Review article
Physical activity and fitness in children with developmental coordination disorder: A systematic review

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Abstract

Developmental coordination disorder (DCD) is a neurodevelopmental condition characterized by poor motor proficiency that interferes with a child's activities of daily living. Activities that most young children engage in such as running, walking, and jumping are important for the proper development of fitness and overall health. However, children with DCD usually find these activities challenging. A systematic review of the literature was conducted to synthesize the recent available data on fitness and physical activity in children with DCD, and to understand the extent of the differences between children with DCD and their typically developing peers. Systematic searches of electronic databases and reference lists identified 40 peer-reviewed studies meeting the inclusion criteria. These studies were reviewed in terms of: (a) study design, (b) population, (c) assessment tools, (d) measures, and (e) fitness and physical activity outcomes. It has been demonstrated that body composition, cardiorespiratory fitness, muscle strength and endurance, anaerobic capacity, power, and physical activity have all been negatively associated, to various degrees, with poor motor proficiency. However, differences in flexibility were not conclusive as the results on this parameter are mixed. Studies’ limitations and the impact of results on future work are discussed.

Research highlights

Systematic review on fitness and physical activity and DCD was conducted. ► Fitness was negatively associated, to various degrees, with poor motor proficiency. ► Children with DCD are less physically active relative to their peers. ► Studies’ limitations and the impact of results on future work are discussed.

Introduction

Developmental coordination disorder (DCD) is a neurodevelopmental condition thought to affect approximately 5–8% of school aged children (APA, 2000, Cermak and Larkin, 2002, Gillberg and Kadesjo, 2003, Gubbay, 1975, Henderson and Hall, 1982). DCD is a complex disorder characterized primarily by poor motor skills that interfere with a child's activities of daily living (Cermak & Larkin, 2002). The movement difficulties experienced by children with DCD do not result from a pervasive developmental disorder or other intellectual or neurological impairments. It is not known precisely what causes DCD, although it is believed that DCD may have a genetic component (Lichtenstein, Carlström, Råstam, Gillberg, & Anckarsäter, 2010), and/or is associated with perinatal oxygen perfusion problems (Pearsall-Jones, Piek, Rigoli, Martin, & Levy, 2009), and is generally a chronic impairment that persists into adulthood (Barnhart et al., 2003, Cantell et al., 1994). In recent years, a growing issue of interest has been the physical health of children with DCD. Considering the increasingly low levels of fitness and physical activity that are typically observed in children in the general population; children with DCD are potentially at a greater disadvantage given the nature of their disorder. Numerous studies have shown that children with DCD have on average lower fitness levels compared to their peers (Table 1). Daily activities that most young children engage in such as running, walking, and jumping are important for the proper development of fitness and overall health (Cermak & Larkin, 2002). However, children with DCD usually find these activities difficult and may experience lower desire to participate in activity, which leads to lower likelihood of participating in opportunities to develop proficient motor skills and adequate fitness levels. Research exploring the fitness and physical activity patterns of children with poor motor proficiency has provided a rather alarming risk profile for cardiovascular disease, due to higher percentage of body fat, decreased aerobic capacity, and generally decreased participation in physical activity (Cairney et al., 2007, Faught et al., 2005, Schott et al., 2007). However, many gaps in the literature exist. In particular, large scale, longitudinal, studies that quantify disease risk are still lacking. In 2002 Hands and Larkin presented a comprehensive review of studies on physical activity and fitness in children with DCD (in Cermak & Larkin, 2002). Since then, the body of knowledge examining various aspects of physical activity, fitness, and health of children with DCD has been steadily increasing. Fitness components including body composition, cardiorespiratory fitness, muscle strength and endurance, anaerobic capacity, power, and flexibility are important in the proper development of children's health and well being. To date, no systematic review of the recent evidence regarding fitness and physical activity in children with DCD has been published. A systematic review of the literature will be valuable in synthesizing the recent available data on fitness and physical activity in children with DCD, and in understanding the extent of the differences between children with DCD and typically developing peers.

Section snippets

Selection of studies

A systematic review of the literature was conducted to identify relevant studies reporting on physical activity and/or fitness in children with motor coordination difficulties. A search strategy was devised that combined three groups of terms, including: (i) motor proficiency, (ii) fitness and physical activity, and (iii) age group of interest. A study's title and abstract were required to contain at least one term from each group to be considered for inclusion in the review. The first group of

Results

The search yielded 1288 potentially relevant publications (Fig. 1). After reviewing the titles and abstracts and removing duplicates; 51 articles were identified that met our relevancy criteria. To avoid repetition, we grouped those studies that were published by the same authors in multiple papers, which narrowed the results down to a total of 40 studies that proceeded to the evidence synthesis stage.

Summary of study results and discussion

The purpose of this study was to systematically review and summarize the literature on the association between poor motor proficiency and fitness and physical activity outcomes in children. Two clear findings emerged from this systematic review. The first was that children with poor motor proficiency generally had poorer performance than their peers on most measures of physical fitness. Second, these children were less physically active than their peers.

Limitations and methodological challenges

There are gaps in the literature evident from this review that require attention in future research on children and adolescents with DCD. First, large scale epidemiologic longitudinal studies that quantify risk over time and changes in health outcomes are lacking. Only eight studies have utilized longitudinal follow up designs. However, short-term follow up durations in some of these studies make it impossible to know how the impact of DCD changes from childhood to adolescence and in

Summary

The results of this systematic review demonstrate that motor competence plays an important part in fitness and physical activity outcomes. It has been clearly demonstrated that body composition, cardiorespiratory fitness, muscle strength and endurance, anaerobic capacity, power, and physical activity have all been negatively associated, to various degrees, with poor motor proficiency. However, differences in flexibility were not conclusive as the results on this parameter are mixed.

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