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The relationship between fundamental movement skills and the health and fitness of Canadian children Horita, Leslie Tomiko Leigh 2008

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THE RELATIONSHIPBETWEEN FUNDAMENTALMOVEMENT SKILLSAND THE HEALTH ANDFITNESS OF CANADIANCHILDRENbyLESLIE TOM IKO LEIGHHORITAB.H.K. Physical Education,University of BritishColumbiaA THESIS SUBMITTED INPARTIAL FULFILLMENTOF THEREQUIREMENTS FOR THEDEGREE OFMASTER OF SCIENCEinTHE FACULTY OF GRADUATESTUDIES(Human Kinetics)THE UNIVERSITYOF BRITISH COLUMBIA(Vancouver)August 2008© Leslie TomikoLeigh Horita, 200811ABSTRACTThe health and fitness statusof Canadian children hasbeen declining over thepast several decades. Children’shealth and fitness impacts futurehealth status asmany health and fitness indicatorstrack from youth into adulthoodand are associatedwith serious illnesses such ascardiovascular disease(CVD). One potential determiningfactor of health and fitness maybe the level of proficiency exhibitedin performingfundamental movement skills (FMS).Failure to master FMSin childhood may decreasethe physical activity options availablein adulthood because FMS providea foundationfor all forms of physical activitypursuits necessary for healthand fitness benefits. To-date, the relationship betweenhealth, fitness and proficiencyof FMS has not beenexamined in Canadian children.Therefore, the purpose ofthe present investigationwasto examine the current state ofmovement skill proficiency in relationto health andfitness in Canadian elementary-agedchildren. Boys (n = 71) and girls(n = 91 girls)ages 8 to 11 years were recruitedfrom schools participatingin the evaluationcomponent of the Action Schools!BC program. Measuresof fundamental movementskill proficiency (i.e., running, horizontaljumping, vertical jumping, jumpingfrom aheight, hopping, and skipping)and indicators of healthand fitness (i.e., bloodpressure,arterial compliance, weightstatus, musculoskeletal andcardiovascular fitness)wereassessed. Results indicatedlow levels of FMS proficiencyfor both boys and girls.Analysis also revealedsignificant relationships betweenEMS and indicatorsof healthand fitness. Correlation analysesfound running and hoppingto be significantly (p <.01)related to musculoskeletaland cardiorespiratory fitnesstests. Significant(p < .01)relationships betweenvertical jumping and weightstatus, musculoskeletal andcardiorespiratory fitnesswere also found by the correlationanalyses. Regressionanalyses were performed todetermine the independentrelationship between healthandfitness indicators. Verticaljump was significantly(p < .01) related to blood pressure(BP) independent ofconfounding health and fitnessvariables. Finding significantrelationships betweenFMS proficiencies and healthand fitness indicators coupledwiththe low proficiencies demonstratedby our sample of childrensuggest the need for agreater emphasis on thedevelopment of FMS.111TABLE OF CONTENTSABSTRACTTABLE OF CONTENTSiiiLIST OF TABLESvLIST OF FIGURESviiABBREVIATIONSviiiCHAPTER I: INTRODUCTION1CHAPTER II: LITERATUREREVIEW42.1 MovEMENT SKILLS42.1.1 MovEMENT SKILLs:WHATARE THEY742.1.2 MOVEMENT SKILLS:WHAT FACTORSPROMOTE OR LIMITDEvELoPMENT762.1.3 MOVEMENT SKILLS:WHAT ROLE Do THEYPLAY THROUGHOUTTHE LIFESPAN?.. 92.2 FuNDAMENTAL MOVEMENTSKILLS122.2.1 FuNDAMENTALMOVEMENT SKILLS: LOCOMOTORSKILLS122.2.2 FUNDAMENTALMOVEMENT SKILLS:RUNNING142.2.3 FUNDAMENTAL MOVEMENTSKILLs: JUMPING152.2.4 FUNDAMENTALMOVEMENT SKILLS:SKIPPING182.2.5 FUNDAMENTALMOVEMENT SKILLS: HEALTHIMPLICATIONS182.2.6 FUNDAMENTALMOVEMENT SKILLS:PHYSICAL EDUCATIONCURRICULUM192.2.7 FUNDAMENTALMOVEMENT SKILLS:CURRENT STATUS202.3 INDICATORS OF HEALTHAND FITNESs212.4 INDICATORS OF HEALTHAND FITNESS: BLOODPRESSURE AND ARTERIALCOMPLIANCE. 212.4.1 BLOOD PRESSUREAND ARTERIAL COMPLIANCE:TRACKING FROMCHILDHOOD TOADULTHOOD232.4.2 BLOOD PRESSUREAND ARTERIAL COMPLIANCE:MEASUREMENT242.4.3 BLOOD PRESSUREAND ARTERIAL COMPLIANCE:RELATIONSHIPTO EMS 252.5 INDICAToRS OF HEALTHAND FITNESS: WEIGHTSTATUS252.5.1 WEIGHT STATUS:CURRENT STATUS AMONGYOUTH AND TRACKINGTOADULTHOOD272.5.2 WEIGHT STATUS:MEASUREMENT292.5.3 RELATIoNsHIP TOFMS302.6 INDIcATORS OF HEALTHAND FITNESS: FITNESS312.6.1 FITNESS: CURRENTSTATUS AMONG YOUTHAND TRACKINGTO ADULTHOOD342.6.2 FITNESS: MEASUREMENT362.6.3 FITNESS: RELATIONTO EMS372.7 GENERAL LIMITATIONSOF PREVIOUS LITERATURE38CHAPTER III: METHODOLOGY413.1 PARTICIPANTS413.2 PROCEDURE413.2.1 DAY 1: WEIGHTSTATUS MEASUREMENTS41iv3.2.2 DAY 2: BLOOD PRESSURE AND ARTERIAL COMPLIANCE ASSESSMENTS 433.2.2 DAY 2: BLOOD PRESSURE AND ARTERIAL COMPLIANCE ASSESSMENTS 433.2.3 DAY 3: FITNESS AND FUNDAMENTAL MOTOR SKILL ASSESSMENTS 433.3 CARDIovAscuLAR DISEASE RISK ASSESSMENTS 433.3.1 BLOOD PRESSURE AND ARTERIAL COMPLIANCE 433.3.2 WEIGHT STATUS 443.3.3 MUscUL0SKELETAL FITNESS 443.3.4 CARDI0RESPIRATORY FITNESS 453.4 FuNDAMENTAL MOVEMENT SKILL ASSESsMENT 463.5 ANALYSIS OF FUNDAMENTAL LOCOMOTOR SKILLS 483.6 STATISTICAL ANALYSIS 61CHAPTER IV: RESULTS 634.1 PARTIcIPANT CHARAcTERISTIcs 634.2 MOvEMENT SKILL PRoFICIENCY 634.2.1 CRITICAL ELEMENTS 634.2.2 ZERO SCORES 774.2.3 GENDER EFFECTS 844.3 REL.ATIONsHIPs BETWEEN FMS AND INDICATORS OF HEALTH AND FITNESS 844.2.1 CORRELATIoN ANALYSIS 844.2.2 REGRESSION ANALYSIS 84CHAPTER V: DISCUSSION 905.1 EMS PROFICIENCY 905.2 GENDER DIFFERENCES 945.3 INDICATORS OF HEALTH AND FITNESS 955.3.1 INDICATORS OF HEALTH AND FITNESS STATUS 955.3.2 REGRESSIoN ANALYSES: BLOOD PRESSURE, ARTERIAL COMPLIANCE AND FMS965.3.3 REGRESSION ANALYSES: WEIGHT STATUS AND FMS 965.3.4 REGRESSION ANALYSES: PHYSICAL FITNESS AND FMS 975.4 FUTURE DIRECTIONS 975.5 LIMITATIONS 985.6 CONCLUSION 100CHAPTER VI: REFERENCES 102APPENDIX A: AS!BC CONSENT AND ETHICS FORMS 113APPENDIX B: AS!BC TESTING INSTRUCTIONS 121VLIST OF TABLESTABLE 3.00 PRoFICIENcYAssEssMENT: RUNNING49TABLE 3.01 PROFICIENCYASSESSMENT: SKIPPING51TABLE 3.02 PROFICIENCYASSESSMENT: VERTICALJUMP53TABLE 3.03 PROFICIENCYASSESSMENT: HOPPING55TABLE 3.04 PROFICIENCYASSESSMENT: HORIZONTALJUMP57TABLE 3.05 PROFICIENCYASSESSMENT: JUMPFROM A HEIGHT59TABLE 4.00 MEANS AND SDsOF BMI VALUES FOR BOYS ANDGIRLS BY AGE AND PERCENTPREVALENCE OF OVERWEIGHTAND OBESE70TABLE 4.01 PERCENTAGEOF CHILDREN WHO SCOREDZERO IN AT LEAST ONECRITICALELEMENT78TABLE 4.02 NUMBEROF CHILDREN WITH ZEROSCORES IN EACH CRITICAL ELEMENTFOR RUNAND MOST COMMONLYATTRIBUTED REASON78TABLE 4.03 NUMBEROF CHILDREN WITH ZERO SCORESIN EACH CRITICAL ELEMENTFOR SKIPAND MOST COMMONLYATTRIBUTED REASON79TABLE 4.04 NUMBER OFCHILDREN WITH ZERO SCORESIN EACH CRITICAL ELEMENTFOR HOPAND MOST COMMONLYATTRIBUTED REASON80TABLE 4.05 NUMBER OFCHILDREN WITH ZERO SCORESIN EACH CRITICAL ELEMENTFORVERTICAL JUMP ANDMOST COMMONLY ATTRIBUTEDREASON81TABLE 4.06 NUMBEROF CHILDREN WITH ZEROSCORES IN EACH CRITICALELEMENT FORHORIZONTAL JUMP AND MOSTCOMMONLY ATTRIBUTED REASON82TABLE 4.07 NUMBER OFCHILDREN WITH ZERO SCORESIN EACH CRITICAL ELEMENTFOR JUMPFROM A HEIGHT ANDMOST COMMONLY ATTRIBUTEDREASON83TABLE 4.08 RESULTSOF SPEARMAN CORRELATIONANALYSIS BETWEEN MALE FMSANDHEALTH AND FITNESS VARIABLES86TABLE 4.09 RESULTS OFSPEARMAN CORRELATIONANALYSIS BETWEEN FEMALEFMS ANDHEALTH AND FITNESS VARIABLES86TABLE 4.10 RESULTSOF SPEARMAN CORRELATIONANALYSIS BETWEENCOMBINED MALE ANDFEMALE FMS DATA ANDHEALTH AND FITNESS VARIABLES87TABLE 411 RESULTS OFMULTIPLE REGRESSIONMODEL FOR DIASTOLIC BLOODPRESSURE INFEMALES87TABLE 4.12 RESULTS OF MULTIPLEREGRESSION MODEL FORDIASTOLIC BLOOD PRESSURECOMBINED MALE ANDFEMALE DATA88viLIST OF FIGURESFIGURE 3.00 DAY 1-3 HEALTH, FITNESSAND FUNDAMENTALMOVEMENT SKILLPROCEDURE42FIGURE 3.01 SCHEMATICDIAGRAM OF EXPERIMENTALSET-UP47FIGURE 4.00 MEAN BLOODPRESSURE AS A FUNCTIONOF GENDER64FIGURE 4.01 MEANARTERIAL COMPLIANCEAS A FUNCTION OF GENDER65FIGURE 4.02 WEIGHTSTATUS AS A FUNCTIONOF GENDER66FIGURE 4.03 CARDIoRESPIIAToRYFITNESS AS A FUNCTIONOF GENDER67FIGURE 4.04 MEAN PUSH-UPSAND CURL-UPSAS A FUNCTION OF GENDER68FIGURE 4.05 GRIP STRENGTHAND SIT & REACH ASA FUNCTION OF GENDER69FIGURE 4.06 CRITICAL ELEMENTSCORES FOR RUNNINGIN MALES AND FEMALES71FIGURE 4.07 CRITICALELEMENT SCORES FORSKIPPING IN MALESAND FEMALES72FIGURE 4.08 CRITIcALELEMENT SCORES FORHOPPING IN MALES ANDFEMALES73FIGURE 4.09 CRITICAL ELEMENTSCORES FOR VERTICALJUMPING INMALES AND FEMALES74FIGURE 4.10 CRITICAL ELEMENTSCORES FOR HORIZONTALJUMPING IN MALESANDFEMALES75FIGuRE 4.11 CRITICAL ELEMENTSCORES FOR JUMPINGFROM A HEIGHT76FIGURE 4.12 FMSPROFICIENCY ASA FUNCTION OF GENDER85viiABBREVIATIONSAS! BC Action Schools! BCBMI body mass indexBP blood pressureCVD cardiovascular diseaseEMS fundamental movement skillsHDL high density lipoproteinLDL low density lipoproteinPE physical educationPLO prescribed learning outcomeSD standard deviationSES socioeconomic statusTGMD Test of Gross Motor DevelopmentVIF variance inflation factorVO2max maximal oxygen consumptionWC waist circumferenceWHO World Health Organization1CHAPTER I: INTRODUCTIONThe health and fitness status ofCanadian children has been declining over thepast several decades [1-4].For example, the cardiorespiratory fitnesslevels of childrenare decreasing throughout developednations [2, 4]. High cardiorespiratoryfitness hasthe ability to attenuate numerous factorsassociated with health risksuch as poor bodycomposition, high blood pressure (BP)and surrogate measures of endothelialdysfunction [5-7]. As such, theability to influence cardiorespiratory fitnessand otherhealth variables in a positive manneris of paramount importance. Further,children’shealth and fitness impacts futurehealth status as many health and fitnessindicatorstrack from youth into adulthoodand are associated with serious consequencessuch ascardiovascular disease (CVD),early morbidity and mortality [8-10]. Thisemphasizesthe necessity for preventativeaction to be taken early in life. While severalfactors,such as heredity and lifestyle,are known to play a role in health status,proficiency infundamental movement skills (EMS)may also play a significant role[11]. This is apotentially important factor becauseFMS are the foundational skillsrequired for allforms of physical activities (i.e., the skillsrequired for leisure time pursuits or moreadvanced sport and game activities).Therefore, it has been suggested that failure tomaster EMS in childhood decreasesthe number of activity optionsavailable to theindividual in adolescence and in adulthoodbecause children are unable to develop thespecialized movement skillsessential for lifelong activity [12, 13]. Thisis of concerngiven the evidence clearly indicatingthe positive effect of physical activity onhealthmeasures in adults and children[14, 15]. Therefore proficiency in FMS may haveaninfluence on health and fitness in thismanner. Thus far, the relationship betweenlevelof EMS proficiency and indicators ofhealth and fitness has not been comprehensivelyexamined in school-aged children. Previousinvestigations have primarily focused onadolescents [11, 16-18] and little is knownabout the level of EMS proficiencyof childrenin general, and in Canada specifically.As such, the purpose of the presentinvestigation was to examine the currentstate of FMS proficiency in Canadianelementary-aged children in relation toindicators of health and fitness. Previousinvestigations have found gender differencesin EMS proficiency levels [11, 16, 19].Therefore, a secondary purposeof this investigation was to determine the effectofgender on movement skill proficiency.2The present experiment wasconducted in collaboration with the Action Schools!BC (AS! BC) program. This programis a best practices physical activitymodeldesigned to assist elementaryschools in creating individualized school actionplans topromote healthy living.The vision of AS! BC is to integrate physicalactivity intoelementary schools to achievelong-term, measurable and sustainable health benefits.This program was originally pilotedin 10 lower mainland elementary schoolsfor 17months between February2003 and June 2004. Results from thisinitial pilot revealedthat students enrolledin the AS! BC program exhibited improvementsin cardiovascularhealth and enhanced bonehealth in comparison to students in non-participatingschools. In the fall of 2005, AS! BCwas expanded to schools throughoutthe province.Over the next three years, anextensive study was conducted to assesswhether theAS! BC program wasan effective means to positively changeschool environments andhealth-related behaviours inchildren when delivered across geographicallydiverseregions and cultures. The presentinvestigation was conducted as partof the first stageof measurements in the evaluationcomponent of the AS! BC program.Specifically, thepurpose of the investigation wasto examine the current state of EMSproficiency inelementary-aged children inrelation to indicators of health and fitness. Measurementswere collected from 162 studentsenrolled in three schools participating in theAS! BCprogram.The present investigation examinedsix fundamental movement skills:running,skipping, hopping, vertical jumping,horizontal jumping and jumping from a height. Toexamine the state of proficiency inthese skills we used an assessmenttool specificallydesigned for this investigation. Fundamentallocomotor skill items were chosenbecause locomotor skills require moving the bodythrough space and more closelyresemble movements employed duringaerobic activities which are closely linked tohealth benefits [201. Manipulative skillsare also involved in many popularaerobicactivities (e.g., tennis, basketball, soccer)as are non-locomotor skills (e.g., balanceandstability) which are an integral part oflocomotor activities. However, the amountof timeavailable for data collection was limited andnot all FMS were able to be examined. Wealso examined health and fitness indicatorsincluding: body mass index (BMI),waistcircumference (WC), BP, arterial compliance,musculoskeletal fitness (grip strength,push-ups, curl-ups, and sit-and-reach) andcardiorespiratory fitness (maximal 20 m3shuffle run). Proficiencyin EMS items were assessedin relation to indicatorsof health,fitness and gender.We hypothesized that:1. The degree of FMSproficiency would besignificantly correlated toeach of thehealth and fitness indicators(positively related to arterialcompliance andphysical fitness andnegatively correlated toweight status andbloodpressure)2. There would be asignificant gender effectwith females demonstratinggreaterproficiency inskipping and hopping andmales demonstrating greaterskill inthe remaining EMSitems (running, vertical jump,horizontal jump, jump from aheight)3. The mean scores achievedby elementary-agedchildren would be in thelower two-thirds ofour movement skill assessmenttool.4CHAPTER II: LITERATURE REVIEWThis chapter reviews literature relevantto the present investigation. Movementskills will be discussed first followed byhealth and fitness indicators and the generallimitations of previous literature. Thereare two sections pertaining to movementskills.The first provides an introduction tomovement skills. The second section pays specificattention to EMS and their relationto health implications. In addition, the current statusof EMS proficiency and the British Columbianphysical education curriculum isexamined. After a brief introduction tohealth and fitness indicators, threesectionsdetail the specific health and fitnessfactors examined in this investigation (i.e., bloodpressure and arterial compliance,weight status, and fitness). Within each healthandfitness section, subsections discussingcurrent status among youth, how each factortracks from childhood to adulthood,common measurement techniques, as well as theirrelationship to EMS will be presented.2.1 Movement SkillsUnderstanding the reasons for whyproficiency in EMS should be examined inrelation to children’s health firstrequires an understanding of movement skillsthemselves. What are movement skills?What factors promote or limit theirdevelopment? What role do movement skillsplay throughout the lifespan? Thefollowing section will address thesequestions and will also provide a frameworkforunderstanding how movement skills impact physicalactivity pursuits and theimplications for the maintenance of health.2.1 .1 Movement Skills: What Are They?Motor development is a continuous andprogressive process from conception todeath where changes in motor behaviouroccur through the interactions of theindividuals’ biology, the task requirementsand the surrounding environment [21,22].Therefore, changes in the performance ofmovements are a result of matu rationalprocesses and learning.Movements performed in an organized mannerare termed movement patterns.When combined in a meaningful way, movementpatterns are able to accomplish5specific tasks throughwhich a person is then able toeffectively interact with and in theirenvironment. Such tasks aretermed motor skills and involvevoluntary physical bodymovements in order toachieve a specific goal [23].Motor skills are often classifiedaccording to one-dimensionalmodels, whichdiscuss skills according to oneaspect of the movement.There are three popular one-dimensional taxonomieswhich categorize skills accordingto 1) the size of musculaturerequired to perform the skill, 2)temporal aspects of themovement, and 3) theenvironmental contextin which the skill is being performed[23, 24]. Aside fromproviding a convenientway of identifying common characteristics,classifying skillspermits us to establisha basis for studying how welearn and execute movement skills.In addition, they allowfor the development of effectiveinstructional strategies andguidelines for learningmovement skills.The categories of ‘gross’ and‘fine’ divide motor skills according tothe size ofmusculature used to performthe task. Gross motor skills uselarge muscles to performmovement tasks suchas an infant lifting their head, crawling,walking and running whilefine motor skills use small muscles.Examples of fine motor tasks include:picking upobjects, writing, and cutting[24].Temporal aspects of a movementrefer to continuous, discrete andserial motorskills. Continuous anddiscrete skills are differentiated bythe way in which a skillbegins and ends. Continuousmotor skills are repetitive andhave an arbitrary beginningand ending (e.g., walking,running and skipping). Discretemovement skills haveidentifiable start and finishpoints (e.g., vertical jump, kicking andthrowing). Serialmotor skills are discrete skillswhich are repeated in succession(e.g., hopping andbasketball dribbling) [24].The environmental context in whichthe skill is performed categorizesskills as‘open’ or ‘closed’. A closedmotor skill is one in which theenvironment is stable withother people and objectsremaining fixed (e.g., horizontal longjump, running, andshooting a free throw in basketball).Comparatively, in an open motorskill theperformer’s environment is dynamicand adaptations are necessaryto the performanceof the skill. For example, during agame of basketball, the actionsof players on bothteams are continually changing forcingeach player to make adjustmentswhile in themidst of performing various movements(e.g., running andthrowing) [23].6From a developmental perspective,motor skills may also be discussed withrespect to the intended functionof the movement skill according to three categories:stability (or nonlocomotion), locomotion,and manipulation. Stability skills arethosewhich focus on maintaining balance suchas standing. Manipulative skills involvethetransfer or absorption of force to an object(e.g., throwing and catching); whereaslocomotor skills are those that move the bodythrough space (e.g., running andjumping).2.1.2 Movement Skills: What FactorsPromote or Limit Development?A central premise of this investigationis that the development of movement skillproficiency plays a pivotal rolefor an active and healthy lifestyle. Thus, it isimportant tounderstand the factors which limit skilldevelopment and may subsequentlyhinderphysical activity pursuits. Thissection will discuss the concept of developmentaltasks,sensitive periods, constraints, andreadiness as they relate to the development andlimitation of movement skills.According to the developmental task theory,there are developmental taskswhich present themselves at acertain point in an individual’s life. Particulartasks mustbe achieved by a certain point in timein order for the individual to accomplishsubsequent tasks relevant to theirsuccessful functioning within the environment.Taskswhich are not achieved at theproper time will be underdeveloped and failure tolearnthese tasks will result in the incompleteachievement of future tasks [12]. This relates tothe notion of “sensitive” or “critical periods”of development, which are points intimewhen an individual is especially receptiveto learning new tasks. These pointsin timeare limited in duration and the learning of aparticular task must take place during thesesensitive periods if developmentand learning is to progress unhindered.Developmental tasks arise from a combinationof factors, biological maturation,cultural/societal expectations and personalvalues of the individual. When applied tomovement tasks, the elementary-aged childencounters tasks required for participationin play and game activities. Biologically, this is atime of general growth for a child’smuscles and bones. There is also acomplementary neural maturation that occursduring this time to allow for more efficientmuscular coordination. Culturally,there aredifferent expectations placed on boys andgirls when it comes to the learning andexecution of movement skills with boys oftenexpected to display a higher degree of7competency then girls in most skills. Socially, theindividual is rewarded by their peergroup for successes and punished for failures in theperformance of movement tasks.Movement tasks consequently become a product of anindividual need and a societaldemand which is resultant from a learner interactingwith their environment. Accordingto Havighurst [12], experiencing success in thesemovement tasks will lead to feelingsof happiness and promote success in the attemptof more advanced movement tasks.In contrast, failure in movement tasks will elicitunhappy feelings and cause difficultiesin performing successive movement tasks.According to Newell’s model of constraints [26] movement is influenced bytheconstraints of the individual performing the task, theenvironment in which the task isperformed and the constraints of the task itself. Constraintsof the individual wouldinclude the biological characteristics of theperson. Structural constraints refer toconstraints related to the structure of the body such as an individual’sbody weight,height, and shape. Functional constraints refer toconstraints related to a behaviouralfunction and are influenced by the neurological and musculoskeletal developmentof theindividual. Each of these constraints plays a role in theexecution of movement skills.As a child grows their body segments increase in size and their bodyproportions arealtered. This in turn alters the biomechanics of the individual which changesthe natureof their movements. For example, the emergence of adult-like gait patternsfor walkingin children occur in conjunction with the establishmentof adult-like proportions in bodysegments. Endomorpic somatotypes1along with increases in height and bodyweightare often associated with poor performances in running and jumping activities.Runningand jumping are activities which require an individual to propel his or her bodythroughspace and because excess adipose tissue (as in an individualwith an endomorphicbody type) contributes to increased body weight withoutparallel increases in strength,running and jumping performance is negatively affected. Incontrast, height and bodyweight is often associated with greater muscular strength whereby theheavier childgenerally performs better in tasks which require an object (ratherthan his or her body)to be propelled through space. Gender differences in task performancemay be related1Somatotyping refers to the characterization of body type based on the contribution of threecomponents:endomorphy, ectomorphy and mesomorphy. Endomorphy is characterized by the predominance of thestomach and by a general roundness of body contours. Ectomorphy is characterized by a tall andthinbody shape with minimal muscular development. Mesomorphy ischaracterized by the predominance ofwell developed muscle tissue.8to the differences between boysand girls in body size and relative muscle masswithboys tending to be bigger withgreater contributions of muscle mass per unit bodyweight. Gender differences in motor tasks requiringbalance may be in part the result ofdifferences in center of gravity between males andfemales with females possessing alower center of gravity than males. A lower centerof gravity is beneficial for uprightbalance activities (e.g., standing on one foot).Subsequently females generallydemonstrate superior performanceon balance activities (e.g., hopping and balance-beam walking). All of these factors have thepotential to act as individual constraints onthe performance of a movementtask [26, 27].Environmental constraints are factors which areexternal to the individual andrefer to the environment in whichthe task is to be performed. Environmentalconstraints are sometimesdifficult to distinguish from task constraints becausetheydepend on the nature of the task. While task constraintsrefer to the goal of the activityand the particular restrictions placedon the performance of the task, environmentalconstraints are generally those which are not adaptationsof the task. This mightinclude temperature, amount of light, or typeof surface over which an action is beingperformed. For example, the movementsperformed by an individual attempting to walkacross an ice surface are different from themovements performed by an individualwalking across a carpeted surface [26].Task constraints include the goal of thetask, the rules surrounding theappropriate movement response and theimplements used in the performance of thetask. Tasks which have outcome goals, suchas making a basket in basketball, oftendo not specify the specific movements thatmust be performed to achieve the goal (i.e.,the basketball may be thrown towards thebasketball hoop using a variety of differentthrowing techniques). Other tasks specify the typeof movement that must beperformed to accomplish the task. For example,movements in dance, diving, orgymnastics must often be performed in a very specific way.The task constraintsimposed by the implements or objects involved inperforming the task may include thesize, weight and shape of the object beingused. For example, if a person needs tomove a box, the movements he or she performswill depend on how big the box is. Isthe box small and light enough to carry or doesit require pushing or pullingmovements? Within individual and environmentalconstraints, the limitations of the task9are ultimately responsible for the movements that are performed. Change the nature ofthe task and the movements required to perform the task inevitably change as well [26].Newell’s [26] model of constraints also pertains to the concept of readiness inmotor development which has wide implications for the understanding of children’smotor learning. Namely, in order for a child to learn a wide variety of movement skills(s)he must be exposed to an enriched environment with a variety of developmentallyappropriate activities. Adults responsible for the child’s immediate environment havethe potential to provide a rich variety of appropriate movement experiences gearedtowards this end. The continual provision of new movement experiences facilitates theongoing development of movement skills. Thus, each preceding movement experiencehelps ensure the child’s state of readiness to encounter the next. Likewise, failure toprovide the movement experiences necessary for skill development will inhibit thechild’s state of readiness for any subsequent learning experiences [28]. In reference tothe acquisition of motor skills, the term readiness encompasses the knowledge, skills(cognitive, emotional and physical) and experience that an individual bringswith them tothe learning of a new movement pattern. Readiness is the convergence of thesefactors placing the individual in a situation where they are able, or ‘ready’, to learn newskills [28]. It was once thought that readiness was solely a function of maturationalage2. It is now widely recognized throughout the motor behaviour literature, thatchildren’s readiness to learn is due in large to the environment in which a child isplaced. This has substantial implications for a child’s learning. Given the properenvironment, a child’s motor learning is able to advance towards increasingly greaterdegrees of movement competence. However, should a child lack access to an enrichedand physically active environment, his or her ability to acquire a wide repertoire of motorskills may be hindered. Hence, the investigation of FMS is warranted as they may haveconsequences for children’s physical activity pursuits and in turn, children’s health andfitness. As such, the implications for the physical education setting are clear.2.1.3 Movement Skills: What Role Do They Play Throughout the Lifespan?2Maturation is defined as the progression towards a mature state. In this case, maturational age refers tothe level of maturity attained by an individual’s biological systems. In contrast an individual’schronological age refers simply to calendar time. Therefore, while two individuals may be the samechronological age, they could be very different in terms of maturational age.10Often overshadowed by the necessity of our society to participate in physicalactivities for the pursuit of health-related fitness (i.e., fitness that is related to someaspect of health), the development of movement skills is continually overlooked.Participation in physical activities is reliant upon one’s ability to perform movementskills. The skills which comprise sport and game activities are termed specialized skillsand these skills are based on the combination and variation of EMS. Thus, FMSproficiency is critical to the development of the specialized skills required forparticipation in physical activity endeavours throughout the lifespan. Moreover, thefundamental skills which comprise the specialized skills used in lifespan sport and gameactivities influence the development and maintenance of health-related fitness.Skill acquisition may be examined as a sequential progression of motorcapabilities across the lifespan. According to Gallahue’s phases of motor development,individuals progress from reflexive movements, which are involuntary controlledmovements that serve the foundation for all movement, through three voluntary phases:the rudimentary, fundamental, and specialized movement phases, respectively. Whendiscussing each phase, it is important to keep in mind that the causal factor in theappearance (or disappearance) of a motor behaviour is not age but rather, aninteraction between the individual, their environment and the task. While this interactionincludes characteristics of the individual such as the physical and cognitive maturationthat is associated with increasing age, age itself is not the cause of the motorbehaviours exhibited [22].Within the first two years of life, a child will develop the ability to exert controlover his or her body by producing voluntary movements referred to as rudimentarymovement skills. Children’s development in this stage is often described according todevelopmental milestones. The rudimentary movement phase includes two stages, thereflex inhibition stage and the precontrol stage. Soon after birth, an infant beginstransitioning away from dependence on reflexes and towards voluntary muscle control.This transition denotes the reflex inhibition stage. While movements become voluntary,they are primarily uncontrolled. Greater degrees of control can be observed at theprecontrol stage of development. The child can now manipulate objects by reaching,grasping and releasing, stabilize his or her body to sit and stand and perform locomotorskills such as crawling. Rudimentary movement skills are essential precursors to theattainment of EMS [24].11The fundamental movement phase of a child’s development typically occursfromtwo to six years of age. Examples of FMS include:standing on one foot, running,jumping, throwing, catching, skipping and striking. Thechanges that occur as FMSdevelop (referred to as a developmental sequence) aregenerally described asprogressing through three stages: initial, elementary and mature. Each phaseischaracterized by particular movement characteristics,which fall along a continuum ofincreasing proficiency rather than belonging to discrete periodsin development. Theinitial stage is characterized by a child’s first attempts at the performanceof a EMS andthere are often perturbations in the execution of a controlled and coordinatedmovementpattern. Movement patterns demonstrated in the elementary stage arebettercoordinated and controlled than in the initial stage. However,many movements presentas either exaggerated or constrained. Maturemovement patterns are well coordinated,controlled and efficient in movement. Children are physically and mentallycapable ofperforming most mature EMS patterns by five or six years of age [30].Fundamental movement skills do not appear simply as a natural extension of thechild’s overall maturation. They require appropriateenvironmental supports such aseffective instruction and opportunities for practice. Therefore, while the transitionthrough these stages typically occurs during childhood, there is nothing to guaranteethat an individual will ever reach the mature stage of any EMS during their lifespan.While physical growth (increase in body size) and maturation (developmentof biologicalsystems) play a role in motor development, the emergence of a mature movementpattern is also inhibited if the individual is not provided opportunities to learn how toperform these skills with proficiency. This has important implications for thedevelopment of lifelong physical activity skills. Children who do not master EMS areinhibited in the development of more complex specialized movement skills such asthose used in a variety of common sport and game activities [12].The acquisition of specialized movement skills provides the individual withoptions to participate in recreational physical activities across the lifespan.Specializedmovement skills are compilations of EMS. In this phase, EMS are assembled in aninfinite number of combinations and are performed in contexts which areincreasinglydemanding. This stage includes three phases referred to as the transitional,applicationand lifelong utilization stages. During the transitional stage, FMS arefurther refined andcombined to form specific movement patterns. These patterns are thenapplied to a12variety of different contexts including various games and sporting activities.Participation in a large variety of general activities should be prevalent during this timeto ensure the child develops an ample repertoire of movement patterns. From this pointthe child, who is now in late childhood (approximately 9 to 12 years of age) toadolescence (approximately 12 to 20 years of age) may begin to make decisions as tothe types of activities he or she wishes to participate in and focus his or her attention onthese specific activities. This is referred to as the application stage. In this stage, anindividual’s decision to participate in a given activity is reflective of the way in which theindividual perceives the activity in relation to his or her ability to experience success andenjoyment through participation. Culminating the process of motor development is thelifelong utilization stage which persists from adolescence through adulthood. Physicalactivity participation at this stage takes into consideration a plethora of factors includingthose external to the individual (e.g., time and money) and also internal factors namely,an individual’s acquired movement skill repertoire and experiences. The concept of‘lifelong utilization’ is limited by the variety and extent of movement competenciesacquired at the earliest phases of skill acquisition [31]. This demonstrates theimportance of investigating the current state of fundamental movement proficiency inCanadian elementary-aged children.2.2 Fundamental Movement SkillsChildhood typically denotes a time when children are learning the basic orfundamental skills of movement which will ultimately set the stage for the pursuit oflifelong physical activities. The following subsections are dedicated to describing: thedevelopmental sequences of select FMS (with specific attention to fundamentallocomotor skills), the health implications of movement skill proficiency, and the currentstatus of movement skill proficiency in Canadian children.2.2.1 Fundamental Movement Skills: Locomotor SkillsDue to their very nature, physical activities involve locomotor skills. While manyphysical activities also have manipulative and stability skills as central components forparticipation, it is most appropriate to focus the discussion on fundamental locomotorskills. Locomotor skills are defined as those skills used to move the body throughspace and are integral to participation in many popular sports, games and activities. As13previously mentioned, the developmental sequences for fundamentalskills are oftencategorized into progressive phase-like stages. The initial, elementaryand maturestages within this phase of development contain specific movement characteristicsthattypify each progression. However, skill development occurs acrossa continuum whereat any given time, an individual may exhibit movement characteristicsfrom two or morestages. In addition, skill level is not always discussed accordingto initial, elementaryand mature stages. Researchers also describe developmentaccording to a componentapproach where the movement characteristics are separated into arm,leg andsometimes trunk components with three or more stages describingeach component. Inaddition, a total body approach also exists where body movementsare described as awhole with multiple stages of increasing proficiency. Outlined hereare some of the keymovement characteristics seen throughout the developmentalsequences for six FMS:running, jumping from a height, vertical jumping, horizontal jumping,hopping andskipping. The descriptions for each of these skills are not limitedto any particularmethod of classification (i.e., they are not discussed solely accordingto either a wholebody, body segment or initial, elementary and mature approach). However,as mostFMS proficiency comparisons are made by comparing childrenwho have and have notachieved mature movement patterns, referenceto the mature form of each skill will bemade along with some references to initial and elementarycharacteristics. In addition,the aforementioned stages and associated figures describe developmentalchangesthat are qualitative in nature.Qualitative changes are observable changes in the qualityof skill performance. They describe the movement characteristicsof how a skill isperformed. Quantitative changes (changes which are directlymeasurable such asrunning speed or jumping height) also take placeas children grow and develop. Theskills assessed in this investigation were analyzed froma qualitative perspective.Therefore, while general quantitative changes arepresented, the following descriptionsfocus on qualitative aspects of skill development.The age at which children arecapable3of performing these skills varies widely from skill to skilland from child to child.However, the majority of children are capable ofperforming mature patterns of mostA distinction must be made between being capable of performingat a particular skill level and the actualperformance at that skill level. Children are capable of performing maturemovement patterns when theyare physically developed enough to perform the demands of the movementtask. However, this does notmean that they will naturally exhibit these movement characteristics because aspreviously mentiOnedmotor skill development is not solely the function of maturation.14FMS by their preschool and early elementary school years [30, 32].In addition, there isevidence to support gender differences in the performance ofFMS. Across FMS,proficiencies are greater in boys than girls with the exception of hoppingand skipping.Girls tend to exhibit mature patterns earlier than boys in these twoskills while boysexhibit mature patterns of running and other jumping skills earlierthan girls [19, 30, 33].2.2.2 Fundamental Movement Skills: RunningRunning is an exaggeration of walking (walking is also a FMS)yet is notdependent on the establishment of a mature walking pattern and isdifferentiated by theappearance of a flight phase. A flight phase exists when there isa brief period whereboth feet are unsupported by the ground. The first appearanceof a flight phase usuallyoccurs in the second year of life and by approximately five years ofage children arecapable of performing a mature running pattern [30, 32].To begin with, children will runflat-footed and with little flexion at the knee. In addition, theirflight phase is minimal.The child will gradually progress towards a heel-toe landing or, during sprintingthe ballof the foot may contact the ground. Flexion at the knee,hip and ankle will increasegradually for greater force absorption and time spent in flight willlengthen.Concurrently, a child’s arms will progress from contributing little(other than assistancewith balance) to becoming active in the movement. Initially, armswill typically be heldabducted to increase balance but are otherwise stiff and do notparticipate. Gradually,the arms will start to move according tobody rotation. This will cause the arms tonoticeably cross the body midline as they swing forwardsand outwards from the bodyduring the back swing. At this point, the elbows willstart to bend slightly. Eventually,the arms will contribute to the running movementby driving along the sagittal plane withelbows bent to approximately 90°. In the maturerunning pattern, arm and legmovement will be coordinated in opposition [22].As both boys and girls increase inchronological age from 3 to 17 years ofage, their running times generally decreaseindicating an improvement in their runningperformance [30]. Changes in joint angleswith increasing age have also been found [34]. Fortneyet al. [34] examined joint anglesin children who were two-, four- and six-years of age.During contact4the angle of theContact refers to the point at which the leading foot initiallycontacts the ground after having been inflight.15swing leg’s5 knee was flexed more in the four- and six-year oldchildren than in thegroup of two-year old children. During the point at which the front legis making contactwith the ground, the knee joint of the other leg (i.e., the leg whichat this point can bereferred to as the swing leg) is flexed to a greater degree in the twoolder age groups.At take-off6,the knee joint of the support leg7 displayed greaterdegrees of extensionwhile the knee joint of the swing leg displayed greater degreesof flexion with increasingage. While Fortney et al. [34] did not find gender differences in runningspeeds they didfind gender differences in various joint angles with boys demonstratinga greater rangeof motion in the hip of their swing leg during contact, take-off andmid-support8.2.2.3 Fundamental Movement Skills: JumpingJumping skills involve similar movement characteristics. The literaturegenerallydescribes jumping by dividing the skill into preparatory, takeoff, flight,and landingphases individualized according to the particular type ofjump being discussed.Jumping skills vary according to the direction of jump(e.g., downwards, upwards, orforwards) and by the number of feet used to perform the jump [35].Jumping from a height (also referred to as a drop or depth jump) involvesjumping downwards from an elevated surface. Initially,the child has difficulty taking offwith two feet and there is no visible flight phase. The leadingfoot will land before thetrailing foot leaves the supporting surface. The child attemptsto use their arms forbalance but does so in an exaggerated or ineffective way. Thesemovements willprogress to a two foot take-off and landing with the appearanceof a flight phase inbetween. Hip, knee and ankle flexion will appropriately absorbimpact upon landing.Arm movements at the mature stage will functionto effectively assist with balance [22].In the vertical jump, the child projects his or herbody upwards reaching overheadwith one hand. Mature forms of the vertical jumphave been demonstrated in childrenas young as two years of age although most children have thecapability to reach themature stage of vertical jump at five yearsof age [36]. During the initial stage ofperformance, children exhibit limited preparatory flexionof the hips, knees, and anklesSwing leg refers to the leg off of the ground during a running stride.6Take-off refers to the point at which the support leg leaves theground (at which time it will become theswing leg).Support leg refers to the leg which is in contact with the ground.8Mid-support refers to the point at which the support leg is perpendicular withthe ground.16(known as a preparatory crouch). As in jumping from a height, children havedifficultytaking-off with both feet simultaneously. During flight, thereis poor upward extension ofthe head and body. In the initial stage of development, the arms arenot involved in themovement. During the elementary stage children will intentionally reachupwards withone arm however, their non-reaching arm will unintentionally reach upwardsas well,therein limiting the amount of tilt by the shoulder girdle. By the mature stage,childrenwill display a preparatory crouch before initiatinga powerful upward extension at thehips, knees and ankles. Similar to a preparatory crouch, a countermovementis whenthere is a quick bend at the hips, knees and ankles before the upward thrustof thevertical jump. Countermovements and a preparatory crouch with kneesbent to1150have been shown to increase vertical jump height. In the maturestage, the shouldergirdle tilts as one arm reaches upwards while the non-reaching armreaches downwards[37, 38]. The main contributor to vertical jump height is lower body strengthand theability to utilize this strength to produce a greater degree of muscularforce. Increasedmuscular force production could be the result of intrinsic factors such asthe proportionof fast-twitch muscle fibres or amount and type of training[39]. However, theperformance of an arm swing has been shown to positively enhancevertical jumpheight by approximately 10% [37, 39]. The height of jump achieved increaseswith ageup to 19 years in boys and 16 years in girls [30].Mature movement patterns of the horizontal jump appear muchlater than in thevertical jump. The horizontal jump requires whole body involvementand not untilapproximately 9 to 10 years do the majority of childrendisplay a mature horizontal jumppattern [32]. During this skill, children propel their body forwards taking-offand landingon two feet. As in the initial stage of jumping from a height, children havedifficultytaking-off and landing with both feet simultaneously. In addition, duringthe early stagesof development children are inclined to jump upwardsmore than forwards. The child’sarms initially serve to maintain balance throughoutthe performance of the skill ratherthan contribute to the forward driving motion as theywill at more mature stages of skilldevelopment. Eventually, the child will swing his or her arms backwardsin preparationand then forwards and up during flight before lowering themto a position in front of hisor her body upon landing. The use of an arm swing has been shownto increasehorizontal jump distance by approximately 21% [40]. As skill increases,the degree towhich the trunk leans forward during the flight phase will also increase.Increases in17forward lean on take-off demonstrate improved jumping distances [41]. The positions inwhich the thighs are held during the flight phase will also change as the child’smovement pattern progresses towards a more mature pattern, Initially, the thighs areprimarily vertical during the flight phase. However, by the mature stage the child carrieshis or her thighs parallel to the ground during flight. The degree of knee joint flexion attake-off and the range of movement in the knee joint throughout the flight phase issignificantly greater in adults than children [42]. In addition, early on in the developmentof this skill, the center of gravity will largely remain over the child’s feet during flight andon landing. By the mature stage of performance, the child’s center of gravity will be wellbehind his or her feet upon landing requiring the forward momentum of the trunk tobring the center of gravity forward and over the base of support after initial foot contacthas been made with the ground [22]. Boys increase their horizontal jump distance withage up to 18 years while girls increase their jump distance until 15 years of age [30].A mature hopping pattern can be demonstrated in children by approximatelyseven years of age [30, 32]. This skill requires the performer to take-off and landrepeatedly on one foot and therefore requires a greater degree of strength and balancethan jumps performed on two feet. The early performer has difficulty projecting his orher supporting foot from the ground. Instead learners pull their foot up off of the groundby quickly flexing at their hip and knee, rather than using the extension of their hip, kneeand ankle to propel their body off the ground. Gradually, this will convert to the smoothtransition from preparatory leg flexion to extension upon take-off and absorption of forceon landing. Initially, a child may not be able to perform more than a couple jumps insuccession. The number of jumps the child is able to perform will increase withincreasing skill proficiency. The non-supporting leg (referred to as the swing leg), isheld high with the thigh approaching parallel with the ground. During the mature stage,the swing leg is held closer to vertical although it will react by lifting upwards with theforce of each jump. The child’s arms will at first be held abducted for balance and willmove in reaction to a loss of balance. This will progress to the active involvement of thearms contributing to the jump [43]. With increasing age there are significant effectsseen in the ratio of time spent in flight vs. time spent in contact with the ground. Flighttimes became proportionately longer than contact time with increasing age. Thiscoincides with greater vertical force production in older children and adults when18compared to younger children [44]. In addition, with increasing developmental level,stiffness of the hopping leg decreases [45].2.2.4 Fundamental Movement Skills: SkippingSkipping combines two other fundamental skills, the step and the hop, in arhythmical and alternating pattern. Skipping is described as a repeated step-hopmovement with the supporting leg alternating on each successive step and hopmovement. The leg action component of the skip progresses from a one-footed skip toa two-footed skip. In the one-footed skip, one foot steps but does not hop whereas theother foot completes a step and hop. In the two-footed skip, both feet complete a stepand hop. However, landing on the hop is with the whole foot. In the most maturepattern of the two-footed skip, the child’s heel will not contact the ground on the hop.Meanwhile, the arm component of the skip progresses from the arms moving upwardstogether during the vertical component of the hop to the arms working in opposition withthe legs and each other. The rhythm displayed by children at the initial stage is unevenand awkward with quick tempo while the rhythm at the mature stage is uniform andsmooth with moderate tempo. Children at six or seven years of age are capable ofperforming a mature skipping pattern [30, 32].2.2.5 Fundamental Movement Skills: Health ImplicationsMature fundamental movement patterns required for the later development ofspecialized skills used in lifelong physical activity pursuits has been discussedextensively in the previous sections. This suggests a relationship between movementskill proficiency and health indicators. However, few investigations have adequatelyexamined this relationship, especially in children. Briefly illustrated here are thepotential health implications associated with demonstrated proficiency in FMS.Given the integral role movement skills play in performing physical activities, it isnot surprising that a relationship between EMS proficiency and organized physicalactivity participation has been found in Australian adolescents and American children[17, 47]. Okely et al. [17] showed that girls and boys who engaged in a greater numberof hours per week in organized physical activity (defined as activities that includedregular classes or training and that were organized with instructors) were more likely todemonstrate greater proficiency in EMS (i.e., running, vertical jumping, catching,19overhead throwing, forehand striking, and kicking). Notably, after dividing children intoquartiles according to motor proficiency, findings indicated a possible threshold effectwhere children who scored in the highest proficiency quartile had significantly longeraverage time spent in physical activity than the three lower proficiency quartiles (whichshowed significant differences in the average time spent in physical activity).Importantly, their investigation also found a significant relationship between motor skillproficiency and time spent in moderate and moderate-to-vigorous physical activity.After controlling for covariates (gender, socio-economical status, # of televisions in thehome, # of children in the home, child and parent BMI z-scores and children’s measureof self-perceptions of adequacy in and predilection for physical activity), motor skillproficiency still accounted for 8.7% of the variance in physical activity [47].Physical activity participation, especially participation in moderate-to-vigorousactivity is a necessary component for fitness. It then follows that a relationship betweenfitness and FMS proficiency may also exist. In fact, Okely et al. [11] have shown such arelationship among adolescents in grades 8 and 10. Running and throwing proficiencydisplayed significant correlations with fitness in girls, while running and kickingproficiency displayed significant correlations in males. Recently, a link has beendemonstrated between movement skill capability in adolescents and their adiposityassessments (sum of skinfolds, BMI, waist circumferemce). Okely et al. [16]determined that twice as many overweight youth (classified by BMI values) scored inthe lowest quintile of FMS proficiency than non-overweight youth. Waist circumstancemeasurements were also shown to increase with a decreasing capability in running,catching, throwing, striking, and kicking, irrespective of gender.2.2.6 Fundamental Movement Skills: Physical Education CurriculumGiven the significant influence movement skills have on lifelong physical activitypursuits and the potential influence on health status, the implications for the physicaleducation setting are clear. It is thereby relevant to consider the physical education(PE) curriculum. All Canadian children have access to PE through the educationsystem whereas many children (particularly those from low socioeconomicbackgrounds) may not have access to any form of physical instruction until they enterelementary school. It is therefore appropriate to consider the PE curriculum as theprincipal vehicle for the delivery of physical instruction. In addition, school-based20settings offer easily accessible areas for the investigation of large numbers of children.Through the school system, investigations are able to assess the current state ofmovement skill proficiencies and implement intervention programs based on thesubsequent findings. In fact, physical education curriculums designed to improvefundamental manipulative skills have been shown to positively impact skill performancein first- and second-grade Greek children [48]. When implemented as an eight-weekprogram with two 45-minute classes per week, instruction geared towards improvingfundamental manipulative skills significantly improved children’s scores on the Test ofGross Motor Development. Pappa’s et aI.’s results support the notion that a physicaleducation curriculum focusing on FMS development positively influences skilldevelopment in children. Knowing the role PE plays in the development of EMS, howmuch attention does the British Columbian PE curriculum pay to the instruction andevaluation of movement skills? And, what level of skills are required by the curriculum’sprescribed learning outcomes (PLO’s)?The 1995 British Columbian physical education resource package organizes thecurriculum into three areas: active living, movement, and personal and socialresponsibility. Movement is further divided into five areas, alternative environmentactivities, dance, games, gymnastics, and individual and dual activities. Within eachmovement area there are PLO’s which describe the behaviours students are expectedto demonstrate [49]. Instruction is then directed towards this end. Unfortunately, thepresent curricular PLO’s are not specific in describing the level of skill students areexpected to demonstrate. In addition, there is no reference to which particularmovement skills are to be taught in each grade. Fortunately, the British ColumbianMinistry of Education has recently developed a revised PE curriculum set for partialimplementation in September 2008 and full implementation in September 2009. Thespecifics of the new curriculum will be discussed further in Chapter V.2.2.7 Fundamental Movement Skills: Current StatusLiterature examining the current state of EMS proficiency is limited worldwideand this knowledge is especially lacking among Canadian children. Okely and Booth[19] recently examined the prevalence of FMS mastery among Australian children. Thisinvestigation examined several fundamental skills in boys and girls in grades one, twoand three. For children in grade one, the hop, skip, side gallop, overarm throw, kick,21and leap skills were assessed. The leap, kick, two-hand strike, dodge, sprint run, andcatch skills were examined in grade two children. Finally, static balance, sprint run,vertical jump, catch, kick, and overarm throw were examined in grade three children.Skills were assessed by the visual observation of process orientated behaviouralcharacteristics. Mastery was determined by the achievement of all movementcomponents. Near-mastery was also reported and defined as the achievement of allbut one movement component. Results indicated that out of all movement skills testedonly 35% of children achieved mastery or near-mastery levels of achievement. Theproportion of children who did not exhibit near-mastery (let alone mastery) offundamental skills is significant especially considering the participants of theaforementioned investigation were six years of age (grade one) or older. While theinvestigation performed by Okely and Booth [19] does not provide insight into theproficiency levels of Canadian children, combined with the dearth of informationregarding this matter it certainly indicates the need for the current status of EMS to beexamined among Canadian children.2.3 Indicators of Health and FitnessCardiovascular disease is a disorder in which the normal physiological functionsof the heart or blood vessels are impaired. The ultimate consequence of CVD is deathor disability from a vascular event such as a heart attack or stroke. Preliminary vasculardisorders such as hypertension and arterial stiffening may be present long before avascular event may actually occur [10, 50, 51].In the following section, specific attention will be given to various health andfitness indicators. In particular, blood pressure, arterial compliance, weight status,musculoskeletal fitness and cardiorespiratory fitness will be addressed.2.4 Indicators of Health and Fitness: Blood Pressure and Arterial ComplianceThis section is dedicated to the discussion of BP and arterial compliance as theyrelate to health, tracking from childhood to adulthood, the measurement of BP andarterial compliance, as well as their potential relationship to FMS.High BP and decreased arterial compliance are related to health consequencessuch as atherosclerosis [52]. Atherosclerosis is a hardening of the arteries thatdevelops over several decades and is preceded by decreased arterial compliance (also22known as decreased elasticity of the arteries or vascular stiffness) and is initiated by thedysfunction of the endothelial cells lining the artery wall. The endothelium normallyfunctions as a semi-permeable and protective barrier between the blood and tissuesplaying an important role in the passage of metabolic substances and gases into andout of the circulating blood. By detecting and responding to hemodynamic changes inthe blood through vasodilation and vasoconstriction the endothelium also maintainsvascular homeostasis. Endothelial dysfunction may be the result of several differentfactors including injury from mechanical forces which impair the proper function of theendothelium [50, 53]. Mechanical forces may consist of the tensile stresses caused byhypertension along with shear stresses caused by the viscous drag and nonlaminar flowof blood against the endothelial surface therein disturbing the endothelial cells [52].Blood platelets and monocytes adhere to the site of injury and interactions betweenthese substances may trigger the movement of smooth muscle cells into the area andinitiate a proliferative response. Such disruption to the endothelium on a chronic basisleads to the calcification of lesions and the eventual establishment of an atheroscleroticplaque which compromises blood flow due to the narrowing of the lumen and limits theblood vessel’s ability to vasodilate [53]. Plaque rupture may follow leading to athrombosis or embolism which in turn may lead to a heart attack or stroke and finallyresult in death or disability [52, 53].Arterial compliance is a surrogate marker of endothelial dysfunction as changesin the compliant properties of the small and large vasculature are suggestive offunctional and structural changes to the endothelium taking place during the earlystages of the atherosclerotic process[101.For this reason, decreased compliancemeasurements are often indicative of current or future vascular health problems [10, 54-56]. For example, along with the development of atherosclerosis, arterial compliance isalso associated with hypertension. It is not certain however, if hypertension precedesor follows decreased compliance [55-57]. Cohn et al. [54] investigated the effectivenessof using arterial compliance testing for the detection of vascular disease. They foundsubjects diagnosed with hypertension and coronary disease to have arterial compliancemeasurements that were reduced by 31% and 24% respectively when compared toage-matched normotensive and coronary disease-free control subjects.Liao et al. [55], Perticone et al. [56] and Arnett et al. [57] investigated therelationship between BP and vascular compliance. In a six-year follow-up investigation,23Liao et al. [55] examined the relationship between the development of hypertension andcarotid artery stiffness in a group of normotensive men and women. This investigationwas conducted as part of the Atherosclerosis Risk in Communities study investigatingcardiovascular and pulmonary diseases. The results revealed a graded associationbetween greater baseline carotid artery stiffness and the subsequent development ofhypertension. This relationship was independent of baseline BP measurements andshowed that even the normotensive group subjects with higher baseline artery stiffnesshad higher baseline BP measurements [55].Within a hypertensive population, forearm endothelial function measured by thevessel’s vasodilatory response to acetylcholine has demonstrated the ability to predictfuture cardiovascular events [56]. Patients with a longstanding history of hypertensionwere measured for their peak percent increase in forearm blood flow during infusion ofacetylcholine as an indication of their vasodilatative response. Participants were thengrouped into tertiles based on their degree of forearm blood flow (vasodilatory)response with those participants who had the lowest blood flow response (i.e., greatestendothelial dysfunction) being placed in the first tertile and those who had the greatestblood flow response (i.e., lowest endothelial dysfunction) placed in the third tertile.Upon a seven-year follow-up, approximately 57% of participants classified in the firsttertile compared to approximately 14% of those in the third tertile had experiencedsome form of cardiovascular event such as: myocardial infarction, stroke, transientcerebral ischemic attack, unstable angina, or bypass surgery/angioplasty [56]. Inaddition, Grey et al. [10] demonstrated reduced small artery compliance as being anindependent risk factor for cardiovascular events such as myocardial infarction andstroke with those persons who had not experienced a cardiac event having significantlyhigher compliance measurements.2.4.1 Blood Pressure and Arterial Compliance: Tracking from Childhood to AdulthoodImportantly, the association between arterial compliance and BP is not limited tothe later adult years but can also be identified between the years of adolescence andearly adulthood. A subset of participants from the Minnesota Children’s Blood PressureStudy took part in a long-term investigation designed to examine the relationship ofarterial compliance with BP [57]. Participants had their BP assessed twice in their finaltwo years of High School and one final time two years after they completed High24School. Five years following completion of High School, participants were categorizedinto high-risk and low-risk groups based on BP measurements taken during HighSchool. At this time (five years post High School), both groups had BP and arterialcompliance measurements taken. After statistically controlling for possible confoundingvariables such as sex, height, weight, insulin, HDL and LDL cholesterol levels, Arnett etal. [57] found a significant relationship between the five year post High Schoolmeasurements of systolic BP and large and small artery compliance.In addition, Arnett et al. [57] explored a further association between BPmeasurements taken throughout adolescence and arterial compliance measurementstaken during young adulthood. They found that the slope of BP measurements takenthroughout adolescence were predictive of future arterial compliance measurements inyoung adulthood. Similarly, BP measurements in adolescents aged 12 to 18 yearspredicted the development of a preclinical marker for atherosclerosis later in life [58].As a part of the Cardiovascular Risk in Young Finns Study, Raitakari et al. (2003)reported that the cardiovascular risk profiles of adolescents 12 to 18 years of age weredirectly related to adult common carotid artery intima-media thickness measurements (apreclinical marker for atherosclerosis) which were taken twenty-one years later. In bothmales and females, youth systolic BP was related to adult intima-media thicknessindependent of age, sex and current (adult) BP status.As a reflective measure of endothelial dysfunction, the appearance of reducedarterial compliance precedes the appearance of unhealthy BP measurements.Therefore, the assessment of arterial compliance is an important technique for the earlydetection health risks and allows for a preventative rather than treatment approachtowards health [10, 54, 57].2.4.2 Blood Pressure and Arterial Compliance: MeasurementParticularly relevant to the discussion of arterial compliance is the cushioningfunction of the arteries. Cushioning function assists the steady conduction of blood bymitigating the pulsations resultant from the hearts intermittent contractions. An artery’scushioning ability can be expressed in terms of its compliance or elasticity [52].Waveforms and reflections generated by the arterial system reveal informationconcerning the functional state of the arteries. Upon ejection of blood from the leftventricle, an initial pressure wave is formed with a secondary reflective wave being25formed in discontinuous areas of the periphery such as points of branching andbifurcation. In healthy young individuals, the reflective wave travels back towards theheart during diastole [51]. The decay of BP from one ventricular contraction to the next(termed diastolic decay) and the oscillatory component of the reflective wave affords theanalysis of vascular compliance by expressing the change in vessel volume by thechange in vessel pressure [52]. Non-invasive analysis can be performed thoughimplementation of the HDIIPuIse Wave CR — 2000 CVProfilor (Hypertension DiagnosticsInc Cardiovascular Profilor system). The CVProfilor system employs an electricalanalog model known as a modified Windkessel model to provide an assessment of thesmall and large vasculature. A tonometer is placed over a superficial artery (in thiscase, the radial artery) to detect changes in beat-by-beat pressure and elucidate acomputer generated tracing of a pressure waveform. Calculations derived fromapplying an algorithm to the waveform are taken to represent small and large arterycompliance. While this non-invasive technique diminishes some of the high-frequencyoscillatory components of the pressure waveform, it none-the-less yields large andsmall artery compliance findings which are statistically similar to those obtained throughinvasive measurements making it a valid means of assessing arterial compliance [54].Data obtained using this non-invasive method has demonstrated reliability over bothshort and intermediate measurement collections [59, 60].2.4.3 Blood Pressure and Arterial Compliance: Relationship to EMSA relationship between BP, arterial compliance and EMS proficiency has notbeen examined. In fact, few experiments have investigated BP and arterial complianceprofiles of children. As BP and arterial compliance play a vital role in the determinationof disease later in life, factors that may be associated with these measurements (suchas proficiency in FMS) should receive closer examination.2.5 Indicators of Health and Fitness: Weight StatusHigh levels of adipose tissue are associated with several health risks includingCVD, premature mortality and morbidity [9, 61, 62]. Additionally, weight status sharesstrong associations with other indicators of health and the clustering of several obesityrelated health problems (large waist circumference, insulin-resistant glucosemetabolism, impaired glucose tolerance, type 2 diabetes mellitus, dyslipidemia and26increased BP) is termed metabolic syndrome. People with metabolic syndrome have aone and a half to three times greater risk of suffering from coronary heart disease andstroke [61]. In a 13-year follow-up on the Canada Fitness Survey, Katzmarzyk et al. [9]found a positive relationship between BMI and risk of mortality in adult males andfemales. Furthermore, research has shown that men and women’s risk of all-causemortality is one and a half times higher and mortality from coronary heart disease is twotimes greater if they were overweight during childhood [62]. This is a long-term affect ofchildhood overweight and obesity in addition to the onslaught of immediate andintermediate consequences.Complications of childhood overweight and obesity typically manifest themselvesseveral decades after childhood. However, the immediate and intermediateconsequences of child obesity are becoming apparent. Investigations consistently findoverweight and obese children to be at greater risk for becoming hypertensive thannormal-weight children [63-65]. Paradis et al. [65] examined the relationship betweenBP and BMI in Canadian children aged 9, 13 and 16 years. Findings indicatedassociations between BMI, systolic and diastolic BP across each age and gender groupthat were independent from fasting insulin level, resting heart rate and family history ofhypertension [65]. As continuous variables, BP and BMI share a linear relationship withincremental increases in BMI associated with incremental increases in BP across age,gender and racial group [63]. When temporal trends in BMI and BP are investigated arelationship is also apparent [66]. Parallel to increases in weight status between theyears 1988 and 2000, is an increase in the systolic and diastolic BP of children andadolescents. Once the increase in BMI was controlled for, the increase in systolic anddiastolic BP was reduced by 29% and 12% respectively. Thus, Muntner et al. [66]attributed the rise in BP in part to the rise in obesity. The mechanism by which obesityis related to BP is not clear however, the relationship may be partially mediated byaltered vascular structure and function as decreased vascular health has also beendemonstrated among obese children [64, 67].Severely obese children (defined by a BMI z- score three or more standarddeviations above the age- and sex- specific means) while normotensive, present withgreater indices of wall stress, intima-media thickness and lower indices of complianceand endothelial function. Further to this, results from the Cardiovascular Risk in YoungFinns Study show an association between childhood BMI and adult risk for27atherosclerosis through both increased artery intima-media thickness and decreasedcarotid artery elasticity [58, 68]. For males and females, adult compliance was inverselyrelated to both childhood BMI and skinfold thickness. The association betweenchildhood BMI and adult compliance became non-significant when adult BMI wasentered into the multivariable analysis however, children’s risk score (calculated as thechild’s total number of risk factors e.g., high LDL and low HDL cholesterol, high systolicBP and high skinfold thickness) remained highly significant even after controlling forthese variables in adulthood. While the association between individual childhood riskvariables was largely attenuated after adjustment for the effects of adult risk factors(such as adult BMI status), Juonala et al. [68] reported approximately 14% of thevariance in adult compliance could still be explained by a child’s calculated risk score.A large portion of the variance in adult compliance can be explained by adult risk factorstherefore, the authors surmised that a partial link between childhood risk factors andadult compliance is likely due to the significant tracking of risk factors from childhood toadulthood. Yet, a substantial relationship independent of adult risk factors still exists,thus providing evidence that there is a direct link between childhood risk factors andadult compliance status [58, 68].2.5.1 Weight Status: Current Status among Youth and Tracking to AdulthoodRegardless of measurement technique, sample population, or definition ofoverweight and obesity, investigations continue to demonstrate a rise in the prevalenceand degree of excess adiposity levels among Canadian youth [1, 3, 69-71]. He andBeynon [71] determined the BMI values for children in grades one to six who attended11 different elementary schools in the south Ontario area. They classified the BMIresults into overweight and obese categories based on two different classificationmethods: the United States Centers for Disease Control and Prevention body massindex-for-age references and Cole’s international BMI references [72]. Both methods ofclassification resulted in similarly high prevalence rates for overweight and obesityamong male and female elementary school children with approximately 25% of childrenfalling in the unhealthy weight categories. Canning et al. [69] compared the prevalenceof overweight and obesity among Newfoundland and Labrador preschool children bornin 1984 and 1997 and found those children born in 1997 were significantly more likely tobe overweight or obese than those born in 1984 suggesting that monitoring weight28status should begin before the age of three. Tremblay and WilIms [3] showed increasesin overweight and obesity in Canadian boys and girls ages 7 to 13 years. From 1981 to1996 the percentage of boys and girls classified as overweight increased from 11 % to33% and 13% to 27% respectively. The prevalence of obesity during the same timeperiod rose from 2% to 10% in boys and from 2% to 9% in girls. Not only is there anincreasing prevalence of Canadian children with BMI values in overweight and obesecategories, there is also an increased proportion of children in the higher BMIcategories. In addition, there is also a more drastic rise in the rate of increased obesityprevalence among children than adults [3]. These trends are of particular concernbecause excess adiposity has been demonstrated to track from youth to adulthood,thus the prevalence of obesity in the adult population of Canada is set to becomeprogressively more obese in the future [73-75].Reasons for Canada’s rise in overweight and obesity are unclear. Yet, theyappear to be multifaceted and are thought to be in part, a result of decreases in physicalactivity level. In fact, in Canadian children aged 7 to 11 years, participation inunorganized sport was negatively associated with overweight and obesity and thebenefit of participation in unorganized sport increased with age [76]. Conversely, whileparticipation in organized sport was also negatively associated with overweight andobesity, this benefit decreased with age. The contribution of physical inactivity tounhealthy weight status was examined by determining time spend viewing television,and playing video games. These activities were significant risk factors for overweightand obesity. Two hours of television viewing per day appeared to be a threshold foroverweight status while three hours per day was a threshold for obesity. In theirinvestigation, Tremblay and WilIms [76] also considered family backgroundcharacteristics (i.e., socioeconomic status (SES) and one or two parent family). Theyconsidered these characteristics to be partially overlapping risk factors in as much asSES and family structure were both significantly related to overweight and obesity. Yet,the relationships between high weight status, unstructured physical activity participationand television viewing totaling less than two hours per day were maintained across alllevels of SES. Furthermore, participation in unstructured physical activity resulted in thesame decrease in the likelihood of having an unhealthy weight as from the associationbetween high SES and decreased risk for overweight and obesity [76].29Paradoxically, when Eisenmann [77] conducted an investigation compiling datafrom several large-scale US and Canadian studies he found that self-reported Canadianphysical activity levels had increased between the years 1981 and 1988 and remainedsteady between the years 1988 and 1998. Explanations for the seemingly contradictorydata (i.e., increases in weight status without parallel decreases in physical activity) maybe the result of using self-reported physical activity questionnaires. Measurementerrors could be the result of respondent bias towards an over-estimation of actualphysical activity levels or due to inaccuracies in memory recall [77]. Another possibleexplanation for the increase in weight status without an apparent decrease in physicalactivity is an increase in energy consumption. Yet according to US data, this is not thecase. However, as with the physical activity data, Eisenmann [77] reported that theinvestigations on dietary intake and composition also used self-reported measureswhich were prone to the same limitations as the physical activity questionnaires.Namely, questionnaires lack a gold standard against which their validity may becompared [78].2.5.2 Weight Status: MeasurementAnthropometric measurements such as BMI and WC are often used as indicatorsof overall and central adipose tissue respectively. These measurement techniques aresimple and are easily employed in large sample sizes making them practical and thusfrequently utilized for population-based investigations of overweight and obesity.Due to the nature of anthropometric measurements, BMI and WC measurementscannot discern between fat mass and fat free mass and they are notdirect measures ofbody adiposity rather, they are indicators of adiposity. There is potential for a child whois heavy due to increased amounts of fat free mass to be mistakenly classified ashaving a BMI in the overweight or obese category. Likewise, a ‘normal’ weight childwith unhealthy amounts of fat but perhaps low fat free mass may be mistakenlyclassified as of ‘normal’ or healthy weight. In addition, different racial groups have beenfound to have different amounts of fat mass than Caucasian individuals forthe sameBMI values. For example, certain groups of Asians, tend to have higher fat mass foragiven BMI compared to their Caucasian peers [79]. Despite this, the World HealthOrganization maintains their recommendation of BMI cut-off points corresponding to25 kg/m2for overweight and 30 kg/m2for obesestating that:30The purpose of a BMI cut-off point is to identify, within eachpopulation, the proportion of people with a high risk of anundesirable health state that warrants a public health orclinical intervention. When applied to a population, thepurpose of anthropometric cut-off points is to identifyindependent and interactive risks of adverse health outcomesassociated with different body compositions...” [80].Therefore, the precise determination of percent body fat is not necessary for thesepurposes [81].There is substantial evidence to indicate that children and adolescents classifiedas overweight or obese are in fact at higher risk for a variety of health problemsultimately leading to increased risk of morbidity. Research also suggests that ifanything, the use of BMI as a diagnostic tool underestimates the presence of obesitybecause while the chances of obtaining a false positive (i.e., the chance of incorrectlyclassifying a child as having an obesity-related health risk when they really do not) arelow, the chances of obtaining a false negative are moderate to high, meaning that theremay be children who have an obesity-related health risk yet are not classified as such[81]. Therefore, despite possible limitations, BMI has demonstrated extensive validity inthe detection of health risk associated with overweight and obesity in both adults andyouths [81-88]. Similarly, WC is a valid indicator of abdominal adipose tissue and hasalso demonstrated utility in the detection of risk factors [83, 85, 88-90]. Lemieux et al.[85] investigated the validity of using WC as a measure of visceral adipose tissue bycomparing WC measurements against abdominal computerized tomography scans.They found WC measurements to be significantly correlated to and predictive of visceraladipose tissue independently of BMI and age in both men and women. Han et al. [89]found WC measurements to have high sensitivity (i.e. low false positive) and specificity(i.e. low false negative) in detecting men and women with high BP as well as total andhigh density lipoprotein cholesterol. Waist circumference has also been established asa predictor of health risk in children and for a given BMI category (normal weight,overweight or obese) children with higher WC measurements are more likely to have anincreased number of health risk factors [90, 91].2.5.3 Relationship to EMSRecently, adiposity assessments (sum of skinfolds, BMI, WC) havedemonstrated relationships to movement skill capability in both children and31adolescents. McKenzie et al. [92] showed an inverse correlation wherein male andfemale children’s ability to balance and jump decreased as their sum of skinfoldmeasurements increased. Additionally, Okely et al. [16] determined overweight youth(classified by BMI values) to be several times less likely to exhibit an advanced level ofFMS proficiency when compared to their non-overweight peers. Waist circumstancemeasurements were also shown to increase with a decreasing capability in running,catching, throwing, striking, and kicking, irrespective of gender. Further, children whoare overweight perceive themselves as less skilled then their leaner peers [18] and self-perception in physical skills is a possible determinant of participation in physical activity[93].2.6 Indicators of Health and Fitness: FitnessMusculoskeletal and cardiorespiratory fitness are commonly used healthindicators and both of these forms of fitness are associated with health status in adults[94, 95]. Low musculoskeletal fitness (grip strength, sit-ups, and vertical jump), ispredictive of disease, disability and all-cause mortality while overall fitness(cardiorespiratory and musculoskeletal) has been found to account for 11 to 30% ofadult metabolic risk factors for coronary heart disease [95].Among Canadian males and females, musculoskeletal fitness has been linkedwith an increased risk of early mortality. In particular, after controlling for covariates(age, smoking, weight, WC and aerobic fitness) progressively lower levels of abdominalendurance (i.e., number of sit-ups performed in 60 s) were associated with aincreasingly higher risk of mortality in both men and women [94]. The authors proposedthat the reason for such an association could be due to the relationship betweenstrength and skeletal muscle mass or simply a result of sufficient strength for themaintenance of independent living. Much more information is needed regarding therole of musculoskeletal fitness in either reducing or preventing the development ofarterial stiffness and high weight status especially when one considers the moderatelystable tracking of musculoskeletal fitness items (including sit-ups, push-ups, and gripstrength) from youth to adulthood [96, 97]. For these reasons, children’smusculoskeletal fitness levels should be given appropriate consideration for theirpossible role in the maintenance of health.32The relationship between higher levels of cardiorespiratory fitness and greaterhealth is consistently indicated throughout the literature in both children and adults [7,95, 98-101]. An investigation conducted by McGavock et al. [101] shows greaterarterial compliance among individuals with greater levels of aerobic fitness. Adult maleand female participants were distributed among three groups (sedentary, physicallyactive and endurance trained) according to their self-reported physical activity levels.Aerobic fitness, as indicated by a maximal oxygen consumption test (known as VO2maxor maximal aerobic power) performed on a cycle ergometer, was significantly higherwithin the physically active group compared to the sedentary group and higher stillwithin the endurance trained compared to the physically active group. Controlling forrelated variables such as age, BMI and serum triglycerides, pulse wave analysisconfirmed the association between cardiorespiratory fitness level and arterialcompliance. While participants in the physically active group had compliancemeasurements that were higher than the sedentary group, the endurance trained grouphad significantly higher compliance measurements than both of the lower fitness groupssuggesting that in particular, frequent vigorous physical activity is associated withconsiderably improved vascular health measures. As in adults, there is a significantcorrelation between a child’s vascular health profile and a child’s fitness level [7, 95]. ACanadian investigation looked at children aged 9 to 18 years old and foundcardiorespiratory fitness (measured as physical working capacity on a progressive cycleergometer test) to account for 11 to 30% of the variance in risk factors for developingcoronary heart disease [95]. In a recent investigation conducted as part of the ActionSchools! BC program, a positive correlation was identified between children’s large andsmall artery compliance and aerobic fitness [7]. Reed et al. [7] showed increasedcompliance measurements to be associated with higher fitness levels in both male andfemale children aged 9 to 11 years old. Moreover, it has been shown that the unhealthyvascular profiles of children and adults can be partially reversed with an increase incardiovascular fitness [99, 102].The cardiorespiratory fitness of children and adults is associated with reducedabdominal adipose tissue and abdominal fat, independent of risk predicted by BMI andmay counteract excess adiposity-related risk factors [5, 6]. As part of the 1981 CanadaFitness Survey the cardiorespiratory fitness, WC, skinfolds and BMI of men and womenwere assessed. Participants were separated into quintiles according to their maximal33aerobic power score as measured indirectly from a submaximal exercise step test(Canadian Aerobic Fitness Test). The two upper (high fitness) and the two lower (lowfitness) quintiles were used in the analysis. Independent of age, both men and womenin the high fitness groups had lower measures of adiposity than those in the low fitnessgroups. More specifically, for a given BMI those in the high fitness groups had lowersum of skinfold and WC measurements than those in the low fitness groups. Thesefindings demonstrate a means by which cardiorespiratory fitness decreases the healthrisk associated with obesity as both total and abdominal adiposity are reduced inpersons with moderate to high cardiorespiratory fitness levels [6]. Similar results havealso been found among overweight and obese children in Greece [5]. Children aged 6to 13 years had skinfold, height and weight measurements taken to determine percentbody fat and BMI scores, respectively. The 20 m shuttle-run was used as an indirectmeasurement of Maximal aerobic power for the evaluation of cardiorespiratory fitness.Children were classified by gender before being further divided into two groups(nonoverweight and overweight/obese) according to age- and sex-specific BMI scores.Children were also grouped into quintiles according to age- and sex-specificcardiorespiratory fitness scores. Individual characteristics such as height and age werenot significantly different between the nonoverweight and overweight obese groups oramong the fitness quintiles. The results were consistent in all cases for males andfemales alike and for those categorized as either nonoverweight or overweight/obese,children in the higher fitness quintiles had statistically lower body fat (as indicated byskinfolds measurements and calculated percent body fat) than children in the lowerfitness quintiles. As in the adult population investigated by Ross and Katzmarzyk [6],the authors of the aforementioned investigation concluded that cardiorespiratory fitnessalso partially attenuates the health risk associated with overweight and obesity within apediatric population [5].While greater cardiorespiratory fitness is associated with lower measures ofadiposity regardless of weight status, improvements in fitness have resulted in positiveeffects on the vascular profiles of children [99, 100]. Woo et al. [99] found that thevascular dysfunction (as indicated by the response to reactive hyperemia and arterialintima-media thickness) of overweight and obese children can be somewhat reversedwithin six weeks with a combination of diet and exercise. Woo et al. [99] employed acombination of aerobic (lasting 10 minutes) and resistance (circuit style lasting 3034minutes) exercise training which the participants performed twice a week for six weeks.Vascular health was further improved with the continuance of a follow-up exerciseprogram performed once a week for one year [99]. Watts et al. [100] found similarresults among obese children after an eight week aerobic exercise program comprisedof various physical activities including games requiring continuous play. Male andfemale obese (defined by age- and sex- specific cutoffs) participants who averagedbetween eight and nine years of age were investigated along with a group of lean maleand female control participants. Body composition was assessed through the use ofskinfold measurements along with BMI. Changes in fitness levels were determined bycomparing pre and post heart rate responses to a submaximal exercise cycle test.Vascular function was evaluated by flow-mediated dilation in response to reactivehyperemia. At baseline, obese participants displayed significantly lower vascular healthmeasures compared to the group of lean control participants. Upon completion of theeight week exercise program the obese children had significantly improved theirvascular function. Notably, improvements in vascular health were found withoutcorresponding improvements in skinfold or BMI measurements. Built into the studydesign was the assessment of variables after an eight week period of detraining.Importantly, the vascular improvements attained after eight weeks of training were notmaintained upon cessation of exercise. Thus, it would appear that physical activitybehaviour needs to be continued in order to maintain the associated health benefits[100].Despite the fact that risk factors for adult health status have their antecedents inchildhood, only a minimum number of investigations have examined health indicatorsusing child participants. Given the level of influence held by cardiorespiratory fitnessover various health indicators (e.g., BP, arterial compliance and weight status) [5-7, 99-102] and its relation to mortality [94, 95] cardiorespiratory fitness is clearly establishedas an essential component to the investigation of health and fitness.2.6.1 Fitness: Current Status among Youth and Tracking to AdulthoodResearch conducted on the temporal trends of children’s musculoskeletal fitnessand on the tracking of musculoskeletal fitness from childhood to adulthood is sparse.Certain musculoskeletal fitness items in childhood have shown significant tracking toadulthood. Grip strength and sit-ups were shown to track in male and female children3510, 11 and 12 years to 35 years old [97]. Between all age ranges (10 to 35, 11 to 35,and 12 to 35 years of age) female grip strength (absolute and relative to body mass)tracked significantly displaying moderate correlations which increased as the baselineage of the child increased. That is to say, the correlations between childhood and adultgrip strength became progressively higher across the 10 to 35, 11 to 35, and 12 to 35age ranges. In males, absolute grip strength in all childhood ages was also significantlycorrelated to adult absolute grip strength and demonstrated the same trend ofincreasingly higher correlations across the age ranges as the female data. However,male grip strength relative to body mass had the reverse trend of progressively lowercorrelations across the 10 to 35, 11 to 35 and 12 to 35 age ranges. In addition, thecorrelations between child and adult grip strength relative to body mass wereinsignificant in males. Results from the data tracking childhood sit-up performance toadulthood sit-up performance showed significant correlations across all age ranges infemales. The age ranges of 11 to 35 and 12 to 35 years demonstrated significantcorrelations in males [97].More information exists on the status and tracking of children’s cardiorespiratoryfitness. Alarmingly, the cardiorespiratory fitness levels of children and adults aredeclining throughout developed nations [2, 4]. A comprehensive investigation compileddata collected from fifty-five investigations conducted in eleven different countriesworldwide on the 20 m shuttle run performance in youth between the years 1980 and2000 [2]. Results from Tomkinson et aI.’s [2] review indicated that the vast majority ofchildren had cardiorespiratory fitness levels which were increasingly lower than theirpredecessors. While there was a fair degree of variability according to country,children’s mean performance (all age groups 6 to 17 years old combined) on the 20 mshuttle run decreased over a twenty year period (with the exception of girls in NorthIreland and Greece and boys in Belgium whose performance increased over the sametime period). The rate at which shuttle run performance decreased per year inCanadian children was roughly -0.7% in boys and -0.5% in girls. When data wasanalyzed by rate of performance change according to age groups results were lessvariable, children’s performances decreased -0.5 to -0.3% per year while adolescents’performance decreased approximately -1.0% per year [2]. A more recent investigationconducted by Reed et al. [4] as part of the Action Schools! BC program compared thechange in cardiorespiratory fitness of Canadian children between the years 1981 and362004. As in Tomkinson et al’s [2] meta-analysis, Reed et al. [4] also used children’sshuttle run performance as an indicator of cardiorespiratory fitness. Maximal aerobicpower scores achieved by children in a separate investigation conducted in 1981 usingidentical protocols were compared to the scores achieved by the same age (9 to 11years) and sex of children in Reed et al.’s [4] 2004 investigation. Using an equationwhich incorporated the child’s age and maximal running speed attained during theshuttle run test, maximal aerobic power was indirectly determined. For all ages (9, 10and 11 years) the estimated maximal aerobic power of both boys and girls in 2004 werefound to be significantly lower than the estimated maximal aerobic power of boys andgirls in 1981. Data from the two investigations were also compared according to thepercentile norms respective to children in 1981 and 2004. Results indicated that a boywho scored in the50thpercentile for aerobic fitness in 2004 would have only scored inthe14thpercentile in 1981. Similarly, a girl who scored in the50thpercentile in 2004would have scored in the 23 percentile in 1981. This is an indication of a decrease inhealth-related fitness. Combined data from boys and girls indicate that overall, childrenmeasured in 2004 had aerobic fitness performances which decreased by approximately30 centiles over a twenty-three year time period [4].The trend of declining cardiorespiratory fitness among children is of concernbecause children’s aerobic fitness has been shown to track from childhood toadolescence and from adolescence to adulthood [103, 104]. At baseline boys aged 8 to12 years and girls aged 7 to 11 years had their aerobic fitness assessed through directmaximal aerobic power measurement on a cycle ergometer [104]. Maximal aerobicpower scores were re-measured once a year for five years. While correlations betweenbaseline fitness levels and follow-up measurements decreased as the period of timebetween measurements increased, there remained low to moderate tracking of fitnessfor boys and girls throughout the five year investigation period [104]. Malina [103]considered the information available on the tracking of cardiovascular fitness and foundmoderate correlations between childhood and adolescent fitness and also betweenadolescent and adulthood fitness to be prevalent throughout the literature.2.6.2 Fitness: MeasurementChildren’s cardiorespiratory fitness is often measured indirectly via the Leger[105] 20 m shuttle run test. Two lines are marked-off 20 m apart. Participants run back37and forth between the two lines to the pace set by a compact disc which initially starts ata running speed of 8.5km/hr and increases in speed every minute by 0.5km/hr.Participants continue running back and forth between the 20 m lines for as long aspossible until they are unable to keep pace with the compact disc recording or untilvolitional fatigue. A researcher records the final number of laps completed by eachparticipant. The speed corresponding to the final lap number is then entered into anequation to indirectly assess the participants’ maximal aerobic power. This has shownto be a valid and reliable method in the estimation of maximal oxygen consumption inboth adults and children [105-108]. The original protocol for Leger’s 20 m shuttle runwas conducted using time increments of 2 minutes where the elapsed time betweeneach beep noise decreased every two minutes. However, in subsequent investigations,Leger & Lambert determined that using time increments of only 1 minute demonstratedsavings in administrative time and increased motivation with school children. Whiledirect assessment is always preferred it is not always practical. Such is the case wheninvestigating larger groups and in particular, larger groups of children. Performingmaximal aerobic power tests in a laboratory on a treadmill or cycle ergometer is timeconsuming and expensive. Also, when considering the practicality of investigatingschool-aged children it often becomes necessary to evaluate the children during theschool day and on the school grounds making a valid and reliable field test such as the20 m shuttle run the measurement of choice. The 20 m shuttle is advantageous in theinvestigation of children’s cardiorespiratory fitness because it can be implementedindoors (in a school gymnasium) or outdoors, is a progressive maximal test and thusresembles standard direct measurements of maximal aerobic power testing, is easy toadminister and is able to maintain child motivation [108]. Validation studies have foundthe 20 m shuttle run to have consistently high correlations with directly measuredmaximal aerobic power scores.2.6.3 Fitness: Relation to FMSOur knowledge is minimal regarding the relationship between FMS proficiencyand fitness. Musculoskeletal fitness has not been examined in relation to FMSproficiency. It is possible that musculoskeletal fitness is associated with the proficientperformance of movement skills because greater muscular fitness is achieved throughthe engagement of proficient movement skills. However, the current literature has not38given attention to the nature or direction of this potential relationship. Okely et al. [11]have shown that FMS may play a potentially important role in promotingcardiorespiratory endurance among adolescents in grades 8 and 10. Skill in runningand throwing demonstrated the greatest correlation between FMS proficiency andfitness in girls, while kicking (followed by running) produced the greatest correlation inmales. Overall, male students exhibited superior proficiency in FMS in comparison tofemale students. However, Okely et al. [11] suggest there may be a gender bias infavour of male students due to the particular skills investigated. Further examinationinto the role that FMS plays in cardiorespiratory fitness levels of children is clearlywarranted.2.7 General Limitations of Previous LiteratureA select number of investigations suggest that certain types of movement skillcapabilities may account for the variance in weight status and fitness among youth [11,16, 109]. However, this concept has been examined in a limited number of populationsand there has been little consistency in the selection of fundamental motor skillsanalyzed. In addition, an emphasis on the use of product-orientated assessment toolsand measurement protocols (versus process-orientated measurement) has beenevident. Product-orientated analysis does not allow for a description of movement skillperformance rather, it is limited to providing only the end result of a performance with noreference to the manner in which the performance result was attained. Take, forexample, an assessment of a child’s running skill. A product-orientated analysis woulduse running speed or running distance as the outcome variable. As a result, noinformation regarding the behavioural characteristics of the skill is gained. In contrast, aprocess-orientated measurement would be an evaluation of the movementcharacteristics the child performs while he or she is running (e.g., does the child’s armsmove in opposition to his or her legs and along the sagittal plane? Is there a definiteflight phase?). The inability to compare investigations employing product-orientatedassessments to those using process-orientated measurements is apparent and resultsin difficulties when attempting to establish a clear picture of EMS proficiency amongchildren.Motor behaviour researchers commonly employ process-orientated assessmenttools because they provide information regarding a child’s behavioural characteristics.39The Test of Gross Motor Development (TGMD) is an accepted evaluation tool whichanalyzes movement skills from such a perspective. The TGMD is a convenient methodof assessing children’s motor development because it can be easily employed in a fieldsetting. The behavioural components assessed by the TGMD generally indicate amature movement pattern [110]. However, the TGMD has its limitations. First, eachskill is only evaluated according to three or four criteria. While evaluating only a fewbehavioural components simplifies testing protocols, other movement characteristicsare not assessed. Second, there is no scale for which behavioural components aregraded, they are evaluated as either being present or absent from the child’sperformance. This method does not place skills along a continuum of development.This severely diminishes the amount of information that can be learned from theassessment because children are simply classified as either having obtained or havingnot obtained a mature movement pattern. This method of evaluation does not describethe skill level of the children who have not yet obtained a mature movement pattern. Asa result, no distinction is made between those children who are close to a maturepattern and those who may be developmentally delayed [111]. Third, evaluation isperformed via visual observation. The visual observation of a child’s performance canlead to two methodological problems. If the observation occurs in real time while thechild performs the skill (i.e., the performance is not video-taped for repeated viewing),extraneous aspects of a child’s performance may distract the observer from otherimportant characteristics of the behaviour. Or, the observer may simply miss keycomponents of the performance. Video taping skills as they are demonstrated canalleviate this problem by allowing the observer to spend more time assessing the skill.However, the skills are still assessed through visual observation and thus have limitedobjectivity. Despite good intentions, an observers’ assessment may be clouded bypersonal bias. In addition, it is difficult to determine the accuracy of joint angles whichare measured via visual observation.Okely etal. [11, 16, 17] have examined the relationship between FMS and bodycomposition, cardiorespiratory fitness, and physical activity. In comparison to otherresearch [92, 109, 112], Okely et al. [11, 16, 17] employed more FMS items in theirassessment. Utilizing six FMS measures, including locomotor (sprint run and verticaljump) and manipulative (catch, kick, over arm throw and forehand strike) movementskills, they were able to provide a more informative picture of this relationship in40comparison to other investigations. However, Okely et al. [11, 16, 17] based theirassessments on observational checklists which contained only a handful of behavioralcomponents (usually four to six items). While this allowed for greater ease of useduring observations, important process characteristics of a skill were not assessed.The cardiovascular measurements employed by Okely et al. [11, 16, 17]consisted of standard measurements: BMI, WC, physical activity questionnaires andmaximal shuttle run. While our investigation will include similar measurements we willalso assess BP and arterial compliance. The assessment of arterial compliance is anovel aspect of the proposed investigation. Arterial compliance has been establishedas an important tool for the detection of health risk before the appearance of high BPmeasurements [57]. Despite its significance as a preventative tool, few studies haveused arterial compliance to assess a childhood population. Our investigation of BP,arterial compliance, weight status and fitness measurements combined with ourmovement skill assessment items will provide a better understanding of the relationshipbetween movement skill proficiency and indicators of health and fitness.41CHAPTER III: METHODOLOGY3.1 ParticipantsA sample of 162 boys and girls (ages 8 to 11 years) were recruited from threeschools in the Burnaby and Vancouver School Districts. All participants were part of thefull evaluation component of the Action Schools! B.C. Program (AS! BC). Informedconsent (refer to Appendix A) was received from 91 female (mean age = 10.0 yrs, SD =0.6) and 71 male (mean age = 9.9 yrs, SD = 0.6) students enrolled in schoolsimplementing the AS! BC program. The investigation was carried out according toethical guidelines set by the University Clinical Science Screening Committee forresearch involving human participants.3.2 ProcedureAll data was collected on three separate days at the participating elementaryschools (see Figure 3.00). On Days I and 3, children were temporarily excused fromtheir classrooms and brought into the school’s gymnasium in groups of approximately 8to 10 children. On Day 2, children were temporarily excused from their classrooms twoat a time. Day I consisted of weight status measurements, Day 2 entailed BP andarterial compliance measurements and Day 3 consisted of musculoskeletal fitness,cardiorespiratory fitness and FMS assessments.3.2.1 Day 1: Weight Status MeasurementsThe first day of assessments were comprised of weight status measurements.Measurements of weight and WC are potentially sensitive issues with some children.To help alleviate any emotional anxiety which children may experience during thesemeasurements, each child had his or her weight status taken individually to ensure thatthe child’s privacy was respected. These measurements took approximately 30minutes per group.Day2:Day1:BloodPressureDay3:WeightStatusandArterialFitnessandFundamentalMovementSkillCompliancePre-testMusculoskeletalEMSCardiorespiratoryScreeningFitnessFitness1.Height1.Blood1.Blood1.SitandReach1.Run1.ShuttleRun2.WeightPressurePressure2.GripStrength2.Skip3.Waist2.Arterial3.Push-ups3.HopCircumferenceCompliance4.Curl-ups4.VerticalJump5.HorizontalJump6.Jumpfroma HeightFigure3.00DayI-3Health,FitnessandFundamentalMovementSkillProcedure-433.2.2 Day 2: Blood Pressure and Arterial ComplianceAssessmentsThe second day of measurement was comprised of BP and arterial complianceassessments. Arterial compliance and BP measurements were taken on aseparateday from the fitness and EMS testing to ensure thatarterial compliance and BPreadings were not influenced by prior physical activity.Each child was required to restquietly in a supine position for five minutes before arterialcompliance and BP readingswere taken. Blood pressure readings were obtained inconjunction with the arterialcompliance measurements. As such, the recorded BP readings weretaken from asupine position. These measurements tookapproximately 10 minutes per group of twochildren.3.2.3 Day 3: Fitness and Fundamental Motor Skill AssessmentsMusculoskeletal fitness, cardiorespiratory fitness and EMS were assessedon thethird day of testing. Seated BP measurements were taken prior to the fitnessand EMSassessment to screen for children who had resting BP abovetheg5thpercentile(120/80). As a precaution against an unsafe rise inBP during the fitness assessmentsthese children were excluded from the fitness and EMS testing. Musculoskeletaltesting(i.e., push-ups, curl-ups, sit and reach, and grip strength) were conductednext, followedby the EMS assessment (i.e., run, skip,hop, horizontal jump, vertical jump, and jumpfrom a height). It was necessary to conduct the EMS assessment prior tothe shuttlerun to minimize the effects of fatigue on movement skill proficiency. Theshuttle runwas conducted last, allowing for the greatest amount of time to rest between themusculoskeletal items which require maximal physical exertion, and the maximal effortshuttle run. Together, these assessments took approximately one hour per group of 8to 10 children.3.3 Cardiovascular Disease Risk Assessments3.3.1 Blood Pressure and Arterial ComplianceFrom a supine position, BP was taken using an automatic sphygmomanometer(left arm). Arterial compliance was measured using radialapplanation tonometery (rightwrist) (Hypertension Diagnostics/PulseWave CR — 2000 CVProfilor).The radial arterialwaveform was obtained simultaneously with BP readings from the left arm. Thisnoninvasive technique allowed for the indirect assessment of endothelial function.Small44artery (ml/mmHg x 10) and large artery (ml/mmHg x 100) indices were used for entryinto the multiple regression analysis. Systolic and diastolic BP measurements wereused in the analyses.3.3.2 Weight StatusHeight (cm) was measured (to the nearest 0.01 cm) by applying gentle upwardpressure on the base of the mastoid process. Weight (kg) was measured (to thenearest 0.01 kg) using an electronic scale (SECA, Germany). Two measurements ofheight and weight were averaged for analysis. Body mass index (kg/rn2)scores werederived from those measurements. Waist circumference was determined bymeasurements taken at the level of noticeable waist narrowing using an anthropometricgirth tape [113]. Two measures were averaged for analysis.3.3.3 Musculoskeletal FitnessGrip strength, push-ups, curl-ups and sit-and-reach comprised themusculoskeletal fitness components of this investigation. These items are typicallyused to assess muscular fitness and were chosen based on their previously establishedrelation to health indicators [94]. The assessment protocols were modified versions ofthose described by the Canadian Society for Exercise Physiology [113]. Children wereasked to complete as many push-ups and curl-ups as possible and the total number ofpush-ups and curl-ups was entered for data analysis. Maximum grip strength wasdetermined by summing the maximum score from the greater of two trials of the rightand left hand. Sit-and-reach scores (cm) were determined by the maximum distanceover two trials. Maximum grip strength and sit-and-reach scores were used in theanalyses. General descriptions for each musculoskeletal test are provided below. Fora detailed description of the testing instructions refer to Appendix B.Curl-ups were measured by having the children lie on their backs with theirknees bent to 90° and their feet flat on the floor. They were then asked to stretch theirhands down towards their feet until the tips of their middle fingers were touching themarker. The children were asked to curl their head, neck and shoulders up off of themat while reaching their hands along the mat towards their feet until their middle fingerstouched the marker. They were then instructed to curl back down until their head once45again touched the mat. Each curl-up was performedto the sound of a metronome setto4Obpm.Push-ups were measured by having the children lie on theirstomachs with theirlegs straight and feet together. Their hands wereplaced just outside of their shoulderswith their fingers pointing forward. Children started from an ‘up’ positionwith theirelbows straight and body up off the mat. Usingtheir feet as a pivot point, they werethen instructed to bend their elbows to lower their body downuntil their elbows werebent to900before pushing their body back up until their elbows were once againstraight.To measure grip strength, children were asked tostand holding a dynamometer45° out from the side of their body. They werethen asked to squeeze the dynamometeras hard as they could. This was performed twicefor each hand, alternating betweenhands.Finally, sit-and- reach was measured by asking the children to removetheirshoes and sit facing the sit- and- reach box withtheir legs straight in front of them andsoles of their feet placed flat on the sit- and-reach box. They were then instructed toplace one hand on top of the other and push thesliding block as far forwards aspossible with their finger-tips.3.3.4 Cardiorespiratory FitnessCardiorespiratory fitness was assessed using Leger’s20 m shuffle run, which isa maximal progressive exercise test [105]. Participants are askedto run back and forthbetween 20 m markers keeping pace with a ‘beep’noise recorded on a compact disc.The time between beeps decreased every minute (referred to as‘stages’) such that itbecame progressively more difficult to maintain running pace.This test has shown tobe a valid and reliable test of cardiorespiratoryfitness [105] and has been usedextensively with children [2, 105]. The total number of laps corresponds to aparticularstage which in turn corresponds to the child’s maximal runningspeed. Final runningspeed can be entered into a regression equation VO2max= 31.025+(3.238*speed) -(3.243*age)+(O.1536*speed*age)to produce an indirect measure of maximal oxygenuptake (VO2max mI/kg/mm) [105].463.4 Fundamental Movement Skill AssessmentParticipants were required to perform six EMS: running, skipping, hopping on thespot, vertical jumping, horizontal jumping, andjumping from a height. Althoughparticipants were assessed in groups of approximately ten or less, each child performedthe required locomotor skills individually. All children in the group executedone skillbefore moving onto the next. Each child was assigned a number and the childrenperformed the first FMS in numerical order. However, for each successive skill, thechildren’s order of performance was rotated such thatwhichever child was first toperform the previous skill was the last to perform the followingskill. This was done tominimize the influence of learning effects.Unlike previous investigations [11, 16-19, 92, 109, 114, 115], the performance ofFMS was captured by two video cameras and videotapedfor later analysis. Refer toFigure 3.01 for a schematic of the experimental set-up. A camera was placed attheend of a 10 m lane (which was marked on the floor) to capture a frontview, and asecond camera was placed perpendicular to the lane to capture a side view. The sidecamera was set-up in such a manner as to ensure that themiddle 8 m of the 10 m lanewas captured on videotape. A 1 m x 1 m square was outlinedin the centre of the 10 mlane to mark the performance area for the jumping and hoppingskills. The I m x I msquare also provided a visual marker for the calibration of siliconCOACH Pro softwarefor further data analysis. The following are specific instructions for the performance ofeach skill.For the running skill, each participant was instructed to run in a straight line downthe 10 m lane. The experimenter instructed the children that it was not a race and theydid not need to run as fast as possible. Instead, the childrenwere instructed to run asthey normally would on the playground during recess. Each child began at the start lineand ran towards the end camera until reaching the end line.For the skipping skill, each participant was asked to skip in a straight line downthe 10 m lane to the best of his or her ability. Each child began at the start line andskipped towards the end camera until reaching the end line.Start Line:RunningSkippingEnd Line:Run ningSkippingEndCamera47im xlm Square:Hopping, Horizontal Jumping,Vertical Jumping, Jumping from a Height4lflmLaneSideCameraFigure 3.01 Schematic Diagram of Experimental Set-Up48Hopping was assessed by asking the participant to stand in the middle of the I mx I m square facing the side camera. He or she was then asked to hop fiveconsecutive times on one foot followed by five consecutive times on the other foot whileremaining in the square.For horizontal jump, children started with their toes on a line marking one edge ofthe square. Each child was asked to perform a big jump towards the front view cameraby taking-off and landing on two feet.For vertical jump, children stood in the middle of the marked square facing thefront view camera. The participant was then instructed to jump and ‘try to touch the sky’with one hand by taking-off and landing in the middle of the square with two feet.Jumping from a height was assessed by having the participant stand on a 30 cmhigh block facing the front view camera. From this position, the child was asked to jumpdown from the bench so that they landed with both feet in the area of the square.3.5 Analysis of Fundamental Locomotor SkillsTo determine level of skill proficiency, the videotaped performances wereanalysed via video analysis software (siliconCOACH Pro) and a coding systemspecifically designed for this investigation.SiliconCOACH Pro software was used to determine ankle, knee, hip and elbowjoint angles from the side view video images while the degree of lateral movement ofthe arms, legs, and trunk was determined from front view images. A coding system wasthen employed to determine level of movement skill proficiency (see Tables 3.00 to3.05). The coding system includes a checklist of 30 behavioural characteristics perlocomotor skill. The checklist items are based on the process characteristics displayedduring varying stages of motor skill acquisition as previously described indevelopmental sequences provided in the literature [24, 34, 35, 45, 93, 116-121]. Eachlocomotor skill checklist has ten behavioural components, referred to as ‘criticalelements’. Each critical element has items regarding performance technique. A child’slevel of proficiency for each item was given a score ranging from 1 to 3 based on thecorresponding description. Skills were assessed for each critical elementand gradedfrom I to 3 with 1 representing characteristics of immature or elementary movementpatterns and 3 representing characteristics of mature or advanced movement patterns.Scores of 0 refer to the demonstration of alternative behavioural characteristics that49Table 3.00 Proficiency Assessment: RunningIdeal: Participant exhibits a definite flight phase with legs driving forward along the sagittal plane, fullyextending in the air. The thigh approaches the horizontal on the forward drive while the rear footapproaches the level of the buttocks upon recovery. Landing is on metatarsal arch. Arm movementsare in opposition of legs and drive along the sagittal plane with wrists reaching up to shoulder level onthe forward swing and hip level on the back swing. Arms are held in an adducted position with elbowsflexed at approximately 90°.Critical Description of Movement Pattern Measurement Notes ScoreElement 13Arm Drive 0=Unclassifiable movement. Front View. Measured via1 =Minimal and stiff movement of arms. visual observation. Score of2=Arms move along the oblique plane and 3 measured from verticalmay or not cross the body midline, line down from shoulders3=Arm movement drives along the sagittal and compared to the upperplane. Wrist reaches up to shoulder level and and lower arm.back to hip.Arm 0=Unclassifiable movement. Front View. Measured viaPlacement 1=Arms are held in an abducted position visual observation. Score ofthroughout arm swing. 3 measured from angle2=Arms move from abducted to adducted between vertical line downpositions throughout arm swing. from shoulders and upper3=Arms are held in an adducted position arm at two points duringthroughout arm swing (1 0° out from arm swing: forward andshoulders). back.Elbow 0=Unclassifiable movement. Side View. Measure angleFlexion 1 =Elbow flexion is a combination of too between shoulder and wristextended (>105°) and/or too flexed (<75°) at two points during armsduring the entire arm swing. swing: forward and back.2=Elbow flexion is inconsistent (elbow mayflex on forward swing and extend on backswing). However, at least half of the armswing (either the forward swing or the backswing) must have an elbow flexion between75° - 105° (otherwise score 1).3=Elbow flexion is held at between 75° - 105°during both the forward and back swing.ArmlLeg 0=No arm opposition. Side View. Viewed at fullOpposition 1=Opposition is inconsistent and sporadic. speed. Measured via visual2=Arms move in opposition to legs but in the observation.horizontal plane.3=Arms move in opposition independent ofspinal rotation.Leg Drive O=Unclassifiable movement. Front View. Forward drive1 =Noticeable ‘toeing out’ of the foot (lower leg measured from vertical linesswings outwards) or a large crossing of the down from hips andbody’s midline during recovery, compared to the placement2=Slight ‘toeing out’ of the foot (no lower leg of the thigh from the point ofswing, external rotation of foot only) or slight recovery throughout thecrossing of the body’s midline during recovery, forward drive. Crossing of3=The thigh drives forward along the sagittal body midline determined byplane. Foot also stays along the sagittal viewing foot placementplane. upon recovery.50Critical Description of Movement Pattern MeasurementNotes ScoreElement13Landing 0=Unclassifiable movement.Side View. Measured via1=Feet land flat. visual observation.2=Feet land heel-toe.3=Feet land on metatarsal arch.Flight Phase 0=Flight phase is inconsistent.Side View. Viewed at full1=Flight phase is consistent but stunted; legs speed. Measured via visualdo not extend fully in air or time off ground is observation.minimal.2=Definite flight phase however, stride lackspower and/or extension.3=Definite flight phase. Stride length is atmaximum extension and power.Recovery: 0=Unclassifiable movement.Side View. Hip flexion ofHip Flexion 1=Hip flexion of forward driving leg is>1200.the swing leg measured2=Hip flexion of forward driving leg is between between the thigh and body106° — 120° in the first frame that shows3=Hip flexion between <90° — 105° on the the support leg taking off.forward drive.Recovery: 0Unclassifiable movement. SideView. Knee flexion ofKnee 1=Flexion at the knee is >105°.the swing leg measuredFlexion 2=Flexion at the knee is between 90° — 105°.between hip and ankle in3=Flexion at the knee is <90°. the first frame that showsthe support leg contactingthe ground.Take-off 0=Unclassifiable movement.Side View. Knee flexion of1=Angle at knee joint is <150°. the supportleg measured2=Angle at knee joint is between 150° - 165°. between the hip and ankle3=Angle at knee joint is >165°. in the first frame that showsthe support leg taking-off.TOTALI30(Carr, 1997; Fortney, 1983; Gallahue, 2002; Payne, 2002;Roberton & Halverson, 1984)*Generalmeasurement area: angles are always measured on the leg or arm that is facingthe side viewcamera during a point in which the participant is either justbefore, or in, the square that is marked by thefour centre cones.**Scoresof 0 which are described as being ‘Unclassifiable’ include the following movements:a. Unusualmovements which cannot be classified as scoring either a 1, 2 or 3 inwhich the child is drawing attentionto themselves either to hide an inability to perform the skill, as aresult of simple misbehaviour, or, forsome unknown reason. b. Gross inconsistencies such that if ameasurement were taken only from thedefined ‘General measurement area’ (described above) the resultingscore would not be representative ofthe entire skill performance or would otherwise give an invalidimpression of the child’s level of skillperformance (eg. a child who overtly changes the movement characteristicsof their running stridemultiple times). c. Not applicable to this skill. d. Not applicable to thisskill.51Table 3.01 Proficiency Assessment: SkippingIdeal: Participant exhibits a consistent, proportional and rhythmical ‘step-’hop’on one leg followed bya ‘step-hop’ on the other leg. Landing is toe first (heel doesnot contact the ground) with weighttransferred to the supporting foot on the ‘hop’. Arms movein a relaxed manner and in synchronousopposition to the legs. Movement follows a straight pathway.Critical Description of Movement PatternMeasurement Notes ScoreElement13Rhythm 0=Unclassifiable movement.Side View. Viewed at full1=Sporadic rhythm. speed. Observefrom the2=Exaggerated movements but rhythm full width ofperipheral view.consistent. Measured via visual3=Consistent rhythm with no exaggerated observation.movements.Leg 0=Unclassifiable movement.Side View. Viewed at fullCoordination 1=Exhibits a galloping movement, speed. Observefrom the2=Exhibits a skipping movement however is full width of peripheral view.uncoordinated or inconsistent (double hops or Measured via visualsteps may occur). observation.3=Exhibits a step and hop on one legfollowed by a step and hop on the other leg.Repeats this pattern consistently.Vertical 0=Unclassifiable movement.Side View. Viewed at fullComponent 1=Exaggerated ‘step’ or ‘leap’ (could include speed.Observed from theexaggerated vertical component). full width ofperipheral view.2=Exaggerated vertical component upon hop Measured via visual(does not included exaggerated step or leap). observation.3=Step and hop movements are in proportionto each other. Vertical hop is low.Movement 0=Unclassifiable movement. FrontView. Measured viaPath 1=Movement does not follow a straight visual observation.pathway.2=Movement mostly follows a straightpathway.3=Movement follows a straight pathway.Head 0=Unclassifiable movement. CombinedView. MeasurePosition 1=Head downwards, eyes watching feet. via visual observation.2=Head placement inconsistent. Head looksdownwards at times.3=Head held straight, looking forwards for theentire duration of the skill.Arm Action 0=Unclassifiable movement. Side View. Observefrom1=Arms contribute very little to the one ‘step’ to another‘step’.movement. Measured via visual2= Exaggerated use of arms in order to aid in observation.lift-off during the ‘hop’ or are inconsistent inaction (sometimes contribute little sometimesare relaxed and rhythmical).3=Arms are rhythmical and relaxed in theirmovements (movement reduced duringweight transfer).52Critical Description of MovementPattern Measurement Notes ScoreElement13Arm 0=Unclassifiable movement.Side View. Wrist movesOpposition 1=Both hands held consistently in frontof behind body on thebody (ie. No opposition), backswing.Observe from2=Limited or inconsistent opposition with both the full widthof peripheralhands in front of the body at some point in view.Measured via visualtime.observation.3=Full opposition with arms and legs movingin synchrony.Foot O=Unclassifiable movement.Side View. Observe fromLanding 1=Heel toe landing (as would beseen during the frame showing foota stepping action).contact with ground during2=Flat footed landing (heel touches the the step.Measured viaground before weight transfer). visualobservation.3=Toe first landing (heel does not touch theground).Weight 0=Unclassifiable movement.Side View. Observe fromTransfer 1 =Weight transfer completed upon the ‘step’the landing of the step tomovement before the ‘hop’. thelanding of the hop.2=Weight transfers to supporting foot on the Observeconsistency and‘hop’ but is inconsistent and/or awkward.rhythm at full speed from3=Weight transfers to supporting foot on the the full width of peripheral‘hop’ and is consistent and rhythmical.view. Measured via visualobservation.Swing Leg O=Unclassifiable movement.Side View. Observe fromPosition 1=Swing leg’s ankle held high (at or abovethe point between lift-off ofsupport leg’s knee) swing leg’s thigh may the hop andthe landing ofalso be held high. the hop. Measured via2=Swing leg’s ankle held between support visual observation.leg’s mid shin and knee.3=Swing leg’s ankle held low to the ground(between support leg’s ankle and mid shin).TOTALl30(Gallahue, 2002; Payne, 2002; Roberton & Halverson,1984)*Generalmeasurement area: Full width of side view.**Scoresof 0 which are described as ‘No observable skippingmovement is made/Unclassifiable’ includesthe following movements: a. Unusual movements which cannot beclassified as scoring either a 1, 2 or 3in which the child is drawing attention to themselves either to hidean inability to perform the skill, as aresult of simple misbehaviour, or, for some unknown reason. b. Grossinconsistencies in thedemonstrated movement skill such that if a measurement weretaken only from one portion of the skillperformance, the resulting score would not be representativeof the entire skill performance or wouldotherwise give an invalid impression of the child’s level of skillperformance (eg. a child who initiallyexhibits a skipping movement but is unable to maintain thismovement pattern throughout themeasurement area (described above) and subsequently reverts to a differentmovement skill such asgalloping or running). c. The performance of an unrelated skillsuch as running. d. The performance ofmovements which are precursors to skipping such as galloping (withthe exception of the critical element,‘leg coordination’ which accounts for the demonstration of a gallopingmovement).53Table 3.02 Proficiency Assessment:Vertical JumpIdeal: Participant flexes knees to approximately900and draws arms straight back behindbody inpreparation for jump. Reaching armsswings upwards the through the sagittalplane with maximal tiltof the shoulder girdle whilethe non-reaching arm reaches downwards. Simultaneously,there isforceful and full extension from thelegs and body. Landing is controlled (balanceis maintainedwithout the use of the arms) and thereis very little displacement on landinq fromthe point of take-off.Critical Descriptionof Movement Pattern MeasurementNotes ScoreElement13Preparatory 0=No identifiable preparatorySide View. Measure angleLeg Position position/unclassifiablemovement, between hipand ankle from1=Knee flexion >120° or <60°.the point at greatest flexion2Knee flexion 60° - 89°.in crouch position.3=Knee flexion between 90° - 120°.Arm Swing 0=Arm starts from araisedSide View. Measured viaposition/unclassifiable movement,visual observation.I =Arm bends upward rather than swingsObserve from start of lift-offupward.to the landing.2=Arm is straight and swings forwardand upstarting from a position behind the body butmust also swing to the sideor backwards forbalance.3=Arm is straight and swings forwardand upstarting from a position behind thebody.Arm 0=Reaching armsstarts from a raisedFront View. Measured viaCoordination position therefore,not coordinated with non- visualobservation.reaching arm/unclassifiable movement.Observe from the frame1=Other arm follows reaching arm.showing the highest point2=Non-reaching arm does not follow reachingof jump.arm.3=Non-reaching arm reaches downwards.Arm 0=Arm starts froma raised position and is SideView. Measured viaCoordination therefore not coordinatedwith leg visual observation.with Legs actions/unclassifiable movement.Observe from point of1=Arm actions are not coordinated withleg lowest crouch to point ofactions (arm does not lift simultaneouslywith highest jump.legs).2=Arm actions are partially coordinatedwithleg actions but do not contribute tojumpheight.3=Arm actions are coordinatedsimultaneously with leg actions andcontribute jump height.Shoulder 0=Unclassifiable movement.Front View. Measured viaGirdle and I =Arm is not fully extendedat the elbow or visual observation.Arm shoulder. Minimalor no tilt of shoulder girdle. Observefrom the frameExtension 2=Arm is either: not fully extendedat the showing the highestpointelbow or shoulder or, there isminimal tilt of of jump.shoulder girdle.3=Arm is fully extended at the elbow andshoulder. Maximal tilt of shouldergirdle.Head Action 0=Unclassifiable movement.Front View. Measured via1=No head lift,visual observation.2=Small head lift up towards target.Observe from the frame3Definite head lift up towards target.showing the highest pointof jump.54Critical Description of Movement Pattern MeasurementNotes ScoreElement13Leg Action 0=Unclassifiable movement.Side View. Measured viaon Take-off 1=Knees flex to bring heals up towards visual observation. Observebuttocks. from point at which toes2=Hips and knees extend fully, ankles do not leave the ground. Powerextend fully. Extension of joints lacks power. viewed at full speed.3=Full extension of hips, knees and ankles.Extension of joints is powerful.Trunk Action 0=Unclassifiable movement. Side View. Measuredviaon Take-off 1=Body starts in an extended position.visual observation. Observe2=Body does not entirely extend. from greatest point of3=Full body extension. extension.Leg Action 0=Unclassifiable movement.Side View. Measured viaon Landing 1=Hips, knees and ankles do not flex tovisual observation. Observeabsorb landing force. Or, exaggerated foot landing from first frameabsorption of force. showing foot contact with2=Hips and knees flex to absorb landing ground to last frame beforeforce but landing is flat footed or on toes. child completes the skill.Landing may appear awkward or have ajarring appearance.3=Controlled landing is from toes to heelswith appropriate absorption of impact fromhip knee and ankle.Displacement 0=U nclassifiable movement.Combined View. Seton Landing 1=Landing is >0.3m square. horizontal reference2=Landing is between 0.2m and 0.3m distance of im between thesquare. cones at the bottom of the3=Landing is <0.2m square. screen in the side view.Measure from toes at pointof take-off (frame just beforetoes leave ground) to pointof landing (first frame toshow toes touch ground).Repeat for front view.TOTALI30(Gallahue, 2002; T. Martin & A. Stull, 1969)*Assessthe one arm vertical jump.**Scoresof 0 which are described as ‘No observable skipping movement is made/Unclassifiable’ includesthe following movements: a. Unusual movements which cannot be classified as scoringeither a 1, 2 or 3in which the child is drawing attention to themselves either to hide aninability to perform the skill, as aresult of simple misbehaviour, or, for some unknown reason. b. Not applicable tothis skill. c. Notapplicable to this skill. d. The performance of movements which are precursor skills (in the caseof verticaljump, this would refer to alternative movements that may be listed along side ‘unclassifiablemovement’e.g. Arm Swing: arm starts from raised position/unclassifiable movement).55Table 3.03 Proficiency Assessment:HoppingIdeal: Flight phase appears relaxedwith no delay between successive take-offs and landings. Thesupport leg’s hip, knee then ankle flex, followed by apretake-off extension in the hip, knee and ankleresulting in full leg joint extensionduring the flight phase. Landing occurs with a smooth transferandabsorption of force. Meanwhile, the non-support leg is heldwith the knee flexed to approximately900.The arms are carried close to the bodywith the elbow flexed to approximately 90° and lift upwardsvigorously in conjunction with the supportleg extenon.Critical Description of Movement PatternMeasurement Notes ScoreElement13Arm Action 0=Unclassifiablemovement. Side View. Viewed at1=Arms swing upward briefly and medially rotate atfull speed. Measuredthe shoulder prior to take-off. Or, armsmove in via visual observation.response to a large loss of balance.2=Arms move minimally as a result of hoppingrhythm or due to a slight loss of balance.3=Arms move up and down consistently.Arm 0=IJnclassifiable movement.Side View. Viewed atCoordination 1=No coordination. Arm movements are sporadicfull speed. Measuredor inconsistent due to loss of balance.via visual observation.2=Arm action is minimal (and therefore cannot betruly coordinated’).3=Arms are coordinated, moving togetherconsistently.Arm Position 0=Unclassifiable movement.Combined View.1=Arms are both held in abducted positions to aidAdduction/abductionin balance (may be asymmetrical or symmetrical),and elbow flexion2=Arms are asymmetrical (one arm adducted one measuredvia visualarm abducted). Or, both arms are adducted butobservation.with elbows approximately straight.3=Arms are held in symmetrical, adductedpositions with both elbows flexed to approximately90°.Arm 0=Unclassifiable movement.Side View. Viewed atCoordination 1=Arm movement is not coordinated withleg full speed. Measuredwith Legs action. Arms move in response to loss ofbalance via visual observation.rather than contributing to jump.2=Arms action is either minimal (and thereforecannot be truly coordinated with legs) orinconsistently coordinated with leg action.3=Arms move purposefully and in opposition tohopping leg in order to contribute to jump height.Flight Phase 0=Unclassifiable movement.Side View. Viewed at1=Vertical displacement is a result of pulling the full speed.Measuredfoot up off the floor. Or, foot barely clears floor, viavisual observation.2=Flight phases appear stiff and somewhatawkward. There may be a slight delay betweensuccessive jumps.3=Flight phases appear relaxed and occurin rapidsuccession as a result of successive joint flexionand extension. Perceptible pretake-off extensionoccurs in the support leg, hip, knee, and ankle.56Critical Description of MovementPattern Measurement Notes ScoreElement13Swing Leg 0=Unclassifiable movement.Side View. Position ofPosition 1Thigh held between 45°and 90°.thigh measured from2=Either thigh approximately vertical (<45°) or betweenvertical lineknee flexed to 90°. downfrom hips to3=Thigh approximately vertical(<450)and knee thigh. Knee angleflexed to 90°.measured betweenankle and thigh.Measure angles onthird jump on landing.Support Leg: 0=Unclassifiable movement.Side View. Viewed atTake-off and I =Foot is lifted off the floor by bendingat the knee full speed. MeasuredFlight Phase or by lifting the knee upwards (may resemblea via visual observation.stomping action). Or, foot barely clears floor.2=Take-off and flight phase appear stunted (hip,knee and ankle do not extend fully inair or timeoff ground is minimal).3=Take-off and flight phase occur smoothly andlegs (hip, knee and ankle) extend fully in theair.Support Leg: 0=Unclassifiable movement.Side View. MeasuredLanding 1 =Landing resembles the ‘catching’ of thebody’s via visual observation.weight (resembling a stomping action) or, hip,knee and ankle joint do not flex to absorblandingforce.2=Landing appears stiff and awkward however,hip, knee and ankle absorb landing force with asmall delay between successive take-off andlandings.3=Smooth transfer and absorption of force fromthe hip, knee and ankle from take-offand landing.No delay between successive take-off andlandings.Head 0=Unclassifiable movement.Side View. MeasuredPosition 1=Head looks down at feet.via visual observation.2=Head sometimes stays straight, sometimeslooks down at feet.3=Head stays straight, looking forward.Body 0=Body turns while performing theSide View. MeasurePosition skill/unclassifiable movement,via visual observation.I =Trunk is not held consistently in a stableFor a score of 3,position (moves in response to loss of balance). measuredangle btw2=Trunk is held in a stable position but is not verticalline drawn upupright, fromhips and line from3=Trunk is held consistently in a stable position, hipsto shoulders.upright and vertical (within 10°).TOTAL130(Gallahue, 2002; Lolas Halverson & Kathleen Williams, 1985;Payne, 2002)*Assessthe first leg chosen by the child.**Scoresof 0 which are described as being ‘Unclassifiable’ include the followingmovements: a. Unusualmovements which cannot be classified as scoringeither a 1, 2 or 3 in which the child is drawing attentionto themselves either to hide an inability to perform theskill, as a result of simple misbehaviour, or, forsome unknown reason. b. Gross inconsistencies suchno one measurement could be representative ofthe entire skill performance or would otherwise give aninvalid impression of the child’s level of skillperformance (e.g., a child who overtly changes the movementcharacteristics of their hopping multipletimes) c. Not applicable to this skill. d. The performance of movementswhich are precursor skills (in thecase of hopping, this would refer to alternative movements that may belisted along side ‘unclassifiablemovement’ e.g., Body Position: body turns while performing the skill/unclassifiablemovement).57Table 3.04 Proficiency Assessment:Horizontal Jump0=Legs do not ‘tuck/Unclassifiablemovement.1=Legs are asymmetrical throughoutflight.2=Legs are symmetrical throughout theentireflight. Knees and hips flex simultaneously.3=Legs are symmetrical throughoutflight.Knees flex before_hips.Combined View.Measured via visualobservation. View legsymmetry from the frontand side views and legaction from the side view.Ideal: Take-off is two-footed andsimultaneous with the participant’s armsand legs extending fully(hips hyper-extending). Thebody has a forward lean of >30°during take-off and flight. During flight,the arms lower to reach forwardin preparation for landing while the kneesflex followed by hips flexingto bring the legs into a ‘tucked’position where the thighs are approximatelyhorizontal. The knees thenextend forward of the bodyin preparation for landing. Landingis two-footed and on heels.Critical Description ofMovement PatternMeasurement Notes ScoreElement/3Body 0=Unclassifiablemovement. SideView. MeasurePosition on 1=Trunk leans forwardslightly(<30°). angle betweenverticalTake-off 2=Trunk leansforward (30° - 60°). linedrawn up from hips3=Trunk leans forward (>60°).and from line drawnbetween hips andshoulders in the firstframe before the feethave left the ground.Knee Angle 0=Movementis from a one foot take-Side View. Measure viaon Take-off off/Unclassifiablemovement,visual observation. For a1 =Knees primarily maintainflexion, extending score of 2or 3, measurelittle into take-off (<140°).angle between hip and2=Knees extend almost fullyinto take-off (140° - ankle in thefirst frame160°).before the feet have left3=Knees extend fully into take-off(>160°). the ground.Hip Angle on 0=Movement is from aone foot take- SideView. MeasureTake-off off/Unclassifiablemovement, anglebetween shoulder,1=Hips partially extend upon take-off(<170°). hip and knee in the first2=Hips extend during take-off (170°- 180°). frame before the feet3=Hips hyperextend into take-off(>180°). have left the ground.Arm Action 0=Unclassifiablemovement.Combined View.During Flight 1=Arms abduct. Or,elbows are bent and arms Abductionand elbowextend minimally (<145°).angle measured via2=Minimal to no abduction. Either,elbows visual observation.straight, or arms reach near full extensionExtension measured from(145°).side view by measuring3=No abduction. Elbows straightand arms angle between elbow,reach full extension (>165°).shoulder and hip at thepoint of greatest armextension.Leg Position 0=Legs do not ‘tuck’or areSide View. MeasureDuring Flight asymmetrical/Unclassifiablemovement, angle betweenhorizontal1=Legs ‘tuck’ minimally (>45° belowhorizontal), line drawn out from hips2=Legs ‘tuck’ partially (15° - 45°below and thighs at the pointofhorizontal),greatest flexion during3=Legs ‘tuck’ fully (within 15° ofhorizontal), flight.Leg ActionDuring Flight58Critical Descriptionof Movement Pattern Measurement Notes ScoreElement13Arm Action O=Arms are not used during theSide View. Measured viaon Landing movement/Unclassifiable movement,visual observation.1=Arms move to maintain balance. Arms may Observedbetween the firstabduct and medially rotate (parachute landing). framethat shows foot2=Arms lower from flight position but end out to contactwith ground andthe side of the body or continue through to end thelast frame before thebehind body. childstands up or walks3=Arms lower from flight position to reach away aftercompleting theforward at landing. skill.Leg Action 0=Movement is from a one foot take-Side View. Measured viaon Landing off/Unclassifiable movement,visual observation.1=Knees are not extended for landing. Landing Observeleg action duringresembles more of a catch. flight tolanding.2=Knees extend for landing.3= Knees extend forward for landing (feetareforward of centre of gravity).Foot 0=Feet do not take-offor land simultaneously Side View. Measured viaCoordination (as might be seen as the result of a one footvisual observation.take-off) /Unclassifiable movement.Observe foot coordination1=Feet either take-off simultaneously or land fromtake-off to landingsimultaneously.(first frame that shows feet2=Feet take off and land simultaneously.leaving the ground to theLanding is either flat footed or on toes.first frame that shows the3=Feet take-off and land simultaneously. feetcontacting theLanding is on heels. ground).Balance 0=One foot landing/Unclassifiable movement.Side View. Measured via1=Balance is lost (child falls or must step/hop visualobservation.forward to maintain balance). Observe from landing (first2=Balance is unstable. Child is able to maintain framethat shows footlanding by lifting onto toes or swinging arms. contactwith ground) to the3=Balance is maintained. Child sticks’ landing. lastframe before the childstands up or walks awayafter completing the skill.TOTALJ30(Gallahue, 2002; T Horita et al., 1991; Roberton & Halverson,1984; M. Wakai & N. Linthorne, 2005)*Scoresof 0 which are described as being ‘Unclassifiable’includes the following movements: a. Anunusual movement which cannot be classified asscoring either a 1, 2 or 3 in which the child is drawingattention to themselves either to hide an inability to perform the skill, as aresult of simple misbehaviour,or, for some unknown reason. b. Not applicable to this skill. c. Not applicableto this skill. . d. Theperformance of movements which are precursor skills (in the case ofhorizontal jump, this would refer toalternative movements that may be listed along side‘unclassifiable movement’ e.g. Knee Angle on Takeoff: Movement is from a one foot take-off/Unclassifiablemovement).59Table 3.05 Proficiency Assessment: Jump from a HeightIdeal: Participant flexes their knees and hips in preparationand then extends hips and knees ontake-off. Take-off is two-footed with feet together.Body stays vertical throughout jump with armsheld out to the sides for balance. Landing is from toesto heels with ankles, knees and hips flexing toabsorb impact. Participant is able to maintain balanceon landing.Critical Description of MovementPattern Measurement Notes ScoreElement13Arm Action 0=Unclassifiable movement.Front View.1=One arm pinned to side while other is used to Measuredvia visualmaintain balance or exaggerated/ineffective use of observation.arms for balance.2=Minimal use of arms.3=Arms held out to the sides for balance andcontribute to height of jump.Knee Joint 0=Step down movement/Unclassifiablemovement. Side View.on Take-off 1=Knees do not flex in preparationor extend upon Measured via visualtake-off. observation.2=Minimal preparatory flexion and/or extension ofknee joint upon take-off (movement may appearstiff or awkward. Or, movement may resemble a‘hop’ down movement).3=Knee joint flexes in preparation and also extendsupon take-off.Hip Joint on 0=Step down movement/Unclassifiablemovement. Side View. MeasuredTake-off 1=Hip joint does not flex in preparation or extendvia visual observation.upon take-off.2=Minimal preparatory flexion and/or extension ofhip joint upon take-of (movement may appear stiffor awkward. Or, movement may resemble a ‘hop’down movement).3=Hip joint flexes in preparation and then extendsupon take-off.Take-off 0=Step down movement/Unclassifiable movement.Combined View.1 =One foot leads on take-off (feet are Measuredvia visualunsynchronized on take-off but not due to a ‘step’ observation.down movement).2=Two foot take-off but feet are asymmetricalshortly after take-off.3=Two foot take-off and feet are symmetrical ontake-off.Flight Phase 0=Step down movement/Unclassifiable movement.Side View. Measured1=Flight phase due to either knees lifting upwards via visual observation.or heals lifting to buttocks.2=Minimal flight phase (as would be exhibited in ahop down motion) or, definite flight phase however,either knees are brought upwards or heels lifted tobuttocks.3=Definite flight phase (as would be exhibited in ajump down motion).Lateral Body 0=Unclassifiable movement.Combined View.Alignment 1=Body twists or bends laterally during jump. Measuredvia visualDuring Flight 2=Body appears ‘loose’ or unstable during jumpobservation.(flight phase lacks control).3Body stays straight throughout jump (controlledflight phase).60Critical Description of Movement Pattern MeasurementNotes ScoreElement13Ankle 0=Step down movement/Unclassifiable movement. SideView. MeasuredFlexion on 1=Little to no flexion of ankle therefore, does not viavisual observation.Landing absorb force appropriately (ie. landing is on toesand heels do not lower to ground).2=Flexion at ankle increases for force absorptionhowever, landing may be flat footed or heel first.3=Flexion at ankle is appropriate to absorb landingforce.Knee and 0=Step down movement/Unclassifiable movement. SideView. MeasuredHip Flexion 1=Little to no flexion at the knee and hip. viavisual observation.on Landing 2=Exaggerated flexion at knee and hip.3=Flexion at knee and hip relative to height ofjump.Foot 0=Step down movement/Unclassifiable movement.Combined View.Landing 1=Feet do not land simultaneously (feet are Measuredvia visualunsynchronized on landing but not due to a step’ observation.down movement).2=Feet land simultaneously, however landing is flatfooted, heel first or toe-first but heels do not lowerfully to the ground.3=Feet land simultaneously and toes contactground first with heels lowering fully to the ground.Balance 0=Step down movement/Unclassifiable movement.Combined View.1=Balance is lost. Child must step or hop forward Measured via visualto keep from falling,observation.2=Balance is maintained by lifting onto toes orswinging arms.3=Balance is maintained. Child ‘sticks’ landing.TOTAL/30(Gallahue, 2002)*Scoresof 0 which are described as being ‘Unclassifiable’includes the following movements: a. Anunusual movement which cannot be classified as scoring either a 1, 2 or 3 in which the child is drawingattention to themselves either to hide an inability to perform the skill, as a resultof simple misbehaviour,or, for some unknown reason b. Not applicable to this skill c.Not applicable to this skill d. Theperformance of movements which are precursors to a ‘jumpdown’ movement, such as a ‘step down’movement.**A‘Step down movement’ refers to a child who seems to require aone foot take-off in order to maintaintheir balance as they leave the box. This will present as a definitestepping down movement with theleading foot stepping down below the box height levelbefore the remaining foot leaves the surface of thebox. This does not refer to a child whose feet fail to simultaneously leavethe box or whose feet simplycome apart as they hop of jump off of the box.61could not be appropriately classified asa score of 1, 2, or 3 (refer to the footnoteslocated at the bottom of theindividual assessment tools for each skill in Tables3.00 to3.05). Scores for each criticalelement were tallied for a total score outof 30. Eachitem score was summed toachieve a total score for that locomotor skill. A scoreof 30out of 30 represents the greatestdegree of proficiency in a movement skill.3.6 Statistical AnalysisVariables were tested for the assumptionsof each specific analysis. Due to thelarge number of analyses performed,significance was set at p < .01. Missingdata wasremoved from the analysis pairwisesuch that a participant’s data was onlyexcluded iftheir missing score was for a variable involvedin the analysis. If their missing scorewas for a variable not involvedin the analysis their data was retained.Descriptive statistics were used to determinethe EMS proficiency in boys andgirls. Means and standarddeviations for each FMS critical elementwere calculated.Overall means and standard deviationsfor each EMS were also calculated.Alsocalculated were the means, standarddeviations, high and low scoresfor individualcritical elements to determine thosemovement characteristics which were particularlychallenging for our participant group.Further, a separate analysis was performedlooking at the frequency of zero scoresin each critical element and the primaryreasonfor their assignment (see footnotes on individual assessment toolsin Tables 3.00 to3.05).To determine gender differencesbetween fundamental locomotor skills aGender(2) x Fundamental Locomotor Skill (6)Analysis of Variance (ANOVA) was conducted.Variables were assessed fornormal distribution via the Kolmogorov-Smirnovtest andfor homogeneity of variance using Levene’s test.Non-normally distributed data was logtransformed and the analysis wasperformed a second time. The non-parametricKruskal-Wallis test was performed tocorroborate the ANOVA results and because theskipping distribution could not be correctedby the log transformation.Bivariate correlations were performed usingthe Spearman correlation coefficientin the case of non-normally distributeddata. Hierarchical multiple regressionanalyseswere performed to determine which EMSskills best predicted our health and fitnessindicators. For each regression model, a healthor fitness indicator was entered as thedependent variable. Health and fitnessvariables were entered into the first blockof62predictor variables to determinethe relationship between EMS proficiencyand healthand fitness indicators independent ofother health and fitness indicators. Todeterminethe unique contribution ofEMS to the dependent variable, the secondblock of theregression model consisted ofFMS skills. Only variables showing significantrelationships in the bivariate correlationmatrix were entered into the regressionanalyses. Since previous investigations[II, 16, 17, 19, 92, 109] have found significantdifferences between males and females,correlation and regression analyseswereperformed separately for malesand females. We also performed analysesoncombined male and femaledata sets and controlled for gender todetermine whethergender moderated the findings. Possiblemulticollinearity among predictor variableswas assessed by searchingfor zero order correlation coefficients R>.30. Forregression models containingpredictor variables with correlationcoefficients R >30,multicollinearity was then assessedby examining collinearity statistics;specifically thevariance inflation factor (VIF) and tolerancestatistics. Regression analyses werefurther assessed for homoscedasticityand linearity by plotting*ZRESIDagainst*zPREDNormally distributed and independenterrors were determined with the use ofnormal probability plots and the Durbin-Watsontest.Data were analyzed usingSPSS statistical software forWindows version 12.0.63CHAPTER IV: RESULTS4.1 Participant CharacteristicsGeneral descriptive,anthropometric and healthand fitness characteristicsareprovided in Figures 4.00to 4.05. Table 4.00displays the mean BMIvalues for boysand girls by age andthe percent prevalenceof overweight and obesity.The percentageof children classified asoverweight or obese wasdetermined using internationallyestablished age- andsex-specific criteria [72].Mean BP measurementswere normalfor both sexes however,4.3% of boys and 6.6%of girls were classifiedas having highsystolic BP (>l2OmmHg).Unfortunately, cut-off valuesassociated with increasedhealth risk are notavailable for children inthe arterial compliance,waist circumferenceor the fitness measurementsemployed. Mean diastolicBP (males 55.5 ± 5.7 vs.females 57.8 ± 5.8),small artery compliance(males 6.1 ± 2.2 vs. females5.2 ± 1.8) andsit-and-reach (males 25.9± 5.5 vs. females 31.0 ±7.4) scores were significantlydifferent between boysand girls (p < .01) with boysdemonstrating lowerdiastolic BPand higher small arterycompliance measurementsand girls demonstratinga greaterdegree of flexibility in sit-and- reach.4.2 Movement Skill Proficiency4.2.1 Critical ElementsFigures 4.06 through 4.11display the means andstandard deviations for thecritical elements assessed foreach EMS (see Tables3.00 through 3.05 for descriptionsof each critical element).For the skill of running, malesand females scoredlowest in the critical elementElbow Flexion (mean 1.2 ± .5).Scores for the critical elementTake-off were the highestin males (mean 2.2 ± .6) andTake-off (mean 2.2 ± .5) andLeg Drive (mean 2.2 ±.7)were the highestin females.Results for skipping showedthe critical elementsFoot Landing (mean 1.0 ± .2)and Weight Transfer (mean0.8 ± .4) to be the lowest andthe critical elementsMovement Path (mean2.3 ± 1.1) and Leg Coordination(mean 2.3 ± 1.1) to bethehighest in males. Theresults for skipping in femalesindicated that scores forthe criticalelements Weight Transfer (mean0.9 ± .3) and Foot Landing(mean 1.0 ± .4) were the64IEci)I.U)U)0-o00140120100806040200*— MalesFemalesSystolic BP Diastolic BP*signficantlydifferent between males and females p < .01Figure 4.00 Mean Blood Pressure as aFunction of Gender65*significantlydifferent between malesand females p < .01— MalesFemalesCCx0)22Eci)U)0)(U-J16 -‘14 -121086420IIir*1614C12x0)-In 2:22826(U42U)20Large ArterySmall ArteryFigure 401 Mean ArterialCompliance as a Functionof Gender6660C)0)0C0)40E04-20— MalesFemales80I.8060(‘4E. 40200-Body Mass IndexFigure 4.02 Weight Status as a Function of GenderWaist Circumference0Cl)Cu-J9-05040302010067MalesI I FemalesShuttle RunFigure 4.03 Cardiorespiratory Fitnessas a Function of Gender353025a)-Q2z150I-105068MalesI FemalesPush-ups Curl-upsFigure 4.04 Mean Push-upsand Curl-ups as a Function ofGender6950— Males50EEEI Females40*403030 -o2020°SoCl)101000Grip Strength Sit & Reach*significantlydifferent between males and females p < .01Figure 4.05 Grip Strength and Sit & Reach as aFunction of GenderTable4.00MeansandSDsofBMIValuesforBoysandGirlsbyAgeandPercentPrevalenceofOverweightandObeseAge(years)NMales%Overweight%ObeseNFemales%Overweight%ObeseByrs118.600n/an/an/an/a9yrs1518.1±3.233.36.71817.3±2.916.65.5lOyrs3817.5±2.318.404817.2±2.412.52.1Ilyrs1619.7±3.86.318.82518.1±2.716.00C71MalesFemales3.02.5(I)2.OI21.5ti)IiiCuC.)IC)0.5•0Figure 4.06 Critical ElementScores for Running in Males and Females72Cl)ci)0C-)C,)-I-.ci)Ea)w0C-)Figure 4.07 Critical Element Scores for Skipping inMales and Females733.53.0C’)U)2.500Cl)2.0U)EU)Lii 1.5U)0C-)0.50.0Figure 4.08 Critical Element Scores for Hopping inMales and Females-n C -I CD 0 (0 C-) -S C) m CD 3 CD 0* (1, C) 0 CD U) CD C) 0 C- C 3 DCO0 CD C,) 0 0 11 CD a 0 CD C,)0 CD U)-n CD a 0 CD Cl)CriticalElementScores-r\)C.)1•75Figure 4.10 Critical Element Scores for Horizontal Jumping inMales and Females763.53.0C))ci)2.5I0C)(I)2.Oci)Ea)LII 1.5a)C)4-,00.50.0\-Figure 4.11 Critical Element Scoresfor Jumping from a Height77lowest while Movement Path scoreswere the highest (mean 3.0 ± .2). Support Leg:Take-off and Flight Phase (males mean1.4 ± .5, and females 1.5 ± .5), represents thelowest critical element scores and BodyPosition (males mean 2.6 ± .6, females 2.7 ±.5) represented the highest criticalelement scores for hopping in both genders.The lowest critical element scores for vertical jumpare Head Action in males(mean 1.8 ± .9) and Arm Swing(males mean 1.7 ± 1.0, females mean 1.4 ± 1.0). Thehighest critical element score isfor Trunk Action on Take-off (mean 2.8 ± .7) in malesand Preparatory Leg Position(mean 2.7 ± .7) in females.The lowest critical element scores forhorizontal jump are Preparatory LegPosition (mean 1.0 ± .3) and Arm Coordination withLegs (mean 1.0 ± .4) in males andPreparatory Leg Position (1.0 ± .1)in females. The highest critical elements are ArmSwing (mean 2.3 ± .9) and Arm Coordination(mean 2.3 ± .9) in males and ArmCoordination (mean 2.4 ± .6) in females.In jump from a height, male scoreswere the lowest in the critical elementofBalance (mean 2.1 ± .8) and highestin the critical element of Knee and HipFlexion onLanding (mean 2.9 ± .3). Femalesscored lowest in the critical elements Knee Joint onTake-off (mean 2.2 ± .7) and Hip Joint onTake-off (mean 2.2 ± .7). Females scoredhighest in the critical element of Knee andHip Flexion on Landing (mean 3.0 ± .3).4.2.2 Zero ScoresThe percentages of children who scored a zeroin at least one critical elementare listed for each FMS in Table 4.01. Tables4.02 through 4.07 display the specificnumber of children who scored zero in eachcritical element. The lowest percentage ofzero scores was seen in jump from a heightwhere 1.1% of females and 2.9% of malesscored zero in at least one critical element. In males,horizontal jump had the greatestpercentage of children (25.7%) who scored zero in atleast one critical element;whereas hopping exhibited the greatestpercentage zero scores in at least one criticalelement (15.4%) for girls. Only in skipping did scoresof zero on individual criticalelements translate into an overall score of zero.This resulted in 11.4% and 4.4% ofboys and girls, respectively displaying overall scoresof zero.78Table 4.01 Percentage of children who scoredzero in at least one critical elementMales (N = 70) Females (N = 91)Run8.6% 9.9%Skip22.9% 7.7%Hop 18.6%15.4%Vertical Jump14.3% 14.3%Horizontal Jump 25.7%14.3%Jump from a Height 2.9%1.1%Table 4.02 Number of children with zero scoresin each critical element for Run and mostcommonlyattributed reason_____________________________Males (n=6) Females (n=9)Critical Element # of ZeroMost # of Zero MostScores Common ScoresCommonReason* Reason*Arm Drive 1b 4 a and bArm Placement 2 aand b 4 a and bElbow Flexion 4 aand b 9 bArmlLeg Opposition 1a 0 n/aLeg Drive 1a 0 n/aLanding 1a 0 n/aFlight Phase1 a 0 n/aRecovery: Hip Flexion Ia 0 n/aRecovery: Knee Flexion Ia 0 n/aTake-off 1 a0 n/a*a.Unusual movements which cannot be classified asscoring either a 1, 2 or 3 in which the childisdrawing attention to themselves either to hide aninability to perform the skill, as a result of simplemisbehaviour, or, for some unknown reason. b.Gross inconsistencies such that if a measurementweretaken only from the defined ‘General measurementarea’ (described above) the resulting scorewould notbe representative of the entire skill performanceor would otherwise give an invalid impression ofthechild’s level of skill performance (e.g., a childwho overtly changes the movement characteristicsof theirrunning stride multiple times). c. Not applicable tothis skill. d. Not applicable to this skill.Table 4.03 Number of children with zero scores in each criticalelement for Skip and most commonlyattributed reasonCritical Element Males (n16) Females (n=7)#of Zero Most #of Zero MostScores Common Scores CommonReason* Reason*Rhythm 11 c 5 cLeg Coordination 9 c 6cVertical Component 12 c 7 cMovement Path 11 c 6 cHead Position 11 c 6 cArm Action 16 c 6cArm Opposition 16 c 6 CFoot Landing 12 c 7 cWeight Transfer 12 c 7 cSwing Leg 12 c 6 c79*a.Unusual movements which cannot be classified as scoringeither a 1, 2 or 3 in which the child isdrawing attention to themselves either to hide an inability toperform the skill, as a result of simplemisbehaviour, or, for some unknown reason. b. Gross inconsistencies in the demonstratedmovementskill such that if a measurement were taken only from oneportion of the skill performance, the resultingscore would not be representative of the entire skill performance or wouldotherwise give an invalidimpression of the child’s level of skill performance (e.g., a child who initially exhibits a skippingmovementbut is unable to maintain this movement pattern throughoutthe measurement area (described above) andsubsequently reverts to a different movement skill such asgalloping or running). c. The performance ofan unrelated skill such as running. d. The performance of movements which are precursors toskippingsuch as galloping (with the exception of the critical element, leg coordination’ whichaccounts for thedemonstration of a galloping movement).80Table 4.04 Number of children with zeroscores in each critical element for Hop and most commonlyattributed reasonCritical Element Males(n=13) Females (n=14)#of Zero Most #of Zero MostScores Common Scores CommonReason* Reason*Arm Action 3 a 0n/aArm Coordination 2 a0 n/aArm Position 3a 0 n/aArm Coordination with 2a 0 n/aLegsFlight Phase 0n/a 0 n/aSwing Leg Position 11b 13 bSupport Leg: Take-off & 0 n/a1 bFlightSupport Leg: Landing 0n/a 0 n/aHead Position 0n/a 0 n/aBody Position Ib 0 n/a*a.Unusual movements which cannot be classified as scoringeither a 1, 2 or 3 in which the child isdrawing attention to themselves either to hidean inability to perform the skill, as a result of simplemisbehaviour, or, for some unknownreason. b. Gross inconsistencies such no one measurement couldbe representative of the entire skill performance orwould otherwise give an invalid impression of thechild’s level of skill performance (e.g., achild who overtly changes the movement characteristics of theirhopping multiple times) c. Not applicableto this skill. d. The performance of movements which areprecursor skills (in the case of hopping, this wouldrefer to alternative movements that may be listed alongside ‘unclassifiable movement’ e.g., BodyPosition: body turns while performing the skill/unclassifiablemovement).81Critical Element Males (n=1O)Females (n13)# of Zero Most # of ZeroMostScores Common Scores CommonReason* Reason*Preparatory Leg Position I a0 n/aArm Swing 4 d10 dArm Coordination 3 d9 dArm coordination with 3d 10 dLegsShoulder Girdle and Arm 0 n/a 0n/aExtensionHead Action 0ri/a 0 n/aLeg Action: Take-off 3 a0 n/aTrunk Action: Take-off 1 a0 n/aLeg Action: Landing 5a I aDisplacement on 4 aI aLanding*a.Unusual movements which cannot be classifiedas scoring either a 1, 2 or 3 in which the child isdrawing attention to themselves either to hide an inabilityto perform the skill, as a result of simplemisbehaviour, or, for some unknown reason. b. Notapplicable to this skill. c. Not applicable to this skill.d. The performance of movements whichare precursor skills (in the case of vertical jump, this wouldreferto alternative movements that may be listedalong side ‘unclassifiable movement’ e.g., Arm Swing: armstarts from raised position/unclassifiable movement).Table 4.05 Number of children with zero scores in eachcritical element for Vertical Jump and mostcommonly attributedreason82Table 4.06 Number of childrenwith zero scores in each critical elementfor Horizontal Jump and mostcommonly attributed reasonCritical ElementMales (n18)Females (n13)# of Zero Most #of Zero MostScores Common ScoresCommonReason* Reason*Body Position: Take-off0 n/a1 aKnee Angle: Take-off4 d 3dHip Angle: Take-off4 d 3dArm Action: Flight3 a 1aLeg Position: Flight10 d 11dLeg Action: Flight6 d 5dArm Action: Landing2 a1 dLeg Action: Landing 2a and d 6dFoot Coordination10 d5 dBalance3 d 4d*a.An unusual movement wnichcannot be classified as scoringeither a 1, 2 or 3 in which the childisdrawing attention to themselveseither to hide an inability to performthe skill, as a result of simplemisbehaviour, or, for some unknownreason. b. Not applicable to thisskill. c. Not applicable to this skill.d. The performance of movementswhich are precursor skills (inthe case of horizontal jump, this wouldrefer to alternative movements thatmay be listed along side ‘unclassifiablemovement’ e.g., Knee Angleon Take-off: Movement isfrom a one foot take-off/Unclassifiablemovement).83Table 4.07 Number of children with zero scoresin each critical element for Jump from a Heightand mostcommonly attributed reasonCritical Element Males(n=2) Females (n=1)#of Zero Most #of Zero MostScores Common Scores CommonReason* Reason*Arm Action 1a 0 dKnee Joint: Take-off 1a 1 ciHip Joint: Take-off1 a1 dTake-off 1a 1 dFlight Phase 1a I dLateral Body Alignment: Flight 0n/a 0 dAnkle Flexion: Landing 1a 1 dKnee and Hip Flexion: Landing 0n/a 1 ciFoot Landing 1a I dBalance 0n/a 1 d*a.Anunusual movement which cannot be classified asscoring either a 1, 2 or 3 in which the chilo isdrawing attention to themselves either to hidean inability to perform the skill, as a result of simplemisbehaviour, or, for some unknown reason b.Not applicable to this skill c. Not applicable tothis skill d.The performance of movements whichare precursors to a ‘jump down’ movement,such as a ‘step down’movement9.A ‘Step down movement’ refers to a child who seems torequire a one foot take-off in order to maintaintheir balance as they leave the box. This will present as adefinite stepping down movement with theleading foot stepping down below the box heightlevel before the remaining foot leaves the surface of thebox. This does not refer to a child whose feetfail to simultaneously leave the box or whose feetsimplycome apart as they hop of jump off of the box.844.2.3 Gender EffectsMeans and standard deviations for eachlocomotor skill are presented in Figure4.12. The results of the ANOVA didnot indicate significant (p < .01) differencesbetween males and females inany of the movement skills. A second ANOVAwasperformed after log transformations werecompleted to reduce the degree of negativeskewness on the FMS variables running,hopping, vertical jump, horizontal jump andjumping from a height. Results were thesame as the ANOVA performed onuntransformed data. Further, because theassumption of homogeneity of variance wasviolated in horizontal jump, and becauseskipping displayed a bimodal distribution whichcould not be corrected through log transformation,the non-parametric Kruskal-Wallistest was also performed.Results of the non-parametric tests yielded similarresults tothe previously reported parametrictests. EMS proficiency was not significantly differentbetween males and females (p < .01).4.3 Relationships between FMS andIndicators of Health and Fitness4.2.1 Correlation AnalysisThe assumption of normality was violated byfour out of six EMS variables and 5out of 11 health and fitness variablesin the male data set. In the female data set, allFMS variables and 8 out of 11 health and fitnessvariables violated the assumption ofnormality. Therefore, a Spearman correlation coefficientwas employed in the bivariatecorrelation analysis to determine significant relationshipsbetween FMS and indicatorsof health and fitness. Several significant relationshipswere revealed (see Tables 4.08through 4.10). Running, hoppingand vertical jumping were significantly (p < .01)related to musculoskeletal and cardiorespiratoryfitness tests. Vertical jumping was alsosignificantly (p < .01) related to weight status.4.2.2 Regression AnalysisHierarchical regression analyses (see Tables4.11 and 4.12) were performed todetermine independent predictors of health andfitness variables. These analysescontrolled for possible confounding health andfitness variables and determined theunique contribution of each FMS tothe prediction of health and fitness indicators. Noneof the EMS variables independently predictedour health and fitness variables in males.85a)00(!)C/)U-30-2520151050— MalesFemalesIçccFigure 4.12 FMS Proficiency as aFunction of Gender86Table 4.08 Results of spearmancorrelation analysis between male FMS and healthand fitness variables.Vert. Jump=vertical jump,Horiz. Jump=horizontal jump, Height Jump=jump from a height, SBP=systolicblood pressure, DBP=diastolic bloodpressure, BMI=body mass index, WC=waist circumference,S&R=sitand reach. Curl=curl-ujs, Push=push-ups, Grip=qrip strenqth.Run Skip Hop- Vert. Jump Horiz. HeightJump JumpSBP NS NSNS NS NSNSDBP NS.231* .207*NS NS NSLAC NS NSNS NS NS NSSAC NS NSNS NS NSNSBMI NS.241*NS.276*NS NSWC214*NS NS317**NS NSS&R.420**NS NS.320**NS.288**Curl NS NSNS.252*NS NSPush NS NSNS NS NSNSGrip NS NSNS NS NS NSShuttle Run.208* .257* .382** .348** NS NS*p (one-tailed) <0.05,**p(one-tailed) < 0.001Table 4.09 Results of spearman correlation analysisbetween female EMS and health and fitnessvariables.Vert. Jump=vertical jump, Horiz. Jump=horizontaljump, Height Jump=jump from a height, SBP=systolicblood pressure, DBPdiastolic blood pressure,BMI=body mass index, WC=waist circumference,S&R=sitand reach, Curl=curl-ups, Push=push-ups,Grip=qrip strenqth.Run - SkipHop - Vert. Jump Horz. Jump HeightJumpSBP NS NS NSNS NS NSDBP NS NSNS.269**NS NSLAC NS NS NSNS NS NSSAC NS NSNS NS.192*NSBMI NS NSNS.190*NS NSWC NS NSNS.186*NS NSS&R.222*NS NS NSNS NSCurl.301**NS NS.291** .175*NSPush NS NS.219*NS NSNSGrip.300**NS.372**NS.185*NSShuttle Run.284**NS.391** .241* .186*NS*p(one-tailed) <QQ5**p(one-tailed) < 0.00187Table 4.10 Results of spearman correlationanalysis between combined male and female FMS dataandhealth and fitness variables.Vert. Jump=vertical jump, Horiz. Jumphorizontaljump, Height Jump=jump from a height, SBP=systolicblood pressure, DBP=diastolic bloodpressure, BMI=body mass index, WC=waist circumference,S&R=sitand reach, Curl=curl-ups, Push=push-ups, Grip=gripstrength.Run Skip HopVert. Jump Horz. Jump HeightJumpSBP NS NSNS NS NS NSDBP NS NSNS.184*NS NSLAC NS NSNS NS NS NSSAC NS NSNS NS NSNSBMI NS NSNS.222**NS NSWC NS NS NS.238**NS NSS&R.258**NS NS NSNS NSCurl.211**NS NS.269**NS NSPush NS NS.178*NS NS NSGrip NS NS.210**NS NS NSShuttle Run.244**NS•37Q**.286**NS NSp (one-tailed) < 0.05,**p(one-tailed) < 0.001Table 4.11 Results of multiple regression modelfor diastolic blood pressure in females.Model Predictor VariablesUnstandardized Beta Standardized Beta1 Systolic blood pressure.47 .64Small artery compliance -.14-.04Shuttle run -.01-.032 Systolic blood pressure.48 .66Small artery compliance -.09-.03Shuttle run -.04-.07Vertical jump .33.22*Note R2 = .423 for block 1; AR’ = .045 for block 2;*p< .0188Table 4.12 Results of multiple regressionmodel for diastolic blood pressure combined male and femaledata.Model Predictor VariablesUnstandardized Beta Standardized Beta1 Gender 1.53.13Systolic blood pressure .43.56Small artery compliance -.08-.03Shuttle run .02.042 Gender 1.58.77Systolic blood pressure .44.06Small artery compliance -.05-.02Shuttle run -.01-.02Vertical jump .33.21*Note R = .366 tor block 1; AR = .040 for block2;*p< .0189For females, diastolic BP was significantly predicted by verticaljump (p .008).Additional FMS variables were not found to beindependent predictors of the remaininghealth and fitness variables in females. In theregression analyses performed on thecombined male and female data set (whichcontrolled for gender as a covariate), thedata also showed a significant (p = .002)relationship between diastolic BP and verticaljump. No other significant (p < .01) relationshipswere found between the remainingFMS and indicators of health and fitness in the combined maleand female data. Theregression analyses met all assumptions tested.90CHAPTER V: DISCUSSION5.1 FMS ProficiencyThe hypothesis that children would score in the lowertwo-thirds of theproficiency assessment tool was supported bythe results for males and females in allskills with the exception of vertical jumping and jumping from aheight which scored inthe upper third of our assessment tools. In general,the proficiencies displayed by thechildren were moderate for horizontal jumping andlow for the remaining skills.Although previous literature has shown that the majority ofchildren are capable ofexhibiting mature movement patterns in skills such as running,skipping, hopping,vertical jumping and jumping from a height bysix years of age, this was notdemonstrated in the present investigation. In contrast, characteristics of amaturemovement pattern for horizontal jumping are more commonlyachieved later inchildhood at approximately 9 or 10 years of age [24, 35].While horizontal jumpingscores were in the lower two-thirds of our assessment tools thisis not unexpected giventhe fact that the average age of the children examined inthis investigation was 10years. Therefore, children of this age would not necessarily be expected toexhibit amature movement pattern in horizontal jumping.These findings are similar to the findings of Okely & Booth [19]who investigatedEMS proficiency in Australian children aged six to eight yearsold. They found that lessthan 10% of boys and girls six years of age achieved masteryin the skills of skippingand hopping, less than 15% of eight year old boys and 10% of eight year oldgirlsdisplayed mastery in running, and less than 10% of eight year oldgirls and boysdisplayed mastery in the vertical jump skill. Okely & Booth[19] also included theadditional category of near mastery (a category defined by displayingall but one maturemovement characteristic) to determine the percentage of childrenwho may be close toachieving mastery. With the inclusion of a near mastery categorythe percentage ofchildren who achieved an advanced fundamental skill level (near masteryor mastery)increased substantially. Nonetheless, proficiency for children sixto eight years oldremained below 40% in the skills of running, skipping, hoppingand vertical jump forboys and girls [19]. Okely & Booth [19] interpretedtheir results as indicating lowdegrees of proficiency.91Reasons for the low level of proficiency displayedby the children in the presentinvestigation may be due in part to the wide varietyof assessment tools used tomeasure proficiency in addition to differences inthe individual FMS assessed. Thenature of our assessment tools may have resultedin a more rigorous evaluation ofchildren’s skill level producing proficiency scoreslower than in other investigations [19,30]. The present investigation utilized videotapedrecordings of participants performingFMS which allowed their performances to be viewedmultiple times. Videotapedrecordings also allowed the performances to be viewedframe-by-frame and in slowmotion. Our investigation utilized videotaped recordingsof participants performing EMSskills which allowed us to view performances severaltimes. We were also able to viewperformances frame by frame and in slow motion.For several movementcharacteristics, a quantitative measurementof joint angles was obtained rather thanrelying on a visual estimate of the joint angles observed.The combination of usingvideotaped performances and the measurementof joint angles provided a moreobjective and precise assessment of FMS proficiency than inprevious investigations.Using video recordings and measuring joint anglesrather than using visual observationalone is preferable as it offers a more objectivedetermination of a child’s level of motorproficiency. This low level of FMS proficiency mayalso be indicative of a larger trendwherein the level of children’s proficiency could have declinedsince the originalinvestigations were performed over 20 years ago[30, 32, 36].Overall, mean scores for both males and females weregreatest in jumping froma height and lowest in horizontal jumping.Horizontal jump was the only skillinvestigated in which mastery is not commonlyachieved by at least seven years of age.As previously mentioned, a mature movementpattern in horizontal jump is notdisplayed by the majority of children until 9 or 10years of age [32]. Therefore, meanscores for the horizontal jump should be the lowest of the skillsinvestigations given thatthe average age of the children in this investigationwas 10 years.Findings revealed specific behavioural characteristicswhich were especiallydifficult for participants to perform with a high level of proficiency.For example, severaltrends emerged when critical elements were examined accordingto body segments(see Table 5.00). For example, in running, childrenappeared to have the greatestdifficulty in critical elements pertaining to upper body movementsand the least difficultyin lower body movements. In hopping, childrenhad the least difficulty in mid-body92Run Skip HopVertical Horizontal HeightJump Jump JumpHhest,JN/AN/A:tfiJ8I8inN/A = not applicable to a specific body segmentUpper Body Segment= MalesLower Body Segment= FemalesMid-body SegmentTable 5.00 Critical Elements by Body Segment93movements and the greatest difficulty in lower body movements. In the case ofjumpingfrom a height, girls had the greatest and least difficultyin lower body movements.However, the lower body movements which were the least difficult corresponded tothelanding phase of the jump whereas the lower bodymovements which were the mostdifficult corresponded to the take-off phase of the jump. Insome cases, such asjumping from a height in girls, children’s difficulties were not according tobody segment.Rather, they were according to the temporal sequence of theskill (e.g., take-off versuslanding). It may be the case that children’s activity programs place a greateremphasison the performance of certain temporal sequencesover others. For example, children’sgymnastics programs place a great deal of emphasis on the performanceof correctlanding movements when dismounting equipment in order to help preventinjuries.Likewise, instruction may also focus on the development ofcertain body segments overthe development of other body segments. In running, many activitiescentre on legrather than arm movements such as high-knee drills and seat kicks.There may also bedevelopmental reasons for the difficulties seen in movements accordingto bodysegment. In the present investigation, stationary hoppingwas examined rather thanhopping over a distance. Stationary hopping involves minimal arm movementsand forthis reason, upper body movements played a lesser rolethan lower body movements inthe performance of this skill. Therefore, children mayhave been developmentally morecapable of performing upper body movements than lower bodymovements. While theprecise reason(s) for these trends cannot be determined by the present investigation,the results suggest that there are specific body segments for eachmovement skill whichrequire a greater degree of attention. These findings could be used to inform children’sphysical activity and education programs. In addition, they may also serve as importantbaseline measurements for future investigations.In each skill, a number of children scored zero on one or more criticalelements.Children were given a score of zero for a number of possible reasons (seeTables 3.00through 3.05). In general, when a child received a score of zeroin running andhopping, it was most frequently attributed to the performance of unusual movements inmales and gross movement inconsistencies in females, which were likely related tobehavioural issues. In skipping, the reason for a score of zero in both males andfemales was solely the result of performing an unrelated skill, whereby the child wasunable to perform any aspect of the required skill. Zero scores in vertical and horizontal94jumping were listed as being the performance ofunusual and precursor skills in bothmales and females. Zero scores for jumpingfrom a height in males was described asbeing the result of unusual movements while infemales it was the result of performingprecursor skills. The performance of precursor skills suggests childrenwere notmisbehaving or attempting to draw attention away fromtheir inability to perform the skillproficiently (as would be the case for unusual movements).Rather, the performance ofprecursor skills suggests that this was an accurateportrayal of the child’s ability.5.2 Gender differencesResults from the investigation did not support the hypotheses that genderdifferences would emerge for the performance ofEMS. These results are contrary toprevious literature out of Australia which has shownboys as being more proficient thangirls in most EMS with the exception of skipping andhopping [II, 16, 19].The reason girls did not demonstrated greater degrees of proficiency thanboysin skipping and hopping due to a lack of statistical power.Skipping and hopping werehigher in girls than in boys at a significance level of p < .05.The fact that results werenot significant at the level of p < .01 could be due toinadequate sample size causing areduction in the amount of statistical power for the detectionof differences betweengenders.Boys did not exhibit greater proficiency than girls in running, or the remainingjumping skills. There are several explanations for these results. First,while genderdifferences in EMS proficiency are prevalent throughout the literature,significantdifferences between boys and girls generally emerge at the onset of pubertyandbecome increasingly salient with increasing age until adulthood [33]. The childrenin thepresent investigation were 8 to 11 years of age and thus it is possible thatpotentialgender differences between children have yet to emerge.Second, differences in male and female movement skill performancehave beenattributed to both biological and environmental factors [33]. The onset of pubertyexplains some of the divergence between the skill of boys and girls starting fromapproximately 11 years of age and continuing throughout adolescence. Yet, the impactof environmental factors should not be overlooked as it toooffers an explanation for theincreased skill divergence between boys and girls. Thereare different expectationsimposed on boys and girls coupled with differences in how boys and girlsare treated95while they learn and perform tasksinvolving motor skills. When provided equalencouragement and opportunities to practice, Thomas[33] asserts that trends in thedata will begin to reflect agreater degree of gender similarity rather than genderdifference in FMS. Third, investigations showingboys’ EMS to be significantly greaterthan girls’ have investigated skills involved in historicallymale dominatedsports/activities. Okely et at. [11] postulated agender bias (favoring boys) in the skillsthey examined (i.e., sprint run,vertical jump, overarm throw, catch, forehand strike andkick) resulting in boys displaying significantly higherEMS scores than girls. They alsonoted that activities classified astraditionally feminine involving FMS which depend onbalance, flexibility and rhythm (e.g., dance and gymnastics)were not represented in theskills tested. With the exception of skipping andhopping the FMS investigated werearguably more gender neutral than those investigatedby Okely et al. [11]. While Okelyet at. [11] investigated skills (e.g., overarmthrow, catch, kick and forehand strike) linkedto traditionally male dominatedactivities (e.g. baseball and soccer), the presentinvestigation examined running and threeforms of jumping (vertical jump, horizontaljump and jumping from a height)which are involved in both traditionally male andfemale dominated activities. For example, dance andgymnastics are female dominatedactivities and involve various forms of jumping.Likewise, a sport such as basketballalso involves jumping yet ishistorically male dominated. Collectively, the inclusion ofskills involved in both male and female dominatedactivities provided a more genderequitable battery of tests.5.3 Indicators of Health and FitnessThe results support the hypothesis of a relationshipbetween EMS proficiencyand indicators of health and fitness. Correlationanalyses found several significantrelationships between FMS and indicators of health and fitness. However,only oneFMS variable showed a significant and independentrelationship to our indicators ofhealth and fitness.5.3.1 Indicators of Health and Fitness StatusWhile the majority of boys and girls were classified by BMI as being ofa normalweight, the results indicated that up to 33.3% of boys and16.6% of girls wereoverweight. An additional 18.8% of boys and 5.5% of girlswere classified as obese.96These findings are important because studies haveshown that being overweight orobese as a child increases the risk ofCVD and early mortality regardless of adult weightstatus [62]. Findings also showed that 6.6%of girls and 4.3% of boys presented withhigh systolic BP. While these percentagesare low, BP measurements were taken froma supine position and would be consequently higherhad they been taken from a seatedposition. Moreover, in combination with the overweightand obesity results, a portion ofchildren in this investigation have multiple indicators ofhealth risk.5.3.2 Regression Analyses: Blood Pressure, Arterial Compliance andFMSFor females, there was a significant relationship (p = .008) between diastolicBPand vertical jump. Vertical jump proficiency in femalesaccounted for 4.5% of thevariance in diastolic BP after having controlled for possible covariates.The combinedmale and female data also showed a significant (p= .002) relationship between verticaljump and diastolic BP with vertical jump accounting for 4.0%of the variance in diastolicBR The direction of the relationship between diastolicBP and vertical jump (for boththe combined male and female data and for the female onlydata) was positive. Thiswas contrary to the hypothesized results. FMS proficiencywas expected to increase asdiastolic BP decreased because lower BP measurements are usuallyindicative ofhealthier vasculature [52, 54]. As children maturephysically, their BP measurementsincrease [27] therefore, the direction ofthe relationship between diastolic BP andvertical jump is likely a product of increased maturational age.As we do not have anaccurate assessment of maturation at our disposal,the impact of this factor cannot bedetermined.Our results offer a nominal degree of support for our hypothesis that EMSproficiency is related to BP in school-aged girls. In boyshowever, our hypothesis wasnot supported as no relationships between FMS, BP orarterial compliance were found.As this was the first investigation of its kind to evaluate therelationship between FMSproficiency, BP and arterial compliance, further investigationis warranted.5.3.3 Regression Analyses: Weight Status and EMSSignificant relationships between BMI values and proficiency were not found.This is in contrast to results demonstrated in previous investigationswhich show youthwho had BMI values classified as overweight to be less proficientthan normal-weight97youth [16]. Also not supported by the results ofthe present investigation, Okely et al.[16] found waist circumference measurements to benegatively related to proficiency invarious FMS for both boys and girls. Thesediscrepancies may be explained by havingcontrolled for several health and fitness covariates which were notcontrolled for inOkely et al’s [16] investigation. For example, regression analysescontrolled for WCwhen examining the relationship between BMIand FMS. This was done to determinehow much of the variance in BMI could be accountedfor by EMS beyond that whichwas accounted for by other factors such as WC. Inthe bivariate correlations resultsindicated several relationships between FMS proficiency and weightstatus indicators.Body mass index was related to skipping in malesand to vertical jump in the male only,female only and combined male and female data.Waist circumference was correlatedto vertical jump in all three data sets and to runningin the male only and combined maleand female data sets. It was upon controlling for potentiallyconfounding health andfitness variables that the significance of these relationships decreased.5.3.4 Regression Analyses: Physical Fitness andEMSPhysical fitness variables were not found to be independently relatedtoproficiency in FMS and was not in with the availableliterature regarding adolescentEMS and cardiorespiratory fitness in males andfemales [11]. Once again, this is likelythe result of including health and fitness data asconfounding variables in the analysis.The spearman correlation analysis found that running, hopping,vertical and horizontaljump were related to cardiorespiratory fitness in females.For males, cardiorespiratoryfitness showed significant correlations with running, skipping,hopping and vertical jump.However, for both males and females the relationships betweenEMS andcardiorespiratory fitness disappeared after controllingfor other health and fitnessvariables.5.4 Future DirectionsThe present research indicates the need for greater emphasis onthedevelopment and refinement of EMS during childhood.Physical education classes arean appropriate setting for such development to take place. Recently,the BritishColumbia Ministry of Education introduced a new PE curriculumset for optionalimplementation by September 2008 and for full implementation bySeptember 200998[122]. The curricular updateplaces movement skills among the central componentsinits organizational structure. Theexpressed goal of PE is to, “. . . provide opportunitiesforall students to develop knowledge,movement skills, and positive attitudes andbehaviours that contribute to ahealthy, active lifestyle.” [122]. Specificnon-locomotor(stability), locomotor and manipulativemovement skills are emphasized in theprescribed learning outcomesfrom kindergarten to grade four withgrades five to sevenaddressing these skills in morecomplex contexts (e.g., the performance ofskills incombination with each other). The individualteaching and evaluation of EMS in primarygrades (grades K-4) provides a foundationfor subsequent sport and game activitieswhich are taught and assessedin the intermediate grades (grades five toseven). Thishas created a clear developmentalprogression throughout the curriculum.Achievement indicators are providedfor each prescribed learning outcome andarecategorized as emerging, developing,acquired or accomplished [122].This is amarked extension from the vague evaluationtools provided in the 1995 resourcepackage and as a result the assessmentof FMS has become substantially morecomprehensive and objectivein nature. The establishment of achievementindicatorsalso provides the PE teacherwith considerably more information regardingthe classes’level of individual and collectivemovement skill proficiency. The directfocus onteaching and assessing FMS skills withinthe curricular update is an important steptowards providing children the opportunityto participate in a wide range of physicalactivities.It is our recommendationthat research continues to investigate thespecific rolemovement skill education playsin the acquisition and maintenance ofhealth beyond therole of physical activity alone.Additional research into teacher knowledgeandeffectiveness in delivering movementskill education should be explored.Meanwhile,initiatives to improve the movement skilland physical activity levels of children,such asthe revised BC PE curriculum shouldcontinue to be undertaken throughouttheeducation system.5.5 LimitationsThe assessment tools developed specificallyfor this investigation served to be amajor strength for the primary purposeof determining the relationship betweenindicators of health and fitnessand FMS proficiency. Yet, they were a limitationwhen99determining our subject’s proficiency level in relationto previous literature. While thisinvestigation was not designed to bea comparative study, the ability to categorizeproficiency levels according to previouslyestablished standards would have lentsupport to the interpretation of children’s proficiencylevels. In regards to movementskill assessment, the literature lacks consistency inwhich skills are assessed, the testused to assess the skills and thetesting methods employed. Alone or in combination,inconsistencies such as these make direct comparisonsbetween results challenging.Typically however, results are reported according to classificationas initial, elementaryor mature movement patterns or in terms of thosewho have achieved mastery (amature movement pattern) and those who havenot. While the assessment tools usedin this investigation were partially based on thoseused to classify skills as initial,elementary or mature movement patterns they werealso based on othercategorizations of developmental sequences andbiomechanics research [22, 24, 34,35, 93, 117-121]. As a result,mastery (as defined in the literature) was not able to bedetermined and thus direct comparisonsbetween the proficiency results observed inthis investigation and those observed in other investigationswere not possible.However, general observations were maderegarding the proficiency exhibited by ourparticipants. As previously stated, this investigationwas not designed to be acomparative study and the gains received from havingdeveloped our own assessmenttools which contain a detailed scoring system andutilize objective measurements alongwith videotaped recordings outweigh these potentialcosts.The relationship between FMS proficiency and indicatorsof health and fitnesspartially relies on our ability to accurately determine each child’sskill level. While theemployed assessment tools had several benefits, there were a fewunavoidabledifficulties due to our subject population whichmade FMS assessment difficult. OurFMS assessment was based on children performingskills to the best of their ability. Insome cases this was complicated by variousfactors. First, some children may havemisunderstood the directions. Children whodid not speak English or who spokeEnglish as a second language may have not clearly understoodthe skill they werebeing asked to perform. Consequently, theirperformance may not reflect their trueability. Second, as is the typical nature of children,there were times when a child wouldbehave in a silly manner while performing a skill. The first of thesefactors could havebeen greatly reduced (if not eliminated) by providing the childrenwith a demonstration100of the skill. However, this wouldhave led to a different problem. A demonstration couldhave caused an indeterminateamount of learning to occur which would influence thechild’s proficiency level. The secondof these factors is largely unavoidable in children.Having children perform each skill more than oncemay have increased the chances ofat least one serious (i.e., not silly)performance which could then be used for dataanalysis. However, a similar problem to demonstratingthe skills would have occurred.Having children perform a skillseveral times provides them with the unintentionalopportunity to practice and would thus influencetheir proficiency. In addition, therewere time constraints during the data collectionperiod which eliminated this possibilityas an option.Finally, the inability to determine the physicalmaturation level of the participantsmay have also been a limitation. Theinclusion of maturational level among covariatesmay have offered some insight intothe reasons we found a positive (rather thannegative) relationship betweenvertical jump and diastolic BP.5.6 ConclusionThis novel investigation has demonstratedproficiency in FMS to be significantly(p < .01) related to several indicatorsof health and fitness. Correlation analyses foundrunning and hopping to be significantly (p < .01)related to musculoskeletal andcardiorespiratory fitness tests. A significant (p< .01) relationship between verticaljumping and weight status, musculoskeletal andcardiorespiratory fitness was alsofound by the correlation analyses. Regression analyseswere also performed todetermine the independent relationship betweenhealth and fitness indicators. Verticaljump accounted for the variance in diastolic BPbeyond that accounted for by otherhealth and fitness variables (i.e., systolicBP, small artery compliance andcardiorespiratory fitness). The direction of the relationshipbetween vertical jump anddiastolic BP was positive. It was hypothesizedthat this relationship would be negativeand therefore the positive relationship between diastolicBP and vertical jump wasunexpected. Additional analysis is warranted todetermine the reasons for thisdiscrepancy and to further establish the relationshipbetween FMS proficiency andhealth indicators.This investigation also examined possible genderdifferences among select FMSin addition to determining the current state of EMSproficiency. While results did not101reveal significant (p < .01) genderdifferences among movement skills, proficiencyfor allFMS was exceptionally low for both boysand girls.In light of findings demonstrating arelationship between FMS proficiency andindicators of health and fitness, combinedwith the evaluation of very low proficiencylevels among elementary aged children,the creation of educational strategies designedto develop children’s EMS are supported.The provision of adequate physical activitytime is also encouraged to providechildren with the opportunities to practicemovementskills, therein furthering skilldevelopment. These are essential stepsto grant childrenthe skills necessary forlifelong physical activity pursuits. In closing, wehaveestablished that through their relationshipto indicators of health and fitness, movementskills are an aspect of children’shealth that warrants greater attention.102CHAPTER VI: REFERENCES1. BaIl, G.D.C. andMcCargar, L.J. 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Bayley, N.,The developmentof motor abilities duringthe first three years.Monograph of theSociety for Researchon Child Development,1935. 1:p.1-26.113Appendix A: AS!BC Consentand Ethics FormsPrincipal InvestigatorsHeather McKay PhD,604.875.5346 and Patti-JeanNaylor PhD,250.721.7844Co-investigatorsJoan Wharf-HigginsPhD, Ryan Rhodes PhD,Stephen ManskePhD, Darren Warburton PhD,Shannon Bredin PhDResearch CoordinatorSharon Storoschuk 604.875.4111extension 62005Information for Families:We are pleased to invite youand your child to be a part of ActionSchools! BC (AS! BC)Research Study. Your child’sschool has agreed to be apart of the AS! BC ResearchStudy and we now inviteyou and your child to read thefollowing information on thisexciting initiative!The Action Schools! BCProgramThe goal of AS! BC is to “makehealthy choices the easychoices” to improve the healthand well-being of all children.The program was developed in responseto the realitythat many Canadian childrenare physically inactive and as aresult are at a greater riskof developing chronicdiseases such as heart disease,obesity, Type II diabetes andosteoporosis. AS! BC helps schoolsto provide more physical activity tostudents andencourage healthy lifestyles.The success of this program wasrecently tested inschools in the Lower Mainland.As a result of participatingin more physical activity,students had improvements inheart and bone health. You canlearn more about ActionSchools! BC and the resultsof the research study on ourwebsite atwwwactionschoolsbc.ca. Weare now offering the AS! BC Programto schools acrossthe province and with fundingfrom the Canadian Institutes ofHealth Research we areconducting a second researchstudy to see if the program will besuccessful in differentareas of BC.The Action Schools! BC Research StudyWe will be conducting a 3-yearstudy to determine if the AS!BC Program can positivelychange physical activity andeating behaviours, self-esteemand heart health instudents across BC. To see ifsuch changes occur as a result ofthe program, it isimportant for us to compare the AS!BC Program with regularschool routines ofphysical activity. For this reason, schoolswho chose to participate in theAS! BCResearch Study will be randomlyassigned to one of two groups;intervention or usualpractice. The intervention schools willreceive the AS! BC Program andthe usualpractice schools will continue with theirregular program of physical activity.Studentsfrom all schools will be invited to participatein the research study. Therefore,if your114child’s school is a usualpractice school (not doing theAS! BC Program) we would stilllike to ask them to participatein the research study. At the end of thestudy period theAS! BC Program will beoffered to all schools.During the first year ofthe research study, therewill be two measurement sessionsbetween September 2005 and June2006 (Fall and Spring).Each session will requireyour child to be absentfrom class for a minimum of 70minutes. Detailed informationabout all measurementsthat will occur during thesesessions is provided in the attachedconsent form.In addition, your child may beasked to wear an accelerometertwice during the schoolyear. Accelerometersare ‘motion sensors’ that workusing the same technology asthemotion sensor lights for housesand carports. The purposeof the motion sensor is toget an idea of your child’sphysical activity patterns.The accelerometer is small andlightweight and is wornon a belt around the waist.At this time we would ask thatyou please consider you and yourchild’s participation inthe AS! BC Research Study. Weinvite you to read, completeand sign the attachedconsent form and HealthHistory Questionnaire. Once youhave completed the forms,please place them in theattached envelope, seal it andplace it in the mail. Please notethat should you and your childchoose not to participate inthe research study, your childwill still be able to participate inAS! BC.We are excited to expandAS! BC to schools throughoutthe province and we lookforward to working withthe students, parents and teachersin your region. You and yourchild’s participation will beimportant in helping us determineif AS! BC is an effectivemeans to provide physicalactivity and encourage healthyliving in schools. If you haveany questions pleasecontact Sharon Storoschuk(Research Coordinator) at604.875.4111 ext 62005 [Sharon.storoschuk@ubc.ca],Dr. Heather Mckay (PrincipalInvestigator) at 604.875.5346[heather.mckay@ubc.ca] or Dr.PJ Naylor (PrincipalInvestigator) at 250.721.7844 [pjnaylor@uvic.ca].Sincerely,Dr. Heather Mckay,Professor,University of British Columbia,Department of Orthopaedics,VGH Research Pavilion 5” Floor828 West10thAvenueVancouver, BC V5Z 1 LB115ActionSchools! BC Consent Form for FamiliesPlease read the followingwith your child, and if you andyour child would like toparticipate please signthe attached form andreturn the signed form in thestamped, addressedenvelope provided. Youmay keep the other pages foryourrecords.Procedures. Your child’sparticipation in the ActionSchools! BC (AS! BC) ResearchStudy will involve twoin-school testing sessions in theFall and Spring of the next twoschool years. All childrenwill participate in the Anthropometryand Questionnairecomponents and a smallerrandom sample of students willparticipate in theCardiovascular Healthand Musculoskeletal Fitness,Fundamental Movement SkillsandAccelerometer components.1. Anthropometrv: Measuresof height, weight and calfand waist circumference willbe taken.Total Time - 10 minutes:Fall and Spring.2. Questionnaires: Yourchild will be assisted in the completionof questionnaires thatwill assess their physicalactivity, nutrition, self-esteemand attitudes andperceptions about physicalactivity. A trained researchassistant will discuss theimportance of these assessmentswith the children.Total Time — Ihour: Fall and Spring.3. CardiovascularHealth and MusculoskeletalFitness: We will evaluateaerobicfitness using a shuttle runin which students repeatedlyrun 20 meter laps in timewith a clearly audible“beep” until they becometired and choose to stop.Musculoskeletal fitness (i.e.muscle strength and power) willbe assessed using ahand held dynamometer.A research assistant will provideclear instructions for eachprocedure to the students.Resting blood pressure andheart rate will be recordedbefore all fitness procedures. Only asubset of students (25%)will be recruited forthis portion of the study.Total Time - 45 minutes:Fall and Spring.4. Accelerometers: Wewill monitor children’s physicalactivity with accelerometers.Children will wear the accelerometer(on a belt around theirwaist) from the time theyget up until the time they go tobed (approximately 12hours) for 5 consecutive days.A research assistantwill provide clear instructionsfor how to weartheaccelerometer. A small groupof students (25%) whoparticipate in thecardiovascular component (item3 above) will be recruitedfor this portion of thestudy. Accelerometerswill be worn for 5 days inthe Fall and Spring. Totaltime — 45minutes in the Fall for a sessionon accelerometer instructions.5. Fundamental MovementSkills: Your child will be askedto perform sevenfundamental locomotor skills.These include: running,vertical jumping, horizontaljumping, jumping from a height,hopping, galloping, and skipping.These skills will bevideotaped from two separate camerasrecording motor performancefrom the frontand from the side. Performanceof each motor skill will bevideotaped so that motorskill proficiency can be assessed.A small group of students(20%) that are116participatingin the cardiovascularcomponent(item 3 above)will be recruitedtoparticipatein this portionof the study.Total Time10 minutes:Fall and Spring.Health HistoryQuestionnaire:If you andyour childagree to participatein the AS’BC ResearchStudy, youwill beasked tocompletethe attachedHealth HistoryQuestionnaireto determineif there areany healthreasons toexcludeyour child fromthe researchstudy andto identify anyconditionsor medicationsthat may affectstudy outcomes.Possible Harms:None.Benefits:If you andyour childchoose toparticipatein the AS!BC ResearchStudy, youand yourchild willlearn moreabout howphysicalactivity andhealthy eatingcan contributetoimprovedhealth. Atthe end ofthe study youand yourchild will receivea summaryofthe resultsindicatingthe generalfindingsof the studyand yourchild’s personalperformance.It is our hopethat throughthis program,your childwill achievethe manyhealth benefitsthat accompanyan activelifestyle.Rightsand Welfareof the Individual:You havethe rightto refuseyour child’sparticipationin this researchstudy. Itisunderstoodthat you arefree to withdrawyour childfrom any orall parts ofthe studyatany timewithout penalty.If you and yourchild choosenot to participatein the studythiswill not preventthem fromparticipatingin AS! BC.If your child’steacher choosestostop participatingin AS! BC wewould like tostill involveyour childin the researchstudy.Confidentiality:Your child’sidentity willremain confidentialas all individualrecords andresults willbeanalyzedand referredto by numbercode only.Files are keptin lockedcabinets attheVancouverGeneral Hospital— ResearchPavilion,Centre forClinical EpidemiologyandEvaluation.Only thosedirectly involvedin the study(namely, theAS! BC ResearchTeam) willhave accessto yourchild’s recordsand results.Your childwill not bereferred to byname in anyprogram reportsor researchpapers. Yourchild’s resultswillremain confidentialand theywill not bediscussedwith anyoneoutside theresearchteam. Videotapesof locomotiveskills will bestored forfive years atwhich pointthey willbe demagnetizedand destroyed.Please beassured thatyou andyour childmay askquestions atany timeand wewelcomeyour commentsand suggestions.We will beglad to discussyour child’s117results whenthey becomeavailable.Should youhave anyconcerns aboutthis programor wish furtherinformationplease contactSharonStoroschuk(ResearchCoordinator),604.875.4111extension62005,Dr. HeatherMckay (PrincipalInvestigator),604.875.5346or Dr. PJNaylor (PrincipalInvestigator)at 250.721.7844.If you haveanyconcernsabout yourchild’s rightsor treatmentas a researchsubject, youmay contactthe Director,Office ofResearchServices atthe Universityof BritishColumbia at604.822.8598.Compensationfor Injury:Signing thisconsent formin no waylimits yourlegal rightsagainst thesponsors,investigatorsor anyoneelse.118ConsentFormPlease fillout both sidesof this formand returnit in the stamped,addressedenvelopeprovided.Please keepthe otherpages foryour records.Parent’sConsentStatement:I/Wethe(Please printthe name ofone or bothparents/guardians)parents/guardiansof___________________________________________________havereceived andread all(Please printchilds first andlast name)Zpages ofthe informationletter andconsentform and understandthe purposeandproceduresof the ActionSchools!BC ResearchStudy asdescribed.Please check fr’)one.I agree tohave mychild participatein the 3-yearAction Schools!BC ResearchStudy (anthropometry,questionnaires)with theunderstandingthat mychild may ormaynot be randomlyselected toparticipatein the cardiovascularhealth, accelerometerandmovementskills portionsof the study.— I donot agreeto havemy childparticipatein ActionSchools! BCResearchStudy.Please check fr”)one.I give permissionto the Departmentof Orthopaedics,as agentof the UniversityofBritish Columbia,to take videotaperecordingsof my childparticipatingin theFundamentalMovementSkills componentof the ActionSchools!BC ResearchStudy. Iunderstandthat suchvideotaperecordingsmay beused by thePrincipalInvestigatorornomineesand will becomeproperty of theUniversityof BritishColumbia.I do notgive permissionto the Departmentof Orthopaedicsto takevideotaperecordingsof my child.(Continued onother side)119I understandthat atany timeduring the3-yearAction Schools!BC ResearchStudy wewill be freeto withdrawwithout jeopardizingany medicalmanagement,employmentoreducationalopportunities.I understandthe contentsof all six pagesof this formand theproposedprocedures.I have hadthe opportunityto ask questionsand havereceivedsatisfactoryanswers toall inquiriesregardingthis program.Signatureof Parent orGuardianDatePrintedname of theParent orGuardian signingaboveChild’s Statement:I havetalked withmy parents/guardiansaboutthe ActionSchools!BC ProgramandResearchStudyand I understandwhat I willbe asked todo. I understandthat if I wantto I can stopbeing inthe researchstudy at anytime andI will stillbe able toparticipatein activitiesat my school.I have hadthe chanceto ask questionsand havereceivedsatisfactoryanswersto all of myquestions.Signature ofChildDatePrinted nameof childSchool NameGrade andDivision120The Universityof BritishColumbiaOffice of ResearchServicesClinical ResearchEthics Board— Room210, 828 West10th Avenue,Vancouver,BC V5Z1L8ETHICSCERTIFICATEOF EXPEDITEDAPPROVAL:RENEWALPRINCIPALiNVESTIGATOR:DEPARTMENT:UBC CREBNUMBER:Heather A.McKayH02-70537INSTITUTION(S)WHERERESEARCHWILL BECARRIEDOUT:N/A)ther locationswhere theresearch will beconducted:N/ACO-INVESTIGATOR(S):Kate ReedDarren WarburtonPatti-JeanNaylorKarim Miran-KhanRyan RhodesHeather MacdonaldSPONSORINGAGENCIES:ProvincialHealth ServicesAuthority- “ActionSchools! BC: Hormones& Lipids inAction Schools!BCChildren”- “ActionSchools! BC”UBC Start-upFunds - “ActionSchools! BC”PROJECTTITLE:ction Schools!BCEXPIRYDATE OFTHIS APPROVAL:December4, 2007APPROVALDATE: December4, 2006CERTIFICATION:n respectof clinical trials:1. The membershipof this ResearchEthics Boardcomplies withthe membershiprequirementsfor ResearchEthicsBoardsdefined in Division5 of theFood and DrugRegulations.2. The ResearchEthics Boardcarries outits functionsin a mannerconsistent withGood ClinicalPractices.3. This ResearchEthics Boardhas reviewedand approvedthe clinicaltrial protocoland informedconsent formforhe trialwhich is to beconductedby the qualifiedinvestigatornamed aboveat the specifiedclinical trialsite. Thisapproval andthe views ofthis ResearchEthics Boardhave beendocumentedin writing.The Chairof the UBCClinical ResearchEthics Boardhas reviewedthe documentationfor theabove namedproject. Theresearch study,as presentedin the documentation,was foundto beacceptableon ethicalgrounds forresearchinvolvinghuman subjectsand was approvedforrenewal bythe UBCClinical ResearchEthics Board.Approval ofthe ClinicalResearch EthicsBoard by oneofDr. BonitaSawalzky,AssociateChair121AppendixB: AS!BCTestingInstructionsBLOODPRESSUREPositionof child• Pleasesit quietlyon a chairwith yourfeet flaton the floorand yourlegsuncrossed.• Pleaseuncover theupper partof yourleft armand placeyour left elbowandforearmon the table.• Your leftarm shouldbe relaxedwith thepalm ofyour handfacing uptowards theceiling.Instructions• For thismeasurementplease staystill andtry not totalk whilewe takethemeasurement.• Youare goingto feelthe cuff squeezingyour armand youmight feelyour handtingling alittle.Note toResearcher:*Ensurethe bloodpressurecuff is theappropriatesize forthe child.Use amanual cuffiftwo errorreadingsare displayedby the automaticcuff. Excessivemovementandincorrectplacementof the cuffare themost commonreasonsfor errorreadings.*Recordtwo measurementsfor SBP,DBP andHR.*lfthe restingBP is above120/80 athird measurementwill be takenafter a 5mm restperiod.*Ifthe thirdmeasurementis still above120/80then thechild willnot performthecardiovascularfitness assessment.122CURL-UPSPositionof Child• Pleaselie on yourback withyou kneesbent to900and feetflat on thefloor.Mark thepositionof the child’sheals withmaskingtape.• Pleasestretch yourhands downtowardsyour feetuntil thetips of yourmiddlefingers aretouchingthe marker.Instructions• Youwill bedoing PartialCurl-ups tothe soundof the metronome(set to 40bpm),you canalso listento metelling youto curl ‘up’,and then‘down’.• WhenI tell youto start,you willcurl yourhead, neckand shouldersup off ofthemat untilyou feelthe endof the markerwith bothof your fingers(10cm).• Thenyou willcurl backdown untilyour headtouchesthe matagain.• Try todo as manycurl-upsas you can.• Anyquestions?• Listento the metronome...• Pleaseget readyand startwhen I saygo.Note toResearcher:*Childis correctedif they performincorrecttechnique.*Childis stoppedif they performmore thantwo consecutivecurl-upswith incorrecttechnique.*Recordthe totalnumber ofcorrectcurl-ups performedby thechild.123PUSH-UPSPosition of Child• Please lie onyour stomach with you legsstraight.• Your feet shouldbe together.• Place your hands justoutside of your shoulders withyour fingers pointingforward.Instructions• You are going to startwith your elbows straight andyour body off of the ground.• When I tell you to start, youwill bend your arms andlower your body until yourelbows are at900,--Make sure you keepyour body really straight like aboard.• Then use your arms topush your body back upuntil your elbows are straight.• Try to do as many asyou can.• Any questions?• Please get ready andstart when I say go.Note to Researcher:*Childis corrected if they performthe incorrect technique.*Childis stopped if theyperform more than two consecutivepush-ups with incorrecttechnique.*Recordthe total number ofcorrect push-ups performedby the child.124GRIP STRENGTHPosition of Child• Please stand holding the dynamometer45° out from the side of your body.Instructions• When I say to, you are going to breathenormally while squeezing as hard as youcan.• You will do this twice with each hand,alternating between hands.• Any questions?• Ready... squeeze.Note to Researcher:*Ensurethat the grip is set to an appropriatesize for each particular child.*Childperforms two on each hand alternatinghands for each trial.*Recordtwo measurements (to the nearestkilogram) from each hand.125SIT & REACHPreparation• Pleaseremoveyour shoesfor this measurement.• Sittingwith one legstraight infront of youthe otherbent andstretch forwardforat least15 seconds.• Pleasestretcheach legtwice.Positionof Child• Pleasesit facingthe Sit& Reachbox withyour legs straightin front ofyou.• Yourfeet shouldbe placedflat on theSit & Reachbox just slightlywider thanthewidth of thesliding block.• Placeyour handson topof each otherand reachout towardsyour feet.Instructions• WhenI tell you tostart, youare goingto stretchas far forwardas youcan,pushingthe measuringblock withthe tips ofyour fingers.• As youstretch forward,please keepyour kneesreally straightand breatheoutslowly.• Try notto bounceduring thetest.• Holdthis stretchfor 2 secondsand thenyou cansit up andrelax.Note toResearcher:*Recordtwo measurementsto the nearest0.5 cm.*lfa childis able toreach beyondthe scalelength, havethe childrelax, whileyou readjust theruler to startat 0 cm(at the edgeof the box).In this position,you will needtoadd 26cm to theirscore forthe finalmeasure.

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