2015 on interventions to improve by copyright. cluster, age) GMS in young children (0–5 years). Seven studies were I Summary results for each group+treatment effect included and 86% found evidence that interventions are (difference between groups)+its precision (eg, 95% successful. Since developing GMS has been recom- CI) mended as part of national physical activity guidelines J Power calculation reported, and the study was for this age group in three countries (which have all – adequately powered to detect hypothesised been released since the original review),24 26 it is inter- relationships esting that only seven interventions have been reported in the past 8 years. Reasons for a limited implementation of programmes to develop GMS could be: a lack of http://bmjopensem.bmj.com/ 2 to 10 months and frequency ranged from two to five funding or interest in this area, the complexity of imple- sessions per week. The session duration varied from 15 menting programmes in childcare settings, or a lack of to 40 min, with two studies not reporting a specified competence and confidence in setting staff.

Figure 1 PRISMA flowchart of studies through the review process. on September 29, 2021 by guest. Protected

Veldman SLC, et al. BMJ Open Sport Exerc Med 2016;2:e000067. doi:10.1136/bmjsem-2015-000067 3 4 pnAccess Open Table 2 Description of study characteristics Reference (author, year, Design and Intervention Motor skill country) setting Sample length Intervention groups Intervention content measurement Results Alhassan et al RCT, preschool N: INT=43, CON=28, 6 months INT: Physical activity INT: Teacher-taught locomotor TGMD-2 INT>CON for 2012, USA17 children mean age=4.3 years intervention, skill-based physical activity leaping skills CON: unstructured programme. 30 min, 5×/week. (p<0.009) free playtime CON: Unstructured free playtime Bellows et al RCT, early N: INT=98, CON=103, 18 weeks INT: The Food INT: Motor skill intervention PDMS-2 INT>CON 2013, USA18 childhood settings mean age=4.3 years Friends: Get Movin’ programme. (p<0.001) With Mighty Moves 15–20 min, 4×/week. Nutrition Programme programme, CON: Food Friends, 12 weeks. a 12-week nutrition CON: Nutrition programme, programme 12-week Bonvin et al RCT, child care N=648, (baseline), N: 10 months INT: Physical activity INT: Physical activity programme Zurich INT=CON eda SLC, Veldman 2013, centres INT=187, CON=202 intervention, designed to intervene at individual Neuromotor Switzerland19 (follow-up), mean CON: Regular care and environmental level. No time Assessment age=3.3 years demands. Test CON: no intervention tal et Hardy et al RCT, preschool N: INT=263, 20 weeks INT: Munch and INT: Resource containing games TGMD-2 INT >CON

. 2010, children CON=167, mean Move, and learning experiences related to (p<0.001) M pnSotEecMed Exerc Sport Open BMJ Australia23 age=4.4 years CON: Regular care healthy eating and fundamental movement skill activities. No time demands. CON: no intervention Jones et al RCT, early N: INT=52, CON=45, 20 weeks INT: Movement skill INT: Structured lessons and TGMD-2 INT>CON 2011, childhood settings mean age=4.1 years development unstructured activities for children. (p=.00) Australia20 physical activity 20 min, 3×/week. programme. CON: no intervention 2016; CON: Usual care Robinson and RCT, preschool N: INT (LA)=38, INT 9 weeks INT: LA or mastery INT: Motor skill intervention TGMD-2 INT>CON 2 e007 doi:10.1136/bmjsem-2015-000067 :e000067. Goodway children (MM)=39, CON=40, motivational (MM) programme. 30 min, 2×/week. (p=.001) 2009, USA22 mean age=3.8 years instructional climate LA: Students following guidance CON: Comparison and directions from instructor. group MM: Students navigated independently through activity stations. CON: Typical Head Start curriculum Tsapakidou Quasi-experiment, N: INT=49, CON=49, 2 months INT: Motor skill INT: Motor skill intervention TGMD-2 INT>CON et al 2014, nursery school ages 3.5–5 years (no development programme, 30–40 min, 2×/week. (p=<0.005) Greece21 mean age reported) programme CON: No intervention CON: Daily routine CON, control group; INT, intervention group; LA, low-autonomy; MM, mastery motivational; PDMS-2, peabody developmental motor scales 2; RCT, randomised controlled trials; TGMD-2,

the test of gross motor development 2.

by copyright. by

BMJ Open Sport Exerc Med: first published as 10.1136/bmjsem-2015-000067 on 4 January 2016. Downloaded from from Downloaded 2016. January 4 on 10.1136/bmjsem-2015-000067 as published first Med: Exerc Sport Open BMJ http://bmjopensem.bmj.com/ on September 29, 2021 by guest. Protected guest. by 2021 29, September on BMJ Open Sport Exerc Med: first published as 10.1136/bmjsem-2015-000067 on 4 January 2016. Downloaded from Open Access

Table 3 Methodological quality assessment Bonvin Hardy Jones Robinson Alhassan Bellows et al et al et al and Goodway Tsapakidou Methodological quality item et al 201217 et al 201318 201319 201023 201120 200922 et al 201421 Key baseline characteristics + − + −−− − reported separately for each group Randomisation procedure clearly −−+ − + −−− described Valid measure of FMS + + + + + + + Dropout ≤20% for <6 months + − ++++ + follow-up or ≤30% for ≥6 months follow-up Assessor blinding −−+++−− Motor development assessed a min + − ++−− − of 6 months after pretest Intention-to-treat analysis −−+++− + Potential confounders accounted +++++−− for in analysis Summary results presented + − +++−− +treatment effect+precision estimates Power calculation reported −−++−− − Total score 6 2 10 8 7 2 3

Implementation connection materials such as educational handouts and All studies were implemented in early childhood set- a music CD18 or parent information sessions to inform tings. This setting is popular for group RCTs because it them on the benefits of physical activity and how to inte- by copyright. is relatively easy to randomise at a whole centre level, grate this within their family environment.19 It is recom- and programmes can be incorporated into regular rou- mended to actively involve parents in centre-based GMS tines. Furthermore, it maximises the number of staff development programmes and encourage them to prac- involved and the responsibility of implementation can tice skills in the home environment12 to reinforce the be shared. Compared to the previous review, the learning that has occurred at the centre and strengthen number of RCTs has increased from 29% to 86%, which the relationship between the centre and home setting. is positive given that RCTs are the ‘gold standard’ in Informing and guiding parents in how to practice GMS, research design. the duration of practice and how to motivate their chil- Setting staff delivered the intervention in six studies dren can be done in several ways such as through infor- and training was offered to increase their competence mation sessions, by handing out home materials or via http://bmjopensem.bmj.com/ and confidence in delivering the programme and to email and the use of social media. – enhance professional development.17 19 20 21 23 This While only seven studies were identified, the sample training varied from a 1 day workshop17 23 to several sep- sizes, duration and programme content varied widely. arate workshops spread over different days.19 20 Most studies included in this review recruited whole Professional development of staff is important to childcare centres, which helps to maximise sample size. enhance their self-efficacy in delivering a programme The duration of the programmes varied between 2 and and to provide them with up-to-date information on the 10 months. Four programmes lasted ≥20 weeks,18 20 22 23 importance of GMS and how to teach them. Especially an increase compared with the average of 12 weeks in

in young children it is important to enhance their motiv- the previous review. Intervention sessions were delivered on September 29, 2021 by guest. Protected ation and involvement through people that have experi- between two and five times a week and the average dur- ence, are competent and confident. Other advantages ation of the intervention sessions was around 20 min. On of setting staff delivering the intervention have been average this gives a greater intervention ‘dose’ compared mentioned in the previous systematic review12 and to the studies in the previous review where there was include maximising the potential sustainability of the approximately 1 h of instruction per week. Based on this programme and minimising costs associated with current evidence it seems that a higher intervention implementation. ‘dose’ with at least two sessions a week may contribute to As recommended by Riethmuller et al12 parents the effectiveness of interventions. should play an important role in developing GMS through role modelling and providing opportunities, Efficacy – encouragement and support.12 24 However, only two Six studies found significant intervention effects.17 18 20 23 studies involved parents. This was done through home Even though Bonvin et al19 had high methodological

Veldman SLC, et al. BMJ Open Sport Exerc Med 2016;2:e000067. doi:10.1136/bmjsem-2015-000067 5 BMJ Open Sport Exerc Med: first published as 10.1136/bmjsem-2015-000067 on 4 January 2016. Downloaded from Open Access quality, they did not collect any data on the exact amount between GMS development and other developmental of daily physical activity time or the use of any specificcur- areas and extra funding should be provided to riculum, which means the intensity might have been inad- support the development of these interventions. equate and there was no control on what activities were 2. Intervention components should be clearly described done. in order to compare the different intervention pro- Not all studies clearly described their intervention pro- grammes and determine which components contrib- gramme which makes it difficult to compare interven- uted to the effectiveness of the intervention. For tion components. Therefore, no key components could future research, this is important in order to imple- be identified that would contribute to a successful ment the most optimal intervention programme. intervention. 3. Based on the current evidence it seems that a higher intervention ‘dose’ with at least two sessions a week Methodological quality may contribute to the effectiveness of interventions. Four included articles had high methodological quality. 4. Consistency in GMS assessment is important to Compared to the review of Riethmuller et al,12 the per- compare results between interventions and conduct centage has increased from <20% to 57%, and the high meta-analysis. number of RCTs might have contributed to this. Power calculations have been recommended to ensure that appropriate statistical analyses could be performed.14 CONCLUSION However, only two studies conducted a power calcula- This review highlights the limited studies evaluated to tion.19 23 A reason why two other included studies did improve GMS in young children over the past 8 years. not perform power calculations could be because they This is surprising since the importance of GMS develop- were pilot studies and therefore not adequately powered ment in young children has been proven and given the to detect statistical significances.17 20 For future studies, recommendations made in the previous review. however, it is important to conduct power calculations in Programmes designed to increase the development of order to appropriately test the effectiveness of these GMS have been promising although further research GMS development programmes in young children. regarding efficacy and the optimal dose of implementa-

tion is required. As stated in the previous review, parents by copyright. Strengths and limitations play an important role in developing GMS in their chil- This review has a number of strengths. These include dren. Up to now, few studies have focused on involving searching multiple databases, extraction of extensive parents and children to increase the development of study details from the articles, methodological quality GMS and therefore, this should be a focus for further assessments with high agreement levels and alignment research. Also, professional development of the educa- with the PRISMA statement.14 Limitations include the tors in this area should be an important component in following: the effectiveness of interventions could not be future interventions to increase the quality of their prac- compared because of different instruments that were tice in early childhood settings. used to assess GMS, only a small number of updated studies were found, and studies had to be published in Competing interests None declared. http://bmjopensem.bmj.com/ English. Provenance and peer review Not commissioned; internally peer reviewed.

Recommendations Open Access This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, Development of GMS in young children is important. which permits others to distribute, remix, adapt, build upon this work non- When given the opportunity and encouragement to commercially, and license their derivative works on different terms, provided learn and practice GMS, children are able to master the original work is properly cited and the use is non-commercial. See: http:// these skills before the end of childhood.27 The recom- creativecommons.org/licenses/by-nc/4.0/ mendations made in the previous review are still import- 12

ant: utilising a partnership approach in which on September 29, 2021 by guest. Protected researchers and childcare staff work together to share REFERENCES responsibilities, minimise the burden and support each 1. Okely A, Booth M, Chey T. Relationships between body composition other; programme facilitators should be chosen carefully and fundamental movement skills among children and adolescents. fi Res Q Exerc Sport 2004;75:238–47. because their competence, con dence and enthusiasm 2. Okely A, Booth M, Patterson J. Relationship of cardiorespiratory influences children’s participation; parents should be endurance to fundamental movement skill proficiency among adolescents. Pediatr Exerc Sci 2001;13:380–91. involved; conducting sample size calculations to ensure 3. Logan S, Robinson L, Webster E, et al. The relationship between appropriate statistical analysis; and improving the meth- motor competence and physical activity engagement during odological quality of interventions (alignment with the childhood: a systematic review. Kinesiol Rev 2014;4;416–26. 4. Best JR. Effects of physical activity on children’s executive function: CONSORT or TREND statement).Additionally, the fol- contributions of experimental research on aerobic exercise. Dev Rev lowing recommendations can be made: 2010;30:331–51. 5. Piek J, Dawson L, Smith L, et al. The role of early fine and gross 1. More high-quality GMS interventions are needed motor development on later motor and cognitive ability. Hum Mov based on the current evidence of relationships Sci 2008;27:668–81.

6 Veldman SLC, et al. BMJ Open Sport Exerc Med 2016;2:e000067. doi:10.1136/bmjsem-2015-000067 BMJ Open Sport Exerc Med: first published as 10.1136/bmjsem-2015-000067 on 4 January 2016. Downloaded from Open Access

6. Leonard H, Hill E. Review: The impact of motor development on 18. Bellows LL, Davies PL, Anderson J, et al. Effectiveness of a typical and atypical social cognition and language: a physical activity intervention for Head Start preschoolers: systematic review. J Child Adolesc Ment Health 2014;19; a randomized intervention study. Am J Occup Ther 2013;67:28–36. 163–70. 19. Bonvin A, Barral J, Kakebeeke T, et al. Effect of a governmentally- 7. Piek J, Baynam G, Barrett N. The relationship between fine and led physical activity program on motor skills in young children gross motor ability, self-perceptions and self-worth in children and attending child care centers: a cluster randomized controlled trial. adolescents. Hum Mov Sci 2006;25:65–75. Int J Behav Nutr Phys Act 2013;10:90. 8. Ulrich B. Perceptions of physical competence, motor competence, 20. Jones R, Riethmuller A, Hesketh K, et al. Promoting fundamental and participation in organized sport: their interrelationships in young movement skill development and physical activity in early childhood children. Res Q Exerc Sport 1987;58:57–67. settings: a cluster randomized controlled trial. Pediatr Exerc Sci 9. Skinner R, Piek J. Psychosocial implications of poor motor 2011;23:600–15. coordination in children and adolescents. Hum Mov Sci 21. Tsapakidou A, Stefanidou S, Tsompanaki E. Locomotor 2001;20:73–94. development of children aged 3.5 to 5 years in nursery schools in 10. Hardy L, Reinten-Reynolds T, Espinel P, et al. Prevalence and Greece. Rev Eur Stud 2014;1–6. correlates of low fundamental movement skill competency in 22. Robinson LE, Goodway JD. Instructional climates in preschool children. 2012;130:e390–8. children who are at-risk. Part I: object-control skill development. 11. Okely A, Booth M. Mastery of fundamental movement skills among Res Q Exerc Sport 2009;80:533–42. children in New South Wales: prevalence and sociodemographic 23. Hardy L, King L, Kelly B, et al. Munch and Move: evaluation of a distribution. J Sci Med Sport 2004;7:358–72. preschool healthy eating and movement skill program. Int J Behav 12. Riethmuller A, Jones R, Okely A. Efficacy of interventions to improve Nutr Phys Act 2010;7:80. motor development in young children: a systematic review. 24. Department of Health. Move and Play every day. In: Australian Pediatrics 2009;124:e782–92. Government DoH, ed. Australia. 2014. http://www.health.gov.au/ 13. Jenni O, Chaouch A, Caflisch J, et al. Correlations between motor internet/main/publishing.nsf/content/F01F92328EDADA5BCA257BF and intellectual functions in normally developing children between 7 0001E720D/$File/Move%20and%20play%20every%20day% and 18 years. Dev Neuropsychol 2013;38:98–113. 200-5yrs.PDF 14. Moher D, Liberati A, Tetziaff J, et al. Preferred reporting items for 25. Department of Health Social Services and Public Safety. Physical systematic reviews and meta-analysis: the PRISMA statement. PLoS activity guidelines for early years (under 5s). In: Department of Med 2009;6:e1000097. Health SSaPS, ed. United Kingdom, 2011. https://www.gov.uk/ 15. Altman D, Schulz K, Moher D, et al. The revised CONSORT government/uploads/system/uploads/attachment_data/file/213737/ statement for reporting of randomized controlled trials. Ann Intern dh_128142.pdf Med 2001;134:663–94. 26. Canadan Society for Exercise Physiology and Participation. 16. Van Sluijs E, McMinn A, Griffin S. Effectiveness of interventions to Canadian physical activity guidelines for the early years: 0–4 promote physical activity in children and adolescents: systematic years. In: Participation. CSfEPa, ed. Canada, 2012. http://www. review of controlled trials. BMJ 2007;335:703. csep.ca/CMFiles/Guidelines/CSEP_PAGuidelines_early-years_ 17. Alhassan S, Nwaokelemeh O, Ghazarian M, et al. Effects of en.pdf locomotor skill program on minority preschoolers’ physical activity 27. Gallahue D, Donnelly F. Developmental physical education for all levels. Pediatr Exerc Sci 2012;24:435–49. children. 4th edn. Human Kinetics, 2003. by copyright. http://bmjopensem.bmj.com/ on September 29, 2021 by guest. Protected

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