Pediatric Physical Therapy:
Clinical Bottom Line
The Children's Hospital of Philadelphia Philadelphia, Pennsylvania, Department of Physical Therapy D'Youville College, Buffalo, New York (Wrotniak)
Littlefield Physical Therapy, Inc, Temecula, California (Littlefield)
“How could I apply this information?”
In applying the study results by Nervik and colleagues, it is important to recognize that 3- to 5-year-old children who are overweight or obese may be more likely to have below-average gross motor skills than peers who are a healthy weight. In the clinical setting, this research helps therapists interpret standardized testing with a deeper understanding of potential contributory factors. Physical activity interventions that encourage maintaining a healthy weight may help promote better motor skills depending on the direction of the association between body mass index (BMI) and motor skills. In the preschool setting, we need to select motor challenges that are inclusive of children with uncoordinated movement patterns, such as group activities (building and navigating an obstacle courses, parachute play, and dancing) rather than activities with specific performance requirements (hit the target, hop 10 times). At the policymaking level, we need to continue to support funding of services by physical therapists to provide health promotion and wellness interventions in the 3- to 5-year-old population.
“What should I be mindful about in applying this information?”
The cause and effect direction of the relationship between gross motor skill and BMI cannot be determined from this cross-sectional study. It may be that children with poorer motor skills are drawn to more sedentary than physically active pursuits, which subsequently lead to obesity. Conversely, it may be that obesity makes movement more difficult, which results in diminished movement skills as children become more sedentary. An additional consideration is that it is unclear on whether the BMI-gross motor skill association is linear, or whether there is a particular BMI threshold children need to reach before a clinically meaningful improvement in motor proficiency is noted. The authors did not find a linear association in the BMI-gross motor skill association, but the sample size was small increasing the possibility of failing to detect a significant association. The convenience sample from a single community daycare in southern New Hampshire included only 12 children classified as overweight or obese. Likewise, the majority of the participants' gross motor skills were categorized as average. These issues limit the external validity of the results. As the authors conclude, additional research is needed to better clarify associations between motor development and body weight.
Brian H. Wrotniak, PT, PhD
The Children's Hospital of Philadelphia
D'Youville College, Buffalo, New York
Melissa Littlefield, PT, MS
Littlefield Physical Therapy, Inc, Temecula, California