1 / Name of the candidate
and Address /
2 /

Name of the Institute

3 /

Course of study and

Subject / Master of Physiotherapy (MPT)
2 years Degree Course.
“Musculoskeletal disorders and Sports”
4 /

Date of Admission

To course / 30/05/2012
5 /

Title of the Topic

7 /
Brief resume of the intended work:
6.1 Need for the study:
Physical activity is important for all children because of the associated benefits to physical, social and psychological health.1 Physical activity is often established during early childhood (two to five years of age)(2,3) and was recently identified as an early risk factor for child obesity.4
Physical activity defines as any bodily movement produced by skeletal muscles that require energy expenditure.5 Physical activity includes activities such as running, climbing, chasing and play fighting. Many modern diseases are due, in part to lack of Physical Activity, the evident being the lack of exposure at an early age to physical development activities.6
Motor Proficiency as the successful accomplishment of motor skills, assuming successful motor development. Motor proficiency is not a synonym for motor performance rather it refers to the specific abilities on which performance is built.7 Motor proficiency reflects a child’s ability to control and direct voluntary muscle movement. Motor control develops from the top down and from central to peripheral muscles.8 Motor proficiency is very important in children. Motor proficiency leads to the development of fundamental motor skills. Fundamental motor skills play a significant role in the development of a child’s overall motor skill.9 Motor skills are related to self-efficacy of confidence in physical activity.10 Decreased competence and confidence may lead preschool children with motor skill difficulties to avoid participating in physical activities as a coping strategy.11 Gannotii et al (2007) states that the development motor proficiency has important implication for health. Children who are physically active on regular basis have good health.12
Having good Motor Proficiency levels can contribute to a child's development both psychologically and socially. Krombholz states that having good Motor Proficiency, which leads to good perceived competency to perform motor skills, plays a significant role in establishing the child’s reputation amongst peers and the development of self-esteem in later childhood.13
Research has also shown significant positive associations among movement skills14, visual-motor coordination15, gross motor development16, and self reported athletic coordination17 and Physical activity in youth. There are several factors that may be related to lower levels of motor skill coordination in youth. For example over-weight youth may be less coordinated than leaner youth15-17and this relationship may extend to infant or pre-school children weight and motor activity relationships.18
There are strong link between obesity and motor proficiency levels. Children who exhibit low motor proficiency levels are likely to be overweight or obese placing them at risk of cardio-metabolic disease.19 People are more likely to take up or continue sports or some kind of physical activity if they possess ‘acceptable’ motor proficiency.20
A study by Wrotniak et al (2006) concluded positive association of motor proficiency and physical activity in 8 to 10 year old children living in Erie County, New York, USA.21 Another study by Abbott et al (2004) reported 5 to 10.5 year old children’s physical activity level and concluded that the more active the children, the lower their percentage of fat or smaller their body mass index and lower percentage body fat, than those children in the lowest tertile of physical activity demonstrating positive effect of higher physical activity in part of preschool age group.22
We have retrieved no literature pertaining to association between physical activity in children and motor skill proficiency of Indian setting and status of preschool children. Physical activity found to be increased significantly during the preschool period when compared to 0 to 4 years. Our study firstly examine the physical activity level in preschool children and further study the motor proficiency in preschool children of Indian settings. Therefore we aimed to examine the relation between Indian preschool children’s level of physical activity and motor skill proficiency.
6.2  Review of Literature:
1.  Lemos AG et al. (2012) conducted study to compare gross motor skill development of young children enrolled in physical education, provided by a specialist teacher, in public school of Guarulhos city, Sao Paulo metropolitan area of Brazil and children enrolled in recreational activities, provided by a regular teacher, in preschool. Fifty children were divided into two groups: 25 children (age of 5.3 ± 0.3 years) constituted the physical education (PE) group and received activities, once a week, ministered by a physical education teacher; 25 children (age of 5.2 ± 0.4 years) constituted the recreational (RE) group and received activities, also once a week, supervised by a classroom teacher. All these children were evaluated performing the locomotor and object control subtests of Test of Gross Motor Development (TGMD-2) at the beginning and at the end of the school year. They concluded that regular physical education, composed by structured practice, ministered by a specialist promote gross motor skill development of pre-school children.23
2.  Bonvin A et al. (2012) conducted study and tested if differences in motor skills and in physical activity according to weight or gender were already present in 2- to 4-year-old children. Fifty-eight child care centers in the French part of Switzerland were randomly selected for the study. Motor skills were assessed by an obstacle course including 5 motor skills, derived from the Zurich Neuro-motor Assessment Test. Physical activity was measured with accelerometers (GT1M, Actigraph, Florida, USA) using age-adapted cut-offs. Of the 529 children (49% girls, 3.4 ± 0.6 years, BMI 16.2 ± 1.2 kg/m2), 13% were overweight. There were no significant weight status-related differences in the single skills of the obstacle course, but there was a trend (p = 0.059) for a lower performance of overweight children in the overall motor skills score. No significant weight status-related differences in child care-based physical activity were observed. No gender-related differences were found in the overall motor skills score, but boys performed better than girls in 2 of the 5 motor skills (p ≤ 0.04). Total physical activity as well as time spent in moderate-vigorous and in vigorous activity during child care were 12-25% higher and sedentary activity 5% lower in boys compared to girls (all p < 0.01).They concluded that at early age, there were no significant weight status or gender-related differences in global motor skills. However, in accordance to data in older children, child care-based physical activity was higher in boys compared to girls. These results are important to consider when establishing physical activity recommendations or targeting health promotion interventions in young children.24
3.  Castetbon K et al. (2012) conducted study to estimate the association between obesity and motor skills at 4 years and 5-6 years of age in the United States. They used repeated cross-sectional assessments of the national sample from the Early Childhood Longitudinal Survey-Birth Cohort (ECLS-B) of pre-school 4-year-old children (2005-2006; n = 5 100) and 5-6-year-old kindergarteners (2006-2007; n = 4 700). Height, weight, and fine and gross motor skills were assessed objectively via direct standardized procedures. They used categorical and continuous measures of body weight status, including obesity (Body Mass Index (BMI) ≥ 95th percentile) and BMI z-scores. Multivariate logistic and linear models estimated the association between obesity and gross and fine motor skills in very young children adjusting for individual, social, and economic characteristics and parental involvement. The prevalence of obesity was about 15%. The relationship between motor skills and obesity varied across types of skills. For hopping, obese boys and girls had significantly lower scores, 20% lower in obese preschoolers and 10% lower in obese kindergarteners than normal weight counterparts, p < 0.01. Obese girls could jump 1.6-1.7 inches shorter than normal weight peers (p < 0.01). Other gross motor skills and fine motor skills of young children were not consistently related to BMI z-scores and obesity. Based on objective assessment of children’s motor skills and body weight and a full adjustment for confounding covariates, we find no reduction in overall coordination and fine motor skills in obese young children. They concluded that Motor skills are adversely associated with childhood obesity only for skills most directly related to body weight.25
4.  LeGear M et al. (2012) conducted study to examine the relationship between motor skill proficiency and perceptions of competence of children in their first year of school. 260 kindergarten children (mean age = 5y 9 m; boys = 52%) from eight schools; representing 78% of eligible children in those schools. Motor skills were measured using the Test of Gross Motor Development-2 and perceptions of physical competence were assessed using the Pictorial Scale of Perceived Competence and Social Acceptance for Young Children. Motor skill scores were generally low (percentile ranks ranged from 16 - 24) but perceptions of physical competence were positive (boys = 18.1/24.0, girls = 19.5/24.0). A MANOVA showed a significant overall effect for gender (Wilk’s lambda = .84 with F (3, 254) = 15.84, p < 0.001) and univariate F tests were significant for all outcome variables. The relationship between object control skills and perceptions of physical competence among girls was not significant; however all other correlations were modest but significant. They concluded that although motor skill levels were quite low, the children generally held positive perceptions of their physical competence. These positive perceptions provide a window of opportunity for fostering skillfulness. The modest relationships between perceptions of competence and motor skill proficiency suggest that the children are beginning to make self-judgments at a young age. Accordingly, opportunities for children to become and feel physically competent need to occur early in their school or preschool life.26
5.  Cliff DP et al. (2012) conducted observational study to compare the mastery of 12 fundamental movement skills (FMS) and skill components between a treatment-seeking sample of overweight/obese children and a reference sample from the United States (US). Mastery of 6 locomotor and 6 object-control skills (24 components in each sub-domain) were video-assessed by one assessor using the Test of Gross Motor Development II (TGMD-2). The 153 overweight/obese children (mean ± s.d. age = 8.3 ± 1.1 years, BMI z-score = 2.78 ± 0.69, 58% girls, 77% obese) were categorized into age groups (for the underhand roll and strike: 7-8 years and 9-10 years; all other FMS: 6-7 years and 8-10 years) and mastery prevalence rates were compared with representative US data (N = 876) using chi-square analysis. For all 12 skills in all age groups, the prevalence of mastery was lower among overweight/obese children compared with the reference sample (all P < 0.05). This was consistent for 18 locomotor and up to 21 object-control skill components (all P < 0.05). Differences were largest for the run, slide, hop, dribble and kick. Specific movement patterns that could be targeted for improvement include positioning of the body and feet, the control or release of an object at an optimal position, and better use of the arms to maintain effective force production during the performance of FMS. They concluded that Physical activity programs designed for overweight and obese children may need to address deficiencies in FMS proficiency to foster the movement capabilities required for participation in heath enhancing physical activity.27
6.  Hardy LL et al. (2010) conducted study to implement fundamental motor skill programs during the preschool years. Cross-sectional study of 425 children attending preschools in the Sydney, Australia. FMS were assessed using the Test of Gross Motor Development-2 including locomotor (run, gallop, hop, horizontal jump) and object control (strike, catch, kick overhand throw) skills. Data were analysed using linear regression and chi-squared analyses. Total locomotor score was higher among girls compared with boys (p < 0.00); however only the hop was significantly different (p = 0.01). Boys had higher total (p < 0.00) and individual object control scores compared with girls, except the catch (p = 0.6). They concluded that the prevalence of mastery differed across each fundamental motor skill. Girls generally had higher mastery of locomotor skills and boys had higher mastery of object control skills. These findings highlight the need to provide structured opportunities which facilitate children’s acquisition of fundamental motor skill, which may include providing gender separated games, equipment and spaces. That mastery of fundamental motor skill is low in primary school children indicates the importance of early intervention programs in preschools. Preschools and child care centers hold promise as a key setting for implementing FMS programs.28
7.  Cliff DP et al. (2009) conducted study to examine gender difference in cross-sectional relationships between fundamental movement skills and objectively measured physical activity in preschool children. Forty-six 3 to 5 year olds (25 boys) had their fundamental movement skill video assessed (Test of Gross Motor Development II) and their physical activity objectively monitored (Actigraph 7164 accelerometers). Among boys, object-control skills were associated with physical activity and explained 16.9% (p = 0.024) and 13.7% (p = 0.049) of the variance in percent of time in moderate-to-vigorous physical activity (MVPA) and total physical activity, respectively, after controlling for age, SES and z-BMI. Locomotor skills were inversely associated with physical activity among girls, and explained 19.2% (p = 0.023) of the variance in percent of time in 12 MVPA after controlling for confounders. They concluded that Gender and fundamental motor skill sub-domain may influence the relationship between fundamental motor skill and physical activity in preschool children.29
8.  Williams HG et al. (2008) conducted study in 3 and 4 year old children of South Carolina. Participants were 80 three- and 118 four-year-old children. The Children’s Activity and Movement in Preschool Study (CHAMPS) Motor Skill Protocol was used to assess process characteristics of six locomotor and six object control skills; scores were categorized as locomotor, object control, and total. The actigraph accelerometer was used to measure PA; data were expressed as percent of time spent in sedentary, light, moderate-to-vigorous PA (MVPA), and vigorous PA (VPA). Children in the highest tertile for total score spent significantly more time in MVPA (13.4% vs. 12.8% vs. 11.4%) and VPA (5% vs. 4.6% vs. 3.8%) than children in middle and lowest tertiles. Children in the highest tertile of locomotor scores spent significantly less time in sedentary activity than children in other tertiles and significantly more time in MVPA (13.4% vs. 11.6%) and VPA (4.9% vs. 3.8%) than children in the lowest tertile. There were no differences among tertiles for object control scores. Children with poorer motor skill performance were less active than children with better-developed motor skills. They concluded that relationship between motor performance and physical activity could be important for the health of children, particularly in obesity prevention. Clinicians should work with parents to monitor motor skills and to encourage children to engage in activities that promote motor skill performance.30