Effects of Structured Physical Activity Breaks and Free Play in Children With Mild Intellectual Disability

Effects of Structured Physical Activity Breaks and Free Play in Classroom on Gross Motor Skills, Endurance, and Behavior in Children With Mild Intellectual Disability

Children with mild intellectual disability (MID) typically exhibit delays in both intellectual and adaptive functioning, with the onset occurring during the developmental period.

These children often learn new information and skills at a slower pace compared to their peers and frequently struggle academically. Structured physical activity breaks (SPAB) in the classroom are short, planned periods of physical exercise integrated into the school day to enhance children's physical fitness and behavioral outcomes. Free play (FP) in which children may choose and engage in activities at their own pace, establishing creativity, social engagement, and self-regulation. Study includes 22 participants and divided into 2 groups, one group receiving (SPAB) and the other group participating in free play (FP). The physical activity breaks, lasting between 5 to 30 minutes. SPAB group will engage in a sequence of activities. These activities will start with a 5-minute stretch, followed by 5 minutes of marching in place, 30 seconds of jumping an invisible rope, 30 seconds of flapping arms like a bird, 5 minutes of mirroring each other's actions and guessing, 5 minutes of hopping on one foot or jumping on both feet, drawing on the board, guessing the color, and making a circle to play a game in class. In comparison, the FP group will have access to various activity stations within the classroom, allowing children to choose their activities within a 30-minute time frame. The intervention will be implemented 5-days a week for a total of 8-weeks. Gross Motor Development-2 (TGMD-2) use for assessing gross motor skills, the 6-minute walk test use for measuring functional capacity of endurance, and the Strengths and Difficulties Questionnaire (SDQ) use for evaluating behavior. Data analysis will be conducted using SPSS version 27.

Study Overview

• Status: Completed
• Conditions: Intellectual Disability, Mild
• Intervention / Treatment: Other: Structured physical activity break

Detailed Description

Children with mild intellectual disability (MID) typically exhibit delays in both intellectual and adaptive functioning, with the onset occurring during the developmental period. These children often learn new information and skills at a slower pace compared to their peers and frequently struggle academically. Structured physical activity breaks (SPAB) in the classroom are short, planned periods of physical exercise integrated into the school day to enhance children's physical fitness and behavioral outcomes. Free play (FP) in which children may choose and engage in activities at their own pace, establishing creativity, social engagement, and self-regulation. Gross motor skills, which include activities such as running, jumping, and balancing, are crucial for the overall physical development of children. Endurance, the ability to sustain physical activity over time often underdeveloped in children with MID. Behavioral outcomes, including social interaction, attention, and self-control, are also influenced by physical activity. This study aims to investigate the comparative effects of implementing SPAB as part of a comprehensive school physical activity program and FP on children with mild intellectual disabilities. Study includes 22 participants and divided into 2 groups, one group receiving (SPAB) and the other group participating in free play (FP). The physical activity breaks, lasting between 5 to 30 minutes. SPAB group will engage in a sequence of activities. These activities will start with a 5-minute stretch, followed by 5 minutes of marching in place, 30 seconds of jumping an invisible rope, 30 seconds of flapping arms like a bird, 5 minutes of mirroring each other's actions and guessing, 5 minutes of hopping on one foot or jumping on both feet, drawing on the board, guessing the color, and making a circle to play a game in class. In comparison, the FP group will have access to various activity stations within the classroom, allowing children to choose their activities within a 30-minute time frame. The intervention will be implemented 5-days a week for a total of 8-weeks. Gross Motor Development-2 (TGMD-2) use for assessing gross motor skills, the 6-minute walk test use for measuring functional capacity of endurance, and the Strengths and Difficulties Questionnaire (SDQ) use for evaluating behavior. Data analysis will be conducted using SPSS version 27.

• Study Type: Interventional
• Enrollment (Actual): 22
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Pakistan
  • Punjab Province
    • Lahore, Punjab Province, Pakistan, 54900
      • PSRD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Child
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Mild Intellectual Disability i-e mild deficit in intellectual and adaptive functions, having onset in developmental period (24) approximate IQ range of 50 to 69 (25).
• ADLs are preserved and complex functions minimally impaired (26).
• Attendance of a special educational center;
• A medically cleared status from any physical ailment for participation in the baseline examinations.
• Children are able/ allowed to interact with the environment and use of resources during free play in school/institute

Exclusion Criteria:

• Children with chronic medical conditions/ physical disabilities/balance issues/injuries that prevent participation in physical activity
• Lack of informed consent from parents' and/or legal guardians' for their children's participation;
• Coexisting conditions: autism, Down syndrome, cerebral palsy (CP), any muscular dystrophy, or neurological disorders such as epilepsy or brain damage;
• Children with severe motor disability Comorbidities like oncological, rheumatic, orthopedic or cardiac diseases

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Structured physical activity break; The structured physical activity breaks in classroom will include 5-30 minutes physical activities sequenced as: Week 1,4,7: 5-mintue stretch break, 5-minute marching in place, 30-sec jumping an invisible rope, 30-sec Flap arms like a bird, 5-minute mirror each other's actions and guess, 5-minute hop on one foot/ jump on both feet, draw on board, guess the color, make a circle and play a game of throw a ball in class. Week 2,5,8: 5-minute stretch break, 2-3 laps throughout the classroom, jumping in and out a circle on command, rock-paper-scissors-jump, paint or sketch on book, guess the animal, up-down-stop-go opposites, make a circle and play a game of throw a ball and clap in class. Week 3,6: 5-minute stretch break, 30-sec balance on one foot, 30-sec hopping, 5-jumping jacks, 5-claps turn around and guess the shape, play a game on board or notebook, make a circle and play a game of throw a ball and jump in class.	Other: Structured physical activity break; The structured physical activity breaks in classroom will include 5-30 minutes physical activities sequenced as: Week 1,4,7: 5-mintue stretch break, 5-minute marching in place, 30-sec jumping an invisible rope, 30-sec Flap arms like a bird, 5-minute mirror each other's actions and guess, 5-minute hop on one foot/ jump on both feet, draw on board, guess the color, make a circle and play a game of throw a ball in class. Week 2,5,8: 5-minute stretch break, 2-3 laps throughout the classroom, jumping in and out a circle on command, rock-paper-scissors-jump, paint or sketch on book, guess the animal, up-down-stop-go opposites, make a circle and play a game of throw a ball and clap in class. Week 3,6: 5-minute stretch break, 30-sec balance on one foot, 30-sec hopping, 5-jumping jacks, 5-claps turn around and guess the shape, play a game on board or notebook, make a circle and play a game of throw a ball and jump in class.
No Intervention: Free play; Free play in classroom will be the activity stations available in the institute. Classroom will be divided into various zones, offering the widest selection of areas for the children to explore. Each zone will have age-appropriate play stations designed to engage the children in diverse activities. In addition to all of the locations, a reserve spots in the classroom will be made so that the students can show their work. This comprises the artwork and crafts that kids will have created in the free play classroom. Free Play is children's self-organized activity. Therapist will observe children in a creative, stimulating play environment and participation in the play.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
TGMD-2 for Gross Motor Skills	"TGMD-2" is a tool for gross motor skills evaluation (30) and physical activity (31) in school age children. It comprises of two subtest categories locomotion to measure ability of child to move from one place to another, object control subtest measure the ability of child to perform object manipulation and visual-motor skills. The locomotor subtest has a maximum score of 48 (6 skills × 4 criteria x 2 trials), as does the object control subtest. The overall TGMD score is the sum of the two subgroups and it ranges from 0 to 96, with higher scores signifying better performance. To calculate the child's percentile rank and standard score, compare the total scores to the normative data in the TGMD-2 manual.	8-weeks.
6MWT for endurance	"6-minute walk test" is a tool for measuring functional endurance and physical fitness. Six minute walk test (6MWT) is a field exercise test widely used in clinical practice both in adults and in pediatric patients. Anthropometric characteristics are measured before the test and, peripheral oxygen saturation (SpO2), heart and respiratory rate are measured before and after a 6-minute walk test	8-weeks
Strengths and Difficulties Questionnaire for behavior	"Strengths and Difficulties" Parent and Teacher reported questionnaire for children aged 04-17 years is a behavioral measuring tool. The SDQ includes 25 items that examine a range of 'strengths and difficulties' as behavioral indicators of probable mental health disorders. The items contribute to 5 subscales, each with 5 items and a minimum score ranging from 0 (lowest score) to 10 (highest score): conduct difficulties, hyperactivity/inattention, emotional signs, problems with peers, and social conduct. The sum of the first 4 subscales, a total difficulty score that ranges from 0 to 40 (40).	8-weeks

Collaborators and Investigators

• Sponsor: Riphah International University
• Investigators: Principal Investigator: Maria Amjad, MSPT(Peads), Riphah International University

Study record dates

Study Major Dates

• Study Start (Actual): April 17, 2025
• Primary Completion (Actual): September 17, 2025
• Study Completion (Actual): October 1, 2025

Study Registration Dates

• First Submitted: April 17, 2025
• First Submitted That Met QC Criteria: April 17, 2025
• First Posted (Actual): April 24, 2025

Study Record Updates

• Last Update Posted (Actual): December 30, 2025
• Last Update Submitted That Met QC Criteria: December 29, 2025
• Last Verified: December 1, 2025

More Information

Terms related to this study

• Keywords: Behavior; Endurance; Neurodevelopmental disorder
• Additional Relevant MeSH Terms: Neurologic Manifestations; Nervous System Diseases; Mental Disorders; Neoplasms; Immune System Diseases; Neoplasms by Histologic Type; Neurobehavioral Manifestations; Lymphatic Diseases; Lymphoproliferative Disorders; Immunoproliferative Disorders; Lymphoma, Non-Hodgkin; Lymphoma; Pathological Conditions, Signs and Symptoms; Signs and Symptoms; Hemic and Lymphatic Diseases; Neurodevelopmental Disorders; Lymphoma, Follicular; Intellectual Disability; Behavior
• Other Study ID Numbers: REC/RCR/AHS/24/0739

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No