The Relationship Between Motor Proficiency and Physical Activity in Children

Brian H. Wrotniak, Leonard H. Epstein, Joan M. Dorn, Katherine E. Jones and Valerie
A. Kondilis
Pediatrics 2006;118;e1758
DOI: 10.1542/peds.2006-0742

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located on the World Wide Web at:
http://pediatrics.aappublications.org/content/118/6/e1758.full.html

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ARTICLE

The Relationship Between Motor Proficiency and

Physical Activity in Children
Brian H. Wrotniak, PT, PhDa,b, Leonard H. Epstein, PhDa,b, Joan M. Dorn, PhDb, Katherine E. Jonesc, Valerie A. Kondilisc

aDepartment of Pediatrics, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York; bDepartment of Social and Preventive Medicine,

University at Buffalo School of Public Health and Health Professions, Buffalo, New York; cDepartment of Psychology, University at Buffalo, Buffalo, New York

The authors have indicated they have no financial relationships relevant to this article to disclose.

ABSTRACT
OBJECTIVES. Youth with better motor abilities may find it easier to be physically active
and may be more likely to engage in physical activity compared with peers with
www.pediatrics.org/cgi/doi/10.1542/
poorer motor competence. The purpose of this study was to examine the relation- peds.2006-0742
ship between motor proficiency and physical activity in 8- to 10-year-old children. doi:10.1542/peds.2006-0742
Self-efficacy toward physical activity was also assessed.
Key Words
motor abilities, physical activity,
METHODS. Sixty-five children (34 girls and 31 boys) were studied. Children’s physical
accelerometry, children
activity was assessed by the Manufacturing Technologies Incorporated/Computer Abbreviations
Science and Applications Incorporated model 7164 accelerometer, and their motor CSAPPA—Children’s Self-Perceptions of
proficiency was determined by the Bruininks-Oseretsky Test of Motor Proficiency. Adequacy in and Predilection for Physical
Activity
The Children’s Self-Perceptions of Adequacy in and Predilection for Physical SES—socioeconomic status
Activity scale measured children’s self-perceptions of adequacy in performing and BOTMP—Bruininks-Oseretsky Test of
Motor Proficiency-Short Form
desire to participate in physical activities. MTI—Manufacturing Technologies Inc
CSA—Computer Science and Applications
RESULTS. Children’s motor proficiency was positively associated with activity counts Inc
and percentage of time in moderate and moderate-to-vigorous intensity physical MVPA—moderate-to-vigorous physical
activity
activity and inversely related to percentage of time in sedentary activity. Children z-BMI—standardized BMI
in the greatest quartile of motor proficiency were the most physically active Accepted for publication Jul 10, 2006
compared with children with lower levels of motor proficiency who had similar Address correspondence to Brian H. Wrotniak,
levels of physical activity. Children with greater standardized BMI were less PT, PhD, The Children’s Hospital of
Philadelphia and University of Pennsylvania
physically active, more sedentary, and had poorer motor proficiency compared School of Medicine, 3535 Market St, Room
with children with a lower standardized BMI. Children’s Self-Perceptions of Ad- 1551, Philadelphia, PA 19104-4399. E-mail:
wrotniak@email.chop.edu
equacy in and Predilection for Physical Activity scores were positively associated
PEDIATRICS (ISSN Numbers: Print, 0031-4005;
with Bruininks-Oseretsky Test of Motor Proficiency standard score for boys. Chil- Online, 1098-4275). Copyright © 2006 by the
dren’s motor proficiency explained an additional 8.7% of the variance in physical American Academy of Pediatrics

activity in multiple linear regression after controlling for factors that may influence
physical activity.
CONCLUSIONS. Motor proficiency is positively associated with physical activity and
inversely associated with sedentary activity in children, but there may be a
threshold of motor proficiency above which children may be the most physically
active. Children’s motor proficiency may be an appropriate target for increasing
physical activity in youth.

e1758 WROTNIAK et al
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M ANY CHILDREN ARE less physically active than rec-
ommended, and physical activity declines as chil-
dren get older.1,2 There are a number of factors positively
associated with physical activity in youth, including self-
efficacy in one’s ability to overcome barriers to physical
activity,3,4 perceptions of physical or sport competence,4,5
having positive attitudes toward physical education,4 en-
joying physical activity,4,6 and parent, sibling, and peer
support.4,5 An additional determinant of physical activity
among children and adolescents may be the level of
mastery of the movement skills that are a foundation for
the skills used in common forms of adult physical activ-
ity.7,8 Movement skills track at low-to-moderate levels
during childhood,9–12 so greater motor proficiency in
youth may be predictive of later physical activity. Youth
with better motor proficiency may find it easier to be
physically active and may be more likely to engage in
physical activity compared with peers with poorer motor
skill competence. Children with poor motor proficiency
may subsequently choose a more sedentary lifestyle to
avoid these movement difficulties.13
Research has shown significant positive associations
among motor skills,8 visual-motor coordination,13 gross
motor development,14 and self-reported athletic coordi-
nation15 and physical activity in youth. This effect may
be different for girls and boys based on differences in
social acceptance for physical activity.16 In addition, the
effect may not be linear but may be most important at
the extremes of the distribution.17 Children with the
poorest motor skills may be the most sedentary. Con-
versely, children who are the most coordinated may be
the most physically active.17
There are several factors that may be related to lower
levels of coordination in youth. For example, more over-
weight youth may be less coordinated than leaner
youth,13–15 and this relationship may extend to infant
weight and motor activity relationships.18 Motor skills
may also be related to self-efficacy of confidence in
physical activity.19 Decreased competence and confi-
dence may lead children with movement difficulties to
avoid participating in physical activities as a coping strat-
egy.20
Although motor coordination has been consistently
related to both physical activity and body weight, there
are important limitations to these studies. Much of this
research has relied on self-report rather than objective
measures of physical activity and has not considered the
effects of children’s self-perception and self-adequacy for
physical activity. Likewise, there has been an absence of
use of a comprehensive, validated measure of gross and
fine motor skills. Therefore, the purpose of this study
was to examine the relationship between motor profi-
ciency and physical activity in 8- to 10-year-old children
using an objective measure of physical activity and a
comprehensive measure of motor proficiency. It was
hypothesized that youth with greater motor proficiency
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would be more physically active and that children’s self-
adequacy in and predilection for physical activity would
be positively related to their physical activity and motor
proficiency. This research has the potential to help us
understand the relationship between motor proficiency
and physical activity that could lead to the development
of more effective strategies for increasing physical activ-
ity in youth.
METHODS
Participants
Children aged 8 –10 years living in Erie County, New
York, were recruited via letters mailed to families, flyers
distributed to school systems, and a 1-week ad in local
newspapers. Children were healthy and free from diag-
nosed orthopedic, neurologic, or developmental condi-
tions that could create motor proficiency or physical
activity impairments as determined by telephone screen.
One parent/guardian participated with each child and
agreed to assist children as necessary. Children who
were in the ⱖ95th BMI percentile (overweight)21 were
excluded to avoid potential effects that excess weight
may have on physical activity and coordination.
Experimental Design
Each child and parent was seen for 2 visits. During the
first visit, consent and assent forms were completed.
Children then completed the Children’s Self-Perceptions
of Adequacy in and Predilection for Physical Activity
(CSAPPA) scale.22,23 The CSAPPA is a 20-item survey of
children’s self-perceptions of their adequacy in perform-
ing and desire to participate in physical activities. A total
score and an adequacy, predilection, and enjoyment
factor were computed. This scale is a reliable and valid
measure of adequacy in and predilection for physical
activity in children.19,22–25
Parents completed an environmental questionnaire
that asked about the number of televisions and children
in the home. Each parent also completed the Hollings-
head’s Four-Factor Index of Social Status26 to assess so-
cioeconomic status (SES). Height and weight were then
measured for each child and parent. Weight was mea-
sured in kilograms to the nearest tenth using a digital
scale (BF-350; Tanita, Arlington Heights, IL) that was
calibrated before each use against a standard weight.
Height was measured in centimeters to the nearest hun-
dredth using a digital stadiometer (Digi-Kit, North Bend,
WA) that was calibrated against a standard height before
each use. Height and weight were used to calculate BMI
for which the percentage overweight was determined.
Percentage overweight was calculated by the formula
(BMI ⫺ BMI at the 50th BMI percentile)/BMI at the
50th BMI percentile.27
PEDIATRICS Volume 118, Number 6, December 2006 e1759
 The Bruininks-Oseretsky Test of Motor Proficiency-
Short Form28 (BOTMP) was then used to assess chil-
dren’s motor ability. The short form has been validated
against the full scale and consists of 14 items taken from
the 8 subtests that correlate highly with the subtest score
and the total score. The 8 subtests assess gross motor
development, including running speed and agility, bal-
ance, bilateral coordination, and strength; gross and fine
motor development, including upper limb coordination;
and fine motor development, including response speed,
visual-motor control, and upper-limb speed and dexter-
ity. A total standard score, adjusted for child age, was
used to interpret test performance. The BOTMP is a
standardized, product-oriented assessment commonly
used in the assessment of motor abilities in children.12,29
Before leaving, children were taught how to wear a
Manufacturing Technologies Inc (MTI) model 7164 Ac-
tigraph (formerly Computer Science and Applications
Inc [CSA]) accelerometer, and each parent and child was
given a habit book to record their physical and sedentary
activities, confirm when the accelerometer was worn,
and document sleep. The MTI/CSA has been extensively
validated as a measure of physical activity in children.30,31
Accelerometers were placed in a pouch that attached to
a belt that children wore around their waist. Children
were instructed to wear the accelerometers for ⱖ6, pref-
erably 7, days of the week for 1 week for a minimum of
10 hours/day and to record each time the device is put
on and taken off. Each child was instructed to wear the
accelerometer during “typical days” and told that if it
was not a typical day, to wear the accelerometer during
the next typical day, and to make up the missed day so
they would have a week’s worth of activity. On return-
ing to the laboratory after wearing the accelerometer for
7 days, it was downloaded, and on and off times for each
day were determined. The times were examined and
discrepancies resolved by review with the parent and
child with the aid of their habit books. The average
number of minutes that participants wore the activity
monitors and the number of activity counts for each
minute (cpm) were calculated. The percentage of time
spent in sedentary (MTI cpm: ⬍800), light (MTI cpm:
ⱖ800 and ⬍3200), moderate (MTI cpm: ⱖ3200 and
⬍8200), vigorous (MTI cpm: ⱖ8200), and moderate-to-
vigorous ([MVPA] MTI cpm: ⱖ3200) physical activity
during the 7 days was determined. These activity thresh-
old counts have been validated in children using the
MTI/CSA and are based on activity energy expendi-
ture.32 The relationship between activity energy expen-
diture and activity counts is independent of age and
gender and is, therefore, appropriate for assessing phys-
ical activity in children. The study was approved by the
Children and Youth Institutional Review Board at the
Women and Children’s Hospital of Buffalo.
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Analytic Plan
Descriptive statistics were used to compute the mean
and SD for family SES, child BMI percentile, parent BMI,
child and parent age, height, weight, percentage over-
weight, and standardized BMI (z-BMI). Descriptive sta-
tistics for physical activity and motor proficiency were
determined, and independent t tests were used to test for
differences in descriptive characteristics, physical activ-
ity, and BOTMP standard score between boys and girls.
Analysis of covariance was used to examine differences
between boys and girls for each of the 14 items of the
BOTMP controlling for child age and child z-BMI. Pear-
son product-moment correlations were computed to ex-
amine relationships between physical activity, motor
proficiency, and child z-BMI, as well as CSAPPA and
physical activity and motor proficiency. BOTMP stan-
dard scores were sorted in quartiles, and the differences
in physical activity between the quartiles were tested
using 1-way analysis of variance with linear contrasts to
examine the distribution of the relationship between
motor proficiency and physical activity. Hierarchical re-
gression was then used to establish whether BOTMP
standard scores accounted for a significant amount of
incremental variance in child mean activity counts per
minute after controlling for child gender, SES, televi-
sions in the home, children in the home, child z-BMI,
parent z-BMI, and CSAPPA score.
RESULTS
Sixty-nine children initially met the inclusion criteria
and were given accelerometers to wear. Four children
were excluded from the final data set: 1 child broke his
arm during the study, another child participated in a
school-based physical activity program during the study,
and 2 children decided not to continue with the study
after a few days of wearing the accelerometer. Therefore,
a total of 65 children (31 boys and 34 girls) and parents
(14 fathers and 51 mothers) were included in the final
sample. Baseline descriptive statistics for parents and
children are presented in Table 1. There were no statis-
tically significant differences between boys and girls or
between participating mothers and fathers for any of the
descriptive characteristics. Physical activity data for the
children are shown in Table 2. Children wore the accel-
erometer an average of 693.0 minutes (11.6 hours) per
day, and reported sleeping an average of 590.4 minutes
(9.8 hours) per day. The average amount of time that
children spent in moderate and in vigorous physical
activity per day was 25.8 minutes and 6.3 minutes,
respectively. There were no differences in the activity
data between boys and girls.
The mean standardized score for the BOTMP was 55.5
⫾ 10.8 and is at approximately the 72nd percentile.28
There were no differences (P ⫽ .78) between overall
BOTMP score for boys (55.9 ⫾ 11.8; range: 24 –73) and
girls (55.2 ⫾ 10.0; range: 35–75). When individual
 TABLE 1 Descriptive Characteristics of Children and Parents TABLE 3 Correlations Between Physical Activity and Motor
Characteristic Data Proficiency and z-BMI
Child Physical Activity Variable BOTMP z-BMI
Gender, male/female 31/34 Standard Score
SES, mean ⫾ SD 51.0 ⫾ 8.6 r P r P
Age, mean ⫾ SD, y 9.6 ⫾ 0.8
Height, mean ⫾ SD, cm 137.1 ⫾ 7.4 Mean accelerometer cpm 0.315 .011 ⫺0.288 .020
Weight, mean ⫾ SD, kg 33.0 ⫾ 6.2 % time in sedentary activity ⫺0.308 .012 0.284 .022
% overweight, mean ⫾ SD 5.0 ⫾ 11.3 % time in light-intensity activity 0.215 .086 ⫺0.183 .144
BMI percentile, mean ⫾ SD 57.5 ⫾ 24.2 % time in moderate-intensity activity 0.329 .008 ⫺0.362 .003
z-BMI, mean ⫾ SD 0.1 ⫾ 0.7 % time in vigorous-intensity activity 0.181 .150 ⫺0.141 .263
Parent % time in MVPA 0.298 .016 ⫺0.304 .014
Gender, male/female 14/51 BOTMP standard score ⫺0.300 .015
Age, mean ⫾ SD, y 40.0 ⫾ 5.2
Height, mean ⫾ SD, cm 167.8 ⫾ 9.2
Weight, mean ⫾ SD, kg 78.1 ⫾ 20.9
% overweight, mean ⫾ SD 25.1 ⫾ 28.2 time in moderate (speed and agility: r ⫽ ⫺0.37, P ⫽ .002;
BMI, mean ⫾ SD 27.5 ⫾ 6.3 broad jump: r ⫽ 0.41, P ⫽ .001), vigorous (speed and
z-BMI, mean ⫾ SD 1.0 ⫾ 1.4
agility: r ⫽ ⫺0.25, P ⫽ .048; broad jump: r ⫽ 0.30, P ⫽
.014), and moderate-to-vigorous (speed and agility: r ⫽
⫺0.36, P ⫽ .004; broad jump: r ⫽ 0.40, P ⫽ .001)
TABLE 2 Physical Activity of Children as Measured by physical activity and the less time they spent in seden-
Accelerometry tary activity (speed and agility: r ⫽ 0.36, P ⫽ .003; broad
Variable Mean SD Range jump: r ⫽ ⫺0.29, P ⫽ .019) compared with children who
(N ⫽ 65)
scored lower in these areas. Children who scored higher
Mean accelerometer cpm 772.94 282.28 385.69–1809.68
on the visual-motor task of copying a picture of over-
% time in sedentary activity 73.43 7.19 47.26–86.11
% time in light-intensity activity 21.93 6.09 11.91–48.86 lapping pencils spent a greater percentage of time in
% time in moderate-intensity activity 3.73 2.06 0.70–9.29 moderate (r ⫽ 0.25; P ⫽ .047) and moderate-to-vigorous
% time in vigorous-intensity activity 0.91 1.27 0.00–6.00 (r ⫽ 0.26; P ⫽ .037) physical activity than children who
% time in MVPA 4.64 3.04 0.72–15.19 scored poorer on this task. There were no differences
between boys and girls in the association of running
speed and agility, broad jump, or copying pencils with
BOTMP items were examined, boys had faster times in physical or sedentary activity.
running speed and agility (P ⫽ .033) and scored higher When motor proficiency was divided into quartiles to
in throwing a ball at a target (P ⬍ .001) and response assess the distribution of the relationship between move-
speed (P ⫽ .034) compared with girls. Girls sorted a ment abilities and physical activity, significant differ-
greater number of shape cards than boys (P ⫽ .019). ences were noted. Children in the greatest BOTMP stan-
There were significant associations between BOTMP dard score quartile had significantly (P ⬍ .01) greater
standard score and activity counts per minute (r ⫽ 0.32; MTI average activity and percentage of time in MVPA
P ⫽ .011), percentage of time in sedentary physical compared with children in the lower BOTMP quartiles
activity (r ⫽ ⫺0.31; P ⫽ .012), moderate physical activity (Fig 1). There were no significant differences in physical
(r ⫽ 0.33; P ⫽ .008), and MVPA (r ⫽ 0.30; P ⫽ .016) as activity among children in the lower 3 quartiles.
shown in Table 3.There were significant negative corre- There were no significant associations among
lations between z-BMI and activity counts per minute (r CSAPPA total score or adequacy, predilection, and en-
⫽ ⫺0.29; P ⫽ .02), percentage of time in sedentary joyment factors and physical activity. There was a posi-
activity (r ⫽ 0.28; P ⫽ .022), percentage of time in tive association between the predilection factor and
moderate physical activity (r ⫽ ⫺0.36; P ⫽ .003), per- BOTMP standard score (r ⫽ 0.40; P ⫽ .001), as well as
centage of time in MVPA (r ⫽ ⫺0.30; P ⫽ .014), and CSAPPA total score and BOTMP standard score (r ⫽
BOTMP standard score (r ⫽ ⫺0.30; P ⫽ .015). There 0.39; P ⫽ .001). The relationship between CSAPPA total
were no differences in the relationship among motor score and BOTMP was different by child gender.
proficiency, z-BMI, and physical activity by child gender. CSAPPA total score was positively related to BOTMP
Three individual BOTMP items were related to phys- standard score (r ⫽ 0.58; P ⫽ .001) for boys but not for
ical activity: running speed and agility, broad jump, and girls (r ⫽ 0.20; P ⫽ .26).
copying overlapping pencils. The faster that children Stepwise multiple hierarchical regression analysis
completed the running speed and agility task and the showed that BOTMP standard score was independently
farther they jumped, the greater their average MTI associated with MTI activity counts per minute and ex-
counts per minute (speed and agility: r ⫽ ⫺0.39, P ⫽ plained 8.7% of the variance in activity after controlling
.001; broad jump: r ⫽ 0.39, P ⫽ .001) and percentage of for child gender, SES, televisions in the home, children

PEDIATRICS Volume 118, Number 6, December 2006 e1761

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FIGURE 1
Accelerometer counts per minute and MVPA (mean ⫾ SEM) for quartiles of the BOTMP. Letters that are different indicate quartiles that are significantly (P ⬍ .02) different from each
other on the basis of 1-way analysis of variance with linear contrasts.

in the home, child z-BMI, parent z-BMI, and CSAPPA response speed, and scored lower in sorting shape cards
score (Table 4). compared with girls. Previous research supports gender
differences in motor skills, with boys performance in
DISCUSSION motor tasks of strength (running speed and long jump)
The results of this study indicate that motor proficiency and throwing a ball exceeding that of girls.33,34 Gender
is positively associated with physical activity and nega- differences in motor proficiency can be explained by
tively related to percentage of time in sedentary activity environmental influences, biological factors, or their in-
in children. When this relationship was examined by teraction. Before puberty, the physical characteristics of
quartiles of motor abilities, children in the highest quar- boys and girls are similar, and environmental influences
tile of motor proficiency were the most physically active, are more likely to explain gender differences in motor
with significantly greater MTI activity and percentage of proficiency.33 The type of sports and games that boys and
time in MVPA compared with children in lower BOTMP girls are drawn to participate in give them more oppor-
quartiles. tunity to practice and refine their motor skills and may
Boys had significantly faster running speed and agil- contribute to gender differences. For example, throwing
ity, threw a ball at a target more successfully, had greater and running games, such as baseball, are more popular
among boys than girls.35,36 Despite the important role of
the environment in motor skill development in child-
TABLE 4 Hierarchical Regression Model Predicting Child Mean hood, some biological factors may also be present for
Accelerometer CPM certain skills, such as throwing. For example, compared
Variable B SEB B P ⌬r2 r2 with girls, boys have more midarm muscle tissue and a
Step 1 — 0.171 greater shoulder/hip ratio.33,37
Child gender ⫺38.123 69.608 ⫺0.068 .586 We found that the faster that children completed the
SES 2.941 4.145 0.089 .481 running speed and agility task and the farther they
Televisions in home 4.615 31.121 0.019 .883
Children in the home ⫺27.193 26.605 ⫺0.129 .311 jumped, the more physically active and less sedentary
Child z-BMI ⫺127.548 52.344 ⫺0.315 .018 they were. This suggests that running speed and agility
Parent z-BMI 42.041 25.199 0.212 .101 and broad jump may be important to consider when
CSAPPA score ⫺2.051 4.736 ⫺0.057 .667 examining the motor proficiency-physical activity rela-
Step 2 0.087 0.258
tionship or when attempting to improve motor profi-
BOTMP standard 9.176 3.582 0.351 .013
score ciency in youth. These movement skills may be funda-
B indicates ␤ coefficients; SEB, SEs of B; B, standardized coefficients; r2 are the coefficients of mental tasks that promote increased strength and
determination. endurance for participation in active games and sports.

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In fact, children involved in extracurricular organized
physical activities had better motor fitness as measured
by a standing broad jump compared with children who
indicated not participating in organized physical activi-
ties even after adjusting for age, height, body mass, and
organized extracurricular physical activities.38 The corre-
lation between copying a picture of overlapping pencils
and physical activity suggests that visual-motor skills
may be another important determinant of physical ac-
tivity in youth in addition to gross motor proficiency.
This finding is supported by previous cross-sectional re-
search that found that children who were obese com-
mitted ⬃50% more errors on a visual-motor drawing
task compared with their normal weight peers.13
Some studies have demonstrated improvements in
movement skills through interventions, such as specially
programmed physical and health education for school
children,39–41 but much of the research examining
changes in motor proficiency after intervention strate-
gies has been in children with disability or movement
impairment conditions.42–46 Additional research is
needed to investigate how much movement skills can be
increased in youth without these conditions.
Although the children in this study were not over-
weight, children with greater z-BMI had significantly
lower activity counts, less time in moderate and MVPA,
more time in sedentary activity, and poorer motor pro-
ficiency. These results are consistent with previous find-
ings that have reported negative associations between
childhood obesity and physical activity,47 as well as
childhood obesity and motor proficiency.13,14
Motor proficiency explained an additional 8.7% of
the variance in physical activity after controlling for
child gender, SES, televisions in the home, children in
the home, child z-BMI, parent z-BMI, and CSAPPA
score. This is larger than the 3% of the variance in time
spent in organized physical activity explained by move-
ment skills reported previously by Okely et al.8 Their
lower value may be the result of physical activity being
self-reported rather than objectively measured, a limited
range of movement skills being tested, and that their
study sample was adolescents rather than children.
Although the results of this and other research8,17
suggest that the association between physical activity
and movement skills may be relatively weak to moder-
ate, there may be a threshold of motor proficiency at
which this relationship is most important. Our findings
indicate that children in the greatest quartile of motor
proficiency were the most physically active compared
with children with lower levels of motor proficiency
who had relatively similar levels of physical activity.
Children with motor proficiency in the highest quartile
had an average of 17.8 minutes per day more MVPA
than youth in the lower quartiles, who averaged 27.9
minutes in MVPA. Because relatively little is known
about the modifiable factors associated with physical
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activity in youth,3 and because even a small increase in
physical activity can be beneficial for health,48 these data
are particularly important for providing insight into mo-
tor proficiency as a determinant of physical activity in
youth.
Children with lower self-perceptions of their abilities
in physical activity have poorer coordination and report
lower levels of physical activity than their peers.19,23 In
our study, children who scored lower on the predilection
factor of the CSAPPA had significantly poorer motor
proficiency compared with children who scored higher
in predilection. However, children’s self-perception of
physical activity was not associated with their measured
physical activity. Other possible mediators of the rela-
tionship between motor proficiency and physical activity
could be neurologic or physiologic in nature. Coordi-
nated movement requires biomechanical and neuro-
muscular systems that provide activation, sequencing,
timing, and scaling of muscle activity.49 Children with
greater motor proficiency may, therefore, have more
opportunities for and choose to participate in more var-
ied physical activities, because they are better at activat-
ing and sequencing movement patterns. More efficient
movement patterns may also result in less energy ex-
penditure and lower levels of fatigue that may conse-
quently lead to greater amounts and intensity of physical
activity. Additional research is needed to more fully
understand the psychosocial and neurophysiological
mechanisms that may explain the association between
physical activity and motor abilities.
This study, in combination with previous re-
search,8,14,15,17,19 provides support for the relationship be-
tween motor proficiency and physical activity in youth.
The MTI accelerometer has been validated in youth, and
pediatric cut points that provide a valid measure of ac-
tivity based on free-living activity were used. There are,
however, several methodologic points to consider in in-
terpreting these results. Because of the cross-sectional
nature of this research, the direction of the relationship
between physical activity and motor proficiency cannot
be determined. The short form of the BOTMP was ad-
ministered, but further research is needed to provide a
more detailed assessment of how motor proficiency may
be related to physical activity. Furthermore, because the
BOTMP is a product-oriented assessment tool, the po-
tential for accurately detecting specific aspects or com-
ponents of motor skill difficulties and determining
where improvement needs to occur is limited. To im-
prove specific motor skills, a process oriented-test (eg,
the Test of Gross Motor Development50) that breaks
down skills, such as the run and broad jump, into spe-
cific observable components that can be taught and prac-
ticed would be appropriate. The accelerometer is a
widely used tool to measure physical activity but may
not assess all physical activities, such as swimming. Fi-
nally, the sample included primarily white children, and
PEDIATRICS Volume 118, Number 6, December 2006 e1763
research is needed on diverse samples to establish the
generalizability of the findings.
CONCLUSIONS
The findings from this study indicate that motor profi-
ciency is positively associated with physical activity and
inversely associated with sedentary activity. There may
be a threshold of motor proficiency above which chil-
dren may be the most physically active. Future research
is needed to further examine the relationship between
motor proficiency and physical activity. Longitudinal
and intervention studies would provide information on
the direction of this association. Research that examines
motor proficiency among family members, such as par-
ents and siblings, could lead to understanding possible
familial factors that may interact to influence physical
activity in youth. If motor proficiency is a determinant of
physical activity, then strategies that increase movement
skills in childhood may be an important target for help-
ing promote increased physical activity and health in
youth.
ACKNOWLEDGMENTS
This research was funded in part by a clinical research
grant from the American Physical Therapy Association
(to Dr Wrotniak) and a Mark Diamond Research Fund
from the University at Buffalo (to Dr Wrotniak).
We acknowledge and thank Drs James Roemmich
and Mike Sill for consultation and advice during this
research. We are also grateful to the families who par-
ticipated in the study.
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PEDIATRICS Volume 118, Number 6, December 2006 e1765
 The Relationship Between Motor Proficiency and Physical Activity in Children
Brian H. Wrotniak, Leonard H. Epstein, Joan M. Dorn, Katherine E. Jones and Valerie
A. Kondilis
Pediatrics 2006;118;e1758
DOI: 10.1542/peds.2006-0742
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