Clinical Bottom Line
“How could I apply this information?”
Nunez-Gaunaurd and colleagues contribute to the growing body of evidence showing that children with obesity tend to have poorer fundamental movement skills than their peers who are leaner. In addition, as suggested by the authors, children with overweight or obesity may have poorer aerobic fitness and decreased trunk and lower extremity strength. Physical therapists can apply the results of this research by recognizing that children with obesity may have poorer motor skills that may be related to lower levels of physical activity and aerobic fitness and excess adiposity. Screening children could help detect motor deficiencies that may contribute to lower levels of physical activity, the substitution of sedentary behaviors for physical activity, decreased perceived physical competence in fundamental movement skills, and heavier weight. Identifying motor skill deficits could provide an opportunity to develop focused interventions to improve motor proficiency and to promote contextual factors that help enhance movement. Age and culturally appropriate activities that challenge children's motor skills and build self-adequacy for physical activity in early childhood could help develop fundamental movement skills and promote physical activity throughout life. Clinicians should include a family-based approach to care by teaching parents to be role models for physical activity, to positively reinforce desired activities, set goals for physical activity and limits for sedentary behaviors, and provide opportunities to expose children to various developmentally appropriate physical activities.
“What should I be mindful about in applying this information?”
Because this is a cross-sectional study, the cause and effect nature of the relationships presented in this study cannot be determined. While poorer motor skills may discourage children from physical activity and lead to obesity, it could be that children with obesity may find movement more difficult and subsequently avoid opportunities to develop motor skills through physical activity. It is unclear whether the relationship between motor skill and weight status is linear or whether there is a particular body mass index at which motor skill development is most affected. For example, Nunez-Gaunaurd and colleagues found that Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2), standard scores were lower for children with obesity than for children with healthy weight, but not children that were overweight. This may suggest a body mass index threshold at which motor skills deficits are observed. In general, the authors found small differences between children with healthy weight and those that were overweight for motor proficiency and muscular strength and endurance. As the differences became more pronounced when comparing these 2 groups with children with obesity, it may suggest the important preventative role that motor skills, muscular strength, and muscular endurance play in slowing the transition from overweight to obesity and the importance of physical therapists assessing these outcomes and working to improve performance by using activities that are fun and developmentally appropriate. Another consideration is that, because the BOT-2, is a product-oriented assessment tool, it may be limited in identifying the specific components of children's motor skills associated with obesity that should be the focus for improvement. A process-oriented test (eg, the Test of Gross Motor Development)1 that breaks down skills, such as the run and broad jump, into specific observable components that can be taught and practiced may be a more useful clinical tool.
Brian H. Wrotniak, PT, PhD
The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
D'Youville College, Buffalo, New York
Anthony D. Okely, EdD
Interdisciplinary Educational Research Institute
University of Wollongong, New South Wales, Australia
1. Ulrich DA. Test of Gross Motor Development. 2nd ed. Austin, TX: Pro-ED Inc; 2000.