The purpose of this cross-sectional cohort study was to examine associations between FMS (locomotor skills and object control skills) and objectively measured PA (LPA and MVPA) on weekdays and weekend days among children with severe ID residing in welfare institutions. Notably, this study provides evidence that attaining adequate FMS, especially object control skills, may lead to greater engagement in PA among children with severe ID.
We found that time spent in sedentary behavior was high among children with ID, a finding similar to other cross-sectional studies [7, 8]. The participants of the present study resided in welfare institutions in China, and parental absence affects children’s physical and mental well-being and, to a larger extent, their social engagement. A study by Bodde et al. [27] found that parental factors (e.g., educational level) were significantly associated with children’ sedentary behavior. The impact of absent parents on children’s PA reported in the present study is important because most of the children included in this study experienced disorders or disabilities that limited their outdoor activities to be less than that of typically developing children. In contrast to the results of earlier reports suggesting that boys spend more time than girls in MVPA [28], the findings from the present study suggested that boys and girls with severe ID spent similar amounts of time in total weekly LPA and MVPA. However, our results also demonstrated that boys accumulated more steps and spent less time in sedentary behavior than girls weekly, which may support previous evidence for boys being more active than girls [29]. A study by Ghosh et al. [30] found that levels of sedentary behavior and pattens of adults with ID throughout the week were similar for men and women and across age groups. Thus, the finding for activity differences among boys compared with girls may be due in part to males tending to perform more unconscious and casual activities in welfare institutions, such as sauntering. Our results suggested that organized PA programs that aim to improve moderate and vigorous PA should be provided for all children with severe ID.
The findings of this study indicated that all participants showed a low level of FMS proficiency, as the percentage of mastery proficiency in sub-skills was 0%. This result is consistent with previous research showing that children with ID have poorer FMS performance than typically developing children, and the risk increased with the severity of ID [31]. The poor FMS performance demonstrated among children with ID is concerning given that the development of these skills is considered a precursor to learning more complex levels of skill proficiency and as a foundation for engaging in more PA. Interestingly, we did not find significant differences in all areas of motor proficiency between boys and girls among children with severe ID. This finding highlights the need to examine individual characteristics, as differences may not be apparent in children with severe ID.
In this cross-sectional study, positive associations were found between FMS and time spent in MVPA and LPA, and the association between MVPA and FMS was more apparent, findings that support those in preschool children [32]. This result suggests that substantial improvement in FMS for children with severe ID may improve their MVPA levels [33]. Furthermore, FMS significantly explained 26.2% of the variance in total weekly MVPA of children with severe ID, similar to the results of a study by Wang et al. [21] that found that FMS explained 32.8% of the variance in the MVPA of children with ID. This finding was also in line with those reported in other studies focusing on typically developing children, which ranged from 5–39% [34, 35]. In the present study, scores for object control skills and locomotor skills were both positively associated with total weekly LPA and MVPA, suggesting that children with severe ID having higher object control skills and locomotor skills participated more in PA. This finding is in contrast to the results reported by Foweather et al. that only one subdomain skill was positively correlated with PA in preschool children [36, 38]. Our findings further indicated that object control skills were more predictive than locomotor skills of total weekly MVPA among children with severe ID. This finding may support recent evidence showing that the combined adherence to PA, screen time, and sleep time recommendations is positively associated with object control skills in preschool children [37]. The results by Mota et al. suggest that PA, especially MVPA, is associated with greater performance of object control skills [38]. It is plausible that children with good object control skills and severe ID tend to be more active in their daily life; thus development of FMS, especially object control skills, may be a key strategy in the promotion of MVPA in these children. Therefore, we suggest the development of FMS programs for children with severe ID that aim to develop object control skills to improve their PA.
There is limited information about weekday and weekend day PA for FMS in children with severe ID. The current study suggests that there were differential associations of FMS with weekday and weekend day PA. FMS was found to be more predictive of LPA and MVPA during weekdays than for weekend days. This finding suggests that children with severe ID who have better FMS participate in more PA during weekdays. This may be indicative of children with severe ID who have better object control skills participating in more structured and organized sports activities during weekdays. In typically developing children, parental beliefs and support for PA have been associated with children’s PA on weekend days [39]. In the present study, children’s main activities (e.g., free playing, handiwork) during the weekends were completed under the supervision of caregivers, and there was no teacher-organized activity. Welfare institutes have relatively closed environments and limited peer-play opportunities. Therefore, the development of additional programs for weekend day activities to improve PA levels and motor skills is necessary.
This study addressed some known limitations of the existing studies. Notably, we examined the association between FMS variables and objectively measured PA levels (during weekdays and weekend days) among children with severe ID. Different from prior studies, we included only children with severe ID residing in welfare institutions in China, and we used a large, robust sample size (which is uncommon in the ID literature). Our results can be considered highly relevant to PA promotion for children with severe ID. However, this study has limitations. Accelerometers detect movement and motion, not specific PA behaviors [40]. Thus, this study did not directly detect children’s specific PA. Future studies should consider children’s PA patterns and the mechanism of FMS to promote PA. Additionally, due to the cross-sectional design of this study, a reverse association between FMS and PA is possible, and a cause-and-effect relationship cannot be inferred. Despite these limitations, this study provides insight into the association between different types of FMS and PA levels among children with severe ID. Future studies should examine a potential bilateral association in this population.