Effect of Functional Training On Fundamental Motor

Effect of Functional Training on Fundamental Motor
Skills Among Children: A Systematic Review

Dong Zhang
Universiti Putra Malaysia
Kim Geok Soh (  kims@upm.edu.my )
Yoke Mun Chan
Marrium Bashir
Wensheng Xiao
Huzhou University
Research Article
Keywords: Fundamental motor skill, Functional training, Locomotor skill, Object control skill, Balance skill,
Children
Posted Date: May 12th, 2023
DOI: https://doi.org/10.21203/rs.3.rs-2875986/v1
License:   This work is licensed under a Creative Commons Attribution 4.0 International License. Read
Full License
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Abstract
Background
Functional training is an exercise program to enhance physical abilities such as balance, coordination,
agility, and power. The effectiveness of functional training in enhancing physical fitness and motor skills has
been established through its use in rehabilitation treatment and sports training. However, current systematic
reviews have not considered the impact of functional training on fundamental motor skills. This review
aimed to examine the effect of functional training on the fundamental motor skills of children.
Methods
Following PRISMA guidelines, a search was conducted in six databases: PubMed, Scopus, ProQuest, Web of
Science, EBSCOhost, and SPORT Discus, from January 2000 to December 2021.
Results
The search yielded 1451 papers, of which only 24 satisfied all inclusion and exclusion criteria. Significant
improvements were found in the three main areas of FMS, namely, locomotor skills (n = 15), balance skills (n
= 9), and objective control skills (n = 2), as well as general physical fitness (n = 14).
Conclusions
This systematic review shows that functional training effectively improves children’s fundamental motor
skills. It is in accordance with the scientific theory of functional training. Closed kinetic chain exercises
connect joints and muscle groups to work together, making movement and training safer and more effective.
Furthermore, the study outcomes provide valuable insight into the potential benefits of functional training for
children. It may help inform physical education programs and provide guidance on how to best use
functional training to enhance children’s fundamental motor skills.
Introduction
Recent studies have highlighted the importance of fundamental motor skills (FMS) and their role in children’s
physical activity and sports participation. These skills are the basis for mastering more complex and
advanced sports skills and are thus essential for children’s engagement in sports and physical activity. The
skills can be categorized as locomotor skills, balance skills, and objective control skills [1]. Increasing
evidence suggests that the effectiveness of FMS is bound up with an individual’s health condition at all
stages of life [2, 3]. Several studies have indicated that children with inadequate FMS are at greater risk of
developing sedentary behaviours and obesity in adolescence and adulthood [4], while those without the
opportunity to develop FMS may be prone to physical delays [5]. Unfortunately, many countries have
reported low FMS proficiency among children, and a significant number of pre-adolescents lack the
necessary mastery of these essential skills [6].
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According to Gallahue’s Hourglass Model of motor development theory, children learn motor skills
sequentially, and the optimal age for FMS development is 5–7 years [7]. It is believed that early childhood
plays a vital role in determining the future development of children [8, 9], as it is during this period that they
reinforce what they have already learned and prepare themselves to acquire more advanced skills [8].
Moreover, research indicates that children possess the necessary developmental capabilities to acquire most
FMS. However, evidence suggests that children do not naturally acquire FMS as they age. Instead, they
require instruction and practice to develop and become proficient in FMS [10, 11]. Therefore, considering the
significance of learning FMS and the actual developmental level of the children, giving them numerous
chances to refine and develop their FMS is imperative.
Due to the growing popularity of functional training, numerous studies have been conducted to investigate
its potential to improve FMS in children. Functional training is an exercise program that emphasizes the
development of coordination, stability, and flexibility through fundamental movement patterns and basic
human body postures [12, 13]. It focuses on coordinating the overall body activity of the muscles, bones, and
joints to achieve specific goals [13]. The core principle behind functional training is that it mainly
emphasizes the closed kinematic chain [14]. Its properties distinguish it from more conventional exercise
methods, highlighting why it produces beneficial results. Consequently, functional training can make the
body have the effect of one plus one being greater than two in different fields of application, including
rehabilitation and sports training. It has been shown to be effective in enhancing motor skills in children with
cerebral palsy and movement disorders [15–18]. In addition, it can also improve athletic performance,
promote physical fitness, and reduce the risk of sports-related injuries in healthy children [12, 19–21].
Functional training has numerous advantages that are strongly associated with FMS. This understanding
has led to increased research studies using functional training as a potential intervention to improve the
FMS of children. However, the current state of knowledge regarding the impact of functional training on
children’s ability to improve FMS is unclear. Therefore, this systematic review was conducted to evaluate the
effect of functional training on FMS in children.
Methods
The methodology of this review was structured according to the PRISMA guidelines for reporting systematic
reviews and meta-analyses [22, 23]. The study was registered in the PROSPERO database,
CRD42022313408.
Search Strategy
A detailed literature search was conducted across six database sources, namely, PubMed, Scopus, ProQuest,
Web of Science, EBSCOhost, and SPORT Discus, covering studies published between January 2000 and
December 2021. By observing the gradual process of change and development over the twenty years, useful
insights into this field can be gained. Keywords related to functional training (“functional training”;
“functional exercise”; “functional task training”; “functional correction training”; and “functional fitness
training”), fundamental motor skills (“fundamental motor skill”; “fundamental movement skill”; “basic motor
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skill”; “motor competence”; and “gross motor skill”) and children (“child*”; “adolescent”; “kid”; and “youth”)
were used to conduct the search. Additionally, this study scanned other potential papers by conducting a
keyword search on Google Scholar and reviewing the reference lists of all the papers included in the study.
Eligibility Criteria
The review employed PICOS (population, intervention, comparison, outcome, and study design) principles to
establish its inclusion criteria [24]. Articles were only included when they satisfied the following criteria:
The population includes children under the age of 18.

The study design involves randomized controlled trials (RCTs) or non-RCTs with two or more groups or a
one-group design with a pre-post-test.
The study involves functional training, its techniques, modes associated with functional training, and
their integration with other training methods.
The primary outcomes are based on analyses that include at least one component of FMS.
The articles are published in English.
Studies meeting the following criteria were not considered:
Reviewed articles, conference papers, notes, and abstract;

The subjects are older than 18 years;
Studies that did not include pre-test or post-test;
Studies that did not conduct any training interventions or experiment;
Studies that did not report any outcomes or detailed data on FMS.
Quality Assessment
The PEDro scale was employed to examine the standard of the experimental procedures. The scale has been
demonstrated to have good validity and reliability [25]. It evaluates four aspects of the research method: the
randomization process, the blinding procedure, the group comparison, and the data analysis. It comprises a
checklist of 11 items scored by responding with a yes (1 point) or no (0 points). A higher score indicates a
higher level of methodological quality. The scores may be evaluated as follows: 9–10 represents excellent
quality; 6–8 represents good quality; 4–5 represents fair quality; and a score smaller than four represents
poor quality. Two reviewers evaluated the articles independently. When faced with conflicting views, the
reviewers discussed the issue or sought an evaluation from a third reviewer.
Study Selection
All articles were imported into Mendeley and checked for duplicates. Firstly, two independent reviewers
checked the titles and abstracts based on the inclusion and exclusion criteria. Then, a full-text review was
conducted to extract information and data from articles identified and agreed to be included. A full-text
review was also conducted for articles that could not be identified by title or abstract. In the event of any
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disagreements during this process, a discussion was held to reach a consensus. If a mutual agreement
could not be reached, the assistance of a third reviewer was enlisted to resolve the issue.
Data Extraction
Specific data were extracted from the articles and recorded in a specially designed excel table. The recorded
data included the following: (1) authors, year, and country; (2) sample characteristics (age, gender, and
sample size); (3) intervention (content, duration, intensity, and frequency); (4) study design; (5) outcomes and
results (pre and post). Two separate reviewers went through this process independently.
Results
Overview of studies
The original search yielded 1440 articles. An additional 11 studies were included by reference checking (n =
9) and Google Scholar (n = 2). When removing duplicate (n = 144) and irrelevant articles (n = 1230), 60
remained. Next, 24 articles that met the inclusion criteria were identified after a full-text review. Figure 1
shows the detailed process.
Figure 1 Article selection process flow chart (PRISMA)

Study Quality Assessment
All studies were evaluated according to the PEDro criteria. Thirteen articles received five points, indicating
acceptable quality. Meanwhile, eight articles received seven points, and three articles received eight points,
both scores indicating good quality. The mean score was 6.04, and no low-quality studies were included,
indicating that the overall quality of the research was good. Nonetheless, no study satisfied all the quality
evaluation criteria. However, all the articles met the following five assessment criteria: similar at baseline,
15% dropouts, intention-to-treat analysis, between-group comparisons, and point measurements and
variability [26]. Besides, subjects and experimenters were not blinded in any of the studies, and only three
articles blinded the assessor of the results. Table 1 presents the assessment findings.
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Table 1
Summary of methodological quality assessment scores
Part Part Part Part Part Part Part Part Part Part Part Score
1 2 3 4 5 6 7 8 9 10 11
Norambuena 1 0 0 1 0 0 0 1 1 1 1 5
et al.
(2021) Chile
Baron et al. 1 0 0 1 0 0 0 1 1 1 1 5
(2020)
Poland
Katsanis et 1 0 0 1 0 0 0 1 1 1 1 5
al.
(2021)
Greece
Laurent et al. 1 1 1 1 0 0 0 1 1 1 1 7
(2018) USA
Labib 1 0 0 1 0 0 0 1 1 1 1 5
(2014) Egypt
Yildiz et al. 1 0 0 1 0 0 0 1 1 1 1 5
(2018)
Tukey
Song et al. 1 0 0 1 0 0 0 1 1 1 1 5
(2014)
Koera
Liao et al. 1 1 1 1 0 0 0 1 1 1 1 7
(2017)
China
Marta et al. 1 1 1 1 0 0 0 1 1 1 1 7
(2019)
Portugal
Eagher et al. 1 1 1 1 0 0 1 1 1 1 1 8
(2016)
Australia
Part 1, eligibility criteria specified; Part 2, random allocation; Part 3, concealed allocation; Part 4, groups
similar at baseline; Part 5, participant blinding; Part 6, therapist blinding; Part 7, assessor blinding; Part 8,
fewer than 15% dropouts; Part 9, intention-to-treat analysis; Part 10, between-group statistical
comparisons; Part 11, point measures and variability data
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1 2 3 4 5 6 7 8 9 10 11
Carvutto et 1 1 1 1 0 0 0 1 1 1 1 7
al.
(2021) Italy
Baron et al. 1 0 0 1 0 0 0 1 1 1 1 5
(2020)
Poland
Bonney et al. 1 1 1 1 0 0 0 1 1 1 1 7
(2019)
South Africa
Gorter et al. 1 0 0 1 0 0 0 1 1 1 1 5
(2009)
Netherland
Mikołajczyk 1 0 0 1 0 0 0 1 1 1 1 5
et al.
(2014)
Poland
Emara et al. 1 1 1 1 0 0 1 1 1 1 1 8
(2016) Saudi
arabia
Ansa et al. 1 0 0 1 0 0 0 1 1 1 1 5
(2020)
Ghana
Surana et al. 1 1 1 1 0 0 0 1 1 1 1 7
(2019) USA
Ketelaar et 1 1 1 1 0 0 1 1 1 1 1 8
al.
(2001)
Netherland
Salavat et al. 1 0 0 1 0 0 0 1 1 1 1 5
(2017)
Netherland
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1 2 3 4 5 6 7 8 9 10 11
Blundell et 1 0 0 1 0 0 0 1 1 1 1 5
al.
(2002)
Australia
Ahl et al. 1 0 0 1 0 0 0 1 1 1 1 5
(2005)
Sweden
Mikołajczyk 1 1 1 1 0 0 0 1 1 1 1 7
et al.
(2014)
Poland
Farrokhian 0 1 1 1 0 0 0 1 1 1 1 7
et al.
(2021) Iran
Table 1 Summary of methodological quality assessment scores

Participant Characteristics
Participants in the 24 studies can be grouped into two categories: 12 studies on healthy children and 12 on
unhealthy children. The included studies evaluated 1133 participants, with 834 healthy children that included
440 boys and 394 girls, with the mean age ranging from 8.54 to 17.0 years. A total of 299 children had
related diseases, including 113 boys and 152 girls, with a mean age ranging from 4.5 to 15.06 years old. The
sample size for most studies was between 10 and 50. Table 2 presents the specific information of the
studies.
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Table 2
Research specific information
Study Design Participant Experimental Control Result
Norambuena PPS Elite athletes IV: No Single-leg horizontal

et al. Suspension- jumping (right leg↑; left
5 Sports: Judo training leg↑), Sorensen↑, SAR↑,
(2021) Chile weeks Y balance (arm↑; leg↑;).
SS: 10 INT: Intensity Grip strength ~; prone
gradually instability test
EG: 10; 8 B/ 2 increased performance ~;
G; Age: 15.4 ±
2.8 year; Freq: 3
/week
Time: 20min
Baron et al. PPS Elite athletes IV: No Functional state

Functional (FMS1↑, FMS2↑,
(2020) 12 Sports: training FMS3↑); Speed and
Poland weeks Football acceleration Tests (0-5m
Time: 70- ~, 5-20m↑, 10-30m↑, 0-
SS: 20 90min 30m↑); Velocity↑.
EG: 20 B; Age:
16.8 ± 0.6 year;
Katsanis et PPS Ordinary IV: IV: Regular In EG (SLJ↑ p < .001, Sit-
al. children Suspension- PE class ups for 30 seconds↑ p
8 training < .001, push-up↑ p
(2021) weeks SS: 321; 158 Freq: 2 /week < .001, handgrip↑ p
Greece B/163 G; INT: < .001); in CG ~. In EG
Time: 45min increased in motivation
Age: 16.54 ± Increased by to participate in the PE
0.91 year; 50%/2weeks. class
EG: 154; 76 Freq: 2

B/78 G; /week
Age: 16.52 ± Time: 45min
0.88 year;
CG: 167; 82 B/
85 G;
Age: 16.56 ±
0.94 year;
Abbreviation: PT, participant; SS, sample size; EG, experiment group; CG, control group; PPS, pre-post-test;
HT, height; BW, body weight; IV, Interventions; INT, intensity; Freq, frequency; ES: effect size; GFT, general
physical fitness; LS, locomotor skills; Bs, balance skill; OCS, objective control skills; B, boy; G, girl; NM, not
mentioned; FMS, functional movement screen; GMFCS, gross motor function classification system. DB,
dynamic balance; SB, Static balance; SAR, sit-and-reach; SLJ, standing long jumping; T,times; FST,
functional strength training; ST, Suspension training. SR, shuttle run; CVJ: countermovement vertical
jump;
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Laurent et al. RCTs Ordinary IV: IV: Regular Pull-Up performance↑(P

children Suspension activities = .01) Lift↑, and FMS
(2018) USA 6 training score↑, relative to CG.
weeks SS: 28; 46% Freq: 2 /week skill-related fitness (SLJ
B/54% G; Freq:2 /week ~, SR ~)
Time: 60min
Age: 9.3 ± Time: 60min
1.5 year;
EG: 17; 58.5%
B/41.5% G;
Age: 9.82 ±
1.22 year;
CG: 11; 27.3%
B/72.7% G
Age: 8.54 ±
1.57 year;
jump;
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Labib PPS Ordinary IV: IV: Normal Standing Stork Test↑,

athletes Functional training DB↑, Static strength↑
(2014) Egypt 10 training and Running shoot↑.
weeks Sports: Freq: 3 /week both Handgrip Strength↑
Handball Freq: 3 and Static strength test↑
/week Time: 60min improved at two group,
SS: 20 G but No Significant
Time: 60min Difference between
EG: 10 G; Age: them.
13 ± 1.5 year;
Training
experience 3 ±
0.7yr
CG: 10 G; Age:
14 ± 1.8 year;
Training
experience 3 ±
0.8yr
Yildiz et al. PPS Ordinary EG1 IV: IV: Normal In CG, FMS scores↓ and
athletes Functional tennis other parameters ~. In
(2018) 8 training training EG1, DB↑ FMS↓ and
Tukey weeks Sports: Tennis other parameters ~.
Freq:3 /week Freq: 3 /week
SS: 28 B; Age: In EG2, all parameters ↑,
9.6 ± 0.7 year; Time: 65- Time: 65- (the vertical jump
75min 70min performances↑,
Training flexibility↑, agility↑, DB↑,
experience 3.1 EG2 IV: SB↑, FMS data↑),
± 1.3yr Traditional between groups showed
training a significant difference,
EG1: 10 B no big difference for
Freq: 3 right left DB.
EG2: 10 B /week
CG: 8 B Time: 65-

75min
jump;
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Song et al. PPS Elite athletes IV: IV: Traditional Strength↑ and
Functional training flexibility↑, hand grip
(2014) Koera 16 Sports: Screen strength↑ 12%, bench-
weeks Baseball training Freq: 3 /week press↑ 9%
SS: 62 B INT: NM Time: NM

EG: 31 B; Age: Freq: 3
17.0 ± T/week
1.06 year;
Time: NM
CG: 31 B; Age:
16.62 ±
0.94 year;
Liao et al. RCTs Ordinary IV: IV: Traditional FMS data↑, deep
children Functional strength squat↑, turn stability↑,
(2017) China 12 strength training muscular strength↑,
weeks SS: 144 G; training flexibility↑ and power↑,
Age: 12.47 ± INT: a FST is better at
0.57yr INT: a moderate improving the quality of
moderate intensity movement Curl-ups, SAR
EG: 72 G; intensity and SLJ.
Freq: 3 /week
CG: 72 G; Freq: 3
/week Time: 45min
Time: 45min
jump;
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Marta et al. RCTs Prepubescent EG1 IV: IV: Regular 1-kg ball throw large↑ (P
children Resistance PE course < .001, 2p = .463), 3-kg
(2019) 8 training ball throw medium↑ (P
Portugal weeks SS: 57 B INT: low to < .001, 2p = .395), and
INT: low to moderate time-at-20m test small
moderate ES. no big difference
Freq: 2 /week between in the CVJ or
Freq: 2 the SLJ. but in ST
/week Time: 45min training the CVJ↑, SLJ↑.
Time: 45min
EG2 IV:
Suspension
training
EG1: 19 B; Age:
10.71 ± INT: low to
moderate
Freq: 2
/week
Time: 45min
0.43 year
EG2: 20 B; Age:
10.92 ±
0.45 year
CG: 18 B; Age:
10.81 ±
0.57 year
Eagher et al. RCTs Ordinary IV: CrossFit IV: Regular SAR↑ (+ 3.0 cm, P
children Teens PE class < .001), SLJ↑ (+ 0.1
(2016) 8 m.021) and SR (+
Australia weeks SS: 96; 46 Freq: 2 Freq: 2 /week 10.3laps, P = 0.019)
B/50 G; Age: /week SAR↑ Curl-up test↑,
15.4 ± 0.5 year; Time: 60min push-up ↑, SLJ↑ grip
Time: 60min strength↑, SR test ↑
EG: 51
CG: 45
jump;
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Carvutto et RCTs Ordinary IV: High- IV: Traditional Group x Time-agility ↑

al. children intensity training
8 functional based on no significant in sprint
(2021) Italy weeks Sports: Score training technical and performance
tactical
SS: 28 B; Age: INT: High- abilities.
12.6 ± 8.8; intensity
Freq: 3 /week
EG: 14 B Freq: 3
/week Time: 90min
CG: 14 B
Time: Lasts
90 minutes
Baron et al. PPS PT: Elite IV: No Functional state↑;

athletes Functional FMS↑, FMS↑, FMS3↑;
(2020) 12 training CM, power and height↑
Poland weeks Sports: CMJ without swing
Football Time: 70- power and height↑,
85min SQUAT Jump power and
SS: 20 B height↑
EG: 20 B; Age:
16.8 ± 0.6 year;
Bonney et al. RCTs PT: Obesity IV: Task- IV: Wii Fit Aerobic↑, coordination↑,
oriented intervention knee extensors
(2019) 14 SS: 52 G functional strength↑, dorsiflexors↑,
South Africa weeks training Freq: 1/week plantar flexors↑,
EG: 26 G Age: anaerobic↑ in both
14.4 ± 0.9 year Freq: 1 Time: 45min groups. lower extremity
/week functional strength↑,
CG: 26 G Age: manual dexterity↑,
14.3 ± 0.8 year Time: 45min balance↑ in both
groups. These changes
were not different
between groups.
jump;
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Gorter et al. PPS Cerebral Palsy IV: No Aerobic Endurance

Functional HR6↓ T max↑; walking
(2009) 9 SS: 13; 8 B/5 G physical distance and velocity ↑,
Netherland weeks training Ambulation TUDS
EG: 13; 8 B/5 Seconds↓. VO2max ↑
G; Age: 9.9 ± Freq: 1 9%, max treadmill time↑
1.15 year /week 23%, walking distance ↑
7%, ambulation ↑ 21%.
normal Time: 30min
intelligence (n
= 1),
mild mental
retardation (n
= 12).
CP and at
GMFCS level 1
(n = 12) or level
2 (n = 1).
Mikołajczyk PPS Intellectual IV: IV: Regular Balance↑ (eyes open

et al. disability Obligatory PE class conditions, eyes closed
12 physical conditions), path length
(2014) weeks SS: 34; 28 B/6 education Freq: 2 /week of the center of pressure
Poland G; classes + (eyes open conditions↓
original dual- Time: 45min significant shortening
moderate ID, task length by 28%, eyes
mean IQ 45.1 functional closed conditions↓,
± 3.3; training significant shortening
36%).
Age: 15.06 ± Freq: 3
0.9 year; /week
EG: 17; Time: 45min
CG: 17;
Emara et al. RCTs Spastic IV: IV: Wii Fit standing↑, walking↑, 10-
diplegia Traditional intervention Meter walking speed↑.
(2016) Saudi 12 therapeutic
arabia weeks SS: 20; 7 B/13 exercises + Freq: 1 /week five times sit to stand,
G; Age: 6-8 body-weight walking speed, sit to
suspension Time: 45min stand transitional skills,
EG: 10; 4 B/6 G training no significant difference
Age: 6.9 ± between groups
0.6 year Freq: 3
/week
CG: 10; 3 B/7
G Age: 6.6 ± Time: 40 +
0.7 year 30min
jump;
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Ansa et al. PPS Cerebral Palsy IV: No GMF D-standing ↑ 8.2%,

Community- E-walking + running +
(2020) 8 SS: 10; 7 B/3 G based jumping ↑ 5.12%,
Ghana weeks functional walking distance↑
SS: 10; 7 B/3 G aerobic 6.09%. physical health ↑
exercise 105.04%, by children
Age: 14.4 ± parent proxy. And
1.53 year; INT: 40–80% physical health ↑
max heart 60.00%, by Self-reported.
Type of CP: rate
4 Diplegia/1 Freq: 4
Hemiplegia/ /week
5 Quadriplegia Time: 50min
Surana et al. RCTs Unilateral IV: LE IV: Obligatory 1MWT↑, ABILOCO-kids↑,

spastic intensive physical single-leg stance↑, fast
(2019) USA 9 cerebral palsy functional education velocity↑, 30-s chair
weeks training classes + NR rise↑. LIFT improved
SS: 24; 10 more than H-HABIT. no
B/14 G Freq: 5 significant differences
/week between LIFT and H-
EG: 12; 5 B/7 G HABIT for self-selected
Time: walking velocity
Age: 5.8 ± 120min
2.3 year
GMFCS, 5 I/7 II
CG: 12; 5 B/7
G
Age: 5.1 ±
2.6 year
GMFCS 3 I/9 II
jump;
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Ketelaar et RCTs Spastic IV: IV: Traditional GMFM↑ and PEDI score
al. cerebral palsy Functional therapeutic ↑in both groups; basic
18 physical exercises + gross motor abilities↑,
(2001) months SS: 55; 33 therapy the treadmill no differ between
Netherland B/22 G; Age: 2- groups. The mean
7yr Freq: 3 /week scores↑ higher than in
the CG. functional skills
EG: 28; 16 Time: 40 + in daily situations↑, self-
B/12 G 30min care and mobility
activities↑.
Age: 54 ± 20
months;
Cerebral palsy
distribution:
16
Hemiplegia/5
Diplegia/
6 Quadriplegia.
CG: 27; 17
G/10 G;
Age: 56 ± 20
months
Cerebral palsy
distribution:
16
Hemiplegia/6
jump;
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Diplegia /
6 Quadriplegia.
Salavat et al. PPS PT: Cerebral IV: No Gross motor

palsy and Functional functioning↑, Functional
(2017) 18 cerebral visual therapy Skills↑
Netherland weeks impairment programmed
SS: 5 2 B/3 G; Freq: 3

Cerebral palsy; /week
Age:114 ± 52
month; Time: 30min
distribution: 5
Spastic,
GMFCS
classified
levels: 2 I/ 1
II/1 V/1 IV;
Blundell et PPS PT: Cerebral IV: IV: Hand-Arm Isometric strength↑; Left
al. palsy Functional Bimanual and right Lateral Step-up
4 strength Intensive ↑; time of 10-m walk↑;
(2002) weeks SS: 8; 7 B/ 1 G training + a Therapy stride length↑.
Australia group circuit
EG: 8; 7 B/ 1 G; training Freq: 5 /week
Age: 6.3 ± 1.3yr INT: Time: 120min

intensive
Cerebral palsy repetitive
distribution: practice
7 spastic Freq: 2
Diplegia/1 /week
Quadriplegia.
Time: 60min
jump;
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Ahl et al. PPS PT: Children IV: Goal- IV: Reference 76 goals fulfilled
with cerebral directed normalization completely, 19 partially
(2005) 5 palsy functional completed; gross motor
Sweden months therapy function↑; self-care
SS: 14; 11 B/3 performance↑; mobility
G; Freq: 2 ↑; social function↑
/week
Age: 1year 6
month to 6 Time: NM
years.
With diplegia
and tetraplegia
cerebral palsy;
EG: 8; 7 B/1 G;
GMFCS
classified
between levels
II–V;
Mikołajczyk RCTs Moderate IV: Unstable- IV: Did not Static balance - COP
et al. mental surface perform any deviation range↑, Path
12 disabilities functional exercises length↓, Path area↓. Eye
(2014) weeks exercises open and eye closed.
Poland SS: 34 Age:
15.06 ± Freq: 3
0.9 year; /week
EG: 17 Time: 45min
CG: 17
Farrokhian RCTs Intellectual IV: IV: Did not SB↑, DB↑, and
et al. disability Functional perform any flexibility↑, student’s'
5 training exercises performance
(2021) Iran weeks SS: 30 Gender: statistically significant.
G Freq: 3
/week
EG: 15
Time: 45-
CG: 15 60min
Age:
Elementary
school
students(Not
specific)
jump;
Table 2Research specific information

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Participants in seven studies were athletes, including soccer [27, 28], tennis [29], handball [30], baseball [31],
and judo players [32]. Moreover, in the twelve studies of children who were unhealthy, the majority of the
individuals were affected by cerebral palsy [16, 18, 33–38], mental disorders [39], and intellectual disabilities
[40]. The remaining five studies were on ordinary children [41–45]. Meanwhile, four studies were conducted
on girls [30, 40, 44, 46], and six focused on boys [27–29, 31, 45], while the remaining 14 articles covered both
boys and girls [16, 18, 32–39, 41–43]. However, none of the studies explored gender differences. Only one
study documented gender disparities in the results of FMS.
The majority of the studies on healthy children reported the participants’ height, weight, and BMI. However,
two studies did not mention the participants’ BMI [31, 44], and just one did not specify the subjects’ weight
[29]. Moreover, most studies of unhealthy children did not specify the subjects’ physical characteristics. Only
one study recorded height, weight, and BMI [46], while three reported height and weight [34, 36, 39]. The rest
of the studies did not disclose these physical characteristics.
Intervention Characteristics
Overall, the majority of the studies employed a parallel group design, whereas six used a one-group design
[16, 27, 32, 34, 38]. Furthermore, two studies applied three independent groups. Eleven studies were RCTs,
while the remaining 13 used pre-and-post-controlled trials.
The effects of functional training are the targeted topic of this systematic review. At the same time, the
intervention groups in all the included studies were submitted to motor intervention programs using
functional training. Furthermore, most of them were conducted by trained teachers or experienced coaches.
The interventions can be categorized into two types to get comprehensive information about the
interventions and conduct meaningful comparisons. One type used pure functional training programs. Pure
functional training was used in 12 studies [16, 27–30, 33, 37–40], while suspension training is a specialized
pure functional exercise used in five studies [32, 36, 42, 43, 45]. The other type used a hybrid programming of
functional training methods. Two studies used functional strength training [35, 44]; the other five used
CrossFit [41], LE intensive functional training [18], task-oriented functional training [46], functional movement
screen training [31], and functional aerobic exercise [34]. Sixteen studies set up controlled experiments and
used different intervention training methods. Compared to the experimental group, the control group
participated through standard physical education courses [27, 39, 41, 43, 45] and sports-specific training
methods [28, 30, 31].
Intervention duration, frequency, and intensity are crucial implementation elements that cannot be neglected.
The duration varied between four weeks and eighteen months. In most of the studies, the duration of the
intervention was either eight [28, 29, 34, 41, 42, 45] or twelve weeks [18, 27, 36, 39]. Moreover, the weekly
intervention frequency in most studies was two to three times per week. Three studies did not provide the
frequency information [27, 37]. The duration of each session ranged from 20 to 90 min, with 45 to 60 min
being the most common. Similarly, three articles did not report the duration of sessions [31, 33, 37]. Apart
from the duration and frequency, training intensity is a crucial aspect of the training process. Only one article
explicitly reported using high-intensity training [28].
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The rest of the articles did not clearly state the intensity of their interventions. Rather, they just described the
interventions as low to moderate in intensity. Table 2 summarizes interventions.
Outcomes and Measures

The effects of functional training were analyzed and discussed in terms of locomotor skill, balance skill,
object control skill, fundamental movement screen score, and general physical fitness.
Effects of Functional Training on Locomotor Skills

Locomotor skill is the primary measure of the children’s proficiency in FMS. The effect of functional training
on locomotor skills was mainly reflected by data such as walking and running distance, speed, acceleration,
agility, and jump performance. These data were evaluated using a series of test methods, including a
walking test (30s, 1 min, 2 min, 10m) [18, 34–36], shuttle run (10m, 25m) [41, 43], sprints test (10m, 20m,
50m) [28, 29, 44], standing long jump test [41–45], and timed up and downstairs test [16] to test the level of
locomotor skills. Moreover, the Gross Motor Function Measure test was the most commonly utilized
evaluation tool for unhealthy children, which uses a four-point scale scoring system with 66 [33, 34] and 88
[35, 36] items separated into five dimensions. It has sufficient validity and reliability for testing FMS in
children with cerebral palsy. In this review, fifteen studies reported findings on locomotor competence, all
showing significant improvements in the variable [16, 18, 27–29, 33–38, 41–43, 45]. However, the analysis
of specific variables in seven studies showed no statistically significant differences. Examples include
running speed (p > 0.05) [11], standing long jump distance (p = 0.16) [45], and countermovement vertical
jump height (p = 0.29) [27]. It seems possible that these results may be due to the characteristics of the
participants, some of whom were professional athletes, while others were unhealthy children. Consequently,
the review results indicate that functional training helps children improve their locomotor skills.
Effects of Functional Training on Balance Skills

Balance skills are an essential component of fundamental motor skills. When it comes to testing balance
skills, the options are extensive. Single-leg stance tests [18, 40], five-times sit-to-stand tests for kids [36],
prone instability tests [32], 5 m timed up-and-go tests [30], Y-balance tests [29], and stabilizer platform ALFA
tests [39] are among the tests used. These tests measure the ability of coordination, joint stability, dynamic
balance, and static balance. Ten studies assessed the balance skills of children. All studies reported a
significant improvement in the test results [18, 29, 31, 32, 36, 39, 40, 46]. However, one study did not discover
a statistically significant difference between the groups on the mean sway of the center of pressure (COP)
along the medio-lateral (M/L) (p = 0.39) and anterior–posterior (A/P) (p = 0.75) [39]. Nevertheless, the overall
results show that functional training is a great way to improve balance skills
Effects of Functional Training on Object Control Skills

Data on the efficacy of object control skills were limited. Only two studies measured object control skills. One
employed the medicine ball throw test [45], demonstrating that children could better throw balls of different
weights after functional training. According to another study that used the Nine-Hole Peg Test [35], which
measures how well children can reach and put things down, children took less time to perform the same task
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after functional training. Although the current review is based on a small sample of studies, the findings
suggest that functional training can promote object control skills.
Functional Movement Screen Test

Functional movement screening is an innovative action pattern evaluation tool that may be broadly applied
to examining the fundamental motor function of varied populations. It can correctly reflect the FMS of
children. A total of six studies utilized the Functional Movement Screen scale to assess the actual motion
state of children [27, 29, 31, 43, 44]. The test findings demonstrated a substantial difference between the
inter-group and intra-group results. The gains found for the composite FMS in the functional training group
might be deemed practically important. Baron et al. (2020) used three tests: deep squat (p = 0.004), hurdle
step (p = 0.012), and in-line lunge (p = 0.001). Meanwhile, Laurent et al. (2021) used all seven tests, and after
four weeks of intervention, the average score gain was 4.06 points, bringing the total score up to a higher
level. Yildiz et al. (2018) also used all seven tests and showed that there was a significant difference
between control group (CG) and functional training group (FTG) and between traditional training group
(TTG) and FTG (p < 0.001). Moreover, Liao et al. (2017) employed all seven FMS items in their study, and the
results revealed a statistically significant difference within the functional strength training (FST) group (p <
0.05) and between the FST and traditional strength training (TST) groups (p < 0.05).
Effects of Functional Training on General Physical Fitness
The development of FMS is inextricably linked to the development of physical fitness. Fourteen studies
reported significant improvements in physical fitness [18, 30–32, 35, 41–46]. Muscular strength is important
since it may directly influence the capacity to run and leap. Muscular strength was the most studied form of
physical fitness, with 11 articles studying it. Investigations assessed changes in lower-body muscle
strength[18, 30, 32, 35, 41, 42, 45, 46] as well as upper-body muscle strength [31, 41–43, 45]. Four studies
assessed muscular endurance levels in the testing regimen and found promising results[32, 41–43].
Meanwhile, six studies reported findings that there was a significant correlation between flexibility, athletic
ability, and balance skills [29, 31, 32, 40, 41, 44]. Moreover, three studies conducted relevant analysis and
testing to describe cardiovascular functional states [16, 30, 46] and illustrate the effects of functional
training on cardiovascular function. In conclusion, the current review indicates that functional training helps
strengthen fundamental motor skills while positively affecting physical fitness development.
Discussion
This review differs from other published reviews because it focuses on functional training programs for
improving children’s FMS. The current review explored and summarized the effects of functional training on
children’s FMS. The results give a comprehensive insight into the development of FMS and the impact of
functional training on children’s FMS. The primary findings demonstrate that functional training improves
children’s FMS and physical fitness related to these skills. The positive outcomes suggest that functional
training may be a promising approach to teaching children FMS.
There have been no previous reviews summarizing the effects of functional training on FMS, so there were
no conclusive findings on the matter. However, consistent with previous research, this review provided
Page 22/31
standardized evidence on the effectiveness of functional training.
Effects of Functional Training on Locomotor Skills

Locomotor skills allow children to move from one location to another in an environment. It is essential in all
daily activities and sports [47]. The greatest improvements in locomotor skills were found in running
performance (speed and agility), jumping performance (long jumping), and countermovement vertical
jumping. Statistics revealed that after five weeks of suspension training, the growth rate of a single-leg
horizontal jump reached 23%. The mean difference of the standing long jump improved its range from 10–
24% after six to eight weeks of intervention, while development in the countermovement vertical jump
reached an average of 8% [29, 32]. Improvements in running performance were most evident in the reduction
of sprint test time. The time diminished by an average of 0.3 s [44] for the 10 m and 50 m sprint tests. These
results align with a systematic review of functional training on sprinting, jumping, and functional movement
in athletes [48]. It is also consistent with detailed research on specific sports that showed that functional
training improved speed and agility in adult basketball players and runners [49, 50]. However, some studies
did show that children did not improve in running and jumping performance. Most of these children had
different levels of Spastic Cerebral Palsy, which may be the main reason for the difference.
Effects of Functional Training on Balance Skills
Balance is the ability to keep the body’s centre of gravity above its base. It is the foundation for all human
dynamic movements. Balance is essential when practicing new skills in all types of sports and physical
activity [51]. Of the ten studies that assessed balance skill, all indicated post-intervention test improvement
over the baseline after functional training, with a significance of p < 0.05. There was a significant positive
association between balance skills and intervention time. Furthermore, static and dynamic balance skills
were the two most common aspects of balance that saw the most significant improvement. Depending on
the statistics, the average value of dynamic balance skill increased by 10%-25%, with p < 0.00 [29, 30, 32].
Static balance skill increased by 46.3% on the single-leg standing test [40]. When using the stable platform
ALFA, regardless of whether the eyes were open or closed, the path length test results indicated that the
static balance skill level varied significantly, with p < 0.001 [36, 39]. The findings are consistent with previous
systematic reviews and controlled experimental research that indicate that functional training has a good
effect on health and balance skills and that the significant effects are greater than that of other training
methods. In addition, balance abilities have been found to be a significant determinant of daily living and
physical activities of the elderly, stroke patients, and those with cerebral palsy. Research on these unique
populations indicate that functional training is more effective and safer than other training methods [52, 53]
Effects of Functional Training on Object Control Skills

Object control skills refer to the ability to move or receive an item with precision and control, also known as
handling or manipulation skills. These skills are typically used in ball games, including basketball, soccer,
and other sports and life experiences [41]. However, among this study’s included articles, only two reported
on object control skills. A significant improvement was observed in throwing performance in one of the
studies. The performance for the 1-kg ball throw increased by 5.94%, while that for the 3-kg ball throw
increased by 8.82%. In contrast, no statistical difference was found in another study on motor control in
Page 23/31
reaching and placing objects. This result is not surprising because no functional training studies have
focused on object control skills in previous research. Overall, the findings show that most researchers have
only looked at locomotor and balance skills or reported a single score based on a battery of tests designed to
assess FMS. One possible interpretation is that functional training affects locomotor and balance skills
more than objective control skills. Another possibility is that the results imply that learning to manipulate
objects is more challenging than learning to move and maintain balance [54]. Objective control skills could
require more time and effort to learn because of their higher complexity and perceptual demands [55].
Therefore, caution must be applied with the small sample size. Further study is required to acquire more
exact data.
It should be highlighted that consideration of the type of intervention approach is essential in influencing the
effect of FMS interventions [55]. Research employing controlled experiments of the interventions used
control groups, which showed that children’s FMS improved in the control group, but the effect was much
less than that of functional training. This finding reveals that the acquisition of fundamental motor skills
does not all occur naturally. It can be further developed through well-designed physical activity and training,
consistent with the reports of earlier research on the efficacy of various interventions in developing FMS [5].
More importantly, interventions should be adapted to meet the development of the acquisition of FMS, and
the training content should be consistent with the movement form of FMS. Functional training can meet this
need and produce better training results than other types of training, mainly because it follows the basic
principle of a kinetic chain system [14]. A closed-chain action helps maintain the joints’ stability and can
potentially engage additional muscles and the joints that are linked with them [56]. It activates many
muscles and joints in different planes and axes, enhancing strength, endurance, flexibility, balance,
coordination, and depth perception [57]. These advantageous effects of functional training tend to
correspond with the movement patterns of fundamental motor skills. Consequently, there is indeed a need to
establish a functional training program for children to improve FMS.
Of particular interest, based on the theory of motor skill development, the crucial period for developing FMS
is before age seven [9]. However, only five studies involved children younger than seven, all involving children
with cerebral palsy [18, 33, 35–37]. The results of the studies indicate that functional training for unhealthy
children at a young age can be of great importance and have the potential to assist them in achieving the
same FMS as healthy children. Another important piece of information that cannot be ignored is the low
levels of FMS proficiency exhibited by many children just beginning elementary school [6]. Using functional
training to intervene with healthy children under the age of seven may have a more positive outcome, and
this may be an essential age period for future research.
Limitations
The results of this review supported the correlation between functional training and FMS in children.
However, there are some limitations. Few studies have reported the intensity of training, an important factor
affecting the training effect. Furthermore, few studies have considered the effects of other variables, such as
demographics, body composition, and intervention environments. Additionally, the main weakness of this
study was the paucity of a standardized measuring methodology and evaluation standard. In summary,
future studies on the current limitations are therefore recommended.
Page 24/31
Conclusion
Notwithstanding its limitations, this study contributes significantly to the knowledge of the impact of
functional training on FMS. The most obvious finding that emerged from this study is that functional
training-based programs are well-established for enhancing fundamental motor skills in children, especially
locomotor and balance skills. This result reflects the scientific theory behind functional training. A closed
kinetic chain encourages interconnected joints and muscle groups to work together to facilitate movement
[58]. Moreover, to better utilize functional training in promoting children’s FMS, it is necessary to design
functional training specifically for children in future research, based on child development knowledge and
the benefits of functional training.
Abbreviations
FMS
fundamental motor skills
PRISMA
The Preferred Reporting Items for Systematic Reviews and Meta-Analyses
PICOS
population, intervention, comparison, outcome, and study design
RCTs
randomized controlled trials
BMI
Body Mass Index
COP
center of pressure
A/P
anterior–posterior
CG
control group
FTG
functional training group
TTG
traditional training group
FST
functional strength training
TST
traditional strength training.
Declarations
Ethics approval and consent to participate
Page 25/31
Not applicable
Consent for publication
Not applicable
Availability of data and materials
All data generated or analysed during this study are included in this published article [and its supplementary
information files].
Competing interests
The authors declare that they have no competing interests
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-
profit sectors.
Authors' contributions
Conceptualization, D.Z. and K.S., methodology, D.Z., software, M.B. WS.X, validation, D.Z, K.S. and Y.C.,
formal analysis, D.Z., investigation, D.Z., resources, D.Z., data curation, D.Z, K.S, Y.C., writing—original draft
preparation, D.Z, writing—review and editing, K.S, Y.C., visualization, D.Z, K.S., supervision, K.S., project
administration, D.Z, K.S. All authors have read and agreed to the published version of the manuscript.
Acknowledgements
I would like to express my deepest gratitude to ShanShan He, Dr. Yang Tieli, Dr. Xiejun for their invaluable
contribution to this systematic review. They have been instrumental in conducting the literature search and
screening process, as well as assisting in data extraction and analysis. Their tireless efforts and expertise
have significantly improved the quality of this review. Without their dedication and hard work, this project
would not have been possible. I am truly grateful for their support and contributions, which have made a
significant impact on the final outcome of this review.
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Figures
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Figure 1
Article selection process flow chart (PRISMA)
Supplementary Files
This is a list of supplementary files associated with this preprint. Click to download.
Additionalfile1.xlsx
Additionalfile2.xlsx
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Effect of Functional Training On Fundamental Motor

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Effect of Functional Training on Fundamental Motor

Skills Among Children: A Systematic Review

Posted Date: May 12th, 2023

The population includes children under the age of 18.

Studies meeting the following criteria were not considered:

Reviewed articles, conference papers, notes, and abstract;

Figure 1 Article selection process flow chart (PRISMA)

Table 1 Summary of methodological quality assessment scores

Norambuena PPS Elite athletes IV: No Single-leg horizontal

Baron et al. PPS Elite athletes IV: No Functional state

EG: 154; 76 Freq: 2

Laurent et al. RCTs Ordinary IV: IV: Regular Pull-Up performance↑(P

Labib PPS Ordinary IV: IV: Normal Standing Stork Test↑,

CG: 8 B Time: 65-

SS: 62 B INT: NM Time: NM

Carvutto et RCTs Ordinary IV: High- IV: Traditional Group x Time-agility ↑

Baron et al. PPS PT: Elite IV: No Functional state↑;

Gorter et al. PPS Cerebral Palsy IV: No Aerobic Endurance

Mikołajczyk PPS Intellectual IV: IV: Regular Balance↑ (eyes open

Ansa et al. PPS Cerebral Palsy IV: No GMF D-standing ↑ 8.2%,

5 Quadriplegia Time: 50min

Surana et al. RCTs Unilateral IV: LE IV: Obligatory 1MWT↑, ABILOCO-kids↑,

Salavat et al. PPS PT: Cerebral IV: No Gross motor

SS: 5 2 B/3 G; Freq: 3

Age: 6.3 ± 1.3yr INT: Time: 120min

EG: 17 Time: 45min

Table 2Research specific information

Outcomes and Measures

Effects of Functional Training on Locomotor Skills

Effects of Functional Training on Balance Skills

Effects of Functional Training on Object Control Skills

Functional Movement Screen Test

Effects of Functional Training on Locomotor Skills

Effects of Functional Training on Object Control Skills

Consent for publication

Availability of data and materials

The authors declare that they have no competing interests

Article selection process flow chart (PRISMA)

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