Abstract
Fundamental movement skill interventions are important for promoting physical activity, but the optimal intervention model for preschool children remains unclear. We compared two 8-week interventions, a structured skill-station and a planned active play approach, to a free-play control condition on pre- and postintervention fundamental movement skills. We also collected data regarding program attendance and perceived enjoyment. We found a significant interaction effect between intervention type and time. A Tukey honest significant difference analysis supported a positive intervention effect showing a significant difference between both interventions and the free-play control condition. There was a significant between-group difference in group attendance such that mean attendance was higher for both the free-play and planned active play groups relative to the structured skill-based approach. There were no differences in attendance between free-play and planned active play groups, and there were no differences in enjoyment ratings between the two intervention groups. In sum, while both interventions led to improved fundamental movement skills, the active play approach offered several logistical advantages. Although these findings should be replicated, they can guide feasible and sustainable fundamental movement skill programs within day care settings.
Introduction
A wealth of evidence has demonstrated that higher physical activity (PA) is positively associated with a number of health benefits in young children and across the life span (Hinkley, Crawford, Salmon, Okely, & Hesketh, 2008; Janssen & Leblanc, 2010; Timmons et al., 2012; Tucker, 2008; Warburton, Nicol, & Bredin, 2006). Although recent data show that most Canadian preschool-aged children (3–4 years old) meet current daily PA guidelines (i.e., 180 minutes of total daily activity at any intensity; Tremblay et al., 2012), as few as 7% of children 5–11 years of age meet the recommended guidelines of 60 minutes of daily moderate-to-vigorous PA (Colley et al., 2013; Tremblay et al., 2011). Of interest, Colley et al. (2013) found that when using the minimum criteria of 60 minutes of moderate intensity activity versus 180 minutes of total PA, only 11% of children 3–4 years of age would meet guidelines as the bulk of their waking hours (41%) are spent engaged in light activity. As higher PA rates in school-aged youth correlate with greater adult PA participation rates (Telama et al., 2005, 2014), the preschool developmental period is critical for promoting PA (Goldfield, Harvey, Grattan, & Adamo, 2012; Telama, 2009). Parents and care providers have more control over a child’s social and physical environment during the developmentally malleable preschool years than later in development, thus presenting a timely opportunity to intervene and cultivate positive health behaviors and lifestyle choices (Goldfield et al., 2012).
Early development of fundamental movement skills (FMS; i.e., basic movement skills including locomotor skills, such as running and jumping, and object control skills, such as catching and throwing) focuses on what Stodden et al. (2008) have termed the ABC’s of movement. The development of these skills has been shown to predict future PA participation, as they form the basis of the specialized movement skills required to participate in recreational and organized activities/sport (Barnett, van Beurden, Morgan, Brooks, & Beard, 2009; Cliff, Okely, Smith, & McKeen, 2009; Cohen, Morgan, Plotnikoff, Callister, & Lubans, 2014; Fisher et al., 2005; Holfelder & Schott, 2014; Williams et al., 2009). Importantly, research has shown that children with superior locomotor skills are more likely to spend more time engaged in nonsedentary behaviors and moderate-to-vigorous levels of PA than children with poorer locomotor skill performance (Williams et al., 2008). Similarly, early development of object control skills has been associated with higher perceived sport competence, increased PA and sport participation, and physical fitness (Barnett et al., 2009).
As many as 33% of Canadian (Sinha, 2014) and 58% of American (United States Department of Education, 2012) parents of children under five years of age rely on day care services, making the day care setting a viable and developmentally appropriate context for fostering FMS acquisition and improvement and for promoting PA (Bower et al., 2008; Goldfield et al., 2012; Ward, 2010). Despite these promising possibilities, systematic research reviews have unveiled few studies examining day care-based FMS interventions (Riethmuller, Jones, & Okely, 2009; Veldman, Jones, & Okely, 2016). Moreover, while FMS interventions are important for promoting PA (Figueroa & An, 2017) and related health outcomes (Cohen, Morgan, Plotnikoff, Barnett, & Lubans, 2015; Hinkley et al., 2014; Tremblay et al., 2012), no optimal intervention model has emerged (Veldman et al., 2016). As FMS must be learned, practiced, and reinforced (Goodway, Crowe, & Ward, 2003; Logan, Robinson, Wilson, & Lucas, 2012), it is not surprising to discover that higher doses of early intervention efforts may play a key role in overall FMS effectiveness (Veldman et al., 2016). Moreover, as studies have shown that “free-play” is often insufficient for fostering FMS development (Logan et al., 2012), most research has emphasized traditional, direct skill-based instruction. Much less is known about planned, active play with instructor encouragement. As traditional motor skill interventions may become repetitive and less enjoyable over time, children may be more likely to abandon skill-based intervention activities (Logan et al., 2012). As play (Pellegrini & Smith, 1998) and activity enjoyment (Allender, Cowburn, & Foster, 2006; Bremer & Cairney, 2018) has been shown to be critical to a child’s development and continued PA participation, this study examined the effectiveness of different day care-based instructional approaches for improving FMS and for eliciting program adherence and perceived enjoyment. Specifically, we compared (a) a traditional structured, skill-station approach (i.e., direct instruction), (b) a planned, active play approach with instructor encouragement, and (c) a free-play control group, while also assessing children’s adherence to and enjoyment of each of the interventions.
Method
Study Design and Participants
The current study employed a cluster-randomized design and observed pre- to postintervention effects at the participant level. We invited participation from a convenience sample of attendees at three day care centers affiliated with the same day care academy. The day cares were selected based on their standardized daily curriculum, weekly meal plans, and adoption of an active, play-based learning environment. Following approval from the day care director, we randomly allocated each of the three centers to one of the three study arms: skill-station, planned active play, or free-play control. Two hundred potentially eligible children and their parents/guardians were sent a letter of invitation to participate from the Directors of each participating center. Children were eligible to participate if they were 3–5 years of age at the time of study initiation, had sufficient understanding of English to comprehend study instructions, and had no preexisting motor impairment that would limit their ability to safely participate or adversely affect motor skill testing. Only those children whose parents gave informed written consent were included in the study intervention and assessments. A total of 68 children were enrolled in the study. After accounting for drop-out and missed testing sessions, 19 children (10 males and 9 females) were included in the free-play control group (M = 3.62; SD = 0.41 years), 16 (10 males and 6 females) completed the skill-station-based intervention (M = 4.0; SD = 0.53 years), and 16 (6 males and 10 females) completed the planned, active play intervention (M = 4.29; SD = 0.78 years; see Figure 1 for a participant flowchart).
Participant flow.
Procedures
This study was reviewed and approved by the University Research Ethics Board. Both intervention protocols consisted of two, 45-minute training sessions per week over an 8-week period (totaling 16 training sessions). Total instructional time (i.e., excluding warm-up/cool-down activities) for both interventions was approximately 560 minutes (35 minutes/session; 70 minutes/week). Sessions were held during the predetermined outdoor (weather permitting) gross-motor play periods, and kinesiology student volunteers were recruited and trained to assist with program delivery. All participating children were asked to assent to participate at each biweekly training session; thus giving them the option to choose not to take part in the investigator-led activities on any given day. Attendance at each session was recorded. The free-play control group continued with their standard daily curriculum, permitting children to select and engage in any activity of their choosing without specific instruction. Children in the control group had access to an outdoor play area with free space, ample toys, and loose parts to facilitate unstructured free-play. The lead researcher was present at one 45-minute session per week to observe play behaviors and obtain attendance from the day care director for the second 45-mintute period.
We assessed baseline FMS proficiency using the second edition of the Test of Gross Motor Development (TGMD-2; Ulrich, 2000). We collected and scored raw scores (for each subtest and overall score) according to the TGMD-2 manual to enable comparison of our participants to standardized age and sex-related norms. Following the 8-week interventions, these measurements were repeated for comparison. All TGMD-2 assessments were completed by an experienced investigator with the help of two trained research assistants. Each assessment required approximately 15 to 20 minutes per child to administer. Research staff were not blinded to group allocation. Following the completion of the study, all participating centers received a summary of study results and copies of all intervention tools and resources.
Movement Interventions
Skill-based
The skill-based station intervention was based on the previously validated Successful Kinesthetic Instruction for Preschoolers program designed to foster the development of FMS in preschool-aged children (Goodway & Branta, 2003; Goodway et al., 2003). A direct instruction approach was used, and each station was supervised by a trained volunteer instructor. We delivered the program outdoors in a sectioned-off portion of the common play area.
We modified the Successful Kinesthetic Instruction for Preschoolers program to include an equal emphasis on balance, locomotor, and object control skills over the course of the 8-week intervention. The program consisted of a circuit of four skill stations completed in smaller groups (4–5 children/station). Children rotated through all four stations during each session and received task instruction/demonstration, encouragement, and feedback from the trained volunteers. Each week consisted of two different lesson plans, focusing on a specific skill or set of skills. Weeks 1 and 2 focused on balance tasks, Weeks 3 and 4 emphasized locomotor skills, and Weeks 5 and 6 targeted object control skills. Weeks 7 and 8 included a variety of activities with a mix of balance, locomotor, and object control skills (see Appendix for an outline of the intervention).
Planned active play
We developed the planned active play intervention using the Active for Life lesson plan builder which incorporates a bank of age-appropriate games developed to improve balance, locomotor, and object control skills (Active for Life, n.d.; see Appendix for an outline of the intervention.) Sessions were conducted in either an indoor gymnasium (weather dependent) or an outdoor recreational field located in close proximity to the center. Two volunteer instructors assisted with the delivery of the intervention (i.e., task demonstration, verbal cueing—“gallop like a horse,” and encouragement).
Instrumentation
FMS development
We used the TGMD-2 (Ulrich, 2000) to measure pre- and post-intervention gross motor ability. The TGMD-2 is a highly reliable and valid tool, ideal for identifying delays or improvement in development and for evaluating the success of motor skill interventions. It also uses a qualitative, process-oriented approach, considered essential when working with such young children (Goshi, Demura, Kasuga, Sato, & Minami, 1999). Twelve skills are observed, including six object control (stationary strike and dribble, catch, kick, underhand roll, and overhand throw), and six locomotor skills (run, hop, gallop, leap, horizontal jump, and slide). Following demonstration and verbal description of the task, children were allowed a practice trial followed by two test trials. We used the age-referenced composite score of the locomotor and object control subtests (i.e., gross motor quotient: GMQ) as the representative score for all participants, as it has been judged the most reliable method of interpreting TGDM-3 cores (Ulrich, 2000). Baseline and post-intervention GMQ results for all participants were determined, and values were compared to normative percentile scores.
Activity enjoyment
Children’s enjoyment in the intervention activities was assessed with a 7-point self-report Likert scale, adapted from the patient mood assessment scale by Lorish and Maisiak (1986) which incorporates various levels of enjoyment, ranging from a very happy (1) to a very unhappy (7) face. The original 20-face “Face Scale” demonstrated good convergent and discriminant validity and test–retest reliability (0.81) in previous research (Lorish & Maisiak, 1986). Although more precise tools to assess PA enjoyment are available (Imms, 2008; Kendzierski & De Carlo, 1991), they have not been designed for very young children. This simple and visual representation of enjoyment was face valid and easily understood. In cases where the children misunderstood the task (e.g., colored the entire scale), a member of the research team assisted the child in completing the scale. We assessed enjoyment each week for both intervention groups and have reported results as a group average.
Statistical Analyses
Data management and analyses were conducted using IBM SPSS Statistics for Windows Version 23. We used a one-way analysis of variance to explore differences in program attendance. A three-group, mixed factorial analysis of variance examined the impact of group assignment on GMQ scores over time, and we ran a follow-up Tukey honest significant difference post hoc comparison and computed and reported effect sizes (Cohen, 1988) to further explore between group effects. We compared enjoyment ratings between the two intervention groups with a Kruskal–Wallis H test.
Results
We detected a significant between-group difference, F(2, 48) = 7.037, p = .002) in group attendance. Post hoc Tukey honest significant difference testing showed that the mean attendance for the free-play (M = 14.58; SD = 2.24; p = .002) and planned active play groups (M = 13.43; SD = 2.66; p = .03) were significantly higher than those for the structured skill-based approach (M = 11.63; SD = 2.31). Attendance for the free-play and planned active play groups did not differ significantly.
Baseline and Postintervention LM, OC, and GMQ Scores.
Note. LM = locomotor; OC = object control; GMQ = gross motor quotient.
Discussion
Although most research to date has endorsed the use of structured skill-based learning, no study has systematically compared this intervention with a planned active play-based intervention for improving FMS ability in preschoolers. The current study addressed this comparison while also controlling for time spent in PA between groups.
In brief, using structured, age-appropriate movement-based games (Active for Life, n.d.), we found the planned active play intervention to be equally effective to the skill-based station approach for improving FMS among preschool-aged children. Consistent with the literature and as hypothesized, the free-play control group total TGMD-2 GMQ scores remained essentially unchanged over the duration of the 8-week study (Goodway & Branta, 2003; Ignico, 1991; Jones et al., 2011). Although no improvements in movement ability in the free-play group were found, we do not intend to trivialize the value of free-play. Free-play provides a multitude of benefits for children’s development, ranging from improved social interaction to increased creativity and problem-solving abilities (Ginsburg, American Academy of Pediatrics Committee on Communications, & American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health, 2007; Maxwell, Mitchell, & Evans, 2008). Thus, although free-play may not improve FMS, it remains vital to children’s overall development and should not be completely sacrificed in favor of more structured activities.
Although both of our interventions fostered equivalent FMS improvements, the relative ease of delivery between the two approaches was notably different. Specifically, the planned active play intervention required a minimum of two trained individuals, while four were required to execute the skill-based lesson plans. Moreover, fluctuations in child attendance had a minimal impact on the group-based activities in the planned active play group, whereas inconsistent participant numbers for the skill-based station groups required activities to be modified at the last minute. When considering the overall feasibility of implementing any new program, staffing requirements must be considered. Day care staff who are already very busy meeting the children’s basic care needs are unlikely to support changes that would require a significantly increased workload. Moreover, the additional help required to fully implement the skill-based station approach would require doubling the minimum student to staff ratio from 8:1 to 4:1 (Province of Nova Scotia, 2016), creating challenging, if not impossible, new demands on day care staff.
Bremer and Cairney (2018) recently reviewed the health-related outcomes associated with FMS ability. In addition to highlighting the importance of FMS ability for PA participation, fitness, and a healthy body composition, they also emphasized the significance of participant enjoyment for sustained PA participation. Specifically, children are less likely to remain engaged if they do not enjoy the motor skill activities, particularly in their younger years (Bremer & Cairney, 2018). Although our modified Likert scale was a simplistic means of assessing participant enjoyment, it offered a useful exploration of this variable in a young preschool population. In contrast to our stated hypotheses that planned active play would be perceived as more enjoyable than skill-based programming, we observed no significant differences between our two intervention groups. Although both groups displayed high enjoyment ratings overall, it was interesting to note that children in the planned active play group attended significantly more sessions than those in the skill-based station group. Although attendance is not a direct measure of enjoyment, it is plausible that children who agreed to participate in the weekly sessions may have found the programming more enjoyable than those children who remained with their regular class. Thus, although average enjoyment ratings were similar, it is possible that more children in the skill stations stopped participating. Perhaps, if attendance were made mandatory, the overall enjoyment of this group may have been lower or may have decreased over time. Future and improved efforts to understand participant enjoyment in different types of movement interventions are needed.
Limitations
A primary limitation of the current study was constrained staff involvement. Research shows that the policies and practices implemented within a childcare setting play a major role in children’s development (Bower et al., 2008; Pate, Pfeiffer, Trost, Ziegler, & Dowda, 2004). This is of particular importance at young ages, as a child’s behavior is fluid and habits may not be fully formed. By implementing positive health behaviors early these habits may be more likely to solidify and persist throughout life (Goldfield et al., 2012). Within the day care setting, directors and teachers have control over this behavioral malleability; therefore their level of involvement in the intervention substantially influences the long-term sustainability of any positive effects from the intervention. Future research should attend to increased, staff participation and involvement, critical to the successful implementation and evaluation of these programs.
Despite high-level administrative support, individual staff support in our study varied. Goldfield et al. (2012) touched on this issue, highlighting how personal beliefs or attitudes toward the importance of PA may affect how willing individual staff members are to facilitate PA participation or the implementation of similar movement interventions. It has been suggested that early childhood educator training may benefit from additional knowledge related to the importance of promoting PA, reducing sedentary behaviors and ways to effectively assist movement development throughout each stage of the preschool years (McGuire, 2012). Interestingly, a recent study by Adamo et al. (2016) found improvements in children’s movement ability solely through increasing teacher involvement and education regarding the importance of PA participation when staff were also provided with additional resources and activity plans to assist implementation.
Practical Implications
Increasing levels of physical inactivity within the general preschool population pose an immediate and long-term threat to children’s health and well-being. As FMS skills have been associated with increased PA rates both in the short and long term, finding ways to improve FMS ability within the preschool population is essential. Findings from this study better inform physical literacy and movement development for the preschool population. The discovery that free-play alone is insufficient to foster proper movement skill development is not novel, but the discovery that planned active play can provide improvements in movement development that are equal to those created by a structured skill-station-based approach is significant. An equally important finding was the relative ease with which the planned active play approach could be implemented in the day care daily routine, with its reduced requirements for teachers and equipment. These discoveries are extremely important for such a program’s feasibility and successful implementation.
Footnotes
Appendix
Acknowledgments
We thank the day care academy, the parents, and children who participated in this study. Without their enthusiasm and support, this project would have not been possible.