Proficiency in fundamental movement skills (FMS) can and should be trained and enhanced at an early age. |
In this review, interventions tackling FMS improvement in typically developing young children (aged 2–6 years) show clear beneficial effects on overall FMS, locomotion, and object control skills. |
As there is very little confidence in the effect estimates, and the true effect in this study is most likely different (stronger or weaker) from the effect estimate, more high-quality research with reduced bias is needed. |
1 Introduction
2 Methods
2.1 Literature Search
2.2 Eligibility Criteria
2.3 Study Selection and Data Extraction
Study | Design | Target population | Setting; participants (mean age ± SD, years) | Assessmenta
| Intervention program | Overview resultsb
|
---|---|---|---|---|---|---|
Alhassan et al. [67] United States | Cluster-randomized controlled trial INT and CON: 4 classrooms from 2 preschool centers in each | Ethnic minority preschoolers | Preschool centers INT: n = 43 (4.5 ± 0.6), CON: n = 28 (4.1 ± 0.6) | FMS: TGMD-2 (LMS) PA: accelerometer BC: height, weight, BMI (z-scores) Data collection: 0, 6 months | Duration: 6 months INT: 30 min structured PA lessons 5/week; lessons focusing on one of the skills of the TGMD-2 LMS; training sessions for teachers (total 8 h) CON: 30 min unstructured free play time 5/week; training sessions for teachers (total 2 h) | FMS: leaping INT > CON; remaining tests INT ≈ CON PA: sedentary INT < CON BC: INT ≈ CON |
Bellows et al. [36] United States | Cluster-randomized controlled trial INT and CON: 4 Head Start centers each | Preschool-aged children | Head Start centers INT: n = 132 (4.4 ± 0.6) CON: n = 131 (4.3 ± 0.6) | FMS: PDMS-2 (totFMS, OCS, LMS) PA: pedometers BC: height, weight, BMI (z-scores) Data collection: 0, 18 weeks | Duration: 18 weeks INT: 15–20 min structured PA lessons 4/week; lessons including multiple activities focusing on one or a group of skills from one of the three gross motor skill categories (Balance, LMS, OCS) by introducing fictive characters promoting motor skills and food; home material; training sessions for teachers. Additionally, those characters were also part of another nutrition-based study called ‘food friends’, which took place at the same time CON: nutrition-based ‘food friends’ study | FMS: INT > CON PA: INT ≈ CON BC: INT ≈ CON |
Bonvin et al. [69] Switzerland | Cluster-randomized controlled trial INT and CON: 29 childcare centers each | Young children aged 2–4 years | Childcare centers INT: n = 313 (3.4 ± 0.6) CON: n = 335 (3.3 ± 0.6) | FMS: adapted ZNA (totFMS) PA: accelerometer BC: height, weight, BMI Data collection: 0, 9 months | Duration: 9 months INT: 5 workshops for educators providing education in PA; promoting PA to parents via childcare educators; flyers; documentation and support at childcare center through coordinator; focus groups every 2 months; financial support for childcare centers to design activity-friendly spaces CON: regular preschool program | FMS: INT ≈ CON PA: INT ≈ CON BC: INT ≈ CON |
Delic [37] Greece | Controlled trial INT1, INT2 and CON: 1 class each, created out of the study participants | Kindergarten children | Preschool center INT1: n = 25 (5.4 ± 0.5) INT2: n = 25 (5.5 ± 0.3) CON: n = 25 (5.4 ± 0.6) | FMS: TGMD PA: none BC: none Data collection: 0, 10 weeks | Duration: 10 weeks INT1: 35 min structured movement lessons 2/week; lessons in week 1–4 including exercises for body/space awareness, lessons in week 5–10 including locomotor skills INT2: 35 min structured music and movement lessons 2/week focusing on percussion, reaction and creative movements; lessons in week 1–4 including exercises for body/space awareness and for determining personal rhythm, lessons in week 5–7 focusing on movement synchronization to external rhythms, and lessons in week 8–10 combining rhythm and fundamental locomotor skills CON: free-play activities | FMS: INT > CON PA: none BC: none |
Derri et al. [70] Greece | Randomized controlled trial INT and CON: 1 group each, created out of the study participants | Preschool children | No information about setting INT: n = 35 (N/A) CON: n = 33 (N/A) INT and CON: (5.4 ± 0.6) | FMS: TGMD (LMS) PA: none BC: none Data collection: 0, 10 weeks | Duration: 10 weeks INT: 35–40 min structured music and movement lessons 2/week; lessons including body/space awareness, reaction, percussion movements and improvisation skills, and combining rhythm and fundamental locomotor skills CON: 30–40 min free-play activities 2/week | FMS: galloping, leaping, horizontal jump, skipping INT > CON; remaining tests INT ≈ CON PA: none BC: none |
Donath et al.c [38] Switzerland | Cluster-randomized controlled trial INT and CON: 3 kindergartens each | Kindergarten children | Kindergartens INT: n = 22 (4.4 ± 1.0) CON: n = 19 (4.4 ± 1.2) | FMS: TGMD-2 (OCS) PA: none BC: height, weight, BMI Data collection: 0, 6 weeks | Duration: 6 weeks INT: 30 min structured training sessions 2/week; lessons including object control exercises CON: instructed and supervised training 2/week for playing activities by inexperienced instructor; no changes of daily physical and sportive activities | FMS: total sum score, stationary dribbling INT > CON; remaining tests INT ≈ CON PA: none BC: INT ≈ CON |
Goodway and Branta [60] United States | Clustered controlled trial INT and CON: 2 preschool classes each | Disadvantaged preschool children | Preschool classes INT: n = 31 (4.7 ± 0.3) CON: n = 28 (4.7 ± 0.3) | FMS: TGMD (OCS, LMS) PA: none BC: none Data collection: 0, 13 weeks | Duration: 12 weeks INT: 45 min instructional lessons 2/week; lessons including sustained activity (10 min), skill instruction (3 × 10 min), and emphasizing key components of those skills (3 min) CON: typical preschool program including free play time | FMS: INT > CON PA: none BC: none |
Goodway et al. [61] United States | Cluster-controlled trial INT and CON: 2 pre-kindergarten classes each | Pre-kindergarten children at risk for DD | Pre-kindergarten INT: n = 33 (4.9 ± 0.4) CON: n = 30 (5.0 ± 0.4) | FMS: TGMD (OSC, LMS) PA: none BC: none Data collection: 0, 9 weeks | Duration: 9 weeks INT: 35 min instructional sessions 2/week; 3 × 10-min periods of skill instruction, using developmentally and instructionally appropriate practice CON: typical pre-kindergarten curriculum | FMS: INT > CON PA: none BC: none |
Hamilton et al. [39] United States | Clustered controlled trial INT: 3 preschool classes CON: 2 preschool classes | Preschool children at risk for DD | Preschool classes INT: n = 15 (3.9 ± 0.2) CON: n = 12 (4.0 ± 0.3) | FMS: TGMD (OCS) PA: none BC: none Data collection: 0, 8 weeks | Duration: 8 weeks INT: 45 min parent-assisted instructional lessons 2/week; lessons including a minimum of 2 of the 5 object control skills, presented by parents at the center; parent instruction prior to each lesson (15 min); parent orientation meetings previous to study begin (2 × 45 min) CON: regular activity program including movement songs and activities with parents, and opportunities for movement exploration 2/week for 45 min | FMS: INT > CON PA: none BC: none |
Hardy et al. [40] Australia | Cluster-randomized controlled trial INT: 15 preschools CON: 14 preschools | Preschool-aged children | Preschools and long-day care centers INT: n = 263 (4.4 ± 0.5) CON: n = 167 (4.5 ± 0.3) | FMS: TGMD-2 (totFMS, OCS, LMS) PA: none BC: none Data collection: 0, 20 weeks | Duration: 20 weeks INT: 1-day professional workshop for preschool staff (incorporating healthy eating and PA into education program; structural and organizational changes in preschools); resources for preschools (manual; small grant for purchasing activity equipment or support staff to attend training); contact with health promotion professionals CON: preschools provided with written information on sun and road safety | FMS: INT ≈ CON PA: none BC: none |
Hashemi et al. [74] Iran | Controlled trial INT and CON: no information about allocation | Preschool girls from non-affluent families without post-graduate education | Kindergartens INT: n = 30 (5.1 ± 0.0) CON: n = 30 (5.0 ± 0.1) | FMS: TGMD-2 (OCS) PA: none BC: height, weight Data collection: 0, 6 weeks | Duration: 6 weeks INT: 45 min structured lessons 3/week; lessons including warm-up, selected games (i.e. ball dodging), and cool-down CON: regular daily activity | FMS: INT > CON PA: none BC: none |
Hurmeric [51] United States | Cluster-randomized controlled trial INT1 and INT2: 3 mixed classes from 1 center CON: 1 group from another center | Preschool children | Head Start centers INT1: n = 22 (4.0 ± 0.5) INT2: n = 25 (4.1 ± 0.5) CON: n = 25 (4.0 ± 0.6) | FMS: TGMD-2 (OCS) PA: none BC: height, weight, BMI, grip strength, body fat Data collection: 0, 8 weeks; follow-up at 12 weeks | Duration: 8 weeks INT1: 30 min structured movement lessons 2/week; lessons including warm-up, instructions for two object control skills (2 × 12 min), and closure activities INT2: same intervention as INT1; additional 10–15 min movement lesson at home conducted by primary caregiver with lesson plan, instructions and standardized equipment provided; workshop prior to intervention CON: regular Head Start curriculum, including outdoor and large muscle activities | FMS: INT1 ≈ INT2 > CON PA: none BC: none |
Ignico [41] United States | Clustered controlled trial INT and CON: 1 kindergarten class each | Kindergarten children | Elementary school INT: n = 15 (N/A) CON: n = 15 (N/A) | FMS: TGMD (totFMS) PA: none BC: none Data collection: 0, 10 weeks | Duration: 10 weeks INT: 28 min structured training sessions 5/week; lessons including 3 stations CON: regular activities, including 20–25 min free play time | FMS: INT > CON PA: none BC: none |
Iivonen et al. [54] Finland | Clustered controlled trial INT and CON: 2 classes from 2 preschools each Distinction of sex | Preschool children | Preschools INT: n = 39 (N/A) CON: n = 35 (N/A) INT and CON: (4.6 ± 0.1) | FMS: adapted APM Inventory (OCS) PA: none BC: none Data collection: 0, 4, 8 months, Follow-up at 11 months | Duration: 8 months INT: 45 min physical education lessons 2/week; lessons according to the Physical Education Curriculum (PEC) of the Early Steps Project [119] CON: 60 min unstructured physical education lesson 1/week | FMS: INT ≈ CON PA: none BC: none |
Jones et al. [75] Australia | Cluster-randomized controlled trial INT and CON: 1 class from 1 childcare center each | Preschool children | Childcare centers INT: n = 52 (N/A) CON: n = 45 (N/A) INT and CON: (4.1 ± N/A) | FMS: TGMD-2 (totFMS) PA: accelerometer BC: height, weight, BMI Data collection: 0, 20 weeks | Duration: 20 weeks INT: 20 min structured PA lessons 3/week; lessons focusing on one motor competency each week; theoretical and practical workshops (4 × 30 min) for the staff; specific equipment provided to childcare CON: usual program, including designated time outside for free play | FMS: INT > CON PA: INT > CON BC: none |
Kelly et al. [42] United States | Clustered controlled trial INT: 2 groups from 1 preschool CON: 1 group from another preschool | Preschool children | Motor Development Clinic (INT), Preschool (CON) INT: n = 21 (4.4 ± 0.7) CON: n = 26 (4.2 ± 0.7) | FMS: MEAP Test PA: none BC: none Data collection: 0, 6, 12 weeks | Duration: 12 weeks INT: 50 min physical education instruction 2/week; lessons including free play (5 min), introductory activities (8 min), instructional activities (30 min) and summary activities (7 min) CON: daily periods of supervised free play on well-equipped playground; no formal instruction in physical education | FMS: INT ≈ CON PA: none BC: none |
Krombholzc [43] Germany | Clustered controlled trial INT and CON: 11 childcare centers each | Preschool children | Childcare centers INT: n = 211 (4.6 ± 0.6) CON: n = 217 (4.5 ± 0.7) | FMS: MoTB 3–7 (totFMS) PA: none BC: height, weight, BMI, body fat Data collection: 0, 11, 20 months | Duration: 20 months INT: 45 min physical education session 1/week; Additional 20 min PA on the other days; lesson contents free to choose; raise awareness and train competency of educators CON: usual curriculum, including 45 min physical education session 1/week | FMS: INT ≈ CON PA: none BC: INT ≈ CON |
Piek et al.c [44] Australia | Cluster-randomized controlled trial INT and CON: 6 schools each | Young children aged 4–6 years from low socioeconomic area | Primary schools INT: n = 254 (N/A) CON: n = 196 (N/A) INT and CON: (5.4 ± 0.3) | FMS: BOT-2SF, MABC-2 (totFMS) PA: none BC: height, weight, BMI (z-score), waist circumference Data collection: 0, 6 months; follow-up at 18 months | Duration: 6 months INT: 30 min PA lessons 4/week; lessons including different modules of the Animal Fun Program (body management, locomotion, object control, etc.); 1-day training course for teachers prior to intervention CON: normal curriculum | FMS: INT ≈ CON PA: none BC: none |
Puder et al. [71] Switzerland | Cluster-randomized controlled trial INT and CON: 20 preschool classes each from a total of 30 preschools in 2 different country regions | Preschool children from an area with high proportion of migrants | Preschool INT: n = 342 (5.2 ± 0.6) CON: n = 310 (5.2 ± 0.6) | FMS: shuttle run (20 m), obstacle course, balance beam and platform PA: accelerometer BC: height, weight, BMI, body fat, waist circumference Data collection: 0, 9 months | Duration: 9 months INT: 45 min PA lessons 4/week; lessons including mainly aerobic exercises in/around the school and in the gym; home material; nutritional intervention CON: regular school curriculum, including 45 min PA in the gym 1/week in both regions, and another 45 min rhythmic lesson in the other region | FMS: shuttle run, obstacle course INT > CON; remaining tests INT ≈ CON PA: INT > CON BC: body fat, waist circumference INT < CON; remaining tests INT ≈ CON |
Reilly et al. [45] Scotland | Cluster-randomized controlled trial INT and CON: 18 nurseries each | Young children | Nurseries INT: n = 268 (4.2 ± 0.3) CON: n = 277 (4.1 ± 0.3) | FMS: MABC (totFMS) PA: accelerometer BC: height, weight, BMI (SD score) Data collection: 0, 6 months; follow-up at 12 months | Duration: 24 weeks INT: 30 min PA lessons 3/week; lessons intending to increase PA levels of children and meet the requirements of the ‘physical development and movement’ component of the nursery curriculum of Scotland; training sessions for nurses (3×); resource pack of materials for home based intervention (health education leaflets); posters displayed at nurseries for 6 weeks CON: usual curriculum, with the head teachers agreeing not to enhance physical development and movement curriculum | FMS: INT > CON PA: moderate-vigorous INT > CON; remaining measures INT ≈ CON BC: INT ≈ CON |
Robinson and Goodway [55] United States | Cluster-controlled trial INT: 1 Head Start center CON: 1 Head Start center | Preschool children at risk for DD | Head Start centers: INT1/2: n = 77 (3.9 ± 0.6) CON: n = 40 (4.0 ± 0.4) | FMS: TGMD-2 (OCS) PA: none BC: none Data collection: 0, 9 weeks; follow-up at 9 weeks | Duration: 9 weeks INT: 30 min motor skill intervention 2/week ‘low autonomy’ (INT1) or ‘mastery motivational climate’ (INT2); warm-up activity (2–3 min), motor skill instruction for OC skills (24 min), closure activity (2–3 min), typical Head Start curriculum; +30 min unstructured recess 2/week CON: typical Head Start curriculum; 30 min unstructured recess 2/week | FMS: INT(INT1/2) > CON PA: none BC: none |
Roth et al. [72] Germany | Cluster-randomized controlled trial INT: 21 preschools CON: 20 preschools | Preschool children | Preschools INT: n = 368 (4.7 ± 0.6 CON: n = 341 (4.7 ± 0.5) | FMS: Single items (obstacle course, standing long jump, balancing on one foot, jumping to and fro sideways) − composite z-score (totFMS) PA: accelerometer BC: height, weight, BMI (z-score), blood pressure, body fat Data collection: 0, 6, 11 months; follow-up at 13–15 months | Duration: 11 months INT: 30 min PA lessons 5/week; lessons including exercises to enhance coordinative skills and perception; manual, collection of games, and exercises for preschools; PA homework cards 1 or 2/week; letters comprising games/exercises for holidays CON: routine schedule, including common daily activity and weekly PA class | FMS: INT > CON, 1-leg stance, standing long jump, lateral jump INT > CON; obstacle course INT ≈ CON PA: INT ≈ CON BC: body fat INT < CON; remaining tests INT ≈ CON |
Tsapakidou et al. [46] Greece | Controlled trial INT and CON: 3 kindergartens together | Children aged 3.5–5 years | Nursery schools INT: n = 49 (N/A) CON: n = 49 (N/A), INT and CON: (3.5–5) | FMS: TGMD-2 (LMS) PA: none BC: none Data collection: 0, 2 months | Duration: 2 months INT: 30–40 min physical education lessons 2/week; lessons including exercises to raise body awareness, rhythm, coordinative skills and creativity to develop basic motor skills CON: daily schedule | FMS: INT > CON PA: none BC: none |
Valentini [62] United States | Controlled trial INT and CON: 1 early education center together | Low motor skill functioning children | Early education center INT: n = 38 (5.1 ± 0.3) CON: n = 29 (5.3 ± 0.5) | FMS: TGMD (OCS, LMS) PA: none BC: none Data collection: 0, 12 weeks; follow-up at 9 months | Duration: 12 weeks INT: 35 min motor skill lessons 2/week; lessons including introduction, motor skill instruction and practice (30 min), and closure, according to TARGET structure [120] CON: regular curriculum | FMS: LMS INT > CON, OCS INT ≈ CON PA: none BC: none |
Venetsanou and Kambas [73] Greece | Controlled trial No information about allocation | Preschool children | Kindergarten INT: n = 28 (N/A) CON: n = 38 (N/A) INT and CON: (5.0 ± 0.5) | FMS: MOT4-6 (totFMS) PA: none BC: none Data collection: 0, 20 weeks | Duration: 20 weeks INT: 45 min musical movement lessons 2/week; lessons including percussive movements and rhythmical locomotion (i.e. singing games, playing percussion instruments) CON: regular kindergarten curriculum activities | FMS: INT > CON PA: none BC: none |
Vidoni et al. [68] United States | Cluster-randomized controlled trial INT and CON: 1 class of the same daycare center in each | Preschool children | Daycare center INT: n = 18 (N/A) CON: n = 15 (N/A) INT and CON: (4.5 ± N/A) | FMS: BOT-2SF (totFMS) PA: none BC: none Data collection: 0, 11 weeks | Duration: 11 weeks INT: 30 min structured PA program 5/week; lessons including circuit training and exercises based on the MAZE approach [121] CON: regular day-care center schedule, including 30 min unstructured PA 5/week | FMS: INT > CON PA: none BC: none |
Wang [47] Taiwan | Controlled trial INT and CON: 1 group from the same preschool in each | Preschool children | Preschool INT: n = 30 (N/A) CON: n = 30 (N/A) INT and CON: (3–5) | FMS: PDMS-2 PA: none BC: none Data collection: 0, 6 weeks | Duration: 6 weeks INT: 30 min creative movement lessons 2/week; lessons including exploring, developing and creating different movements in relation to dancing CON: unstructured free play | FMS: LMS INT > CON; remaining tests INT ≈ CON PA: none BC: none |
Weiss et al. [48] Germany | Controlled trial 1 group from the same kindergarten in each | Kindergarten children | Kindergarten INT: n = 24 (4.7 ± N/A) CON: n = 22 (4.9 ± N/A) | FMS: MOT4-6 PA: none BC: height, weight, BMI Data collection: 0, 6 months | Duration: 6 months INT: 60 min back training lessons 1/week; lessons including a variety of games in combination with different material CON: usual kindergarten schedule including regular PA lessons | FMS: INT > CON PA: none BC: none |
Yin et al. [52] United States | Clustered controlled trial INT1: 14 classes in 2 centers INT2: 5 classes in 1 center CON: 6 classes in 1 center | Preschool-aged children | Head Start centers INT1: n = 179 (4.1 ± 0.6) INT2: n = 80 (4.2 ± 0.5) CON: n = 97 (4.1 ± 0.5) | FMS: LAP-3 (totFMS) PA: pedometer BC: height, weight, BMI (z-score) Data collection: 0, 18 weeks; Additional 3 mid-study tests | Duration: 18 weeks INT1: 30–45 min structured and unstructured outdoor lessons 5/week; lessons including gross motor skills teaching and dance instruction; supplemental classroom activities; healthy eating promotion INT2: same intervention as INT1; additional take-home activities, parent obesity education and family support monitoring for healthy eating and PA CON: regular schedule, including unstructured free play on the playground 5/week | FMS: INT1 > CON, INT2 > CON PA: INT1 > CON, INT2 > CON BC: BMI INT1 ≈ CON, INT2 < CON |
Zask et al. [49] Australia | Cluster-randomized controlled trial INT: 18 preschools CON: 13 preschools | Children aged 3–6 years | Preschools INT: n = 273 (N/A) CON: n = 142 (N/A) INT and CON: (4.6 ± 0.6) | FMS: TGMD-2 (totFMS, LMS) PA: none BC: height, weight, BMI (z-score), waist circumference Data collection: 0, 10 months | Duration: 10 months INT: 25–30 min structured FMS development lessons 2/week; lessons including warm-up (5 min), games in groups (15–20 min), and cool-down (5 min); small grant for equipment; playground review to encourage more active behavior; workshops and monthly newsletter for parents; healthy eating intervention CON: regular curriculum | FMS: INT > CON PA: none BC: BMI, waist circumference INT < CON |
2.4 Risk of Bias Assessment
2.5 Missing Data
2.6 Meta-Analyses
2.7 Investigation of Heterogeneity, Subgroup and Exploratory Analyses
2.8 Certainty in Treatment Estimates
3 Results
3.1 Study Characteristics
3.2 Risk of Bias
3.3 Effects of Interventions to Improve Fundamental Movement Skills
Quality assessment | No. of participantsf
| Absolute effect (95% CI)f
| Quality | Importance | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|
No. of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | INT | CON | |||
Overall FMS (follow-up: range 6 weeks to 20 months; assessed with or converted to TGMD-2; standard score from 2 to 40)
| |||||||||||
16 | RCT and CT | Seriousa,b
| Seriousc
| Seriousd
| Not serious | Publication biase
| 2103 | 1847 | SMD 0.46 higher (0.28–0.65 higher) | Very low | Important |
OCS (follow-up: range 6 weeks to 8 months; assessed with or converted to TGMD-2; standard score from 1 to 20)
| |||||||||||
11 | RCT and CT | Seriousa,b
| Seriousc
| Seriousd
| Not serious | Publication biase
| 619 | 499 | SMD 1.36 higher (0.80–1.91 higher) | Very low | Important |
LMS (follow-up: range 6 weeks to 11 months; assessed with or converted to TGMD-2; standard score from 1 to 20)
| |||||||||||
10 | RCT and CT | Seriousa,b
| Seriousc
| Seriousd
| Not serious | Publication biase
| 796 | 572 | SMD 0.94 higher (0.59–1.30 higher) | Very low | Important |