Protocol for a two-cohort randomized cluster clinical trial of a motor skills intervention: The Promoting Activity and Trajectories of Health (PATH) Study

Leah E Robinson, Lu Wang, Natalie Colabianchi, David F Stodden, Dale Ulrich, Leah E Robinson, Lu Wang, Natalie Colabianchi, David F Stodden, Dale Ulrich

Abstract

Introduction: Data supports that motor skills are an underlying mechanism that influence physical activity along with perceived motor and physical competence, but the relationship between motor skills and physical activity during the early years is unclear. The goal of this study, Promoting Activity and Trajectories of Health (PATH) for Children, is to examine and compare the immediate (pre-test to post-test) and sustained (3-year follow-up) effect of an intervention on motor performance, physical activity and perceived physical competence to a control condition (ie, standard practice) in preschool-age children.

Methods and analysis: The PATH study is a two-cohort, randomised cluster clinical trial. 300 children between the ages of >3.5 to 5 years of age will be randomised to the motor skill intervention (n=153) or control (n=147) condition. Each assessment involves a measure of motor skill performance; product and process, seven consecutive days of physical activity monitoring and perceived physical competence. These measures will be assessed before and after the intervention (pre-test to post-test) and then each academic year across 3 years, grades kindergarten, first grade and second grade (3-year follow-up). To assess the clustered longitudinal effect of the intervention on outcome measures, random-effects models (eg, mixed model regression, growth curve modelling and structural equation modelling) will be used. The PATH study addresses gaps in paediatric exercise science research. Findings hold the potential to help shape public health and educational policies and interventions that support healthy development and active living during the early years.

Ethics and dissemination: Ethical approval for this study was obtained through the Health Sciences and Behavioral Sciences Institutional Review Board, University of Michigan (HUM00133319). The PATH study is funded by the National Institutes of Health. Findings will be disseminated via print, online media, dissemination events and practitioner and/or research journals.

Trial registration number: NHLBI ClinicalTrials.gov Identifier, NCT03189862. Registered 17 August 2017, https://ichgcp.net/clinical-trials-registry/NCT03189862.

Keywords: community child health; preventive medicine; public health.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
StandardProtocol Items: Recommendations for Interventional Trials diagram for the schedule of enrolment, interventions and assessments. X1=Cohort 1; X2=Cohort 2 **See detailed description of collected variables in main protocol. - Motor performance will be evaluated using the TGMD-3 (process measures) and product measures of motor skills. - Physical Activity will be measured for one full week (ie, 5 weekdays and 2 weekend days) with accelerometers. - Perceived Physical and Motor Competence will be assessed with physical and motor competence subscales – Harter and Pike pictorial scale of competence and social acceptance and the digital-scale of perceived motor competence. CHAMP, Children’s Health Activity Motor Program; TGMD-3, Test of Gross Motor Development-third edition.
Figure 2
Figure 2
Product measures setup for kicking, throwing and catching motor skills.
Figure 3
Figure 3
Sample size to achieve 90% power for physical activity.
Figure 4
Figure 4
Power to detect changes in motor performance and perceived motor competence.

References

    1. Ogden CL, Carroll MD, Kit BK, et al. . Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA 2014;311:806–14. 10.1001/jama.2014.732
    1. National Physical Activity Plan Alliance The 2018 United States report card on physical activity for children and youth. Washington, DC: national physical activity plan alliance, 2018. Available: [Accessed 7 May 2019].
    1. Katzmarzyk PT, Denstel KD, Beals K, et al. . Results from the United States 2018 report card on physical activity for children and youth. J Phys Act Health 2018;15:S422–4. 10.1123/jpah.2018-0476
    1. Troiano RP, Berrigan D, Dodd KW, et al. . Physical activity in the United States measured by Accelerometer. Med Sci Sports Exerc 2008;40:181–8. 10.1249/mss.0b013e31815a51b3
    1. Lohman TG, Ring K, Pfeiffer K, et al. . Relationships among fitness, body composition, and physical activity. Med Sci Sports & Exercise 2008;40:1163–70. 10.1249/MSS.0b013e318165c86b
    1. Liu J, Probst JC, Harun N, et al. . Acculturation, physical activity, and obesity among Hispanic adolescents. Ethn Health 2009;14:509–25. 10.1080/13557850902890209
    1. Fernandez E. Early childhood: dimensions and contexts of development and well-being : Ben-Arieh A, Casas F, Frønes I, et al., Handbook of child well-being. Dordrecht, Netherlands: Springer, 2014: 1629–47.
    1. Daniels SR, Hassink SG, COMMITTEE ON NUTRITION . The role of the pediatrician in primary prevention of obesity. Pediatrics 2015;136:e275–92. 10.1542/peds.2015-1558
    1. Pate RR, O'Neill JR. Physical activity guidelines for young children: an emerging consensus. Arch Pediatr Adolesc Med 2012;166:1095–6. 10.1001/archpediatrics.2012.1458
    1. Pate RR, O'Neill JR, Brown WH, et al. . Prevalence of compliance with a new physical activity guideline for preschool-age children. Child Obes 2015;11:415–20. 10.1089/chi.2014.0143
    1. Tambalis KD, Sidossis LS. Physical activity and cardiometabolic health benefits in children : Kokkinos P, Narayan P, Cardiorespiratory fitness in cardiometabolic diseases. Switzerland: Springer, Cham, 2019: 405–23.
    1. Bellows LL, Johnson SL, Davies PL, 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, 2013: 1146.
    1. Fitzgibbon ML, Stolley MR, Schiffer L, et al. . Two-Year follow-up results for Hip-Hop to health Jr.: a randomized controlled trial for overweight prevention in preschool minority children. J Pediatr 2005;146:618–25. 10.1016/j.jpeds.2004.12.019
    1. Fitzgibbon ML, Stolley MR, Schiffer LA, et al. . Hip-Hop to health Jr. obesity prevention effectiveness trial: Postintervention results. Obesity 2011;19:994–1003. 10.1038/oby.2010.314
    1. Pfeiffer KA, Saunders RP, Brown WH, et al. . Study of health and activity in preschool environments (shapes): study protocol for a randomized trial evaluating a multi-component physical activity intervention in preschool children. BMC Public Health 2013;13:728 10.1186/1471-2458-13-728
    1. Robinson LE, Webster EK, Whitt-Glover MC, et al. . Effectiveness of pre-school- and school-based interventions to impact weight-related behaviours in African American children and youth: a literature review. Obes Rev 2014;15:5–25. 10.1111/obr.12208
    1. Robinson LE, Stodden DF, Barnett LM, et al. . Motor competence and its effect on positive developmental trajectories of health. Sports Med 2015;45:1273–84. 10.1007/s40279-015-0351-6
    1. Barnett LM, van Beurden E, Morgan PJ, et al. . Childhood motor skill proficiency as a predictor of adolescent physical activity. J Adolesc Health 2009;44:252–9. 10.1016/j.jadohealth.2008.07.004
    1. Lopes VP, Rodrigues LP, Maia JAR, et al. . Motor coordination as predictor of physical activity in childhood. Scand J Med Sci Sports 2011;21:663–9. 10.1111/j.1600-0838.2009.01027.x
    1. Jaakkola T, Yli-Piipari S, Huotari P, et al. . Fundamental movement skills and physical fitness as predictors of physical activity: a 6-year follow-up study. Scand J Med Sci Sports 2016;26:74–81. 10.1111/sms.12407
    1. Lima RA, Pfeiffer KA, Møller NC, et al. . Physical activity and sedentary time are positively associated with academic performance: a 3-year longitudinal study. J Phys Act Health 2019;16:177–83. 10.1123/jpah.2017-0587
    1. Manoel EDJ. Motor development: implications for school physical education I. Revista Paulista de Educação Física 1994;8:82–97. 10.11606/issn.2594-5904.rpef.1994.138423
    1. Burton AW, Miller DE. Movement skill assessment. Champaign, IL: Human Kinetics, 1998.
    1. Gabbard C. Lifelong motor development. 5th edn London, UK: Pearson, 2008.
    1. Haga M, Tortella P, Asonitou K, et al. . Cross-Cultural aspects: exploring motor competence among 7- to 8-year-old children from Greece, Italy, and Norway. SAGE Open, 2018: 1–9.
    1. Goodway JD, Branta CF. Influence of a motor skill intervention on fundamental motor skill development of disadvantaged preschool children. Res Q Exerc Sport 2003;74:36–46. 10.1080/02701367.2003.10609062
    1. Goodway JD, Smith DW. Keeping all children healthy: challenges to leading an active lifestyle for preschool children qualifying for at-risk programs. Fam Community Health 2005;28:142–55. 10.1097/00003727-200504000-00006
    1. Robinson LE, Goodway JD. Instructional climates in preschool children who are at-risk. Part I: object-control skill development. Res Q Exerc Sport 2009;80:533–42. 10.1080/02701367.2009.10599591
    1. Goodway JD, Robinson LE, Crowe H. Gender differences in fundamental motor skill development in disadvantaged preschoolers from two geographical regions. Res Q Exerc Sport 2010;81:17–24. 10.1080/02701367.2010.10599624
    1. Morley D, Till K, Ogilvie P, et al. . Influences of gender and socioeconomic status on the motor proficiency of children in the UK, 2015: 150–6.
    1. Robinson LE, Rudisill ME, Goodway JD. Instructional climates in preschool children who are at-risk. Part II. Res Q Exerc Sport 2009;80:543–51. 10.1080/02701367.2009.10599592
    1. Logan SW, Robinson LE, Wilson AE, et al. . Getting the fundamentals of movement: a meta-analysis of the effectiveness of motor skill interventions in children. Child Care Health Dev 2012;38:305–15. 10.1111/j.1365-2214.2011.01307.x
    1. Robinson LE. Effect of a mastery climate motor program on object control skills and perceived physical competence in preschoolers. Res Q Exerc Sport 2011;82:355–9. 10.1080/02701367.2011.10599764
    1. Robinson LE, Webster EK, Logan SW, et al. . Teaching practices that promote motor skills in early childhood settings. Early Child Educ J 2012;40:79–86. 10.1007/s10643-011-0496-3
    1. Logan S, Robinson L, Webster EK, et al. . Exploring preschoolers’ engagement and perceived physical competence in an autonomy-based object control skill intervention. Eur Phy Educ Rev 2013;19:302–14. 10.1177/1356336X13495627
    1. Zanella LW, Souza MS, Kim MJ, et al. . Motor skill intervention: the impact in ball skill, manual dexterity, balance, and daily life of children with developmental coordination disorder, at risk and typically developing. J Sport Exercise Psy 2015;37:S92.
    1. Robinson LE, Palmer KK, Bub KL. Effect of the Children’s Health Activity Motor Program on Motor Skills and Self-Regulation in Head Start Preschoolers: An Efficacy Trial. Front Public Health 2016;4:173 10.3389/fpubh.2016.00173
    1. Hestbaek L, Andersen ST, Skovgaard T, et al. . Influence of motor skills training on children’s development evaluated in the Motor skills in PreSchool (MiPS) study-DK: study protocol for a randomized controlled trial, nested in a cohort study. Trials 2017;18:400 10.1186/s13063-017-2143-9
    1. Robinson LE, Veldman SLC, Palmer KK, et al. . A ball skills intervention in preschoolers: the CHAMP randomized controlled trial. Med Sci Sports Exerc 2017;49:2234–9. 10.1249/MSS.0000000000001339
    1. Veldman SLC, Palmer KK, Okely AD, et al. . Promoting ball skills in preschool-age girls. J Sci Med Sport 2017;20:50–4. 10.1016/j.jsams.2016.04.009
    1. Robinson LE, Palmer KK, Webster EK, et al. . The effect of CHAMP on physical activity and lesson context in preschoolers: a feasibility study. Res Q Exerc Sport 2018;89:265–71. 10.1080/02701367.2018.1441966
    1. Babic MJ, Morgan PJ, Plotnikoff RC, et al. . Physical activity and physical self-concept in youth: systematic review and meta-analysis. Sports Med 2014;44:1589–601. 10.1007/s40279-014-0229-z
    1. Nicholls JG. The competitive ethos and Democratic education. Cambridge, MA: Harvard University Press, 1989.
    1. Dweck CS, Leggett EL. A social-cognitive approach to motivation and personality. Psychol Rev 1988;95:256–73. 10.1037/0033-295X.95.2.256
    1. Barnett LM, Morgan PJ, van Beurden E, et al. . Perceived sports competence mediates the relationship between childhood motor skill proficiency and adolescent physical activity and fitness: a longitudinal assessment. Int J Behav Nutr Phys Act 2008;5:40–12. 10.1186/1479-5868-5-40
    1. Barnett LM, Morgan PJ, van Beurden E, et al. . A reverse pathway? actual and perceived skill proficiency and physical activity. Med Sci Sports Exerc 2011;43:898–904. 10.1249/MSS.0b013e3181fdfadd
    1. Harter S. The perceived competence scale for children. Child Dev 1982;53:87–97. 10.2307/1129640
    1. Rudisill ME, Mahar MT, Meaney KS. The relationship between children's perceived and actual motor competence. Percept Mot Skills 1993;76:895–906. 10.2466/pms.1993.76.3.895
    1. Barnett LM, Vazou S, Abbott G, et al. . Construct validity of the pictorial scale of perceived movement skill competence. Psychol Sport Exerc 2016;22:294–302. 10.1016/j.psychsport.2015.09.002
    1. Estevan I, Barnett LM. Considerations related to the definition, measurement and analysis of perceived motor competence. Sports Med 2018;48:2685–94. 10.1007/s40279-018-0940-2
    1. Feitoza AHP, Henrique RdosS, Barnett LM, et al. . Perceived motor competence in childhood: comparative study among countries. J Mot Learn Dev 2018;6:S337–50. 10.1123/jmld.2016-0079
    1. Stodden DF, Goodway JD, Langendorfer SJ, et al. . A developmental perspective on the role of motor skill competence in physical activity: an emergent relationship. Quest 2008;60:290–306. 10.1080/00336297.2008.10483582
    1. Larsen LR, Kristensen PL, Junge T, et al. . Motor performance as predictor of physical activity in children. Med Sci Sports Exerc 2015;47:1849–56. 10.1249/MSS.0000000000000604
    1. Reilly JJ, Kelly L, Montgomery C, et al. . Physical activity to prevent obesity in young children: cluster randomised controlled trial. BMJ 2006;333:1041–6. 10.1136/bmj.38979.623773.55
    1. Bonvin A, Barral J, Kakebeeke TH, et al. . Effect of a governmentally-led physical activity program on motor skills in young children attending child care centers: a cluster randomized controlled trial. Int J Behav Nutr Phys Act 2013;10:90 10.1186/1479-5868-10-90
    1. Roth K, Kriemler S, Lehmacher W, et al. . Effects of a physical activity intervention in preschool children. Med Sci Sports Exerc 2015;47:2542–51. 10.1249/MSS.0000000000000703
    1. Aivazidis D, Venetsanou F, Aggeloussis N, et al. . Enhancing motor competence and physical activity in kindergarten. J Phys Act Health 2019;16:184–90. 10.1123/jpah.2018-0260
    1. Jones RA, Riethmuller A, Hesketh K, et al. . Promoting fundamental movement skill development and physical activity in early childhood settings: a cluster randomized controlled trial. Pediatr Exerc Sci 2011;23:600–15. 10.1123/pes.23.4.600
    1. Jones RA, Okely AD, Hinkley T, et al. . Promoting gross motor skills and physical activity in childcare: a translational randomized controlled trial. J Sci Med Sport 2016;19:744–9. 10.1016/j.jsams.2015.10.006
    1. Bellows LL, Davies PL, 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. 10.5014/ajot.2013.005777
    1. Chan A-W, Tetzlaff JM, Altman DG, et al. . Spirit 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med 2013;158:200–7. 10.7326/0003-4819-158-3-201302050-00583
    1. Logan SW, Robinson LE, Webster EK, et al. . The influence of instructional climates on time spent in management tasks and physical activity of 2nd-grade students during physical education. Eur Phy Educ Rev 2015;21:195–205. 10.1177/1356336X14555304
    1. Palmer KK, Matsuyama AL, Robinson LE. Impact of Structured Movement Time on Preschoolers’ Physical Activity Engagement. Early Child Educ J 2017;45:201–6. 10.1007/s10643-016-0778-x
    1. Robinson LE, Palmer KK, Meehan SK. Dose–response relationship: the effect of motor skill intervention duration on motor performance. J Mot Learn Dev 2017;5:280–90. 10.1123/jmld.2016-0004
    1. Palmer KK, Chinn KM, Robinson LE. The effect of the CHAMP intervention on fundamental motor skills and outdoor physical activity in preschoolers. J Sport Health Sci 2019;8:98–105. 10.1016/j.jshs.2018.12.003
    1. Ames C. Achievement goals, motivational climate, and motivational processes : Roberts GC, Motivation in sport and exercise. Champaign, IL: Human Kinetics Books, 1995: 16–75.
    1. Ames C. Classrooms: goals, structures, and student motivation. J Educ Psychol 1992;84:261–71. 10.1037/0022-0663.84.3.261
    1. Epstein J. Effective schools or effective students? Dealing with diversity : Hawkins R, MacRae B, Policies for America’s public schools. Norwood, NJ: Ablex, 1988: 89–126.
    1. Epstein J. Family structures and student motivation: A developmental perspective : Ames C, Ames R, Research on motivation in education. 3rd edn San Diego, CA: Academic Press, 1989: 259–95.
    1. Newell K. Constraints on the development of coordination : Wade MG, Whiting HTA, Motor development in children: aspects of coordination and control. Netherlands: Springer, 1986: 34–60.
    1. Ulrich DA. Test of gross motor Development—second edition. Austin, TX: Pro-Ed, 2000.
    1. Ulrich DA. TGMD-3: test of gross motor Development—third edition. Austin, TX: Pro-Ed, 2019.
    1. Webster EK, Ulrich DA. Evaluation of the psychometric properties of the test of gross motor Development—Third edition. J Mot Learn Dev 2017;5:45–58. 10.1123/jmld.2016-0003
    1. Stodden DF, Gao Z, Goodway JD, et al. . Dynamic relationships between motor skill competence and health-related fitness in youth. Pediatr Exerc Sci 2014;26:231–41. 10.1123/pes.2013-0027
    1. Stodden DF, True LK, Langendorfer SJ, et al. . Associations among selected motor skills and health-related fitness: indirect evidence for Seefeldt's proficiency barrier in young adults? Res Q Exerc Sport 2013;84:397–403. 10.1080/02701367.2013.814910
    1. Stodden DF, Langendorfer SJ, Fleisig GS, et al. . Kinematic constraints associated with the acquisition of overarm throwing Part I. Res Q Exerc Sport 2006;77:417–27. 10.1080/02701367.2006.10599377
    1. 2018 Physical Activity Guidelines Advisory Committee 2018 physical activity guidelines Advisory Committee scientific report. Washington, DC: U.S. department of health and human services, 2018. Available: [Accessed 7 May 2019].
    1. Hildebrand M, van Hees VT, Hansen BH, et al. . Age group comparability of raw accelerometer output from wrist- and hip-worn monitors. Med Sci Sports Exerc 2014;46:1816–24. 10.1249/MSS.0000000000000289
    1. Hildebrand M, Hansen BH, van Hees VT, et al. . Evaluation of raw acceleration sedentary thresholds in children and adults. Scand J Med Sci Sports 2017;27:1814–23. 10.1111/sms.12795
    1. Miller GD, Jakicic JM, Rejeski WJ, et al. . Effect of varying accelerometry criteria on physical activity: the look ahead study. Obes 2013;21:32–44. 10.1002/oby.20234
    1. Cain KL, Sallis JF, Conway TL, et al. . Using accelerometers in youth physical activity studies: a review of methods. J Phys Act Health 2013;10:437–50. 10.1123/jpah.10.3.437
    1. van Hees VT, Gorzelniak L, Dean León EC, et al. . Separating movement and gravity components in an acceleration signal and implications for the assessment of human daily physical activity. PLoS One 2013;8:e61691. 10.1371/journal.pone.0061691
    1. Harter S, Pike R. The pictorial scale of perceived competence and social acceptance for young children. Child Dev 1984;55:1969–82. 10.2307/1129772
    1. Robinson L, Palmer K. Development of a digital-based instrument to assess perceived motor competence in children: face validity, test-retest reliability, and internal consistency. Sports 2017;5:48–56. 10.3390/sports5030048
    1. Maud PJ, Foster C. Physiological assessment of human fitness. 2nd ed Champaign, IL: Human Kinetics, 2006.
    1. Lohman TG, Roche AF, Martorell R. Anthropometric standardization reference manual. Champaign, IL: Human Kinetics Books, 1991.
    1. Rudolf MCJ, Walker J, Cole TJ. What is the best way to measure waist circumference? Pediatr Obes 2007;2:58–61. 10.1080/17477160601095177
    1. Dwyer GM, Hardy LL, Peat JK, et al. . The validity and reliability of a home environment preschool-age physical activity questionnaire (Pre-PAQ). Int J Behav Nutr Phys Act 2011;8:86–13. 10.1186/1479-5868-8-86
    1. McGreavey JA, Donnan PT, Pagliari HC, et al. . The Tayside children's sleep questionnaire: a simple tool to evaluate sleep problems in young children. Child Care Health Dev 2005;31:539–44. 10.1111/j.1365-2214.2005.00548.x
    1. Cohen KE, Morgan PJ, Plotnikoff RC, et al. . Physical activity and skills intervention: scores cluster randomized controlled trial. Med Sci Sports Exerc 2015;47:765–74. 10.1249/MSS.0000000000000452
    1. Browne RH. On the use of a pilot sample for sample size determination. Stat Med 1995;14:1933–40. 10.1002/sim.4780141709
    1. Tsiatis AA. Semiparametric theory and missing data. New York: Springer-Verlag, 2006.
    1. Fitzmaurice GM, Laird NM, Ware JH. Applied longitudinal analysis. Hoboken, NJ: John Wiley & Sons, 2004.
    1. Diggle PJ, Liang K-Y, Zeger SL. Analysis of longitudinal data. New York, NY: Oxford University Press, 1994.
    1. Verbeke G, Molenberghs G. Linear mixed models for longitudinal data. New York, NY: Springer, 2000.
    1. McCullagh P, Nelder JA. Generalized linear models. 2nd ed London, UK: Chapman & Hall, 1989.
    1. Little RJA, Rubin DB. Statistical analysis with missing data. 2nd ed Hoboken, NJ: John Wiley & Sons, 2002.
    1. Cody R. Longitudinal data and SAS: a programmer’s guide. Cary, NC: SAS Institute, 2001.
    1. Venetsanou F, Kambas A. Can motor proficiency in preschool age affect physical activity in adolescence? Pediatr Exerc Sci 2017;29:254–9. 10.1123/pes.2016-0119
    1. Clark JE, Metcalfe JS. The mountain of motor development: a metaphor. Mot Dev Res Rev 2002;2:163–90.

Source: PubMed

3
Abonner